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Hypertension and nephrology

APRIL 24, 2020

[Polycystic kidney]

DOLGOS Szilveszter, TÁRNOKI Ádám Domonkos, TÁRNOKI Dávid László

[The most common monogenic nephropathy is a congenital, cystic, bulky process in the kidney that leads to a gradual deterioration in renal function. Renal failure is often associated with cystic liver or pancreatic lesions, cerebral artery aneurysm, or mitral prolapse.]

Hypertension and nephrology

APRIL 24, 2020

[Cardiovascular risk assessment in chronic kidney disease, significance of left ventricular myocardial mass index]

SÁGI Balázs, KÉSŐI István, VAS Tibor, CSIKY Botond, NAGY Judit, KOVÁCS Tibor

[Introduction: Earlier studies have shown that cardiovascular (CV) mortality and morbidity in chronic kidney disease (CKD) often exceed their average population, and left ventricular hypertrophy (LVH) is an independent risk factor for CV disease. However, in CKD, the relationship between LVH, arterial stiffness (AS) and renal function has not yet been fully elucidated. Little data is available on their prognostic role. Aims of our study a) cross-sectional examination of the relationship between left ventricular mass index (LVMI), arterial vascular stiffness, and renal function, b) in our follow-up study, clarification of the LVMI, the prognostic role of AS in patients with CKD, IgA nephropathy (IgAN). Methods: In our cross-sectional study, 79 IgAN patients were examined in our clinic. The myocardial mass index (LVMI) was determined using an estimation formula after echocardiographic measurements. Arterial stiffness was measured using a photoplethizmography technique (PulseTrace) and characterized by the stiffness index (SI). The MDRD formula was used to estimate renal function (GFR) (eGFR, ml/min/1.73 m2). In the prognostic study the primary combined endpoint was total mortality, the most important CV events (stroke, myocardial infarction or cardiovascular interventions such as revascularization) and end stage renal disease. Secondary endpoints were CV and renal endpoints separately. Results: Of the 79 patients included in our cross-sectional study, 50 were men, with an average age of 46 ± 11 years. The mean value of LVMI was 106.66 ± 22.98 g/m2. Patients were divided into groups of 115 g/m2 for males considered to be abnormal and 95 g/m2 for women. LVMI is closely correlated with SI and inversely with eGFR (corr. coeff: 0.358; p <0.05 or -0.526; p <0.001). In case of LVH, SI was significantly higher in both sexes (p = 0.005 in males, p = 0.04 in females). In case of higher LVMI, renal function was significantly lower (p = 0.002 in males, p = 0.01 in females). Metabolic syndrome occurred in several cases in both sexes with LVH, but the difference was only significant in male patients (males 6 vs. 10, p = 0.008; females 2 vs. 4, p = 0.29). In our follow-up study, the presence of LVH in men significantly reduced survival in both primary and secondary endpoints, whereas in women there was no significant difference. Conclusion: In IgAN decreasing of renal function is closely related to left ventricular hypertrophy and vascular stiffness, as well as a close relationship was found between LVMI and AS. Reduced renal function is associated with an increase in LVMI and an increase in AS, which may result in a worse prognosis for both CV and renal outcomes. The underlying role of all these can be assumed to be a common vascular and myocardial pathological remodeling.]

Lege Artis Medicinae

NOVEMBER 15, 2019

[The hypertensive, non-diabetic nephropathy]

LÉGRÁDY Péter

[According to the increase of the number of the hypertensive patients the prevalence of hypertensive nephropathy will increase also. According to the data in the Registry of Hungarian Society of Hypertension, in 2015 the proportion of hypertension patients with chronic kidney disease was 12.3% of the males, 39.1% of the females and generally 26.1% of all the hypertensives. In Hungary the hypertensive nephropathy was the 2nd most common condition led to chronic dialysis in 2010 and 2015 (21% and 22%). According to the Hungarian Society of Hypertension 2018 Guideline the classic inhibitors of the renin-angiotensin system can decrease significantly the progression of renal function decline and the proteinuria. ]

Hypertension and nephrology

JUNE 20, 2019

[Overview of a 10 years kidney biopsies data from the Nephrological and Blood Pressure Center Szeged]

