AIM The most common type of kidney transplantation in Bosnia and Herzegovina is from living donors, but there is a lack of published data on glomerular filtration rate (GFR) values and kidney outcomes in living kidney donors. This study aimed to evaluate the safety of living kidney donation at our centre. METHODS One hundred and seventy living kidney donors at the University Clinical Centre Tuzla were analysed. Initially, there were 170 participants; however, only 31 provided all the required medical data and completed the study. GFR was estimated (eGFR) using the CKD-EPI and MDRD formulas, and a web-based calculator was used to predict GFR > 90 ml/min/1.73 m², along with measurement of creatinine clearance (CrCl). Measured GFR (mGFR) was assessed through technetium-99m diethylene triamine pentaacetic acid (DTPA) renogram, with follow-up visits to estimate post-donation GFR. RESULTS The CKD-EPI, MDRD, and web-based application showed similar diagnostic performances, with MDRD and CKD-EPI systematically underestimating mGFR. CrCl demonstrated strong diagnostic performance. Follow-up visits showed that most donors had post-donation eGFR values between 45 and 89 mL/min/1.73 m², with none progressing to pre-dialysis or the dialysis stage after kidney donation. CONCLUSION CrCl demonstrated strong diagnostic performance in our study population, and the DTPA renogram reliably assessed kidney function. Post-donation eGFR levels were satisfactory, indicating that our diagnostic workup for potential living kidney donors in our centre is safe and effective.

AIM To evaluate the clinical impact of corticosteroids (CS) overuse in inflammatory bowel disease (IBD) patients. Excessive use of CS could delay more efficacious treatment and may indicate poor quality of care. METHOD This is a two-phase study that used Steroid Assessment Tool (SAT) to measure corticosteroid exposure in IBD patients. In the first phase, data from 211 consecutive ambulatory patients with IBD (91 with ulcerative colitis, 115 with Crohn's disease, and five with unclassified inflammatory bowel disease) were analysed by SAT. In the second phase, one year after data entry, clinical outcome of patients with corticosteroids overuse was analysed. RESULTS Of the 211 IBD patients, 132 (62%) were not on corticosteroids, 45 (22%) were corticosteroid-dependent, and 34 (16%) used corticosteroids appropriately, according to the European Crohn's and Colitis Organization guidelines. In the group of patients with ulcerative colitis, 57 (63%) were not on corticosteroids, 18 (20%) were corticosteroid-dependent, and 16 (16%) used corticosteroids appropriately; in the group of patients with Crohn's disease 70 (61%), 27 (23%) and 18 (16%), respectively. Overall, 24 (out of 45; 53%) patients with IBD could avoid the overuse of corticosteroids if they had a timely change of the treatment, surgery, or entered a clinical trial. CONCLUSION An excessive corticosteroid use can be recognized on time using the SAT. We have proven that excessive corticosteroid use could be avoided in almost half of cases and thus the overuse of CS may indicate poor quality of care in those patients.

The John Cunningham virus (JCV) is a polyomavirus that usually infects people at a young age and does not cause any symptoms in immunocompetent individuals. However, in immunocompromised individuals, such as kidney transplant recipients, JCV can cause severe and potentially fatal disease. Unfortunately, JCV has not been researched as extensively as the BK virus and is not mentioned in relevant kidney transplant guidelines. This lack of attention to JCV can lead to less consideration in kidney transplant patients’ care. Surveillance using locally available diagnostic methods is of the utmost importance. The presence of JCV can be diagnosed with urine decoy cells, viruria, or viremia verified by the PCR method. A low threshold for considering JCV as a possible cause of any neurological or renal dysfunction in kidney transplant recipients must be maintained. In such cases, kidney and brain biopsy are indicated. Maintaining the appropriate immunosuppression while avoiding over-immunosuppression to prevent JCV disease is crucial, and the approach should be individual, according to overall immunological risk. We hypothesize that the presence of the JCV can indicate overt immunosuppression and identify kidney transplant recipients more prone to opportunistic infections and diseases, including some malignancies. To explore that, future observational studies are needed.

