Hypertension and nephrology - 2012;16(03-04)

Hypertension and nephrology

SEPTEMBER 21, 2012

[Hypertensive and cardiovascular risks of nonsteroidal antiinflammatory drugs]

FARSANG Csaba, BEDROS J. Róbert, ALFÖLDI Sándor

[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used medicines. During the last ten years several original publications, reviews and meta-analyses were published on the cardiovascular safety of NSAIDs and the results underlined their potentially harmful cardiovascular side effects. It can also be emphasized that there are substantial differences between different compounds, and the CV risk does not depend on the ratio of COX-1/COX-2 selectivity. Cardiovascular risk can be increased by all NSAIDs and paracetamol with the possible exception of naproxen and probably aceclofenac.]

Hypertension and nephrology

SEPTEMBER 21, 2012

[The apparatus which controls our kidney too. - Part 1]

ROSIVALL László

[The series gives a brief overview on the discovery of the juxtaglomerular apparatus (JGA), an interesting story, as well as on details of its structure and function down to the molecular level. The discovery of JGA, i.e., a phylogenetically ancient organ, is a fine example of the close morphological and functional correlations characteristic of living organisms. Presented are the JGA related misconcepts and the underlying theoretical and practical difficulties. Utilization of the most modern methods, such as atomic force microscopy, as well as the in vivo multiphoton laser microscopy revealed previously unrecognized phenomen highlighting the ambiguities of textbook information, accepted paradigms. The author is looking for relationship between the new and provocative theoretical research and clinical consequences of pharmacological interventions. He shows that JGA is not only a participant of the salt-water balance and blood pressure regulation, but it can also play a significant role in the pathogenesis of the major public diseases. Finally, he makes an attempt to analyze the current research directions that predict some potential scientific discoveries and describe some general lessons from his own research career.]

Hypertension and nephrology

SEPTEMBER 21, 2012

[Etiology and diagnosis of renal failure after pediatric cardiac surgery]

TÓTH Roland, CSERÉP Zsuzsanna, SZÉKELY Andrea

[Acute kidney injury is a common and severe clinical problem in children after cardiac surgery, defined by abrupt decline in renal function, with manifestations ranging from minimal elevation of serum creatinine to anuric renal failure. The condition can have a negative influence on the long-term outcome of the illness. The problem is more likely in pediatric cardiac surgery, where the low birth-weight neonates and premature infants can be even more affected. On the other hand chronic renal disease can occur as a severe consequence of acute renal failure. The standard methods to diagnose the acute renal failure in patients are henceforward good applicable, but besides these based on the latest articles of scientific journals there are a lot of new alternatives, which could help us to establish the diagnosis of renal failure more quickly and correctly. These renal specific biomarkers and proteins could predict renal failure sensitively and specifically. Although the applicability of these methods is limited yet, there are a lot of cardiac centres for children, where they are used as routine tests.]

Hypertension and nephrology

SEPTEMBER 21, 2012

[Is there a role of triple combination in the therapy of hypertension? - Antihypertensive efficiency of perindopril-amlodipine-indapamide]

PÁLL Dénes, SZÁNTÓ Ildikó, PARAGH György, KATONA Éva

[Blood pressure reduction to target level decreases cardiovascular morbidity and mortality. However, in the vast majority of cases, this can be achieved only with a (multiple) combination regimen. The primary objective of the PAINT (Perindopril- Amlodipine plus Indapamide Combination for Controlled Hypertension Non-intervention Trial) study was to evaluate the efficacy of combination therapy with perindopril, amlodipine, and indapamide in patients who had not reached target blood pressure with their pre-existing therapy. Secondary objectives included the monitoring of metabolic parameters and the number of antihypertensive tablets taken by the subjects. In this subgroup-analysis we involved 126 patients (74 females and 52 males, mean age 59.8±12.5 years) who had a valid 24-hour ambulatory blood pressure monitoring both at baseline and at the end of the 4-months follow-up. At the beginning of the study none of the subjects reached blood pressure target despite taking on average 2.4±1.4 antihypertensive drugs. During the study, the subjects received the combination of amlodipine, perindopril, and indapamide instead of their pre-existing antihypertensive regimen. 24-hour mean systolic blood pressure decreased from 139.2±13.4 mmHg to 126.5±12.9 mmHg (p<0.01), as well as mean diastolic blood pressure from 77.3±11.3 mmHg to 71.1±8.7 mmHg (p<0.01). Heart rate remained unchanged. Blood pressure reduction was statistically significant both during the day and the night. We found significant blood pressure reduction in all hours (10.1-15.4/5.1-7.8 mmHg; p<0.001). Hyperbaric impact decreased from 366.9±251.1 mmHg × hour to 166.2±185.4 mmHg × hour (p<0.01) for systolic blood pressure, and from 112±130.6 mmHg × hour to 41.6±65.6 mmHg × hour (p<0.01) for diastolic blood pressure. We also could observe favourable changes in metabolic parameters, not only in lipids, but also in blood sugar level. The mean number of tablets taken by the subjects increased from 2.4 to 2.9, but this led to a significantly improved control of blood pressure. Triple combinations of state-of-the-art antihypertensive agents - such as of perindopril, amlodipine and indapamide - ensure effective blood pressure control in sufficiently compliant patients.]

