Hypertension and nephrology

[The Principles of Mediterranean Diet]

KÉLES Ede

OCTOBER 20, 2018

Hypertension and nephrology - 2018;22(05)

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Hypertension and nephrology

[Hungarian Vasculitis Registry – results of the first five years]

HARIS Ágnes, TISLÉR András, ONDRIK Zoltán, FILE Ibolya, MÁTYUS János, ZSARGÓ Eszter, DEÁK György, AMBRUS Csaba

[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.]

Hypertension and nephrology

[The new European ESH/ESC guidelines - Part II. Therapy]

FARSANG Csaba

[The most important features of the new European joint hypertension guidelines of the European Society of Hypertension (ESH) and European Society of Cardiology became available as lectures at the ESH meeting in Barcelona, in 2018 June, while the publication came out in the Journal of Hypertension and also in the European Heart Journal in August, 2018. Based on the published new guidelines I summarise its most important therapeutic suggestions.]

Hypertension and nephrology

[The actual aspects of the medical therapy of PAD patients after endovascular intervention. Through the eyes of an angiologist]

JASSÓ István

[After endovascular intervention in PAD the optimal medical therapy is essential for improving the patency and the quality of life as well as the cardiovascular risk reduction. According to the current guidelines the author gives an overview of the routine therapy and the possible advantages of longtermuse of cilostazol for these patients.]

Hypertension and nephrology

[The importance of recognition and proper treatment of hypertension and the maintenance of adherence in hypertension care]

NEMCSIK János, PÁLL Dénes, JÁRAI Zoltán

[Hypertension is the leading cause of death and disability-adjusted life years. In the United States hypertension accounts for more cardiovascular (CV) deaths than any other modifiable CV disease risk factor and was second only to cigarette smoking as a preventable cause of death for any reason. In our country the situation is similar. In Hungary the number of subjects with hypertension is approximately 3.5 million and this high prevalence contributes markedly to the poor Hungarian CV morbidity and mortality figures. The recognition of hypertension, the initiation of drug therapy and the long-term follow- up of the patients is mainly the task of primary care. Besides that it inheres high responsibility, this is also a grateful commitment, as hypertension in most of the cases can be treated properly with lifestyle-changes and medications leading to a marked decrease of CV complications, especially stroke. In our review article we would like to focus on the high prevalence of hypertension worldwide as well as in our country, the exact implementation of screening, the risk reduction potential of the proper treatment and the importance of the long-term maintenance of treatment adherence.]

Hypertension and nephrology

[Report of the 26th Postgraduate Training Congress of the Hungarian Society of Hypertension]

NEMCSIK János

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Hypertension and nephrology

[“Diet” Soft Drinks Increase Blood Pressure More than Those with Added Sugar]

VÁLYI Péter

Lege Artis Medicinae

[Drug treatment possibilities in chronic liver diseases]

HAGYMÁSI Krisztina, LENGYEL Gabriella, FEHÉR János

[Alcoholic and drug induced liver diseases, nonalcoholic steatohepatitis, hepatitis C and B chronic hepatitis, autoimmune diseases (primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis) and metabolic disorders (hemochromatosis, Wilson's disease) are the main chronic liver diseases. Authors summarize, based on the latest literature data, the medications of chronic liver diseases, emphasizing the treatment of the everyday practice. Natural and synthetic antioxidants are approved for the treatment of chronic alcoholic liver diseases besides abstinence, with diet of adequate quality and quantity. Nucleoside analogues (lamivudin) are recommended for the first-line therapy of the treatment of chronic hepatitis B. Interferon is presently considered the optimal treatment for only certain patients. Interferon and ribavirin combined therapy is well-established in the treatment of chronic hepatitis C. Ursodeoxycholic acid is the beneficial treatment option for primary biliary cirrhosis and primary sclerosing cholangitis. Prednisolon and azathioprine constitute the basic therapy of autoimmune hepatitis. Presumably, in the future, new strategies based on immunosuppressive combinations will play a crucial role. The chelating deferoxamine has less important part in the treatment of hemochromatosis. D-penicillamine still plays principle role in the medication of Wilson's disease.]

