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

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

The use of artificial intelligence in nephrology

Introduction and methods Artificial Intelligence(AI) is a relatively new branch of science that studies the display of intelligent behavior by machines and its use in advanced analysis and computation. Due to the potential use of AI, it has also been introduced into medicine and nephrology. The following article is an analysis of the current knowledge on the potential of AI in nephrology and its relevance to clinicians based on the latest publications contained in the PubMed and Google Scholar databases. Stage of knowledge AI found its application in the prognosis of the development of IgA nephropathy thanks to the use of a neural network, which by analyzing the results of research and the drugs used in a large group of patients has learned to detect patients at high risk of developing severe complications at the beginning of the disease. What is more, AI makes it possible to detect DKD earlier and delay renal replacement therapy. In patients undergoing hemodialysis, artificial intelligence developed a model that calculated the appropriate duration of the procedure and adjusted drugs to control blood pressure. Another example of the use of AI is its use in relation to patients undergoing kidney transplantation. The AI calculates the beneficial concentration of an immunosuppressive drug specifically for a given patient, which allows clinicians to limit adverse effects. Summary AI is a breakthrough technology that is constantly being developed. Despite the high cost of implementing this technology, it is believed that it could represent the future of medicine and be a new way in treatment techniques and in the early detection of diseases in nephrology

Semaglutide for the treatment of obesity

Introduction and purpose Due to the growing tendency to diagnose obesity in patients, scientists are trying to find drugs that facilitate weight reduction.  An example of such a formulation is the GLP-1 analogue semaglutide. The following article is an analysis of the current knowledge on the effectiveness and safety of obesity treatment with semaglutide based on available publications in Pubmed and Google Scholar databases. State of knowledge The main mechanism of semaglutide is based on a stimulation of insulin secretion from pancreatic beta cells, and inhibition of glucagon from alpha cells, inhibition of hepatic gluconeogenesis, and reduction of energy consumption with minimal impact on energy expenditure. In clinical trials, it showed the best results compared to placebo and other drugs used in weight reduction. Participants treated with semaglutide achieved a reduction in waist circumference, improvements in blood pressure parameters, HbA1c levels, total cholesterol, LDL cholesterol, triglycerides, and CRP protein, and increased HDL cholesterol levels. Semaglutide is well tolerated by patients, and its main side effects come from the gastrointestinal tract, including nausea, emesis, diarrhea. Summary The analysis of the latest publications and meta-analyzes of the literature shows that the use of semaglutide is safe and effective in the treatment of obesity. The positive effect of semaglutide on weight reduction also contributes to the reduction of the risk of cardiovascular events and other obesity-related complications. It is also well tolerated by patients, which translates into possible longer use, and weekly subcutaneous injections are not burdensome for patients. Key words: semaglutide; obesity; GLP-1 analogue; overweigh