Pub Date : 2021-12-29DOI: 10.22141/2307-1257.10.4.2021.247893
O. Boiko, V. Rodionova
Background. Hypertension determines both the social and economic component of the impact on the health of the population with a tendency to a significant increase in this pathology rate. Another common disease that can be prevented and treated is a chronic obstructive pulmonary disease (COPD). The concept of comorbidity implies the formation of relationships and interactions due to the common pathogenetic mechanisms, namely chronic inflammation, oxidative stress, and endothelial dysfunction. Hypertension is both a cause and a consequence of chronic kidney disease (CKD) and contributes to its progression. Patients with COPD have a higher risk of comorbidities. Aim. To study the dynamics of renal function and frequency of CKD development in patients with hypertension and COPD based on the retrospective analysis of case reports and outpatient medical records. Materials and methods. According to the criteria of inclusion and exclusion from the study, 188 patients were selected, which were divided into three groups by the clinical diagnosis: group 1 consisted of 64 patients with hypertension, group 2 — 58 patients with hypertension and chronic obstructive pulmonary disease, and group 3 — 66 patients with chronic obstructive pulmonary disease. The average age of patients with hypertension was 61.0 (57.0; 72.0) years, patients with hypertension and COPD — 62.3 (11.5), the average age of patients with COPD — 58.5 (55.0; 62.00). The physical examination, the laboratory tests of blood and urine were analyzed in all patients by studying the case reports and outpatient medical records. The obtained results were processed using biostatistical methods (Statistica v.6.1). Results. Important significance between the frequency of anemia in patients was not found, but there was a tendency to increase in anemia frequency in hypertensive patients — 14.1 % and in the comorbidity of hypertension and COPD — 8.6 %. The lowest incidence of anemia was recorded in patients with COPD and was 7.6 %. The level of total cholesterol in the respective groups did not differ statistically and was equal to 4.8 (4.2; 5.3), 4.7 (4.0; 5.4), and 5.3 (4.5; 5.9) mmol/l. The highest values of total blood cholesterol were determined in patients with hypertension and chronic obstructive pulmonary disease. The highest level of blood creatinine was determined in patients with hypertension and COPD, and the lowest — in patients with COPD. Thus, the patients with hypertension had the lowest GFR and the patients with COPD had the highest one. Conclusions. COPD has a tightening effect on the renal function of patients with hypertension and leads to an increase in blood creatinine levels with statistical significance. Also, in the group of patients with hypertension and comorbid pathology, a higher incidence of anemia was registered than in the group of patients with COPD. But, in turn, the filtration function of the kidneys, which was determined by GFR, was the lowest in hypertension.
{"title":"Changes in renal function in patients with hypertension and chronic obstructive pulmonary disease according to retrospective analysis of medical records","authors":"O. Boiko, V. Rodionova","doi":"10.22141/2307-1257.10.4.2021.247893","DOIUrl":"https://doi.org/10.22141/2307-1257.10.4.2021.247893","url":null,"abstract":"Background. Hypertension determines both the social and economic component of the impact on the health of the population with a tendency to a significant increase in this pathology rate. Another common disease that can be prevented and treated is a chronic obstructive pulmonary disease (COPD). The concept of comorbidity implies the formation of relationships and interactions due to the common pathogenetic mechanisms, namely chronic inflammation, oxidative stress, and endothelial dysfunction. Hypertension is both a cause and a consequence of chronic kidney disease (CKD) and contributes to its progression. Patients with COPD have a higher risk of comorbidities. Aim. To study the dynamics of renal function and frequency of CKD development in patients with hypertension and COPD based on the retrospective analysis of case reports and outpatient medical records. Materials and methods. According to the criteria of inclusion and exclusion from the study, 188 patients were selected, which were divided into three groups by the clinical diagnosis: group 1 consisted of 64 patients with hypertension, group 2 — 58 patients with hypertension and chronic obstructive pulmonary disease, and group 3 — 66 patients with chronic obstructive pulmonary disease. The average age of patients with hypertension was 61.0 (57.0; 72.0) years, patients with hypertension and COPD — 62.3 (11.5), the average age of patients with COPD — 58.5 (55.0; 62.00). The physical examination, the laboratory tests of blood and urine were analyzed in all patients by studying the case reports and outpatient medical records. The obtained results were processed using biostatistical methods (Statistica v.6.1). Results. Important significance between the frequency of anemia in patients was not found, but there was a tendency to increase in anemia frequency in hypertensive patients — 14.1 % and in the comorbidity of hypertension and COPD — 8.6 %. The lowest incidence of anemia was recorded in patients with COPD and was 7.6 %. The level of total cholesterol in the respective groups did not differ statistically and was equal to 4.8 (4.2; 5.3), 4.7 (4.0; 5.4), and 5.3 (4.5; 5.9) mmol/l. The highest values of total blood cholesterol were determined in patients with hypertension and chronic obstructive pulmonary disease. The highest level of blood creatinine was determined in patients with hypertension and COPD, and the lowest — in patients with COPD. Thus, the patients with hypertension had the lowest GFR and the patients with COPD had the highest one. Conclusions. COPD has a tightening effect on the renal function of patients with hypertension and leads to an increase in blood creatinine levels with statistical significance. Also, in the group of patients with hypertension and comorbid pathology, a higher incidence of anemia was registered than in the group of patients with COPD. But, in turn, the filtration function of the kidneys, which was determined by GFR, was the lowest in hypertension.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"93 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79658096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-29DOI: 10.22141/2307-1257.10.4.2021.247892
