Hypertension and nephrology

[My teacher, Pál Gömöri (1905-1973)]

RADÓ János

JUNE 10, 2011

Hypertension and nephrology - 2011;15(03)

[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 ]



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Hypertension and nephrology

[Launching “Outlook”, a New Reporting Coloumn]

RADÓ János

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

[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

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


[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.]

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.]

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[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

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[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]


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Lege Artis Medicinae

[Notes on the management of hypertension in chronic kidney disease ]


[The prevalence of hypertension among pa­tients with chronic kidney disease is high, reaching more than 80%. Hypertension is both one of the main causes and also the most common consequence of chronic kidney disease. It is also a main factor responsible for the high cardiovascular morbidity and mortality in this patient population. Blood pressure control can improve patient outcomes, lower cardiovascular risk and slow down the progression of kidney dis­ease, irrespective of the underlying cause. The optimal therapy should therefore focus not only on blood pressure reduction but also on renoprotection. Basic understanding of the renal pathophysiology in hypertension and renal effects of various medications is of paramount importance. In this review, we summarized cornerstones of the antihypertensive therapy in patients with chronic kidney disease. The management of patients receiving kidney replacement therapies, such as hemodialysis, peritoneal dialysis or transplanta­tion requires special knowledge and expe­rience, therefore it is not discussed here. The aim of this review was to allow non-nephrologist physicians to take care of their kidney patients with more confidence and effectiveness.]

Hypertension and nephrology

[The importance of assessing subclinical organ damage in risk prediction of hypertensive patients]

GODINA Gabriella, JÁRAI Zoltán

[As the cardiovascular risk influences the quality and intensity of blood pressure lowering therapy, the goal blood pressure values and the frequency of medical control of hypertensive patients, as well as global risk assessment has an important role in the management of hypertension. In the last couple of years many data have been accumulated showing the poor prognostic value of traditional cardiovascular risk factors. This is the reason why recent Hungarian and international guidelines on the management of hypertension advise the screening for subclinical organ damage. Our goal was to summarize the importance of subclinical organ damage by discussing recently published literature on this topic. An overview has been made on the markers of vascular subclinical damage, like carotid atherosclerosis proved with carotid ultrasonography, peripheral arterial disease assessed with ankle-brachial pressure index measurements and vascular rigidity defined with pulse wave velocity measurements. The prognostic values of myocardial hypertrophy assessed with ECG and/or echocardiography and renal damage proved with decreased estimated glomerular filtration rate and proteinuria are also discussed. Summing up what has been said so far, the assessment of subclinical organ damage has a role in cardiovascular risk prediction, however more randomized and prospective studies have to be performed to define the most suitable (i.e. the most reliable and the most cost-effective) markers for this purpose.]

Lege Artis Medicinae

[The effects of angiotensin receptor blockers on the nervous system in hypertension and dementia]


[The renin-angiotensin system (RAS) is one of the most important mechanisms regarding the pathomechanism and treatment of hyprtension. The most of the elements of the RAS are found in the nervous system too. The effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ARBs) is based on the inhibition of the RAS. ARBs might have a special role in the central nervous system because they do not decrease the production of angiotensin but inhibit its harmful effects mediated through the AT1 receptor while allowing the stimulation of AT2 receptors with resulting pleiotrophic actions. Hypertension is the most important risk factor for stroke and has a negative effect on cognitive functions. Antihypertensive treatment has an effect on the nervous system; in addition to the consequences of the reduced blood pressure, ARBs might provide additional advantages in stroke and dementia prevention.]