Hypertension and nephrology

[Pyelonephritis acuta]

APRIL 29, 2021

Hypertension and nephrology - 2021;25(2)

[Primarily bacterial infections (E. coli, Proteus mirabilis, Klebsiella, Enterococcus), tubules, interstitium, acute inflammatory condition of the renal calves and pelvic pelvis. Most often as a result of ascending urinary tract infection less frequently due to haematogenic variance. Risk factors for the development of diabetes are immunosuppressive condition, obstructive in maintaining urinary retention uropathies (kidney stones, tumors, or congenital urotra or acquired dysfunction and / or anatomical abnormalities), and instrumental interventions on the urinary tract and pregnancy.]



Further articles in this publication

Hypertension and nephrology

[Current evidence on the accuracy and precision of non-invasive cardiac output monitoring]

VÉGH Anna, REUSZ S György

[Purpose of review: Assessing cardiac output (CO) is an important part of monitoring the hemodynamically unstable patients. Different non-invasive CO measurement devices are currently available, that can be useful in various clinical situations. The purpose of this article is to review current literature on commonly employed methods especially regarding their accuracy and precision. Results: Most of the devices, especially the non-invasive ones have the disadvantage of questionable accuracy and precision. Generally speaking, the more a method is based on assumptions and mathematical models, the less precise it will be. There is also significant heterogeneity between individual studies. Clinically it is important to consider the purpose of the measurement before choosing a method. In terms of accuracy the most reliable ones are, the ones that are based on simple physical principles and minimal assumptions, for example transthoracic echocardiography, and thermodilution. Conclusions: To have better comparability between individual studies it would be imperative to have standardized study protocols regarding the number of cardiac cycles assessed, the used method, the clinical environment, the age and clinical condition of the study population.]

Hypertension and nephrology

[At the doorstep of an attitude change: our novel knowledge on renal fibrosis in chronic kidney disease]


[In spite of the diverse etiology, chronic kidney disease is finally leading to end-stage renal disease uniformly by the fibrotic transformation of the kidneys. In recent years – mainly due to experimental data – the explanation of this transformation changed profoundly: it has been revealed, that renal fibrosis is a dynamic, actively ongoing process involving many keyfactors. Influencing these factors, give us hope to prevent the progression of chronic kidney disease. This review summarizes the connection of renal fibrosis and chronic kidney disease, the results of the widely used different methods and the recently discovered mechanisms, which caused paradigm change in this topic]

Hypertension and nephrology

[When should antihypertensive be taken: in the morning and/or evening? Chronopharmacotherapy of hypertension in practice]


[The circadian (24-hour) variability of blood pressure (BP) is influenced by constant and variable (external and internal) factors. With this in mind and by determining the type of hypertension with a 24-hour blood pressure monitoring (ABPM), individual chronopharmacological (chronopharmacotherapy) treatment can be planned. There are significant differences in the chronokinetics of antihypertensive drugs administered at different times. Their therapeutic range and efficacy depend significantly on their circadian timing. Although the most modern antihypertensives have a 24-hour effect, they are not able to lower blood pressure at all times. Morning intake of ACE inhibitors, ARB-s, alpha-blockers mainly affect the afternoon and early evening rise, while evening intake reduces nocturnal and morning rise. Calcium channel blockers, beta-blockers (except carvedilol and labetolol), do not affect the circadian blood pressure profile. Therefore, in nondipper hypertension or in the case of morning rise, the twice daily morning and evening administration is more effective than the single morning administration. (Usually a lower dose is sufficient in the evening.) Adequate control of nocturnal or morning blood pressure elevations can be achieved with medication taken in the evening. According to the relevant studies the conclusion is that there is no convincing evidence that the administration of BP-lowering drugs in the evening provides any significant advantage in terms of quality of BP control, prevention of target organ damage or reduction of cardiovascular events, so evening intake only is not recommended. In particular the administration of antihypertensive drugs at bedtime, especially in the case of elderly patients may cause excessive BP fall at night with increased risk of silent cerebral infarct and the myocardial ischemia in patients with coronary heart disease.]

Hypertension and nephrology

[Primary aldosteronism, the mysterious object of desire – in the context of a study]


[The aldosterone-producing adenoma, aldosteronoma, the actual Conn syndrome, is a relatively well-defined entity, while the separability of idiopathic hyperaldosteronism and low-renin primary hypertension appears to be inherently uncertain according to our current knowledge. In this way, the diagnosis of primary aldosteronism (PA) is in fact more or less probabilistic and this also contributes fundamentally to the uncertainty of prevalence data. These are confirmed by a recent study in which PA was evaluated in the form of 24- hour urinary aldosterone excretion measured with oral salt loading instead of the standard technique. The paper has contributed to the change of paradigm by which the chair of the most widely accepted PA guideline, renewed in 2016, called to be jettisoned much of it.]

Hypertension and nephrology

[Covid-19 and peripheral arterial disease]

FARKAS Katalin

[Patients with peripheral vascular disease (PAD) are negatively affected by the coronavirus epidemic in several ways. Fewer-than-usual doctor-patient encounters make it more difficult to detect disease or disease progression. Outbreaks due to the epidemic reinforce a sedentary lifestyle that can mask the symptoms of PAD through lack of exercise. Another risk is that patients with cardiovascular disease are at risk for severe Covid-19 disease, and have a significantly increased risk of mortality. In the case of home treatment of Covid-19 infection in a patient with PAD, close observation is required to make a timely decision on the need for hospitalization. Vaccination, which is gradually available to all PAD patients, could be the solution to prevent the disease.]

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Hypertension and nephrology

[Infections associated to vesicoureteral reflux disease in children below 1 year of age: the infulence of continuous antibiotic prophylactic therapy on the prevalence of resistant pathogenic bacteria]


[Background: The primary goal when children with vesicoureteral reflux disease (VUR) are treated is the prevention of pyelonephritis and persisting renal damage. Continuous antibiotic prophylaxis (CAP) is usually applied to reach this aim. The selection of resisting pathogens is the major risk of CAP. The aim of our survey was to describe the patterns of pathogenic strains leading to pyelonephritis in patients treated with and without CAP. Patients and method: The pathogenic strains implicated in pyelonephritis were identified in 48 and 56 children below 1 year of age who were treated with or without CAP, respectively, between years 2006 and 2011. Results: Breakthrough urinary tract infections developing in the presence of CAP are more frequently (with about a double risk) caused by polyresistant bacteria compared to infections that emerged without CAP. Nevertheless, it should be noted that the prevalence of resistant pathogens was about 40% even in infants without CAP. Discussion: The pattern of pathogenic strains leading to pyelonephritis alters significantly even in the cohort of children below 1 year of age treated with CAP to prevent infections associated to VUR. The risk may be decreased through the rational use of antibiotics. To reach this goal national guidelines on VUR should be updated and the role of additional non-antibiotic treatment should be established.]