Hypertension and nephrology

[Launching “Outlook”, a New Reporting Coloumn]

RADÓ János

JUNE 10, 2011

Hypertension and nephrology - 2011;15(03)

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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

[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

[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.]

Hypertension and nephrology

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

MÁTYUS János, PARAGH György

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.]

Hypertension and nephrology

[Postconditioning in major vascular operations for the prevention of postoperative renal complications]

ARÁNYI Péter, TURÓCZI Zsolt, GARBAISZ Dávid, VARGA Márk, LOTZ Gábor, KUPCSULIK Péter, SZIJÁRTÓ Attila

[Objectives: During vascular surgeries on the abdominal aorta, lower extremities suffer ischaemia-reperfusion (IR) injury which can lead to rhabdomyolysis. A severe complication is the myonephropathic metabolic syndrome with acute renal failure. The aim of the study was to investigate whether postconditioning (rapid repetitive cycles of ischaemia and reperfusion on the onset of the organ reperfusion, a novel technique to reduce ischaemia-reperfusion injuries) could prevent renal failure in major vascular surgery. Subjects and methods: Male Wistar-rats underwent 180 minutes of bilateral lower limb ischaemia and four hours of reperfusion. Postconditioning consisted of 6 cycles of 10-second aortic occlusion/10-second declamping. Microcirculation of the kidney was detected with laser Doppler flowmeter. After 4, 24, 72 hours of reperfusion serum, urine, and histological samples were collected. Acid-base state was evaluated immediately after reperfusion. Results: After four hours of reperfusion there were no significant histological alterations in the muscle in contrast to the 24 hour rhabdomyolysis with inflammation. CK, LDH, AST levels increased in the acute phase but improved in the 24th and 72nd postoperative hours. Kidney histology and laboratory tests showed definite signs of acute tubular injury in control animals. In the early stage serum creatinine; seBUN/creatinin; FENa showed significantly (p<0.05) lower kidney injury in the postconditioned group. Postconditioning improved the kidney cortex microcirculation. Conclusion: Postconditioning can reduce the prevalence and consequences of renal failure after experimental major vascular surgery in rats.]

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Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

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.

Clinical Neuroscience

The effects of the level of spinal cord injury on life satisfaction and disability

GULSAH Karatas, NESLIHAN Metli, ELIF Yalcin, RAMAZAN Gündüz, FATIH Karatas, MÜFIT Akyuz

Introduction - Spinal Cord Injury (SCI) may often lead to significant disability in affected individuals and reduce life satisfaction. Herein we aimed to investigate the effects of the level of injury on disability and life satisfaction as well as the relation between life satisfaction and disability. Methods - Patients with at least one-year history of SCI were included. Demographic-clinical data of patients were recorded. The Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) was used for quantifying the degree of patients’ disability. Life satisfaction was assessed by the Satisfaction with Life Scale (SWLS). Results - Of the 76 patients, 21 (27.6%) were tetraplegic and 55 (72.4%) were paraplegic. SWLS was found to be similar in tetraplegic vs. paraplegic patients (P=0.59), whereas CHART parameters such as physical independence, mobility, occupation, and total CHART value were significantly higher in paraplegic patients (P=0.04, P=0.04, P=0.001 and P=0.01, respectively). Social integration was found similarly high in both groups. There was a positive correlation between elapsed time after the injury and CHART physical independence, occupation and the level of economic sufficiency (P<0.01, P<0.01, P=0.01). Excluding the economic sufficiency (P=0.02), there was not any other association between the rest of CHART parameters and SWLS. Conclusions - According to our findings, although the level of injury seems to be influential on disability, it seems to have no significant effect on life satisfaction. Since the only thing that positively affects life satisfaction is economic sufficiency, more emphasis should be placed on regulations that increase the return to work in patients.

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BALOGH Ádám, BHATTOA Harjit Pál

[The authors surveyed the already known factors responsible for the osteoporotic bone fragility. Then the results of using modern imaging techniques (micro-CT, high-resolution peripheral computed quantitative tomograph - HR-pQCT) and advanced computer analytic methods (finite element analysis, FEA) are presented. These data - beyond the already known fracture risk factors (age, risk of falling, bone mineral density - BMD, and fine structure damage of trabecular bone) are stressing the importance of the (micro)damage of cortical bone as a fracture risk factor, which has been still underrated. The cortical thickening and increased porosity - verified on various population samples - are increasing the risk of fractures in certain subgroups of subjects having identical BMD values, even among those, who are considered only osteopenic by the earlier classification based on BMD values. Backed with modern software batteries, the new imaging techniques are expected to enter clinical application in the near future. Pharmacologic agents with stronger cortical effect are already available and research is continuing to find new drugs to use in the management of osteoporotic patients of high fracture risk.]

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[Neurophysiological methods are gaining ground in the diagnosis and therapy of cerebrovascular disease. While the role of the EEG (electroencephalography) in the diagnosis of post-stroke epilepsy is constant, quantitative EEG para-meters, as new indicators of early efficiency after thrombolysis or in prognosis of patient’s condition have proved their effectiveness in several clinical studies. In intensive care units, continuous EEG monitoring of critically ill patients became part of neurointenzive care protocols. SSEP (somatosesnsory evoked potencial) and EEG performed during carotid endarterectomy, are early indicative intraoperativ neuromonitoring methods of poor outcome. Neurorehabilitation is a newly discovered area of neurophysiology. Clinical studies have demonstrated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in the rehabilitation of stroke patients. Brain computer interface mark the onset of modern rehabi-litation, where the function deficit is replaced by robotic tehnology. ]