Lege Artis Medicinae



DECEMBER 20, 2003

Lege Artis Medicinae - 2003;13(08)

[The relentless increase of patients with kidney failure requiring renal replacement therapy has been documented world-wide. Recently, diabetic renal diseases has become the major cause of end-stage renal disease in the United States and in western Europe and is forecasted to become the most frequent cause of end-stage renal disease in Hungary. The most common renal lesion in type 1 as well as in type 2 diabetes is diabetic nephropathy. However, in the last few years numerous studies have demonstrated that there is a difference between patients with type 1 and those with type 2 diabetes in the expression and frequency of their renal disease. In type 1 diabetes a histological examination should only be made when a patient has features atypical of diabetic nephropathy and the indications of renal biopsy are well known. At the same time there is no agreement on renal biopsy indications in type 2 diabetes. In this review, we will summarise the characteristic features of diabetic nephropathy and other kidney alterations in the diabetic patient. Furthermore, we will raise the question of the renal biopsy indications and the more extensive use of the renal biopsy in type 2 diabetic patients for more effective prevention and treatment strategies.]



Further articles in this publication

Lege Artis Medicinae

[Scientific Browsing]

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VERESS Gábor, BERÉNYI István, SIMON Attila

[Cardiac rehabilitation programs are performed to decrease the physiologic and psychological effects of cardiac illness, reduce the risk of reinfarction and cardiac symptoms, stabilize the arteriosclerotic process and enhance the psychosocial status of selected cardiac patients. The cardiac rehabilitation intervention should be integrated into multifactorial secondary prevention program involving hospital phase, medical evaluation and adequate oral and interventional treatment, risk factor modification, prescription of exercise training, education and psychosocial counseling. These rehabilitation programs should be followed by long term risk reduction and secondary prevention program directed by the family physicians. On the basis of the review of scientific literature, the authors present the important components of cardiac rehabilitation and address actual objectives like new indications, selection of a professional rehabilitation team, appropriate training programs, counseling and education.]

Lege Artis Medicinae

[Nobel Prize in Medicine for the Pioneers of MR Imaging]


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[The method of gradual limb lengthening plays a significant role in equalizing limb discrepancies, making dwarfs taller, correcting axial and other deformities coexisting with limb deficiency. Limb lengthening is carried out by one of two basic methods: diaphyseal lengthening with the Wagner unilateral distraction apparatus or metaphyseal lengthening with a series of rings and crossed K-wires. Gradual limb lengthening is presently having its golden days. At our institution 302 limb lengthening intervention were done between 1977 and 2002, 164 cases with Wagner, 137 cases with Ilizarov method, and one distraction epiphyseolysis. In average, 4.1 cm lengthening was achieved, 18.4% of the original length of the bone. The high incidence of complications was due to superficial infections at the entry points of the Kwires, infrequently worsening the outcome of the operation. Operative limb lengthening performed with appropriate indications and technique is a successful and rewarding area of orthopaedic surgery.]

Lege Artis Medicinae


NAGY Viktor

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[Mazes and compass in prognostic value of cardiovascular risk factors]

KÉKES Ede, KISS István

[The risk assessment of cardiovascular disease is dispensable in everyday practice, because this disease-group gives the high-est death rates all over the world - in developed countries, in Central European Region, including Hungary. Based on reliable surveys world side, we need in addition to coronary heart disease, stroke has been reckoned today to peripheral vascular disease, type-2 diabetes, and chronic kidney diseases as well. It seems useful to the new name i.e., atherosclerotic cardiovascular diseases. It stands as smoking, hypertension, dyslipidemia risk factors among this group of diseases in the background, but more and more importance is given to visceral obesity, physical inactivity, alcohol consumption and psycho-social status. It has to count with the fact that the individual factors together and appear further worsen to mortality rate. The greatest interference arises because the cardiovascular risk estimation proposed by embodiments of non-uniform principles. Undoubtedly, the resolution of ACC/AHA 2010 was the first correct compass, because the classification and utility values of the factors precisely regulated. But in addition, it is essential that in the risk assessment not only the “global estimation” (tables, other forms) will be conducted, but also other important parameters characterizing the extended factors (vascular structure, obesity, psycho-social status, etc.) - set schedule and regulations - acting on to be carried out. We presented in cardiovascular risk assessment methodology and the most profitable methods of estimation based on the preventive guidelines, extern opinions generally accepted now and own experiences. We propose to modify the risk assessment me-thod.]

