Kyselina močová a hyperurikemie

Hana Rosolová

Vnitr Lek 2025, 71(1):3  

Hyperuricemia and gouty arthritis

Jan Voříšek, David Suchý

Vnitr Lek 2025, 71(1):8-13 | DOI: 10.36290/vnl.2025.001  

Crystal-induced arthropathy is caused by the deposition of crystal deposits in joint structures. Most often in clinical practice we encounter the deposition of sodium urate crystals, which is the cause of gouty arthritis. Gouty arthritis in adulthood is one of the most common inflammatory joint disorders. Especially in the developed part of the world, where in recent years we have seen a trend towards an increase in this disease. The main risk factor for the development of gouty arthritis is hyperuricemia, i.e. a pathological increase in the level of uric acid in the blood. Gouty arthritis affects the quality of life of patients not only by significant...

Hyperuricaemia and kidneys

Brenda Mercy Musungu, Marie Vaňková, Kateřina Oulehle, Oskar Zakiyanov, Jan Vachek, Vladimír Tesař

Vnitr Lek 2025, 71(1):14-17 | DOI: 10.36290/vnl.2025.002  

Hyperuricaemia occurs in 60% of patients with chronic kidney disease (CKD) and gout in about 25% of these patients. Despite the frequent co-occurrence, the influence of uric acid on the progression of kidney disease is not clearly understood. There is controversy over the indications for treatment of asymptomatic uricemia in patients with CKD. The preponderance of evidence suggests that asymptomatic hyperuricaemia is likely to be harmful, but may be particularly relevant to certain subgroups of patients, namely those with systemic crystal deposits, urate crystalluria or urolithiasis, and those with high intracellular uric acid levels. Current evidence...

Hyperuricaemia and metabolic syndrome

Lukáš Rozsíval, Michael Jenšovský, Jana Urbanová, Natálie Michalcová, Ludmila Brunerová, Jana Malinovská, Juraj Michalec, Jan Brož

Vnitr Lek 2025, 71(1):18-23 | DOI: 10.36290/vnl.2025.003  

Uric acid (UA) is predominantly formed in the liver, intestine and vascular endothelium as an end product of the metabolism of purines derived from food and endogenously from damaged or dead cells. The kidneys play a major role in the excretion of UA, eliminating about 70 % of the daily production. The remainder (approximately 30 %) is excreted by the intestine. If the production of UA exceeds the capacity of its excretion, hyperuricaemia results. Overexpression of urate transporter 1 (URAT1), glucose transporter 9 (GLUT9) and impaired glycolysis due to insulin resistance may be related to the development of hyperuricaemia in metabolic syndrome. Hyperuricemia...

Allopurinol and uricosurics

Jiří Slíva

Vnitr Lek 2025, 71(1):24-26 | DOI: 10.36290/vnl.2025.004  

The presented text briefly characterizes the basic possibilities of pharmacotherapeutic treatment of hyperuricemia. Allopurinol acting as a competitive xanthine oxidase inhibitor with a potential for use beyond the mere influence of uricemia is still the most commonly used active substance in this indication. Other substances are also briefly mentioned, although many of them are not currently available in the Czech Republic.

The significance of metabolism-associated steatotic liver disease and its treatment

Adam Vašura, Evžen Machytka, Marek Bužga, Jitka Macháčková, Jan Král

Vnitr Lek 2025, 71(1):29-36 | DOI: 10.36290/vnl.2025.005  

Non-alcoholic fatty liver disease (NAFLD) is one of the most important chronic liver diseases, which is closely related to metabolic syndrome. It was renamed to metabolic-dysfunction-associated steatotic liver disease (MASLD) in May 2023. In recent decades, this disease has experienced a global prevalence increase, which is currently 32 %, mainly in connection with the increase of obese patients in all regions. MASLD prevalence copies the increase of metabolic syndrome. It is necessary to actively search for this disease and use available diagnostic tools, which will detect this disease and also will help with selection of high-risk patients who are...

Estrogenic treatment and liver functions

Jiří Slíva

Vnitr Lek 2025, 71(1):37-39 | DOI: 10.36290/vnl.2025.006  

Estrogens are key hormones that play a vital role in the physiology of the reproductive system in women. However, their therapeutic use in hormonal treatment, contraception and the treatment of hormone-dependent diseases may be associated with a number of side effects, especially on the liver. This article focuses on the mechanisms of action of estrogens and their potential hepatotoxic effects, as well as risk factors and possible differences between representatives.

