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Hypertension and nephrology

SEPTEMBER 10, 2019

[Serum uric acid level in hypertension. Domestic experience based on the data of the Hungarian Hypertension Registry 2011., 2013. and 2015. Part III. - Relation of uric acid to clinical and laboratory characteristics]

KÉKES Ede, PAKSY András, ALFÖLDI Sándor

[2013. and 2015, we examined the correlation between the serum uric acid level and blood pressure, target blood pressure, prevalence of ISH and other diseases associated to high blood pressure used trend analysis and linear regression in 22,668 hypertensive men (mean age 60.8 years) and 24,684 hypertensive women (mean age 64.1 years). We have extended the correlation analysis to metabolic factors (BMI, abdominal circumference, lipid profile, blood sugar) and kidney function. Significant correlation was found between SH level and systolic and diastolic blood pressure as well as target blood pressure. There was a significant correlation between SH level and metabolic parameters (abdominal circumference, BMI, total cholesterol, HDL cholesterol, triglyceride, fasting blood sugar) and in hyperuricemia the prevalence of metabolic syndrome was higher. As the level of SH increases, the prevalence of hypertension-related KVB, ISZB and diabetes have increased. The closest correlation between uric acid levels and chronic kidney disease was in women and between the uric acid levels and ischemic heart disease in men. ur analysis supports the international declaration that hyperuricemia is an independent cardiovascular, metabolic and renal risk factor.]

Hypertension and nephrology

JUNE 20, 2019

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.]

Lege Artis Medicinae

SEPTEMBER 20, 2018

[Differential diagnosis and treatment of hyponatraemia]

NÉMETH Zsófia, DEÁK György

[Hyponatraemia (serum sodium concentration < 136 mmol/l) is the most frequent electrolyte abnormality that inceases the risk of both in-hospital, and outpatient mortality. Antidiuretic hormone action or low glomerular fitration rate or low excretable osmoles or their combination are involved in its pathogenesis. Differential diagnosis is based on medical and medication histories, serum- and urine osmolality and urine sodium concentration. Measurement of fractional excretions of urea and uric acid help identifying low effective circulting volume, renal hypoperfusion. Symptomatic hyponatraemia or an acute decrease of serum sodium concentration exceeding 10 mmol/l should be treated with 3% NaCl to avoid impending threat to life. The principles of the treatment of chronic hyponatraemia are restriction of water intake and elimination of etiologic factor(s) (eg. medications - most often thiazides). In case of contracted axtracellular volume, isotonic saline should be given. In case of euvolaemia, restriciton of water intake is fundamental. In case of expanded extracellular volume, (heart failure, liver cirrhosis, nephrosis), water and NaCl intake should be restricted along with aldosteron antagonist and loop diuretic therapy. In chronic hyponatraemia, the rise of serum sodium concentration should not exceed 10 mmol/l during the first 24 hours and 8 mmol/l/day thereafter. ]

Clinical Neuroscience

SEPTEMBER 30, 2018

A rare condition mimicking stroke: Diabetic uremic encephalopathy

TEKESIN Aysel, ERDAL Yuksel, MAHMUTOGLU Soydan Abdullah, HAKYEMEZ Ahmet, EMRE Ufuk

Uremic encephalopathy (UE) is a metabolic disorder associated with acute or chronic renal failure. It is characterized by the acute or subacute onset of reversible neurological symptoms and specific imaging findings. It is uncommon for uremic encephalopathy to be associated with acute bilateral lesions of the basal ganglia in diabetic uremic patients, and this can be seen most often in Asian patients. Here, we report a patient with diabetic uremic encephalopathy and bilateral basal ganglia lesions who developed acute onset dysarthria. The clinical and magnetic resonance brain imaging findings resolved after hemodialysis treatment.

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.]