Acute kidney injury in patients with cirrhosis - practical summary

Kateřina Množil Střídová, Soňa Fraňková, Jan Šperl

Vnitr Lek 2023, 69(5):299-304 | DOI: 10.36290/vnl.2023.059  

Acute kidney injury (AKI) is a relatively common condition in patients with advanced liver disease and which is associated with increased mortality. It mainly affects patients with decompensated cirrhosis, particularly those with advanced portal hypertension and ascites. The dual organ involvement may have different forms. The contributing pathogenetic mechanisms are common and predict a dismal prognosis. Early diagnosis and interventions involving specialists (in particular, hepatologists and nephrologists) are essential to improve outcomes.

Cardiovascular disease and kidney transplantation

Silvie Rajnochová Bloudíčková

Vnitr Lek 2023, 69(5):282-288 | DOI: 10.36290/vnl.2023.056  

Compared to general population, patients with chronic kidney disease (CKD) exhibit high prevalence of cardiovascular disease (CVD) that increases with a stage of CKD. Traditional and non-traditional risk factors associated with CKD contribute to accelerated atherosclerosis leading to CVD. CVD represents the main cause of morbidity and mortality in CKD population. Pretransplant examination is essential to evaluate and optimize the state of cardiovascular system prior transplantation, thus to minimize risks that could have a negative impact on transplant outcome.

Implications of highly suppressive treatment HIV infection

Svatava Snopková, Petr Husa

Vnitr Lek 2023, 69(5):289-292 | DOI: 10.36290/vnl.2023.057  

Treatment of HIV infection has modified the initially fatal infection into a typically chronic disease requiring lifelong treatment. However, there is no complete normalization of immune activation, signs of inflammation and prothrombotic state in treated patients. This condition is the result of many factors, but the main cause is thought to be the residual production of HIV-1 RNA and viral proteins by infected cells in cellular reservoirs. Persistence of immune activation/inflammation/prothrombotic state leads to the pathophysiology of "sterile inflammation" and so-called non-AIDS diseases, which manifest one to two decades earlier in those infected....

Internal comorbidities and complications of multiple sclerosis therapy -don't be caught off guard!

Dominika Šťastná, Jana Seňavová, Michaela Andělová, Ingrid Menkyová, Otakar Pšenička, Dana Horáková

Vnitr Lek 2023, 69(5):294-298 | DOI: 10.36290/vnl.2023.058  

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system, mainly affecting young adults. Factors positively influencing its course include early antiinflammatory treatment and the influencing of other comorbidities. The most common comorbidities occurring in MS patients with a higher frequency than in the general population are neurological, psychiatric, cardiovascular, metabolic and autoimmune. Just as comorbidity compensation affects the course of MS, in some cases, MS decompensation is associated with a worse course of associated diseases. Due to common risk factors and partially shared immunopathogenesis, treatment...

Dyslipidemia - the known unknown

Martin Šatný

Vnitr Lek 2023, 69(5):305-311 | DOI: 10.36290/vnl.2023.060  

Dyslipidemia (DLP) is the most important risk factor for atherosclerotic cardiovascular disease (ASCVD) and, in the context of severe hypertriglyceridemia (TG > 10 mmol/l), a risk factor for the development of acute pancreatitis. The prevalence of DLP is very high, but their control, especially among the patients at highest risk, is often inadequate. When diagnosing DLP, we should always exclude its possible secondary aetiology (e.g. DLP in the context of hypothyroidism, diabetes, ...). Based on the assessment of the overall CV risk (according to SCORE2/SCORE2-OP or according to the comorbidities of the individual), target values for blood lipids,...

Differentiated thyroid cancer - possible risks of treatment, suppressive therapy and adherence to current recommendations

Petra Němčíková, Ludmila Brunerová

Vnitr Lek 2023, 69(5):312-315 | DOI: 10.36290/vnl.2023.061  

Thyroid carcinoma (TC) is rare and represents 1-2 % of all human tumors. The incidence of TC has been increasing worldwide. TC comprises of a heterogeneous group of tumours with variable biological activity. Women are mostly affected. TC can be divided in differentiated TC/DTCs (papillary - PTC, follicular - FTC, from Hürthle cells - HCC), medullary carcinoma - MTC and anaplastic thyroid cancer - ATC. In this article, we focus on possible pitfalls of suppression therapy (cardiovascular, bone and mental), particularly in low-risk patients, and we discuss the data on the adherence to guidelines for suppression therapy in DTC.

Successful treatment of SAPHO syndrome (chronic nonbacterial osteomyelitis and acne) with anakinra and denosumab. Case report and review of therapy

Zdeněk Adam, Anna Šedivá, David Zeman, Zdeněk Fojtík, Hana Petrášová, Jana Diatková, Miroslav Tomíška, Zdeněk Král, Jana Treglerová, Vojtěch Peřina, Kateřina Kamarádová, Zdenka Adamová, Luděk Pour

Vnitr Lek 2023, 69(5):E4-E14 | DOI: 10.36290/vnl.2023.065  

SAPHO is an acronym derived from capital letters of Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO). SAPHO syndrome is an umbrella term covering a constellation of bone lesions and skin manifestations. A 40-year-old male complained about his jaw and back pain, swelling of multiple joints and weight loss accompanied by physical deterioration and acne type skin lesions. Laboratory tests revealed abnormal elevation of inflammatory markers. Imaging studies illustrated multiple osteolytic bone lesions and paraosseal infiltrates. According to the set of criteria diagnosis of SAPHO syndrome was stated. The patient was treated with glucocorticoids...

