The aim of the study was to compare ultrasound findings of morphometric measurements and registration of Doppler signs of kidneys between children and adolescents with diabetes mellitus type 1 (DMT1) with microalbuminuria, and metabolic control with duration of the disease. Retrospective-prospective study included 80 patients, who got DMT1 in the age from 2 to 16 years. In relation to the duration of the disease, all patients were divided into two groups: the first was whose illness had lasted less than 10 years, the second group was with duration of DMT1 more than 10 years. In patients with duration of DMT1 more than 10 years, the frequency of microalbuminuria, pathological findings of the volume of right kidney, and higher HbA1C were significantly greater. The significant difference was found in the frequency of pathological findings of the resistance index (RI) in the interlobar arteries in both kidneys. Alongside microalbuminuria, monitoring the dimension and volume of the kidneys may indicate the existence of the early phases of diabetic nephropathy.

INTRODUCTION Accurate information about the cause of death is given by expert teams based on pathological or forensic expertise. Reliable information can be obtained from doctors from clinical-hospital institutions if the deceased person was treated in such an institution and with previously diagnosed disease (hospital mortality). Analysis of hospital mortality provides a lot of data that can be used in planning the hospital beds capacities, the amount of drug procurement, purchasing equipment, organization and creation of highly specialized medical teams (medical team for resuscitation), the number of reanimation techniques, the number of pathologists who are required for autopsy procedures, etc. GOAL was to determine the total number of deaths, the most common causes of death and the 10 leading diagnoses of deceased patients at the Clinic for Internal Medicine of Clinical Center in Tuzla during 2008. MATERIAL AND METHODS We used the material from the archive (medical records and reports on deceased patients, delivered by physicians working at the Clinic for Internal Medicine of Clinical Center in Tuzla). RESULTS During 2008 at the Clinic for Internal Medicine 368 patients died. According to the analyzed data leading cause of death and leading diagnosis as cause of death at the Clinic for Internal Medicine in 2008 were as follows: cardiogenic shock in 73 (19.84%), cerebrovascular stroke in 46 (12.50%), coma due to stroke in 32 (8.70%), coma not classified as cerebral in 25 (6.79%) (metabolic 13 (3.53%) and hepatic 12 (3.26%), cardiomyopathy in 22 (5.98%), malignant neoplasm of the abdomen in 17 (4.62%), respiratory insufficiency in 17 (4.62%), acute myocardial infarction and myocardial infarction with rupture in 17 (4.62%), pulmonary edema in 16 (4.35%), and cardiorespiratory arrest in 13 (3.53%) deaths. CONCLUSION During 2008 at the Clinic for Internal Medicine of Clinical Center in Tuzla died a total of 368 patients. The most common cause of death of patients at the Clinic for Internal Medicine of Clinical Center in Tuzla are cardiovascular disease (n = 175; 47.55% of deaths), in second place was cerebrovascular disease (n = 76; 20.65% of deaths) for a total of 251 (68.20%) of deaths from cardiovascular and cerebrovascular disease.

Introduction: “The fatty liver” is over collection of fat (triglycerides) inside of the liver cells leads to middle increased liver. Non-alcoholic steatohepatitis appears at the patients with pathological level of the lipids in their blood, at the diabetic patients, and at the obese patients. The safest method for diagnosis of the fatty liver is biopsy of the liver, but the ultrasound of the liver is also very objective method for diagnosis. The goal of the research was to find connection between pathological ultrasound of liver (fatty liver) and pathological levels cholesterol, triglycerides, sugar in the blood of all of the patients. The patients and Methods: There were 170 of the patients in the trans-section study (57 of the men (33.50%) and 113 of the women (66.50%). The patients were divided in two groups: a) experimental group with the patients with pathological level of lipids in their blood (32 of the men, and 59 of the women), and b) control group with the patients with normal values of the lipids in their blood (25 of the men, and 54 of the women). Criteria for excluding from research are: the patients under age of 30 years. Cholesterol, triglycerides, sugar, ultrasound of liver was determined in all patients. Results and Discussion: There were 40 of the patients with pathological ultrasound in experimental group, and 11 of the patients with pathological ultrasound in control group (P<0.0001). Conclusion: The patients with pathological levels of lipids in their serum have fatty liver, as a pathological ultrasound finding.