Yusuf Erçin Sonmez
CsA, obtained from a fungus called Tolypocladium inflatum came into medical use in 1983. Organ transplants have shown great success after the use of Cyclosporine, especially in 3- and 5-year graft survival. However, nephrotoxicity seen in the early and late periods complicates its use. It is very important to distinguish especially early toxicity from rejection attacks; because the treatments of both processes are completely different. While vasocostriction in the renal artery system is prominent in the early period, the underlying factor for late toxicity is the thickening of the arteriolar intima and the consequent decrease in tissue oxygenation. The article discusses the variants of toxicity caused by the use of cyclosporin A. Morphological changes with the use of cyclosporin A are shown in rat models. The results of our own observations on the use of prostaglandin, which demonstrated the effect of vasodilation, are also presented, which can probably be used for further studies in order to reduce the nephrotoxicity of cyclosporin A. In particular, we found that PGE2 significantly reduced vasoconstriction and reduced the toxic effect due to CsA. The limitations was the usage of these agents once, so we couldn’t continue and only gave them intravenously. However, the results obtained were found to be significant.
{"title":"Cyclosporine A nephropathy, its pathogenesis and management","authors":"Yusuf Erçin Sonmez","doi":"10.22141/2307-1257.10.4.2021.247892","DOIUrl":"https://doi.org/10.22141/2307-1257.10.4.2021.247892","url":null,"abstract":"CsA, obtained from a fungus called Tolypocladium inflatum came into medical use in 1983. Organ transplants have shown great success after the use of Cyclosporine, especially in 3- and 5-year graft survival. However, nephrotoxicity seen in the early and late periods complicates its use. It is very important to distinguish especially early toxicity from rejection attacks; because the treatments of both processes are completely different. While vasocostriction in the renal artery system is prominent in the early period, the underlying factor for late toxicity is the thickening of the arteriolar intima and the consequent decrease in tissue oxygenation. The article discusses the variants of toxicity caused by the use of cyclosporin A. Morphological changes with the use of cyclosporin A are shown in rat models. The results of our own observations on the use of prostaglandin, which demonstrated the effect of vasodilation, are also presented, which can probably be used for further studies in order to reduce the nephrotoxicity of cyclosporin A. In particular, we found that PGE2 significantly reduced vasoconstriction and reduced the toxic effect due to CsA. The limitations was the usage of these agents once, so we couldn’t continue and only gave them intravenously. However, the results obtained were found to be significant.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82603954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-29DOI: 10.22141/2307-1257.10.4.2021.247896
B. Rovin, S. Adler, J. Barratt, F. Bridoux, Kelly A. Burdge, T. Chan, H. Cook, F. Fervenza, K. Gibson, R. Glassock, D. Jayne, V. Jha, A. Liew, Zhi-Hong Liu, J. Mejía-Vilet, C. Nester, J. Radhakrishnan, Elizabeth M. Rave, H. Reich, P. Ronco, J. Sanders, S. Sethi, Yusuke Suzuki, S. Tang, V. Tesar, M. Vivarelli, J. Wetzels, J. Floege
No abstract
没有抽象的
{"title":"KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases","authors":"B. Rovin, S. Adler, J. Barratt, F. Bridoux, Kelly A. Burdge, T. Chan, H. Cook, F. Fervenza, K. Gibson, R. Glassock, D. Jayne, V. Jha, A. Liew, Zhi-Hong Liu, J. Mejía-Vilet, C. Nester, J. Radhakrishnan, Elizabeth M. Rave, H. Reich, P. Ronco, J. Sanders, S. Sethi, Yusuke Suzuki, S. Tang, V. Tesar, M. Vivarelli, J. Wetzels, J. Floege","doi":"10.22141/2307-1257.10.4.2021.247896","DOIUrl":"https://doi.org/10.22141/2307-1257.10.4.2021.247896","url":null,"abstract":"No abstract","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"29 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82731756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.22141/2307-1257.10.3.2021.239599
T. Saliba, Albert Huard
Epstein-Barr virus (EBV) affects 9 out of 10 people at some point in their lives. Though generally a benign infection, it can present with a plethora of symptoms and complications. We present the case of a 21-year-old previously healthy male suffering from EBV who presented with an 8-day history of odynophagia, pharyngitis, cough, abdominal pain and fatigue, previously he also had a fever which reached a maximum of 38.5 °C. The patient’s clinical exam was positive only for abdominal tenderness. During his hospitalisation for EBV, our patient suffered sudden renal failure over the course of 4 days, with a glomerular filtration rate dropping to 33 mL/min/1.73 m2, before spontaneously recovering to normal levels. This occurred with supportive treatment only and without the use of corticosteroids. This case illustrates an atypical presentation of EBV infection and provides a further example of spontaneous recovery of renal function.
