Publications by authors named "Agnes Haris"

15 Publications

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Investigation of lifestyle difficulties in dialysis patients using quantitative testing methods

Orv Hetil 2021 07 25;162(30):1208-1215. Epub 2021 Jul 25.

3 Péterfy Kórház-Rendelőintézet és Manninger Jenő Országos Traumatológiai Intézet, I. Belgyógyászat, Nephrológia és Gasztroenterológia Osztály, Budapest.

Összefoglaló. Bevezetés: A krónikus vesebetegség tünetei, a kezelés sajátosságai nagymértékben korlátozzák a páciensek mindennapi életvitelét, hatással vannak testi és lelki egészségükre, és nehezítik társas kapcsolataikat. Célkitűzések: A jelen kutatás célja a magyar dializált betegpopuláció egészségműveltségének, életminőségének és betegségterhének megismerése, továbbá a kezelési típusok hatását kívántuk felmérni a fent említett pszichológiai tényezők mentén. Módszer: A vizsgálatban 42 krónikus dializált személy vett részt: 31 hemodializált és 11 hasi dialízist végző vesebeteg. Átlagéletkoruk 63,33 ± 12,92 év. A minta életkor, nemi eloszlás és családi állapot alapján reprezentatív. Kérdőíves technikával mértük a betegek életminőségét, egészségműveltségét és betegségterhét. Eredmények: Eredményeink szerint a peritonealis dialízist végző betegek szignifikánsan magasabb egészségműveltséggel rendelkeznek, mint hemodializált betegtársaik. Ez a jelentős különbség az életminőségük több területén is kimutatható volt. Következtetés: Eredményeink a betegedukáció és a kezelőszemélyzettől kapott támogatás (bátorítás) jelentőségére hívják fel a figyelmet. A betegoktatás a hemodializált betegcsoport esetében is kiemelten fontos. A klinikai szempontból hasznos intervenciós javaslatokat fogalmaztunk meg, melyek célzottan az egészségműveltség fejlesztésére irányulnak. Orv Hetil. 2021; 162(30): 1208-1215.

Summary:

Introduction: The symptoms of chronic kidney disease, the peculiarities of the treatment greatly limit the patients' daily life, affect their physical and mental health and make their social relationships more difficult.

Objective: The purpose of this research is to explore the health literacy, the health-related quality of life and illness intrusiveness of Hungarian dialysis patients. Furthermore, we wanted to assess the effect of treatment types along the psychological factors mentioned above.

Method: The sample consisted of 42 patients with chronic kidney disease, 31 of whom have hemodialysis and 11 have peritoneal dialysis treatment. Their mean age was 63.33 ±12.92 years. The sample is representative by age, gender, and marital status. We measured the health-related quality of life, the health literacy and illness intrusiveness of the patients using special questionnaire techniques.

Results: The peritoneal dialysis patients have significantly higher health literacy than their hemodialysis counterparts. This significant difference was seen in several areas of their quality of life as well.

Conclusion: Our results draw attention to the importance of patient education and the special support by the treatment staff. The patient education for the haemodialysis group is of paramount importance for the hemodialysis group, too. We have formulated clinically useful intervention proposals aimed at improving health literacy. Orv Hetil. 2021; 162(30): 1208-1215.
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http://dx.doi.org/10.1556/650.2021.32154DOI Listing
July 2021

Multidisciplinary education and lifestyle camps for CKD patients and their closest family members: effects on disease progression, self-management and psychosocial condition-a retrospective cohort study.

Int Urol Nephrol 2021 Jul 15. Epub 2021 Jul 15.

1st Department of Internal Medicine and Nephrology, Péterfy Hospital and Outpatient Clinic, 8-20 Péterfy Street, Budapest, 1076, Hungary.

Background: Multidisciplinary education including psychosocial care (MDE) may alleviate high burden of chronic kidney disease (CKD). Family support also has utmost importance, yet, MDE has rarely been provided jointly for patients and their relatives.

