The problem of pregnancy complicated by chronic kidney disease

Chronic kidney disease (CKD) in high-risk pregnancies is a challenge for multidisciplinary teams of doctors. Due to the fact that the disease affects both the mother and the fetus, and the course of the pregnancy. The following article reviews the literature about the interaction between pregnancy and CKD and dialysis therapy. Even pregnancy itself can lead to a worsening of kidney dysfunction. The risk of this consequence increases with the degree of renal failure, therefore renal parameters and other pregnancy test results should be monitored. On the other hand, the most common complications of chronic kidney disease in pregnancy described in the literature include pre-eclampsia, preterm labor, intrauterine growth restriction (IUGR) or low birth weight, surgical delivery by caesarean section and miscarriage. Dialysis therapy also leads to abnormalities in the course of pregnancy, and patients require constant monitoring during its course. Attention is also drawn to the high percentage of newborns requiring intensive postpartum care. Due to the risk for the fetus and mother mentioned in the article, nephrologists and gynecologists should cooperate closely from the pre-contraceptive period in order to reduce the risk of sequelae and better control of the underlying disease

Aristolochic acid nephropathy - still real danger

Arystolocholic acid nephropathy is chronic kidney disease caused by the use of substances of natural origin that contain arystolocholic acid. The effects of their use are arystolochic acid nephropathies, which include "Chinese Herbs" nephropathy. The course of the disease is very fast, resulting in progression to end-stage renal disease, and in the future it results in the development of urinary tract cancer. That is why it is so important to recognize it early and start treatment. However, due to disease progression, some patients require dialysis and even kidney transplantation. Although the World Health Organization is trying to stop the spread of the use of harmful substances, there are still reports of this nephropathy appearing in some populations. Despite warnings from the Food and Drug Administration regarding the safety of botanicals containing arystolochic acid and its classification as a human carcinogen, products containing it are still available for purchase online. The purpose of the literature review below is to analyze the latest knowledge on aristolochic acid nephropathy and its associated complication

COVID-19 impact on kidneys

Introduction and purposeThe COVID-19 pandemic, which has been ongoing since early 2020, has significantly affected the health care system worldwide. SARS-CoV-2 virus being the etiological factor of the disease has a high affinity for the renal organ. The purpose of this study was to provide an overview of the current knowledge of the problem of frequent AKI in the course of coronavirus infection, the impact of COVID-19 disease in patients with chronic kidney disease and on renal replacement therapy or dialysis.Review methodIn the process of writing, we used available articles and scientific papers in Pubmed and Google Scholar databases based on keywords: COVID-19, SARS-CoV-2, AcuteKidneyInjury, ChronicKidneyDisease.State of knowledgeSARS-CoV-2 virus enters target cells through the ACE2 receptor. In the pathophysiology of AKI in the course of COVID-19, a key role is attributed to secondary damage mechanisms such as cytokine storm, hypoperfusion with hypoxia, endothelial dysfunction. The incidence of acute kidney injury ranges from 5.1% to 36.6%. The development of AKI, renal transplant status, the presence of chronic kidney disease or renal replacement therapy is associated with an increased risk of severe course and higher mortality on COVID-19. SummaryThe COVID-19 pandemic has posed new logistical and therapeutic challenges to the health care system. Due to the high tropism of SARS-CoV-2 to the kidneys and the frequent occurrence of AKI during the course of the infection, nephrology patients, those on renal replacement therapy and those awaiting transplantation should be placed under special surveillance. Patients in these groups are at particular risk for a severe course of COVID-19