Lege Artis Medicinae

[The sensor-augmented insulin pump and its use in clinical practice]


[Diabetes is one of the most common chronic diseases. Technological advances provide increasingly refined tools for clinicians to manage type 1 and type 2 diabetes. Continuous subcutaneous insulin infusion (CSII), also known as insulin pump, allows for a sophisticated delivery of basal as well as bolus insulin. Continuous glucose monitoring helps patients and clinicians understand and manage changes in blood glucose trends and minute-to-minute blood glucose variablitiy. The sensor-augmented insulin pump was created by the merging of these devices, which has been a revolutionary step towards self-regulatory, closed-loop insulin delivery or the creation of an artificial pancreas.]

Hypertension and nephrology

[How can we improve the chronic renal patient care?]


[The author summarizes on the base of forty year’s experience in the field of Hungarian nephrological care, that which are the main developmental problems and possibilities in the clinical nephrology and in dialysis therapy in Hungary recently. There is a clear claim to change in the training of nephrological nurses and nephrologists, and it is very important the organized education of predialysis patients, improving capacity of outpatient nephrological care in his opinion. He recommends organizing the total nephrological care in every county (except nephropathology and renal transplantation) and changing the relevant health law. He emphasizes the importance of conservative care in chronic kidney diseases and home renal replacement therapies. Highly educated nurses must play much more important role in care of dialyzed patients (with more competencies). It is very important planned start in dialysis, and instead of uniform regimes, the therapy provided individually. He suggests measuring of the health-related quality of life regularly and the survival of patients on renal replacement therapy, also. It would be important to determine the residual renal function in dialysis program, monthly. He is considering the phenomenon of “recovery of renal function” and the problem of withdrawal of dialysis.]

Journal of Nursing Theory and Practice

[Patients with type-1 and type-2 diabetes mellitus in the program of peritoneal dialysis]


[Aim of the research: To evaluate the efficacy of the treatment and incidence of complications in diabetes type 1 and 2 patients treated with peritoneal dialysis. Research and sampling methods: During a retrospective study with 85 diabetic PD patients (19 type 1 patients and 66 type 2 patients) was compared data of 22 years with regard to the following parameters: Glucose metabolism, body weight, changes in residual urine clearance values, distribution of quantity and glucose content of the solutions used, incidence of infections, and average duration in PD programme before transferring to haemodialysis. Results: All patients, irrespective of their type of diabetes: spend the same time in PD on average, gained body weight during PD. Diabetes type 1 patients: had a lower residual urine clearance, had HbA1c values decreasing during PD, reported peritonitis less frequently, had a higher incidence of catheter-related infections. Diabetes type 2 patients: had a better glucose metabolism, had a higher body weight from the beginning of therapy, required PD solution with higher glucose concentration. Conclusions: Diabetes patients, irrespective of the type of diabetes, can successfully be treated with PD, but require more attention because of their underlying disease and associated complications. ]

Hypertension and nephrology

[Predictive factors for ischemic heart disease, diabetes mellitus and chronic kidney disease among hypertensive patients based on the data of the Hungarian Hypertension Registry 2011-2013-2015. Part I. Hypertensive population aged 35 to 64 years]

KÉKES Ede, PAKSY András, SZEGEDI János, JÁRAI Zoltán

[The association of hypertension with ischemic heart disease, diabetes and chronic kidney disease is the greatest therapeutic challenge because these associations significantly increase mortality and deteriorate life expectancy. It is important for the clinician to clarify the predictive factors of each association for successful prevention or slowing the progression of diseases. According to the database of the Hungarian Hypertension Registry 2011-2013-2015, 11,137 men and 11,112 women with hypertension and comorbidities (CHD, diabetes, CKD) aged between 35 and 64 were analyzed for the purpose of assessing the predictive value of the traditional risk factors in co-morbidity. We analyzed the predictive weight of each variable with single- and multi-variable stepwise logistic regression, and reported Odds ratio (OR, odds ratio). In patients with hypertension aged 35-64 (male / female), the prevalence of CHD was 41.6% / 35.8%, diabetes 27.1% / 23% and KVB 16.2% / 33.8%, respectively. The chance of developing CHD is highest in hypertensive individuals (male/female) who have diabetes (OR 1.30/1.48), who are obese (OR 1.22/1.21), who smoke (OR 1.50/1.51), and whose blood pressure >140/90 mmHg (OR 1.23/1.29). The dominant predictive factors of type 2 diabetes are obesity (visceral obesity) (OR 1.46/1.49), low HDL cholesterol (OR 1.32/1.35), and high triglyceride levels (OR 1.20/1.42); in women the uric acid level also showed high odds ratio (OR 1.39). There is a significant chance of developing chronic kidney disease in hypertension in both sexes, if abnormal uric acid levels (OR 1.73/1.46) and inadequate treatment of high blood pressure (>140Hgmm SBP) (OR 1.43/1.19) are present. In women, the abnormal triglyceride level) also showed a high odd (OR 1.81).]