Methods: We organized intensive, 1-week-long boarding MDE and lifestyle camps for CKD stage III-V patients and their relatives and assessed the rate of CKD progression, proportion of participants' home-based dialysis choice, transplant activity, and improvement of their coping and attitude evaluated by written narratives. Outcome was compared to 40 controls with similarly advanced CKD, under standard of care on our outpatient clinic.

Results: In 60 predialysis patients, serum creatinine 12 months before participation was 281 [IQR 122] µmol/l, right before MDE 356 [IQR 141] µmol/l, 12 months after MDE 388 [IQR 284] µmol/l, eGFR decreased from 18.5 [IQR 10] ml/min to 14.0 [IQR 7] ml/min and 13.0 [IQR 8] ml/min, respectively. Twelve months' changes before and after MDE differed significantly (p = 0.005 for creatinine; p = 0.003 for eGFR). Decreased progression was found in comparison to controls (p = 0.004; 0.016, respectively) as well. During follow-up, MDE patients compared to controls chose PD as dialysis modality more often (p = 0.004), and were more active in renal transplantation (p = 0.026). Based on narratives, MDE enhanced participants' disease-specific knowledge and ability for coping. It also improved sympathy, helpfulness, and the mutual responsibilities of family members.

Conclusions: Our unique MDE programme with participation of the closest relatives enhanced the effectiveness of education and strengthened family support, which contributed to favorable CKD outcome, increased activity in home-based dialysis selection and transplant activity.
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http://dx.doi.org/10.1007/s11255-021-02948-xDOI Listing
July 2021

Overcoming barriers and building a strong peritoneal dialysis programme - Experience from three South Asian countries.

Perit Dial Int 2021 Jun 2:8968608211019986. Epub 2021 Jun 2.

Department of Nephrology, Teaching Hospital, Kandy, Sri Lanka.

The development of peritoneal dialysis (PD) programmes in lower-resource countries is challenging. This article describes the learning points of establishing PD programmes in three countries in South Asia (Nepal, Sri Lanka and Pakistan). The key barriers identified were government support (financial), maintaining stable supply of PD fluids, lack of nephrologist and nurse expertise, nephrology community bias against PD, lack of nephrology trainee awareness and exposure to this modality. To overcome these barriers, a well-trained PD lead nephrologist (PD champion) is needed, who can advocate for this modality at government, professional and community levels. Ongoing educational programmes for doctors, nurses and patients are needed to sustain the PD programmes. Support from well-established PD centres and international organisations (International Society of Peritoneal Dialysis (ISPD), International Society of Nephrology (ISN), International Pediatric Nephrology Association (IPNA) are essential.
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http://dx.doi.org/10.1177/08968608211019986DOI Listing
June 2021

Outcome of patients with lupus nephritis under long-term immunonephrological care

Orv Hetil 2020 08;161(31):1293-1301

I. Belgyógyászat, Nephrológia és Gasztroenterológia Osztály,Péterfy Kórház-Rendelőintézet és Manninger Jenő Országos Traumatológiai Intézet, Budapest, Péterfy S. u. 8-20., 1076.

Introduction: Lupus nephritis is the most severe complication of systemic lupus erythematosus (SLE), its development and the effectiveness of immunosuppressive therapy substantially influence patients' quality of life and survival.

Aim: In this retrospective observational investigation, the long term-outcome of patients with lupus nephritis, followed at the St. Margit Hospital Immunonephrological Outpatient Clinic, was evaluated.

Results: Between 1997 December 1 and 2019 April 30, 73 patients (age 33.7 ± 15 years, 82% female, 18% male) were under care with median observation of 119 [between 3-264] months. At diagnosis, eGFR showed 68 [7-120] ml/min, proteinuria was 2800 [23-16812] mg/day; 10 patients needed dialysis treatment acutely. Renal biopsy, performed in 68 patients, proved proliferative lupus nephritis in 55 and pure membranous lupus nephritis in 6 patients. Administering combined immunosuppressive therapy, complete remission was achieved in 50 and partial remission in 21 cases; one or repeated relapses developed in 28 subjects. Two patients, by the time they got under our care, had already required chronic dialysis, and in the long term, three more patients progressed to end-stage renal disease requiring renal replacement therapy. Renal function stabilized in all other participants, clinical activity of SLE, SLEDAI score, complement levels and immunserology results improved significantly.

