Hypertension and nephrology

[The interpretation of metabolic syndrome]

KÉKES Ede, KISS István

DECEMBER 08, 2012

Hypertension and nephrology - 2012;16(05)

[The significant increase of the splanchnic ectopic fat, the disturbance of carbohidrate metabolism, atherogenic dyslipidemia and high blood pressure creates the syndrome so called deadly quartet. These components promote the early appearance of cardiovascular diseases (ischemic heart disease, stroke, peripheral artery disease, etc.) as well as the enormous growth of type 2 diabetes mellitus. It was thought, that the ectopic fat is the only background of the syndrome and the insulin resistance with hyperinsulinemia as well as the disruption of associated endocrine regulatory balance system and elevated sympathetic drive explain jointly the clinical events. We now know that cytokines released by ectopic fat issue (CRP, TNF-α, IL-6 etc.) launch processes in our organism, which contribute to the development of vascular remodelling, endothelial dysfunction and in the end to that of atherothrombotic processes. The diagnostic criteria of the syndrome were changed continuously parallel growing theoretical knowledge till 2009, when on the Harmony Conference the important components of the syndrome were accepted, but some laboratory and other parameters do not enter into everyday praxis.]



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Hypertension and nephrology

[News of the Hungarian Society of Nephrology]

Hypertension and nephrology

[Role of ramipril/amlodipine fixed combination in treatment hypertension of patients with chronic kidney disease]


[Hypertension is an important risk factor of chronic kidney disease (CKD) however CKD can cause hypertension. Untreated CKD may result in renal failure. Hypertension and CKD are important cardiovascular risk factors. Several mechanisms play role in the worsening of renal function. The main pathogenetic factor is the increased activity of the renin-angiotensin-aldosteron system (RAAS) that can result in glomerulosclerosis, destroy of nephrons and proteinuria. In the treatment of hypertension in CKD patients inhibiting RAAS is very important because ACE-inhibitors and angiotensin-receptor blockers provide efficient control not only of blood pressure, but also of proteinuria, an effect associated with improved long-term nephroprotection. Between ACE-inhibitors ramipril has proved nephro- and cardiovascular protection effect. Fix combination therapy of ramipril with amlodipine has a very pronounced blood pressure lowering effect and can improve patient compliance too.]

Hypertension and nephrology

[Association between the genetic polymorphism of heat-shock protein 72 and pediatric kidney diseases]

BÁNKI Nóra Fanni, RUSAI Krisztina, KÁROLY Éva, SZEBENI Bea, VANNAY Ádám, SALLAY Péter, REUSZ György, TULASSAY Tivadar, SZABÓ J. Attila, FEKETE Andrea

[Recurring urinary tract infections (UTI) in childhood may result in chronic- and end-stage-renal-disease (ESRD), which leads to the initiation of dialysis and renal transplantation (NTx). Heat shock protein (HSP) 72 protects the kidney, whereas it refolds destroyed proteins and cells, and helps regenerating the renal tissue. The HSPA1B (1267)G allele is associated with lower HSP72 expression. This study assesses the role of HSPA1B A(1267)G polymorphism using PCR-RFLP in 103 children treated because of recurrent UTI, 26 children after NTx and 235 healthy controls. Clinical data were also evaluated. HSPA1B (1267)GG genotype and HSPA1B (1267)G allele occurred more frequently in the UTI (p=0.0001; CI: 1.378-2.68) and in the NTx (p=0.014; CI: 2.29-187.7) patient group than in the controls group, and were associated with a higher risk for scarring (p=0.012; CI: 0.33-1.00) and renal malformation (p=0.0072; CI: 1.623- 140.6). Our data indicate a relationship between the carrier status of HSPA1B (1267)G allele and the development of recurrent UTI and ESRD, raising further questions about the clinical and therapeutic relevance of these polymorphism.]

Hypertension and nephrology

[The history of diuretic treatment in Hungary. Part I. Imre Fodor]

RADÓ János

[The diuretic effect of mercurial compounds was discovered in 1920. However, the term of “mercurial diuresis” was created 36 years earlier by Ernő Jendrassik. Imre Fodor published his experiences with the mercurial diuretic, which has been cited by several authors worldwide. The Hungarian pharmaceutical industry also took its part from the production of the mercurial diuretic with Novurit that proved to be an excellent and worldwide well known preparation in the next 40 years. Even Imre Fodor required the repeated administration of mercurial diuresis because of his severe cardiac oedema in the last period of his life. When the drug became ineffective, i.e. developed refractory oedema, he made a “self-experiment” with the administration of ACTH to restore the sensitiveness to the mercurial diuretic on the basis of most recent American literature at that time. His experience has been published by his colleagues just before his death. Imre Fodor was an eminent clinician, a school creating internist who entered his name into the science dealing with the use of diuretics.]

Hypertension and nephrology

[News of the Hungarian Society of Hypertension]

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After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose – The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.

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