Objective: The aim of this work is to evaluate the effect of warm ischemia on renal function. Methods: Within a multicentric study, the data about tumor-affected solitary kidney were obtained from 9 urological centers in the Czech Republic. Patients were divided into groups according to the WIT (warm ischemia time). In each group the mean preoperative serum creatinine was determined, as well as on 3rd and 7th postoperative day and the lowest GF postoperatively. In each group the mean R.E.N.A.L. nephrometric score was determined. Results: The study compriese data totally of 97 patients. The open approach was chosen in 78 cases, in 16 cases laparoscopic approach was chosen. The robotic surgery was performed in 3 patients. PN with zero ischemia was performed in 29 patients (30%). Conclusion: Our findings confirm that non-clamping partial nephrectomy in a solitary kidney minimizes renal injury. For the non-clamping partial nephrectomy can be mainly indicated smaller exophyticall tumors without deep parenchymal invasion. Unfortunately, most of PN should be performed with vascular clamping, allowing precise closure of collecting system, vascular and parenchymal defect, especially for larger tumors with deep parenchymal invasion. According to our observation that WIT of 15 minutes for a kidney is safe. Clamping of...

Objective: The aim of this work is to evaluate the effect of warm ischemia on renal function. Methods: Within a multicentric study, the data about tumor-affected solitary kidney were obtained from 9 urological centers in the Czech Republic. Patients were divided into groups according to the WIT (warm ischemia time). In each group the mean preoperative serum creatinine was determined, as well as on 3rd and 7th postoperative day and the lowest GF postoperatively. In each group the mean R.E.N.A.L. nephrometric score was determined. Results: The study compriese data totally of 97 patients. The open approach was chosen in 78 cases, in 16 cases laparoscopic approach was chosen. The robotic surgery was performed in 3 patients. PN with zero ischemia was performed in 29 patients (30%). Conclusion: Our findings confirm that non-clamping partial nephrectomy in a solitary kidney minimizes renal injury. For the non-clamping partial nephrectomy can be mainly indicated smaller exophyticall tumors without deep parenchymal invasion. Unfortunately, most of PN should be performed with vascular clamping, allowing precise closure of collecting system, vascular and parenchymal defect, especially for larger tumors with deep parenchymal invasion. According to our observation that WIT of 15 minutes for a kidney is safe. Clamping of...

8 ABSTRACT Author: Bc. Lucie Moravcová Supervisor: MUDr. Vít Řeháček Charles University, Faculty of Pharmacy in Hradec Králové Title of master's thesis: Kidney transplantation: donor-recipient pairing in University Hospital Hradec Králové Background: The aim of this study was to determine HLA, blood group, age and sex match in donor-recipient pairing in kidney transplantation. HLA alleles of deceased donors were typed in Transfusion Department of the University Hospital Hradec Králové. Methods: Donor's HLA-A*, HLA-B* and HLA-DRB1* alleles were typed by PCR - SSP method. Complex data evaluating and processing was then performed. Results: 97 deceased donors were tested between 2013 and 2018. A total of 98 kidneys received from them were subsequently transplanted to 98 recipients in University Hospital Hradec Králové. 60,2 % of the donors were men, 63,3 % of the recipients were men. Most of the donors, as well as the recipients, were 51-70 years old (50,0 % and 59,2 %, respectively). The most common diagnoses in the group of deceased donors were associated with brain damage (66,3 %), the most common cause of renal failure in the group of recipients was chronic inflammatory kidney disease (41,8 %). All 98 transplantations (100,0 %) were AB0 compatible. 74 transplantations (75,5 %) were RhD compatible. 5...

