Zofia Wańkowicz

Publications of Zofia Wańkowicz

• Extracorporeal versus peritoneal ultrafiltration in diuretic-resistant congestive heart failure--a review.

  Authors: Zofia Wańkowicz, Agnieszka Próchnicka, Anna Olszowska, Daniel Baczyński, Paweł Krzesiński, Mirosław Dziuk

  Medical science monitor : international medical journal of experimental and clinical research. 12/2011; 17(12):RA271-81.

  Diuretic-resistant congestive heart failure in the form of type 2 cardiorenal syndrome is a problem of growing significance in everyday clinical practice because of high morbidity and mortality.Diuretic-resistant congestive heart failure in the form of type 2 cardiorenal syndrome is a problem of growing significance in everyday clinical practice because of high morbidity and mortality. There has been scant progress in the treatment of overhydration, the main cause of symptoms in this group of patients. The aim of our review is to present recent advances in the ultrafiltration therapy of congestive heart failure, with special attention to the new dedicated device for extracorporeal isolated ultrafiltration, as well as modifications of peritoneal dialysis in the form of peritoneal ultrafiltration with icodextrin solution and incremental peritoneal dialysis. Technical and clinical features, costs and potential risks of available devices for isolated ultrafiltration are presented. This method should be reserved for patients with true diuretic resistance as part of a more complex strategy aiming at the adequate control of fluid retention. Peritoneal ultrafiltration is presented as a viable alternative to extracorporeal ultrafiltration because of medical and psychosocial benefits of home-based therapy, lower costs and more effective daily ultrafiltration. In conclusion, large, properly randomized and controlled clinical trials with long-term follow-up will be essential in assessing the logistics and cost-effectiveness of both methods. Most importantly, however, they should be able to evaluate the impact of both methods on preservation of renal function and delaying the progression of heart failure by interrupting the vicious circle of cardiorenal syndrome. Our review is supplemented with the case report of the use of peritoneal ultrafiltration with a single 12-hour nighttime icodextrin exchange as a life-saving procedure in a patient with congestive heart failure resistant to pharmacological treatment.

• Multiple renal abscesses leading to nephrectomy of the solitary kidney in a young female with type 1 diabetes and history of recurrent urinary tract infections.

  Authors: Zofia Wańkowicz, Anna Grzywacz, Marek Saracyn, Henryk Zieliński

  Archives of medical science : AMS. 04/2011; 7(2):349-52.

  This report presents the case of a young female suffered for many years from type 1 diabetes, complicated by recurrent urinary tract infections and urosepsis with multiple abscesses which led toThis report presents the case of a young female suffered for many years from type 1 diabetes, complicated by recurrent urinary tract infections and urosepsis with multiple abscesses which led to right nephrectomy in 2002. The patient was hospitalised in our Department in June 2009 because of urosepsis in the course of multiple left renal abscesses and subsequent acute renal failure requiring hemodialysis. A dramatic decision of removing the solitary kidney was taken, and patient was included in a long-term renal replacement therapy programme in our Centre as a preparation to kidney and pancreas transplantation.

• Renal autoregulation in medical therapy of renovascular hypertension.

  Authors: Arkadiusz Lubas, Grzegorz Zelichowski, Agnieszka Próchnicka, Magdalena Wiśniewska, Zofia Wańkowicz

  Archives of medical science : AMS. 12/2010; 6(6):912-8.

  Renovascular hypertension (RVH) is caused by renal ischaemia associated with haemodynamically significant renal artery stenosis (RAS). The choice of optimal treatment of atherosclerotic RAS is stillRenovascular hypertension (RVH) is caused by renal ischaemia associated with haemodynamically significant renal artery stenosis (RAS). The choice of optimal treatment of atherosclerotic RAS is still controversial. Increase in the renal resistive index (RI) value after captopril administration is considered to indicate preserved renal autoregulation. The objective of the study was to assess the effect of medical therapy of RVH on renal autoregulation efficiency in patients with atherosclerotic RAS. 19 persons (38 kidneys) in 2 groups: 1) study: with RVH and stenosis of 1 renal artery - 8 patients; 2) control: - 11 healthy volunteers. Doppler captopril test with RI measurements and estimation of creatinine clearance (CCr) were performed in both groups at baseline, and after a period of controlled medical therapy (CMT) only in the study group. ABPM was evaluated in controls at baseline, and in the study group at the end of CMT. In the study group the mean period of CMT was 8.3 ±2.7 months, the number of antihypertensive drugs was 4.1 ±1.0, and mean 24-hour blood pressure was 138/74 mmHg. Mean CCr was stable during the study. Significant increase of RI after captopril was found only in controls. At baseline, in the group of kidneys with a non-stenotic renal artery, significant lowering of RI was observed, and ΔRI differed significantly from controls. After CMT, ΔRI increased in non-stenotic kidneys in comparison to the baseline, and did not differ from controls. Adequate medical therapy of RVH preserved renal function and improved renal autoregulation efficiency in non-stenotic kidneys.

