Hlavní téma – Nefrologie

Ivan Rychlík

Vnitr Lek 2022, 68(7):415  

Current options for slowing the progression of chronic kidney disease

Vladimír Tesař

Vnitr Lek 2022, 68(7):420-424 | DOI: 10.36290/vnl.2022.089  

From a certain stage, chronic kidney disease progresses to terminal kidney failure that requires renal replacement therapy with dialysis or transplantation. The progression can be significantly slowed by blocking the renin angiotensin aldosterone system (RAAS) with angiotensin converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor blockers (ARB). Another new option to enhance the effect of blocking the RAAS system is the use of sodium glucose cotransporter 2 (SGLT2) inhibitors, or gliflozins. Dapagliflozin is currently available and reimbursed for patients with both diabetic and non-diabetic kidney disease. In the near future, treatment...

Expert opinion on the cooperation of diabetologists and internists with nephrologists in the care of patients with chronic kidney diseases

Ondřej Viklický, Romana Ryšavá, Vladimír Tesař, Ivan Rychlík, Martin Prázný, Richard Češka, Martin Haluzík

Vnitr Lek 2022, 68(7):426-431 | DOI: 10.36290/vnl.2022.090  

Chronic kidney disease (CKD) affects 10% of the population of developed countries and significantly affects the population health. In addition to the well-known renoprotection tools slowing down the progression of CKD, SGLT2 inhibitors have been newly introduced into clinical practice based on the results of extensive studies, both in diabetics and non-diabetics. This expert opinion discusses the classification of CKD, current renoprotection options, and the recent role of SGLT2 inhibitors in the care of patients with CKD.

Glomerulonephritides associated with infections

Martin Havrda

Vnitr Lek 2022, 68(7):432-437 | DOI: 10.36290/vnl.2022.091  

Glomerulonephritides associated with infections constitute an important group of diseases. Their occurrence is shifting from children and young people to elderly people. The rates of acute post-streptococcal glomerulonephritis, a condition with a good prognosis, are decreasing, and the rates of glomerulonephritides associated with various bacterial, viral, or parasitic infections, often with a poor prognosis, are increasing. Renal biopsy plays an important role in the diagnostic process. Manifestations of glomerulonephritis can be the initial sign of an occult infection. When evaluating renal biopsy specimens, certain signs may suggest this option,...

New developments in anaemia treatment - erythropoietin versus prolyl hydroxylase inhibitors?

Romana Ryšavá

Vnitr Lek 2022, 68(7):438-443 | DOI: 10.36290/vnl.2022.092  

Anaemia is a very common complication of chronic kidney disease (CKD) and renal failure. The view of the treatment of anaemia has changed considerably since the introduction of ESAs (erythropoiesis-stimulating agents) into clinical practice, and the safety of this treatment is now prioritised over complete normalisation of haemoglobin (Hb) values. Iron administration is the mainstay of treatment in this group of patients, with intravenous administration proving to be both more effective and safer in both predialysis and dialysis patients. In addition to the long-used ESAs, a number of new agents developed to favourably influence erythropoiesis have...

Covid-19 in kidney transplant recipients

Mária Magicová, Ondřej Viklický

Vnitr Lek 2022, 68(7):444-448 | DOI: 10.36290/vnl.2022.093  

Kidney transplant recipients are a very vulnerable population at risk of severe course and death from Covid-19. Several antiviral drugs are now available for the treatment of nonhospitalized individuals with mild to moderate Covid-19 and hospitalized patients with severe disease. The combination of monoclonal antibodies is also available to be used as pre-exposure prophylaxis in elderly patients. Previously used monoclonal antibodies for post-exposure prophylaxis are no longer effective because of the new mutations and are no longer recommended. Although the immune response to Covid-19 vaccines is impaired in kidney transplant recipients, the effectiveness...

Reactive, infectious, or post‑infectious arthritis?

