[The Czech and Slovak Internal Medicine Association, the Czech Nephrologic Society, the Medical Society of Liberec, the Hospital and Euro-Congress of Liberec and the Nephrologic Section of the Czech Nursing Association present the 123rd Internal Medicine Seminar on Thursday, 5 December 2002, in the Babylon Center Congressional Room in Liberec. Internal Medicine Aspects of Chronic Kidney Failure].

Vnitr Lek 2003, 49(5):357-433

[Epidemiology of functional disorders of the kidneys].

S Sulková

Vnitr Lek 2003, 49(5):358-361

The new classification K/DOQI of chronic renal disease differentiates five stages according to the grade of glomerular filtration. In the fifth, most severe grade (= renal failure) dialyzation/transplantation treatment is indicated. For dialyzation/transplantation activities in developed countries relatively accurate epidemiological data exist (national and supranational registers of dialyzation and transplantation programmes). The number of patients increases year by year, in particular in the more advanced age groups. The predominating diagnosis is renal failure is diabetes. Although treatment by one of the methods substituting renal function involves...

[Epidemiology of chronic kidney failure].

J Lachmanová, V Tesar

Vnitr Lek 2003, 49(5):362-364

[Progression of chronic renal insufficiency and its prevention using angiotensin converting enzyme inhibitors and angiotensin antagonists].

V Tesar

Vnitr Lek 2003, 49(5):365-369

Progression of chronic nephropathies can be significantly retarded by optimal control of blood pressure. To achieve target blood pressure combined treatment is usually necessary in patients with chronic nephropathies. Drugs interfere with the renin-angiotensin-aldosterone system (angiotensin converting enzyme inhibitors and angiotensin antagonists) have as compared with other antihypertensive agents with a comparable blood pressure control a more marked renoprotective effect and are renoprotective also in normotensive microalbuminuric patients with diabetic nephropathy and in proteinuric patients with non-diabetic nephropathies. Treatment with angiotensin...

[Nephrogenic metabolic acidosis].

R Dzúrik, V Spustová

Vnitr Lek 2003, 49(5):370-373

Metabolic acidosis is a major risk factor of kidney disease progression as a consequence of impaired H+ urinary excretion by the decreased kidney NH3 synthesis. Two key enzymes participate: a) Phosphate-dependent glutaminase under the genomic control of metabolic acidosis and b) Phosphate independent glutaminase localized on proximal tubule microvili under the nongenomic control. Two types of kidney disease metabolic acidoses are dominant: a) Hyperchloremic metabolic acidosis usually on the basis of hereditary or toxic alterations, isolated or as a part of Fanconi syndrome. b) Hyperphosphatemic metabolic acidosis of renal insufficiency. Metabolic acidosis...

[Metabolic and nutrition care in patients with chronic renal insufficiency and chronic kidney failure].

V Teplan, O Schück, O Marecková

Vnitr Lek 2003, 49(5):374-378

Metabolic and nutritional care implies procedures which involve normalization or improvement of metabolic deviations in chronic renal insufficiency and failure by dietary and medicamentous means. The therapeutic procedure not only improves some metabolic disorders associated with a decline of the excretory and metabolic endocrinological renal function but can have a positive impact also on progression of renal insufficiency. Conservative treatment thus involves low protein diets, modification of electrolyte and water intake, adjustment of the acid-base balance, Ca, P metabolism, haemogram, hypertension, proteinuria and hyperlipidaemia. In non-diabetic...

[Anemia in chronic renal insufficiency and chronic failure].

J Zahálková

Vnitr Lek 2003, 49(5):379-382

Complicated metabolic changes in chronic renal insufficiency interfere with the formation and survival of erythrocytes at many levels. Anaemia which thus develops influences in a significant way not only the quality of life but also the prognosis of nephrological patients. The confirmed relationship between cardiovascular morbidity and mortality must be the starting point for early diagnosis and treatment of this anaemia. Administration of recombinant human erythropoietin in the early stage of renal insufficiency can moreover probably retard its progression. European guidelines for the treatment of anaemia give clear instructions how to proceed in...

