Hypertension and nephrology

[Nephrology]

DOLGOS Szilveszter1, TÁRNOKI Ádám Domonkos2, TÁRNOKI Dávid László2

JUNE 20, 2019

Hypertension and nephrology - 2019;23(03)

AFFILIATIONS

  1. Szent Margit Kórház, Nefrológiai Osztály, Budapest
  2. Semmelweis Egyetem, Radiológiai Klinika, Budapest

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Hypertension and nephrology

[Letter to our Readers]

ALFÖLDI Sándor, KÉKES Ede

Hypertension and nephrology

[Overview of a 10 years kidney biopsies data from the Nephrological and Blood Pressure Center Szeged]

[The authors retrospectively analyzed the data of kidney biopsies performed between 01/01/2007 and 31/12/2016 performed in the Center. During this period 452 biosies were performed. Mean age of patients was 48.7±15.0 years, of them, 43.5% were man and 56.5% women. The nephrotic syndrome was the most common (38.8%) clinical indications for a biopsy. The mos common histological diagnoses were the membranous nephropathy (16.7%), the IgA nephropathy (11.6%) and the FSGS (10.9%). The most common suggestions by nephrologists were the FSGS (17.4%), the membranous nephropathy (16.1%) and the IgA nephropathy (10.3%). These percentages of diabetic nephropathy were 7.5% and 12.2%. Minor complications not requiring any interventions occured in 98 cases (21.7%), major ones in 13 cases (2.9%). By the results FSGS seems to be overrated by nephrologists, but it is among the 3 most common histological findings. Diabetic nephropathy is a similarly excessive clinical diagnosis, sithence the histologically confirmed diagnoses are only a little more than half of it. Regular meetings of pathologists and nephrologists about clinical suggestions and real histological diagnoses may help to improve the ratio of more accurate suggestions.]

Hypertension and nephrology

[Experimental models of renal fibrosis]

KÖKÉNY Gábor

[The high incidence of chronic kidney diseases and, regardless of the etiology, their progression to renal fibrosis with end-stage renal failure rise the urgent need to reveal the pathomechanisms. As the disease leads to complex changes in the body, it is essential to use in vivo model systems for these investigations. Animal experiments choosing the appropriate model system helps to develop more sensitive early diagnostic markers and new therapeutic approaches. Several animal experimental model descriptions can be found in the literature, which mimic specific or more general human diseases in order to help the better understanding of the pathomechanisms. Using these model systems, we are able to analyze the detailed pathophysiology of glomerulonephritis, tubulointerstitial fibrosis, glomerular scarring or generalized renal fibrosis. The most commonly used model systems for renal fibrosis are presented and discussed.]

Hypertension and nephrology

[Hyperuricemia in hypertension. Domestic experience based on the data of the Hungarian Hypertonia Register 2011., 2013., 2015. Part II.]

ALFÖLDI Sándor, PAKSY András, KÉKES Ede

[Asymptomatic hyperuricemia is frequent in hypertension and its prevalence is increasing. Authors studied the incidence of serum uric acid levels and its correlation with age, risk factors, anthropological, metabolic characteristics, blood pressure, blood pressure target, organ damage, age-related co-morbidity in 47,372 hypertensive patients (22,688 males, 24,694 women). In the second part of their analysis the prevalence of hyperuricemia was 13.8% in hypertensive men and 21.6% in women. The age, BMI, waist diameter, systolic and diastolic blood pressure and onset of hypertension, serum cholesterol, triglyceride, blood glucose and serum creatinine were slightly higher, but serum HDL cholesterol and eGFR were slightly lower in hyperuricemic hypertensive patients, independently of their gender. Among hypertension mediated organ damage ischemic and left ventricular hypertensive ECG alterations, mild chronic kidney disease and proteinuria, among hypertension associated diseases diabetes associated ischemic heart disease, chronic kidney disease associated diabetes and both ischemic and chronic kidney disease associated diabetes were significantly more frequent in hyperuricemic hypertensive patients.]