{"title":"Acute renal failure secondary to EBV in a 21-year-old healthy male: a case report","authors":"T. Saliba, Albert Huard","doi":"10.22141/2307-1257.10.3.2021.239599","DOIUrl":"https://doi.org/10.22141/2307-1257.10.3.2021.239599","url":null,"abstract":"Epstein-Barr virus (EBV) affects 9 out of 10 people at some point in their lives. Though generally a benign infection, it can present with a plethora of symptoms and complications. We present the case of a 21-year-old previously healthy male suffering from EBV who presented with an 8-day history of odynophagia, pharyngitis, cough, abdominal pain and fatigue, previously he also had a fever which reached a maximum of 38.5 °C. The patient’s clinical exam was positive only for abdominal tenderness. During his hospitalisation for EBV, our patient suffered sudden renal failure over the course of 4 days, with a glomerular filtration rate dropping to 33 mL/min/1.73 m2, before spontaneously recovering to normal levels. This occurred with supportive treatment only and without the use of corticosteroids. This case illustrates an atypical presentation of EBV infection and provides a further example of spontaneous recovery of renal function.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"11 12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78804809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.22141/2307-1257.10.3.2021.239592
D. Ivanov
The effectiveness of the dietary supplement Aneza is presented with a practical approach. Aneza is positioned to control the size of simple kidney cysts. The author considers the properties of dietary supplements, which became the basis for a 6-month initiative study EFFECTIVENESS OF ANESA IN SIMPLE KIDNEY CYSTS (ETAP). The POEM study design was based on evidence-based practice and was conducted as an open prospective randomized in one group free of charge in 60 people aged 30 to 65 years with a diagnosed cyst I–II according to Bosniak. Exclusion criteria were as follows: invasive urological history, renal failure (chronic kidney disease stage 3 and above). The average decrease in the volume of the cyst on the background of receiving Aneza in the right kidney was minus 46.5 %, in the left — minus 39.9 %, on average minus 42.9 % (P ≤ 0.01). The best dynamics of cyst volume reduction was observed in women older than 40 years — 66.8 % vs. 52.5 % up to 40 years: (t = 0.97), and in men up to 40 years old: 27.1 % vs. 30.5 % (t = 0.29). The study confirms the effectiveness of Aneza in people with simple kidney cysts and, in the author’s opinion, a dietary supplement can be recommended as an additional means of controlling the growth of kidney cysts I–II according to Bosniak.
膳食补充剂Aneza的有效性提出了一个实用的方法。Aneza用于控制单纯性肾囊肿的大小。作者考虑了膳食补充剂的特性，这成为为期6个月的单纯性肾囊肿(ETAP)麻醉有效性研究的基础。POEM研究设计基于循证实践，作为一项开放的前瞻性随机分组，在60名年龄在30至65岁之间诊断为囊肿I-II的患者中免费进行。排除标准如下:有侵入性泌尿史，肾功能衰竭(慢性肾病3期及以上)。右肾经Aneza治疗后，囊肿体积平均减少- 46.5%，左肾- - 39.9%，平均减少- 42.9% (P≤0.01)。在40岁以上的女性中观察到囊肿体积减小的最佳动态- 66.8% vs. 52.5% (t = 0.97)，而在40岁以下的男性中:27.1% vs. 30.5% (t = 0.29)。该研究证实了Aneza对单纯性肾囊肿患者的有效性，在作者看来，可以推荐一种膳食补充剂作为控制肾囊肿I-II生长的额外手段。
{"title":"Control of the size of simple kidney cysts by a combination of dietician supplement","authors":"D. Ivanov","doi":"10.22141/2307-1257.10.3.2021.239592","DOIUrl":"https://doi.org/10.22141/2307-1257.10.3.2021.239592","url":null,"abstract":"The effectiveness of the dietary supplement Aneza is presented with a practical approach. Aneza is positioned to control the size of simple kidney cysts. The author considers the properties of dietary supplements, which became the basis for a 6-month initiative study EFFECTIVENESS OF ANESA IN SIMPLE KIDNEY CYSTS (ETAP). The POEM study design was based on evidence-based practice and was conducted as an open prospective randomized in one group free of charge in 60 people aged 30 to 65 years with a diagnosed cyst I–II according to Bosniak. Exclusion criteria were as follows: invasive urological history, renal failure (chronic kidney disease stage 3 and above). The average decrease in the volume of the cyst on the background of receiving Aneza in the right kidney was minus 46.5 %, in the left — minus 39.9 %, on average minus 42.9 % (P ≤ 0.01). The best dynamics of cyst volume reduction was observed in women older than 40 years — 66.8 % vs. 52.5 % up to 40 years: (t = 0.97), and in men up to 40 years old: 27.1 % vs. 30.5 % (t = 0.29). The study confirms the effectiveness of Aneza in people with simple kidney cysts and, in the author’s opinion, a dietary supplement can be recommended as an additional means of controlling the growth of kidney cysts I–II according to Bosniak.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84963515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.22141/2307-1257.10.3.2021.239593