Lege Artis Medicinae

[Renal care - possibilities of complex organ protection]

WAGNER Gyula, AMMA Zoltán, JUHÁSZ László, KULCSÁR Katalin

[The authors analyse data of the last ten years of renal care. According to the principles of care they prefer to have contact at least once to all patients with an estimated clearance less than 60 ml/min, and on a regular basis to those with less than 30 ml/min. Their fundamental ambition is to develop the most favourable therapy for the patients together with general practitioners and with representatives of other specialities. The most important aim is to reduce cardio-renal morbidity and mortality. Early detection and effective treatment of target organ damage are the tools for this. It is clear from their previous work that it was not successful in the first period of care (2000-2005) especially in patients with diabetic nephropathy. Before the initiation of renal replacement therapy only half of the patients have been seen by a nephrologist. One-year-mortality after initiating dialysis was significant among patients who did not receive such care. Their medication was also not up-to-date. Through regular continuing medical education for general practitioners and in close collaboration with diabetologist colleagues the number of patients taken care of has doubled. Furthermore, the proportion of patients with hypertension or diabetes as an underlying disease among the patients receiving renal care increased to 68%. These findings may contribute to that their patients receive effective treatment taking the actual therapeutic recommendations into account. Hopefully it will be apparent in the hard end-points at the time of the analysis of the second period.]

Hypertension and nephrology

[Kidney diet and the patient compliance issue ]

LADÁNYI Erzsébet

[There have been significant developments in the field of nephrology and dialysis as for the science and technology are concerned in the past decades. However, CKD patients still show high mortality and morbidity. From among the several factors determining the long-term outcome of CKD patients metabolic disorder and malnutrition play an important role. Malnutrition is often not diagnosed or is not paid enough attention to in the complex treatment of CKD patients. It is important to make both the patients and clinical staff more aware of proper nutrition and importance of prevention and treatment of malnutrition, respectively. The early diagnosis and treatment of malnutrition is of utmost importance in CKD patients. The long term renal failure and the accompanying malnutrition have a negative impact on their long term outcome and quality of life. Since the malnutrition causes a lot of complications, it is indispensable for dietitians and nephrologists to work closely together. Patient compliance is a determining factor in the successful implementation of renal diet.]

Clinical Neuroscience

[Neurology! Adieau? (Part 1)]

SZIRMAI Imre

[The neurological practice suffered considerable changes during the last twenty years. The recent therapeutic methods and the acceptance of the ideology of evidence based medicine, which is based on confidence in statistics, changed the reasoning of the neurologists. Therapy protocols intrude into the field of individual medicine, and doctors accept treatment schemes to alleviate responsibility of their decisions. In contrast with this, recent achievements in pharmacogenetics emphasize the importance of individual drug therapies. The protocol of intravenous cerebral thrombolysis does not require defining the origin of cerebral ischaemia in the acute stage, therefore, this procedure can be regarded as human experiment. According to the strict protocol thrombolysis might be indicated only in 1-8% of patients with cerebral ischaemia. According to the Cohrane database more trials are needed to clarify which patients are most likely to benefit from treatment. Because of the change in therapeutic principles transient ischaemic attack has been newly defined as “acute neurovascular syndrome”. Multiplication of neurological subspecialties has been facilitated by the development of diagnostic tools and the discovery of effective new drugs. The specialization led to narrowing of interest and competency of clinicians. Several new neurological scientific societies were founded for the representation of specific disorders. In Hungary, between 1993 and 2000 nine scientific societies were grounded within the field of clinical neurology. These societies should be thankful to the pharmaceutical industries for their existence. In some European countries in 2007 only three neurological subspecialties were accepted, which are neurophysiology, neuro-rehabilitation and childneurology. Neuro-radiology is in the hands of general radiologists, the specialization is not granted for neurologists. Because of the subspecialization the general professionalism of neurologists has diminished. Among young neurologists the propedeutic skills suffered most seriously. Subspecialisation of teachers also interferes with the practice oriented teaching of medical students and residents.]