MÁTTYUS István, KENESEI Éva, VÁSÁRHELYI Barna
FEBRUARY 20, 2012
Hypertension and nephrology - 2012;16(01)
[Background: The primary goal when children with vesicoureteral reflux disease (VUR) are treated is the prevention of pyelonephritis and persisting renal damage. Continuous antibiotic prophylaxis (CAP) is usually applied to reach this aim. The selection of resisting pathogens is the major risk of CAP. The aim of our survey was to describe the patterns of pathogenic strains leading to pyelonephritis in patients treated with and without CAP. Patients and method: The pathogenic strains implicated in pyelonephritis were identified in 48 and 56 children below 1 year of age who were treated with or without CAP, respectively, between years 2006 and 2011. Results: Breakthrough urinary tract infections developing in the presence of CAP are more frequently (with about a double risk) caused by polyresistant bacteria compared to infections that emerged without CAP. Nevertheless, it should be noted that the prevalence of resistant pathogens was about 40% even in infants without CAP. Discussion: The pattern of pathogenic strains leading to pyelonephritis alters significantly even in the cohort of children below 1 year of age treated with CAP to prevent infections associated to VUR. The risk may be decreased through the rational use of antibiotics. To reach this goal national guidelines on VUR should be updated and the role of additional non-antibiotic treatment should be established.]
Hypertension and nephrology
[The circadian (24 h) rhythm shows great importance in the pharmacotherapy of hypertension. There is growing interest in how to best tailor the treatment of hypertensive patients according to the circadian blood pressure pattern of each individual. Significant administration-time differences are in the chronokinetics of antihypertensive medication. The therapeutic coverage and efficacy of different antihypertensive drugs are all markedly dependent on the circadian time of drug administration. Administration of ACE inhibitors, ARBs, doxazosin and aspirin at bedtime, as opposed to upon wakening, results in an improved diurnal/nocturnal blood pressure ratio (recommended for nondipper type of hypertension). Other antihypertensive medications: calcium channel blockers and β receptor blockers are non effective at the circadian blood pressure pattern. Chronotherapy provides a means of individualizing the treatment of hypertension according to the circadian blood pressure profile of patients and constitutes a new option to optimize blood pressure control and reduce the risk of cardiovascular disease and the risk of end organ injury.]
Hypertension and nephrology
[Patients suffering from chronic kidney disease reach the end-stage renal disease in ever growing numbers and this necessitates the start of their dialysis treatment. The alteration of bone and mineral metabolism together with the development of the consequent organ damages starts in early stages of the chronic kidney disease. The goal of our present trial was to survey the alterations or characteristics (laboratory results, concomitant diseases and treatment practice in Hungary) of the calcium (Ca) and phosphate (PO4) metabolisms [mineral-bone disorder occurring in chronic kidney disease (CKD-MBD) or formerly known as secunder hyperparathyreosis or renal ostedistrophy] in patients chronically treated with dialysis. We collected and analyzed data/results from 5334 chronically dialyzed patients. We categorized the patients into different groups according to the guidelines of CKD-MBD so basically by the level of serum calcium and parathormone (PTH) (se-Ca level is below or above 2.4 mmol/l; PHT level is below 65 pg/ml, between 65-150, 150-300, 300-500, 500-800 pg/ml or above 800 pg/ml) and then the characteristic variances were compared. The two most frequent primary causes of end-stage renal disease are hypertension (23%) and diabetes mellitus (22%). Serum calcium level was below the upper limit of the normal range (Ca <2.4 mmol/l) in the greatest proportion of our patients (n=4386), while the parathormone level was elevated (PTH >500 pg/ml) in large portion of patients (n=833). Likewise in a significant part of our patients (44.9%) the parathormone level was low (PTH <150 pg/ml). The concurrent pathological elevation of both the serum calcium and the parathormone levels was found in only a minority of the patients (n=150; 2.8%). All of the drugs influencing calcium-phosphate and parathormone levels were already accessible during the time of origin of the trial in Hungary, although the financial limitations significantly affected their prescription. This is one of the reasons why local treatment practice was not fully aligned with guidelines. On the other hand the application of native vitamin D had an especially low prevalence. To sum up, our results match the European practice on the whole, although we definitely need improvement in reaching the treatment targets and also the clinical treatment practice leading to it. We will prepare a proposal for further analysis and longterm extension of this trial.]
Hypertension and nephrology
[A nation can only survive and keep its identity through its traditions. This is why the initiative to launch this series coming from professor János Radó is worthy of attention. Gyula Petrányi is an outstanding personality in 20th century internal medicine, to be more precise in nephrology and immunology, his activity being wide-ranging. The first part of the current summary of his work deals with a tribute to his personality, and his role in immunomodularity treatment in glomerulonephritis. The second part shall cover his role in spreading renal biopsy, screening and caring kidney patients, dialysis, in developing kidney patients’ care, furthermore in clinicopharmacology and renal transplantation.]