Conclusions: Lupus nephritis can be effectively treated by combined induction and prolonged maintenance immunosuppression, but to prevent progression of the disease, long-term care is necessary by co-operation of nephrologist and immunologist. To provide adequate prevention and therapy of the SLE's multiorgan involvement and also the potential complications of immunosuppression, multidisciplinary team is needed with all specialists who may facilitate these patients' complex care. For the long-term management of patients with lupus nephritis, the nephrologists have to be responsible, and the multidisciplinary teams also have to be under their direction. Orv Hetil. 2020; 161(31): 1293-1301.
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http://dx.doi.org/10.1556/650.2020.31801DOI Listing
August 2020

Validation of distinct pathogenic patterns in a cohort of membranoproliferative glomerulonephritis patients by cluster analysis.

Clin Kidney J 2020 Apr 21;13(2):225-234. Epub 2019 Jun 21.

FMC Center of Dialysis, Miskolc, Hungary.

Background: A novel data-driven cluster analysis identified distinct pathogenic patterns in C3-glomerulopathies and immune complex-mediated membranoproliferative glomerulonephritis. Our aim was to replicate these observations in an independent cohort and elucidate disease pathophysiology with detailed analysis of functional complement markers.

Methods: A total of 92 patients with clinical, histological, complement and genetic data were involved in the study, and hierarchical cluster analysis was done by Ward method, where four clusters were generated.

Results: High levels of sC5b-9 (soluble membrane attack complex), low serum C3 levels and young age at onset (13 years) were characteristic for Cluster 1 with a high prevalence of likely pathogenic variations (LPVs) and C3 nephritic factor, whereas for Cluster 2-which is not reliable because of the small number of cases-strong immunoglobulin G staining, low C3 levels and high prevalence of nephritic syndrome at disease onset were observed. Low plasma sC5b-9 levels, decreased C3 levels and high prevalence of LPV and sclerotic glomeruli were present in Cluster 3, and patients with late onset of the disease (median: 39.5 years) and near-normal C3 levels in Cluster 4. A significant difference was observed in the incidence of end-stage renal disease during follow-up between the different clusters. Patients in Clusters 3-4 had worse renal survival than patients in Clusters 1-2.

Conclusions: Our results confirm the main findings of the original cluster analysis and indicate that the observed, distinct pathogenic patterns are replicated in our cohort. Further investigations are necessary to analyse the distinct biological and pathogenic processes in these patient groups.
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http://dx.doi.org/10.1093/ckj/sfz073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7147314PMC
April 2020

C4 nephritic factor in patients with immune-complex-mediated membranoproliferative glomerulonephritis and C3-glomerulopathy.

Orphanet J Rare Dis 2019 11 8;14(1):247. Epub 2019 Nov 8.

FMC Center of Dialysis, Miskolc, Hungary.

Background: Acquired or genetic abnormalities of the complement alternative pathway are the primary cause of C3glomerulopathy(C3G) but may occur in immune-complex-mediated membranoproliferative glomerulonephritis (IC-MPGN) as well. Less is known about the presence and role of C4nephritic factor(C4NeF) which may stabilize the classical pathway C3-convertase. Our aim was to examine the presence of C4NeF and its connection with clinical features and with other pathogenic factors.

Results: One hunfe IC-MPGN/C3G patients were enrolled in the study. C4NeF activity was determined by hemolytic assay utilizing sensitized sheep erythrocytes. Seventeen patients were positive for C4NeF with lower prevalence of renal impairment and lower C4d level, and higher C3 nephritic factor (C3NeF) prevalence at time of diagnosis compared to C4NeF negative patients. Patients positive for both C3NeF and C4NeF had the lowest C3 levels and highest terminal pathway activation. End-stage renal disease did not develop in any of the C4NeF positive patients during follow-up period. Positivity to other complement autoantibodies (anti-C1q, anti-C3) was also linked to the presence of nephritic factors. Unsupervised, data-driven cluster analysis identified a group of patients with high prevalence of multiple complement autoantibodies, including C4NeF.