• Renal vascular response to angiotensin II inhibition in intensive antihypertensive treatment of essential hypertension.

  Authors: Arkadiusz Lubas, Grzegorz Zelichowski, Agnieszka Próchnicka, Magdalena Wiśniewska, Marek Saracyn, Zofia Wańkowicz

  Archives of medical science : AMS. 08/2010; 6(4):533-8.

  High blood pressure (BP) leads to target organ damage. It is suggested that regression of early organ lesions is possible on condition of BP normalization. The study objective was to assess whetherHigh blood pressure (BP) leads to target organ damage. It is suggested that regression of early organ lesions is possible on condition of BP normalization. The study objective was to assess whether permanent reduction of BP to the recommended values modifies renal vascular response to acute angiotensin II inhibition in the Doppler captopril test (DCT) in patients with essential hypertension (EH). Twenty-nine persons (58 kidneys) were found eligible for the study: 18 patients with EH and 11 healthy volunteers constituting the control group. Glomerular filtration rate estimation (eGFR), 24-h ambulatory BP monitoring (ABPM) and DCT with evaluation of renal resistive index change (ΔRI) were performed before and after a 6-month period of intensive antihypertensive therapy (IAT). Additional ABPM was performed at the end of IAT. The mean IAT period was 8.5 ±2.4 months. The mean 24-h values of systolic and diastolic BP in the EH group were significantly lower in the IAT period than at the beginning and at the end of the study. Significantly lower systolic and diastolic BP (p < 0.05) and improvement of renal function (eGFR 121 ±38 vs. 139 ±40 ml/min, p < 0.001) were found after IAT as compared to initial values. Before IAT, ΔRI was significantly lower in the EH group as compared to the controls, but no such differences were found after IAT. In EH patients, intensive BP lowering to the recommended values was associated with improvement of renal function and normalisation of renal vascular response to acute angiotensin II inhibition.

• Insulin resistance as a novel therapeutic target in patients with chronic kidney disease treated with dialysis.

  Authors: Piotr Wesołowski, Marek Saracyn, Zbigniew Nowak, Zofia Wańkowicz

  Polskie Archiwum Medycyny Wewnętrznej. 01/2010; 120(1-2):54-7.

  Clinical significance of insulin resistance in patients with chronic renal failure treated with dialysis has not been fully elucidated and requires further research. The available data indicate thatClinical significance of insulin resistance in patients with chronic renal failure treated with dialysis has not been fully elucidated and requires further research. The available data indicate that long-term dialysis therapy promotes the development of insulin resistance. Furthermore, it has been proven that insulin resistance in this patient group is a strong independent predictor of mortality from cardiovascular causes. Insulin resistance as a potential modifiable cardiovascular risk factor should be considered as a novel therapeutic target in patients undergoing both hemo dialysis and peritoneal dialysis.

• Psychological aspects of dialysis: does cognitive appraisal determine the overall outcome?

  Authors: Krzysztof Laudański, Zbigniew Nowak, Zofia Wańkowicz

  Polskie Archiwum Medycyny Wewnętrznej. 01/2010; 120(1-2):49-52.

  Psycho logical aspects of renal replacement therapy have been studied by numerous researchers. However, many of these studies are of poor quality, involve small study groups, or focus only on aPsycho logical aspects of renal replacement therapy have been studied by numerous researchers. However, many of these studies are of poor quality, involve small study groups, or focus only on a narrowly defined hypothesis. Due to a lack of general conceptual framework, it is difficult to generalize and inter pret the data, especially in terms of the cause-and-effect relationship. Further research is required to assess how patients with end-stage renal disease cope with dialysis-related stress. Particular emphasis should be placed on the preparation of experimental studies and clinical trials with a longer follow-up.

• Peritoneal dialysis as a therapeutic approach in congestive heart failure resistant to pharmacological treatment.

  Authors: Agnieszka Próchnicka, Anna Olszowska, Daniel Baczyński, Grzegorz Zelichowski, Zofia Wańkowicz

  Polskie archiwum medycyny wewnȩtrznej. 12/2009; 119(12):815-9.

