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392
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1. Ilpo Ala-Houhala Article ID: ebm00224 (010.003) 2005 Duodecim Medical Publications
Ltd
1. EBM Guidelines, 28. 6. 2004, www.ebm-guidelines.com
2. 3
3. 2007.
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278

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.
.
1. Hodson EM, Knight JF, Willis NS, Craig JC. Corticosteroids for nephrotic syndrome in
children. The Cochrane Database of Systematic Reviews, Cochrane Library number:
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frequently
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syndrome in children. The Cochrane Database of Systematic Reviews, Cochrane
Library number: CD002290. In: The Cochrane Library, Issue 2, 2002. Oxford: Update
Software. Updated frequently
3. Eero Honkanen Article ID: ebm00227 (010.030) 2004 Duodecim Medical Publications Ltd
2. 2
3. 2006

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1. Hogan SL, Muller KE, Jennette JC, Falk RJ. A review of therapeutic studies of idiopathic
glomerulopathy. Am J Kid Dis 1995;25:862-875
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no.: DARE-951607. In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software
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membranous nephropathy? A meta-analysis of the controlled trials. J Am Soc Nephrology
1995;5:1553-1558
5. Del Mar CB, Glasziou PP. Antibiotics for sore throat. The Cochrane Database of
Systematic Reviews, Cochrane Library number: CD000023. In: The Cochrane Library,
Issue 2, 2002. Oxford: Update Software. Updated frequently.
6. Jukka Mustonen Article ID: ebm00229 (010.031) 2005 Duodecim Medical Publications
Ltd
2. 2
3. 2006
281
282
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284
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286
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.
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antineutrophil cytoplasmic antibody (c-ANCA) testing in the diagnosis of Wegener
granulomatosis: a literature review and meta-analysis. Ann Intern Med 1995;123:925-932
1. EBM Guidelines, 14.6.2004, www.ebm-guidelines.com
2. 2
3. 2006
- HENOCH-SCHNLEIN
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Henoch-Schoenlein.
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CRP 20 mg/l 11 35 mm/;

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.
1. Ronkainen J, Nuutinen M, Koskimies O. The adult kidney 24 years after childhood

Henoch-Schnlein purpura: a retrospective cohort study. Lancet 2002;360:666-670
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2. 2
3. 2006
11 -
287
288
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30%
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Henoch-Schnlein.
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.
: , , ( ) 24- .
1. Pozzi C, Bolasco P, Fogazzi G, Andrutti S, Altieri P, Ponticelli C, Locatelli F. Corticosteroids

in IgA nephropathy: a randomised controlled trial. Lancet 1999;353:883-887
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patients with primary IgA nephropathy. Nephrol Dial Transplant 1990;suppl 1:47-52
Ltd
2. 2
3. 2006
289
290
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292

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293
294
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17 .
14
15
16
17
(-B).
.
.
.
.
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-
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. 2
.
1. Suomen diabetesliiton nefropatiatyryhm. Diabeettinen nefropatia -seulonta, seuranta

ja hoito. Suomen Lkril 1996;51:24792489
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Tract Infection Study Group. N Engl J Med 2002;347:1576-1583 (B)
5. Leo Niskanen Article ID: ebm00494 (023.041) 2005 Duodecim Medical Publications
Ltd
2. 2
3. 2006
()
().
Puumala () (Clethrionomys glareolus).
3-4- .
295
296
(Nephropathia epidemica) .
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297
298

( > 150 mola/l),

() 10% . .
,
.
.
.
.
. .
1. Mustonen J et al. Nephropathia epidemica in Finland: a retrospective study of 126

cases. Scand J Infect Dis 1994;26:7-13
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caused by Puumala hantavirus. Kidney Int 1996;49:217-21
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Transplant 1998;13:2729-31
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infections. Rev Med Virol 1998;8:67-86
Ltd
2. 2
3. 2006
,
( 50% 50 ).
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299
300
1. Thurston W, Wilson S. The urinary tract. Renal cystic disease. In: Rumack CM, Wilson
S, Charboneau JW (Eds.) Diagnostic Ultrasound. Second Edition. Mosby, St. Louis,
1997, p. 371
Ltd
2. 3
3. 2007
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1 28 1 g 2 (-C). - .
28 .
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.

.
.