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biochemical Sciences Candidate: Bc. Ľubica Múčková Supervisor: Prof. MUDr. Jaroslav Dršata, CSc. Consultant: Ing. Jana Netriová, PhD. Title of diploma thesis: Laboratory diagnostics of kidney injury in patients with diabetes mellitus I and II Diabetes mellitus is a chronic metabolic disease. This disease leads to develompement of both microvascular and macrovascular complications. In this work we examined a microvascular complication - diabetic nephropathy - and its laboratory diagnostics. We focussed on parameters cystatin C and creatinine. We estimated a glomerular filtration with Grubb, Stevens and MDRD equations. The Grubb and Stevens equations use cystatin C to determine the glomerular fitrlation rate (GFR), MDRD equations use creatinine, albumin and urea. For the asessment of kidney function we evaluated albumin and total protein waste in urine samples collected for 24 hours. The parameters were measured in file of 183 patients. Number of pacients with diabetes I.type was 49 and with diabetes II.type was 134. The main intention of this work was to evaluate equations used for determination of GFR, to compare their pros and cons and put them in contrast with albumin and total proteins waste. In case of the patients...

Photoprotection in Patients after Kidney Transplantation Author: Zuzana Hajšelová Tutor: doc. PharmDr. Josef Malý, PhD. Consultant: Mgr. Barbora Vaňková Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradci Králové, Charles University Introduction and aims: Patients after kidney transplantation (KT) are in a higher risk of developing skin cancer as a result of lifelong immunosuppressive (IS) therapy. Thorough photoprotection is therefore recommended. The aim of this study was to determine patients' awareness and level of photoprotection and to analyse selected risk factors for skin cancer development in patients after KT. Methods: The cross-sectional study was undertaken from 15th April to 31st December 2019 at the Haemodialysis Centre in the Teaching Hospital Hradec Králové. Patients included in this study were above 18 years old, who visited Haemodialysis Centre in the defined period. The data was collected from the patients' medical documentation (e.g. occurrence of skin cancer and skin cancer type, current IS) and from the written version of questionnaires (e.g. phototype, sun exposure, photoprotection). The data was analysed using descriptive statistics. Results: There were 410 KT patients in regular care of the Haemodialysis Centre, 361 fulfilled the questionnaire (88.0...

The purpose of the dissertation Continuous Elimination Methods in Intensive Care in Prospective of Hospital Nurse is to inform about acute kidney injury and chronic kidney disease. These are major reason to use elimination methods at intensive care units and anesthesiological resuscitation departments. We further determine elimination issues. Continuous elimination methods in intensive care medicine are important medical treatment at acute kidney injury and chronic kidney disease. Particularly, acute kidney injury belongs to frequent complications at critically diseased patients, therefore will be properly discussed. It is afraid, because decreased renal function leads to incapability to excrete waste products of metabolism and sustain homeostasis. Mortality at acute kidney injury is higher than at chronic kidney disease so support or renal replacement therapy, in order to save life, is the only accepted method of choice at present time. The techniques of renal support or replacement therapy are integral part of instensive care medicine. The aim of this thesis is to elaborate latest accessible findings and specialized nursing care at continuous elimination methods. Ve have tried to create integrated, comprehensible summary of knowledge of this topic. We expect these findings are fundamental to high-quality nursing at patients with this disorder. The dissertation was conducted as a method of review and synthesis. As long as this part is purely theoretical-based, it gathers informations from czech and also foreign sources. The data was acquired from scientific publications, technical papers, monographs and web. The outcome of this work can be used for further research of this topic or contribute to resource information for paramedical staff. In the thesis we analyze acute kidney injury, briefly chronic kidney disease, then we proceed through the history of dialysis and its specifications. These are closely explained. We focus on technical aspect of various elimination methods, the division, indication to initation, advantage and disadvantage, vascular access will also be described. The possibilities of anticoagulation have been defined, the types of membrane hemofiltrates and dialysators, substitutional and dialysing solutions have been characterized, the need of dietary measures has been emphasized. The complications that can happen during the use of elimination method have not been left out of consideration. We describe the intensive care units, nurse competencies, their work, monitoration, patients' and elimination unit preparation and vascular access care.

