Hypertension and nephrology

[Hyperkalaemia part 6]

DEÁK György1, PATÓ Éva1, KÉKES Ede2

DECEMBER 19, 2020

Hypertension and nephrology - 2020;24(6)


  1. Uzsoki Utcai Kórház, III. Belgyógyászati-Nefrológiai Osztály, Budapest
  2. Pécsi Tudományegyetem, Klinikai Központ, I. Belgyógyászati Klinika, Kardiológiai Tanszék, Pécs



Further articles in this publication

Hypertension and nephrology

[The efficiency of angiotensin receptor blocker/neprilysin inhibitor (ARNi) treatment in heart failure 2020 ARNI, VIDI, VICI…]


[A new compound ARNi (valsartan/sacubitril) – as a member of a new pharmacoterapeutic group – has several clinical evidences almost in the whole spectrum of heart failure, especially in case of reduced left ventricular ejection fraction and hypertension. The most important and essential evidence based studies and the efficiency of the treatment with ARNi in heart failure have been demonstrated in this overview. Due to the favorable results of the studies the recommendations of ARNi indication are increasingly dominant in the clinical guidelines. The usage provides effective, safe therapeutic help for the poor life expectancy heart failure patients in the everyday clinical practice. The treatment is already available in Hungary.]

Hypertension and nephrology

[Arrhythmias in hypertension]


[Hypertension has been recognized as the principal and most common risk factor and underlies many cardiovascular (CV) conditions, including heart failure, coronary artery disease, stroke, and chronic renal failure. Different cardiac arrhythmias have been recognized as clinical manifestations of hypertensive heart disease, related to structural and functional pathophysiological changes of the myocardium, which may predispose to arrhythmias, most commonly atrial fibrillation. Both supraventricular arrhythmias and ventricular arrhythmias may occur in the hypertensive patients, especially when associated with left ventricular hypertrophy or heart failure.]

Hypertension and nephrology

[Possibility of ARNI (angiotensin receptor-neprilysin inhibitor) treatment in hypertension]


[The natriuretic peptide (NP) is an important endocrine, autocrine and paracrine system that is in constant interaction with RAAS and the sympathetic nervous system in order to ensure a continuous cardio-renal homeostasis. In abnormal conditions – if the pressure/volume load develops in the heart or there are some disorder in the vascular tone or in sodium-water balance, the NP system triggers the body’s defense mechanism. The neutral endopeptidase (NEP) inactivates the vasodilator NPs, bradykinin and vasoconstrictor angiotensin II and endothelin I as well. From this knowledge, the idea that inhibition of the effect of NEP (NEPg) offers a potentially beneficial option in the treatment of heart failure and hypertension was initiated, only the stimulatory effect of angiotensin II needs to be blocked. After a lengthy search, they arrived at a dualacting molecule with a beneficial effect of NEP inhibition (secubitrile) and the angiotensin II AT1 receptor antagonist valsartan (ARNI). Several clinical studies have shown that ARNI alone and in combination with other antihypertensive agents significantly reduces SBP and DBP in hypertensive patients. Its effect is also present in isolated systolic hypertension and in chronic kidney disease with high risk. Do not administer with an ACE inhibitor. Based on clinical experience to date, there is a logic expectation that ARNI will also be classified as a useful antihypertensive agent in the near future.]

Hypertension and nephrology

[Hypertension aspects of Hungary’s Comprehensive Health Screening Program (MÁESZ) – The first 10 years]


[Screening tests are known in GP practice, but it is also important for the population living away from the test sites to have access to screenings and to know the information that can be obtained. Hungary’s Comprehensive Health Screening Program 2010-2020 is a unique initiative in Hungary and in the world. It is the largest health protection program in Hungary, operating in a humanitarian form, which provides the population with free-of-charge screening with the most modern tools, keeping in mind the importance of prevention. The program is performed by the cooperation of 76 professional organizations, the national program for the prevention and treatment of cardiovascular diseases coordinated by the Association of Hungarian Medical Companies and Associations (MOTESZ) on the basis of European Union directives, and by consensual cooperation. In this publication, we present some hypertension-related data performed among 2010-2019.]

Hypertension and nephrology

[Left ventricular remodeling and echocardiographic assessment of heart failure]

HATI Krisztina

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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Neuroscience highlights: Main cell types underlying memory and spatial navigation

KRABOTH Zoltán, KÁLMÁN Bernadette

Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.

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Retinal morphological changes during the two years of follow-up in Parkinson’s disease

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[Stroke is one of the most frequent causes of death and the most important cause of permanent disability worldwide and also in Hungary. The Hungarian medical literature has mentioned this disease and has been giving recommendations for its treatment since 1690. Initially folk medicines, herbal preparations and phlebotomy were used as standard therapy. Later, cooling the head joined these methods. Pharmacy preparations emerged at the middle of the 19th century. From the middle of the 20th century, products of the pharmaceutical industry like blood flow enhancers and neuroprotective drugs were in the frontline of the acute care. Anti­hy­per­ten­sive, antithrombotic and lipid-lowering medications became part of stro­ke prevention. Imaging techniques – mainly computer tomography of the brain and ultrasound examination of the cervical large arteries – have radically changed the diagnostics of cerebrovascular diseases from the middle of the 1980s. Since the 1990s, diagnostic and therapeutic decisions are based on reliable evidence from good quality clinical trials. Since the beginning of the 21st century, reperfusion treatments (intravenous thrombolysis and mechanical thrombectomy) re­present the most effective emergency care. The current direction is the extension of the therapeutic time-window of reperfusion treatments based on sophisticated neruoimaging. This review provides a brief summary of the development of stroke care in the last three and a half centuries as reflected in the Hungarian medical literature. ]

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[Disease burden of Duchenne muscular dystrophy patients and their caregivers]


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