3-4 .
.
,
(-A).
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2. 2
3. 2006
305
306
.
29;
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75-80%
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307
308
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4-5 mm.
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32, , (-B).

, , . (-A).
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N Engl J Med 2002;346:77-84
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Ltd
2. 2
3. 2006
32 .
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314
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Pygeum africanum
(-C).
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hyperplasia. The Cochrane Database of Systematic Reviews, Cochrane Library number:
frequently

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3. 2006
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patients. N Engl J Med 2000;342:14553
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Investigators. The effect of spironolactone on morbidity and mortality in patients with
severe heart failure. N Engl J Med 1999;341:70917
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mortality in patients with symptomatic heart failure randomized trialthe Losartan heart
Failure Survival study ELITE II. Lancet 2000; 355:15827

119.Golzari H, Cebul RD, Bahler RC. Atrial fibrillation: restoration and maintenance of sinus
rhythm and indications for anticoagulation therapy. Ann Intern Med 1996;125:31123
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Am J Cardiol 2000;85:3D-11D
121. Segal JB, McNamara RL, Miller MR ym. The evidence regarding the drugs used for
ventricular rate control. J Fam Pract 2000;49:4759
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the management of hypertension. Task Force for the Development of the 1999
Canadian Recommendations for the Management of Hypertension. Can Med Assoc J
1999;161(Suppl 12):S117
123.The INDANA (Individual Data Analysis of Antihypertensive interventional trials) Project
Collaborators, Guyffier F, Boissel J-P, Boutitie F, Pocock S, Coope J, Cutler J, et al.
Effect of antihypertensive treatment in patients having already suffered from stroke:
gathering the evidence. Stroke 1997;28:255762
124. MacMahon S, Rodgers A, Neal B, Chalmers J. Blood pressure lowering for the
secondary prevention of myocardial infarction and stroke. Hypertension 1997;29:5378
125. Feldman RD, Norman C, Larochelle P ym. 1999 Canadian recommendations for the
management of hypertension. Can Med Assoc J 1999;161(Suppl 12):S117
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127. Joint National Committee. The Sixth Report of the Joint National Committee on
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Intern Med 1997; 57:241346
128. Kvasnicka J, Flack JM, Grimm RH. Treatment of hypertension in the presence of
coexisting medical conditions. Drugs Aging 1994;4:30412
129.Hill NS. Fluid and electrolyte considerations in diuretic therapy for hypertensive patients
with chronic obstructive pulmonary disease. Arch Intern Med 1986;146:12933
130. Lindgren BR, Andersson RGG. Angiotensin-converting enzyme inhibitors and their
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2. ESH-ESC Guidelines for the management of arterial hypertension - 2003 ; www.escardio.org
3. JNC VII-Detection, Evaluation and Treatment of High Blood Pressure -
2003 ; (dostapen na www.google.com)
4. ICSI Guideline for Hypertension diagnosis and treatment - 2002
; www.isci.org
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Intervention Cooperative Study Group. The effect of balloon angioplasty on hypertension
in atherosclerotic renal-artery stenosis. N Engl J Med 2000;342:1007-1014
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mortality in patients with symptomatic heart failure randomized trialthe Losartan heart
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ventricular rate control. J Fam Pract 2000;49:4759
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for the management of hypertension. Task Force for the Development of the 1999
Canadian Recommendations for the Management of Hypertension. Can Med Assoc J
1999;161(Suppl 12):S117
36.The INDANA (Individual Data Analysis of Antihypertensive interventional trials) Project
Collaborators, Guyffier F, Boissel J-P, Boutitie F, Pocock S, Coope J, Cutler J, et al.
Effect of antihypertensive treatment in patients having already suffered from stroke:
359
360
gathering the evidence. Stroke 1997;28:255762