Hypertension and nephrology

SEPTEMBER 21, 2012

[Estimation of serum uric acid in the Hungarian population]

KÉKES Ede, BARNA István, DAIKI Tenno, DANKOVICS Gergely, KISS István

[The clinical significance of serum uric acid markedly increased in the last years, especially in the civilized countries, but the abnormal serum uric acid level shows a significantly strong increasing tendency worldwide. The high level of uric acid is an integral part of metabolic syndrome. Today we recognized the important role of xanthine oxidase in the clinical practice for developing of oxidative stress in some tissues and organs. In 2011 during the Hungarian Health Care Screening Program we analyzed the prevalence of metabolic factors in 18 886 subjects. In the present publication we have dealt with uric acid and calculated the occurrence of abnormal values in percentage of the observed population. We found abnormal values in 12.3% of women (over 350 µmol/l) and 16.5% of men (over 400 µmol/l). The average values were higher in hypertensive subjects against normotensive ones in both gender. There was a close correlation among the metabolic components and the elevated uric acid level. The screening had given a possibility for detecting hidden gout and some other diseases, where the elevated uric acid level is specific of the clinical entity.]

Hypertension and nephrology

SEPTEMBER 21, 2012

[The prognostic role of serum albumin levels in survival of chronically hemodialized patients]

KULCSÁR Imre, SZAKÁCS Gyuláné, SZEGEDI János, KISS István

[The authors have investigated the survival of 238 patients on chronic haemodialysis program regarding serum albumin levels (measured at starting dialysis and at the end of observation) adjusted for age, gender, diabetes, serum haemoglobin and body weight. The mean observational period was 5.5 years. Our investigation has documented a tight positive correlation between the survival and serum albumin levels both at starting and ending of investigation independently of epidemiological parameters. It was demonstrated that serum albumin levels decrease by aging, so the authors recommend a little bit lower serum albumin target level for older dialyzed people, because the normal range is also decreasing by aging. The level of serum albumin has not shown changing in younger patients (less than 60 years) in this long observational period, but there was a significant decrease in olders (especially above 70 years).]

Hypertension and nephrology

SEPTEMBER 21, 2012

[Prevalence of bone abnormalities and soft tissue calcification and their determining factors in dialyzed patients]

KISS Zoltán, AMBRUS Csaba, SZABÓ András, SZEGEDI János, BALLA József, TÖRÖK Marietta, LADÁNYI Erzsébet, CSIKY Botond, ÁRKOSSY Ottó, TÚRI Sándor, KULCSÁR Imre, KISS István

[Disturbances of bone and mineral metabolism are frequent complications of chronic kidney disease. In the last decades, increasing evidence of both pathophysiological and epidemiological nature support the relationship between bone disease and soft tissue calcification. In this current research, we analysed characteristics, determining factors and relationship of these two complications in a nationwide, cross-sectional cohort of dialysed patients. We collected demographical data (age, gender, body weight, height, diabetes, type of dialysis), laboratory results (serum parathormone, calcium, phosphat, albumin levels) and the presence of diabetes mellitus, bone abnormalities and soft-tissue calcification in patients on maintenance dialysis in 2010. The prevalence of bone abnormalities and soft tissue calcification followed similar pattern: both prevalences were high when parathormone <150 pg/ml (42.9% and 51.5%, respectively) or >500 pg/ml (44.2% and 55.5%) and they were significantly lower when parathormone was between 150-500 pg/ml (30.7% and 47.4%). In a multivariate logistic regression model, independent predictors of bone abnormalities were low (<150 pg/ml) and high (>500 pg/ml) parathormone levels (p<0.001), orhemodialysis (vs peritoneal dialysis) (p<0.001), age (p<0.001) and diabetes (p<0.001). In a similar statistical model, predictors of soft tissue calcification were also low (<65 pg/ml) (p<0.01) and high (>500 pg/ml) parathormone levels (p<0.001), hemodialysis (p<0.001), age (p<0.001), diabetes (p<0.001) and serum calcium level greater than 2.4 mmol/l (p<0.05). In summary, there was a U-shaped relationship between increasing serum parathormone levels and prevalence of bone abnormalities and soft tissue calcification in ESRD patients on maintenance dialysis. Further research and long term follow up are needed in order to reveal more detailed relationship among the two diseases and their determining factors.]