  Given an increasing number of patients with congestive heart failure (CHF) refractory to diuretics, new and more effective therapeutic modalities are sought. Peritoneal dialysis (PD), which providesGiven an increasing number of patients with congestive heart failure (CHF) refractory to diuretics, new and more effective therapeutic modalities are sought. Peritoneal dialysis (PD), which provides continuous, slow ultrafiltration, may be an alternative to hemodialysis in this population. The current paper, based on a comprehensive literature review, addresses the role of PD in improving the quality of life of patients with CHF.

• Peritoneal dialysis as a therapeutic approach in congestive heart failure resistant to pharmacological treatment: case report.

  Authors: Agnieszka Próchnicka, Anna Olszowska, Daniel Baczyński, Grzegorz Zelichowski, Arkadiusz Lubas, Magdalena Wiśniewska, Mirosław Dziekiewicz, Zofia Wańkowicz

  Polskie archiwum medycyny wewnȩtrznej. 12/2009; 119(12):834-7.

  This report describes the use of continuous peritoneal dialysis (PD) as an alternative to hemodialysis (HD) in a patient with type 2 cardiorenal syndrome in the course of congestive heart failureThis report describes the use of continuous peritoneal dialysis (PD) as an alternative to hemodialysis (HD) in a patient with type 2 cardiorenal syndrome in the course of congestive heart failure resistant to standard pharmacological treatment. A 39-year-old man presented with a 24-year history of progressive heart failure. Ineligibility for heart transplant and previous inefficient treatment with different modifications of HD reduced his treatment options to PD. After 7 months of continuous PD (1 overnight exchange with icodextrin and 2 daily standard continuous ambulatory PD exchanges) his overall condition significantly improved compared with his status while on HD. An increase from NYHA class IV to class II, increase in left ventricular ejection fraction from 50% to 55%, decrease in right ventricular systolic pressure from 73 to 53 mmHg, and improvement in the quality of life enabled him to resume his daily activities.

• Atypical clinical presentation of Churg-Strauss syndrome with rapidly progressive glomerulonephritis: case report.

  Authors: Agnieszka Próchnicka, Grzegorz Zelichowski, Anna Wojtecka, Arkadiusz Lubas, Andrzej Bant, Agnieszka Perkowska-Ptasińska, Zofia Wańkowicz

  Polskie archiwum medycyny wewnȩtrznej. 12/2009; 119(12):830-3.

  The case of a 48-year-old man presented in this paper illustrates an atypical clinical course of Churg-Strauss syndrome with rapidly progressive glomerulonephritis with no signs of bronchial asthma.

• The kinetics of water transperitoneal transport during long-term peritoneal dialysis performed using icodextrin dialysis fluid.

  Authors: Anna Olszowska, Grzegorz Zelichowski, Jacek Waniewski, Joanna Stachowska-Pietka, Andrzej Weryński, Zofia Wańkowicz

  Polskie archiwum medycyny wewnȩtrznej. 06/2009; 119(5):305-10.

  INTRODUCTION: Dialysis fluid containing icodextrin is used in patients on peritoneal dialysis (PD) because of its significant ultrafiltration properties. The use of the fluid in treating patientsINTRODUCTION: Dialysis fluid containing icodextrin is used in patients on peritoneal dialysis (PD) because of its significant ultrafiltration properties. The use of the fluid in treating patients with congestive heart failure resistant to diuretics has also been reported. OBJECTIVES: The aim of the study was to evaluate water peritoneal transport during a 16-hour dialysis exchange performed using icodextrin-containing dialysis fluid. PATIENTS AND METHODS: Eleven clinically stable patients were enrolled in the study (5 women and 6 men; mean age, 50.4 +/- 18.3 years), treated with PD for 26.9 +/- 22.4 months. Water transperitoneal transport was evaluated using a modified version of Babb-Randerson-Farrell thermodynamic model of membrane transport with human albumin marked with iodine as the marker of intraperitoneal volume. Based on blood and dialysate samples collected during the 16-hour dialysis exchange, the intraperitoneal volume of dialysate and dialysate reverse absorption were calculated. RESULTS: There were no clinical complications associated with the use of icodextrin fluid during the study. A significant increase in intraperitoneal volume of dialysate (950 ml on average) compared to the initial value was observed in the whole group at the 16th hour of the exchange. CONCLUSIONS: The study demonstrated that dialysis fluid with icodextrin ensured effective ultrafiltration during a 16-hour dialysis exchange. This indicates its potential usefulness in the treatment of patients with severe congestive heart failure with or without coexisting end-stage renal disease.

