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Hypertension and nephrology

SEPTEMBER 10, 2019

[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.]

Hypertension and nephrology

SEPTEMBER 10, 2019

[Role of IL-10 family of cytokines in kidney fibrosis]

PAP Domonkos, VERES-SZÉKELY Apor, SZEBENI Beáta, SZIKSZ Erna, KISS József Zoltán, TAKÁCS István Márton, REUSZ György, SZABÓ J. Attila, VANNAY Ádám

[Chronic renal failure is a major health problem, affecting 8 to 16% of the population. Regardless of the etiology the common hallmark of chronic renal failure is inflammation, leading to the activation of renal myofibroblasts. Chronic activation of myofibroblasts lead to abnormal accumulation of extracellular matrix, disruption of the architecture of the kidney and finally to reduced renal function. Although our knowledge is rapidly expanding about the pathomechanism of chronic renal failure, we still have no drug to treat or hinder the progression of the disease. In our present review article, we summarize the role of the cytokines of the IL-10 family in renal scarring.]

Hypertension and nephrology

JUNE 20, 2019

Hypertension and nephrology

JUNE 20, 2019

[Experimental models of renal fibrosis]

KÖKÉNY Gábor

[The high incidence of chronic kidney diseases and, regardless of the etiology, their progression to renal fibrosis with end-stage renal failure rise the urgent need to reveal the pathomechanisms. As the disease leads to complex changes in the body, it is essential to use in vivo model systems for these investigations. Animal experiments choosing the appropriate model system helps to develop more sensitive early diagnostic markers and new therapeutic approaches. Several animal experimental model descriptions can be found in the literature, which mimic specific or more general human diseases in order to help the better understanding of the pathomechanisms. Using these model systems, we are able to analyze the detailed pathophysiology of glomerulonephritis, tubulointerstitial fibrosis, glomerular scarring or generalized renal fibrosis. The most commonly used model systems for renal fibrosis are presented and discussed.]

Lege Artis Medicinae

MAY 20, 2019

[Notes on the management of hypertension in chronic kidney disease ]

AMBRUS Csaba

[The prevalence of hypertension among pa­tients with chronic kidney disease is high, reaching more than 80%. Hypertension is both one of the main causes and also the most common consequence of chronic kidney disease. It is also a main factor responsible for the high cardiovascular morbidity and mortality in this patient population. Blood pressure control can improve patient outcomes, lower cardiovascular risk and slow down the progression of kidney dis­ease, irrespective of the underlying cause. The optimal therapy should therefore focus not only on blood pressure reduction but also on renoprotection. Basic understanding of the renal pathophysiology in hypertension and renal effects of various medications is of paramount importance. In this review, we summarized cornerstones of the antihypertensive therapy in patients with chronic kidney disease. The management of patients receiving kidney replacement therapies, such as hemodialysis, peritoneal dialysis or transplanta­tion requires special knowledge and expe­rience, therefore it is not discussed here. The aim of this review was to allow non-nephrologist physicians to take care of their kidney patients with more confidence and effectiveness.]

Hypertension and nephrology

MAY 10, 2019

[Hungarian dialysis statistics: changing trends in the renal epidemiology]

KULCSÁR Imre, KISS István, SZEGEDI János

[In the last 30-35 years, dialysis care in Hungary has been a major development: both the incidence and prevalence of patients have increased year by year. Over the last decade, growth has slowed and is becoming more and more stabilized (similar trends can be seen in dialysis statistics in developed countries). Behind the dialysis indication the acute kidney injury (AKI) is more common than the end-stage renal disease (ESRD). The latter incidence has been stable for last 6 years (200-230 patient/million population). The annual average growth rate of prevalent dialysis patients was only 0.9%/year in the last 6 years. Among prevalent dialysis patients, the proportion of diabetic patients has remained unchanged for 10 years (26-27%), but those have increased who had hypertension nephropahty. The average age of incident and prevalent dialyzed patients has decreased gradually over the past 8 years (between 2009 and 2017 incident rate was from 67.1 to 63.0 years, prevalent rate was from 65.6 to 61.8 years). Unfortunately, just over half of the patients who dialyzed due to chronic kidney disease (CKD) have reached dialysis day 91. This is due to the high proportion of patient who was in urgent need of dialysis. In chronic hemodialysis (HD) program, the proportion of patients treated with arterovenous fistulas (AVF) decreases, while the rate of central venous catheter (CVC) users increases. The Hungarian peritoneal dialysis program in Europe is very good. The number of prevalent patients receiving renal replaement therapy (RRT) in Hungary in 2017 was 1005 for 1 million inhabitants.]

Hypertension and nephrology

MAY 10, 2019

[Circulatory dinamics assay about lercanidipine treatment]

MOSER György

[Lercanidipine is of unique importance amongst calcium channel blockers. In the first section, the author creates two visual analogies to demonstrate the effect of calcium channel blockers. The control of the parallelism of the particular elements of the model of circulatory dynamics, and the biostructure was supported by an engineer of flud dynamics. In the second part, he deals with the effect of these drugs exerted on the pulmonary circulation and renal function, primarily for mind-raising purposes. He focuses on the edema induced by dihydropyridines, pays attention to its patomechanism, prevention and therapy, highlighting the distinctive benefits of lercanidipine. The presence or disappearance of this adverse effect may arbitrate whether this effective and valuable pharmacological intervention should stand the test of clinical practice.]

Hypertension and nephrology

DECEMBER 10, 2018

[PAX2: lotium et visus sine pace]

VIOLETTA Antal, KERTI Andrea, JÁVORSZKY Eszter, MÁTTYUS István, REUSZ György, SZABÓ Attila, VÁRKONYI Ildikó, MAKA Erika, TORY Kálmán

[The autosomal dominant papillorenal syndrome results from primarily de novo mutations of PAX2. It encodes a transcription factor expressed in the kidney, urinary tract, nervous system, eye and the ear. Its haploinsufficiency causes primarily hypoplastic and hyperreflective kidney, or other forms of CAKUT. The clinical appearance may be dominated by nephrotic-range proteinuria with focal segmental glomerulosclerosis. The renal survival rate is highly variable: most of the recognized cases lead to ESRD during the first four decades of life. PAX2 mutations cause typical optic papillary alterations, most frequently papillary dysplasia. In contrast to the name of the syndrome, one fourth of the affected patients do not develop ocular involvement. Hearing impairment is associated in less than 10% of the patients. The affected members of the five families that we identified with PAX2 loss-of-function mutations, developed end-stage renal disease during the 2-4. decades of life.]