Hypertension and nephrology

SEPTEMBER 21, 2012

[Effect of bilateral catheter-based renal artery sympathetic denervation on blood pressure, therapy and baroreflex-sensitivity in a patient with resistant hypertension]

LÉGRÁDY Péter, NAGY Ferenc Tamás, THURY Attila, BAJCSI Dóra, FEJES Imola, SIMON Judit, NAGY Endre, UNGI Imre, ÁBRAHÁM György

[Hypertension is a global problem all over the world and also in Hungary. Although there is a wild spectrum of pharmacological and non-pharmacological antihypertensive interventions, the rate of hypertensive patients not achieving the goal blood pressure is still high. Recently developed endovascular catheterbased technology enables selective radiofrequent denervation of kidney through the lumen of renal artery. We report a case of a 52-year old hypertensive women on a combination of 11 antihypertensive medications. A successful sympathetic radiofrequent denervation was performed without complications resulting a decrease in blood pressure and medication and an increase of spontaneous baroreflex- sensitivity.]

Hypertension and nephrology

SEPTEMBER 21, 2012

[Protein-energy wasting and quality of life in kidney transplant recipients]

UJSZÁSZI Ákos, VÁRADY Tímea, CZIRA Mária Eszter, FORNÁDI Katalin, Novák Márta, MUCSI István, MOLNÁR Miklós Zsolt

[Chronic kidney disease has profound effects on the health related quality of life (HRQoL) of patients with serious physiological, psychological and socio-economic implications. The co-occurrence of protein-energy wasting (PEW) and inflammation in end stage renal disease patients is associated with worse HRQoL and increased mortality. We designed this study to examine the relationship between nutritional and inflammatory status and HRQoL in kidney transplant recipients. Data from 100 randomly selected kidney transplant patients were analyzed in a crosssectional survey. Socio-demographic parameters, laboratory results, transplantation related data, co-morbidities, medication and malnutrition-inflammation score (MIS) (Kalantar Score) were tabulated at baseline. Patients completed the Kidney Disease Quality of Life-SF (KDQoL-SFTM) self-administered questionnaire. Mean age was 51±13 years, median (interquartile range, IQR) time since transplantation 66 (83) months, 57% were males and 19% had diabetes. The median (IQR) MIS was 3 (3). MIS significantly and negatively correlated with almost all HRQoL domains analyzed, and this association remained significant in multivariate linear regression analysis for the log-transformed scores on energy/fatigue (β=-0.059, p<0.001), bodily pain (β=-0.056, p=0.004), physical functioning (β=-0.029, p=0.022), and symptoms/problems (β=-0.023, p=0.005) domains after statistical correction for age, gender, eGFR, dialysis vintage, Charlson Comorbidity Index and occupational status. Additionally, cubic spline analyses revealed linearly increasing, “dose-response” relationship between almost all domains of KDQoL-SFTM and the MIS. Malnutrition Inflammation Score is independently associated with different dimensions of health related quality of life in kidney transplant recipients.]

Hypertension and nephrology

SEPTEMBER 21, 2012

[Professor István Taraba MD., the scientist, physician and man. - „Difficulties are to defeat them!”]

POLNER Kálmán

[Only few such outstanding physicians lived, whose achievements and personality influenced the development of the Hungarian nephrology as remarkably as professor István Taraba did. He started his university career as an experimental researcher at the Institute of Physiology on Semmelweis University, Budapest, then at the age of 34, after completing his Ph.D thesis, decided to treat patients to utilize his acquired knowledge in the field of renal failure’s pathophysiology. This way he devoted himself to cure patients with kidney failure being in very poor circumstances at that time. Besides his daily clinical activity, he accomplished outstanding organizing work in establishing and leading the Hungarian Nephrology Society, and also in initiating specialty training for nephrologists and nephrology nurses. The hallmark of his professional work was that in spite of extremely adverse circumstances he forced to improve the quality of dialysis treatment to approach European standards. Among the renal replacement treatment modalities- antecedently to his age - he respected peritoneal dialysis equal to hemodialysis, and attempted to popularize it in his country. Under his leadership the Nephrology Department of Margit Hospital in Budapest became the therapeutic and educational centre of Hungarian nephrology. His achievements have been acknowledged internationally, and his early death is substantial loss for Hungarian nephrology as a whole. It was a great honour to me to work beside him during the whole period he spent in the Margit Hospital, and since March of 1997 I have the opportunity to lead the department he had established in his intellectuality.]