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Hypertension and nephrology - 2017;21(03)
Content
Hypertension and nephrology
MAY 20, 2017
Hypertension and nephrology
MAY 20, 2017
[Systemic ANCA-associated vasculitis. Induction immunosuppression therapy, complications and outcome. Part 1]
[The present review is compiled of two parts, the first part aims to summarize the induction immunosuppressive therapy, the second part delineates the outcome and complications of ANCA-associated vasculitis. ANCA-associated vasculitis is a systemic disease, accompanied with rapidly progressive glomerulonephritis and severe, often life-threatening extrarenal complications. By early diagnosis and immediate initiation of immunosuppressive therapy, both patient and renal outcome have been substantially improved. The major aims of modern therapeutic protocols are, besides improving survival, to decrease immunosuppressive drug toxicity and avoid infections. Immunosuppression is based on the combination of large dose of corticosteroid and cyclophosphamide, which is advisable to supplement by plasma exchange. The B-cell depleting anti-CD20 monoclonal antibody rituximab, which has already been available in Hungary, has been proved to be similarly effective in newly diagnosed ANCA-vasculitis, and even more effective in a relapsing disease, compared to cyclophosphamide. Amongst rituximab’s further indications in this disease is the preservation of young women’s fertility, and it also has priority in some other special cases. Early diagnosis and prompt immunosuppressive treatment have resulted that ANCAvasculitis became a treatable disease with reasonably good clinical outcome, yet both the disease and the immunosuppressive medications frequently cause complications, which necessitate continuous alertness of the attending nephrologists.]
Hypertension and nephrology
MAY 20, 2017
[Isolated systolic hypertension in children and young adults I.]
[Prevalence of the isolated increase in systolic blood pressure ≥140 mmHg with normal or low diastolic blood pressure ≤80 mmHg, is defined as isolated systolic hypertension. Its prevalence increases with age up to >90% in patients aged >90 years. Isolated systolic hypertension is also found in the young and the clinical significance of it is still debated. For the therapy, those drugs should be used which have a license for use in children: angiotensin converting enzyme inhibitors, angiotensin AT-1 receptor antagonists, calcium channel blockers beta-blockers and diuretics and their combinations. The young adults with isolated systolic hypertension had a much higher risk of dying from coronary heart disease or cardiovascular disease, then the normotensive individuals, and should be treated to normalise their blood pressure. In the elderly and very elderly (>80 yrs), a wealth of data from large clinical trials are available, showing the necessity of treatment mostly with drug combinations - fix-combinations are preferred for increasing the adherence / persistence to therapy. Using diuretics, ACE-inhibitors / ARBs with calcium antagonists, and when needed diuretics and beta-blockers are suggested by recent European guidelines. The target is <140 mmHg, but in octogenarians <150 mmHg. Some studies are pressing for even lower SBP (to around 120 mm Hg), but it seems to be wise to balance advantages / disadvantages, so the optimal SBP may be around 130 mmHg.]
Hypertension and nephrology
MAY 20, 2017
[Prevalence of isolated systolic hypertension in our country]
[Prevalence of hypertension over the age of 56 is increasing in size and a significant proportion (60-80%) of isolated systolic hypertension. Within the population screening in the older age groups - in the light of economic development - 25-40% of the prevalence. We have an opportunity to analyse the prevalence and specificity of isolated systolic hypertension from age 36 to age 10 years on the base of 7 years data of the MÁESZ (Comprehensive Health Protection Screening Program of Hungary 2010- 2020) survey. Between 56-65 years 23.27-24.23% (male/female) 66-75 years 34,89-33,15% and over 76 years 44.04-41.5% occurrence was found. Divergence of systolic and diastolic pressure has begun since 36 years. Pulse pressure was used to separate individuals with varying degree of vascular disorders.]
