Hypertension and nephrology

[Comparison of HbA1c levels of diabetic and non diabetic patients at a nephrology outpatient department]

MÁCSAI Emília, SZABÓ Emília, KIRÁLY Mónika, BENKE Attila, LAKATOS László

JUNE 10, 2011

Hypertension and nephrology - 2011;15(03)

[Introduction: The role of HbA1c in the diagnostic criteria of diabetes has been more emphasized in the american medical literature. The prevalence of disturbed glucose tolerance in adult population is considered significant. In primary care, in case of identified diabetics the regular HbA1c measurement is not used generally. We screened our proteinuric patients on the spot HbA1c measurement selecting the patients with metabolic syndrome and known diabetes. Patients and methods: During the three week period 51 consecutive patients fulfilled the inclusion criteria, we measured HbA1c along with registration of other laboratory and clinical data. Results: In the non-diabetic group five patients showed HbA1c below 5%, 12 patients between 5.1-5.5%, 19 patients in the range of 5.6-6%, and 6 patients above 6%. The rate of proven diabetes was 14% (6/42 patients) by confirmatory laboratory examination. In the diabetic group the HbA1c values were around 6.7% (median; and range 5.2- 7.9%). Conclusion: We do suggest on the spot HbA1c measurement as screening test in patients with high risk of diabetes at the nephrological outpatient department, further laboratory HbA1c analysis and glucose tolerance test can demonstrate the diagnosis. In patients with overt type 2 diabetes it can help to identify those, who should be sent to diabetological consultation.]



Further articles in this publication

Hypertension and nephrology

[Combination Treatment with Simvastatin and Ezetimib Reduce the Frequency of Atherosclerotic Events in Chronic Renal Disease]


Hypertension and nephrology

[Launching “Outlook”, a New Reporting Coloumn]

RADÓ János

Hypertension and nephrology

[Measurement of ambulatory arterial stiffness index in kidney transplant children]

DÉGI Arianna Amália, KERTI Andrea, KIS Éva, CSEPREKÁL Orsolya, REUSZ György

[Background: Cardiovascular (CV) diseases are the leading cause of death among renal transplant patients (TX). Ambulatory arterial stiffness index (AASI) has been suggested to individually predict the cardiovascular morbidity and mortality. Our aim was to evaluate the relationship between traditional and nontraditional risk factors and AASI in renal transplant children. Patients and methods: In our cross-sectional study, 35 TX patients (15.6±4.3 years of age) were investigated with 24-h ambulatory blood pressure monitoring and AASI was defined. Anthropometric data, metabolic parameters and body composition values were also assessed. Results: By univariate regression analysis, BMI, volume excess, systolic blood pressure SD score, mean pulse pressure, diastolic diurnal index, nocturnal diastolic blood pressure fall, and the presence of hypertension showed positive correlation with AASI (respectively r=0.53, 0.39, 0.34, 0.33, 0.41, –0.42; p<0.05). Hypertensive patients had higher AASI values (0.47±0.13 vs. 0.36±0.18; p=0.04), which may be due to the longer duration of dialysis and longer time since transplantation (p<0.05). BMI SDS and nocturnal diastolic blood pressure fall remained to be the main predictors of AASI in the whole (R2=0.44, SE=0.14, β=0.34 and –0.30, p=0.03) and in the hypertensive group (R2=0.48, SE=0.10, β=0.47 and –0.41, p=0.01 and 0.02). Conclusion: Early transplantation then the early treatment of obesity and hypertension may be essential in the prevention of target organ damage and CV mortality in children after kidney TX.]

