Acta Medica Croatica最新文献

Cardiorenal syndrome, a complex pathophysiological disorder of both the heart and kidneys, is a condition in which acuteor chronic damage to one organ can lead to acute or chronic dysfunction of the other organ. Depending on primary organdysfunction and disease duration, there are five different types of cardiorenal syndrome. Type 1 cardiorenal syndrome(acute cardiorenal syndrome) is defined as acute kidney injury caused by sudden decrease in heart function. Type 2cardiorenal syndrome (chronic cardiorenal syndrome) refers to chronic kidney disease linked to chronic heart failure. Type3 cardiorenal syndrome (acute renocardial syndrome) is caused by acute kidney injury that leads to heart failure. Type 4cardiorenal syndrome (chronic renocardial syndrome) includes chronic heart failure due to chronic kidney disease. Type5 cardiorenal syndrome (secondary cardiorenal syndrome) is reversible or irreversible condition marked by simultaneousheart and kidney insufficiency, as a result of multiorgan disease such as sepsis, diabetes mellitus, sarcoidosis, amyloidosis,etc. The pathophysiological patterns of cardiorenal syndrome are extremely complicated. Despite numerous publications,perplexed physiological, biochemical and hormonal disturbances as parts of the main pathogenic mechanisms ofcardiorenal syndrome remain obscure. Even though there are guidelines for the treatment of patients with heart failureand chronic kidney disease, similar guidelines for the treatment of cardiorenal syndrome are lacking. In everyday practice,it is crucial to diagnose cardiorenal syndrome and use all diagnostic and therapeutic procedures available to prevent oralleviate kidney and heart failure.

Chronic kidney disease (CKD) is one of the leading public health issues due to frequent and serious complications. Oncethe function of kidneys is disrupted, regardless of etiology, there are numerous factors that can speed up decrease ofglomerular filtration rate, including hypertension, proteinuria and dyslipidemia. Statins are widely used in primary andsecondary prevention of cardiovascular diseases in general population. Clinical advantages of statins in CKD patientsare not as clear. The aim of this paper is to present lipid status in CKD patients and indications for statin therapy with theaim to reduce cardiovascular risk in this group of patients. CKD is a well-known independent risk factor in cardiovascularevents, but professional associations issuing guidelines differ in the approach to treatment of dyslipidemia. The resultsof some studies indicate that treatment with statins may slow down the rate of kidney function reduction in patients withmild to moderate kidney damage, whereas other studies deny this effect. Furthermore, CKD patients have a higher riskof side effects, in part due to the reduced kidney excretion, polypharmacy, and numerous other comorbidities. Familyphysician has the role of providing preventive measures, with focus on appropriate treatment of patients with hypertensionor diabetes, as the most common cause of CKD, and timely detection of CKD in initial stage.

The interdependent damage to the heart and kidney organ systems is defined as cardiorenal syndrome, a complexpathophysiological disorder of the heart and kidney in which acute or chronic dysfunction of one organ can lead to acuteor chronic damage to the other. Identification and early diagnosis of some subtypes of cardiorenal syndrome very oftenbegin at family physician office, however, the use of simple and reliable diagnostic procedures such as MICE score usingECG and biomarkers has not been implemented yet. The clinical picture, diagnosis and treatment vary according to the 5cardiorenal syndrome subtypes, as described herein. Rational diagnosis of heart failure at family medicine office shouldinclude biomarkers (BNP and NT-pro BNP) before performing ultrasound of the heart, while for kidneys creatinine andestimated glomerular filtration rate are still in use, but not cysteine C and NGAL. Diagnostic procedure for suspected heartfailure at family medicine office should include kidney function estimate and vice versa. Access to treatment of cardiorenalsyndrome differs depending on the specialty to which the patient is referred first, i.e. consultant examination, cardiologistor nephrologist. A multidisciplinary approach to treatment of cardiorenal syndrome is still lacking.