[Cardiovascular complications in patients with chronic renal insufficiency and chronic kidney failure].

V Tesar

Vnitr Lek 2003, 49(5):383-387

Patients with chronic renal failure have, as compared with age-matched controls with normal renal function, a markedly higher cardiovascular mortality. The reason is probably accelerated atherosclerosis and left ventricular hypertrophy as a result of accumulation of "classical" cardiovascular risk factors and the presence of some risk factors relatively specific for "uraemia" (e.g. anaemia, hyperhydratation, dyslipidaemia). It is assumed that the reversibility of left ventricular hypertrophy is limited in chronic renal failure due to more marked myocardial fibrosis ("uraemic cardiomyopathy"). Its regression can be achieved by treatment of hypertension...

[Hypertension and chronic renal insufficiency--chronic kidney failure].

V Monhart

Vnitr Lek 2003, 49(5):388-394

The prevalence of hypertension in patients with chronic renal insufficiency is high. In the stage of renal insufficiency it is 60% and in conservatively terminal renal failure it is as high as 90%. After the initiation of dialyzation treatment it declines temporarily, it is higher during chronic haemodialysis (50-80%) and lower in continuous ambulatory peritoneal dialysis (30%). After transplantation it is recorded in 70-80% recipients of a renal graft. Among the causes of renal hypertension in subjects with conservatively treated chronic renal insufficiency at present secondary renal impairment is increasing--in type 2 diabetes and also renal vascular...

[Diabetes mellitus and chronic renal insufficiency].

I Rychlík, S Sulková

Vnitr Lek 2003, 49(5):395-402

In the nineties of the 20th century diabetic nephropathy has become the leading cause of regular dialysis treatment (RDT) in developed countries. In particular type 2 diabetics are involved. A similar trend can be observed also in the Czech Republic which holds in this respect the first place among countries of the former eastern block (33% patients with RDT) suffer from diabetes. The cause of the increase of patients with diabetic nephropathy and renal failure caused by diabetes is not only the rising prevalence and incidence of type 2 diabetes in the population but in particular the better care provided to patients with type 2 diabetes which enables...

[Renal bone disease].

S Sulková, M Fortová, M Válek, F Svára

Vnitr Lek 2003, 49(5):403-408

Renal bone disease is a serious complication associated with chronic renal failure. The pathogenetic mechanisms are very complicated. The disorder develops as a result of hypophosphataemia, hypocalcaemia and calcitrol deficiency already during the period when renal functions decline below 50%. Formerly the form with an excessive bone turnover predominated, nowadays we encounter ever more frequently so-called a dynamic bone disease. A serious manifestation are extraosseous calcifications. In treatment phosphate binding substances in the gastrointestinal tract are involved (along with other provisions, correcting hypophosphataemia), supplementation of...

[Acute states in nephrology. Overview of problems].

V Teplan

Vnitr Lek 2003, 49(5):409-423

Acute conditions in nephrology are situations when treatment of the diagnosis and immediate therapeutic procedures to prevent damage of the kidneys and urogenital tract are urgent. Most important are conditions associated with oligoanuria or polyuria, vascular diseases with an acute course, acute obstructions of the urinary pathways and acute conditions in dialyzed and transplanted patients. An important group is also toxoallergic damage caused by drugs.

[Hemodialysis in the treatment of chronic kidney failure. Present status].

K Opatrný, S Opatrná

Vnitr Lek 2003, 49(5):424-429

In advanced countries haemodialysis treatment is available to all patients with chronic renal failure who need it. At present nephrologists must resolve the problem when it is possible to with-hold long-term haemodialysis treatment, or withdraw it because it no longer leads to prolongation of a good quality life. The results of long-term dialysis treatment depend on the correct timing of its initiation and the quality of nephrological care provided already a long time before the development of renal failure. The morbidity, mortality and quality of life of the patients are influenced in a fundamental way by the quality of provided haemodialysis. An...

[Pitfalls in immunosuppressive therapy].

J Lácha

Vnitr Lek 2003, 49(5):430-433