What does the future look like - home hemodialysis

Home hemodialysis (HHD) is a discovery from 1961 that is now experiencing a revival. It is a convenient and modern method of renal replacement therapy that allows the patient to undergo hemodialysis sessions at home. Due to the growing interest in home hemodialysis, we decided to present the potential of this renal replacement method, show both its benefits and complications resulting from its use. Undoubtedly, HHD has many benefits resulting mainly from the possibility of regulating the duration of the sessions and increasing their frequency. However, this method is also burdened with numerous complications. There are training courses in the use of HHD for patients who have just been diagnosed with end-stage renal disease as well as for patients undergoing dialysis using other methods. Appropriate patient selection is an important factor for the success of home therapy. There is a fierce battle in the home hemodialysis machine market. Manufacturers are outdoing each other in innovative technologies to ensure ease of use, trouble-free operation and minimize complications. The costs of home hemodialysis include more components than the dialysis treatment itself. Home hemodialysis gives patients comfort and independence above all. This is part of nephrology that undoubtedly requires a lot of work and development, but is certainly an invention of the 21st century

Nutritional treatment in chronic kidney disease - review article

INTRODUCTION: Chronic Kidney Disease (CKD) is a condition affecting nearly 16% of the population. It is a disease that cannot be completely cured with modern medical capabilities. However, it is possible to halt the progression of the disease and postpone renal replacement therapy through pharmacotherapy. In order to monitor the progression of the disease, GFR should be determined.        PURPOSE OF THE WORK: This article reviews the potential impact of typical Western diet and eating habits on the occurrence and progression of chronic kidney disease. Reducing the intake of animal protein, foods rich in sodium potassium and phosphorus, and increasing the intake of fruits, vegetables and fiber help prevent or delay end-stage renal disease. The literature on the role of a low-protein plant-based diet in patients with CKD was also reviewed.        DESCRIPTION OF THE STATE OF KNOWLEDGE: In addition to pharmacological methods, whose main goal is to reduce proteinuria and control blood pressure, drug therapy can be supported by non-pharmacological methods. One of them is the use of a low-protein diet and adequate provision of macro- and micronutrients in the diet.         SUMMARY: In order to support pharmacotherapy in the treatment of chronic kidney disease, the use of an appropriate diet plays an important role. According to the literature, the most important is restriction of protein supply, weight reduction in obese patients and supplementation of micronutrient deficiencies that occur

Quantitative assessment of metamorphopsia using M-charts and Amsler tests in patients with non-treated central serous chorioretinopathy

INTRODUCTION. The aim of this study is the assessment of the clinical parameters related to metamorphopsia using M-charts and traditional Amsler tests in patients with central serous chorioretinopathy (CSCR). MATERIA LS AND METHODS. Seventeen eyes of 17 patients were examined with M-charts and Amsler tests, as well as with ocular coherence tomography (OCT) at each of three visits during four months of follow-up. The rate of metamorphopsia detection was 82% with M-charts and 76% with Amsler test. RESULTS . The vertical metamorphopsia score decreased after four months in nine patients (52.9%), 0.1° on average; increased in two patients (11.8%), mean 0.2°; and there was no change in six patients (35.3%). The horizontal metamorphopsia score decreased in seven patients (41.2%), 0.2° on average, increased in three patients (17.6%), 0.23° on average, and there was no change in seven patients (41.2%). CONCLUSIONS. M-charts are superior to the traditional Amsler charts in the monitoring of metamorphopsia in patients with CSCR. M-charts are a good diagnostic tool for quantitative assessment of metamorphopsia and monitoring over time in patients with CSCR.