• [Ambulatory peritoneal dialysis--benefits, limitations and hopes].

  Authors: Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):285-8.

  Benefits and limitations of peritoneal dialysis as the first modality of integrated renal care are presented and supported by own clinical experience. Special attention was paid to the medical asBenefits and limitations of peritoneal dialysis as the first modality of integrated renal care are presented and supported by own clinical experience. Special attention was paid to the medical as well as non medical factors responsible for declining utilization of peritoneal dialysis as the only one form of home dialysis in Poland. Especially, promotion of new programmes supporting home dialysis assisted by qualified medical personnel was underlined.

• [Advances in diagnosis and treatment of AL amyloidosis].

  Authors: Grzegorz Zelichowski, Arkadiusz Lubas, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):340-5.

  AL amyloidosis is a systemic disease characterized by extracellular amyloid deposition in tissues, causing progressive dysfunction of affected organs. The main clinical syndroms includeAL amyloidosis is a systemic disease characterized by extracellular amyloid deposition in tissues, causing progressive dysfunction of affected organs. The main clinical syndroms include nephrotic-range proteinuria with or without renal dysfunction, congestive heart failure, hepatomegaly and peripheral or autonomic neuropathy. The aim of therapy is the reduction of monoclonal light chains, by suppressing the underlying plasma cell dyscrasia. Recent therapeutic strategies involve intermediate-dose chemotherapy or high-dose melphalan supported by peripheral blood stem cell transplantation. Alternative therapeutic approaches include thalidomide, lenalidomide, iododoxorubicin, etanercept and rituximab. This paper reviews the pathogenesis, diagnosis and therapy of the AL amyloidosis, focusing on clinico-morphological symptoms of renal involvement, monitoring of treatment response and supportive therapy.

• [Ambulatory or home peritoneal dialysis--time for changes?].

  Authors: Bozena Pietrzak, Daniel Baczyński, Monika Prokopiuk-Wierzbicka, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):338-9.

  Ambulatory peritoneal dialysis need to be adopted to the changing population of patients with irreversible renal failure who require more and more nursing support in normal performance of dialysisAmbulatory peritoneal dialysis need to be adopted to the changing population of patients with irreversible renal failure who require more and more nursing support in normal performance of dialysis procedure. Such possibility might be provided by introduction of supported or assisted by medical personal peritoneal dialysis in patient's home.

• [Tartrate resistant acid phosphatase--TRACP-5b as a modern bone resorption marker].

  Authors: Zbigniew Nowak, Maria Konieczna, Marek Saracyn, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):351-4.

  The evaluation of bone metabolism in everyday practise is based on measurements of non-invasive bone markers. TRACP-5b has been considered as a potentially useful marker of bone resorption rate. ItThe evaluation of bone metabolism in everyday practise is based on measurements of non-invasive bone markers. TRACP-5b has been considered as a potentially useful marker of bone resorption rate. It is an enzyme that is secreted by osteoclasts in the course of bone resorption. This review summarizes recent informations about TRACP 5b as a bone resorption marker in various clinical situations.

• [Nephrotic syndrome in the course of primitive neuroectodermal tumor--case report].

  Authors: Grzegorz Kade, Tomasz Sarosiek, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):328-30.

  Case of Primitive Neuroectodermal Tumor (PNET) in a 47 years old woman with renal failure and nephrotic syndrome is presented. Few similar cases in adults reported in the literature with a variable,Case of Primitive Neuroectodermal Tumor (PNET) in a 47 years old woman with renal failure and nephrotic syndrome is presented. Few similar cases in adults reported in the literature with a variable, nonspecific clinical presentation and an aggressive course are discussed.

• [Translumbar cannulation of vena cava inferior as an alternative method of vascular access for hemodialysis].

  Authors: Jarosław Leś, Joanna Grzesiak, Małgorzata Łabuś, Grzegorz Kade, Grzegorz Zelichowski, Krzysztof Brzozowski, Paweł Zukowski, Zofia Wańkowicz, Zbigniew Rybicki

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):331-4.

  The aim of our report is description of the first in Poland translumbar cannulation of vena cava inferior used as an alternative vascular access for hemodialysis in 62 years old patient withoutThe aim of our report is description of the first in Poland translumbar cannulation of vena cava inferior used as an alternative vascular access for hemodialysis in 62 years old patient without further access for hemodialysis and no access for peritoneal dialysis.

