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Vaverkova Dr. H.,III. interni klinika nefrologicka
Interni Medicina pro Praxi | Year: 2013

The risk of death from cardiovascular disease is increased already in early stages of chronic kidney disease (CKD), and increases significantly in more advanced stages. This risk is comparable to that in diabetes and pre-existing ischemic heart disease. The increased cardiovascular risk in CKD is due to both traditional and untraditional risk factors, including dyslipidemia. Dyslipidemia is modifiable and should be treated. Statins slow the progression of CKD and have a beneficial effect on proteinuria. Statins reduce all-cause and cardiovascular mortality as well as the occurrence of cardiovascular events in early stages of CKD (stages 1 to 4); in stage 5D, however, they only have a minor effect on the above-mentioned events. The benefit of statin treatment in stage 5D in terms of cardiovascular events can likely be expected only in persons with increased LDL cholesterol. Fenofibrate favorably affects the progression of albuminuria in type 2 diabetics. The largest reduction in cardiovascular events and cardiovascular mortality in the FIELD study with fenofibrate was achieved in diabetics with stage 3 CKD. The dose of hypolipidemic agents (except for atorvastatin and ezetimibe) must be adjusted to the degree of impaired renal function. Roughly 10% of the population have CKD and only a small proportion of them are aware of it. Early stages of CKD are asymptomatic and CKD is often diagnosed incidentally on examination by a general practitioner or internist. Routine use of estimated glomerular filtration rate (eGFR) and determination of microalbuminuria in at-risk individuals (particularly diabetic and hypertensive patients) could identify a large number of people in the population who can benefit from hypolipidemic therapy.

Background. The diagnostics and treatment of multiple myeloma (MM) requires precise analysis of serum immunoglobulins, which might be limited by the sensitivity of standard examination methods. Hevylite™ method enables quantitative analysis of heavy/light chain pairs (HLC) of normal and tumor IgG and IgA immunoglobulin and their ratio (HLC-r). The aim of the study was to assess the contribution of Hevylite™ method in the diagnostics of MM in comparison with nephelometry (NEF), standard protein electrophoresis (SPE), immunofixation electrophoresis (IFE) and the examination of serum free light chains (FLC) of immunoglobulin using Freelite™ test and heavy/light chain pairs of immunoglobulin (HLC) using Hevylite™. Methods. Using the methods Hevylite™, NEF, SPE, IFE and Freelite™, we examined a cohort of 134 individuals fulfilling the International Myeloma Working Group (IMWG) criteria. 96 patients were of IgG and 38 of IgA type. Results. The levels of HLCkappa (K) and HLC-lambda (L), as well as HLC-r were independent of age and gender. Abnormal HLC levels were present in 84-100%, pathological HLC-r was in 92-100% cases based on MIg isotype. We found strong positive correlation between IgG and IgA (NEF) and the sum of HLC IgG-K + IgG-L (Hevylite™) (r = 0.80, p <0.0001) and HLC IgA-K + IgA-L (r = 0.75, p < 0.0001). Very strong positive correlation was between the concentration of MIg (SPE) and the levels of HLC (Hevylite™) in IgG-K (r = 0.73), IgG-L (r = 0.76), IgA-K (r = 0.70) and IgA-L (r = 0.89), p < 0,0001. Systematic difference between Hevylite™ vs. MIg (SPE) was confirmed by Bland-Altmann test in the case of HLC IgA-K and IgA-L (not HLC IgG-K and IgG-L), and in the correlation of HLC with IgG and IgA (NEF). The most significant correlation between SPE (patients with < 15 g/L) vs. Hevylite™ was found within the analysis of HLC IgG-K+ IgA-K (r = 0.85, p < 0.0001), and in the whole cohort of MM patients, i.e. IgG + IgA-kappa and lambda (r = 0.76, p < 0.0001), confirmed by Bland-Altmann test. Tight positive correlation was between HLC-r and index of monoclonality FLC-K/L in MM of IgG and IgA type MM (p < 0.0001). Conclusion. Hevylite™ method, especially the assessment of HLC-r of IgA type MM is more sensitive in comparison with SPE evaluated by NEF, and increases the diagnostic sensitivity and the extent of tumor mass examination. Despite its limitation in the case of high levels of IgG type MIg, Hevylite™ technique has a promising potential to enrich the standard analytic tools as it enables to assess the concentration and ratio of the levels of both tumor and physiological immunoglobulins e.g. depth of immunoparesis, valid especially in MM with low levels of MIg.

Pika T.,III. interni klinika nefrologicka | Lochman P.,Oddeleni klinicke biochemie | Flodr P.,Ustav Klinicke a Molekularni Patologie | Minarik J.,III. interni klinika nefrologicka | And 3 more authors.
Klinicka Biochemie a Metabolismus | Year: 2013

Objective: The objective of this report is to point out the clinical importance of select biological indicators applied to diagnostics and monitoring of AL amyloidosis patients. In addition to the usual parameters such as urine analysis or the monoclonal immunoglobulin level assay, the benefits of free light immunoglobulin chains serum level assay and its application to treatment response evaluation are pointed out, as well as the benefits of heart indicator assays (troponins and natriuretic peptides) for the stratification of AL amyloidosis patients. A brief introduction of this rare diagnosis is also included in the report.

Minarik J.,III. interni klinika nefrologicka | Hrbek J.,Radiologicka Klinika | Pika T.,III. interni klinika nefrologicka | Herman M.,Radiologicka Klinika | And 3 more authors.
Osteologicky Bulletin | Year: 2013

The aim of the paper is to compare the contribution ot three imaging methods used in the diagnosis of multiple myeloma in accordance with recent guidelines. Conventional radiography is easily accessible and economically convenient examination which is recommended in all patients with newly diagnosed multiple myeloma. Its limitations are low sensitivity and high percentage of false-negative findings. Therefore, it should not remain the "gold standard" but should be supported with more sophisticated methods. Magnetic resonance imaging provides significant contribution with higher sensitivity and specificity. It enables to assess bone marrow processes and extramedullary spread including damage to the spinal cord or nerve structures. It shifts the borders of the symptomatic form of multiple myeloma and has also prognostic potential in patients with monoclonal gammopathy of undetermined significance. Low-dose computed tomography (CT) is an alternative for the whole-body assessment. It can be performed using standard CT scanners with reduced radiation exposure. It is fast, sensitive and economically accessible with potential to compensate for the worse access to magnetic resonance imaging.

Skacelova M.,III. interni klinika nefrologicka | Horak P.,III. interni klinika nefrologicka
Osteologicky Bulletin | Year: 2013

Male osteoporosis is a condition with an increasing incidence and relatively high mortality associated with fractures. A secondary etiology is quite common, mostly contributed to by deficiency of sex hormones (testosterone, estradiol), other diseases and medication use. Prior to treatment initiation, a secondary etiology should be clearly ruled out. A significant role in the prevention and treatment is played by modification of lifestyle factors (physical activity, smoking, alcohol consumption, etc.) and sufficient calcium and vitamin D supplementation. In the treatment of male osteoporosis, bisphosphonates are currently used. If taken regularly, they increase BMD of the lumbar spine and proximal femur and aid in reducing the risk of osteoporotic fractures. Drugs currently approved for use are alendronate, risedronate and zoledronic acid. Other drugs known to be effective in the treatment of male osteoporosis are strontium ranelate and teriparatide.

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