D. Ivanov
The scientific review presents a practical analysis of the properties of Lespedeza capitata in terms of its attractiveness for nephrological practice. Lespedeza shows many effects on ectoderm derivatives, including skin and the kidneys. Thus, the results of studies showed significant stimulation of the growth of fibroblasts and keratinocytes, as well as increased collagen synthesis with a lipolytic effect on adipocytes. The researchers concluded the possibility of using herbal medicinal preparations of Lespedeza capitata to stimulate skin cells and tissue regeneration, for anti-aging therapy and induction of lipolysis due to flavonoid extract. Lespedeza capitata extract enhances diuresis, eliminates edema, reduces azotaemia and albuminuria, increases sodium excretion, and to lesser extent potassium, promotes renal filtration and excretion of nitrogenous products in the urine. The advantages of phytotherapy in normalizing the capillary permeability of the glomeruli are a mild diuretic effect, which prevents a significant loss of electrolytes in contrast to synthetic diuretics. These effects are now considered as potentiating the action of inhibitors of the renin-angiotensin system, which is the basis of renoprotection in modern nephrology. Lespedeza flavonoids improve protein-energy metabolism, which has been demonstrated in many models of acute renal failure. Correction of protein metabolism has a favourable nephroprotective effect and slows the progression of chronic kidney disease (CKD) while maintaining normal excretory function. Lespedeza extract can be considered as a substance that enhances the action of renin-angiotensin-aldosterone system inhibitors (RAASi), acting synergistically in inhibiting the activity of the renin-angiotensin system. This property of the drug becomes very relevant in patients with CKD stage 5 when the abolition of RAASi today corresponds to the current trend. Maintaining a small dose of RAASi in stage 10 CKD, or the use of RAASi with extrarenal elimination in combination with Lespedeza extract demonstrates encouraging results in clinical practice.
{"title":"How to potentialize the effect of renin-angiotensin-aldosterone system inhibitors?","authors":"D. Ivanov","doi":"10.22141/2307-1257.10.3.2021.239593","DOIUrl":"https://doi.org/10.22141/2307-1257.10.3.2021.239593","url":null,"abstract":"The scientific review presents a practical analysis of the properties of Lespedeza capitata in terms of its attractiveness for nephrological practice. Lespedeza shows many effects on ectoderm derivatives, including skin and the kidneys. Thus, the results of studies showed significant stimulation of the growth of fibroblasts and keratinocytes, as well as increased collagen synthesis with a lipolytic effect on adipocytes. The researchers concluded the possibility of using herbal medicinal preparations of Lespedeza capitata to stimulate skin cells and tissue regeneration, for anti-aging therapy and induction of lipolysis due to flavonoid extract. Lespedeza capitata extract enhances diuresis, eliminates edema, reduces azotaemia and albuminuria, increases sodium excretion, and to lesser extent potassium, promotes renal filtration and excretion of nitrogenous products in the urine. The advantages of phytotherapy in normalizing the capillary permeability of the glomeruli are a mild diuretic effect, which prevents a significant loss of electrolytes in contrast to synthetic diuretics. These effects are now considered as potentiating the action of inhibitors of the renin-angiotensin system, which is the basis of renoprotection in modern nephrology. Lespedeza flavonoids improve protein-energy metabolism, which has been demonstrated in many models of acute renal failure. Correction of protein metabolism has a favourable nephroprotective effect and slows the progression of chronic kidney disease (CKD) while maintaining normal excretory function. Lespedeza extract can be considered as a substance that enhances the action of renin-angiotensin-aldosterone system inhibitors (RAASi), acting synergistically in inhibiting the activity of the renin-angiotensin system. This property of the drug becomes very relevant in patients with CKD stage 5 when the abolition of RAASi today corresponds to the current trend. Maintaining a small dose of RAASi in stage 10 CKD, or the use of RAASi with extrarenal elimination in combination with Lespedeza extract demonstrates encouraging results in clinical practice.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"54 5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85045439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.22141/2307-1257.10.3.2021.239591
