Controversy over renin–angiotensin–aldosterone system (RAAS) inhibitors treatment in nephrology and cardiovascular diseases

Drugs that act by inhibiting the renin–angiotensin–aldosterone system (RAAS), such as angiotensin-converting enzymeinhibitors (ACE-Is) and angiotensin II receptor type 1 (AT1) blockers (ARBs), have been recognized as a basiccanon of nephroprotection for years. They are commonly used in monotherapy for glomerulonephritis with proteinuria.At present, they are rarely used in combination therapy in a form of dual blockade of RAAS due to concernabout possible side effects. On the other hand, both ACE-Is and ARBs are also wrongly referred to as nephrotoxicdrugs. The significance of therapy with these drugs is seen in evoking acute kidney injury (AKI) or acceleration ofCKD. The aim of this article was to clarify the opinion on the relationship between ACE-Is or ARBs treatment andAKI occurrence, and to attempt to reassess the role of dual RAAS blockade in the treatment of kidney diseases. Theprinciples of heart failure (HF) therapy with ACE-Is or ARBs and current data on the importance of RAAS dualblockade in hypertension are also discussed

Structural health monitoring of a rail bridge structure impacted by mining operation

Structures located in areas affected by mining operation are subjected to movements and tilting. Continuous monitoring of the structure’s response to these forces allows for the control of their impact on the technical condition of the structure. In the case of railway structures, the measurements may allow further determination of the impact of modifications to the geometry of the structure on the track. This paper presents the results of observing indications of Structural Health Monitoring installed on an actual bridge construction under which mining operations were being conducted

Proteinuria and progression of chronic kidney disease. Does the kind of excreted protein affect progression of renal disease?

Nadmierne wydalanie białek z moczem charakterystyczne dla pierwotnych chorób kłębuszków nerkowych zależy od 2 zasadniczych mechanizmów: zwiększonej przepuszczalności ściany naczyń włosowatych kłębuszków oraz zaburzenia mechanizmu resorpcji białek, a w szczególności tych o niskiej masie cząsteczkowej, przez komórki nabłonka cewek bliższych, spowodowane zwiększonym obciążeniem i/lub uszkodzeniem toksycznym, wskutek zwiększonej przepuszczalności bariery filtracyjnej. Bariera ta cechuje się selektywnością przepuszczalności zależnej od wielkości cząsteczek obecnych w osoczu oraz ich ładunku. Wraz ze wzrostem stopnia zaburzenia integralności strukturalnej ścian naczyń włosowatych kłębuszków nerkowych rośnie nie tylko ilość białek, ale w świetle cewek pojawiają się białka o większym promieniu i masie cząsteczki, a ponadto dochodzi do zaburzenia selektywności bariery filtracyjnej. Początkowo pojawia się selektywny białkomocz, a dominującym białkiem jest albumina (masa cząsteczkowa — 69 kD, promień cząsteczki — 36Å). Przy rosnącym stopniu uszkodzenia kłębuszków ściany naczyń włosowatych są pokonywane przez coraz większą liczbę białek o większej masie cząsteczkowej, a na przykład ilość IgG (masa cząsteczkowa — 150 kD, promień cząsteczki — 55 Å) w świetle cewek wyraźnie wzrasta. Jak się od dłuższego czasu uważa, rodzaj wydalanych białek może być lepszym wyznacznikiem stopnia uszkodzenia ściany naczyń włosowatych kłębuszków niż całkowita wielkość białkomoczu, może mieć on ponadto wpływ na odpowiedź na leczenie i dalsze rokowanie u chorych z białkomoczem. W niniejszej pracy autorzy pragną bliżej zaprezentować ten problem.Massive proteinuria in the case of glomerular disease is an effect of deragements in filtration barrier and disorders of proteins resorption (concerning mainly low-molecular proteins) by the epithelial cells of proximal tubules. The barrier’s permeability is selective and depends on the size of the molecules in the plasma and their charge. The growing intensity of disorders of structural integrity of glomerular capillary walls is accompanied not only by the increased amount of proteins; proteins of larger molecule radius and larger molecular weight appear in the tubular lumens; the selectivity of the filtration barrier is disturbed. Initially, selective proteinuria appears, with albumin (molecular weight - 69 kD, molecular radius - 36 Å) as the dominant protein. With increasing damage to the glomeruli, a growing amount of proteins with greater molecular weight gets through the capillary walls and the amount of, e.g., IgG (molecular weight - 150 kD, molecular radius - 55 Å) in the tubular lumen increases rapidly. It has been believed for a long time that the sort of excreted proteins can be a better indicator of the damage to the glomerular capillary walls than the total protein excreted with urine; it can also affect the response to treatment and prognostication for patients with proteinuria. We would like to discuss the problem in this paper

