Nephrology

Hypertension and nephrology

OCTOBER 30, 2023

[Chronic kidney disease and venous thromboembolic events]

VÁRADY Tímea, MÁCSAI Emília, SZLOVÁK Edina, DOLGOS Szilveszter

[Our aim is to analyse venous thromboembolic events regarding chronic kidney disease. Based upon epidemiologic data, both thromboembolic and haemorrhagic events are more frequent among patients with chronic kidney disease. Changes in levels of coagulant factors, thrombocyte and endothel disfunction, uremic toxins and dialysis related issues share role in pathogenesis. Guidelines lack of adequate information regarding this specific patient group. Therapeutic shift can be observed from vitamin K antagontists toward direct oral anticoagulants, not only in general population but also in CKD patients, with special interest in apixaban. Another therapeutic trend is change from unfractioned heparin to low molecular weigh heparins with anti Xa level monitoring among CKD population. Special attention is needed for thrombotic events related to eritropoietin therapy and hemodialysis access.]

HUN 2023;27(05)

Hypertension and nephrology

OCTOBER 30, 2023

[Acute tubulointerstitial nephritis occurring during treatment with a B-RAF inhibitor in a patient with colorectal adenocarcinoma]

PAKSICZA Lilla, DOBI Deján, TAKÁCS Veronika, MÉSZÁROS Edina, TOKODI Zsófia, DEÁK György

[With the expansion of targeted biological treatments in oncology and the improvement in life expectancies, it is increasingly common to consider the long-term and short-term effects of anti-tumor agents on the kidneys, which significantly influence patient mortality and future oncological treatment options. B-RAF inhibitors are widely used, primarily in cases of malignant melanoma and colorectal cancers. We present the case of a young patient with colorectal adenocarcinoma treated with B-RAF (v-Raf murine sarcoma viral oncogene homolog B) and EGFR (epidermal growth factor) inhibitors as second line agents. During treatment, acute renal failure developed, necessitating hemodialysis. Renal biopsy confirmed acute tubulointerstitial nephritis, and we suspected the nephrotoxic effect of the B-RAF inhibitor as the underlying cause. Steroid treatment was initiated, but unfortunately, we lost the patient due to rapid progression of the malignant disease.]

HUN 2023;27(05)

Hypertension and nephrology

OCTOBER 30, 2023

[The importance of early detection of chronic kidney disease]

LÉGRÁDY Péter

[The number of patients affected by chronic kidney disease (CKD) is continuously increasing worldwide. It can be present in 1 out of every 10 adults. The prevalence of CKD is over 25% among individuals with diabetes and 26.1% among individuals with hypertension. Unfortunately, due to the late onset of symptoms, the diagnosis of earlier stages of CKD is low. The lack of recognition of stage 3 CKD in patients without comorbidities ranges from 65.0% to 97.1%. In case of comorbidities, the lack of recognition ranges from 47.5% to 94.6%. Screening for CKD, early recognition, and initiating treatment in the early stages can improve kidney function or at least slow down the progression of CKD.]

HUN 2023;27(05)

Lege Artis Medicinae

SEPTEMBER 30, 2023

[V. Hypertonia Days Szekszárd]

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HUN 2023;33(8-9)

Lege Artis Medicinae

SEPTEMBER 30, 2023

[Hypertension and nephro-protection in elderly patients]

DOLGOS Szilveszter, HUSZÁR Liliána

[The older people’s proportion and life expectancy is gradually increasing in our society, additionally the prevalence of hypertension and impaired kidney function can exceed 60 per cent in this age group. This study aims to highlight the importance of interrelation between hypertension and chronic kidney disease (CKD) and its adequate management, emphasizing professional considerations for the early recognizing and management of CKD, while keep­ing in mind the specific features of the ageing population in terms of prevention and therapy respectively. The overall mortality risk is higher in patients of advanced age, especially that of the elderly patient with CKD. This can increase their cardiovascular (CV) risk to such an extent that only a small proportion of patients with kidney disease reach the end-stage renal disease (ESRD) status. They die earlier by CV complications before having developed definite ESRD and needed renal replacement therapy. In conclusion, patients suffering from hypertension and CKD have a complex pathogenesis of cardiovascular risks and their CV risk is significantly high­er, which requires increased caution and vigilance from the attending physician in the holistic care of elderly patients with kidney disease.]

HUN 2023;33(8-9)

Hypertension and nephrology

SEPTEMBER 13, 2023

[Prevalence, Cardiometabolic Comorbidities and Reporting of Chronic Kidney Disease; A Hungarian Cohort Analysis]

[Célkitűzés: A krónikus vesebetegség (CKD) megnövekedett komorbiditási teherrel, rokkantsággal és halálozással társul, így világszerte jelentős népegészségügyi problémát jelent. Magyarországon azonban nem rendelkezünk prevalenciaadatokkal. Módszerek: Vizsgálatunkban a CKD prevalenciáját, stádiummegoszlását és a gyakori társbetegségeket határoztuk meg Magyarországon, a Pécsi Tudományegyetem vonzáskörzetében, Baranya vármegyében élő, egészségügyi szolgáltatást igénybe vevő egyének csoportjában, 2011 és 2019 között, a becsült glomerularis filtrációs ráta (bGFR), az albuminuria és a nemzetközi betegségkódok alapján, adatbázis-elemzés segítségével. Összehasonlítottuk a laboratóriumi mérésekkel igazolt és a releváns diagnóziskódokkal regisztrált CKD-betegek számát. Eredmények: A régióban elő 296 781 egyén közül 31,3%-nál történt bGFR-mérés és 6,4%-nál végeztek albuminuriameghatározást, akik között 13 596 CKD-beteget (14,0%) azonosítottunk a laboratóriumi határértékek alapján. Meghatároztuk a bGFR szerinti stádiummegoszlást (G3a: 70%, G3b: 22%, G4: 6%, G5: 2%). Az összes CKD-beteg 70,2%-a volt hypertoniás, 41,5%-a volt diabeteses, 20,5%-ánál fordult elő szívelégtelenség, 9,4%-ánál szívinfarktus és 10,5%-ánál stroke. A laboratóriumilag igazolt esetek csupán 28,6%-ánál történt meg a CKD diagnózis kódolása a 2011–2019 közötti időszakban. Következtetések: A CKD prevalenciája 14,0% volt az egészségügyi szolgáltatást igénybe vevő lakosok magyarországi szubpopulációjában a 2011–2019 közötti időszakban, emellett a CKD diagnózisának dokumentálását jelentősen alacsonyabbnak találtuk.]

HUN 2023;27(04)