Comparison of the effects of Puumala and Dobrava viruses on early and long‐term renal outcomes in patients with haemorrhagic fever with renal syndrome

Aim: The clinical course and outcome of patients with haemorrhagic fever with renal syndrome (HFRS) caused by Puumala (PUUV) and Dobrava viruses (DOBV) were analyzed and whether it left long‐term consequences on kidney function after 10 years was evaluated. Methods: Cross‐sectional studies were conducted to test the kidney function and blood pressure of HFRS‐affected patients and to follow them up 10 years after. Eighty‐two PUUV‐ and 53 DOBV‐induced HFRS patients and 14 and 31 participants 10 years after having contracted PUUV‐ and DOBV‐related diseases, respectively were evaluated. Results: Serum creatinine concentrations were 279.5 and 410 mcmol/L in PUUV and DOBV groups, respectively (P = 0.005). There were six and 13 anuric (P < 0.05), none and seven dialysis‐dependant (P < 0.05), and nine and 18 hypotensive patients (P < 0.05) in PUUV and DOBV groups, respectively. After 10 years, glomerular filtration rates were 122.1 ± 11.1 and 104.7 ± 20.2 mL/min (P < 0.05) in PUUV and DOBV groups, respectively. Conclusion: During the acute phase, DOBV causes more severe renal impairment than PUUV infection. After 10 years follow up, renal function was found within normal limits, although after DOBV infection glomerular filtration rate (GFR) was significantly lower than after PUUV infection.     

The impact of war on Sarajevans with non-insulin-dependent diabetes mellitus

The objective of this study was to investigate the impact ofalmost 3 years of war on glycaemic control and blood pressurein Sarajevans with non-insulln-dependent diabetes mellitus (NIDDM).Fifty-five patients with NIDDM were randomly selected from aregister of 279. Data from pre-war records were retrieved andthe same measurements were repeated using a similar methodology.These included blood glucose levels, ghycosylated haemoglobinAle (HbAlc), serum cholesterol and triglycerides. Other measurementsincluded weight, height and systolic and diastolic blood pressure.Information was collected on the prescribed therapy, the availabilityof drugs and access to medical facilities. Weight was significantlyreduced by 11.7 ± 8.2 kg. Sixty per cent of the samplewere obese (body mass index (BMI) >30) before the war comparedwith only 18% afterwards. The percentage of patients with NIDDMwith acceptable blood glucose values Increased from 15 to 35%.The values of HbA1c improved significantly but no differencesin the total serum cholesterol or in the trigiyceride levelswere found. Twenty-five of the participants were hypertensive(BP > 140/90 mmHg) before the war compared with only 14 in1994–1995. The number of patients controlled without anyanti-diabetic medication increased from 3 to 13. The reductionin anti-diabetic drugs and blood pressure probably occurredas a result of the significant weight loss. It can be concludedthat glycaemic control and the level of hypertension improvedin patients with NIDDM in Sarajevo during the war. These findingshave major implications for future policies related to publichealth.     

Microalbuminuria as a possible marker of risk of Balkan endemic nephropathy

Aim: To evaluate whether microalbuminuria could be a marker of early tubular damage in individuals at risk of developing Balkan endemic nephropathy (BEN). Methods: A cross-sectional study was used to determine urinary albumin-to-creatinine ratio (UACR) in a test group of 61 participants from a BEN endemic region and control group of 64 participants from a nearby non-endemic region, both recruited from the general population of Bosnia and Herzegovina. The correlation between UACR and urinary b2 microglobulin-to-creatinine ratio (UBCR) and the receiver operating characteristic curve for UACR were analyzed in the test groups of 58 participants. The correlation analysis was also performed in a subset of nine subjects with elevated UBCR. Results: Medians, interquartile ranges and confidence intervals (CI) for medians of UACR in the test and control groups were 2 mg/mmol, 0.975–8.247 mg/mmol, 1.3472–3.2691 mg/mmol and 1 mg/mmol, 0.695–1.41 mg/mmol, 0.8466–1.2053 mg/mmol, respectively (P = 0.0001). Microalbuminuria was found in 30 of the 61 examinees in the test group, in contrast to six of the 64 examinees in the controls (P < 0.0001). Participants from the endemic region had 9.3 times the odds of having microalbuminuria in contrast to participants from the non-endemic region. Pearson's correlation coefficients r of the log-transformed ratios and Kendall–tau coefficients of rank correlation in the group of 58 and in a subset of nine subjects with elevated UBCR were: 0.55 (P < 0.0001); 0.317 (P = 0.0005) and 0.59 (P = 0.045); 0.48 (P = 0.037), respectively. The area under the curve for UACR was 0.882 (P = 0.0001), sensitivity 100% and specificity 67.3%. Conclusion: Microalbuminuria may be a useful marker of early tubular injury in individuals at risk of developing BEN.