Štefan Alušík

Vnitr Lek 2022, 68(7):449-453 | DOI: 10.36290/vnl.2022.094  

The issue of reactive arthritis belongs to one of the most complex problems in rheumatology. Although the original concept of reactive arthritis as a "sterile arthritis" has already been overcome, much remains unclear. Non-uniform terminology, classification and diagnostic criteria as well as treatment guidelines leave room for different interpretations of this issue. Therefore it is difficult for non-rheumatologists (internal medicine physicians and general practitioners) to find their way around this topic. Our comprehensive report discusses the latest findings from etiology to treatment of reactive arthritis. It also addresses the aforementioned...

Inflammatory markers in clinical practice

Štefan Sotak

Vnitr Lek 2022, 68(7):E11-E16 | DOI: 10.36290/vnl.2022.100  

Inflammation is the general defense response of the body against various harmful irritations. Diagnosis of the inflammatory process and monitoring of its treatment is based on a combination of clinical and laboratory findings. Biochemical inflammatory markers usually serve to support the diagnosis of the infection, to monitor it, and to monitor the effectiveness of anti-infective treatment. The inflammatory marker should be selected according to the clinical condition with regard to the treachery and deficiencies of the markers, with knowledge of their dynamics and with regard to the length of the anamnesis. As an optimal procedure for detecting bacterial...

Pegvisomant in the treatment of acromegaly

Ivana Ságová, Marián Mokáň, Juraj Payer, Peter Vaňuga

Vnitr Lek 2022, 68(7):E17-E22 | DOI: 10.36290/vnl.2022.101  

Despite improvements in surgical techniques, current radiotherapy options and development of long-acting somatostatin analogues, biochemical control of acromegaly is not achieved in some patients. The failure to achieve optimal serum growth hormone (RH) and insulin-like growth factor-1 (IGF-1) levels means increased morbidity and mortality of acromegaly patients. The RH receptor antagonist pegvisomant (PEG) is a genetically engineered RH analog that prevents of RH receptor dimerization, i.e. a process that is crucial for the action of RH at the cellular level. The effect of the treatment is suppression of IGF-1 production. In pilot studies, normalization...

Podiatric care from diabetologists point of view

Vladimíra Fejfarová, Miroslav Koliba, Jarmila Jirkovská, Hana Kůsová, Pavlína Piťhová, Alexandra Jirkovská, Bedřich Sixta, Marcela Szabo

Vnitr Lek 2022, 68(7):E3-E10 | DOI: 10.36290/vnl.2022.099  

Scoring for the risk of Diabetic foot syndrome (DFS) should be performed regularly in each patient with diabetes mellitus (DM). Patients at risk for DFS should be followed by diabetologists, those with moderate and severe risk for the development of DFS or those with DFS in remission should be already followed by podiatrists. The aim of our study was to determine the extent of DFS risk screening procedures, dispensary care of patients at risk for DFS and treatment of patients with newly developed DFS in diabetes clinics in the Czech Republic. Methods: To find out the study data, we prepared in cooperation with the ČDS ČLS JEP Committee a questionnaire...

Effect of SGLT2 inhibitor empagliflozin on the stabilization of heart failure progress with the possibility of further interventions in a patient with HFrEF - a case report

Filip Málek

Vnitr Lek 2022, 68(7):454-457 | DOI: 10.36290/vnl.2022.095  

SGLT2 inhibitors are included in the first line medical therapy of HFrEF. We report a case study of a patient in whom introduction of treatment with empagliflozin after recurrent heart failure decompensation lead to stabilization of the progress of the disease. Heart failure progress stabilization enabled interventions of cardiovascular comorbidities with delay of heart transplantation or mechanical assist device implantation need.

