Strict therapy protocol, which would be used universally for certain morphological forms of primary nephrotic syndrome, does not exist. The aim of the study was to show the effects of used therapy protocol in treatment of primary nephrotic syndrome at the Institute of Nephrology, Clinical Center University of Sarajevo in period of 2000-2005. The retrospective analysis covered 48 patients (17 women and 31 men) with idiopathic nephrotic syndrome, where pathomorphological changes were proved by kidney biopsy. Minimal change disease was confirmed with 6 (12.5%) patients. All patients were initially treated with corticosteroids with dose of 1 mg/kg of body weight. Five patients were in the group of primary responders (83.3%) with long term total remission, and 1 patient (16.6%) was a primary responder with 3 relapses in 8 months with a therapy of corticosteroids and bolus of cyclophosphamide. Diffuse mesangial proliferative glomerulonephritis was shown in 13 patients (27.1%). Seven patients from this group were treated with corticosteroid therapy (1 mg/kg of body weight for 4 weeks, followed by 0.5 mg/ kg of body weight until therapeutical response was achieved, and finally gradual exclusion of therapy after eight weeks in responsive patients). Six patients were treated with corticosteroids and one-month of bolus cyclophosphamide during half of year (10-5 mg/kg of body weight). Total remission was achieved in 37,9% of the patients. The IgA nephropathy presented with the nephrotic syndrome was shown in 10.4% (5) of the patients. Three patients from this group were treated with corticosteroid therapy (1 mg/kg of body weight for 4 weeks, followed by 0,5 mg/ kg of body weight until therapeutical response was achieved, and finally gradual exclusion of therapy after eight weeks in responsive patients) and.2 patients with corticosteroids and cyclophosphamide (1.5 mg/kg of body weight) during 6 months. Complete remission of nephrotic syndrome from this pathomorphological category was achieved in 2 patients. Membranoproliferative glomerulonephritis was shown in 6 patients (12.5%). All were treated with corticosteroids plus bolus of cyclophosphamide. Partial remission was achieved in one patient. Membranous glomerulonephritis was confirmed in 18 patients (37.5 %). Combined therapy of corticosteroids and bolus of cyclophosphamide was used in 7/18 patients, in 2/18 patients therapy of corticosteroids and per os cyclophosphamide (2 mg/kg of body weight) and in 9/18 patients cyclosporine therapy (3 mg/kg of body weight). Complete remission was achieved in 38.8% of the patients. A high percentage of achieved remissions of primary nephrotic syndrome in adults shows the efficiency of immunomodulating therapy used. Membranoproliferative glomerulonephritis still remains a therapy problem.

Osteoporosis (OP) is a generalized skeletal disorder characterized by low bone mineral density (BMD), deterioration of the microarchitecture of bone tissue and susceptibility to fracture. Most frequently it occurs in postmenopausal women and the aged. It is a chronic condition of multifactorial etiology and is a major global healthcare problem in developed and rising in developing countries. Patients with uncomplicated OP are usually asymptomatic which contributes to serious under-diagnosing of this potentially devastating condition. It is estimated that less than half of patients with OP are diagnosed in many developed countries. Therefore preventive measures and timely diagnosis have to be a key aspect of management of this disorder. In this article we briefly underline pato-physiology of the disorder, review current methods of measuring bone mineral density, describe risk factors and evaluate current and potential therapies.