INTRODUCTION Transplantation of kidneys (TK) is the best way of curing patients with terminal kidney disease. Unfortunately, right after the operation, different kinds of complications are possible and might happen to transplant. The worst and the most often complication is acute rejection (AR). PURPOSE The aim of work is to find the most often clinical signs and symptoms of AR. The aim of research is to value the influence of AO on function of graft and to find the influence of AR on surviving patients and graft. METHODS This study has been done on 91 patients, 62 male and 29 female patients in the age of 38.58 +/- 11.4. Patient are divide in two groups: experimental group which includes 29 patients that have had one or more episodes of acute rejection. We used serum concentration of creatinine defined by Cocroft-Gault curve to measure function of transplant. Time of patients and graft survival is estimated by Caplan-Meier curve. RESULTS In a group of patients with acute rejection we registered 42 episodes of dysfunction of graft which are treated as AR. The average creatinine in a group of patients with acute rejection was 183.42 +/- 65.39 micromol/L. Clearance of creatinine of group patient without AR is much bigger (p < 0.0001) than average clearance of creatinine of patients with acute rejection. Average serum creatinine in this group of patients is 147.59 +/- 62.57 and it is quite smaller (p < 0.002) than average creatinine at patients with acute rejection. Survival of all patients after five years is 91%, survival of patients without acute rejection is 96%, and with acute rejection is 80% (p < 0.014). Five year survival of graft is 78%, at the patients without acute rejection is 96% and at the patients with acute rejection is 64% (p < 0.0001), which is quite shorter. DISCUSSION Clinical image of acute rejection is unspecific. There is not arranged values of serum creatinine although in some research those values are 130-170 micromol/L. This values includes patients which did not have an acute rejection. Five year survival patients and graft in our patients that did not have an acute rejection is same as in the results of relevant centers. But survival of patients and grafts in patients that had an acute rejection is little bit lower than it is in the results in relevant centers. CONCLUSION There is no clinical picture than can help you to recognize an acute rejection because many other dysfuncion look the same. Acute rejection reduces function of transplant. Survival of patients and graft is mutch longer in the patients without acute rejection.

The aim of the study was to compare ultrasound findings of kidneys in children and adolescents with diabetes mellitus type 1 (DMT1), establish the association with microalbuminuria, blood pressure values and metabolic control of the disease, and creatinine clearance. In 80 children and adolescents with DMT1, in whom illness occurred in period between 2 and 16 years of age, morphometry measurements with ultrasound were performed. Nephelometric method of three consecutive samples of urine determined microalbuminuria. In patients with microalbuminuria, creatinine clearance was also measured. Demographic data were obtained from the parents and from the patients medical records. In relation to the duration of the disease, all patients were divided into two groups: the first group of patients with illness lasting for less than 10 years, and the second were those whose illness had lasted more than 10 years. In patients with duration of DMT1 of more than 10 years, the frequency of pathological findings of the longitudinal diameter and volume of both kidneys in relation to age and anthropometric standards was statistically significantly greater. Also, the finding of microalbuminuria was more frequent. In the group of patients with DMT1 lasting for more than 10 years, the mean value of HBA1c was statistically significantly higher In patients with microalbuminuria the total mean value of creatinine clearance was within the bounds of the reference values and was statistically significantly higher in patients in whom the illness had lasted less than three years, which indicates hyperfiltration of the kidneys. Alongside microalbuminuria, monitoring of the dimension and volume of the kidneys may indicate the existence of the early phases of diabetic nephropathy and result in its prevention and prevention of illness progression.

INTRODUCTION Diabetes currently affects more than 170 million people world-wide, but the World Health Organization (WHO) expects that the number of patients will double within the next 20 years. Diabetic nephropathy (DN) is the leading cause of kidney disease in patients who need renal replacement therapy. It is defined by increased urinary albumin excretion in the absence of other renal diseases. The goal of the study is evaluation of DN in older patients with diabetes mellitus (DM) type 2. PATIENTS AND METHODS Prospective study has been used to analyze 182 patients of old age with DM type 2 according to the criteria of WHO. According to the concentration of albumin in urine the patients were divided in 2 groups: the patients who have confirmed type 2 DM with DN and patients who have confirmed type 2 DM without DN. The following parameters were determined and compared in both groups of patients: age, sex, duration of diabetes, concentration of glucose in blood, microalbuminuria, blood pressure, smoking, obesity, and family history with kidney disease. Albumin/ creatinine ratio was calculated and concentration of albumin in urine was tested by specified albumin straps. RESULTS The prevalence of type 2 DM in the health care center is 3.64% and prevalence of DN is 24.72%. Results show that duration of DM type 2 is significantly longer in patients with DN (p<0.0001) and concentration of albumin in urine is inreased (p<0.0001), and that significantly higher concentration of HbA1c (p=0.005) and increased creatinine in serum (p=0.04) is present when compared with patients without DN. This study did not find evidence of age, sex, blood pressure, smoking, obesity and family history with kidney disease as risk factors in genesis of DN. CONCLUSION Duration of DM type 2, increased concentration of glycosyllated HbA1c, and increased creatinine in blood are the risk factors in genesis of DN in older patients with DM type 2.

