Vnitřní lékařství, 2011 (vol. 57), issue 7-8
136th internal medicine day, XXIV. Vanýskův den, Brno 2011
The past, the present and the future of renal replacement therapy
V. Tesař
Vnitr Lek 2011, 57(7-8):603-606 
The observation that renal failure leads to 'uraemia' through retention of solutes that would otherwise be excreted by healthy kidneys, has been formulated as early as the first half of 19th century. The discovery of osmosis and a colloid membrane facilitated the first testing of dialysis, originally in animals and in the first quarter of 20th century also in humans. In the mid 1940s, dialysis became the method of choice for the treatment of acute renal failure. At the beginning of 1960s, the development of long-term venous access made programmes of chronic haemodialysis possible in many countries. These achievements, together with kidney transplantation,...
Aetiology and a clinical picture of chronic renal failure
J. Zadražil
Vnitr Lek 2011, 57(7-8):607-613
The term chronic renal failure (CRF) usually means the final stage of chronic kidney disease (CKD) with a decline in glomerular filtration rate (GF) below 0.25 mL/s. CRF is a world-wide serious health and economic issue with an increasing incidence and prevalence. CRF patients are, in comparison to other patients, hospitalized more often and for longer and, despite improvements in care, their quality of life is usually low and morbidity and mortality high. We present an overview of the most important CKD risk factors and the diseases most likely to result in CRF. Diabetic nephropathy, followed by various forms of ischemic renal disease and primary...
Hypertension and cardiovascular complications of chronic renal failure
M. Souček, V. Monhart, M. Nedbálková
Vnitr Lek 2011, 57(7-8):615-619
Chronic renal failure is associated with a significant cardiovascular risk due to an increased incidence of cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidemia). Cardiovascular mortality is due to an increased incidence of left ventricular hypertrophy, ischemic heart disease and chronic heart failure. Management focuses on risk factors, mainly high blood pressure in patients with mild to moderate chronic kidney disease, but it often fails in patients with chronic kidney failure.
Bone disease in chronic renal failure and its modern therapy
S. Dusilová Sulková
Vnitr Lek 2011, 57(7-8):620-625
Renal bone disease is one of the most serious complications of chronic renal failure. Secondary hyperparathyreosis is decisive for its pathogenesis. Current prevention and treatment emphasises pathogenetic and clinical interrelationships between bone tissue involvement and cardiovascular complications (CKD-MBD, bone and venous involvement associated with chronic renal disease). The treatment should first correct hyperphosphatemia and, subsequently, hyperreactivity of parathyroid glands through vitamin D receptor (VDR) and calcium receptor (CaR) modulation. Three groups of drugs play a fundamental role here (GIT phosphate binders, calcimimetics and...
Urinary tract infections and chronic renal failure
D. Sobotová
Vnitr Lek 2011, 57(7-8):626-630
The paper briefly summarizes issues related to urinary tract infections in adults:predispositions and risk factors, classification, assessment of pathogenicity of bacterial agents, the role of bacteriuria and leucocyturia, interpretation of findings, treatment principles and an association with chronic renal failure. Urinary tract infections are the second most frequent infectious disease in the population. They most often affect women of childbearing potential and then seniors of both sexes who have multiple risk factors. Escherichia coli and Staphylococcus saprophyticus are the most pathogenic towards urinary tract; they...
Anemia and chronic kidney failure
S. Štěpánková
Vnitr Lek 2011, 57(7-8):631-634
Anaemia is a common manifestation of a chronic kidney failure. It is caused by a relative shortage of erythropoetine (EPO) and iron deficite with its metabolism defect. The most important factor in the pathogenesis of iron metabolism defects is hepcidin. Hepcidin maintains the iron homeostasis in the organism. The therapy of renal anaemia is based on the iron substitution and erythropoiesis stimulating agents (ESA) application. The most common reasons for the resistance to ESA are (after iron deficiency) inflammation and malnutrition.
Peritoneal dialysis and its modification in the treatment of chronic renal failure
V. Bednářová, Z. Hrušková, V. Motáň, M. Neprašová
Vnitr Lek 2011, 57(7-8):635-639
Three methods can be used to treat chronic renal failure - haemodialysis, peritoneal dialysis and renal transplantation (from a living donor or transplantation of a cadaver kidney). In 2009, 5 763 patients were treated with haemodialysis in the Czech Republic, while peritoneal dialysis was used in just 8% (458) of patients. This low number of peritoneal dialyses may be due to the still high number of chronic renal failure patients who come to dialysis centres "off the street". Following acute initiation of haemodialysis, these patients are usually retained on haemodialysis. Poor awareness of peritoneal dialysis among patients as well as health care...
Haemodialysis - the current practice
M. Nedbálková
Vnitr Lek 2011, 57(7-8):640-644
New techniques and technological innovations developed over the last decades have facilitated improvements in haemodialysis. An emphasis is on an early insertion of arteriovenous fistula as a venous access for haemodialysis. Dialysis treatment should be initiated when the glomerular filtration rate falls to 8-10 mL/min, and to15 mL/min when the patients have risk factors. Haemodialysis is usually performed 3 times a week for 4 hours; less frequent or shorter haemodialysis is acceptable only in patients with well-preserved residual renal function. Extending haemodialysis to 5-6 hours is useful in preventing complications. Haemodiafiltration with high...
An overview of the results of renal transplantation in the Czech Republic
E. Pokorná, P. Bachleda, J. Dědochová, P. Fixa, M. Kuman, P. Navrátil, P. Němec, T. Reischig, J. Samlík, T. Seeman, D. Sobotová, J. Špatenka, P. Trunečka, V. Třeška, O. Viklický, J. Zadražil
Vnitr Lek 2011, 57(7-8):645-649
Renal (kidney) transplantation is now a routine and the most successful form of renal replacement therapy. There is a long tradition of renal transplantation in the Czech Republic, The first was performed as early as 1961 in Hradec Kralove, and the programme as such was launched in 1966 with the first successful transplantation at the Institute of Experimental Surgery (later Institute for Clinical and Experimental Medicine, Prague). At present, transplantations are being performed at 7 transplantation centres (IKEM Prague, Centre for Cardiovascular and Transplantation Surgery Brno, Faculty Hospitals Hradec Kralove, Plzen, Olomouc and Ostrava and Faculty...
Biological treatment following renal transplantation
O. Viklický
Vnitr Lek 2011, 57(7-8):650-653
Renal transplantation represents a method of choice in irreversible renal failure. The outcome of renal transplantation is affected by acute or chronic rejection and long-term evaluation also suggest a role of adverse effects of immunosuppressive therapy, mainly the incidence of cardiovascular complications and tumours. Immunosuppressive therapy with biologic agents aims to reduce the incidence of acute rejections, prolong allograft survival and, consequently, patient survival. Apart from a reduction in acute rejection incidence, biological agents are used in a selected group of patients to eliminate the need for an adjunctive treatment with steroids...
Immunosuppressive therapy and its problems
M. Kuman
Vnitr Lek 2011, 57(7-8):655-658
Immunosuppressive therapy is crucial for successful kidney transplantation. Induction, antirejection and maintenance immunosuppressive therapy are basic types of immunosuppressive therapy. Base of maintenance immunosuppressive therapy are corticoids + tacrolimus + mycofenolate mofetil. Short and long-term adverse effects are present. Drug interaction with macrolids and antimycotics are substantial. Cooperation between transplantologist and other specialists are crucial for adequate immunosuppressive therapy actualization. Lack of correlation and communication may lead to irrecoverable damage to transplanted kidney.