37.MacMahon S, Rodgers A, Neal B, Chalmers J. Blood pressure lowering for the secondary
prevention of myocardial infarction and stroke. Hypertension 1997;29:5378
38.Feldman RD, Norman C, Larochelle P ym. 1999 Canadian recommendations for the
management of hypertension. Can Med Assoc J 1999;161(Suppl 12):S117
39.Brunner HR. ACE inhibitors in renal disease. Kidney Int 1992;42:46379
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Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Arch
Intern Med 1997; 57:241346
41.Kvasnicka J, Flack JM, Grimm RH. Treatment of hypertension in the presence of
coexisting medical conditions. Drugs Aging 1994;4:30412
42.Hill NS. Fluid and electrolyte considerations in diuretic therapy for hypertensive patients
with chronic obstructive pulmonary disease. Arch Intern Med 1986;146:12933
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influence on inflammation, bronchial reactivity and cough. Med Toxicol Adv Drug Exp
1989;4:36980
44.Lfdahl C-G. Antihypertensive drugs and airway function, with special reference to
calcium channel blockade. J Cardiovasc Pharm 1989;14(Suppl 10):S4051
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2. 2
3. 2007
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Ltd
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93 .
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17.European Best Practice Guidelines for Renal Transplantation (Part 1) Nephrol Dial
Transplant (2000) 15 [Suppl 7]: 60
18.European Best Practice Guidelines for Renal Transplantation (Part 2) Nephrol Dial
Transplant (2002) 15 [Suppl 4]: 19-30
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Consensus Workshop on Cytomegalovirus Management in Solid Organ Transplantation
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3. EBP Guidelines for Transplantation Prat 1 (http://ndt.oxfordjournals.org./content/
vol15/suppl 7)
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1. European Best Practice Guidelines for Haemodialysis. Nephrol Dial Transplant (2002)
17 (Suppl 7)
1. European Best Practitce Guidelines for Hemodialysis,
oxfordjournals.org/content/vol17/suppl_7)
2. 4
3. 2006
2002,
(http://ndt.
392

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1. Revised European Best Practice Guidelines for the Management of Anaemia in Patients
with Chronic Renal Failure. Nephrol Dial Transplant (2004) 19 (Suppl 2)
1. Revised European Best Practice Guidelines for the Management of Anaemia in
Patients with Chronic Renal Failure, 2004, (http://ndt.oxfordjournals.org/content/
vol14/suppl_5)
2. 4
3. 2008
405
406
Expert Panel on Urologic Imaging, American College of Radiology (ACR). Acute onset
flank pain, suspicion of stone disease. Reston (VA): American College of Radiology
(ACR); 2001. 3 p. (ACR appropriateness criteria). [25 references]
.
: Fritzsche P, Amis ES, Bigongiari LR, Bluth EI,
Bush WH, Choyke PL, Holder L, Newhouse JH, Sandler CM, Segal AJ, Resnick MI,
Rutsky EA. Acute onset flank pain, suspicion of stone disease. American College of
Radiology. ACR Appropriateness Criteria. Radiology 2000 Jun;215(Suppl):683-6.
Appropriateness Criteria
.
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408
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- - American College of Radiology (ACR) www.acr.org
; : Sandler CM, Amis

ES, Bigongiari LR, Bluth EI, Bush WH, Choyke PL, Fritzsche P, Holder L, Newhouse JH,
Segal AJ, Resnick MI, Rutsky EA. Imaging in acute pyelonephritis. American College of
Radiology. ACR Appropriateness Criteria. Radiology 2000 Jun;215(Suppl):677-81.
.
merican College of Radiology (ACR), Expert Panel on Urologic Imaging. Imaging in

acute pyelonephritis. Reston (VA): American College of Radiology (ACR); 2001. 4 p.
(ACR appropriateness criteria). [17 references]
()
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PDF- - American College of Radiology (ACR) www.acr.org
American College of Radiology (ACR), Expert Panel on Urologic Imaging. Radiologic

investigation of causes of renal failure. Reston (VA): American College of Radiology
; : Bush WH, Amis

ES, Bigongiari LR, Bluth EI, Choyke PL, Fritzsche P, Holder L, Newhouse JH, Sandler
CM, Segal AJ, Resnick MI, Rutsky EA. Radiologic investigation of causes of renal
failure. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000
Jun;215(Suppl):713-20.
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414
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investigation of patients with hematuria. Reston (VA): American College of Radiology
. : Newhouse
JH, Amis ES, Bigongiari LR, Bluth EI, Bush WH, Choyke PL, Fritzsche P, Holder L,
Sandler CM, Segal AJ, Resnick MI, Rutsky EA. Radiologic investigation of patients with
hematuria. American College of Radiology. ACR Appropriateness Criteria. Radiology
2000 Jun;215(Suppl):687-91.
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American College of Radiology (ACR), Expert Panel on Urologic Imaging. Recurrent

lower urinary tract infections in women. Reston (VA): American College of Radiology
. : Segal AJ, Amis

ES, Bigongiari LR, Bluth EI, Bush WH, Choyke PL, Fritzsche P, Holder L, Newhouse
JH, Sandler CM, Resnick MI, Rutsky EA. Recurrent lower urinary tract infections in
women. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000
Jun;215(Suppl):671-6.
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American College of Radiology (ACR), Expert Panel on Gastrointestinal Imaging.