Hypertension and nephrology

[My teacher, Pál Gömöri (1905-1973)]

RADÓ János

[Great Hungarian physicians have contributed a lot to the development of international medical science. Pál Gömöri was one of them. It is impossible to list the versatility of his scientific interests, but one of his ambitions was the introduction of the investigational methods of renal nuclear medicine to Hungary. The author’s feeling is that his own activity in renal nuclear medicine concerning “diuretic renography” was inspired partly by the information which was learned from Gömöri. The scientific results produced by Gömöri will be preserved in the libraries and on the internet. The spirit of his medical teaching, however, must be passed over by his students and followers, to provide his remembrance to fade as late as possible ]

Hypertension and nephrology

[Recent developments in the diagnosis and therapy of haemolytic syndrome.Part 2: Aspects of long-term treatment and prognosis]

PROHÁSZKA Zoltán, SZILÁGYI Ágnes, RÉTI Marienn, SZABÓ J. Attila, REUSZ György

[In this review the aspects of long-term therapy and patient care with the management of renal transplantation of patients with hemolytic uremic syndrome are summarized. The indication and practice of plasmapheresis in adult and childhood patients are described. Furthermore, additional therapies, such as requirement for immunosuppressive treatment are also mentioned. In addition, detailed information is given about the associations of different genetic variations and risk of renal transplantfailure in these patients. At the end of the review novel observations are summarized about the clinical data obtained with the emerging anti-C5 monoclonal antibody, eculizumab.]

All articles in the issue

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[Bone mineral density and diabetes mellitus - First results]


[INTRODUCTION - Data on bone mineral density (BMD) in diabetes mellitus are contradictory in the literature. Early studies described a decreased bone mineral density in type 1 diabetes mellitus (T1DM), but recent studies report no osteopenia in T1DM.The BMD may depend on the quality of treatment for diabetes mellitus and on the presence of chronic complications. In type 2 diabetes mellitus (T2DM) the BMD is not decreased, occasionally it can even be increased. PATIENTS AND METHODS - Bone mineral density was measured in 122 regularly controlled diabetic patients (T1DM: n=73, mean age: 43.6±11.1 years,T2DM: n=49, mean age: 61.8±9.8 years) by dual energy X-ray absorptiometry at the lumbar spine and at the femur. Results were compared to those of 40 metabolically healthy control persons with a mean age of 47.5±11.9 years.The patients’ carbohydrate metabolism was assessed by the average HbA1c level of the last three years.These values were 7.9±1.4 % in T1DM, and 7.5±1.7 % in T2DM. BMDs were classified based on the T-score and Z-score using the WHO criteria. RESULTS - There was no significant difference in T1DM or in T2DM compared to the reference group in the prevalence of either osteoporosis or of osteoporosis and osteopenia combined. CONCLUSION - BMD was not found to be decreased in patients with well-controlled metabolism compared to healthy controls.]

Lege Artis Medicinae

[Changes of diabetes deaths in Hungary from 2000 to 2009]

VOKÓ Zoltán, ZSÓLYOM Adriána, JERMENDY György

[INTRODUCTION - Official mortality statistics underestimate the etiological role of diabetes in mortality. METHODS - With the use of attributable risk ratio we estimated the proportion of total mortality and mortality under age 65 years due to diabetes in Hungary in 2000-2009. We corrected the analysis for the co-occurrence of diabetes and hypertension. The prevalence figures of diabetes were taken from the National Health Interview Surveys 2000, 2003 and 2009; the relative mortality figures in patients with diabetes from the Canadian Chronic Disease Sur­veillance System of the Public Health Agency Canada; and the Hungarian age-, and sex-specific mortality figures from the Demographic Yearbooks of the Central Statistical Office. RESULTS - The total mortality decreased by 15%, mortality under age 65 years by 16% in the studied period in Hungary. Mean­while diabetes attributable mortality corrected for hypertension decreased by only 6%, premature mortality increased by 4%. As a consequence, the proportion of diabetes attributable mortality within total mortality increased from 4.6% to 5%, premature mortality from 4.3% to 5.5% by 2009, as the prevalence of diabetes increased from 6.9% in 2000 to 8.2% in 2009. Diabetes attributable mortality is approximately 2.5 times higher than the figures in the official mortality statistics. CONCLUSION - Diabetes and its main risk factors, overweight and obesity due to unhealthy diet and physical inactivity are one of the most important public health challenges nowadays. The burden of diabetes and its complications is already enormous. Mortality attributable to diabetes is much higher than it is reflected in the official mortality statistics. ]

