Hypertension in children with chronic kidney disease: pathophysiology and management

Arterial hypertension is very common in children with all stages of chronic kidney disease (CKD). While fluid overload and activation of the renin–angiotensin system have long been recognized as crucial pathophysiological pathways, sympathetic hyperactivation, endothelial dysfunction and chronic hyperparathyroidism have more recently been identified as important factors contributing to CKD-associated hypertension. Moreover, several drugs commonly administered in CKD, such as erythropoietin, glucocorticoids and cyclosporine A, independently raise blood pressure in a dose-dependent fashion. Because of the deleterious consequences of hypertension on the progression of renal disease and cardiovascular outcomes, an active screening approach should be adapted in patients with all stages of CKD. Before one starts antihypertensive treatment, non-pharmacological options should be explored. In hemodialysis patients a low salt diet, low dialysate sodium and stricter dialysis towards dry weight can often achieve adequate blood pressure control. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers are first-line therapy for patients with proteinuria, due to their additional anti-proteinuric properties. Diuretics are a useful alternative for non-proteinuric patients or as an add-on to renin–angiotensin system blockade. Multiple drug therapy is often needed to maintain blood pressure below the 90th percentile target, but adequate blood pressure control is essential for better renal and cardiovascular long-term outcomes

Patients' satisfaction and subjective happiness after refractive surgery for myopia

Shinichiro Matsuguma,1 Kazuno Negishi,1 Motoko Kawashima,1 Ikuko Toda,2 Masahiko Ayaki,1 Kazuo Tsubota1,2 1Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; 2Minamiaoyama Eye Clinic, Tokyo, Japan Purpose: The purpose of this study was to assess patients’ satisfaction and change in subjective happiness after laser-assisted in situ keratomileusis (LASIK). Patients and methods: This was a retrospective cross-sectional study of 307 patients (mean age, 34.3 years; range, 20–63 years) who underwent bilateral LASIK surgery and ocular examinations, including subjective refraction and visual acuity axial length measurements at Minamiaoyama Eye Clinic. Patients also completed questionnaires on their satisfaction with the surgery, and on the subjective happiness scale (SHS) within 1 month before and 1 month after surgery. A multiple regression analysis was performed to determine the independent predictors of the SHS score. Results: In total, 91.2% of the patients were satisfied with surgery (very satisfied: n=155; satisfied: n=125). The SHS score increased postoperatively from 5.2±0.9 to 5.3±0.9 (P<0.001). The multiple regression analysis revealed that the preoperative SHS score (β=0.77; P<0.001) and satisfaction with surgery (β=-0.11; P=0.05) were predictors of postoperative SHS score. Conclusion: LASIK may contribute to increased patient happiness. Keywords: satisfaction, subjective happiness, laser in situ keratomileusis, eye surger