Abnormal vitamin K status was documented in patients with chronic kidney diseases (CKD), especially those undergoing hemodialysis. The data related to patients undergoing peritoneal dialysis (PD) are contradictory. Therefore, in the present study we aimed to evaluate vitamin K status in patients with CKD who are treated with continuous ambulatory PD. Twenty-eight patients entered into the study. Dialysis vintage ranged from 3 to 89 months. Vitamin K status was assessed in all subjects using undercarboxylated prothrombin measurement (PIVKA-II). In addition, total protein and albumin levels, total cholesterol, LDL cholesterol, triglyceride, calcium, urea and creatinine concentrations were determined. PIVKA-II concentrations were abnormal in 13 (46.4 %) subjects. BMI values, both total and LDL cholesterol concentrations were significantly higher in patients with than those without vitamin K deficiency. Moreover, PIVKA II levels correlated with BMI values (r = 0.441, p < 0.019), LDL cholesterol (r = 0.434, p < 0.021) and creatinine (r = 0.406, p< 0.032) concentrations. However, through the use of logistic regression analysis and multiple regression analysis, no clinical factor was documented to be the independent risk factor of vitamin K deficiency. In conclusion, vitamin K deficiency is a frequent condition in peritoneally dialyzed patients. Assessment of vitamin K status should become a standard procedure in this group of patients.

Chlamydia trachomatis is one of the causes of acute and chronic urinary tract infections and acute or silent salpingitis. Chronic or recurrent female urinary or genital tract infections with Chlamydia trachomatis have been recognised as a significant factor in the development of acute or chronic renal interstitial inflammation or increased risk of ectopic pregnancy. In most cases Chlamydia trachomatis is sexually transmitted. Moreover, it is one of the most common sexually transmitted pathogens. The current estimate is that in the United States there occur 4.5 million new infections each year. We describe 3 cases of recurrent urinary tract infections due to Chlamydia trachomatis.

No abstract

Cytomegalovirus (CMV) infection after renal transplantation is major cause of morbidity and mortality. Cytomegalovirus disease typically occurs in fi rst 6 months after transplantation and causes fever, leukopenia, thrombocytopenia and slightly elevated transaminases. More invasive forms of CMV infections are rare because of prophylactic regimen in high-risk patients and early treatment with gancyclovir. We report the case of 36-year-old patient who developed CMV related colonic multiple perforations 3 years after renal transplantation. Initially after transplantation the immunosupressive regimen consisted of steroids(Metypred),calcineurin inhibitor(Prograf)and mycophenolate mofetil(CellCept). CMV infection was not present. Three weeks and 3 months after transplantation the patient presented two incidents of acute rejection treated successfully with antithymotic globulin(fi rst episode) and steroids(second episode). Furthermore in the fi rst year after transplantation patient demonstrated recurrent urinal tract infections and severe Pneumocystis carinii infection treated with Pentamidine. At the same time Prograf was withdrawal. Three years after transplantation patient presented symptoms of enterocolitis(abdomen pain, diarrhea, nausea, weight loss) with biochemical disorders hypoproteinemia, hypoalbuminemia and temporary graft dysfunction. At the beginning of enterocolitis manifestation, investigation of CMV pp65 antigenemia test and CMV-DNA polymerase chain reaction (CMV-DNA PCR) were negative. However CMV IgG antibodies were positive. At that time conversion from CellCept to Myfortic was performed with temporary improvement of symptoms. Six months after fi rst symptoms, colonic biopsy was performed -the histological investigation gave evidence of typical CMV infection. CMV infection was also confi rmed by positive CMV pp65 antigenemia test and CMV-DNA PCR. Ganciclovir therapy was initiated immediately and resulted in improvement of symtoms. However periodically abdomen pain and diarrhea was observed. Control examination of CMV pp65 antigenemia test and CMV-DNA PCR were negative. Three months after ganciclovir therapy symptoms of colonic perforation occured and total colectomy was necessary. The relationship between CMV infection and colonic perforation has been confi rmed by histological examination of the resected colon. Colonic perforationas are often fatal and life-threatening complications in transplant recipients with CMV infection. In such cases only rapid diagnosis and agressive surgical treatment can save the patient from death. The history of our patient illustrated the need to consider CMV infection in patients with enterocolitis symptoms even more than 3 years after solid organ transplantation.