Hypertension and nephrology

[The Effects of Focused Ultrasound on Glomerular Filtration]

FISCHER Krisztina

NOVEMBER 20, 2010

Hypertension and nephrology - 2010;14(06)

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Hypertension and nephrology

[Pleiotropic effects of vitamin-D mainly related to the cardiovascular system]

NAGY Judit, KOVÁCS Tibor, KÖVESDY Csaba

[Hypovitaminosis D has emerged as a risk factor for multiple adverse outcomes, including cardiovascular and cancer related morbidity and mortality. Observational studies along with laboratory investigations have lead to the discovery of the pleiotropic effects of vitamin D which affect a variety of physiologic processes such as blood pressure regulation, cell proliferation or the modulation of inflammation, and may account for the many negative clinical outcomes associated with hypovitaminosis D. Our article reviews studies that describe the incidence and prevalence of hypovitaminosis D, and the various adverse outcomes that low serum vitamin D has been linked with. This review will provide the reader with a better understanding of why vitamin D is currently regarded as a very promising area of research to try and lower adverse outcomes in a variety of patient groups and in the general population, with the main emphasis on patients with chronic kidney disease (CKD). Most of our discussion on the harmful effects of hypovitaminosis D will concentrate on conditions related to cardiovascular disease morbidity and mortality due to the significance of these in patients with CKD, with less mention of other deleterious effects related to low vitamin D levels such as malignancies.]

Hypertension and nephrology

[Protective Effects of Vitamin D in Patients with Chronic Renal Disease]

KÖVESDY Csaba, NAGY Judit

Hypertension and nephrology

[Erythropoiesis-stimulating agents and oxidative stress in hemodialysis patients]

MONOSTORI Péter, S. VARGA Ilona, KISS József Zoltán, KISS István, HASZON Ibolya, PAPP Ferenc, SÜMEGI Viktória, BERECZKI Csaba, NÉMETH Ilona, TÚRI Sándor

[Oxidative stress plays an important role in the elevation of the cardiovascular risk of patients with chronic kidney insufficiency. The oxidative stress becomes more severe together with the deterioration of the renal function, and the hemodialysis sessions may also induce repetitive oxidative insults. Erythropoesis-stimulating agents (ESAs) may alter the level of oxidative stress via their effects on hematopoiesis, resulting in indirect effects on changes of iron metabolism and the levels of antioxidants. We review the current knowledge about the administration of ESAs as concerns effects on oxidative parameters in hemodialysis patients. We discuss the relationship between the characteristics of the ESA therapy (type, administration frequency and dosage of ESA, length of the therapy, administration withdrawal) and the oxidative stress in view of earlier and recent research.]

Hypertension and nephrology

[Is there a connection between neuropathy and hypertension?]

ISTENES Ildikó, KERESZTES Katalin, KEMPLER Péter

[Neuropathy is usually not an independent entity, its symptoms usually occur as part of other underlying diseases. Diabetes, chronic alcoholism, chronic liver diseases and chronic kidney diseases belong to the most important pathogenetic factors of neuropathy. It is less well known that neural damage may occur among patients with hypertension as well. Autonomic and sensory nerve dysfunction are considered as progressive forms of neuropathy. Both of them are associated with poor prognosis while quality of life is also significantly impaired among these patients. Key clinical characteristics of sensory and autonomic neuropathy are reviewed. There is a relationship between autonomic neuropathy and hypertension in patients with diabetes. Parasympathetic neuropathy and as a consequence relative sympathetic overactivity seems to have a pathogenetic role in this respect. The prevalence of previously unknown hypertension is doubled in diabetic patients with autonomic neuropathy - ambulatory blood pressure monitoring is suggested to be performed among these patients. The authors provided evidence that autonomic and sensory nerve dysfunctions are frequent complications of essential hypertension as well, which are closely related to traditional cardiovascular risk factors. Their observations may confirm the role of vascular factors in the pathogenesis of neuropathy.]

Hypertension and nephrology

[Focus on central arterial pressure. Beta blockers - one group of agents with different efficacy]

BARNA István

[Not only have beta blockers excellent antihypertensive effect but both in monotherapy and in combination they exert antiarrhythmic and antiischemic efficacy, as well. They are recommended on A level of evidence in the treatment of patients with primary hypertension. Certain beta blockers differ from each other considering their lipid solubility, membrane stabilizing effect and in many other characteristics which difference can be exploited in the treatment. Nebivolol increases the release of nitrogen oxide, it is metabolically neutral and has vasodilating and antioxidant effect. The consequence of the stiffness of the arterial wall is the rise of systolic blood pressure, the diminshed diastolic circulation in the coronary vessels, the increase of the central pulse pressure and the frequent occurrence of cardiovascular diseases. Various antihypertensive agents have different mode of action on central blood pressure and arterial stiffness. Comparing nebivolol/atenolol and nebivolol/bisoprolol, respectively, nebivolol decreased aortic pulse pressure with greater efficacy than other beta blockers. The extent of the reduction of blood pressure was the same in the nebivolol and atenolol group while the augmentation index decreased significantly among the patients receiving nebivolol. In addition to the well known beneficial effects of nebivolol recent studies proved another, yet still unknown and unique characteristic of this agent, i.e. favourable influence on arterial stiffness. It not only improves endothelial dysfunction which has emphasized role on development of atherosclerosis but - independently of its antihypertensive effect - it has favourable action on arterial stiffness, too. These features guarantee a decisive position in the treatment of arterial hypertension.]

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Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

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[The rapidly spreading SARS-CoV2 respiratory virus has evoked an epidemic with serious aftermath around the world. In addition to the health effects, the global economic damage is actually unpredictable. At the same time, the pandemic has launched a series of unprecedented collaborative scientific research, including the development of vaccines. This study summarizes up-to-date information on vaccines, immune memory, and some emerging clinical effects.]

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[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]

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A variant of Guillain-Barre syndrome after SARS-CoV-2 vaccination: AMSAN

TUTAR Kaya Nurhan, EYIGÜRBÜZ Tuğba, YILDIRIM Zerrin, KALE Nilufer

Introduction - Coronavirus disease 2019 (COVID-19) is a respiratory infection that has rapidly become a global pandemic and vaccines against SARS-CoV-2 have been developed with great success. In this article, we would like to present a patient who developed Guillain-Barré syndrome (GBS), which is a serious complication after receiving the inactive SARS-CoV-2 vaccine (CoronaVac). Case report – A 76-year-old male patient presented to the emergency department with nine days of progressive limb weakness. Two weeks prior to admission, he received the second dose of CoronaVac vaccine. Motor examination revealed decreased extremity strength with 3/5 in the lower extremities versus 4/5 in the upper extremities. Deep tendon reflexes were absent in all four extremities. Nerve conduction studies showed predominantly reduced amplitude in both motor and sensory nerves, consistent with AMSAN (acute motor and sensory axonal neuropathy). Conclusion - Clinicians should be aware of the neuro­logical complications or other side effects associated with COVID-19 vaccination so that early treatment can be an option.

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The applications of transcranial Doppler in ischemic stroke

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Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.