Hypertension and nephrology

[Network of specialist care facilities for the treatment of hypertension]

ÁDÁM Ágnes1,2

DECEMBER 20, 2021

Hypertension and nephrology - 2021;25(06)

AFFILIATIONS

  1. Vezető főorvos - Zuglói Hypertonia Centrum, Budapest
  2. Tudományos munkatárs - Semmelweis Egyetem Családorvosi Tanszék, Budapest

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Further articles in this publication

Hypertension and nephrology

[Data on blood pressure over two years in resistant hypertensive patients with lett brain stem microvascular decompression]

FEJES Imola, VÖRÖS Erika, BARZÓ Pál, ÁBRAHÁM György, LÉGRÁDY Péter

[In the background of resistant hypertension (RHT) the neurovascular pulsatile compression (NVPC) of the left rostral ventrolateral medulla may play a role. In these cases a microvascular decompression (MVD) may decrease the blood pressure (BP). The aim of this work was to investigate how the BP has changed after the MVD in the operated patients recorded at the farthest time from the MVD up to maximum 31 December 2016. We have retrospectively collected data from 9 patients whose follow-up data fór 2 years has already been published earlier. Data collection was carried out from the patient register program of the University of Szeged Albert-Szent Györgyi Clinical Centre. The MVDs were performed between 2000 and 2004. The mean follow-up time was 11.1±4.6 years. Both the systolic and the diastolic BPs were significantly lower at the time of last record compared to the BPs at the time of MVD (systolic BP 211±40 vs. 135±20 mmHg, p=0.003; diastolic BP 116±17 vs. 81±14 mmHg, p=0.007). Last recorded BPs compared to the 24-month data alsó were lower bút nőt signffi- cantly (systolic BP 148±32 vs. 135±20 mmHg, p=0.25; diastolic BP 96 vs. 85 mmHg, p=0.11). The mean number of antihypertensives at the last Office visít was nőt sig- nificantly higher compared to MVD (5.9±1.4 vs. 6.3±1.5; p=0.5) bút signfficantly increased compared to MVD +1 month data (4.7±0.9vs. 6.3±1.5; p=0.03). These results confirmed our previous opinion that in severe RHT nőt respond- ing to conventional therapy an MVD of the left side NVPC could be a therapeutic option and may guarantee a long-lasting BP reduction. Evén if the number of antihypertensives increased in the meantime, as they still responded better to therapy. ]

Hypertension and nephrology

[Nonproteinuric diabetic kidney disease]

LENGYEL Zoltán, SCHANDL László

[Diabetic nephropathy is one of the most common causes of chronic kidney disease. In recent years, besides the classic phenotype with increased urinary albumin excretion, another phenotype showing Progressive kidney failure without albuminuria has been observed with increasing frequency. The histology, the pathophysiology and the course of non-proteinuric diabetic kidney disease differs from the classic phenotype in several respects. The former shows traits similar to atherosclerotic kidney disease with respect to association with cardiovascular disease and histological alterations and the progression is slower. This has important implications concerning the screening, treatment and prognosis of the disease. While the available data about non-proteinuric diabetic nephropathy is relatively scant, it deserves attention both in everyday clinical practice and in scientific research.]

Hypertension and nephrology

[Extrapulmonary multiple organ damage and dysfunction in Covid-19]

KÉKES Ede, NAGY Judit

[SARS-CoV-2 virus attacks nőt only the lungs bút alsó many other or- gans (heart, kidney, liver, pancreas, gastrointestinal tract, brain, hematopoiesis) and regulatory system (RAAS, immuné system) to different degrees and with dif- ferent pathomechanisms. Accordingly, cell death, tissue damage and dysfunction or failure of somé organs has been developed. Our paper provides a detailed analysis of the incidence of extrapulmonary lesions, clinical manifestations, and the underlying pathomechanisms. This multi-organ damages was detected dom- inantly in severe Covid cases, bút may occur in moderate or mild cases. It should alsó be taken intő account that the consequences may occur after the acute phase, in a seronegative State - months after the onset of infection. In particu- lar, the heart (myocarditis, coronary insufficiency, arrhythmia), the kidney (acute renal failure and then permanent GFR decrease), glucose metabolism disorder (diabetes worsening, ketoacidosis, new diabetes) are the biggest therapeutic challenge. Multi-organ damage is due to direct virus-induced cell death, endo- thelial cell damage in the vascular system, and thrombo-inflammation with the formation of microthrombi, imbalance in the RAAS regulatory system, and early and delayed abnormal immuné response (cytokine storm).]

Hypertension and nephrology

[Risk of drug-drug interactions in hemodialyzed patien]

SZABÓ Alexandra, HARIS Ágnes

[Hemodialysis patients usually need large number of medications fór treatment of their multiple comorbidities. Because of the polypharmacy we have to count on several drug-drug interactions, which might necessitate modification of types and dosages of drugs, based on the patient's actual condition and current treatment. The use of anticoagulants causes everyday problems, because these drugs have high pharmacokinetics potency, and on the other hand their administration is indispensable. In our investigation we aimed to analyze the drug therapy of chronic hemodialysis patients in the Szent Margit Hospital Taraba István Dialysis Unit, and present the clinical pharmacist's role in the hospital team.]

Hypertension and nephrology

[Changes in systolic blood pressure in the Hungárián aduit population between 2010 and 2018 based on public health screening data]

KÉKES Ede, BARNA István, DAIKI Tenno, DANKOVICS Gergely

[Using our mobile public health screening system, we examined the changes in systolic blood pressure averages and systolic pressure distribution between 2010 and 2018 by analyzing the data of 72,857 women (mean age 42.3±13.9 years) and 61,563 mén (mean age 42.2±13.9 years) in three consecutive time periods. The SBP averages have been gradually and significantly decreased since 2010 in all age groups. The parametric and non-parametric characteristics of the systolic distribution curves alsó showed a favorable change during the indicated period. The observed changes may indicate that the primary and secondary prevention, as well as the treatment of hypertension and the physician-patient cooperation in Hungarywere successful in the indicated period.]

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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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Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

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Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

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