Agnieszka Perkowska-Ptasińska

Publications of Agnieszka Perkowska-Ptasińska

• 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.

• Influence of preservation method on histopathological lesions of kidney allografts.

  Authors: Artur Kwiatkowski, Michał Wszoła, Agnieszka Perkowska-Ptasińska, Krzysztof Ostrowski, Piotr Domagała, Sławomir Fesołowicz, Janusz Trzebicki, Magdalena Durlik, Leszek Paczek, Wojciech Rowiński, Andrzej Chmura

  Annals of transplantation : quarterly of the Polish Transplantation Society. 01/2009; 14(1):10-3.

  Background: Cold storage (CS) of cadaveric kidneys procured from hemodynamically stable donors for less than 24 hours is a safe procedure. Some papers indicate that continuous pulsatile machineBackground: Cold storage (CS) of cadaveric kidneys procured from hemodynamically stable donors for less than 24 hours is a safe procedure. Some papers indicate that continuous pulsatile machine perfusion (MP) allows for extension of preservation times, permits a wider use of kidneys damaged by preagonal ischemia, results in superior immediate function rate as compared to CS and improves long-term graft survival. The aim of the study was to evaluate the influence of kidney preservation method prior to transplantation on the characteristics of histopathological lesions of allografts at long-term post transplantation. Material/Methods: The study group consisted of 274 patients who received a cadaveric kidney allograft between 1994 and 1999. Altogether 553 biopsy specimens were obtained from this group of patients between 1994 and 2004and graded according to Banff 2005 criteria.Two groups were identified: CS - recipients of kidneys stored in simple hypothermia (n=114) and MP - recipients of kidneys stored by machine perfusion (n=160). There were 161 cadaveric donors, 92 in the Mp group and 69 in the CS group. The 553 biopsy specimens obtained revealed the following: interstitial fibrosis and tubular atrophy - 189, chronic rejection - 19, acute rejection - 64, arteriosclerosis - 117, calcineurin inhibitor toxicity - 25, microangiopathy - 44, focal glomerulosclerosis - 82, arteriole hyalinization - 85, ATN - 241. Results: In the CS group histopathological lesions consistent with interstitial fibrosis and tubular atrophy were more frequently encountered than in the MP group (90% vs 64%, p<0.05) Also, chronic rejection was more frequent in the CS group (9% vs 3%, p<0.05). The remaining lesions encountered in biopsies did not differ significantly between the groups. Conclusions: Kidneys preserved by cold storage are more frequently affected by chronic rejection and interstitial fibrosis.

• [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.

• Renin-Angiotensin-Aldosterone system inhibitors and statins prolong graft survival in post-transplant glomerulonephritis.

  Authors: Joanna Pazik, Joanna Ostrowska, Zbigniew Lewandowski, Andrzej Mróz, Agnieszka Perkowska-Ptasińska, Teresa Baczkowska, Magdalena Durlik

  Annals of transplantation : quarterly of the Polish Transplantation Society. 02/2008; 13(4):41-5.

  Background: Novel immunosuppressives neither prevent nor attenuate post-transplant glomerulonephritis, third common cause of late allograft loss. Data addressing in fl uence of ACEI/ARA and statinsBackground: Novel immunosuppressives neither prevent nor attenuate post-transplant glomerulonephritis, third common cause of late allograft loss. Data addressing in fl uence of ACEI/ARA and statins on kidney transplants survival is contradictory. The aim of this study was to evaluate ef fi cacy of therapeutic interventions undertaken in post-transplant glomerulonephritis. Material/Methods: In 75 individuals with biopsy-con fi rmed post-transplant glomerulonephritis, engrafted in Warsaw Transplantation Institute, graft survival from index biopsy to permanent dialysis need, in regard to numerous therapeutic interventions was analysed. Evaluation of graft survival was performed using Kaplan-Meier estimator, log-rank and Wilcoxon tests. Relations between introduced treatment and time to graft loss was expressed with hazard ratio (HR), results regarded signi fi cant at p<0.05. Results: Glomerulonephritis diagnosis was established 50.2+/-39.5 months after engraftment. Maintenance immunosuppression modi fi cations included: methylprednisolone infusions (n=28), cyclofosfamide/ chlorambucil introduction (n=10), mycophenolate mofetil addition to maintenance treatment (n=23). Immunosuppression modi fi cations did not result in graft survival prolongation. Statins (n=20) and renin-angiotensin-system blockers (n=49) substantially diminished the risk of graft loss (respectively: HR=0.37 (95% CI 0.15-0.88), p<0.02. and HR=0.39 (95% CI 0.16-0.98; p<0.05). The effect persisted after adjustment for presentation with nephrotic syndrome, graft dysfunction, mean arterial pressure, immunosuppression enhancement with mycophenoalte mofetil. Best result was obtained with combined RAASB and statin treatment (HR=0.24; 95% CI 0.69-0.09, p=0.008). Conclusions: According to our data statins and renal renin-angiotensin system blockers prolong graft survival in patients with posttransplant glomerulonephritis. We feel that these relatively safe agents, bringing also other pro fi ts, should be routinely applied in patients with post transplant glomerulonephritis.