D. Ivanov, M. Ivanova, T. Crestanello
Background. The question of the possible effect of the inhibitors of the renin-angiotensin system (iRAS) on hypertensive subjects who fell ill with COVID-19 has been discussed in the literature. SARS-CoV-2 is well-known to use an angiotensin-converting enzyme 2 receptors facilitating virus entry into host cells. There are three possible mechanisms of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) effect in COVID-19 in clinical practice: with worsening, neutral, or helpful function. Considering the different mechanisms of blood pressure reduction by iRAS, one can expect differences in people with COVID-19 receiving these drugs. The purpose of the BIRCOV study is to pinpoint possible clinical and laboratory differences in hypertensive people who received iRAS and suffered from coronavirus infection. Materials and methods. Patient-Oriented Evidence that Matters (POEM) intervention was designed as an open prospective randomized two medical centers trial in subjects suffering from COVID-19 who have been receiving iRAS, either ACEi, ARB, or direct renin inhibitor (DRi) as basic antihypertensive therapy. One hundred and twenty people with stage 1–2 hypertension have been screened, 108 subjects were enrolled in the BIRCOV study. COVID-19 was confirmed by a PCR test; the disease follow-up was divided into 2 periods: up to 12 weeks and up to 24 weeks. The primary outcome measure was as follows: blood pressure (BP) was known one week before COVID-19 onset and was measured during the disease on weeks 2, 4, 12, 24. The secondary outcome measures were clinical features. Subanalysis in patients with chronic kidney disease (CKD) was performed. Results. All patients were randomized into 3 groups who received: ACEi — 42 (39 %), ARB — 35 (32 %), or DRi — 31 (29 %). The BIRCOV trial documented the trend of BP lowering in the first two weeks of the COVID-19 disease with its gradual return to baseline values up to the 12th week. Twenty-three (21 %) patients have withdrawn medicine for up to 2 weeks due to severe hypotension. However, the BP values after COVID-19 in most subjects remained lower than the baseline ones for 4 weeks. The use of ACE inhibitors significantly increased the risk of withdrawal compared to DRi (RR 1.648; 95% CI 0.772–3.519; NNT 7.0) and ARB (RR 13.023; 95% CI 1.815–93.426; NNT 2.9) due to COVID-19. The synchronous decline of estimated glomerular filtration rate (eGFR) and systolic BP was more pronounced in CKD patients. The greatest decrease in eGFR was noted in people who have been taking ACEi. The drop in eGFR ranged from 23 % in CKD stage 1 to 45 % in CKD stage 4. Two people required short-term dialysis. The analysis of secondary outcome points demonstrated that in 23 % of people without preceding albuminuria it developed in the A2 range. During 12 weeks of observation, 81 % of patients had spontaneous albuminuria reduction. Post-COVID-19 (above 12 weeks) albuminuria remained in 19 % of patients, 90 %
背景。肾素-血管紧张素系统(iRAS)抑制剂对合并COVID-19的高血压患者可能产生的影响已经在文献中进行了讨论。众所周知，SARS-CoV-2利用血管紧张素转换酶2受体促进病毒进入宿主细胞。在临床实践中，血管紧张素转换酶抑制剂(ACEi)和血管紧张素受体阻滞剂(ARB)在COVID-19中的作用可能有三种机制:加重、中性或有益。考虑到iRAS降低血压的不同机制，我们可以预期在接受这些药物的COVID-19患者中存在差异。BIRCOV研究的目的是查明接受iRAS治疗并感染冠状病毒的高血压患者的临床和实验室差异。材料和方法。以患者为导向的证据至关重要(POEM)干预是一项开放的前瞻性随机双医学中心试验，在接受iRAS、ACEi、ARB或直接肾素抑制剂(DRi)作为基础降压治疗的COVID-19患者中进行。120例1-2期高血压患者已被筛查，108名受试者被纳入BIRCOV研究。经PCR检测确诊COVID-19;疾病随访分为2期:12周和24周。主要结局指标如下:在COVID-19发病前一周已知血压(BP)，并在发病第2、4、12、24周测量血压。次要结局指标为临床特征。对慢性肾脏疾病(CKD)患者进行亚分析。结果。所有患者被随机分为3组，分别接受ACEi - 42(39%)、ARB - 35(32%)和DRi - 31(29%)治疗。BIRCOV试验记录了在COVID-19疾病的前两周血压降低的趋势，并在第12周逐渐恢复到基线值。23例(21%)患者因严重低血压停药长达2周。然而，大多数受试者在COVID-19后的4周内血压值仍低于基线值。与DRi相比，ACE抑制剂的使用显著增加了停药的风险(RR 1.648;95% ci 0.772-3.519;NNT 7.0)和ARB (RR 13.023;95% ci 1.815-93.426;NNT 2.9)。肾小球滤过率(eGFR)和收缩压的同步下降在CKD患者中更为明显。在服用ACEi的人群中，eGFR下降幅度最大。eGFR下降幅度从CKD 1期的23%到CKD 4期的45%不等。有两人需要短期透析。次要转归点分析显示，23%既往无蛋白尿的患者发展为A2范围。在12周的观察中，81%的患者自发性蛋白尿减少。covid -19后(12周以上)19%的患者仍有蛋白尿，其中90%有CKD病史。既往CKD患者蛋白尿在78%的病例中增加，在第12周只有24%的患者恢复到基线，在24周只有49%的个体恢复到基线。结论。接受慢性iRAS治疗的1-2期高血压患者并患有COVID-19，使用ACE抑制剂可能会出现低血压。COVID-19导致短暂性蛋白尿和肾小球滤过率降低，这对CKD患者尤其危险。