Poród a schorzenia narządu wzroku

There are many controversies among ophthalmologists and obstetricians regarding indications for caesarean section due to preexisting eye diseases. Many ophthalmologists still believe myopia, retinal detachment, glaucoma or diabetic retinopathy to be indications for a caesarean section. There is a discrepancy between clinical practice and evidence-based medicine, as none of the published trials have reported any retinal changes after vaginal delivery. This report provides information on the infl uence of physiological changes on eye diseases during the fi nal stage of the delivery. We conclude that an eye disease is not an indication for a caesarean section.Wskazania do skrócenia drugiego okresu porodu z powodu współistniejących schorzeń okulistycznych stanowią wciąż źródło wielu kontrowersji zarówno wśród okulistów, jak i ginekologów. Schorzenia narządu wzroku, takie jak: krótkowzroczność, odwarstwienie siatkówki, retinopatia cukrzycowa oraz jaskra są nadal uważane przez wielu okulistów za wskazanie do cięcia cesarskiego. Istnieje rozbieżność pomiędzy praktyką kliniczną a doniesieniami naukowymi, nie istnieją bowiem żadne udokumentowane publikacjami badania potwierdzające pogorszenie stanu narządu wzroku będące wynikiem porodu siłami natury. Niniejsza praca przedstawia zmiany fizjologiczne zachodzące w oku podczas końcowych etapów porodu. Wnioskujemy, że choroby narządy wzroku nie są wskazaniem do cięcia cesarskiego

M-charts as a tool for quantifying metamorphopsia in age-related macular degeneration treated with the bevacizumab injections

Background This article is aimed to assess quantitatively metamorphopsia using M-charts in patients suffering from wet age-related macular degeneration (AMD) treated with the intravitreal bevacizumab injections and to compare the results with traditional Amsler grid and ocular coherence tomography (OCT). Methods Thirty-six patients diagnosed with wet AMD were examined one day before and one month after the intraocular injection of bevacizumab. Horizontal and vertical metamorphopsia scores using M-charts, distance visual acuity, Amsler test and OCT were performed at each visit. Additionally, 23 healthy subjects were examined as a control group. Results The rate of metamorphopsia detection was 89% with M-charts and 69% with Amsler test. The horizontal metamorphopsia score improved in 22 patients, the vertical metamorphopsia score improved in 16 patients, the Amsler grid results improved in 6 patients, visual acuity improved in 17 patients. There was no correlation between the degree of metamorphopsia and the visual acuity or the central retinal thickness (CRT). The specificity of both the M-charts and Amsler grid was 100%. Conclusions The rate of metamorphopsia detection in wet AMD patients was better with M-charts than with Amsler grid. M-charts may be used in the assessment of efficacy of treatment with intravitreal bevacizumab injections as another outcome measure, moreover they can be used even at home for the self-assessment. M-charts provide additional information concerning the visual function, independent of the visual acuity, CRT and morphological changes in OCT

Perinatal outcome according to chorionicity in twins — a Polish multicenter study

Objectives: The aim of the study was to analyze the perinatal outcome of twin gestations and estimate the influence of chorionicity on the outcome in a large cohort of twin pregnancies in Poland. Material and methods: A retrospective analysis of 465 twin deliveries in 6 Polish centers in 2012 was conducted. Baseline characteristics, the course of pregnancy and labor, as well as the neonatal outcome were analyzed in the study group and according to chorionicity. Results: A total of 356 twin pregnancies were dichorionic (DC group) (76.6%), and 109 were monochorionic (MC group) (23.4%). There were no differences in the occurrence of pregnancy complications according to chorionicity, except for IUGR of at least one fetus (MC 43.1% vs. DC 34.6%; p = 0.003). 66.5% of the women delivered preterm, significantly more in the MC group (78% vs. 62.9%; p = 0.004). Cesarean delivery was performed in 432 patients (92.9%). Mean neonatal birthweight was statistically lower in the MC group (2074 g vs. 2370 g; p < 0.001). Perinatal mortality of at least one twin was 4.3% (2.8% in the DC group vs. 9.2% in the MC group; p = 0.004). Neonatal complications, including NICU admission, respiratory disorders, and infections requiring antibiotic therapy, were significantly more often observed among the MC twins. Conclusions: The overall perinatal outcome in the presented subpopulation of Polish twins and its dependence on cho­rionicity is similar to the reports in the literature. Nevertheless, the rates of preterm and cesarean deliveries remain higher. It seems that proper counselling of pregnant women and education of obstetricians may result in reduction of these rates