Hypertension and nephrology
MAY 20, 2017
[Prognostic significance of stiffness index determined by digital volume pulse method in polycystic kidney disease]
[Introduction: It is known from previous studies, that in chronic renal failure cardiovascular mortality and morbidity are more frequent than in the general population. The prognostic significance of arterial stiffness on cardiovascular outcomes trials was first demonstrated in end-stage renal disease patients by epidemiological longitudinal studies. Our aim was to assess the prognostic significance of arterial stiffness in polycystic kidney disease. Methods: 55 patients with polycystic kidney disease (PKD) were examined and followed in our clinic. Pulse wave velocity was determined by digital volume pulse (DVP) method, and a so-called stiffness index (SI DVP) was calculated. MDRD formula was used for estimating the glomerular filtration rate (eGFR, mL/min/1.73 m2) to determine renal function. Patients were observed regularly, in every 3-6 months, and we checked lab tests, which assessed the patient’s renal function and cardiovascular events occurred in patients were collected in our outpatient department. Results: Our study involved 55 patients, 21 were male, the mean age was 45±12 years. The average follow-up was 63±32 months. The average value of the stiffness index was 11.11±2.22 m/s. We divided the patients by 11 m/s as cut off point of SI values into two groups and analysed their outcome. In the increased arterial stiffness group (SI >11 m / s) the probability of the combined endpoint occurrence was signi - fi cantly higher than in the group with flexible arteries (χ-square: 4.571; p=0.033). Between the two groups we did not found significant difference in cardiovascular endpoint, but we found a statistically significant difference between the two groups in renal outcomes (χ-square: 5.591; p=0.018). Conclusion: In polycystic kidney disease the increased arterial stiffness may predict the onset of end-stage renal failure. Digital Pulse volume as determined by Pulse Trace system appears an appropriate method for making prognosis in chronic kidney disease.]
Hypertension and nephrology
MAY 20, 2017
Hypertension and nephrology
MAY 20, 2017
[New agents in the therapy of hyperkalaemia]
[Serum potassium level higher than 5,5 mmol/l denotes hyperkalemia that becomes severe above 7,5 mmol/l being a potentially life threatening condition due to ventricular arrythmias. It may develop as a consequence of high potassium intake, decreased renal excretion, and extracellular potassium shift. Its treatment is a challenge even nowadays especially in the setting of chronic kidney disease, diabetes mellitus, and heart failure where RAAS inhibion is an essential component of the therapy. Sodium polystyrene sulfonate, an ion exchange resin is applied for more than fifty years. Recently new angents, patiromer and sodium zirconium cyclosylicate (ZS-9) were introduced and available results show a safer, more tolerable and predicatble effect. Efficiency of patiromer to reduce hyperkalemia is verified in clinical trials in patients with chronic kidney disease, or diabetes mellitus, or hypertension or heart failure on RAAS inhibitor therapy.]
Hypertension and nephrology
MAY 20, 2017
[Quality of life: the effect of the environment - a European comparison]
[The present study analyses the natural and living environment of the European people. The survey made among the European citizens proved that the environment is a crucial factor in the quality of their life. They are worried firs of all about the air pollution. The paper deals in details with the causes and effects of air pollution. It shows how air pollution has changed (improved) in the European countries. The study ends with the analysis of how the satisfaction with the natural and living environment has developed in the European countries.]
Hypertension and nephrology
MAY 20, 2017
[Antihypertenive effect of rilmenidine. Evaluation of the Hungarian multicenter VERITAS study]
[The VERITAS study showed that in hypertensive patients the imidazoline I1 receptor agonist, rilmenidine significantly decreased the office blood pressure as well as the blood pressure measured by ambulatory blood pressure monitoring (ABPM). The white-coat reaction and left ventricular hyperthrophy (LVH) were also decreased. Ain a separate study involving hypertensive subjects rilmenidine significantly increased baroreflex sensitivity. This effect may contribute - mainly during daytime - to the antihypertensive effect.]
Hypertension and nephrology
MAY 20, 2017
Hypertension and nephrology
MAY 20, 2017
[Cilostazol is effective and safe option for the treatment of intermittent claudication. Results of the NOCLAUD study]
[Intermittent claudication can seriously impair the patients’ quality of life. Cilostazol was registered in Hungary in 2014. This study aimed to evaluate the efficacy and safety of cilostazol in patients with intermittent claudication. 1405 patients were enrolled to the 6 months, multicenter, non-interventional trial. From the 1331 patients, who completed the study, the data of 674 patients were subjected to efficacy analysis. Pain free and maximal walking distance and the 6 minute walking test improved significantly at 3 months (78.65%, 65.23%, 56.09%; respectively, p<0.001), and a further increase was observed after 6 months treatment (129.74%, 107.2, 80.38% respectively, p<0.001). Adverse events occured in 7.26% of the patients. The most frequent adverse events were headache, diarrhea, dizziness, tachycardia or palpitation. 24 patients (1.7%) stopped cilostazol treatment because of side effects. 6 month cilostazol treatment significantly increased the walking distance in patients with intermittent claudication, without important safety problems.]
Hypertension and nephrology
MAY 20, 2017
Hypertension and nephrology
MAY 20, 2017
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