Hypertension and nephrology

[Nutritional recommendations during the Covid-19 epidemic]

VÁLYI Péter

JUNE 24, 2020

Hypertension and nephrology - 2020;24(3)

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Hypertension and nephrology

[Dear Reader]

KÉKES Ede, ALFÖLDI Sándor

Hypertension and nephrology

[Treatment of hypertension in patients with chronic renal failure]

SZLOVÁK Edina, SZILVESZTER Dolgos

[The prevalence of chronic renal failure and hypertension is steadily increasing worldwide. The risk of possible cardiovascular death in patient with advanced renal failure is greater than the risk of progression to end-stage renal failure. Therefore treating and achieving target blood pressure is important in order to slow renal function decline in parallel with cardiovascular risk reduction. However, guidelines do not specify a single blood pressure target to be achieved in patients with renal failure, but suggest evidence based, reno- and cardioprotective therapy. This paper summarizes the clinical practice of treating hypertension (drug and nondrug treatment, therapeutic algorithm, target value, effectiveness of therapy) in patients with chronic renal failure.]

Hypertension and nephrology

[Covid-19 and the kidney]

PATÓ Éva, DEÁK György

[Covid-19 pandemy has emerged from Wuhan, China in December 2019. The infection affects not only the lung but other organs such as the kidney, as well. The relation between Covid-19 infection and the kidney is bidirectional. On one hand, Covid-19 infection may cause kidney damage in 50-75% of the cases resulting in proteinuria, haematuria and acute kidney injury (AKI). The etiology of AKI is multifactorial. Main pathogenic mechanisms are direct proximal tubular cell damage, sepsis-related haemodinamic derangement, citokine storm and hypercoagulability. The virus enters proximal tubular cells and podocytes via the ACE2 receptor followed by multiplication in the lysomes and consequential cell lesion. Histopathology shows acute tubular necrosis and acute tubulointerstitial nephritis. AKI is a strong predictor of mortality in critically ill patients. On the other hand, the risk of Covid-19 infection and mortality is substantially increased in patients with chronic kidney disease – especially in those with a kidney transplant or on dialysis – due to their immunocompromised status. Among haemodialysis patients, infection may spread very easily due to the possibility of getting contacted in the ambulance car or at the dialysis unit. The mortality rate of patients on renal replacement therapy with Covid-19 infection is 20-35%. In order to avoid mass infection it is obligatory to employ preventive measures and implement restricions along with (cohors) isolation of infected patients. In Hungary, every dialysis or kidney transplant patient with Covid-19 infection should be admitted to dedicated Covid-19 wards.]

Hypertension and nephrology

[Hypertension and Covid-19 – Part I. Significance of age, underlying diseases, and ACEI/ARB therapy in hypertension and co-morbidities during SARS-Cov2 infection]

KÉKES Ede, SZÉKÁCS Béla, NAGY Judit, KOVÁCS Tibor

[The appearance of the Covid-19 epidemic in different continents shows specific clinical features. Confirmed infected patients are detectable from approximately 30 years, with a maximum between 40 and 70 years of age. At the same time, however, a significant proportion of those who die from the infection come from patients over 65 years. The prevalence and mortality rates of the hypertensive population show a very similar formation. Based on the data collected, it is not surprising that hypertension as the underlying disease in the Covid- 19 epidemic is the first in all analysis. A more precise analysis clarified that it is not hypertension per se, but co-morbidities and complications of hypertension that play a primary role behind large-scale mortality in old age, such as diabetes, coronary heart disease, stroke, heart failure, and chronic kidney disease. Data from China, North America, and Italy suggest that hypertension and diabetes – and in North America, pathological obesity – in infected patients actually only reflect the prevalence of these diseases in a given population. The presence of comorbidities (coronary artery disease, stroke, heart failure, arrhythmia, chronic kidney disease) – based on multivariate logistic regression analysis – presents a more risk for severe clinical course and mortality. Some recent analyses have provided strong evidence that ACEI/ARB treatment does not pose a higher risk for the course or outcome of infection. Their administration is constantly needed in hypertension and comorbidities due to their organ protective and slowing the progression of diseases.]