Hypertension and nephrology
[In this review we discuss the importance of the multi-photon fluorescence microscopy in the relevance of kidney physiology. Most functions of the kidney, including the clearance of metabolic waste products, maintenance of body fluid, electrolyte homeostasis and blood pressure are achieved by complex interactions between multiple renal cell types and previously inaccessible structures that have been difficult to study. Multi-photon fluorescence microscopy offers an advanced imaging technique for deep optical sectioning of living tissues and organs with minimal deleterious effects. Dynamic regulatory processes and multiple functions in the intact kidney can be quantitatively visualized in real time with submicron resolution. This article reviews the application of multi-photon imaging technology that provided the most complex, spatial and temporal portrayal of renal function, depicting as well as analyzing the components and mechanisms involved in renal (patho)physiology such as glomerular structure and function, tubular transport, tubular-vesicular interaction and the intrarenal renin-angiotensin system.]
Lege Artis Medicinae
[Similarly to other acute inflammatory responses, the mortality curve of acute pancreatitis has two distinct peaks. The first one, which coincides with a hyperinflammatory phase, is due to the development of an overwhelming systemic inflammatory response syndrome and subsequent multi-organ failure. The second peak of mortality is detected much later, after 14 days from the onset of the disease, when the compensatory antiinflammatory phase results in the infection of the necrotising pancreatic glandular substance. Since no therapy has been shown to efficiently prevent the activation of inflammatory and proteolytic cascades that evoke and sustain the disease, the treatment of acute pancreatitis is basically symptomatic. Beside adequate fluid and volume replacement and pain relief, medical and mechanical support may become necessary if organ failure develops. Recent studies suggest that there are ways to decrease the incidence of infection in pancreatic necrosis, which is usually due to bacterial translocation from the gut. The results of attempts to decrease the frequency of septic complications are controversial. A number of studies support the need of antibiotic prophylaxis but the evidence is weak. Furthermore, the increasingly observed infections by multi-resistant strains of Gram-positive bacteria and Candida species are due to long-term antibiotic use, which strongly questions the grounds for prophylactic antibiotic treatment. Recently, various clinical studies aimed to decrease bacterial translocation in other ways, including probiotic use and enteral feeding. This paper provides a systematic review of the data available in the evidence-based literature on the use of antibiotics and the role of alternative and adjuvant therapy in the treatment of severe acute pancreatitis.]
Clinical Oncology
[Genetic fusions are the cosequence of genomic rearrangement including chromosomal inversion, interstitial deletion, duplication, amplifi cation, translocation. Fusions can influence tumor development and progression. Fusions fi rst discovered in hematological malignances (e.g. BCR-ABL), butlater more and more were identified dueto the higly sensitive NGS. It has been found that the oncogenic fusions are in minority in a given tumor. Today, some fusions were apprevedas targets (ALK, ROS1, PDGFB) by FDA. Asino ther targeted therapy resistance is in evitable, which is a very important challenge for newly designed drugs.]
Lege Artis Medicinae
[Physicians are faced with increasingly rapid emergence and spread of antibiotic resistant Gram-negative bacilli and, in particular, Gram-positive bacteria. It poses a major problem for hospitals and general practice as well. The article focuses on the change of resistance of four important and frequently occurring Gram-positive bacteria (Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp. and Streptococcus pneumoniae). Among the therapeutic choices recently introduced fluoroquinolones, oxazolidinones, streptogramins and ketolids are reviewed.]
Hypertension and nephrology
[Voiding sonocystography with intravesical administration of ultrasound contrast agent is a sensitive method to detect vesicoureteral reflux without irradiation. Depicting microbubbles in the ureters and collecting system is feasible even with very small amounts of a second-generation ultrasound contrast agent, Sonovue. The reflux is graded (I-V) in a similar manner to the system used in voiding cystourethrography. In this article a detailed description is presented.]
Lege Artis Medicinae
[INTRODUCTION - In the past few years, a number of studies have been published about acetylsalicylic acid resistance and its potential clinical consequences. PATIENTS AND METHODS - 281 patients with chronic cerebrovascular disease have been involved in our study. The patients were divided in two groups on the basis of their optical aggregometer results (acetylsalicylic acid responder vs. resistant). We compared the risk profiles, drug therapies, laboratory parameters and clinical outcomes of the two groups. RESULTS - Acetylsalicylic acid resistant patients were more likely to be women [23 (45.1%) vs. 92 (40%) (p<0.05)], to smoke (38% vs. 25%), have hypertension (92 vs. 78%), hypercholesterolaemia (5.69 vs. 4.85 mmol/l), and elevated LDL-levels (3.71 vs. 2.85 mmol/l), triglyceride levels (2.78 vs. 1.97 mmol/l) and hsCRP levels (17.89 vs. 7.09 mmol/l) (p<0.01). The use of statins was more frequent (56% vs. 36%) in the responder group (p<0.01). Platelet aggregation values (triggered by agonists) were significantly correlated with cholesterol, LDL, triglyceride and hsCRP levels (p<0.05). Adverse outcomes were reached in 13 (25.5%) acetylsalicylic acid nonresponders and 32 (13.9%) acetylsalicylic acid responder patients (p<0.01). In a multivariate analysis, however, only smoking (OR: 2.38, CI: 1.77-5.44) and increased LDL (OR: 3.01, CI: 2.34-5.67) and hsCRP levels (OR: 2.44, CI: 1.55-7.02) (p<0.05) were independent risk factors of adverse vascular outcomes. CONCLUSION - On the basis of our results, acetylsalicylic acid resistance was associated with a worse clinical outcome, but it was not an independent risk factor of future ischaemic events. Our results implicate that inappropriate prevention therapy might have a role in this phenomenon.]
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Clinical Neuroscience
Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease
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