ity of patients with type  disease. Diabetic nephropathy is becoming the single most com- mon cause of end stage renal failure, while diabetic retinopathy is the most common cause of blindness in working-age population. Th e main aim of the study was to evaluate the progres- sion of late microvascular complications in type  diabetic patients treated by conventional or intensifi ed insulin regimen over the period of  years. We selected a random sample of  patients, including  males and  females, aged , ± , years, with average duration of the disease of , ± , years. Th ey did not show signs of overt diabetic nephropathy, while  patients had background retinopathy. All the patients had their fasting and postprandial gly- caemia, HbAlc, /hour proteinuria, blood pressure, height and weight measured and body mass index calculated (BMI). Th ere was a trend towards increasing values of HbAlc (. ±. vs. . ± . , p < .), fasting glycaemia (. ±  vs. . ± . mmol/l, p < .), postpran- dial glycaemia (. ± . vs. . ± . mmol/l, p <.), systolic and diastolic blood pressure values (. ± . vs. . ± . mmHg, p<.; and . ± . vs. . ± . mmHg, p< .) although no hypertensive patient was diagnosed. Th ere were  persons (.) with persistent proteinuria of  mg/ hour or more and signifi cant diff erence in overall pro- teinuria in  yrs period (. ± . vs. . ± . mg/ h, p< .). Overall,  persons (.) were diagnosed with simple, background retinopathy, but  of them (.) had signs of proliferative form of the disease. Th e results indicate signifi cant changes in progression of proteinuria in both groups although retinopathic progression was observed but was not sig- nifi cant in the intensively treated group.

Aim of kidney transplantation is to keep the functions of graft as long as possible, with an improvement of survival and quality of patients’ lives. Aim of this article was to show the outcome of kidney transplantation in patients who were treated and monitored on Institute of Nephrology, CCU of Sarajevo in period between 1996 and 2004. and to identify the factors which can interfere with graft surviving. Retrospective analysis of data from the register of kidney transplanted patients was done. In the mentioned period 29 kidney transplants were performed, and at the same time 15 previously transplanted patients (total of 44) were monitored. Patients were followed until death or graft insufficiency. Most often cause of chronic renal failure before the transplantation were glomerular diseases (3l,8% cases), and chronic pyelonephritis in 29,5% cases. Living-donor related kidney transplantation was performed in 56,8% of patients, living-donor unrelated in 27,3% of patients and cadaveric in 15,9% of patients. Post-transplant complications occurred in 29,5% of patients. Analysis of graft surviving on 12 months, 5 years and 10 years monitoring showed functional grafts in 87,5%, 80% and 75,0% of patients. Cumulative survival of patients on one year monitoring is 100%, on 5 year 100%, and on 10 year 93,8%. Primary causes of graft function loss were recurrent kidney diseases. Three patients (6,8%) died due to concomitant diseases, irrespective of the transplantation. Kidney transplantation is a successful treatment of a chronic renal failure with a high percentage of patients survival and long term graft survival, but also with serious post-transplant complications.

UNLABELLED Cardiovascular diseases are the major cause of mortality in uraemic patients treated by hemodialysis. Left ventricular hypertrophy (LVH) is considered to be a major cardiac risk factor. AIM To investigate the presence of some potential adverse risk factors in hemodialysis patients with developed LVH echocardiography verified and determine their relative contribution to the LVH in comparison with patients with normal LV. METHOD The study included 50 patients with end-stage renal disease in the first 2 years of hemodialysis treatment, who were followed up during one year. All participants have the echocardiography performed as well as serial measurements of potential modifiable cardiovascular risk factors. RESULTS This investigation showed that LVH is present in high percentage (72%) in uraemic patients, even at the beginning of hemodialysis treatment. This LV morphological abnormality is statistically significantly related to anaemia (p<0,001), systolic (p<0,001) and diastolic hypertension (p<0,001)), elevated mean arterial pressure (p<0,001) and hyperparathyroidism (p=0,002). CONCLUSION Modification of existing risk factors in uraemic patients could contribute to prevention and treatment of LV hypertophy and thus reduce cardiovascular morbidity and mortality.