Renal tubulointerstitial tissue damage, central pressure and vascular function in patients with untreated primary arterial hypertension

Background The aim of the study was to examine the correlation of the conventional method of arterial pressure measurement in the brachial artery and non-invasive aortic pressure measurement by applanation tonometry with vascular and left ventricular structure and function. An attempt was made at determining a correlation of morphological and functional changes within the cardiovascular system with selected parameters of renal filtration function and the renal interstitium in patients with previously untreated primary arterial hypertension.Material and methods 25 patients with untreated primary arterial hypertension without albuminuria and 15 healthy volunteers underwent arterial pressure measurement with a standard mercury sphygmomanometer using the Korotkoff technique and non-invasive measurement of aortic pressure by applanation tonometry using a SphygmoCor device. For all subjects, the concentrations of creatinine, uric acid, 1,25(OH)2D3, erythropoietin, and 25-hour NAG excretion were determined and GFR was estimated using the MDRD equation. PWV measurement was performed using a SphygmoCor device, whereas IMT was measured by ultrasound.Results Hypertensive patients showed higher values of arterial pressure compared to the control group: SBP, DBP, PP, MAP, as well as CSP, CDP, CPP and MCAP. In both the studied and the control group, the following statistically significant positive correlations were found: CPP vs IMT and CPP vs AIx. Only in the studied group, the following positive linear correlations were found: NAG vs PWV (R = 0.46; p = 0.019); NAG vs IMT (R = 0.36; p = 0.078). In the multiple regression model, a statistically significant positive effect was found of PWV and IMT [PWV (b 0.41; p = 0.0158), IMT (b 0.49; p = 0.0048)] on the dependent variable NAG (R2 = 0.503) in hypertensive patients. eGFR or uric acid concentration in serum included additionally in the model had no statistically significant effect on the dependent variable NAG (p = 0.9307 and p = 0.4938, respectively).Conclusions Damage to the renal tubulointerstitial tissue in hypertensive patients is concomitant with a decrease in vascular resistance. CPP may constitute a useful parameter for assessing the development of atherosclerotic lesions in vessels and the function of the left ventricle of the heart.Background The aim of the study was to examine the correlation of the conventional method of arterial pressure measurement in the brachial artery and non-invasive aortic pressure measurement by applanation tonometry with vascular and left ventricular structure and function. An attempt was made at determining a correlation of morphological and functional changes within the cardiovascular system with selected parameters of renal filtration function and the renal interstitium in patients with previously untreated primary arterial hypertension.Material and methods 25 patients with untreated primary arterial hypertension without albuminuria and 15 healthy volunteers underwent arterial pressure measurement with a standard mercury sphygmomanometer using the Korotkoff technique and non-invasive measurement of aortic pressure by applanation tonometry using a SphygmoCor device. For all subjects, the concentrations of creatinine, uric acid, 1,25(OH)2D3, erythropoietin, and 25-hour NAG excretion were determined and GFR was estimated using the MDRD equation. PWV measurement was performed using a SphygmoCor device, whereas IMT was measured by ultrasound.Results Hypertensive patients showed higher values of arterial pressure compared to the control group: SBP, DBP, PP, MAP, as well as CSP, CDP, CPP and MCAP. In both the studied and the control group, the following statistically significant positive correlations were found: CPP vs IMT and CPP vs AIx. Only in the studied group, the following positive linear correlations were found: NAG vs PWV (R = 0.46; p = 0.019); NAG vs IMT (R = 0.36; p = 0.078). In the multiple regression model, a statistically significant positive effect was found of PWV and IMT [PWV (b 0.41; p = 0.0158), IMT (b 0.49; p = 0.0048)] on the dependent variable NAG (R2 = 0.503) in hypertensive patients. eGFR or uric acid concentration in serum included additionally in the model had no statistically significant effect on the dependent variable NAG (p = 0.9307 and p = 0.4938, respectively).Conclusions Damage to the renal tubulointerstitial tissue in hypertensive patients is concomitant with a decrease in vascular resistance. CPP may constitute a useful parameter for assessing the development of atherosclerotic lesions in vessels and the function of the left ventricle of the heart

Nephrosclerosis - are kidneys the victim of evolution?