Evaluation of left lower quadrant pain. Reston (VA): American College of Radiology
. : (Evaluation of
left lower quadrant pain. American College of Radiology. ACR Appropriateness Criteria.
Radiology 2000 Jun;215(Suppl):167-71).
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Percutaneous nephrostomy. Reston (VA): American College of Radiology (ACR); 2002.
9 p. (ACR appropriateness criteria). [60 references]
; ACR Appropriateness Criteria

5 , , .
2007 .
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investigation of patients with renovascular hypertension. Reston (VA): American College
of Radiology (ACR); 2003. 9 p. (ACR appropriateness criteria). [45 references]
.
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443
Test za
mikroalbuminurija
Ne
za
albumin
Da
Sostojbi koi davaat
la`no pozitivna
ekskrecija na
albumin vo urinata
Da
Ne
Da se lekuva i/ili da se
po~eka da se povle~e. Da
se povtori testot
za proteini?
Da
Da se povtori testot za
mikroalbuminurija za
period 3-6 meseci
Reskrining za edna
godina
Ne
2 od 3 testa pozitivni?
Da
Mikroabminurija, da
se lekuva
2.
444
Pacient so novo-dijagnosticirana asimptomatska mikroskopska hematurija
Isklu~i gi benignite pri~ini, vklu~uvajki menstruacija, silni ve`bi, seksualna

aktivnost, virusni bolesti, trauma i infekcii
Ako se prisutni eden ili pove}e od slednite:

Mikroskopska hematurija prosledena so
signifikantna proteinurija
Dizmorfni eritrociti ili eritrocitni
cilindri
Poka~en serumski kreatinin (baziran na
normalni referentni vrednosti za ma` i èna)
Dokolku nema znaci za primarna bubre`na

bolest (t.e. normalen kreatinin, otsatsvo
na proteinurija, na dizmorfni eritrociti
ili eritrocitni cilindri), ili prisustvo na
slednite:
Anamneza za pu{awe
Profesionalna izloènost na hemikalii
ili boi (benzol ili aromatski amini)
Anamneza za masivna hematurija
Vozrast > 40 godini
Predhodni urolo{ki bolesti
Anamneza za iritativni simptomi
Anamneza za rekurentni infekcii na
urinarniot trakt nasproti na upotreba na
antibiotici
Urolo{ka evaluacija
445
Pacient bez za primarna bubre`na bolest
Slabo -rizi~en pacient:

Vozrast < 40 god.
Nepu{a~
Bez iritativni simptomi
Bez anamneza za masivna hematurija
Neizloènost na hemikalii
Bez anamneza za urolo{ki bolesti i
zaboluvawa
Visokorizi~ni pacienti
Kompletna evaluacija
(prikaùvawe na gorniot trakt,
citologija, cistoskopija)
Prikaùvawe na gorniot trakt
Citologija
Cistoskopija
Negativen
pozitiv
atipi~en
ili
somitelen
Negativ

vnimanie
Pozitiven
Pozitiven
Tretiraj
Tretiraj
Cistoskopija
Pozitiven
Negativen za 3 god.
Bez ponatamo{no
urolo{ko sledewe
Tretiraj
3.
. - , -
Negativen
Analiza na urina
KP, citologija na 6, 12,
24 i 36 meseci
Perzistentna
hematurija,
HTA
proteinurija,
glomerularno
krvarewe
Evaluacija na
primarna
bubre`na
bolest
Glomerularno
krvarewe ili
proteinurija
Izolirana
hematurija
bubre`na
biopsija
biopsija
Masivna
hematurija,
abnormalna
citologija,
iritativni
simptomi
bez infekcija
Obnovi ja
kompletno
celata
evaluacija
< 5/

6-12
< 1/

1g/

,
&
5/
4.
. - 24 , -,
- , -
5/

< 5/

6-12
, ,

5/
446

447

12
()
1,
:
- odnos na Alb/Cr ili
- 24 ~asovno sobirawe na urina za proteini i kreatinin (V)
2. Dobivawe na serumski kreatinin i presmetuvawe na GFR
(S)
5
4
Da
Urinaren Alb/Cr >