[The authors retrospectively analyzed the data of kidney biopsies performed between 01/01/2007 and 31/12/2016 performed in the Center. During this period 452 biosies were performed. Mean age of patients was 48.7±15.0 years, of them, 43.5% were man and 56.5% women. The nephrotic syndrome was the most common (38.8%) clinical indications for a biopsy. The mos common histological diagnoses were the membranous nephropathy (16.7%), the IgA nephropathy (11.6%) and the FSGS (10.9%). The most common suggestions by nephrologists were the FSGS (17.4%), the membranous nephropathy (16.1%) and the IgA nephropathy (10.3%). These percentages of diabetic nephropathy were 7.5% and 12.2%. Minor complications not requiring any interventions occured in 98 cases (21.7%), major ones in 13 cases (2.9%). By the results FSGS seems to be overrated by nephrologists, but it is among the 3 most common histological findings. Diabetic nephropathy is a similarly excessive clinical diagnosis, sithence the histologically confirmed diagnoses are only a little more than half of it. Regular meetings of pathologists and nephrologists about clinical suggestions and real histological diagnoses may help to improve the ratio of more accurate suggestions.]

Hypertension and nephrology

DECEMBER 10, 2018

[Prognostic role of arterial stiffness in IgA nephropathy]

SÁGI Balázs, KÉSŐI István, VAS Tibor, CSIKY Botond, KOVÁCS Tibor, NAGY Judit

[Background: Arterial stiffness has a prognostic role in chronic cardiovascular diseases. Pulse wave velocity (PWV) determined by the carotid-femoral pulse detection is accepted as a gold standard method. Further diagnostic procedures are in use to assess the arterial stiffness including the finger photoplethysmography. The prognostic role of this method is limited in chronic renal diseases. The goal of our investigation was to determine the prognostic significance of the stiffness index (SIDVP) measured by the photoplethysmographic method in IgA nephropathy. Patients and methods: One hundred and three histologically proved IgA nephropathy patients with chronic kidney disease stage 1-4 were investigated (67 male, 36 female, 45 ± 11 years) and followed for an average 65 (6-107) months. The stiffness index was determined by the volume alteration of the digital artery during the cardiac cycle (Pulse Trace system, Micro Medical, Gilingham, Kent, UK). The primary combined end point was total mortality, major cardiovascular events (stroke, myocardial infarction or cardiovascular procedure, for example revascularisation) plus achieving end stage renal disease. The secondary end points were cardiovascular and renal end points alone. Results: The patients with increased stiffness index (> 10 m/s) had significantly more combined primary end point events (10/60 vs. 19/43, P = 0.015). In case of the secondary end points the renal end points were significantly more frequent in patients with higher stiffness index. Stiffness index has also proved to be an independent predictor on survival from other cardiovascular risk factors (age, hypertension, diabetes, obesity, lipid disturbances and decrease of renal function) using the Cox regression model in IgA nephropathy. Every 1 m/s increase in stiffness index resulted a 17% gain in the occurrence of the combined primary end point. Conclusions: Stiffness index determined by finger photoplethysmography is an eligible parameter to assess the prognosis in IgA nephropathy. Increased stiffness index in IgA nephropathy seems to be a good prognostic tool for identification of higher risk patients.]

Hypertension and nephrology

SEPTEMBER 14, 2018

[Role of ketoanalogue amino acids and diet in the treatment of patients with chronic kidney disease]

KISS István, HARIS Ágnes, DEÁK György

[Low protein diet is an important component of the non-pharmacological treatment of patients with chronic kidney disease (CKD). Along with the diet it is important to maintain appropriate energy intake to avoid malnutrition. It is recommended to supplement low protein diet (0.6-0.7 g protein/kg body weight/day) with essential amino acids and their ketoanalogues (ketoacids) in a dose of 1 tablet/8-10 kg body weight if there is a threat of protein malnutrition (eg. vegan diet). Very low protein diet (0.3-0.4 g protein/kg body weight/day) should be supplemented with ketoacids in a dose of 1 tablet/5 kg body weight. Low protein diet is recommended for patients with CKD stage 3 and progressively declining renal function, or nephrotic syndrome; in diabetic nephropathy; in CKD stage 4 and non-dialyzed CKD stage 5. Nephroprotective effect of very low protein diet is primarily expected is patients with an eGFR below 20-25 ml/min/1.73 m2 and good compliance. Dietary protein restriction may diminish acidosis and proteinuria, slow the progression of CKD and delay initiation of dialysis. Diets reduced in protein supplemented with appropriate energy intake and ketoacids are nutritionally safe. Dietary education and guidance of patients by qualified dietitians are of great importance in nephrology clinics. We illustrate the main points of our review with case reports.]

