INTRODUCTION In BiH there are no summary data about chronic dialysis patients (CDP). With this study we tray to make first step to establish B&H system for collecting necessary data. METHODS This is a retrospective study for 1999 years. We collect data with question form which have been distributed to dialysis centers (DC) in BiH. RESULTS We got answer from 6 (37.5%) DC: Tuzla, Sarajevo, Bihac, Odzak, Travnik and Tesanj. Totally number of CDP was 533, 256 female (48%) and 277 male (52%), and 79% of them are between 26-65 yrs. Leading primary renal diseases were: glomerulonephritis 22%, pyelonephritis 16%, endemic nephropathy 11%, unknown ESRD 10%, polycystic renal disease 9% and diabetes 9%. Peritoneal dialysis have ben performed in 10 patients only, and bicarbonat HD in 46% of CDP. Half of the patients had serum haemoglobin lower than 7 mmol/1 and only 12% received erythropoietin. 17% of the patients had coronary disease, and 7% peripheral vascular disease. We registered 43 (8%) HBsAg, but 294 (55%) antiHCV positive patients. 52% of the CDP have been vaccinated against B hepatitis. Last year died 76 patients (14.26%), mostly caused by coronary diseases (21%), cardial failure (20%), cerebrovascular accidents (15%) and sepsis (11%). 53% of patients are on dialysis between 1-5 yrs. CONCLUSION In this study participated 6 DC only, but we think that data we collect are good basis for establishing B&H system for registration and follow-up of the ESRD patients.

BACKGROUND Renal involvement is one of the most common manifestations of MM, with different pathogenetic mechanisms, like overproduction of monoclonal light chains and hypercalcemia, those are commonest precipitating factors for renal failure which occurs in nearly 25% of myeloma patients. Some renal pathology is noted in over half. METHODS We studied retrospectively 16 patients with MM treated at Nephrology and Haemathology Clinic in Sarajevo, in the period from 1996-1999 y (10 females and 6 males). All fulfilled criteria for MM diagnosis: 1. Bone marrow involvement by greater than 20% plasma cells 2. Monoclonal paraprotein in the serum and/or urine 3. Lytic bone lesions. RESULTS Appearance of high creatinine plasma level, red and white blood cells in urine, and proteinuria are the signs of renal function reduction. Renal failure was noted in 10/16, erythbruria 6/16, pyuria, 7/16 hyperuricemia in 8/16 and 3/16 (19%) were died during hemodialysis programme, and Bence-Jones protein was noted in urine with 7/16 (43%). Severe renal failure with 5/16 was noted and beside high plasma creatinine we found high plasma calcium and Bence Jones in urine. CONCLUSION High plasma levels of creatinine and calcium and Bence-Jones in urine, are poor prognostic signs of MM.

BACKGROUND It's known that uremia is accompanying with different alteration of immune system. Also, different type of dialysis membranes can affect the immunological competence cells--lymphocytes and their function during hemodialysis (HD). AIM OF STUDY To establish the effect of single hemodialysis session with polysulfonic and cellulose--acetat membranes on lymphocyte subpopulations and their activation markers. METHODS In two groups of seven patients with end stage of renal disease (ESRD) on periodic HD we were investigated flow-cytometrical expression the following markers using monoclonal antibodies (BECTON DICKENSON): CD3 (T-Ly), CD19 (B-Ly), CD4 (T helper/inducer), CD8 (T-suppressor/cytotoxic), CD4/CD8 ratio, CD16 (NK cells), CD3/HLA-DR (late activated T-cells), CD4/CD 25 (IL-2R early activated T4), CD4/HLA-DR (late activated T8), CD8/CD25 (early activated T8), CD8/CD71 (late activated CD8). Blood samples were taken before HD, 30 minutes into HD and at the end of a four-hours HD session. RESULTS Demostrates statistical increased expression T helper cells on both membranes on minute 30 from beginning of HD procedure, but more on cellulose-acetat membranes and the significant falls to normal value at the end of HD: start 46.7% minute 30: 54.9%, minute 240: 42.7%. Significant changes were in expression of NK cells on cellulose-acetat membranes: start 12.7%; minute 30: 6.0; minute 240: 11.1%. No changes were noted in activations of T Ly, T4 and T8 on the both membranes. CONCLUSION No significant difference was found in expression of lymphocyte subpopulations and their activations during HD with polysulfone membranes. Significant changes of the expression of NK cells during HD with cellulose acetat, indicated that NK cells can be sensitive marker for biocompatibility of HD membranes.

Cardiovascular diseases cause death in 40% patients on the chronic haemodialysis program. Our aim was to assess the heart changes in these patients by echocardiography. We have tested 40 patients, but 34 of them accomplished criteria for this study. There were 19 (55.88%) females and 15 (44.12%) males. The average age was 44 years and average duration of haemodialysis treatment was 4.72 years. The research was made with ultrasound device TOSHIBA SSH 65 A SONOLAYER and transducers 3.5 and 2.75 MHz. Twenty patients (58.82%) have had pathological echocardiogram. Ten patients (29.42%) have had conditionally normal echocardiogram while four patients (11.76%) have had completely normal echocardiogram. In patients with pathological echocardiogram, some of the left ventricle hypertrophy forms dominated. Echocardiography is a useful method in morphologic and functional cardiac assessment at the last stage renal disease patients on the chronic haemodialysis program. Using the aforementioned method we are able to select the patients who need intensive cardiac care.

Renal amyloidosis is a rare disease when compared to other kidney diseases. During the period of last fifteen years, at the Institute of Nephrology and Immunology in Sarajevo renal amyloidosis was diagnosed with 15 patients. The disease occurred more often with men than with women. Only during 1988, renal amyloidosis was revealed and followed up with five patients. The most common clinical manifestations of renal amyloidosis are nephrotic syndrome and chronic renal failure, with respective laboratory findings. Using immunofluorescent analysis of the kidney biopsy material, we discovered deposits of immunoglobulins of different intensity and deposits of lambda and kappa light chains of immunoglobulins. The intensity of lambda light chains is greater than that of kappa chains. The analysis of light microscopy showed nodular mesangial deposits and deposits along GBM without proliferation. The diagnosis of amyloidosis was confirmed by staining of amyloid. Application of therapy for amyloidosis was without any effect. Although renal amyloidosis is a rare disease, we want to point out disease as being an etiologic factor in nephrotic syndrome.

The intention of this work is to show the usefulness of use of enzymatic essay in the anti-body detection against GBM in the serum of the Patient with linear deposits of IgG. Full success was obtained. Maximal sensibility of test sensibility and reproduction, as well as the advantage that tests are simply enough for the empiric application in everyday clinical practice was achieved through multiplied vibration of anti-bodies. Test were done 30 patients in the Immunology Laboratory of the Institute for Nephrology in Sarajevo.