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Zakiyanov O.,Klinika nefrologie VFN | Zakiyanov O.,Ustav lekarske biochemie a laboratorni diagnostiky VFN | Vachek J.,Klinika nefrologie VFN | Tesar V.,Klinika nefrologie VFN
Kardiologicka Revue | Year: 2014

Rapidly progressive glomerulonephritides (RPGN) are the most severe form of the nephritic syndromes. In this case, glomerular injury is so acute that irreversible renal failure develops over the course of a few days to weeks. RPGN usually presents as proteinuria < 3g/ day, hematuria with dysmorphic red blood cells and/ or red cell casts, with or without signs of systemic vasculitis. A specifi c fi nding upon kidney bio psy is a crescent formation in more than 70% of glomeruli. The most common diseases presenting as RPGN are ANCA-associated vasculitides, Goodpasture's disease (anti-renal nephritis), and the much less common immunocomplex glomerulonephritides. Treatment includes glucocorticoids, cyclophosphamide and novel therapies including targeted treatment (rituximab), sometimes in combination with plasma exchange.


Zakiyanov O.,Klinika nefrologie VFN | Zakiyanov O.,Ustav lekarske biochemie a laboratorni diagnostiky VFN | Vachek J.,Klinika nefrologie VFN | Tesar V.,Klinika nefrologie VFN
Kardiologicka Revue | Year: 2014

Chronic kidney disease belongs among the most frequent clinical problems, but often remains underdiagnosed. Decreased renal function affects all pharma-cokinetic properties of drugs. Thus, patients with chronic kidney disease are at increased risk of adverse drug effects -especially overdoses of drugs that are primarily eliminated by the kidneys. Other frequent problems in patients with kidney disease are polymorbidity and polypharmacy. Before using any new medication, determination of the glomerular filtration rate is obligatory, since the value of serum creatinine alone is not a reliable indicator of kidney function. The dosing of drugs eliminated mainly or solely by the kidneys can be adjusted by reducing the dose, prolonging the interval between doses, or combining both these methods.


Vachek J.,Klinika nefrologie VFN | Zakiyanov O.,Klinika nefrologie VFN | Zakiyanov O.,Ustav lekarske biochemie a laboratorni diagnostiky VFN | Bandur S.,Interni klinika FN Kralovske Vinohrady | Tesar V.,Klinika nefrologie VFN
Kardiologicka Revue | Year: 2014

Acute kidney injury is generally defined as a condition characterised by the rapid loss of the kidney's excretory function with a decline of the glomerular fil-tration rate and is typically diagnosed by the accumulation of the end products of nitrogen metabolism or decreased urine output, or both. It is the clinical manifestation of a number of disorders that can affect the kidney acutely. Acute kidney injury is common in hospital patients and very common in critically ill patients, and is often secondary to extrarenal causes. New diagnostic techniques including renal bio markers may help with early diagnosis. No specific therapies have emerged that can attenuate acute kidney injury or expedite recovery; thus, treatment is supportive. Patients are given renal replacement therapy if acute kidney injury is severe and bio chemical or volume -related, or if uraemic- toxaemia-related complications are of concern. Patients typically recover to dialysis independence. However, evidence suggests that patients who have had acute kidney injury are at increased risk of subsequent chronic kidney disease. In general, acute kidney injury is associated with serious and far- reaching consequences not only for the patient (dialysis dependence, increased morbidity and mortality), but it also has significant economic implications for the health system.

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