30 g/mg (D)
Ne
Da
Da
Ako odnosot na
urinarniot Alb/Cr >
300 g/mg ili
proteinurija > 300
g /4 ~asa (E)
Ako dijabeti~nata
nefropatija e suspektna
(isklu~eni
nedijabeti~ni bubre`ni
bolesti) (F)
Ne
Ne
Upatuvawe do
nefrolog (H)
Ako serumskiot kreatinin >

125 mol/l ili eGFR < 60 ml/
min? (G)
Povikuvawe ili konsultacija

so nefrolog
Reevaluacija na nedijabeti~ni
pri~ini za poka~en kreatinin
(H)
Da
Ne
9
12
Procena i sledewe na
glikemiska kontrola (Vidi
Modul G)
Da
Ima li identifikabilna
pri~ina za visok
kreatinin?
13
Ne
Start/prilagoduvawe na tretman so ACE-i
Ako ima nesakani efekti na ACE-i,
promeni so ARB
Proveri go serumskiot kalium pred
po~nuvawe so terapija i povtori na 2 do 4
nedeli (I)
11
Upati do
nefrolog (H)
10
Tretiraj spored
indikacii
448

14
15
da
Prodolì so prilagoduvawe na
tretmanot za dobivawe na target
sprema Hypertension Guidelines i
Glycemic Control Module
Ako HbA1c > 8% ili KP >

140/80? (J)
ne
16
Monitoriraj slu~aen urinaren protein: albumin/kreatinin

odnos i serumski kreatinin (eGFR)
Prilagodi go tretmanot i sledi godi{no
(K)
17
18
Prodolì so vodewe na
dijabetot
(Vrati se na Modul D)
Pacient so DM i odnos na urinaren

protein/kreatinin > 30 g/mg ili
potvrdena nefropatija
20
19
da
Ako bubre`na insuficiencija e

prisutna (serumski kreatinin >
175 mol/l ili eGFR < 50 ml/
min)? (H)
Upati ili konsultiraj nefrolog za

obezbeduvawe optimalno sledewe i plan za
ESRD
ne
21
Razmisli za prepora~uvawe na dieta so

reduciran vnos na proteini (L)
22
Start/prilagoduvawe na tretman so ACE inhibitori

Ako ima nesakani efekti na ACE-i, promeni so ARB
Proveri go serumskiot kalium i kreatinin pred
zapo~nuvawe so ACE-i i povtori na 2 do 4 nedeli (I)
449
23
Sledi go krvniot pritisok spored Hypertension

Guideline za namaluvawe na progresijata na
nefropatijata
25
24
da
Ima li nus efekti od
tretmanot so ACE-i
(M)
Prekini go tretmanot
so ACE-i
Promeni so ARB (N)
ne
26
Monitoriraj slu~aen
primerok na urina za
protein/kreatinin indeks,
serumski kreatinin i eGFR
na sekoi 6 meseci
Prilagodi go tretmanot i
sledeweto spored indikacija
(O)
28
27
Ako e prisutna bubre`na
slabost (serum kreatinin
> 175 mol/l ili eGFR <
50 ml/min)? (H)
da
Upati do nefrolog za
obezbeduvawe optimalno
sledewe i plan za ESRD
ne
29
Prodolì so
sledewe na DM
(Vrati se na Module
D)
Algoritam 5. Bubre`na funkcija

kaj pacient so dijabetes melitus
Kratenki: DM-dijabetes melitus;
ACE-i- angiotenzin konvertira~ki
enzim inhibitori; ARBangiotenzin receptor blokatori;
eGFR-proceneta glomerularna
filtracija; ESRD- terminalna
faza na bubre`na bolest
450
Kolika od urinaren kalkul
Rtg grafija na
urinaren trakt
bez kontrast
Negativen
- Drugi pri~ini
za bolki?
- Dodeka se
otkrijat drugi
pri~ini
Urografija
Analiza na
kalkul i
primerok na
urina
Pozitiven
Urografija
Serum i urinaren kalcium, urat,

natrium, kalium i kreatinin
Poka~en serum
urat?
- Giht
Serum urat normalen

Urinaren urat
poka~en
- Hereditarno
Algoritam 6. Ispituvawe na urinarna kalkuloza