Lege Artis Medicinae

[Rationality of incretin based therapy in type 1 diabetes]

KIS János Tibor, GROSZ Andrea, SCHANDL László

[The incretin based therapy is applied at the early stage of type 2 diabetes mellitus. The mechanism of these drugs is partly independent from the functional β cells, therefore therapeutic effect can be expected at the late stage of type 2 diabetes mellitus, what is more in the case of type 1 diabetes. The type 1 diabetes mellitus can be used as a model to test these non-insulin secretion effects. In our work we summarize those clinical trials, in which incretin based therapy was used as a treatment of type 1 diabetic patients.]

Hypertension and nephrology

[Monitoring of effectiveness of ramipril-amlodipine fixed combination in metabolic syndrome, a non-interventional trial (The RAMSES Study)]


[Hypertension is a cardiovascular risk factor. The 6th Cardiovascular Consensus Conference has recommended metabolic syndrome in high-risk category. In diabetic patients hypertension is observed in most cases. Aims: Monitoring the effectiveness and safety of the fix combination of ra - mipril/amlodipine therapy in patients with metabolic syndrome suffering from mild or moderate hypertension despite current antihypertensive treatment. Patients and methods: Open, prospective, phase IV clinical observational study, which involved known metabolic syndrome patients (age over 18 years) with mild or mode - rate hypertension. Ramipril/amlodipine fixed combination (5/5, 5/10, 10/5 or, 10/10 mg) were administered or titrated in 3 visits, during the 6 months of trial period. The doses of the fixed combination drugs were determined individually during the visits by physicians involved in the study. The target blood pressure value was 140/90 mmHg and <140/85 mmHg in diabetic patients. Results: 63% of total patient (9,052) have fulfilled the protocol during the four month of trial (5,707 patients). The age of patients was 61.3±11.97 (mean±SD) years, 2.736 (47.9%) men and 2,971 (52.1%) women. 74.0% of total metabolic patients has reached target blood pressure at the end of 6th month (primary end point). The blood pressure has decreased significantly from 158.7±8.97/91.9±7.30 mmHg (1. visit) to 131.6±7.73/79.8±12.20 mmHg (-27.1±10.43 /12.1±13.38 mmHg) to the 6th month (3. visit) (p<0.0001). Patients with hypertension in metabolic syndrome have tolerated the various fixed combination of ramipril/amlodipine well. ]

Lege Artis Medicinae

[Anti-atherosclerotic effect of pioglitazone - The first evidence of the role of triglyceride/HDL ratio]


[The presence of multiple risk factors can multiply exponentially the risk of cardiovascular events, thus cardiovascular diseases are more severe in diabetes mellitus. One of the challenges we face today is the application of drugs that, besides improving glucose homeostasis, also have antiatherosclerotic effect. Such candidates are glitazones, which have pleiotropic efficiency beyond their main effect: they improve distribution of adipose tissue, blood pressure and endothelial function and also have anti-inflammatory and anti-coagulation capacity. Regarding the effects on lipid metabolism, there are differences between various glitazones: improvements are mainly achieved by pioglitazone, which markedly reduces triglyceride levels, and also elevates HDL levels and decreases the ratio of small, dense LDL-particles. Studies on clinical outcomes also show the superiority of pioglitazone. Imaging of blood vessels (carotis-IMT, intracoronary ultrasound technique) also suggest a greater efficiency of pioglitazone. According to the latest analysis of the PERISCOPE study, the stability of the coronary plaque was associated only with the triglyceride/ HDL ratio in case of pioglitazone. The newest data also revealed that pioglitazone uniquely increases the cholesterol-efflux attributed to HDL-related macrophages. On the basis of the latest results, pioglitazone not only improves glucose homeostasis, but also has a remarkable anti-atherosclerotic effect, which is primarily due to its favourable lipid metabolism profile.]