Sir, Idiopathic retroperitoneal fibrosis (IRF) is a collagen vascular disease of unknown aetiology. It is characterized by chronic, non-specific retroperitoneal inflammation, which may cause ureteric obstruction. Many authors believe that it is a type of immune disorder [1]. Bosnia and Herzegovina is known as a region where Hanta virus infection has been endemic for >50 years [2]. A case of IRF associated with haemorrhagic fever with renal syndrome (HFRS) has not been reported up to now. A 44-year-old, previously healthy man was hospitalized with acute renal failure. He was febrile 2 days before admission, had dull abdominal pain, decreased urine output, shortness of breath, diarrhoea and arterial hypertension (190/120mmHg). Blood tests showed metabolic acidosis (HCO3: 15.9mmol/l) and increased C-reactive protein (11.26mg/l), potassium (7.9mmol/l), serum creatinine (884 mmol/l), blood urea nitrogen (17.6mmol/l) and globulins (49.1 g/l) and decreased haemoglobin (7.4mmol/l). Urinanalysis showed proteinuria and leukocyturia. Urine culture was negative. Indirect immunofluorescene tests for Hanta viruses were positive for Pummala virus. Ultrasound showed acute renal parenchymal lesions with bilateral hydronephrosis, grades I–II, and widening of the wall of the abdominal aorta. The presence of a great number of rodents in the forest where the patient was working has been reported by the epidemiology service. After supportive, antihypertensive and diuretic therapy, the patient’s renal function stabilized, with serum creatinine at 187 mmol/l and potassium at 4.5mmol/l. Intravenous urography showed a functioning left kidney, with a suspected retrocaval ureter on the right side and dilation of the channels of the right kidney. A computed tomography contrast scan showed a solid retroperitoneal mass, in the form of thick plate of high density, extending from the level of the renal hilum down caudally to the bifurcation of the aorta (compatible with retroperitoneal fibrosis). A double-J stent was applied and steroids and androgens were administered (pronison 60mg plus tamoxifen 20mg 2). After 3 months, the stents were removed and medications were continued. After 6 months, the patient’s total DTPA clearance was 61.1ml/min (11.8ml/min in the left kidney and 49.3ml/min in the right kidney), measured by technetium marked by diethylaminoacid. Steroids and androgens were withdrawn after 12 months. The patient has normal blood pressure and stable renal function, with serum creatinine at 125mmol/l. It remains a mystery whether HFRS triggered an immune abnormality and acceleration of the symptoms of a latent IRF or whether the two diseases merely coincided. Adequate treatment of HFRS was certainly the reason that renal function recovered and the progression of the disorder caused by the chronic disease, IRF, was hampered.

Several criteria are necessary to meet in order to have the diagnosis of Balkan endemic nephropathy established. One of them is tubular proteinuria type that may be found, but not in the early stage of the disease. Beta 2 microglobulin may be found in the early stage, but its determination is rather cumbersome and not suitable for a daily routine. Therefore, urinary albumin/creatinine ratio was determined in 8 patients (all females, aged 58,37±4,37 years) from the town of aamac region (Bosnia and Herzegovina) as a measure of albumin excretion in order to establish useful marker in the early stage of the disease. Increased urinary albumin/creatinine ratio, was found in 50% of BEN patients. According to these preliminary results, microalbuminuria could be used as the reliable marker for the early detection of BEN.

INTRODUCTION The adequate vascular access in the patients on chronically hemodialysis treatment is very importance element in patient feel secure, and medical staff in hemodyalisis centre. The aim of this work is to examinee possibility of the use of permanent double lumen central venous catheter (PermCath) in patients with inadequate vascular access. PATIENTS AND METHOD PermCath has been placed with local anesthesia in chirurgical room. Eight catheters was application in vena subclavia (three of them in links vena subclavia and six in right vena subclavia) and 26 in vena jugularis internal (for of them in links vena jugularis and 22 in right vena jugularis. The catheters were long 19 cm (26 catheters) and 23 cm (nine catheters). The catheters has been placed in 35 patients on chronically hemodialysis program, eight mean and 27 women, average age 56.03 +/- 16.52 (19 to 77 years). The causal chronically kidney disease has been diabetes mellitus in 12 (34.29%) patients, chronically pyelonephritis in eight (22.86%) patients, polycystic kidney disease in five (14.29%) patients, chronically glomerulonephritis in three (8.57%) patients and seven (20%) patients with other diseases. RESULTS The catheters has been placed average 233.55 +/- 303.58 days (9 to 1256 days). For three catheters have not registered wail the patients was from another hemodialysis centre. In four of patients were registered catheter sepsis episodes. In two of them catheter was treated with adequate doses of antibiotics since we have performed adequate and systemically antibiotics in lumen of catheter. The isolated bacteria from microbiological examination were: Enterococcus species and Pseudomonas species. Van catheter was isolated, and in microbiological examination from blood were registered Acinobacter species and Enterobacter species. A van patient past away and microbiological examination shown Staphylococcus species. CONCLUSION PermCath is very security permanent vascular access in the patients with loss construction arteriovenous fistula. The catheter in the patients who has been not adequate arteriovenous fistula, and with adequate treatment he has exchange for arteriovenous fistula.

