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

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

Pharmacotherapy of androgenetic alopecia – a literature review

INTRODUCTION: Androgenetic alopecia, also known as male pattern baldness, is a common dermatological problem. It manifests as hair thinning and miniaturization of hair follicles. In recent years, knowledge of the risk factors and pathomechanisms of this disease has increased, making treatment more effective. Serious consequences of this condition include reduced quality of life and patient self-esteem. PURPOSE OF THE WORK: The purpose of this paper is to review and discuss selected studies involving agents used in the pharmacotherapy of androgenetic alopecia and to evaluate their safety and efficacy. DESCRIPTION OF THE STATE OF KNOWLEDGE: There are two drugs approved by the Food and Drug Administration (FDA) for the treatment of androgenetic alopecia - oral finasteride 1 mg and 2% or 5% minoxidil solution for topical use. There are also other preparations for external use, such as 0.1% finasteride solution or ketoconaloze shampoo, and for oral use, dutasteride. They seem to be a promising alternative for the treatment of androgenetic alopecia, but require further research. It is possible to use one drug of choice or to use combination therapy to achieve better therapeutic effects. SUMMARY: In order to achieve the best and fastest treatment results, patients should be treated with combination therapy consisting of two or more preparations. To reduce systemic side effects, consider using several topical preparations

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

Renal cell carcinoma - epidemiology, risk factors, diagnosis and treatment - review article

INTRODUCTION: Renal cell carcinoma (RCC) is the most common urological malignancy. It accounts for 2% of deaths from all malignancies.  Most cases of renal cell carcinoma are diagnosed incidentally during routine ultrasound or CT scans. Most cases are diagnosed in the asymptomatic stage. The presence of symptoms such as lower extremity edema and varicose veins of the seminal vasculature usually indicate the presence of an advanced neoplastic process.   PURPOSE OF THE WORK: In this article we reviewed the literature on renal cell carcinoma. We collected and compared information on the epidemiology of risk factors, histological classification and treatment of RCC.STATUS OF KNOWLEDGE: According to GLOBOCAN data, there is an increase in the incidence of RCC in developed countries. In the treatment of renal cell carcinoma, the method of choice is surgical excision of the tumor. A kidney-sparing approach is preferred if the conditions exist. VEGF inhibitors, tyrosine kinase inhibitors and m-TOR kinase inhibitors are used in the treatment of metastatic renal cell carcinoma.CONCLUSION: Renal cell carcinoma is the most common urological cancer. By promoting healthy lifestyles, patients can significantly reduce their risk of developing it. The method of choice for treatment is still surgical excision of the tumor

ETHER - a partially forgotten anesthetic

INTRODUCTION: Ether is the common name for diethylether (CH3-CH2-O-CH2-CH3). It is a colorless, volatile and highly flammable liquid with a characteristic pungent odor. It was widely used as an anesthetic in the past and is now a component of solvents.  PURPOSE OF THE WORK: The purpose of this paper is to introduce ether as a potentially forgotten substance in the world of Western medicine. Its history, current use, potential for abuse for narcotic purposes, addiction, and the benefits of anesthesia with this agent in impoverished countries. DESCRIPTION OF THE STATE OF KNOWLEDGE: Ether was first synthesized in 1540 by Valerius Cordus. Ether is characterized by rapid absorption, rapid distribution in the central nervous system and rapid, short-lasting effects. Ether has high solubility in blood/gas, which slows both induction and recovery of anesthesia. In developing countries, it is suggested that ether be used as an intraoperative analgesia. But it should be remembered, despite the new psychoactive substances, other inexpensive and readily available intoxicants can be found, among them ether. It has been noted in numerous publications that abuse of ether is associated with abuse of other drugs and/or alcohol dependence. SUMMARY: It is important to remember that ether compounds are widespread. People struggling with the urge to abuse substances can get these substances easily and cheaply. On the other hand, ether anesthesia is a great solution for developing countries. There are situations there that due to lack of funds, some operations are carried out without anesthesia. Ether is cheap, and administering anesthesia with it is quite simple, and could give wonderful relief to these patients

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

Unintentional overdose of paracetamol as a problem of modern times - a case report