Delivery of care for kidney failure (KF) globally has a significant disparity; even in some countries, it means end of life for the person. The International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) tries to address gaps in KF care and standardize global nephrology care. From the third iteration of the ISN-GKHA, we present data for countries in the ISN Eastern and Central Europe region. The median prevalences of chronic kidney disease (12.8%) and treated KF (873.5 pmp) were higher than the global rates, respectively. Hemodialysis was the most preferred modality for KF in adults, whereas kidney replacement therapy was more balanced in children. Although most of the countries in the region had lower-middle-income and upper-middle-income levels, health expenditures for kidney health care were almost generally covered publicly. Nephrologists were responsible for the medical kidney care of people with KF in all countries. There was adequate infrastructure to provide all kinds of treatment for kidney care in the region. Regional characteristics such as high levels of obesity, smoking, and Balkan nephropathy as an endemic disease coupled with a shortage of workforce and finance continued to affect kidney care in the region negatively. By making organizational and legislative arrangements, partnerships with national authorities and societies may accelerate the improvement of kidney health care in the region.

Aim To analyse prevalence of metabolic syndrome (MS) in kidney transplant recipients at the University Clinical Centre Tuzla in Bosnia and Herzegovina (B&H), and determine effects of a modern drug therapy in achieving target metabolic control in kidney transplant patients. Methods A single-centre prospective study that included 142 kidney transplant patients over one year follow-up period was conducted. Patient data were collected during post-transplant periodical controls every 3 months including data from medical records, clinical examinations and laboratory analyses. Results Out of 142 kidney transplant patients, MS was verified in 85 (59.86%); after a pharmacologic treatment MS frequency was decreased to 75 (52.81%). After a one-year period during which patients were receiving therapy for MS, a decrease in the number of patients with hyperlipoproteinemia, decrease in average body mass index (BMI), glycemia and haemoglobin A1C (HbA1C) were observed. Hypertension did not improve during this period, which can be explained by transplant risk factors in the form of immunosuppressive drugs and chronic graft dysfunction. Conclusion A significant reduction in components of the metabolic syndrome after only one year of treatment was recorded, which should be the standard care of kidney transplant patients.

Background Bosnia and Herzegovina (BiH) and Serbia are countries in the Western Balkans that share parts of their social and political legacy from the former Yugoslavia, such as their health care system and the fact that they are not members of European Union. There are very scarce data on COVID – 19 pandemic from this region when compared to other parts of the world and even less is known about its impact on the provision of renal care or differences between countries in the Western Balkans. Materials and methods This observational prospective study was conducted in two regional renal centres in BiH and Serbia, during the COVID – 19 pandemic. We obtained demographic and epidemiological data, clinical course and outcomes of dialysis and transplant patients with COVID – 19 in both units. Data were collected a via questionnaire for two consecutive time periods: February – June 2020 with a total number of 767 dialysis and transplant patients in the two centres, and July – December 2020 with a total number of 749 studied patients, corresponding to two of the largest waves of the pandemic in our region. Departmental policies and infection control measures in both units were also recorded and compared. Results For a period of 11 months, from February to December 2020, 82 patients on in-centre haemodialysis (ICHD), 11 peritoneal dialysis patients and 25 transplant patients who tested positive for COVID-19. In the first study period, the incidence of COVID – 19 positive in Tuzla was 1.3% among ICHD patients, and there were no positive peritoneal dialysis patients, or any transplant patients who tested positive. The incidence of COVID-19 was significantly higher in both centres in the second time period, which corresponds to the incidence in general population. Total deaths of COVID-19 positive patients was 0% in Tuzla and 45.5% in Niš during first, and 16.7% in Tuzla and 23.4% in Niš during the second period. There were notable differences in the national and local/departmental approach to the pandemic between the two centres. Conclusion There was poor survival overall when compared to other regions of Europe. We suggest that this reflects the lack of preparedness of both of our medical systems for such situations. In addition, we describe important differences in outcome between the two centres. We emphasize the importance of preventative measures and infection control and highlight the importance of preparedness.