Hypertension and nephrology

[Systolic and diastolic blood pressure by height, BMI, gender and age between 14 and 18 years of age]

SZABÓ László, SCHEURING Noémi, GÁCSI Erika, KORMOS-TASI Judit

[The aim of the screening program was to investigate blood pressure levels in different ages according to obesity. Blood pressure, heart rate, body composition, bodyweight, height and BMI were assessed. 2202 adolescent (1326 girls, 876 boys) participated in the screening program. The mean systolic blood pressure of all screened adolescents was 126.34 ± 12.55 mmHg. Boy/girl values were 131.87 ± 13.59/117.49 ± 5.69 mmHg, p < 0.001. The mean diastolic blood pressure of all screened adolescents was 71.86 ± 8.74 mmHg. Boy/girl values were 72.61 ± 9.17/66.69 ± 5.04 mmHg, p < 0.001. The 50%, 90%, 95%, and 99% thresholds and cases for systolic, diastolic blood pressure, and the BMI and BodyFluid thresholds, detailed for 14–18 year olds, girls and boys, are tabulated. Systolic blood pressure (SBP) was over 99% in 12 girls (14- year-olds), 39 (15), 42 (16), 33 (17), 5 (18) to height. SBP was over 99% in 17 boys (14-year-olds), 73 (15), 100 (16), 33 (17), 5 (18) to height. It is emphasized that systolic blood pressure (SBP) is > 99% in 12 girls (14 years), 39 (15), 42 (16), 33 (17), 5 (18) to body height. SBP > 99% for 17 boys (14 years), 73 (15), 100 (16), 33 (17), 5 (18) to body height. Elevated diastolic values were associated with elevated systolic values, but less occurred. The percentage of high blood pressure was more frequent among boys and girls who were in the overweight group (58.6% and 18.6%). Normal blood pressure is higher in overweight and obese adolescents and is a significant risk factor for developing high blood pressure in young adulthood.]

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Hypertension and nephrology

[Dietary treatment of dialysis patients]

ZAKAR Gábor

[Adequate nutritional indices and intake are the corner stone of long term success of renal replecement therapies (hemo- and peritoneal dialysis, transplantation) characterized by favourable survial rates and a good quality of life. There has been no major change in basic principles of nutritional prescription (protein, energy, fluid intake, restriction of sodium, potassium and phosphorous), increasing emphasis has been placed on the reduction of calcium load and ”native” vitamin-D therapy in these patients. Less avareness has been put however in the past ten years (according to recent metaanalyses) on the role and replacement of the full scale of vitamins, in spite of their occasionally altered metabolism and replacement-requirements in ESRD patients. Usually there is a need for their replacement, but some of them are represented in abundant, sometimes toxic amounts in commercially available multivitamin preparates. With in the scope of general aspects of nutrition in ESRD patients, the article gives a detalied overview of their multivitamin recommendations and alternatives of a specified substition.]

Hypertension and nephrology

[Covid-19 and the kidney]

PATÓ Éva, DEÁK György

[Covid-19 pandemy has emerged from Wuhan, China in December 2019. The infection affects not only the lung but other organs such as the kidney, as well. The relation between Covid-19 infection and the kidney is bidirectional. On one hand, Covid-19 infection may cause kidney damage in 50-75% of the cases resulting in proteinuria, haematuria and acute kidney injury (AKI). The etiology of AKI is multifactorial. Main pathogenic mechanisms are direct proximal tubular cell damage, sepsis-related haemodinamic derangement, citokine storm and hypercoagulability. The virus enters proximal tubular cells and podocytes via the ACE2 receptor followed by multiplication in the lysomes and consequential cell lesion. Histopathology shows acute tubular necrosis and acute tubulointerstitial nephritis. AKI is a strong predictor of mortality in critically ill patients. On the other hand, the risk of Covid-19 infection and mortality is substantially increased in patients with chronic kidney disease – especially in those with a kidney transplant or on dialysis – due to their immunocompromised status. Among haemodialysis patients, infection may spread very easily due to the possibility of getting contacted in the ambulance car or at the dialysis unit. The mortality rate of patients on renal replacement therapy with Covid-19 infection is 20-35%. In order to avoid mass infection it is obligatory to employ preventive measures and implement restricions along with (cohors) isolation of infected patients. In Hungary, every dialysis or kidney transplant patient with Covid-19 infection should be admitted to dedicated Covid-19 wards.]