According to consensus definition, chronic kidney disease (CKD) includes urinary excretion of albumin >30 mg/day and/or reduction in kidney function defined as a decrease in estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2for a period longer than three months, in the presence of kidney tissue damage verified by imaging or histologic methods.In developed world, the first cause of CKD is diabetes, followed by arterial hypertension, and the less frequent causesare inflammatory disease (glomerulonephritis, interstitial nephritis) and congenital condition (polycystic kidney disease).Currently, there is valid classification under the acronym CGA, where C stands for the cause, G for glomerular filtration rate(GFR category) and A for the level of albuminuria category. In early stages, patients usually have no symptoms but there arechanges in creatinine values, estimated GFR (eGFR) reduction and presence of albuminuria, especially in patients at risk.Determining the grade of renal impairment is important because of different approaches to treatment, monitoring, expectedcomplications, and patient education. Due to improved diagnostic methods and population aging, CKD is diagnosed evermore increasingly. Family physicians should be familiar with the basic principles of screening and diagnosis of CKD toprovide them with appropriate care in collaboration with secondary and tertiary health care.

Chronic kidney disease is clearly defined as a state of damaged kidney function lasting for more than three months.Changes manifest in serum and urine pathological findings with frequent morphological changes in the kidneys andreduction in glomerular filtration. The aim is to show the possibilities of renal replacement therapy and waste relateddisease during dialysis treatment. The methods are based on strong evidence and guidelines. Glomerular filtration isthe basis in evaluating the stage of chronic kidney disease. Based on the measures of glomerular filtration reduction,chronic kidney disease is classified into five stages, thus facilitating approach to treatment of particular groups of patientsdepending on the level of glomerular filtration damage. Kidney function can be replaced by dialysis or transplantation andin certain cases symptomatically if the patient refuses dialysis treatment. Malnutrition, hypertension, kidney anemia andbone-mineral disease are often present in patients with higher stages of chronic kidney disease, particularly stage 5 andkidney function replacement by dialysis. In conclusion, timely treatment reduces morbidity and mortality in patients withchronic kidney disease.

Transplantation is sometimes the only therapeutic option to treat acute or chronic organ failure. In the care of transplantpatients, there are numerous complications that are caused by powerful immunosuppressive drugs, cardiovascular,metabolic, and neoplastic diseases. These diseases are associated with significant morbidity and mortality in patientsafter transplantation, which will become an important part for supporting the transplant patient care. In the first yearafter transplantation, patients have regular contact with transplant center, and family doctor acts as a contact connectingpatients with specialized centers, while also detecting and managing health problems and issues that are not related onlyto transplantation. After that, the role of family physicians is becoming ever more important and active in the preventionof morbidity and mortality in transplant patients by appropriate and timely intervention in detection of side effects ofimmunosuppressive therapy and threatening metabolic disorders. The aim of this article is to show the role of familyphysician in tracking the welfare of organ transplant patient.

Although asymptomatic hyperuricemia is rather often in laboratory reports, it cannot be considered a disease. Despite thehigh prevalence of hyperuricemia in patients with arterial hypertension (AH), chronic kidney disease (CKD), cardiovasculardisease (CVD) or metabolic syndrome, hyperuricemia is not confirmed as a causative factor of these disorders. The aim isto point to the latest studies of the importance of urate as a possible cardiorenal risk factor. The literature published in 2015and 2016 was searched for the possible impact of urate level on the development of cardiorenal diseases. The PubMed,Cochrane, Medline, and UpToDate databases were searched for the literature published between November 2009 andOctober 2016 using the following key words: urate, hyperuricemia, cardiovascular disease, and chronic kidney disease.Causative correlation of hyperuricemia is confirmed only in disorders where deposits of monosodium urate crystals arepresent. Results of recent studies do not justify routine use of xanthine oxidase inhibitors in asymptomatic hyperuricemia.Some studies with small numbers of patients and short follow up report on endothelial function improvement on therapywith xanthine oxidase inhibitors. Nonpharmacological intervention by changing unhealthy lifestyle is preferred. Treatmentof asymptomatic hyperuricemia in CKD is still debated, and additional studies are necessary to demonstrate the benefitof lowering urate level in CKD. Family doctors (general practitioners) should be familiar with the recommended approachto patients with asymptomatic hyperuricemia. Evidence based medicine still does not recommend target determinationof serum urate level for identifying CVD and CKD risk factors. Recent studies suggest the possible effect of uric acid incardiorenal diseases and that treatment of asymptomatic hyperuricemia with xanthine oxidase inhibitors may also beuseful in CVD prevention. Additional studies are needed to prove this statement.