Kratenki: - , -
Poka~en serum
kalcium?
- Kancer ili
imobilizacija
- Primaren
HPTH?
- Ispitaj PTH
Serum kalcium
normalen
Urinaren kalcium
poka~en
- Idiopatska
hiperkalciurija
451
()
<120

120-139
1
140-159
2
160
> 140/90
130/80 ,

1.
2.
3.
7.
: = , = , , s
80
80-89
90-99
100
452
Pacient so perzistentno poka~en serum

Cr ili proteinurija (A)
Obrabotka na istorija, fizikalni

ispituvawa i labaratoriski testovi (B)
Itna, urgentna
sostojba ? (C)
da
Upatuvawe/stabilizirawe
sprema indikacija
ne
5
Procena na bubre`na funkcija (D)

Izvr{uvawe na dijagnosti~ka obrabotka (E)
Akutna
egzacerbacija na
utvrdena bubre`na
bolest? (F)
da
Tretman spored indikacija

ili konsultacija
ne
8
Dokolku
SCr > 175 ili GFR < 50
ili nefrotski rang
na proteinurija ili
somnitelna
etiologija ? (H)
da
Konsultacija/sovetuvawe
so nefrolog (I)
Pregovori za idna poteba
od HBZT (J)
11
Konsultacija/sovetuvawe
so nefrolog (I)
Pregovori za idna
poteba od HBZT (J)
ne
10
Dokolku SCr > 350
ili eGFR < 25 ili simptomi
na hroni~na bubre`na
slabost (G)
da
ne
12
13
Nadgleduvawe na primarna
etiologija: HTA, DM, GN, UTO,
PCBB, HIV, HCV RVD, MM (K)
Inicijacija na strategijata za usporuvawe

na progresijata na bolesta ( L)
14
15
16
Prevencija i tretman na
simptomi i komplikacii (M)
Prevencija i tretman na
kardiovaskularni bolesti (N)
Obezbeduvawe na edukacija na
pacienti ( O) Sledewe (P)
8.
: - , , -
, , - , , -
, -
, -
, -
, - ,
453
Odredi serumski
25(OH)D
Dali serumskiot 25 (OH) D e

<50ng/ml (75nmol/L)?
ne
Vidi upatstvo 8A
da
Zapo~ni so oralna vitamin
D2 ili D3 terapija
Pauza
so vitamin D
terapija
Zapo~ni ili zgolemi doza na

fosfo - vrzuva~ (upatstvo 5)
ili namali vnes na fosfor so
hrana (upatstvo 4)
Odredi serumski P i Ca
ne
Dali serumskiot Ca e
<10,2 mg/dl (2.54 mmol/l)?
da
Dali Serumskiot P e
<4.6 mg/dL
(1.49 mmol/L)?
ne
da
Prodolì ili revidiraj ja

terapijata so vitamin D2, D3
9. (1).
: 25()- , - , -
454
Odredi serumski PTH
Dali serumskiot PTH e

>70 pg/ml (7.7pmol/L) (stadium 3)
ili >150pg/ml (12.1pmol/L)
(Stadium 4)?
ne
Sledewe spored
Upatstvo 1
da
Zapo~ni so vitamin
D sterol terapija
Pauza ili
namali doza na
vitamin D
Odredi serumski P i Ca
ne
Zapo~ni ili zgolemi vnos na

fosfo-vrzuva~i (Upatstvo 5)
ili namali vnos na fosfor so
hrana
Dali
serumskiot Ca e
<9.5 mg/dL (2.37
mmol/L)?
da
Isklu~i ili
namali vnos
na Kalciumski
fosfo
-vrzuva~i, ili
namali
vnos na
Ca(Upatstvo 5)
<35pg/ml (3,85 pmol/l) (Stadium 3),

ili
<70pg/ml (7,7pmol/l (Stadium 4)
Dali serumskiot P e
< 4.5mg/dL
(1.49 mmol/L)
ne
Prodolì so oralna
doza na vitamin D
sterol
da
Odredi
serumski
PTH
>70pg/ml (7,7 pmol/l) (Stadium 3),

ili
>110pg/ml (12,1pmol/l (Stadium 4)
10. (2)
: - , - , -
455
Ca > 10,2 mg/dl

(2,54mmol/l)
Odredi serumski Ca
Ca < 9,5 mg/dl

(2,37mmol/l)
Ca 9,5 10,2mg/dl (2,37 -2,54 mmol/l)
Isklu~i vitamin
D terapija
Namali doza na Kalciumski

vrzuva~i na fosfor ili
zameni gi so /ili zgolemi ja
dozata na nekalciumski
fosfo-vrzuva~i
Ca > 10,2 mg/dl