Primary cardiac synovial sarcoma mimicking SARS-CoV-2 associated pericarditis

Eva Cinková, Ondrej Ondič, Alexander Malán

Vnitr Lek 2022, 68(7):E23-E27 | DOI: 10.36290/vnl.2022.102  

Primary cardiac synovial sarcoma is an extremely rare tumor with a higher incidence in young men. The mean age of occurrence is 32 years. Synovial sarcomas are tumors with high aggressiveness, proliferate rapidly and metastasize to regional and distant lymph nodes or surrounding organs. The typical location of synovial sarcoma of the heart is the atrial and ventricular septum. Its size, the degree of infiltration of the surrounding tissues and the presence of metastases influence clinical symptoms, which are very non-specific. The low specificity of the symptoms complicates the clinical diagnosis and in most cases the tumor is detected during its progression...

Differential diagnosis of leukocytosis and leukopenia

Tomáš Arpáš, Michael Doubek

Vnitr Lek 2022, 68(7):E28-E35 | DOI: 10.36290/vnl.2022.103  

The blood cell count is often examined in routine clinical praxis. Physiologic leucocyte count is in range 4-10 × 109 in liter of blood. Abnormal values of leukocytes and subtypes of leukocytes in differential count are often present. Changes in leukocytes counts are caused by variety of benignant or malignant conditions. It is important in clinical praxis to interpret changes in blood cell count correctly and choose adequate approach in investigation process. In general, leukocytosis and leukocytopenia may present in primary hematologic disorder or secondary/reactive states, caused by reaction of hematopoiesis to underlying condition. This article...

Thyroid incidentalomas

Jan Jiskra

Vnitr Lek 2022, 68(7):465-474 | DOI: 10.36290/vnl.2022.098  

Thyroid nodules are very common. Most of them are benign non-secerning incidentally found nodules - thyroid incidentalomas. Ultrasound (US) is an essential initial diagnostic tool in thyroid nodules management. Based on the US character, thyroid nodules should be classified to one of the US risk categories (TIRADS - Thyroid Imaging Reporting and Data System). Based on the US risk category and size, some nodules should be referred to fine needle aspiration with cytological evaluation of the sample (FNAC), some should be followed just by US, and some require no follow-up. Further management depends on the FNAC (Bethesda category) and US risk category....

Můžeme novou léčbou ovlivnit dosavadní terapií neřešený zánět a fibrózu u pacientů s DM2 a CKD?

Milan Kvapil

Vnitr Lek 2022, 68(7):475-478 | DOI: 10.36290/vnl.2022.104  

Therapy of hypertension in elderly population and its potential risks

Jiří Widimský

Vnitr Lek 2022, 68(7):461-464 | DOI: 10.36290/vnl.2022.097  

Arerial hypertension is comon in subjects ≥ 65 years old and includes in majority of subjects systolic/diastolic form or isolated systolic hypertension. Basic therapeutic principles to the therapy of hypertension of elderly subjects are summarized. Slow and careful uptitration of antihypertensive therapy is recommended. Potential complications and caveats of therapy are also discussed, which are especially related to older frail subjects. Pharmacotherapy of hypertension in elderly is in vast majority of subjects highly beneficial with decrease of cardiovascular (CV) events and CV mortality.

New technology in the hypolipidemic drugs development. Inclisiran (LEQVIO)

Hana Rosolová

Vnitr Lek 2022, 68(7):458-460 | DOI: 10.36290/vnl.2022.096  

The development of lipid modifying drugs was expanding during the past 30 years. Statins stay to be the first choice drugs in dyslipidemia treatment. Inhibitors of proprotein convertase subtilisin- kexin type 9 (PCSK9) enzyme in combination with statin and/or ezetimibe represent very effective therapy and better atherosclerotic cardiovascular disease (ASCVD) prevention. Antisense therapy based on oligonucleotides belongs to the new technology drugs. This therapy inhibits translation of some proteins important for the production of atherogenic lipid particles. Inclisiran is a small interfering RNA that suppresses translation of PCSK9 in the liver cells....

Telemedicine, Innovative Technologies and Digital Health Working Group

MUDr. Jan Škrha jr., Ph.D.

Vnitr Lek 2022, 68(7):E36