Hypertension and nephrology

[The prognostic role of serum albumin levels in survival of chronically hemodialized patients]

KULCSÁR Imre, SZAKÁCS Gyuláné, SZEGEDI János, KISS István

SEPTEMBER 21, 2012

Hypertension and nephrology - 2012;16(03-04)

[The authors have investigated the survival of 238 patients on chronic haemodialysis program regarding serum albumin levels (measured at starting dialysis and at the end of observation) adjusted for age, gender, diabetes, serum haemoglobin and body weight. The mean observational period was 5.5 years. Our investigation has documented a tight positive correlation between the survival and serum albumin levels both at starting and ending of investigation independently of epidemiological parameters. It was demonstrated that serum albumin levels decrease by aging, so the authors recommend a little bit lower serum albumin target level for older dialyzed people, because the normal range is also decreasing by aging. The level of serum albumin has not shown changing in younger patients (less than 60 years) in this long observational period, but there was a significant decrease in olders (especially above 70 years).]

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Hypertension and nephrology

[Etiology and diagnosis of renal failure after pediatric cardiac surgery]

TÓTH Roland, CSERÉP Zsuzsanna, SZÉKELY Andrea

[Acute kidney injury is a common and severe clinical problem in children after cardiac surgery, defined by abrupt decline in renal function, with manifestations ranging from minimal elevation of serum creatinine to anuric renal failure. The condition can have a negative influence on the long-term outcome of the illness. The problem is more likely in pediatric cardiac surgery, where the low birth-weight neonates and premature infants can be even more affected. On the other hand chronic renal disease can occur as a severe consequence of acute renal failure. The standard methods to diagnose the acute renal failure in patients are henceforward good applicable, but besides these based on the latest articles of scientific journals there are a lot of new alternatives, which could help us to establish the diagnosis of renal failure more quickly and correctly. These renal specific biomarkers and proteins could predict renal failure sensitively and specifically. Although the applicability of these methods is limited yet, there are a lot of cardiac centres for children, where they are used as routine tests.]

Hypertension and nephrology

[Professor István Taraba MD., the scientist, physician and man. - „Difficulties are to defeat them!”]

POLNER Kálmán

[Only few such outstanding physicians lived, whose achievements and personality influenced the development of the Hungarian nephrology as remarkably as professor István Taraba did. He started his university career as an experimental researcher at the Institute of Physiology on Semmelweis University, Budapest, then at the age of 34, after completing his Ph.D thesis, decided to treat patients to utilize his acquired knowledge in the field of renal failure’s pathophysiology. This way he devoted himself to cure patients with kidney failure being in very poor circumstances at that time. Besides his daily clinical activity, he accomplished outstanding organizing work in establishing and leading the Hungarian Nephrology Society, and also in initiating specialty training for nephrologists and nephrology nurses. The hallmark of his professional work was that in spite of extremely adverse circumstances he forced to improve the quality of dialysis treatment to approach European standards. Among the renal replacement treatment modalities- antecedently to his age - he respected peritoneal dialysis equal to hemodialysis, and attempted to popularize it in his country. Under his leadership the Nephrology Department of Margit Hospital in Budapest became the therapeutic and educational centre of Hungarian nephrology. His achievements have been acknowledged internationally, and his early death is substantial loss for Hungarian nephrology as a whole. It was a great honour to me to work beside him during the whole period he spent in the Margit Hospital, and since March of 1997 I have the opportunity to lead the department he had established in his intellectuality.]

Hypertension and nephrology

[Estimation of serum uric acid in the Hungarian population]

KÉKES Ede, BARNA István, DAIKI Tenno, DANKOVICS Gergely, KISS István

[The clinical significance of serum uric acid markedly increased in the last years, especially in the civilized countries, but the abnormal serum uric acid level shows a significantly strong increasing tendency worldwide. The high level of uric acid is an integral part of metabolic syndrome. Today we recognized the important role of xanthine oxidase in the clinical practice for developing of oxidative stress in some tissues and organs. In 2011 during the Hungarian Health Care Screening Program we analyzed the prevalence of metabolic factors in 18 886 subjects. In the present publication we have dealt with uric acid and calculated the occurrence of abnormal values in percentage of the observed population. We found abnormal values in 12.3% of women (over 350 µmol/l) and 16.5% of men (over 400 µmol/l). The average values were higher in hypertensive subjects against normotensive ones in both gender. There was a close correlation among the metabolic components and the elevated uric acid level. The screening had given a possibility for detecting hidden gout and some other diseases, where the elevated uric acid level is specific of the clinical entity.]

