Vnitřní lékařství, 2016 (vol. 62), Supplementum 6

Original articles

Theralite and multiple myeloma

Jana Lachmanová, Vladimír Tesař, Romana Ryšavá, Magdalena Bartková

Vnitr Lek 2016, 62(Suppl 6):9-13

Multiple myeloma associated with an increased FLC production causes renal failure (cast nephropathy) requiring dialysis. Theralite is a dialyser with a high cut-off membrane (HCO) - with large size pores that allow permeability for substances of molecular masses up to 45 kDa. The FLC concentrations over hemodialysis will significantly decrease and if hematological treatment is also effective, the FLC production will significantly fall as well. The aim of this comprehensive therapy is to improve the renal functions to such an extent that a substantial removal of FLC (70-90 %) is reached in patients and even interruption of dialysis therapy (50-75 %)....

[Na⁺] - [Cl^-] difference significantly contributes to acidemia in patients with liver cirrhosis

Jana Lůžková, Bořivoj Lůžek, Karel Matoušovic

Vnitr Lek 2016, 62(Suppl 6):14-20

Aim:To evaluate the role of strong ion difference (SID) in acid-base disorders in patients with liver disease. Patients and methods:We evaluated the acid-base status in 11 patients with liver cirrhosis both by traditional and quantitative Stewart-Fencl methods. Results:Nine of eleven patients had pH within the norm, 2/11 had pH above 7.44. One patient had respiratory alkalosis, the second had a combined respiratory alkalemia and metabolic acidemia. The anion gap was increased only in one patient, but after correction for serum albumin concentration, it was above the norm in 10/11 patients. pCO₂ was...

Prevalence of microalbuminuria in patients with diabetes mellitus in the Czech Republic: Project IDN-Micro

Ondřej Pátek, Miroslava Horáčková, Milan Kvapil

Vnitr Lek 2016, 62(Suppl 6):21-24

Introduction:Prevalence of a positive testing for microalbuminuria (MA) in patients with diabetes mellitus in the Czech Republic is not described in the available literature. The data is important with regard to monitoring effectiveness of the comprehensive therapy for diabetes mellitus, from the prognostic and pharmacoeconomic perspective. The aim of the study was to assess the prevalence of presence of microalbuminuria or proteinuria (PU) in randomly chosen patients with diabetes mellitus aged up to 65 years in a cross-cutting study. The secondary aim was to assess the distribution of eGFR (estimated glomerular filtration) in...

Plasma and salivary markers of oxidative and carbonyl stress in patients with acute intermittent porphyria

Miroslav Mydlík, Katarína Derzsiová, Ivana Koborová, Katarína Šebeková

Vnitr Lek 2016, 62(Suppl 6):25-29

Background:Acute intermittent porphyria (AIP) is an autosomal inherited disease caused by deficiency of the third enzyme in the heme biosynthetic pathway, porphobilinogen deaminase. The clinical course of the disease is characterized by acute attacks, most often with abdominal pain. The aim of our study was to investigate selected markers of oxidative and carbonyl stress in plasma and saliva in patients with AIP and to find out whether saliva could be used for monitoring the disease progression. Saliva is an attractive biological fluid for determination of biochemical markers in various pathological conditions. The advantage is...

Reviews

Metabolic acidosis in chronic kidney disease

Jan Havlín, Karel Matoušovic, Světlana Vaňková, Otto Schück

Vnitr Lek 2016, 62(Suppl 6):30-39

Metabolic acidosis (MAC) is a constant symptom of chronic kidney disease (CKD) in advanced stages. However, its onset and degree do not depend only on the decrease of glomerular filtration but also on tubular functions. Therefore, in patients with predominant tubulointerstitial involvement it may already appear in earlier stages of CKD, usually as MAC with normal anion gap. The progressive decrease of glomerular filtration leads to acid retention that develops in a MAC with an increased anion gap. MAC has many adverse clinical impacts, including the progression of the underlying CKD. The development and degree of MAC in CKD is usually influenced by...

