Hypertension and nephrology

[State Ceremony on the 150th Anniversary of the Birth of Sándor Korányi ]

RADÓ János

OCTOBER 20, 2016

Hypertension and nephrology - 2016;20(05)

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Hypertension and nephrology

[Letter to the Reader]

A szerkesztôség

Hypertension and nephrology

[Hemodynamic approach of the treatment of hypertension. The possible role of impedance cardiography in the tailored antihypertensive therapy]

SIMONYI Gábor, ZSUZSA Pál

[It is important to achieve the blood pressure targets in the course of antihipertensive therapy. It will be beneficial to increase the proportion of patients on blood pressure target to avoid adverse cardiovascular consequences. In hypertension the main definition the elevation of blood pressure alone, but in hypertension are several abnormalities of cardiac output, systemic vascular resistance, stroke volume and arterial compliance too. Impedance cardiography is a simple highly accurate non-invasive device to assess hemodynamic parameters in hypertension. Hemodynamic assessment may help in the treatment of hypertension. Various authors report the improving rate of blood control rate using impedance cardiography which may decrease the risk of target organ damage.]

Hypertension and nephrology

[A new perspective on the extrarenal regulation of sodium and water balance]

AGÓCS Róbert István, SUGÁR Dániel, SULYOK Endre, SZABÓ J. Attila

[The regulation of the homeostasis of sodium and water is one of the oldest fields in medical research. Our article exhibits a new aspect of sodium balance: the concept of the regulated sodium storage taking place in the interstitium of the skin. We summarize the history of the research carried out in this area, beginning with the discovery of osmotically inactive sodium reservoirs to the localization of these buffers and the elucidation of the role of a regulating cutaneous cascade, which has an effect on blood pressure. Glycosaminoglycan (GAG) macromolecules present in the skin interstitium, come into reversible contact with the excess of dietary sodium intake. Thus in addition to the known role of the kidney, the above system may contribute to the regulation of sodium- and water balance and thereby to the regulation of blood pressure.]

Hypertension and nephrology

[Dialysis treatment in Hungary: 2010–2015]

KULCSÁR Imre, ILLÉS Melinda, KOVÁCS LÁSZLÓ

[The authors show the data of Hungarian dialysis statistics from 2010 to 2015. The questionnaire - based data collection was made by Dialysis Registry Committee of the Hungarian Society of Nephrology. The number of all patients entered in the dialysis program increased by 8.4% over six years (an average of 1.4/ per year) and the number of new ones increased by 10.5% (1.75% per year). Between 2003 and 2009 the mean annual increasing of new patients was 7.5%! The incidence of new dialyzed patients was 440/1 million population in 2010 and 486/1 million) in 2015. The population point prevalence at the end of the year was 621/1 million in 2010 and 643/1 million in 2015. The penetrance of peritoneal dialysis was 13.5% in 2010, and 13.6% in 2015. The proportion of incident patients with diabetic or hypertensive nephropathies (conditions which lead to end stage renal disease) was about the same in 2010 (27 and 21%) than in 2016 (27 and 22%). The mean age of incident patients entered into dialysis program decreased from 66.9 years (2010) to 62.8 years (2015), surprisingly. The rate of patients on waiting list for renal transplantation was 10.7% in 2009 and increased to 15,8% in 2015. There is also a significant increase in the number of the annual renal transplantations (268 in 2010 and 356 in 2015). The mortality rate of chronically dialyzed patients shows little decrease (14.4-13.1%).]

Hypertension and nephrology

[Quality of Life: How Health is Considered. A European Comparison ]

KÉKES Ede, REKETTYE Gábor

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Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.

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[The aim was to assess the levels of burnout and depressive symptoms among nursing staff members. We designed an online questionnaire for the present cross-sectional study, which was filled out by 10 285 participants between 01-27-2022 and 02-14-2022. The mean score of burnout showed a decrease compared to the score measured in 2021; however, the percent of nursing staff members suffering from burnout is still high (64.4%), from which 42% indicates severe burnout which would requires treatment. Concerning depressive symptoms, 57.8% of participants did not indicate the presence of depression, the rest presented different levels of depressive symptoms (6.8% showed severe depressive symptoms). Currently patients’ chance of recovery is under the expected level of what our healthcare system could provide, which is partially due to the affected mental state of healthcare nursing staff.]

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[In pregnancy complicated with diabetes, treatment of hyperglycaemia is of fundamental importance during delivery in order to improve the outcome parameters of both the mother and the neonate. This is particularly important in the case of mothers with type 1 diabetes and of all mothers who require insulin treatment during their pregnancy. The use of antenatal steroids for women at risk of pre-term birth further complicates the treatment of hyperglycaemia in the period immediately before delivery and requires the appropriate change of insulin therapy. The requirement of nil per os in the delivery period necessitates proper fluid, glucose and insulin treatment in the pre-delivery hours. After surgical delivery the patients may also need infusion treatment until the first meal. As there is no unified guideline for the peripartum management of diabetes, the author re­views the international literature on the internal medicine issues concerning the peripartum treatment of pregnant women with diabetes. This study reviews the characteristics of insulin treatment of women with various types of diabetes before, du­ring and di­rect­ly after delivery. It presents a dosing schedule for women who needed an antenatal steroid treatment in the period before delivery due to premature birth for the purpose of lung maturation. The study also addresses the application and programming of pe­ripartum blood glucose tests, continuous interstitial glucose monitoring (CGM) and insulin pump treatment (CSII).]