Hypertension and nephrology

[News of the Hungarian Society of Nephrology]

DECEMBER 20, 2011

Hypertension and nephrology - 2011;15(05)



Further articles in this publication

Hypertension and nephrology

[Antihypertensive therapy in patients with COPD - the significance of nebivolol]


[The occurrence of hypertension associated with chronic obstructive pulmonary disease (COPD) is increasing. Recognising COPD is important in order to choose the appropriate antihypertensive drugs. Anti-hypertensive drugs that can be used to treat patients with hypertension and COPD include diuretics, ACE-inhibitors, angioten-sine receptor blockers (AT1 receptor antagonists) and calcium antagonists, as well as cardioselective beta blockers, as these drugs decrease total and cardiovascular mortality. Of these agents, the importance of the most cardioselective one, nebivolol should be stressed, as this drug has no clinically significant effect on parameters of respiratory function, and, through its additional effects (namely by increasing the synthesis of NO), it has a beneficial effect on COPD-related deterioration of respiratory functions, haemodynamic alterations (cor pulmonale) and local factors that participate in the respiratory inflammation and endothelial dysfunction.]

Hypertension and nephrology

[Similarities and differences in the renal effects of statins]


[By efficiently reducing serum cholesterol level, statins significantly decrease both cardiovascular morbidity and mortality. Decreasing LDL-cholesterol level by 1% reduces coronary mortality risk by 1%, whereas increasing HDL-cholesterol level by 1% reduces the risk by 3%. At the same time, renal failure significantly increases cardiovascular events and/or mortality compared with the population mean. It is an exciting question whether statins are able to prevent and decelerate the deterioration of kidney function deterioration, preserve GFR and decrease albuminuria. Depending on the strength of their effect, statins have different cholesterollowering capacity (rosuvastatin and atorvastatin are especially effective). An important question is whether these differences can be detected in the renal function as well. The results of experimental data and major clinical trials (e.g. AURORA, PLANET I-II, SHARP) are often controversial. Nevertheless, statin therapy has advantages for patients with kidney diseases, although to a lesser extent than it has in the normal population.]

Hypertension and nephrology

[Genetics of isolated steroid-resistant nephrotic syndrome - results of the two decades around the turn of the millennium]

TORY Kálmán, KERTI Andrea, REUSZ György

[Childhood steroid-resistant nephrotic syndrome (SRNS) is a devastating clinical condition which progresses to end-stage renal disease in 30-40% of the cases after a follow up of 10 years. Based on its etiology, two forms can be distinguished, an immune and a genetic form. During the last two decades, mutations of ten genes - encoding mainly podocyte proteins - were identified in the latter group. As the treatment in the immune and genetic forms are different, and only the identification of the causative mutation can reliably distinguish them, it is important to be familiarized with the genotype-phenotype correlations. The aim of the present review is to summarize our current knowledge on the phenotypes linked to the identified genes.]

Hypertension and nephrology

[Association of body composition and mortality in patients on maintenance dialysis and on waitlist and after kidney transplantation]


[Overweight [body mass index (BMI) = 25-30 kg/m2] and obesity (BMI ≥30 kg/m2) are epidemic in both developed and developing countries. Obesity has been recognized as risk factor for the development and progression of chronic kidney disease and is associated with increased cardiovascular risk and poor survival. Almost 2/3 of maintenance hemodialysis patients die within five years of commencing dialysis treatment. Although patients on the waitlist having less severe comorbidities than their non-listed counterparts, the death rate remains high while it can take years for an organ donation. In patients with end stage renal disease (ESRD) undergoing maintenance hemodialysis an “obesity paradox” has been consistently reported, i.e., a high BMI is incrementally associated with better survival. Overweight and obesity are highly prevalent in patients at the time of kidney transplantation. Indeed, most transplant centers in US may suspend wait-listing of obese patients with a BMI above 30 or 35 kg/m2 and refer them for weight reduction procedures such as bariatric surgery as a contingency for the transplant surgery. The effect of pre- and post-transplant obesity in kidney transplanted patients on long-term graft and patient survival has not been well established. We have reviewed and summarized salient recent data pertaining to body composition and clinical outcomes about the association of survival and body composition in transplant-waitlisted dialysis patients and kidney transplanted recipients. ]

Hypertension and nephrology

[Association between complications of percutaneous kidney biopsy and histological diagnosis ]

FISI Viktória, MAZÁK István, DEGRELL Péter, HALMAI Richárd, MOLNÁR Gergő A., FEHÉR Eszter, NÉMETH Kinga, PINTÉR István, KOVÁCS Tibor, WITTMANN István

[Background: Percutaneous renal biopsy is an essential tool in diagnosis and prognosis of renal diseases. It is well-known that this method has potential complications. The connection between complication occurrence related to renal biopsies and histological diagnoses of the biopsy specimen was analyzed in the present study. We also analyzed the distribution of diagnoses in our population. Methods: In this retrospective survey, 353 patients undergoing renal biopsy was studied. Biopsies were performed after marking the site of puncture with ultrasound imaging. Influence of diagnoses and clinical parameters on complications was evaluated. Results: We found a complication rate of 44.5%. In patients with diabetic nephropathy (likelihood ratio (LR) 0.44) or acute tubular necrosis (LR 0.38) a significantly lower rate of complications was found, while patients with thin basement membrane syndrome had more than 6-fold higher risk for evolvement of intrarenal haemorrhage. Patients with acute interstitial nephritis (LR 3.18) or vasculitis (LR 2.88) have a more than 2-fold risk for arteriovenous shunts while in patients with severe arteriosclerosis the occurrence of this complication was lower (LR 0.46). In rapidly progressive glomerulonephritis, arteriovenous shunts evolved also in a significantly higher rate. Conclusion: Patients with vasculitis, rapidly progressive glomerulonephritis, thin basement membrane syndrome or acute interstitial nephritis should be monitored more carefully after renal biopsy due to the significantly higher risk for complications. ]

All articles in the issue

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Lege Artis Medicinae

[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]


Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]


[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Lege Artis Medicinae

[A short chronicle of three decades ]


[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]

Lege Artis Medicinae

[History of vaccine production in Hungary ]


[This study presents the complete history of the Hungarian vaccine production, partly in association with the process of fighting vaccine-preventable infectious diseases, and underlines the fact that every government actively contributed to the age-adjusted mandatory vaccination schedule of the past 140 years. It demonstrates the various achievements from the smallpox lymph production through the launch of diphtheria serum production at Phylaxia and the establishment of the National Public Health Institute (OKI) with its vaccine production and the later institutional transformation of OKI into Humán as economic corporation to its closure. Among all OKI’s vaccine production activities, this study focuses on the production of influenza vaccines, due to its international importance in the 1960s and 1970s. The vaccine production against diphtheria tetanus and pertussis stands out from Humán’s activities, and the tetanus component of this vaccine is still used in the products of a multinational vaccine manufacturer. ]

Lege Artis Medicinae

[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]


[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]