• [Severe nephrotic syndrome requiring bilateral renal arteries embolisation in patient with membranous and diabetic nephropathy].

  Authors: Monika Prokopiuk-Wierzbicka, Przemysław Wierzbicki, Agnieszka Perkowska-Ptasińska, Krzysztof Brzozowski, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):321-4.

  On the case of 62 year old patient with diabetes type 2 complicated by diabetic nephropathy, we present diagnostic and therapeutic problems of severe nephrotic syndrome caused by membranousOn the case of 62 year old patient with diabetes type 2 complicated by diabetic nephropathy, we present diagnostic and therapeutic problems of severe nephrotic syndrome caused by membranous nephropathy confirmed by renal biopsy superimposed on diabetic nephropathy. Special attention was paid to the difficulties in achievement the remission of nephrotic syndrome with typical pharmacological treatment and necessity of using drastic form of treatment which was bilateral embolisation of renal arteries and subsequent continuous renal replacement therapy.

• [Biocompatibility of dialysis fluid in peritoneal dialysis--limitations and possibilities of improvement].

  Authors: Anna Olszowska, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):364-7.

  Standard glucose dialysis solutions are characterised by low biocompatibility because of hyperosmolality, low pH, lactate buffer and presence of glucose degradation products. These factors causeStandard glucose dialysis solutions are characterised by low biocompatibility because of hyperosmolality, low pH, lactate buffer and presence of glucose degradation products. These factors cause failure of peritoneum as dialysis membrane. In our paper we present problems of biocompatibility of glucose-based solutions as well as possibilities of improvement in this field thanks to application of alternative solutions.

• [Influence of controlled hypotensive therapy on renal autoregulation efficiency in the doppler captopril test in patients with chronic glomerulonephritis].

  Authors: Arkadiusz Lubas, Grzegorz Zelichowski, Iwona Obroniecka, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):289-92.

  Regulation of renal vascular resistance is one of main mechanisms of the renal autoregulation. Renal vascular resistance is expressed in the Doppler sonography as a resistance index (RI). EstimationRegulation of renal vascular resistance is one of main mechanisms of the renal autoregulation. Renal vascular resistance is expressed in the Doppler sonography as a resistance index (RI). Estimation of renal resistance index variability in the Doppler Captopril Test in patients with chronic glomerulonephritis and hypertension in the course of controlled hypotensive therapy. 21 patients (13 men + 8 female, age 40 +/- 14.5 years) with chronic glomerulonephritis and hypertension were enrolled to the study. Twice, in about 6 months period of intensive hypotensive treatment, the Doppler Captopril Test was performed and variability of RI (deltaRI) was estimated. Significant rise of deltaRI 0.11 (-11.86:2.83) vs 1.15 (-3.86:7.11); p < 0.05 was found, after 5.8 +/- 2.4 months of hypotensive therapy, and by preserved renal function. Controlled hypotensive therapy significantly improves efficiency of renal vascular autoregulation expressed as the variability of renal resistance index in the Doppler Captopril Test.

• [Role of nitric oxide system in pathogenesis of experimental model of hepatorenal syndrome].

  Authors: Marek Saracyn, Piotr Wesołowski, Zbigniew Nowak, Janusz Patera, Wojciech Kozłowski, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):293-7.

  Hepatorenal syndrome (HRS) is still one of a few great secrets of today's medicine. Pathomechanism of this syndrome, specially in case of an acute liver damage, is still poorly understood. In ourHepatorenal syndrome (HRS) is still one of a few great secrets of today's medicine. Pathomechanism of this syndrome, specially in case of an acute liver damage, is still poorly understood. In our study in experimental galactosamine (Ga1N) model, using the nitric oxide synthase (NOS) inhibitor- N omega-nitro-L-Arginine (L-NAME), we tried to explain, whether the nitric oxide plays some role in this model of HRS. We used 56 male Sprague-Dawley rats (SDR) divided into 7 groups. To achieve acute renal failure in all tested groups of animals GalN was given intraperitoneally. To determine influence of nitric oxide inhibition, L-NAME was given before and after Ga1N injection. Control groups received adequate volume of 0.9% saline solution. Liver and renal failure developed in all tested groups. Inhibition of NOS significantly but dose independently prevented the development of acute renal failure both before and after Ga1N injection. Pretreatment with L-NAME was significantly more succesful than post Ga1N treatment. Our study showed that inhibition of nitric oxide synthase prevents the development of renal failure in animal model of HRS. This is probably the first observation that nitric oxide plays important role in this model of HRS.