Hypertension and nephrology

[Protein-energy wasting and quality of life in kidney transplant recipients]

UJSZÁSZI Ákos, VÁRADY Tímea, CZIRA Mária Eszter, FORNÁDI Katalin, NOVÁK Márta, MUCSI István, MOLNÁR Miklós Zsolt

[Chronic kidney disease has profound effects on the health related quality of life (HRQoL) of patients with serious physiological, psychological and socio-economic implications. The co-occurrence of protein-energy wasting (PEW) and inflammation in end stage renal disease patients is associated with worse HRQoL and increased mortality. We designed this study to examine the relationship between nutritional and inflammatory status and HRQoL in kidney transplant recipients. Data from 100 randomly selected kidney transplant patients were analyzed in a crosssectional survey. Socio-demographic parameters, laboratory results, transplantation related data, co-morbidities, medication and malnutrition-inflammation score (MIS) (Kalantar Score) were tabulated at baseline. Patients completed the Kidney Disease Quality of Life-SF (KDQoL-SFTM) self-administered questionnaire. Mean age was 51±13 years, median (interquartile range, IQR) time since transplantation 66 (83) months, 57% were males and 19% had diabetes. The median (IQR) MIS was 3 (3). MIS significantly and negatively correlated with almost all HRQoL domains analyzed, and this association remained significant in multivariate linear regression analysis for the log-transformed scores on energy/fatigue (β=-0.059, p<0.001), bodily pain (β=-0.056, p=0.004), physical functioning (β=-0.029, p=0.022), and symptoms/problems (β=-0.023, p=0.005) domains after statistical correction for age, gender, eGFR, dialysis vintage, Charlson Comorbidity Index and occupational status. Additionally, cubic spline analyses revealed linearly increasing, “dose-response” relationship between almost all domains of KDQoL-SFTM and the MIS. Malnutrition Inflammation Score is independently associated with different dimensions of health related quality of life in kidney transplant recipients.]

Hypertension and nephrology

[Effect of bilateral catheter-based renal artery sympathetic denervation on blood pressure, therapy and baroreflex-sensitivity in a patient with resistant hypertension]

LÉGRÁDY Péter, NAGY Ferenc Tamás, THURY Attila, BAJCSI Dóra, FEJES Imola, SIMON Judit, NAGY Endre, UNGI Imre, ÁBRAHÁM György

[Hypertension is a global problem all over the world and also in Hungary. Although there is a wild spectrum of pharmacological and non-pharmacological antihypertensive interventions, the rate of hypertensive patients not achieving the goal blood pressure is still high. Recently developed endovascular catheterbased technology enables selective radiofrequent denervation of kidney through the lumen of renal artery. We report a case of a 52-year old hypertensive women on a combination of 11 antihypertensive medications. A successful sympathetic radiofrequent denervation was performed without complications resulting a decrease in blood pressure and medication and an increase of spontaneous baroreflex- sensitivity.]

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Hypertension and nephrology

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[The authors show the data of Hungarian dialysis statistics from 2003 to 2009. The questionnaire-based data collection was made by the Dialysis Committee of the Hungarian Society of Nephrology. The number of all patients entered in the dialysis program increased by 45.2% over six years (an average of 7.5% per year) and the number of new ones increased by 51.2% (8.5% per year). The increase in number of patients treated with haemodialysis was 39% (6.5% per year) in this period. The increase in the number of patients in the peritoneal dialysis program was extremely high: 80.6% (an average of 13.4% per year). The population incidence of new dialysed patients was 332/1 million in 2003 and 483/1 million in 2009. The population point prevalence at the end of the year was 437/1 million in 2003, but 607/1 million in 2009. The penetrance of peritoneal dialysis was 12.8% in 2009. Differences exist among the regions of Hungary in the number of patients, the penetrance of peritoneal dialysis and the prevalence of renal replacement therapies. Among patients suffering in conditions which lead to end stage renal disease the proportion of patients with diabetic or hypertensive nephropathies is increasing and the proprtion of patients with glomerular or tubulointerstitial damage is decreasing. The number (and rate) of the elderly people is growing continuously year by year. The rate of patients on waiting list for renal transplantation is decreasing (the rate was 20% in 2003, but only 10.7% in 2009). There is also a slow decrease in the number of the annual renal transplantations. The mortality rate of chronically dialysed patients shows a little increase. Five dialysis centres for paediatric patients and 58 for adults have been functioning in Hungary by the end of 2009. In average 106 patients have been treated by each Hungarian dialysis centre in contrast to the optimal of 60 persons. The number of nephrologists increased between 2003 and 2007, but slightly decreased since then. The case is similar regarding nephrological nurses.]

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Long-term follow-up results of concomitant chemoradiotherapy followed by adjuvant temozolomide therapy for glioblastoma multiforme patients. The importance of MRI information in survival: Single-center experience

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