Nefroskleroza dosłownie oznacza „stwardnienie nerek”. Pod pojęciem tym kryje się konkretny obraz histopatologiczny. Swoiste dla nefrosklerozy są zmiany patologiczne w tętnicach łukowatych i międzypłacikowych pod postacią szkliwienia i przerostu mięśniówki naczyń. Zmianom w obrębie naczyń mogą towarzyszyć zmiany w obrębie kłębuszków nerkowych i tkanki cewkowo-śródmiąższowej. Etiologia nefrosklerozy nie jest do końca poznana, ale podłoże genetyczne wydaje się mieć bardzo istotne znaczenie. Zmiany o typie nefroangiosklerozy występują niezależnie od nadciśnienia tętniczego, być może prowadzą do jego rozwoju. Interesujący jest również fakt, iż roczny spadek filtracji kłębuszkowej w osób dotkniętych nefrosklerozą podobny jest do tego, jaki towarzyszy starzeniu się organizmu. Być może nefroskleroza, podobnie jak nadciśnienie tętnicze, jest chorobą cywilizacyjną, która ujawniła się w obecnym środowisku, bogatym w wodę i sól, a wcześniej po prostu nie występowała.The term “nephrosclerosis” literally means “hardening of kidney”, and is a reflection of a particular histopathological state. Pathological changes in arcuate arteries and interlobular arteries in the form of hyalinosis and hypertrophy of vasal muscular coat are specific to nephrosclerosis. Vascular lesions can be accompanied by gromerular and tubulo-intestitial tissue alteration. The etiology of nephrosclerosis is not fully known, but genetic factors seem to play an important role. Nephroangiosclerosis changes occur independently of arterial hypertension, and possibly lead to its development. Interesting is the fact, that a yearlong decrease of gromerular filtration in nephrosclerotic patients is similar to those associated with aging process. It is possible, that nephrosclerosis, just as arterial hypertension, is a civilization disease which has emerged in the contemporary, rich in water and salt environment, and earlier simply did not occur

Nefropatia nadciśnieniowa - opis przypadku

W pracy przedstawiono opis przypadku nefropatii nadciśnieniowej u 44-letniego mężczyzny przyjętego do kliniki w celu zdiagnozowania przyczyn zaawansowanej przewlekłej choroby nerek

Long-term, 12-month impact of olanzapine treatment on psychosocial functioning of schizophrenic patients

Introduction. Long-term, 12-month effects of olanzapine treatment were evaluated in a sample of 1053 schizophrenic patients. Material and methods. A repeated-measure, naturalistic, prospective design was used. Data were collected at baseline and at three-month follow-ups. Patients were switched from various antipsychotics because of insufficient response and/or marked intolerance. Several psychosocial functioning dimensions were evaluated based on Clinical Global Impression scale. Results. After 12 months, significant improvement in psychosocial functioning was found. Similar patterns of improvements in family relationships, occupational engagement, and other distorted social domains were established. Conclusions. Long-term olanzapine treatment appeared to be effective method for psychosocial intervention among patients with schizophrenia.Wstęp: Rezultaty długoterminowego, 12-miesięcznego leczenia olanzapiną oceniono w grupie 1053 pacjentów ze schizofrenią. Materiał i metody: Badanie miało charakter prospektywny, naturalistyczny, z oceną powtarzaną co 3 miesiące. Pacjenci byli przestawiani z różnych neuroleptyków z powodu niedostatecznej poprawy klinicznej i/lub znaczącej nietolerancji. Przeprowadzono pomiary w szeregu wymiarach funkcjonowania psychospołecznego, stosując skalę Clinical Global Impression. Wyniki: Po 12 miesiącach uzyskano znaczącą poprawę funkcjonowania psychospołecznego. Podobnie przebiegające, korzystne zmiany objęły relacje rodzinne, zaangażowanie zawodowe i inne dysfunkcjonalne obszary psychospołeczne. Wnioski: Długoterminowe leczenie olanzapiną okazało się efektywną metodą poprawiającą psychospołeczne funkcjonowanie pacjentów ze schizofrenią