(2,54mmol/l)
Prodolì ili
modificiraj ja dozata na
vitamin D spored
Algoritam 4 (Serumski
R) i Algoritam 5
(Serumski PTH)
Ca < 9,5 mg/dl

(2,37mmol/l)
Odredi
serumski
Ca
Ca 9,5 10,2mg/dl
(2,37 -2,54 mmol/l)
Odredi serumski PTH
Opcija:
Dijalizat so Ca
2.0mEq/L za 2-3
HD Rx
Dali serumsko
PTH e
> 300pg/ml
da
Opcija:
Zameni so *Pomalku
kalcemi~en* vitamin
sterol
ne
Prodolì ili
modificiraj go
vitaminot D spored
Algoritam 4 (Serum
P) i Algoritam 5
(Serum PTH)
11. (3).
: - , - , , -
456
P > 6,0mg/dl
(1,94mmol/l)
Bez vitamin D
terapija
Odredi serumski P
P 5,5 6,0 mg/dl
(1,78 1,94mmol/l)
P < 5,5mg/dl
(1,78mmol/l)
Zgolemi doza na
fosfo-vrzuva~i
Prodolì ili
modificiraj ja dozata na
vitamin D spored
Algoritam 1 (Serumski
Ca) i Algoritam 5
(Serumski PTH)
Odredi serumski P
Dali
serumskiot P e
< 5.5mg/dl
(1.78 mmol/L)?
ne
da
Dokolku pacientot primal

vitamin D dozata reduciraj ja
25%-50%
Dokolku vitaminot D e
prethodno pauziran da se o
otpo~ne povtorn so doza
namalena za 25 - 50%
12. (4)
. - , - ,
457
Odredi serumski PTH
PTH > 300pg/ml (33 pmol/l)

P < 5,5 mg/dl (1,75mmol/l)
Ca < 9,5mg/dl (2,37 mmol/l)
PTH 150-200 pg/ml

(16,5 22,0 pmol/l)
PTH < 150 pg/ml

(16,5pmol/l)
Zgolemi ja dozata na
vitamin D za 25%-50%
PTH 200 300 pg/ml
(22,0 33,0 pmol/l)
Namalija dozata na
vitamin D na
polovina dva meseca
Bez vitamin D
terapija eden mesec
PTH < 150 pg/ml (16,5pmol/l)
Odredi
serumski
PTH
Istata doza na
vitamin D tri
meseci
PTH > 300pg/ml (33,0pmol/l)
Bez terapija so
vitamin D 3 meseci
PTH 150-200 pg/ml
(16,5 22,0 pmol/l)
Dokolku prima vitamin D

namali ja dozata za u{te 25-50%
Dokolku vitamin D ne se dava
vrati se na prethodnata
terapiska doza
PTH 200 300 pg/ml

(22,0 33,0 pmol/
Dokolku prima vitamin D

zgolemi ja dozata za 10-25%
Dokolku e odloèno davaweto
vitamin D vrati se na doza od
75% od po~etnata doza tri
meseci
Odrùvaj ja istata
doza na vitamin D
u{te tri meseci
13. (5)
. - , - , -
458
*Odredi serumski Al
Dali e
serumskiot Al
<200mikrog/L?
da
Al raste > 300 microg/l

Ili so nevrolo{ki nusefekti
Napravi
**DFO
test
Dijaliza 6 dena
nedelno
Isklu~i vnes na Al
ne
Odreduvaj Al 1-2 pati

nedelno dodeka da Al
<200 mikrog/L
Al raste < 50 microg/l
Al raste 50 - 300 microg/l

bez nusefekti
Povtori go DFO
testot za 1 mesec
Al raste < 50 microg/l
Bez nusefekti
Premini na ~ekor A
odAlgoritam 8
Premini na ~ekor B
Algoritam 9
Premini na ~ekor C
Algoritam 9
14. (6)
. - , -
459
Aluminiumkoskenabolest
Drugi simptomatski
ili te{ki
optovaruvawa so
aluminium
Dijalizna
encefalopatija
Napravi EEG
Terapija so
Vitamin D **Rx
Simptomatski
sek.hiperparatiroidizam
i visoka Al ekspozicija
Odloì ja
paratireidektomijata
*Odredi serumski Al
Dali e
serumskiot Al
<200mikrog/L?
da
Serum Al raste <50microg/L

ili bez nusefekti po DFO test
**DFO test 5mg/

kg vo posledniot
~as od HD,
Izmeri serumski
Al pred slednata
HD po dva dena
ne
Dijaliza 6 dena nedelno