Humoral biomarkers and atrial fibrillation

Martin Ihnatko, Ivica Lazúrová

Vnitr Lek 2025, 71(1):40-44 | DOI: 10.36290/vnl.2025.007  

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, contributing to increased morbidity and mortality. Humoral biomarkers, such as natriuretic peptides, troponin, aldosterone, cortisol, copeptin, and apelin, are gaining importance in the diagnosis, prognosis, and management of AF. Elevated levels of these biomarkers indicate not only myocardial dysfunction and atrial remodeling but also inflammatory and procoagulant states that influence the progression and complications of AF. Monitoring biomarker levels provides deeper insight into the pathophysiological mechanisms of AF and can aid in identifying patients at higher risk...

Nutrition and its role in the primary prevention of osteoporosis

Matej Kohutiar, Monika Bartolomějová, Magdaléna Fořtová, Eva Klapková, Jana Čepová

Vnitr Lek 2025, 71(1):E8-E13 | DOI: 10.36290/vnl.2025.012  

Osteoporosis is a chronic metabolic bone disease that results from an imbalance between bone formation and resorption. Bone remodeling is a dynamic process influenced by genetic factors, nutrition and physical activity. Calcium, phosphorus, and vitamin D are key nutritional factors in the prevention and treatment of osteoporosis, but due to the complexity of bone tissue, other nutrients must also be considered. This article summarizes the importance of each nutrient, discusses the risks associated with inappropriate dietary habits, increasing consumption of ultra-processed foods and emphasizes the importance of overall lifestyle in the prevention of...

Analysis of indications for blood components in the Regional Hospital Liberec, as

Petr Papoušek, Renata Procházková

Vnitr Lek 2025, 71(1):E1-E7 | DOI: 10.36290/vnl.2025.013  

Aim: Correct indications of blood components (BC) are the key to effective and safe haemotherapy. The aim of this study was to evaluate the indication criteria of BC, to compare the changes in BC indications between two periods and to improve the quality of haemotherapy at the Regional Hospital Liberec, as (KNL). Materials and methods: The study population consisted of all BCs (erythrocytes, platelets, plasma) administered in the KNL in the period from 1 October 2020 to 30 September 2021 and from 1 August 2022 to 31 July 2023. From the database of the laboratory information system, the laboratory results of BC recipients were matched to each BC: haemoglobin...

Angioedema caused by of C1 esterase inhibitor deficiency

Ondrej Šantavý, Jaroslav Žák

Vnitr Lek 2025, 71(1):47-49 | DOI: 10.36290/vnl.2025.008  

Our case study presents patient with C1 esterase inhibitor deficiency, whose first manifestation was due to abdominal colic. Our diagnosis was confirmed by assessing the C1INH levels and C1INH functional deficit. Therapy was started with B2 receptor antagonist Icatibant with promising result.

Treatment of monoclonal gammopathy of renal significance with manifestations of Light Chain Deposition Disease (LCDD) in the transplanted kidney

Tomáš Roháľ, Martin Kment, Luděk Voska, Zdeněk Adam, Marek Borský, Lenka Zdražilová-Dubská, Marta Krejčí, Zdeněk Král, Luděk Pour

Vnitr Lek 2025, 71(1):E14-E24 | DOI: 10.36290/vnl.2025.011  

Light Chain Deposition Disease (LCDD) is a very rarely diagnosed condition affecting the kidneys. We describe a case where this diagnosis was morphologically confirmed in a biopsy of a transplanted kidney, and retrospectively identified in a previous kidney biopsy where the changes were not correctly classified. The biopsy of the transplanted kidney was performed due to worsening graft function. Subsequent testing focused on monoclonal gammopathy, revealing elevated serum concentrations of free kappa light chains (FLC) with a maximum FLC kappa value of 226 mg/l and FLC lambda at only 6 mg/l. The FLC kappa / FLC lambda ratio was clearly pathological...

New recommendations on hyperglycemic crises treatment in patients with diabetes

Jan Škrha jr.

Vnitr Lek 2025, 71(1):58-61 | DOI: 10.36290/vnl.2025.010  

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are the most severe hyperglycemic situations in patients with diabetes. In 2024, a new consensual recommendation on epidemiology, pathophysiology, manifestation, and therapy of these acute situations was published after 15 years. The most important information from this document is presented in the manuscript.

Tirzepatide - a promising medication for cardiovascular protection and treatment of Type 2 diabetes and obesity

Pavlína Piťhová

Vnitr Lek 2025, 71(1):51-57 | DOI: 10.36290/vnl.2025.009  

Tirzepatide is a dual GLP-1/GIP receptor agonist. It is very promising substance in treatment of Type 2 diabetes mellitus, obesity treatment, improvement of metabolic profile and cardiovascular protectivity. This article summarizes mechanisms of effect and results of finished clinical trials.