Hypertension and nephrology

[Recent developments in the diagnosis and therapy of haemolytic syndrome.Part 2: Aspects of long-term treatment and prognosis]

PROHÁSZKA Zoltán1,2, SZILÁGYI Ágnes1,2, RÉTI Marienn3, SZABÓ J. Attila4, REUSZ György4

JUNE 10, 2011

Hypertension and nephrology - 2011;15(03)

[In this review the aspects of long-term therapy and patient care with the management of renal transplantation of patients with hemolytic uremic syndrome are summarized. The indication and practice of plasmapheresis in adult and childhood patients are described. Furthermore, additional therapies, such as requirement for immunosuppressive treatment are also mentioned. In addition, detailed information is given about the associations of different genetic variations and risk of renal transplantfailure in these patients. At the end of the review novel observations are summarized about the clinical data obtained with the emerging anti-C5 monoclonal antibody, eculizumab.]

AFFILIATIONS

  1. Semmelweis Egyetem, Általános Orvostudományi Kar, III. sz. Belgyógyászati Klinika, Kutatólaboratórium, Budapest
  2. MTA-SE, Gyulladásbiológiai és Immungenomikai Kutatócsoport, Budapest
  3. Fôvárosi Önkormányzat Egyesített Szent István és Szent László Kórház-Rendelôintézet, Hematológiai és Õssejt-transzplantációs Osztály, Apheresis és Õssejt-feldolgozó Részleg, Budapest
  4. Semmelweis Egyetem, Általános Orvostudományi Kar, I. sz. Gyermekgyógyászati Klinika, Nefrológiai Osztály, Budapest

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Hypertension and nephrology

[My teacher, Pál Gömöri (1905-1973)]

RADÓ János

[Great Hungarian physicians have contributed a lot to the development of international medical science. Pál Gömöri was one of them. It is impossible to list the versatility of his scientific interests, but one of his ambitions was the introduction of the investigational methods of renal nuclear medicine to Hungary. The author’s feeling is that his own activity in renal nuclear medicine concerning “diuretic renography” was inspired partly by the information which was learned from Gömöri. The scientific results produced by Gömöri will be preserved in the libraries and on the internet. The spirit of his medical teaching, however, must be passed over by his students and followers, to provide his remembrance to fade as late as possible ]

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[Measurement of ambulatory arterial stiffness index in kidney transplant children]

DÉGI Arianna Amália, KERTI Andrea, KIS Éva, CSEPREKÁL Orsolya, REUSZ György

[Background: Cardiovascular (CV) diseases are the leading cause of death among renal transplant patients (TX). Ambulatory arterial stiffness index (AASI) has been suggested to individually predict the cardiovascular morbidity and mortality. Our aim was to evaluate the relationship between traditional and nontraditional risk factors and AASI in renal transplant children. Patients and methods: In our cross-sectional study, 35 TX patients (15.6±4.3 years of age) were investigated with 24-h ambulatory blood pressure monitoring and AASI was defined. Anthropometric data, metabolic parameters and body composition values were also assessed. Results: By univariate regression analysis, BMI, volume excess, systolic blood pressure SD score, mean pulse pressure, diastolic diurnal index, nocturnal diastolic blood pressure fall, and the presence of hypertension showed positive correlation with AASI (respectively r=0.53, 0.39, 0.34, 0.33, 0.41, –0.42; p<0.05). Hypertensive patients had higher AASI values (0.47±0.13 vs. 0.36±0.18; p=0.04), which may be due to the longer duration of dialysis and longer time since transplantation (p<0.05). BMI SDS and nocturnal diastolic blood pressure fall remained to be the main predictors of AASI in the whole (R2=0.44, SE=0.14, β=0.34 and –0.30, p=0.03) and in the hypertensive group (R2=0.48, SE=0.10, β=0.47 and –0.41, p=0.01 and 0.02). Conclusion: Early transplantation then the early treatment of obesity and hypertension may be essential in the prevention of target organ damage and CV mortality in children after kidney TX.]

Hypertension and nephrology

[Comparison of HbA1c levels of diabetic and non diabetic patients at a nephrology outpatient department]

MÁCSAI Emília, SZABÓ Emília, KIRÁLY Mónika, BENKE Attila, LAKATOS László

[Introduction: The role of HbA1c in the diagnostic criteria of diabetes has been more emphasized in the american medical literature. The prevalence of disturbed glucose tolerance in adult population is considered significant. In primary care, in case of identified diabetics the regular HbA1c measurement is not used generally. We screened our proteinuric patients on the spot HbA1c measurement selecting the patients with metabolic syndrome and known diabetes. Patients and methods: During the three week period 51 consecutive patients fulfilled the inclusion criteria, we measured HbA1c along with registration of other laboratory and clinical data. Results: In the non-diabetic group five patients showed HbA1c below 5%, 12 patients between 5.1-5.5%, 19 patients in the range of 5.6-6%, and 6 patients above 6%. The rate of proven diabetes was 14% (6/42 patients) by confirmatory laboratory examination. In the diabetic group the HbA1c values were around 6.7% (median; and range 5.2- 7.9%). Conclusion: We do suggest on the spot HbA1c measurement as screening test in patients with high risk of diabetes at the nephrological outpatient department, further laboratory HbA1c analysis and glucose tolerance test can demonstrate the diagnosis. In patients with overt type 2 diabetes it can help to identify those, who should be sent to diabetological consultation.]

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[Combination Treatment with Simvastatin and Ezetimib Reduce the Frequency of Atherosclerotic Events in Chronic Renal Disease]

MÁTYUS János, PARAGH György

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[Launching “Outlook”, a New Reporting Coloumn]

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[Launching the Hungarian Vasculitis Registry aimed to collect information about prevalence and outcome of our patients with ANCA-associated vasculitis, and treatment protocols of the disease. The on-line data collection has been developing dynamically since its initiation five years ago, presently 278 patients’ files are available. Patients’ mean age is 58.2±14.5 years, 62% are women; their disease is associated with c-ANCA positivity in 51% and p-ANCA in 49%. At diagnosis GFR was 24.6±21.6 ml/min/1,73 m2, that time 29%, during the total follow up 39% of the registered subjects needed dialysis. Renal replacement therapy could be discontinued in 23% of them. In cases with focal histological changes, also with upper respiratory tract and skin involvement dialysis was significantly less frequently necessary, which underlines the importance of early diagnosis. In induction therapy steroid was administered for 94% of the patients, 85% of them got cyclophosphamide, 59% was treated by plasmapheresis, 11% got rituximab. Maintenance treat ment contained steroid in 80%, per os cyclophosphamide in 23%, parenteral cyclophosphamide in 22%, furthermore 40% of the patients got azathioprin, 8 subjects got mycophenolate and 6 got methotrexate. Median follow up was 30 months (IQR 6-78), during which period 20% of the patients died, 5% got kidney transplantation, and 5% were lost to follow up. Median survival was 14.8 years, five years survival was 85%, and ten years survival was 70%. Long term survival in patients with c-ANCA vasculitis seemed better comparing to p-ANCA vasculitis, but when correcting by age this difference disappeared. Predictors of death were age and dialysis dependent renal failure. Relapses developed in 27% of patients, 28% of them presented in the first year, 21% suffered it after five years of care. Collected data by the Hungarian Vasculitis Registry shows our society’s successful professional activity. Our results are comparable to the published data in the literature, yet there are several areas in our care where further improvements are warranted in order to increase our patient’s survival and quality of life.]

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