Objectives  Bosnia and Herzegovina is a known endemic region for Hantavirus infection. In this region at least two different Hantaviruses, the Dobrava viruses (DOBV) and Puumala viruses (PUUV) have been found. The aim of the study was to determine glomerular filtration rate (GFR) in patients with a history of hemorrhagic fever with renal syndrome (HFRS) 9 to 10 years after the acute phase of the disease. Design and Methods  We prospectively reviewed clearance of technetium marked diethyl three amino pentacetic acid (Tc99m DTPA) in 42 male convalescents with serologically confirmed HFRS, 13 patients with PUUV infection and 29 patients with DOBV infection. Results  The tubulosecretory phase of the GFR was prolonged in six patients (46%) with PUUV infection and 23 patients (79%) with DOBV infection (P < 0.05). Total and separate clearance EDTA were significantly statistically lower (P < 0.001) in patients with serologically confirmed DOBV infection. In patients with DOBV infection elimination of radio pharmac was prolonged. Conclusions  Hemorrhagic fever with renal syndrome can cause sustained renal damage that very rarely progresses into renal failure. The tubulosecretory DTPA phase was prolonged in 46% of examinees with PUUV and in 79% of examinees with DOBV infection. Elimination of radio pharmac from the kidney was prolonged in both groups of patients. The DTPA clearance rate was lower in patients with serologically confirmed HFRS than in normal populations, especially in patients with DOBV infection.

The target organ for Puumala (PUU) and Dobrava (DOB) viruses is the kidney, but the impact on renal function seems far more important in DOB infection than in PUU infections. Aim of study was to estimate the renal failure and capillary leak during the acute stage of DOB-infection and PUU-infection. 50 patients with serological conformed diagnosis of acute hantavirus infection were included in the study. Diuresis, serum urea and creatinine were measured. Size of kidneys and presence of ascites was followed by ultrasonography. Enlargement of both kidneys were found in all (100%) patients. Ascites was present in 8/25 (32%) DOB patients; in 1/25 (4%) PUU patient and pleural effusion in four 4/25 (16%) DOB patients. The statistically significant difference in the mean urinary output was during 5th, 6th and 7th day of hospitalization (P<0,05). Serum creatinine and urea levels were at significantly higher levels for DOB than for PUU patients (P<0,05). Acute haemodialysis was needed in 7/25 (28 %) of the DOB patients. One DOB patient died. DOB virus infection is associated with a more severe kidney function disorders than PUU virus infection. Capillary leak, which caused swollen of kidney and ascites is probably the pathogenesis key factor.

INTRODUCTION There are significant changes in small blood vessels with increased permeability, edema of abdominal organs and ascites in the acute phase of hemorrhagic fever with renal syndrome (HFRS). We analyzed ultrasound changes of abdominal organs in patients with serologically verified HFRS, in order to assess the value of this method in the diagnosis of acute renal failure (ARF). METHODS The study included 14 sporadic patients with ARF and suspicion of HFRS, treated in 2002. Ultrasonography of the liver, gallbladder, pancreas, spleen, kidneys, prostate and retroperitoneum was performed on a Toshiba 220 SSA. RESULTS Parenchymal edema with increased echogenicity, sinus narrowing and enlargement of both kidneys were found in all 14 (100%) patients. Hepatosplenomegaly was found in seven (50%), ascites in four (28.6%), and pleural effusion in two (14.3%) patients. Increased thickness of the bladder wall was found in two (14.3%), gallbladder enlargement in one (7%), and edema of the pancreas in one (7%) patient. CONCLUSION Ultrasound examination has a very important role in the diagnosis and follow-up of changes in the parenchymal organs in the acute acute phase of the disease.