Introduction. Renal osteodystrophy is a severe complication of chronic kidney disease (CKD) that increases morbidity and mortality in these patients. Mineral and bone disorder starts early in CKD and affects the incidence of bone fractures. The aim of this study was to observe the frequency of diverse bone fractures in patients with CKD not on dialysis.Methods. This cohort study included 68 patients that were followed during the two-year period. The patients were divided into two cohorts: one that developed bone fractures and the other that did not. There were 35 (51.5%) men and 33 (48.5%) women. The mean age of patients ranged 62.88±11.60 years. During follow-up serum values of chronic kidney disease -mineral and bone indicators were measured. The methods of descriptive and analytical statistics were used in order to analyze obtained data.Results. During this two-year follow-up seven patients developed bone fractures. Among them, females dominated (6 patients) compared to males (only 1 patient). The most common were fractures of forearm. The mean level of parathyroid hormone (PTH) at the beginning of the monitoring was higher in the group of patients with bone fractures (165.25 ± 47.69 pg/mL) in regard to another group (103.96 ± 81.55 pg/mL). After two-year follow-up, this difference became statistically significant at the level p < 0.05. Patients that developed bone fractures had higher FRAX (Fracture Risk Assessment) score compared to another group.Conclusion. In our study, about 10% of patients had bone fractures in the two-year follow-up period. Patients who developed fractures had a higher PTH level and FRAX score.

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Kratak sadržajUvod. Bolesnici sa dijabetes melitusom mogu osim dijabetesne nefropatije da imaju i nedijabetesnu bolest bubrega koja se najbolje dokazuje biopsijom bubrega. Cilj rada je da se biopsijom bubrega utvrdi učestalost i vrsta nedijabetesne bolesti bubrega kod bolesnika sa dijabetesom.Metode. U periodu od aprila 2007. do maja 2013. godine urađeno je devet biopsija (dva muškarca) bubrega kod bolesnika sa dijabetesom na Odjelu za nefrologiju Klinike za unutrašnje bolesti KC Banja Luka. Prosjek trajanja dijabetesa je bio 4,9 godina, retinopatiju je imao jedan, a hipertenziju sedam bolesnika. Biopsija je rađena biopsijskim pištoljem Fast Gun sa iglom promjera 16G, pod kontrolom ultrazvuka (Toshiba Famio 5 sa sondom vodilicom). Uzimana su dva uzorka tkiva: za optičku mikroskopiju i imunofluorescenciju.Rezultati. Indikacije za biopsiju su bile: nefrotski sindrom kod šest bolesnika, asimptomatske urinarne abnormalnosti (perzistentna proteinurija i/ ili mikrohematurija) kod dva, sistemski lupus eritematodes kod jednog. Kod šest pacijenata je postavljena patohistološka dijagnoza dijabetesne nefropatije, dva pacijenta su imala kombinovano dijabetesnu nefropatiju sa drugom bolešću bubrega (jedan sa hipertenzivnom nefroangiosklerozom, a drugi sa lupus nefritisom) i jedan pacijent primarni membranozni glomerulonefritis.Zaključak. Biopsija bubrega kod naših devet bolesnika sa dijabetesom je pokazala da su tri bolesnika (33,3%) imala nedijabetesnu bolest bubrega. Dva od tri bolesnika sa nedijabetesnom bolesti bubrega su imala glomerulsku, a jedan vaskularnu bolest bubrega (hipertenzivna nefroangioksleroza). Iako je uzorak bolesnika manji u poređenju sa studijama drugih autora, naša prva iskustva ukazuju da postoji značajan procenat bolesnika sa dijabetesom koji imaju nedijabetesnu bolest bubrega, što se sigurno može dokazati samo biosijom bubrega.

Peritonitis is a very common complication in patients treated with continuous ambulatory peritoneal dialysis. The most common causes are gram positive cocci (part of the normal skin flora), and then gram negative bacteria, while fungi are listed as a rare cause of peritonitis. Aeromonas species are identified as a rare cause of continuous ambulatory peritoneal dialysis-related peritonitis. Among them, Aeromonas hydrophila is somewhat more common, followed by Aeromonas caviae. Case presentation. We reported a case of continuous ambulatory peritoneal dialysis peritonitis caused by Aeromonas sobria that is extremely rare cause of this type of peritonitis. In our patient, pseudomembranous colitis occured as a complication and, reinfection -another episode of peritonitis with Klebsiella pneumoniae. Treatment with third-episode cephalosporins was successful and patient continued treatment with continuous ambulatory peritoneal dialysis. Conclusions. The rare causes of peritonitis should not be ignored, especially those which lead to increased morbidity and mortality of patients.

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