Kontrowersje wokół leczenia lekami blokującymi układ renina–angiotensyna–aldosteron (RAA) w nefrologii oraz chorobach układu sercowo-naczyniowego

Leki hamujące układ renina–angiotensyna–aldosteron (RAA), takie jak inhibitory konwertazy angiotensyny (ACE-Is) oraz antagoniści receptora AT1 dla angiotensyny II (ARBs), są uznanym od lat, podstawowym kanonem nefroprotekcji. Powszechnie stosuje się je w monoterapii kłębuszkowych chorób nerek przebiegających z białkomoczem. Obecnie rzadziej zaleca się je w leczeniu skojarzonym w formie tak zwanej podwójnej blokady układu RAA w obawie o ewentualne działania niepożądane. Jednocześnie zarówno ACE-Is, jak i ARBs są także niesłusznie określane jako leki nefrotoksyczne. Upatruje się znaczenia terapii tymi lekami w wywoływaniu ostrego uszkodzenia nerek (AKI) czy też zaostrzenia przewlekłej choroby nerek (PChN). Celem tej pracy jest próba zweryfikowania poglądów dotyczących związków pomiędzy prowadzeniem leczenia ACE-Is lub ARBs a rozwojem AKI oraz próba ponownego spojrzenia na rolę podwójnej blokady układu RAA w terapii chorób nerek. Omówiono również zasady terapii niewydolności serca (HF) z zastosowaniem ACE-Is lub ARBs oraz aktualne dane dotyczące znaczenia podwójnej blokady układu RAA w nadciśnieniu tętniczym

Continuous structural health monitoring of selected geotechnical quantities within Kościuszko Mound in Cracow

Kościuszko Mound in Cracow is earthen structure particularly susceptible to deformations, among other things, due to the unfavourable physical and mechanical properties of the ground and a significant tilt of slopes. Since the beginning of its existence to the present day, structural failures were repeatedly occurred, and the biggest took place after 1997, when heavy rains led to the greatest destruction of the entire mound solid ever. Overall renovation, however, did not produced the expected results and did not stop negative atmospheric influences on the monument behaviour. Therefore, in 2012, structural health mo nitoring was installed on-site, providing remote, continuous and automatic measurements of selected physical quantities, which are important from mound technical condition point of view. System is measuring, among other things, changes in vertical displacements, circumferential and radial deformations, ground pore pressure of water within a mound body and humidity of its surface layers. Correlation of results from geodetic, inclinometer and meteorological (derived from the weather station which is part of the monitoring system) measurements will enable a comprehensive assessment of ground layer work mechanisms within the whole mound solid and will be one of the bases for effective strengthening design in the future

Continuous structural health monitoring of selected geotechnical quantities within Kościuszko Mound in Cracow

Kościuszko Mound in Cracow is earthen structure particularly susceptible to deformations, among other things, due to the unfavourable physical and mechanical properties of the ground and a significant tilt of slopes. Since the beginning of its existence to the present day, structural failures were repeatedly occurred, and the biggest took place after 1997, when heavy rains led to the greatest destruction of the entire mound solid ever. Overall renovation, however, did not produced the expected results and did not stop negative atmospheric influences on the monument behaviour. Therefore, in 2012, structural health mo nitoring was installed on-site, providing remote, continuous and automatic measurements of selected physical quantities, which are important from mound technical condition point of view. System is measuring, among other things, changes in vertical displacements, circumferential and radial deformations, ground pore pressure of water within a mound body and humidity of its surface layers. Correlation of results from geodetic, inclinometer and meteorological (derived from the weather station which is part of the monitoring system) measurements will enable a comprehensive assessment of ground layer work mechanisms within the whole mound solid and will be one of the bases for effective strengthening design in the future