• Pathological analysis of lesions within intestines resected due to ulcerative colitis.

  Authors: Jarosław Wejman, Krzysztof Bielecki, Joanna Ostrowska, Lech Baczuk, Agnieszka Perkowska-Ptasińska, Wiesław Tarnowski

  Polish journal of pathology : official journal of the Polish Society of Pathologists. 02/2006; 57(2):113-6.

  INTRODUCTION: Ulcerative colitis (UC) and Lesniowski-Crohn's disease together constitute a type of intestinal pathology known as Inflammatory Bowel Disease. The etiology of UC still remains unknown,INTRODUCTION: Ulcerative colitis (UC) and Lesniowski-Crohn's disease together constitute a type of intestinal pathology known as Inflammatory Bowel Disease. The etiology of UC still remains unknown, however some epidemiological data suggest the role of bacteria and viruses and also some habitual as well as environmental factors like smoking, diet, drugs, geographical and social status, as well as stress. The genetic predisposition is also suggested. UC affects young people in 2nd - 4th decades of life. Exacerbations of the disease may result in the necessity of surgical treatment, typically in the form of total proctocolectomy accompanied by the subsequent formation of ileo-pouch-anal anastomosis. The aim of our study was to analyze morphological pictures of resected specimens. MATERIAL AND METHODS: We analyzed 67 cases (40 women and 27 men) of UC with the special interest being focused at macro- as well as microscopic features of the intestines resected. We reviewed macroscopic characteristics of intestines (i.e. the length of resected fragments, localization, shape and diameter of the ulcers, polyps, number of resected lymph nodes), as well as microscopic descriptions concerning, among others the character and localization of inflammatory infiltrate, the architecture of glands, the presence of crypt abscesses and Paneth's metaplasia. Special attention was paid to the morphology of intestinal wall vasculature. RESULTS: In 42% of the cases macroscopically the inflammation covered the whole length of the resected colon. In 58% macroscopically detected inflammatory changes were segmental in distribution. In four cases the disease had clinically the fulminant course and the inflammation was transmural. There were 3 cases, in which histological assessment revealed the presence of malignancy (2 cases of mucus producing adenocarcinoma and one case of carcinoma in situ situated in the anal canal). Generally, microscopic findings were typical for the active phase of UC. We found intensive vascularization and hyperemia of the intestinal wall to be the common features accompanying the inflammation. CONCLUSIONS: Young people in the 3rd and 4th decades of life constitute the group being relatively commonly affected by the UC, and undergo the surgical proctocolectomy. Some of the cases present with the fulminant course of the disease. A rich vascular network is a common finding in the inflamed intestinal wall. We hypothesize, that intensive vascularization may play a significant role in the pathogenesis of UC.

• C4d-positive renal transplants: single-center clinical outcomes.