Hypertension and nephrology

[Hypertension and Covid-19 – Part I. Significance of age, underlying diseases, and ACEI/ARB therapy in hypertension and co-morbidities during SARS-Cov2 infection]

KÉKES Ede, SZÉKÁCS Béla, NAGY Judit, KOVÁCS Tibor

[The appearance of the Covid-19 epidemic in different continents shows specific clinical features. Confirmed infected patients are detectable from approximately 30 years, with a maximum between 40 and 70 years of age. At the same time, however, a significant proportion of those who die from the infection come from patients over 65 years. The prevalence and mortality rates of the hypertensive population show a very similar formation. Based on the data collected, it is not surprising that hypertension as the underlying disease in the Covid- 19 epidemic is the first in all analysis. A more precise analysis clarified that it is not hypertension per se, but co-morbidities and complications of hypertension that play a primary role behind large-scale mortality in old age, such as diabetes, coronary heart disease, stroke, heart failure, and chronic kidney disease. Data from China, North America, and Italy suggest that hypertension and diabetes – and in North America, pathological obesity – in infected patients actually only reflect the prevalence of these diseases in a given population. The presence of comorbidities (coronary artery disease, stroke, heart failure, arrhythmia, chronic kidney disease) – based on multivariate logistic regression analysis – presents a more risk for severe clinical course and mortality. Some recent analyses have provided strong evidence that ACEI/ARB treatment does not pose a higher risk for the course or outcome of infection. Their administration is constantly needed in hypertension and comorbidities due to their organ protective and slowing the progression of diseases.]

Lege Artis Medicinae

[The significance of the identification of SARS-CoV-2 virus and the possible errors of the sampling method]

NOSZEK László

[The COVID-19 pandemic caused by SARS-CoV-2 virus while emerging suddenly and spreading throughout the globe challenged seriously also the modern medicine. Diag­nostic methods recognising viral infections of the upper airways developed essentially in the last 20 years, and it was specifically progressing during the SARS and MERS epidemics thus facilitating the recognition and identifica­tion of infections by influenza, RS- and adenoviruses as well. Nevertheless the present novel coronavirus (SARS-CoV-2) also de­mon­strated that the relatively simple procedures of naso- and oropharyngeal sampling are fallible too. Thus they may have a relatively high risk of false-negative outcomes. However the correct sampling prior the RT-PCR tests provides reliable diagnosis by high sensitivity and specificity. Thus improving the quality of sampling and avoiding failures by correct training and education of the personnel make more reliable the detection of viral infection or indicate recovery after the infection. Finally, this is a key issue while overcoming the present pan­demic.]

Lege Artis Medicinae

[Case report about the choice of care at Olajág Elderly Home in Budapest during the COVID-19 epidemic in spring 2020]

PETRÓ Kata, PETKE Zsolt, RADNAI Zoltán, SZIRMAI Viktor

[During the COVID-19 pandemic caused by the SARS-CoV-2 virus, elderly people in long-term nursing homes were espe­cially risks exposed. In this study, the au­thors analyse the causes of local outbreak at the Olajág Elderly Home Vezér street facility in Budapest and the means and ways to curb the spreading of infection. They summarise the measures, which proved to be effective in isolation and treat­ing the patients. The number of infected residents as well as the course of the disease are demonstrated by statistical data. The authors consider as pre-eminently important to identify asymptomatic but in­fec­ted residents, further the rapid introduc­tion of screening tests, strict compliance with protocols, patient path regulation and the use of enhanced, supportive communication.]