Title: Muscle metabolism and its effect on physical condition in patients with chronic renal failure receiving hemodialysis Objective: Assess the status of muscle metabolism in patients starting hemodialysis and patients receiving hemodialysis long time, to determine some changes in muscle metabolism in both groups in the time period and ultimately assess its impact on physical condition and quality of life of hemodialysis patients. Method: Fill anamnestic questionnaire and examination of body composition using bioimpedence device (BCM) in the group of patients with chronic renal failure who are beginning to be treated with hemodialysis and a group of patients treated with hemodialysis for several years. Compare the results of both groups. To obtain additional information from medical records. Results: It was found that hemodialysis therapy affects the status of muscle metabolism in terms of reducing muscle mass (LTM). The dependence of LTM, however, the duration of hemodialysis treatment assays. The study showed that if patients are nutritionally stable and regularly engaged in some physical activity, loss of muscle mass is lower than in individuals who have a passive way of life. Keywords: chronic renal failure, hemodilysis, muscle metabolism, physical condition

INFECTIOUS COMPLICATIONS IN CHRONIC RENAL FAILURE Infections represent a serious problem in chronic kidney disease (cohort and they are) associated with signifficant morbidity and mortality. The thesis originated in the nephrology division of the Department of Internal Medicine I., Charles University Teaching Hospital and Medical Faculty in Pilsen, an institution with a long standing research activity in the field. In the theoretical part of this work, a general summary of infectious complications in chronic kidney disease population is presented. The other part of this work presents results of our research dealing with pharmacoeconomical aspects of cytomegalovirus infection and finally our results in the field of influenza vaccination. The Aim of the first presented work was to evaluate the cost impact of four different strategies for prevention of cytomegalovirus infection after renal transplantation. We provide post hoc analysis of 2 randomized studies performed in our department and calculating direct CMV-related expenses using valacyclovir prophylaxis, ganciclovir prophylaxis, preemptive vlaganciclovir treatment and deferred therapy. To simulate ihe impact of varying prices of prharmacotherapy or diagnostic procedures, a sensitivity analysis was performed. With respect to our results, valacyclovir...

Nutrition plays a major role in the treatment and preventing the progression of renal disease. Malnutrition is the determining factor for morbidity and mortality in dialysis patients. Patients with renal disease tend to have reduced food intake, due to loss of appetite, depression, but also as a consequence of chronic inflammation or lack of antioxidant mechanisms. Poor nutritional status of these patients must be recognized early and treated. It is important to ensure adequate intake of energy, protein and calcium, and at the same time to reduce intake of potassium, sodium, phosphate and fluids. A supplementation of vitamins and micronutrients may be appropriate. The nutritional status should be checked regularly. The research part demonstrates the dependence of laboratory values on nutritional status and a positive effect of education on patients' compliance with the recommended diet.

Chronic disorder of kidneys is a gradual progression from the state of health to the state of a disease, resulting in permanent failure of excretory, regulatory, and hormonal (metabolic) functions of kidneys. During a kidney failure water and electrolyte imbalance, retention of catabolites, and metabolic acidosis occur; there is a shortage of substances produced in kidneys. A complex metabolic disorder occurs, whose clinic corelate is a uremic syndrom. Conservative treatment consists in adjusting or positive influencing of metabolic deviations through a diet and medication. However, if the conservative treatment is insufficient, it is necessary to proceed to some of the blood purifying methods {--} hemodialysis, peritoneal dialysis. These methods are then followed by kidney transplant. Dialysed people have an abnormal life, as a vitally important organ of theirs does not work and is replaced by an apparatus. Patients are faced with many stresses and bans {--} they have to be on a diet with liquid restrictions, they have to take remedies regularly, due to dialysis days they are time limited, their appearance is often changed, they suffer from sexual disfunction, their sickness rate is high, etc. A successful transplant is a great white hope for the patients, but it also has its medical contraindications, therefore it does not concern all the dialysed patients. Thus a big occurence of depressions and suicides among patients cannot be a surprise. Besides medical care it is then necessary to focus on psychological care and social recovery. However, the results of a questionnaire research did not prove the occurence of psychological problems among the clients of dialysis centres. It proved true that the clients of centres are not interested in using psychosocial services, which was the third hypothesis.Further it came out that the clients are not well informed about social services and social benefits. Thus the second hypothesis was confirmed {--} The clients of centres do not know psychosocial services. The first hypothesis {--} Psychosocial workers are not used by hemodialysis centres {--} was also confirmed. The teams of the centres miss a psychologist absolultely and only one centre has a social worker.