Lege Artis Medicinae

MARCH 20, 2017

[County level mortality data of urogenital system in Hungary between 2010-2014]

KISS István, PAKSY András

[According to The International Statistical Classification of Diseases and Related Health Problems (10th Revision, ICD 10; XIV), urogenital diseases resulted in an average 910 yearly deaths in Hungary from 2010 through 2014, less than 1% of the cumulative mortality rate. Out of all urogenital conditions, kidney and bladder diseases were the leading cause of death, accounting for nearly 85 percent of all deaths in the examined period. It should be noted that mortality due to urogenital cancers, renovascular hypertonia, diabetic nephropathy, congenital malformations and pathologies related to childbirth and pregnancy are excluded from consideration in the present review. As the Hungarian Central Statistical Office does not disclose the causes of death by age and gender at its county-level data, this paper reports gender-specific mortality rates. Due to the fact that the county-level mortality rate of urogenital diseases is low and the yearly standard deviation is high, the five-year overall mortality rate of 2010-2014 is presented. Hungarian counties differ greatly in terms of mortality from urogenital diseases. The number of deaths per 100 000 population ranges between 6.74 in Békés county and 16.38 in Fejér county. Counties within the same region may exhibit substantially different mortality rates. An overall 7.01 deaths per 100 000 population was reported in Győr-Moson-Sopron county, whereas among residents of the neighbouring Vas county the rate was reported as 14.73 per 100 000 population. The observed variations prevail even when standardised mortality rates are compared and thus the differences in the counties’ age distributions are accounted for. Regional differences become more apparent when only the deaths caused by kidney diseases are analysed out of all urogenital pathologies. In this case, two- or threefold differences are observed between the respective Hungarian counties. Major disparities are still present between counties within the same region. For example, the number of deaths per 100.000 population is 3.74 in Hajdú-Bihar county, and 8.04 in Jász-Nagykun-Szolnok county, respectively. The diagnosis frequency of kidney diseases has a strong positive correlation with case fatality, but it may not fully account for all regional variations in mortality rates. Regional characteristics of dialytic care and the accessibility of dialytic facilities is not related to patient mortality. ]

Hypertension and nephrology

DECEMBER 20, 2016

[New development in the pathogenesis, diagnosis and treatment of IgA nephropathy]

NAGY Judit, VAS Tibor, KOVÁCS Tibor

[IgA nephropathy is one of the leading cause of primary glomerulonephritis worldwide. IgA nephropathy is regarded as an immune mediated disease with a multi-hit pathogenesis starting with the production of poorly glycosylated IgA1 and glycan-specific IgG and IgA autoantibodies leading to the formation of IgA1 containing immune complexes. These immune complexes deposit in the glomerular mesangium followed by the onset of mesangioproliferative glomerulonephritis. The disease has variable clinical presentation and outcome. There is a need to identify patients who have the potential to progress to end-stage renal disease with the help of clinical, histological and biological markers. Treatment options for IgA nephropathy are largely based on opinion or weak evidence. It is true for the KDIGO Clinical Practice Guideline for Glomerulonephritis treatment recommendations containing low level of evidence for almost all recommendations related to IgA nephropathy. It is suggested to separate the patients into 3 groups on the basis of risk to progression and to give not-specific supportive treatment (especially angiotensin converting enzyme inhibitors or angiotensin receptor blocking agents) to all of them on the basis of the risk factors. We discuss the recommendations of the KDIGO Guideline about steroid and immunosuppressive treatment for moderate and high risk patients. Lastly, we provide our perspective on the existing other treatment options (tonsillectomy etc.) and on ongoing clinical trials.]

Hypertension and nephrology

SEPTEMBER 20, 2015

[The role of sodium-glucose cotransporters in diabetic nephropathy]

HODREA judit, BALOGH Dóra Bianka, LÉNÁRT Lilla, KŐSZEGI Sándor, HOSSZÚ Ádám, VANNAY Ádám, WAGNER J. László, REUSZ György, SZABÓ J. Attila, FEKETE Andrea

[Diabetic nephropathy is the main cause of chronic kidney disease affecting about one-third of type 2 diabetic patients. The exact pathomechanism is not known, therefore the treatment and the prevention is still unsolved. However appropriate glycemic control and lowering blood pressure significantly slow the progression of kidney damage these treatment options are still not enough to stop renal injury. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are the newest drugs in the treatment of diabetes. By inhibiting the glucose reabsorption in the proximal tubules SGLT2 inhibitors lower blood glucose level and facilitate glucosuria. This paper summarizes the effect of SGLT2 inhibitors currently approved in Europe paying particular attention to their possible renoprotective effects.]