{"title":"Final results of BIRCOV trial (ARB, ACEI, DRi in COVID-19)","authors":"D. Ivanov, M. Ivanova, T. Crestanello","doi":"10.22141/2307-1257.10.3.2021.239591","DOIUrl":"https://doi.org/10.22141/2307-1257.10.3.2021.239591","url":null,"abstract":"Background. The question of the possible effect of the inhibitors of the renin-angiotensin system (iRAS) on hypertensive subjects who fell ill with COVID-19 has been discussed in the literature. SARS-CoV-2 is well-known to use an angiotensin-converting enzyme 2 receptors facilitating virus entry into host cells. There are three possible mechanisms of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) effect in COVID-19 in clinical practice: with worsening, neutral, or helpful function. Considering the different mechanisms of blood pressure reduction by iRAS, one can expect differences in people with COVID-19 receiving these drugs. The purpose of the BIRCOV study is to pinpoint possible clinical and laboratory differences in hypertensive people who received iRAS and suffered from coronavirus infection. Materials and methods. Patient-Oriented Evidence that Matters (POEM) intervention was designed as an open prospective randomized two medical centers trial in subjects suffering from COVID-19 who have been receiving iRAS, either ACEi, ARB, or direct renin inhibitor (DRi) as basic antihypertensive therapy. One hundred and twenty people with stage 1–2 hypertension have been screened, 108 subjects were enrolled in the BIRCOV study. COVID-19 was confirmed by a PCR test; the disease follow-up was divided into 2 periods: up to 12 weeks and up to 24 weeks. The primary outcome measure was as follows: blood pressure (BP) was known one week before COVID-19 onset and was measured during the disease on weeks 2, 4, 12, 24. The secondary outcome measures were clinical features. Subanalysis in patients with chronic kidney disease (CKD) was performed. Results. All patients were randomized into 3 groups who received: ACEi — 42 (39 %), ARB — 35 (32 %), or DRi — 31 (29 %). The BIRCOV trial documented the trend of BP lowering in the first two weeks of the COVID-19 disease with its gradual return to baseline values up to the 12th week. Twenty-three (21 %) patients have withdrawn medicine for up to 2 weeks due to severe hypotension. However, the BP values after COVID-19 in most subjects remained lower than the baseline ones for 4 weeks. The use of ACE inhibitors significantly increased the risk of withdrawal compared to DRi (RR 1.648; 95% CI 0.772–3.519; NNT 7.0) and ARB (RR 13.023; 95% CI 1.815–93.426; NNT 2.9) due to COVID-19. The synchronous decline of estimated glomerular filtration rate (eGFR) and systolic BP was more pronounced in CKD patients. The greatest decrease in eGFR was noted in people who have been taking ACEi. The drop in eGFR ranged from 23 % in CKD stage 1 to 45 % in CKD stage 4. Two people required short-term dialysis. The analysis of secondary outcome points demonstrated that in 23 % of people without preceding albuminuria it developed in the A2 range. During 12 weeks of observation, 81 % of patients had spontaneous albuminuria reduction. Post-COVID-19 (above 12 weeks) albuminuria remained in 19 % of patients, 90 % ","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90848424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.22141/2307-1257.10.3.2021.239590
Ya.M. Filenko, O. Korzh
The study aimed at optimization of diagnosis and evaluation of chronic kidney disease (CKD) in hypertensive patients by studying the role of adipokines (leptin, omentin, visfatin, resistin) in patients with hypertension combined with chronic kidney disease. Materials and methods. The study enrolled 100 patients with hypertension of II and III degrees of Stage 2, of which 51 patients were diagnosed with chronic kidney disease. The control group consisted of 20 apparently healthy people. Results. Our study showed that leptin, omentin, resistin, and visfatin levels were significantly higher in patients with essential hypertension (EH) combined with CKD, in contrast to patients with EH without CKD and in the control group. The results of the Kraskel-Wallis dispersion analysis demonstrated that in patients with EH combined with CKD, adipokines significantly correlated with systolic blood pressure (BP), diastolic blood pressure, hypertension degree, body mass index, low-density lipoproteins, thyroglobulin, glomerular filtration rate, creatinine, end-diastolic size, relative wall thickness index, left ventricular myocardial mass, left ventricular myocardial mass index, presence of diastolic dysfunction, type of diastolic function. Conclusions. Hypertensive patients with CKD presented with a significant increase in adipokine levels (leptin, omentin, resistin, visfatin) in the blood compared to patients with EH without CKD (p < 0.05) and apparently healthy individuals (p < 0.05). The data obtained indicate that adipokines (leptin, omentin, resistin, visfatin) have a significant pathogenetic role in patients with hypertension combined with chronic kidney disease.