Vitamin D₃ supplementation and cellular calcium homeostasis in patients with chronic kidney disease

Ingrid Lajdová, Adrián Okša, Viera Spustová

Vnitr Lek 2016, 62(Suppl 6):40-45

Mini review summarizes the results of our studies focused on elucidation of the pathophysiological mechanisms of altered calcium homeostasis in nonexcitable cells from patients with early stages of chronic kidney disease (CKD), as well as on determining the effect of vitamin D₃ supplementation on these mechanisms. The basic mechanisms of calcium entry to and removal of the cell are already changed in early stages of CKD. These disturbances cause an increased the concentration of cytosolic free calcium ([Ca²⁺]_i), which may change a number of cellular processes, and the expression of various signaling molecules. Vitamin...

Bioimpedometry and its utilization in dialysis therapy

František Lopot

Vnitr Lek 2016, 62(Suppl 6):47-54

Measurement of living tissue impedance - bioimpedometry - started to be used in medicine some 50 years ago, first exclusively for estimation of extracellular and intracellular compartment volumes. Its most simple single frequency (50 kHz) version works directly with the measured impedance vector. Technically more sophisticated versions convert the measured impedance in values of volumes of different compartments of body fluids and calculate also principal markers of nutritional status (lean body mass, adipose tissue mass). The latest version specifically developed for application in dialysis patients includes body composition modelling and provides...

The results of SPRINT study from the point of nephrology

Václav Monhart

Vnitr Lek 2016, 62(Suppl 6):55-57

There is no consensus of the opinion that the value of systolic blood pressure (SBP) is the most favourable for the treatment of hypertension in patients with chronic kidney disease (CKD). The interventional study SPRINT (The Systolic Blood Pressure Intervention Trial) demonstrated the significant reduction in major cardiovascular events and overall mortality with intensive control of SBP (< 120 mm Hg) in individuals with high risk, including those with CKD and mild proteinuria. Nephrologists should take into account the results of the SPRINT study in the determination of the optimal SBP in patients with CKD, but at the same time they pay the attention...

Systemic and intraperitoneal inflammation in peritoneal dialysis patients

Sylvie Opatrná

Vnitr Lek 2016, 62(Suppl 6):58-61

Any degree of microinflammation is an independent risk factor for mortality for patients with chronic kidney disease in all stages. During peritoneal dialysis, intraperitoneal activation of inflammation occurs, the degree of which in stable patients without infectious complications depends in particular on the content of peritoneal dialysis solution with regard to osmotic agents (glucose, icodextrin) and buffer (lactate, bicarbonate or their combination) which as the same time defines the level of biocompatibility of these solutions. The degree of intraperitoneal inflammation affects peritoneal permeability, however there is no evidence of it directly...

Utilisation of salivary markers in nephrology

Ľudmila Podracká, Peter Celec, Katarína Šebeková

Vnitr Lek 2016, 62(Suppl 6):62-65

Saliva has a broad diagnostic potential which can be used for detection many pathological conditions including renal dysfunction. In saliva can be measured concentration of urea and creatinine as well as the other uremic markers. Saliva urea nitrogen and creatinine and blood urea and creatinine highly correlated therefore might be used for screening in patients with CKD. Saliva collection is truly non-invasive and is especially suitable for small children and elderly patients. Recently, semiquantitative saliva urea test strip is available. Saliva might become promising diagnostic biofluid in nephrological practice.

IgA nephropathy - research-generated questions

Milan Raška, Josef Zadražil, Milada Stuchlová Horynová, Leona Rašková Kafková, Alena Vráblíková, Karel Matoušovic, Jan Novák, Jiří Městecký

Vnitr Lek 2016, 62(Suppl 6):67-77

IgA nephropathy (IgAN) is the most common type of glomerulonephritis. Its etiology involves an increased production of polymeric immunoglobulin A1 with an abnormal composition of some carbohydrate chains. The reaction of these abnormal forms of IgA1 with specific autoantibodies while circulating immune complexes arise and settle in the renal mesangium with subsequent inflammatory activation of mesangial cells which in up to 50% of cases results in end-stage kidney failure. Pathogenesis involves an interplay of genetic predisposition and environmental effects, mainly of microbial nature. Current therapy is not sufficiently effective and lacks the focus...