Selected biomarkers of orthostatic intolerance

Barbora Bačkorová, Ivica Lazúrová

Vnitr Lek 2023, 69(5):E15-E19 | DOI: 10.36290/vnl.2023.066  

Orthostatic intolerance (OI) is defined as a group of diseases which symptoms are typically manifested in a standing position. These symptoms result from cerebral hypoperfusion and disappear in the supine position. We include postural orthostatic intolerance syndrome (POTS), orthostatic hypotension (OH) and vasovagal orthostatic syncope in this group of diseases. Each of them have similar clinical presentation (blurred vision, weakness, dizziness, nausea, headaches, fatigue). However, they vary from each other in biochemical, autonomic and hemodynamic characteristics. The aim of the work is to provide an overview of humoral and non-human markers that...

The patient with acute vertigo - the role of clinical examination and imaging

Lukáš Martinkovič

Vnitr Lek 2023, 69(5):E20-E24 | DOI: 10.36290/vnl.2023.067  

Vertigo/dizziness or balance disorders are among the most common patients complaints in emergency clinics. Up to 25% of them are potentially life-threatening, especially cardiovascular or cerebrovascular events. The combination of a careful history taking (triggers, duration of difficulties, associated symptoms) and the performance of a basic vestibular examination (nystagmus, oculomotor, head impulse test, positional maneuvers, standing and walking examination) leads to a reliable differentiation of central and peripheral vestibular etiology. Standardized diagnostic algorithms (HINTS, HINTS+, STANDING) are used to identify high-risk patients requiring...

Atypical form of Goodpasture's disease

Michaela Habánová, Petra Divácká, Jitka Řehořová, Iva Svobodová

Vnitr Lek 2023, 69(5):316-321 | DOI: 10.36290/vnl.2023.062  

Goodpasture's disease and anti-glomerular basement membrane nephritis (anti-GBM nephritis) are rare autoimmune small vessel vasculitis predominantly affecting young men. Goodpasture's disease plays an important part in differential diagnosis of pulmonary - renal syndrome. The evidence of circulating autoantibodies, a typical histological appearance of the kidney biopsy with finding of the crescent glomerulonephritis and clinical presentation of nephritic syndrome play an important role in diagnosis. Our case report describes a case of a young male with anti-GBM nephritis that presents as rapidly progressive glomerulonephritis (RPGN) with progression...

Steroid responsive encephalopathy associated with autoimmune thyroiditis as a cause of acuteencephalopathy

Milan Maretta, Alexandra Lacková, Hedviga Wágnerová, Eva Feketeová, Zuzana Gdovinová

Vnitr Lek 2023, 69(5):E25-E29 | DOI: 10.36290/vnl.2023.068  

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), known as Hashimoto's encephalopathy (HE), represents a heterogeneous group of neurological and neuropsychiatric symptoms associated with a presence of antithyroid antibodies in case of other causes of encephalopathy were excluded. Clinical symptoms most commonly includes acute onset of encephalopathy, behaviour changes and cognitive dysfunction, epileptic seizures as well as cerebellar and extrapyramidal symptoms. Corticoids provides rapid and sustained therapeutic benefit in most patients and only a few patients require other immunosuppressive therapy such as plasmapheresis,...

Finerenon: další možnost léčby u pacientů s chronickým onemocněním ledvin a diabetem 2. typu

Roman Dvořák, Miroslav Souček

Vnitr Lek 2023, 69(5):335-338  

Pharmacological profile of mepolizumab

Norbert Pauk

Vnitr Lek 2023, 69(5):322-328 | DOI: 10.36290/vnl.2023.063  

An elevated number of eosinophils have been implicated in several type 2 inflammatory chronic diseases that occur at various sites in the body. Over the past 20 years, our knowledge of diseases associated with increased numbers of eosinophils has advanced thanks to the development of drugs that can reduce or even eliminate eosinophils. One such agent is mepolizumab, a humanized monoclonal antibody that binds to interleukin -5 (IL-5). This article briefly and clearly summarizes the pharmacological profile of mepolizumab and its current indications for a number of chronic eosinophilic diseases.

Zemřela prof. MUDr. Marie Brodanová, DrSc.

Radan Brůha

Vnitr Lek 2023, 69(5):341  

News in respiratory medicine

Kristián Brat, Martina Doubková, Monika Bratová, Nela Šťastná, Jiří Wallenfels, Ivana Čierná Peterová

Vnitr Lek 2023, 69(5):329-334 | DOI: 10.36290/vnl.2023.064  

Pneumology and phthisiology (respiratory medicine) has undergone dynamic development in the last two decades. The main focus of pulmonology in the past was care for patients with tuberculosis and pneumonia. Since then, respiratory medicine evolved and the current focus is on chronic pulmonary diseases, including chronic obstructive pulmonary disease, bronchial asthma, interstitial lung diseases, but also on acute lung conditions (e.g., pneumonia, pleural diseases, respiratory failure), pneumooncology or highly specialized care for rare lung diseases (e.g., cystic fibrosis, rare interstitial diseases). Bronchology, interventional pneumology and pulmonary...