INTRODUCTION Without sufficient insulin treatment, acceptable level of glycoregulation, avoidance of dislipoproteinaemia and maintenance of body mass is difficult to achieve in patients with type 1 diabetes mellitus (DM). On the other hand sometimes it is difficult to prevent weight gain, endogenous hyperlipidemia and iatrogenic insulin resistance. AIM To compare metabolic control indicators in patients with type 1 DM in patients treated conventionally to those on intensified insulin regimen. MATERIAL AND METHODS A sample of 52 persons with type 1 DM, without late complications and long duration of the disease, was selected. Among them 19 (36.5%) persons were treated with insulin in 4 or 5 doses, and 33 (63.5%) conventionally, in 2 doses. All the participants had biochemical indicators of metabolic control determined (glycosylated Hb , fasting and postprandial glycaemia, total cholesterol, triglycerides as well as lipoprotein fractions, HDLC and LDLC), body height (BH) and weight (BW) measured, body mass index calculated (BMI) and blood pressure measured (BP). RESULTS In the group treated conventionally we found significantly higher mean values of BMI as compared to those on intensified insulin treatment (23.2 +/- 2.0 kg/m2, and 21.2 +/- 1.2 kg/m2 respectively, p%<0.01) and proportion of those with overweight was as well significantly higher (27.3% versus 0%, p =0.012). We noted higher mean values of systolic (134.2 +/- 17.6 mmHg, versus 123.4 +/- 12.7. p<0.05) and diastolic (83.2 +/- 10.1, versus 74.0 +/- 9.7, p<0.01) BP. Biohemical indicators of glycoregulation were significantly worse with, at the same time, higher total dose of applied insulin ( 55.9 +/- 8.5 IU, versus 46.3 +/- 10.0 IU, p<0.01), and insulin units per kg of body weight (0.84 +/- 0.11 IU/kg versus 0.77 +/- 0.15 IU/kg, p<0.05). CONCLUSION Results indicate that intensified insulin treatment is more favourable variant of treatment, by which the certain level of insulin resistance, which might be present in patients treated with two higher insulin doses, is probably reduced. Therefore it improves metabolic outputs, blood pressure values and body mass index but also may have beneficial impact to economic aspect of insulin treatment as well.

Anaemia appears to play an important role in left ventricular (LV) enlargement in chronic kidney disease patients. The objective of this study was to evaluate LV echocardiography changes during anaemia correction with recombinant human erythropoietin (rHu-Epo) in chronic haemodialysis patients (HD pts) with signs of anaemia and LV hypertrophy (LVH). The study included 20 HD pts aged 39,6 +/- 5,3 yrs, with the same condition of HD treatment, anaemia and echocardiographically LVH verified. At the beginning of the rHu-Epo treatment haemoglobin (Hb) level was < 90 g/L and the target Hb level was 110 g/L. Echocardiography was performed at the beginning (baseline) and after six months of rHu-Epo treatment. LVH was defined as LV mass index >100 g/m2 in women and >131 g/m2 in men. We observed significant reduction of LV mass index (LVMI) (mean 26,4%, p=0.008), as well as LV volumen. There was a significant negative correlation between Hb level and LVMI with predictive LVMI reduction of 2,317 g/m2 for each 1g/L rising of mean Hb level. The results of the study confirm the importance of early anaemia correction in haemodialysis patients aimed to improve LV parameters.

UNLABELLED The concentration of circulating immune complexes (CIC) was investigated in the group of 9 patients with revealed systemic lupus crythematosus in active disease period and remission. In the same time it was estimated the blood level of complement C3 and C4, anti-dsDNA antibody and qualitative estimation of antinuclear antibody (ANF). It was estimated the significance of their changes in the remission and in activity period. CIC were performed with N-Latex (Clq) CIC nephelometry, C3 and C4 k.k. with nephelometry, and anti-dsDNA antibodies with ELISA test, specific for dsDNA antigen, IgG type, and ANF was performed with direct immunofluorescence microscopy. In the results, we found increase the concentration of CIC with all patients in active disease period, but in the remission period it was decreased (therapy effect). The blood level of ANF, C3, C4 were not significantly different between activity and remission period. The anti-dsDNA level was significantly elevated (90%) in the period of high SLE activity, while decrease was confirmed during remission. IN CONCLUSION the CIC level in patients with SLE is adequate parameter for disease activity estimation, together with measuring other immunological parameters (C3, C4, anti-dsDNA antibody), is useful in follow up of SLE activity.