Gitelman's syndrome as common cause of hypokalemia and hypomagnesemia

Romana Ryšavá, Jana Reiterová, Markéta Urbanová, Jitka Štekrová, Petr Lněnička, Vladimír Tesař

Vnitr Lek 2016, 62(Suppl 6):78-83

The Gitelman syndrome (GS) is an autosomal recessive disorder characterized by hypokalemic metabolic alkalosis and presence of hypocalciuria and hypomagnesemia. It is one of the most common congenital "salt-wasting" tubulopathies, where the impairment of function of the Na⁺-Cl^- cotransporter (NCCT) in the distal convoluted tubule is primary and hypokalemia secondary. Hypomagnesemia is caused by the impairment of magnesium reabsorption through TRPM6 channel which is located just by NCCT. Clinically, patients suffer from fatigue and hypotension due to loss of salt and water and also have cramps and tetany. In some patients chondrocalcinosis...

Osteoporosis - epidemiology and pathogenesis

Ivo Sotorník

Vnitr Lek 2016, 62(Suppl 6):84-87

Osteoporosis is considered as a lifestyle disease with high prevalence in the developed countries. Its appearance with number of related fractures has increasing tendency. In the Czech Republic approximately 7 % of the population is affected, which is 700,000 people, 50,000 osteoporosis fractures a year are documented. Most frequent type of osteoporosis is postmenopausal osteoporosis which is classified in the group of primary osteoporosis similarly as a senile osteoporosis (involutive). Secondary osteoporosis is a line of causal risk factors. Osteoporosis at men is usually part of primary or secondary hypogonadism. Idiopathic juvenile osteoporosis...

Suplemented restricted diet in old patients with chronic renal disease

Vladimír Teplan

Vnitr Lek 2016, 62(Suppl 6):88-96

In last decades was confirmed remarkable increase in number of old patients with chronic kidney disease. Despide of developments in dialysis technology and kidney transplantation there is a growing number of old patients who are not suitable for these methods. Recently were published data showing long-term effect of protein restricted diet supplemented with keto amino acids in elderly. Based on our results obtained in re-analysis of 3 000 patients we can confirm also good compliance and low risk of malnutrition.

Current options of treatment of hyponatremia

Vladimír Tesař

Vnitr Lek 2016, 62(Suppl 6):97-101

During the past 50 years the molecular mechanisms of renal reabsorption of sodium and water have been described and molecules specifically interfering with these mechanisms have been developed (diuretics, vasopressin receptor antagonists). Chronic hyponatremia is caused by relative excess of free water, it occurs within a broad spectrum of diseases associated with hypervolemia (heart failure, liver cirrhosis), normovolemia and hypovolemia and it is a negative prognostic factor for patients with chronic heart failure and cirrhotic ascites. Vaptans (vasopressin antagonists, vasopressin V2-receptor inhibitors) reduce reabsorption of water in the distal...

Chronic dysfunction of a transplanted kidney: the problem still unresolved

Ondřej Viklický

Vnitr Lek 2016, 62(Suppl 6):102-105

Kidney transplantation represents the best treatment of end stage renal diseases in respect of patient survival and quality of life. Despite many advances in immunosuppression and surgical techniques, many kidney grafts are being lost in the long term, mainly due to chronic rejection and recurrence of glomerulonephritis. Calcineurin drug nephrotoxicity, which was overestimated in last decades, seems to have only minor impact on graft survival if any. Despite better understanding of mechanisms of kidney graft injuries, which are reflected by never-ending changes in histological classification systems, optimal treatment strategies are not available for...

Case reports

Present possibilities of monitoring the effectiveness of hyponatremia therapy

Miroslava Horáčková, Lenka Vítová, Ondřej Pátek, Otto Schück

Vnitr Lek 2016, 62(Suppl 6):106-111

Changes to the overall volume of body water and acid base equilibrium can be reflected in the values of differences and ratios relating to serum concentrations of natrium and chlorides. Both these quantities can be used for patients with hyponatremia in the hyponatremia differential diagnosis. This paper presents a case study which is an example of the clinical use of differences in and ratios of serum concentrations of natrium and chlorides when monitoring effectiveness of the therapy.