{"title":"Features of adipokine status in hypertensive patients with chronic kidney disease","authors":"Ya.M. Filenko, O. Korzh","doi":"10.22141/2307-1257.10.3.2021.239590","DOIUrl":"https://doi.org/10.22141/2307-1257.10.3.2021.239590","url":null,"abstract":"The study aimed at optimization of diagnosis and evaluation of chronic kidney disease (CKD) in hypertensive patients by studying the role of adipokines (leptin, omentin, visfatin, resistin) in patients with hypertension combined with chronic kidney disease. Materials and methods. The study enrolled 100 patients with hypertension of II and III degrees of Stage 2, of which 51 patients were diagnosed with chronic kidney disease. The control group consisted of 20 apparently healthy people. Results. Our study showed that leptin, omentin, resistin, and visfatin levels were significantly higher in patients with essential hypertension (EH) combined with CKD, in contrast to patients with EH without CKD and in the control group. The results of the Kraskel-Wallis dispersion analysis demonstrated that in patients with EH combined with CKD, adipokines significantly correlated with systolic blood pressure (BP), diastolic blood pressure, hypertension degree, body mass index, low-density lipoproteins, thyroglobulin, glomerular filtration rate, creatinine, end-diastolic size, relative wall thickness index, left ventricular myocardial mass, left ventricular myocardial mass index, presence of diastolic dysfunction, type of diastolic function. Conclusions. Hypertensive patients with CKD presented with a significant increase in adipokine levels (leptin, omentin, resistin, visfatin) in the blood compared to patients with EH without CKD (p < 0.05) and apparently healthy individuals (p < 0.05). The data obtained indicate that adipokines (leptin, omentin, resistin, visfatin) have a significant pathogenetic role in patients with hypertension combined with chronic kidney disease.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90944507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.22141/2307-1257.10.3.2021.239595
G. Bonkat, R. Bartoletti, F. Bruyère, T. Cai, S. Geerlings, B. Köves, S. Schubert, F. Wagenlehner
No abstract
没有抽象的
{"title":"Urological infections — 2021","authors":"G. Bonkat, R. Bartoletti, F. Bruyère, T. Cai, S. Geerlings, B. Köves, S. Schubert, F. Wagenlehner","doi":"10.22141/2307-1257.10.3.2021.239595","DOIUrl":"https://doi.org/10.22141/2307-1257.10.3.2021.239595","url":null,"abstract":"No abstract","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74173512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.22141/2307-1257.10.3.2021.239594
S. Kushnirenko, D. Ivanov, S. Rotova, О.V. Kushnirenko
Background. Today, issues of renoprotection have gone beyond the use of antihypertensive therapy alone. Stable glucose-lowering and urate-lowering therapy are integral parts of modern renoprotection, which improve the functional state of the kidneys by increasing the glomerular filtration rate (GFR) and reducing the albumin excretion rate (AER) and the albumin-to-creatinine ratio (ACR). Nevertheless, hypoazotemic therapy aimed at reducing the content of nitrogenous wastes remains the leading component of the treatment of patients with chronic kidney disease (CKD). The aim of the study is the assessment of the renoprotective potential of the drug Libera (Lespedeza capitata) in patients with CKD stages 2–3 on the background of type 2 diabetes mellitus (DM). Materials and methods. The study included 107 patients with type 2 DM, aged 19 to 75 years (female — 41.1 %, male — 58.9 %), CKD stages 2–3, micro- and macroalbuminuria (category A2 and A3). The patients were divided into two groups: group I — traditional stable glucose-lowering and antihypertensive therapy (n = 50) and group II — traditional stable glucose-lowering and antihypertensive therapy in combination with Libera (Lespedeza capitata) (n = 57), which was prescribed 1 capsule t.i.d. regardless of food intake for 3 months. The criteria for the effectiveness of treatment were dynamics of GFR, AER/ACR in daily urine. The observation period for the patients was 3 months. Results. The renoprotective potential of Lespedeza capitata (Libera) was demonstrated after 3 months of treatment in the form of a significant increase in GFR in patients with CKD stage 2 in group II up to 79.0 ± 1.4 ml/min/1.73 m2 in comparison with the initial data (p < 0.01) and the results obtained in group I after 3 months of using only traditional stable glucose-lowering and antihypertensive therapy (p < 0.05). The use of Libera in the complex