Dijalizata so Al<5microg/L
Isklu~i vnes na Al
Odreduvaj Al 1-2 pati
nedelno dodeka da Al
<200 mikrog/L
Serum Al raste nad>300microg/L

ili nusefekti po** DFO test
~ekaj 1 mesec
Povtori go **DFO
testot
Serum Al raste <50microg/L
i bez nusefekti po DFO test
Premini na ~ekor C
od Algoritam 9
Premini na ~ekor B
Algoritam 9
Premini na ~ekor A
odAlgoritam 8
15. (7)
. - , - , -, -
460
Al nad 300mikrog/L
Ili nusefekti po
**DFO test
**DFO terapija, 5 mg/kg na

~as i.v. 5 ~asa pred HD,
edna{ nedelno, 4 meseci
Visoko-efikasna dijaliza
po **DFO-Rx
Eden mesec bez DFO

Terapija
Serum Al raste< 50microg/L
Izvedi
DFO test
5mg/kg
Eden mesec bez DFO

Terapija
Serum Al raste
50-299 microg/L
Povtori
DFO test
5mg/k
DFO terapija, 5 mg/kg na

~as i.v., 5 ~asa pred HD,
edna{ nedelno, 4 meseci
Visoko-efikasna dijaliza
po DFO-Rx
Premini na ~ekor B
Algoritam 9
Serum Al raste < 50microg/L
Premini na ~ekor C
od Algoritam 9
16. (8)
. - , - , -
461
Al porast <300mikrog/L i
bez nusefekti po **DFO
testot
**DFO terapija 5 mg/kg na

posleden ~as od HD, edna{
nedelno, dva meseca visokoefikasna HD 44 ~as podocna
Bez DFO
Terapija 1 mesec
Napravi
**DFO
test, 5mg/
kg
Serum Al raste
50-299 microg/L
Serum Al raste
< 50microg/L
Bez DFO
Terapija 4 meseci
Serum Al raste 50-299 microg/L
Povtori
DFO test,
5mg/kg
Serum Al raste
< 50microg/L
Isklu~i terapija so
DFO
17. (9)
. -, - , -

Nefrologija

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0,5% , 1-4% , 5-10%

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1. EBM Guidelines, 1.1.2005, www.ebm-guidelines.com

41 = glomerular filtration rate

47: (, ), , ( /), , , , -, - ( JNC VII) , ;

(18.5 - 24.9 /2)

Amilorid 5-10 / 1-2

1. Australian Health Technology Advisory Committee. Ambulatory blood pressure

47.The Database of Abstracts of Reviews of Effectiveness (University of York), Database

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Issue 2, 2002. Oxford: Update Software. Updated frequently.

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gathering the evidence. Stroke 1997;28:255762

2-6 g/24 , , , 1-6 g/24 .

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< 60 ml/min, < 30 ml/min.

95 - Modification of Diet in Renal Disease

, 30 / 180 mol/l 150 mol/l

eKt/V = spKt/V ( 0.6 x spKt/V) + 0.03

urea eKt/V 1.20 ( sp Kt/V ~ 1.4)

3. New York Heart Association classification of congestive heart failure patients

- - American College of Radiology (ACR) www.acr.org

; : Sandler CM, Amis

merican College of Radiology (ACR), Expert Panel on Urologic Imaging. Imaging in

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; : Bush WH, Amis

Body coil 109

Body coil 111

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American College of Radiology (ACR), Expert Panel on Urologic Imaging. Radiologic

Body coil 112

Body coil 114

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< 1g/ &

Pacient so novo-dijagnosticirana asimptomatska mikroskopska hematurija

Isklu~i gi benignite pri~ini, vklu~uvajki menstruacija, silni ve`bi, seksualna