INTRODUCTION Paracetamol is one of the most widely used analgesics and antipyretics in the world. An overdose of this drug can occur after a single ingestion of a large amount of paracetamol or after repeated ingestion of smaller amounts that eventually exceed the recommended total dose and can result in liver damage.  It is believed that the maximum daily dose of paracetamol for an adult is 4g. MATERIALS AND METHOD Patient information was collected from hospital records available in the clinical toxicology department. In addition, we conducted a literature review on paracetamol using PubMed. CASE REPORT A patient, 16 years old, was admitted from a district hospital to the Clinical Toxicology and Cardiology Department in Lublin for paracetamol intoxication and suspected intoxication with a psychoactive substance. The patient's history revealed that he had taken a total of 20 paracetamol 500mg (10g) tablets in short intervals of 2 h for abdominal pain. The patient was treated with a full dose of antidote (ACC), and the drug infusion was continued at a maintenance dose. Despite the treatment administered, increasing features of liver damage were observed (INR 2.78, AST 6273 U/l, ALT 8854 U/l, bilirubin 3.83 mg/dl).The patient was consulted to qualify for a possible liver transplant. With intensive treatment maintained, a downward trend in liver damage parameters was achieved. The patient was discharged from the Department in good general condition, without complaints. CONCLUSION Due to the increasing number of paracetamol overdoses (intentional or accidental), strategies should be implemented to raise awareness and prevent this-educating patients, encouraging label/leaflet reading, reducing the amount of paracetamol in packages, more visible warnings on packages

Risk factors of atrial fibrillation recurrence despite successful radiofrequency ablation of accessory pathway: At 11 years of follow-up

Background: Previous reports on patients with radiofrequency catheter ablation (RFCA) of accessorypathway (AP) and atrial fibrillation (AF) include only short follow-up periods. The aim of this studywas to analyze predictors of recurrence of AF in patients after successful RFCA of APs over long termfollow-up periods.Methods: Of the 1,007 patients who underwent non-pharmacological treatment of APs (between theyears 1993–2008), data of 100 consecutive patients were retrospectively analyzed (75 men, mean age43.6 ± 14.7), with the longest period of follow-up (mean 11.3 ± 3.5 years) after successful RFCA ofAP. In Group 1, there were 72 patients (54 men, mean age 40.66 ± 13.85 years) without documentedepisodes of AF after RFCA of AP. Group 2 consisted of 28 patients (21 men, mean age 50.79 ± 14.49years) with AF episodes despite successful elimination of AP.Results: In univariate analysis, patients from Group 1 were significantly younger at the time of ablationthan patients from Group 2 (40.66 ± 13.85 vs. 50.79 ± 14.49 years; p = 0.002), had shorter historyof AF episodes (4.11 ± 4.07 vs. 8.25 ± 7.50 years; p = 0.024) and had less frequently documentedatrial tachycardia (AT) prior to ablation (3.39 vs. 20.00%; p = 0.022). In multivariate analysis, thehistory of AF in years (p = 0.043), was an independent risk factor for AF recurrences.Conclusions: Older patient age, longer history of AF and AT prior to RFCA of APs identified a subgroupof patients who required additional treatment. In the multivariate analysis, the history of AF inyears (p = 0.043) was a risk factor for AF recurrence

Reduction of left ventricular mass, left atrial size, and N-terminal pro–B-type natriuretic peptide level following alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy

Background: Alcohol septal ablation (ASA) is an alternative to surgical treatment in patients with hypertrophic obstructive cardiomyopathy (HOCM). Through alcohol-induced necrosis, ASA leads to an increase in left ventricular outflow tract (LVOT) diameter and a decrease in LVOT pressure gradient. Aims: We sought to assess the effect of ASA on left ventricular (LV) wall thickness and mass, left atrial (LA) size, and N-terminal pro–B-type natriuretic peptide (NT-proBNP) level. Methods: The study cohort consisted of 50 patients with HOCM (30 in the ASA group, 20 in the optimal pharmacotherapy group [OPG]). Transthoracic echocardiography (TTE), cardiac magnetic resonance (CMR), and NT-proBNP level analysis were performed at baseline and at six months. Results: All parameters are presented as means. In the ASA group, the maximal LVOT pressure gradient decreased from 122.7 to 54.8 mmHg directly after ASA and to 37.2 mmHg after a further six months (p < 0.0001). The NT-proBNP level decreased from 2174.4 to 1103.4 pg/mL (p < 0.001). On TTE, the interventricular septum (IVS) thickness decreased to from 23.6 to 19.4 mm (p < 0.0001) and the lateral wall (LW) thickness decreased from 15.9 to 14.2 mm (p < 0.007). On CMR, basal IVS thickness decreased from 23.7 to 18.0 mm (p < 0.0001) and the LW thickness decreased from 13.2 to 12.2 mm (p = 0.02). IVS mass reduced from 108.9 to 91.5 g (–16%; p < 0.001). All of the above parameters remained unchanged in the OPG. Conclusions: Successful ASA reduces LV hypertrophy and improves parameters of the LV overload, resulting in LV wall hy­pertrophy regression, and LA size and NT-proBNP level reduction. The above parameters may be as useful in assessing the efficacy of ASA as the LVOT gradient itself