  Authors: Michał Ciszek, Agnieszka Perkowska-Ptasińska, Magdalena Durlik, Leszek Paczek

  Clinical transplants. 01/2006;

  Among 269 biopsies performed in our institution in 2006, 24 biopsies were C4d positive. There were seven cases of early AMR (< 6 months post-transplant) and 17 cases of late AMR. Cellular rejectionAmong 269 biopsies performed in our institution in 2006, 24 biopsies were C4d positive. There were seven cases of early AMR (< 6 months post-transplant) and 17 cases of late AMR. Cellular rejection was found in 12 biopsies (50%) and classified as type I tubulointerstitial (six biopsies: five Banff IA and one Banff IB) and type II vascular (six biopsies: Banff IIA); in five biopsies (21%), borderline rejection was diagnosed. Changes consistent with chronic rejection were found in six biopsies (25% of all and 35% of biopsies in the late post-transplant period). Among patients with early-onset AMR, there were three cases with thrombotic microangiopathy. Graft function improved in all cases of early AMR after treatment with steroid pulses, and in two cases it improved with ATG and increasing doses of MMF, respectively. All of these patients showed good graft function during follow-up. Methylprednisolone pulses with various modifications of immunosuppressive protocols were used for treatment of late-onset AMR with rather poor effect. Graft function improved in only five patients (29%) but decreased thereafter in three cases; dialysis was started in four cases (24%), and one patient died in sepsis. AMR could be associated with various histological features; trombotic microangiopathy was the specific type of injury for the early-onset AMR in our study, and all but one late-onset AMR were associated with chronic changes. Conventional treatment of acute rejection with steroid pulses or ATG was effective in cases of AMR diagnosed early after transplantation but was of little benefit in cases during the late post-transplant period. Treatment with plasmapheresis with or without immunologlobins or rituximab could be the best therapy in such cases.

• [Atherosclerotic or hypertensive nephropathy--case report]

  Authors: Arkadiusz Lubas, Agnieszka Perkowska-Ptasińska, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 09/2004; 17(98):155-7.

  Atherosclerotic nephropathy is actually taken into consideration as a potential cause of chronic renal failure of unknown origin in older patients with advanced systemic atherosclerosis (ATS), butAtherosclerotic nephropathy is actually taken into consideration as a potential cause of chronic renal failure of unknown origin in older patients with advanced systemic atherosclerosis (ATS), but this diagnosis is often ignored in young patients without evident symptoms of systemic ATS. On the case of 45 years old female with occasionally recognised renal failure, significant proteinuria and hypertension, without clinical symptoms of ATS we present problem of differentiation of atherosclerotic and hypertension cause of nephropathy.

• [The usefulness of tubular and glomerular proteinuria measurement in non-invasive diagnosis of vascular changes accompanying chronic allograft nephropathy]

  Authors: Tomasz Cieciura, Magdalena Durlik, Agnieszka Perkowska-Ptasińska, Marek Cieciura, Jadwiga Majchrzak, Ewa Nowacka-Cieciura, Bartłomiej Matłosz, Teresa Baczkowska, Olga Tronina, Olga Kozińska-Przybył, Mieczysław Lao

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 11/2003; 15(88):360-1; discussion 361-2.

  Chronic allograft nephropathy (CAN) is the most important cause of late renal allograft loss. The standard diagnosis of CAN is based on pathological examinations according to Banff'97 scheme. The aimChronic allograft nephropathy (CAN) is the most important cause of late renal allograft loss. The standard diagnosis of CAN is based on pathological examinations according to Banff'97 scheme. The aim of the study was to evaluate the usefulness of tubular and glomerular proteinuria in non-invasive recognition of vascular changes accompanying CAN (AH--arteriolar hyaline thickening, CV--vascular fibrous intimal thickening). beta 2- and alpha 2-microglobulin (beta 2-m and alpha 2-m), albumin (alb), immunoglobulin G (IgG), total protein (tp) and creatinine (cr) concentration were measured in the second time urine specimen in 66 renal allograft recipients. Then the subsequent renal biopsies were done. The aim of statistical analysis (MANOVA, Stepwise Discriminant Analysis, SDA) was to diagnose CV and AH changes based on results of urine analysis listed above and the patient's age, time after transplantation and serum creatinine level (scr). Results obtained with statistical analysis were in 90.91% and 87.69% identical with CV and AH pathological diagnoses, respectively.