treatment of patients of the II group with CKD stage 3 against the background of type 2 DM for 3 months had a positive effect on nitrogen and water excretory kidney function, which manifested itself in an improvement in GFR to 56.6 ± 2.1 ml/min/1.73 m2 in comparison with the initial data (p < 0.05) and the results obtained in group I — 50.8 ± 1.9 ml/min/1.73 m2 (p < 0.05). In group I with traditional stable glucose-lowering and antihypertensive therapy, only 3 patients (9.1 %) transferred from category A2 to category A1 (normoalbuminuria) after 3 months and 2 patients (11.8 %) from category A3 to category A2. In group II, the appointment of Lespedeza capitata (Libera) in combination with stable glucose-lowering and antihypertensive therapy facilitated the transfer of 10 patients (27.8 %) from category A2 to A1 and 7 patients (33.3 %) from category A3 to A2 (p < 0.001). Conclusions. Lespedeza capitata (Libera) in combination with traditional stable glucose-lowering and antihypertensive therapy contributes to the preservation and improvement of the filtration function of the kidneys,
{"title":"Renoprotective opportunities of Lespedeza capitata in patients with chronic kidney disease and type 2 diabetes mellitus","authors":"S. Kushnirenko, D. Ivanov, S. Rotova, О.V. Kushnirenko","doi":"10.22141/2307-1257.10.3.2021.239594","DOIUrl":"https://doi.org/10.22141/2307-1257.10.3.2021.239594","url":null,"abstract":"Background. Today, issues of renoprotection have gone beyond the use of antihypertensive therapy alone. Stable glucose-lowering and urate-lowering therapy are integral parts of modern renoprotection, which improve the functional state of the kidneys by increasing the glomerular filtration rate (GFR) and reducing the albumin excretion rate (AER) and the albumin-to-creatinine ratio (ACR). Nevertheless, hypoazotemic therapy aimed at reducing the content of nitrogenous wastes remains the leading component of the treatment of patients with chronic kidney disease (CKD). The aim of the study is the assessment of the renoprotective potential of the drug Libera (Lespedeza capitata) in patients with CKD stages 2–3 on the background of type 2 diabetes mellitus (DM). Materials and methods. The study included 107 patients with type 2 DM, aged 19 to 75 years (female — 41.1 %, male — 58.9 %), CKD stages 2–3, micro- and macroalbuminuria (category A2 and A3). The patients were divided into two groups: group I — traditional stable glucose-lowering and antihypertensive therapy (n = 50) and group II — traditional stable glucose-lowering and antihypertensive therapy in combination with Libera (Lespedeza capitata) (n = 57), which was prescribed 1 capsule t.i.d. regardless of food intake for 3 months. The criteria for the effectiveness of treatment were dynamics of GFR, AER/ACR in daily urine. The observation period for the patients was 3 months. Results. The renoprotective potential of Lespedeza capitata (Libera) was demonstrated after 3 months of treatment in the form of a significant increase in GFR in patients with CKD stage 2 in group II up to 79.0 ± 1.4 ml/min/1.73 m2 in comparison with the initial data (p < 0.01) and the results obtained in group I after 3 months of using only traditional stable glucose-lowering and antihypertensive therapy (p < 0.05). The use of Libera in the complex treatment of patients of the II group with CKD stage 3 against the background of type 2 DM for 3 months had a positive effect on nitrogen and water excretory kidney function, which manifested itself in an improvement in GFR to 56.6 ± 2.1 ml/min/1.73 m2 in comparison with the initial data (p < 0.05) and the results obtained in group I — 50.8 ± 1.9 ml/min/1.73 m2 (p < 0.05). In group I with traditional stable glucose-lowering and antihypertensive therapy, only 3 patients (9.1 %) transferred from category A2 to category A1 (normoalbuminuria) after 3 months and 2 patients (11.8 %) from category A3 to category A2. In group II, the appointment of Lespedeza capitata (Libera) in combination with stable glucose-lowering and antihypertensive therapy facilitated the transfer of 10 patients (27.8 %) from category A2 to A1 and 7 patients (33.3 %) from category A3 to A2 (p < 0.001). Conclusions. Lespedeza capitata (Libera) in combination with traditional stable glucose-lowering and antihypertensive therapy contributes to the preservation and improvement of the filtration function of the kidneys,","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75051621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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