Measuring the Health Related Quality of Life (HRQOL) is part of the general concept of quality of life. According to thesurvey, quality of life in dialysis patients is significantly lower as compared to general population. The aim is to show theimportance and impact of the quality of life in dialysis patients on treatment outcomes. In October 2016, the MEDLINEand EBSCO databases were searched for the 2005-2016 period. Kidney transplantation offers better HRQOL as comparedto dialysis, since there is no significant difference in HRQOL between patients on hemodialysis and those on peritonealdialysis. Good clinical practice in the treatment of dialysis patients is based on individual approach and on improving thequality of life, for which collaboration of family doctors and consultant nephrologists is necessary. In daily practice, usingquestionnaires on the quality of life of dialysis patients would increase the awareness of this very important segment ofcare for dialysis patients because quality of life is an outcome measure of treatment in these patients.

Responsible health behavior plays an important role in every individual. Oral health quality results from the level ofinformation available, attitudes, habits and nutrition. Family is the most important environment where children can acquireknowledge, attitudes and habits related to oral health. The aim of the study was to compare the habits of parents andchildren related to their oral health, and to conclude how parental behavior influences oral health of their children. Thestudy included 101 parent-child pairs (age 11-15 years), their knowledge and behavior according to their oral hygiene,fluoro-prophylaxis and nutrition assessed by anonymous questionnaire. Oral health of parents was estimated according totheir tooth loss and compensation, while oral health of children was assessed by dental examination. A total of 101 child-parentpairs were included. Most children were excellent pupils (43.56%). In the group of parents, most participants weremothers (73.27%). Most parents had high school education (65.35%) and were employed (61.62%), and most perceivedthemselves to be living with average financial situation (86%). A comparable proportion of parents (95%) and children(87%) believed that it was necessary to wash teeth at least twice a day (p=0.125) and most of them thought it necessary tobrush teeth for 1-3 minutes (57% of children and 57.43% of parents; p=0.599). The majority of children (56%) and parents(72%) considered it necessary to use dental floss with a toothbrush and toothpaste (p=0.065), while 63% of children and71.72% of parents believed that toothpaste contained fluoride (p=0.156). Most of the parents (72.3%) and children (65.35%)brushed teeth in the morning and at bedtime (p=0.167) for 1-3 minutes (p=0.098). About 30% of parents and children usedthe handler for brushing teeth (p=1). Most children (86.32%) and parents (92.1%) had 3-5 meals a day (p=0.181), and 80%of them had their teeth examined by a dentist the year before (p=0.658). The children believing that teeth should be brushedonly in the morning have a 3.38-fold greater chance to develop tooth disorders (DMFT >0; p=0.004). Those that do notknow that caries and periodontal diseases can be prevented have a 26.3-fold greater chance to develop caries comparedto those who are aware of it. Children of parents who only brush their teeth in the morning have a 25 times higher chanceof developing CEP >0 as compared with those that brush their teeth after each meal (p=0.016). Children of parents whogive them money to buy snacks are 2.9 times more likely to develop CEP >0 (p=0.01) compared to children without moneyfor snack. Children of parents who feel that their health is not good have 3.9 times higher chance of developing CEP >0as compared to those whose parents think they have a neat bite (p=0.017). Oral hygiene in Croatia is still not at a level ofthe standards in Western countries. Ignorance about oral hygiene and irresponsible health behavior are the

The share of elderly persons in the population is growing rapidly and continuously. Requirements for their surgical treatmentare increasing and so is the number of published papers on the safety and success of some surgical procedures performedin these patients. The present study included 183 patients aged ≥65 out of 897 patients surgically treated for thyroid glanddiseases. They were divided into two groups (group 1 aged 65-69 and group 2 aged ≥70) in order to determine between-groupdifferences in the indications, surgical strategy, final histopathologic analysis, preoperative physical status, numberof comorbid diseases and postoperative complications. Analysis of the results justified our decision to divide our patientsinto two groups of younger and older ones. In group 1, the indications for surgery were mostly benign changes (93.2%),whereas malignant, verified and suspected disease was considerably more frequent in group 2 (21.8%), with a significantlyhigher percentage of compressive syndrome. Significant between-group differences were recorded in the preoperativephysical status (group 2: ASA III and IV, 73.8% and 5%, respectively), number of thyroidectomies performed (group 1,56.2% vs. group 2, 77.3%) and secondary hemithyroidectomy. A difference was also found in the number of surgical andnon surgical complications. The absence of a higher percentage of permanent complications, hypocalcemia and recurrentlaryngeal nerve paralysis, in total and by groups, confirmed that surgical treatment of thyroid gland diseases can beconsidered safe and successful in older age groups, regardless of the between-group differences observed.