Hypertension and nephrology

[Proposed Methods for Reducing LDL Cholesterol Levels in Atherosclerotic Cardiovascular Disease for Secondary Prevention in American and European Recommendations]

KÉKES Ede

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[Novelties in the diagnosis and treatment of X-linked hypophosphatemia]

RUESZ György Sándor, MIKES Bálint, CSIZEK Zsófia, HORVÁTH Orsolya

[X-linked hypophosphataemia (XLH) is the most common inherited cause of phosphate wasting. Its pathogenesis is complex, determined by the dysregulation of phosphate homeostasis and bone metabolism. We review herein the pathophysiology of XLH leading to multiple manifestations, stages of diagnosis and the treatment strategies. XLH is now in the scientific interest of pediatric nephrology, because a new treatment modality, burosumab became available in Hungary. Burosumab is a monoclonal antibody against fibroblast growth factor 23 (FGF-23). XLH is caused by the loss of function mutations in ”phosphate regulating endopeptidase homolog, X-linked” (PHEX) gene, which results enhanced secretion of the phosphaturic hormone FGF-23. The diagnosis of XLH is based on signs of rickets and/or osteomalacia and decreased growth velocity in association with hypophosphataemia and renal phosphate wasting in the absence of vitamin D or calcium deficiency. Conventional treatment with oral phosphate supplementation together with active vitamin D (calcitriol or alfadiol) can improve bone metabolism, but only partial results can be achieved, and can promote side effects (nephrocalcinosis). The better understanding of the role of PHEX gene and FGF-23 levels in the pathomechanism helped to identify therapeutic options more properly. With monoclonal antibody therapy against FGF-23 the disease process can be interrupted, and complications can be prevented if the therapy is initiated in time. However, deformities already leading to disability cannot regress completely during burosumab therapy, highlighting the need of early diagnosis and the start of the biological treatment before complications.]

Hypertension and nephrology

[Unattended automated office blood pressure measurement versus classic office automated blood pressure measurement in a hypertension outpatient clinic]

LÉGRÁDY Péter, FEJES Imola, CZOMBOS András, ÁBRAHÁM György

[Accurate measurement of blood pressure is a fundamental prerequisite requirement for an appropriate management of arterial hypertension. In order to eliminate the well-known limitations of classic office blood pressure measurements, the so-called unattended automatic office blood pressure measurement method can be a solution. In 52 patients arriving for regular followup into one of the Hypertension Outpatinet Clinic of the Nephrology-Hypertension Center of the University of Szeged 3-3 blood pressure measurements were made at 1-1 minute intervals first by a doctor with an MIT5 automatic device and then in a separate room unattended, starting alone by the patient with a Hem-907 device. ]

Hypertension and nephrology

[Beyond the diagnosis – the value of renal biopsy in clinical practice through the example of two glomerular diseases]

DOBI Deján

[In this review, the publications that established the value of renal biopsy in nephrology are referenced, the pathomechanism of lupus nephritis (LN) and IgA glomerulonephritis (IgAGN) is briefly summarized, and a detailed account is given on the previous and currently accepted classification systems of LN and IgAGN and on the prognostic relevance of these systems. ]

Hypertension and nephrology

[Sevelamer: an old-new phosphate binder in chronic kidney disease]

BERECZKI Csaba, TÚRI Sándor

[Sevelamer HCl is a non-metal and non-calcium based phosphate binder, ion exchange resin, which not selectively binds the phosphate ions in the gastrointestinal tract. In Hungary since 2005, on the basis of strict professional guidelines, sevelamer is available therapy for chronic kidney disease patients with severe hyperphosphatemia on dialysis. On the basis of 17 prospective and retrospective studies, sevelamer HCl is an at least as effective phosphate binder as other calcium based binders, in reducing the serum phosphate level. The advantage of sevelamer compared to the other widely used calcium based phosphate binders is the significantly lower serum calcium level and less hypercalcemic episodes. Sevelamer therapy in chronic kidney disease patients reduces the progression of cardiovascular calcification and it has also a positive effect on cholesterol and LDL-cholesterol levels. The side effects of sevelamer therapy may be acidosis, and gastrointestinal complaints. This year the improved form, sevelamer carbonate, becomes available in Hungary. Sevelamer carbonate has similar phosphate and cholesterol binding capacity as that of sevelamer HCl, but it has several advantages: it has a positive effect on acid-base parameters, and may be administered in powder form, which is beneficial for children and for patients with swallowing disorders. The primary analysis of the DCOR study has not revealed any significant difference in the survival and cardiovascular mortality between patient groups treated with calcium based binder or sevelamer. The RIND trial data showed improved survival of new dialysis patients, who were initially treated with sevelamer. Further clinical studies are needed to kaverify the benefits of sevelamer therapy (mortality, cardiovascular calcification) in chronic kidney disease patients. The management of hyperphosphatemia in chronic renal failure is a major challenge even in the first decade of the 21th century. This is the fact, despite that recently three different groups of phosphate binders are available in the clinical practice: the calcium based binders (calcium carbonate, calcium acetate), sevelamer and lanthanum. Which is the best binder? A calcium based or a non-calcium based one? Over the past decade, these issues are in the mainstream of clinical research of nephrology.]

Hypertension and nephrology

[The 27th Great Assembly of the Hungarian Society of Nephrology]