Conclusions: In conclusion, C4NeF may be a possible cause of complement dysregulation in approximately 10-15% of IC-MPGN/C3G patients.
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http://dx.doi.org/10.1186/s13023-019-1237-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839100PMC
November 2019

Simple, readily available clinical indices predict early and late mortality among patients with ANCA-associated vasculitis.

BMC Nephrol 2017 02 23;18(1):76. Epub 2017 Feb 23.

Department of Medicine (Nephrology), University of Toronto, Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, M5G 2 N2, ON, Canada.

Background: The early identification of patients with ANCA-associated vasculitis (AAV) who are at increased risk for inferior clinical outcome at the time of diagnosis might help to optimize the immunosuppressive therapy. In this study we wanted to determine the predictive value of simple clinical characteristics, which may be applicable for early risk-stratification of patients with AAV.

Methods: We retrospectively analyzed the outcome of 101 consecutive patients with AAV receiving a protocolized immunosuppressive therapy. Baseline Birmingham Vasculitis Activity Score (BVAS) and non-vasculitic comorbidities were computed, then predictors of early (<90 days) and late (>90 days) mortality, infectious death, relapse and end stage kidney disease (ESKD) were evaluated.

Results: The baseline comorbidity score independently predicted early mortality (HR 1.622, CI 1.006-2.614), and showed association with infectious mortality (HR 2.056, CI 1.247-3.392). Patients with BVAS at or above median (=21) had worse early mortality in univariable analysis (HR 3.57, CI 1.039-12.243) (p = 0.031), and had more frequent relapses (p = 0.01) compared to patients with BVAS below median.

Conclusions: Assessing baseline comorbidities, beside clinical indices characterizing the severity and extension of AAV, might help clinicians in risk-stratification of patients. Future prospective studies are needed to investigate whether therapies based on risk-stratification could improve both short term and long term survival.
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http://dx.doi.org/10.1186/s12882-017-0491-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324214PMC
February 2017

Therapy and prognosis of ANCA-associated vasculitis from the clinical nephrologist's perspective.

Int Urol Nephrol 2017 Jan 26;49(1):91-102. Epub 2016 Sep 26.

Nephrology Department, Szent Margit Hospital, 132 Bécsi Street, Budapest, 1032, Hungary.

This paper reviews the recently published scientific information regarding ANCA-associated vasculitis (AAV), aiming to highlight the most important data from the clinical nephrologists' perspective. The classification, pathomechanism, recent achievements of the treatment, short-term and long-term outcomes of the disease, and the difficulties nephrologists face when taking care for patients with AAV are summarized. There has been significant progress in the understanding of the genetic and pathologic background of the disease in the last years, and results of histological studies guide us to predict long-term renal function. Findings of several multicentered trials with reasonable number of participants provide comparison of the efficacy and safety of different remission induction and maintenance therapies, and evaluate recently introduced immunosuppressive agents. Although the clinical outcome of patients with AAV has improved significantly since modern immunosuppressive drugs are available, the treatment-related complications still contribute to the morbidity and mortality. To improve the survival and quality of life of patients with AAV further, knowledge of the predictors of relapse, end-stage kidney disease, and mortality, also prevention of infections and other treatment-related adverse events are important. The eligibility for renal transplantation and the option for successful pregnancies for young women are also important factors which influence the patients' quality of life. In order to provide favorable outcome, the clinicians need to establish personalized treatment strategies to optimize the intensity and minimize the toxicity of the immunosuppressive therapy.
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http://dx.doi.org/10.1007/s11255-016-1419-4DOI Listing
January 2017

Genetic analysis and functional characterization of novel mutations in a series of patients with atypical hemolytic uremic syndrome.

Mol Immunol 2016 Mar 27;71:10-22. Epub 2016 Jan 27.

3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary. Electronic address:

Atypical hemolytic uremic syndrome (aHUS) is a rare disorder caused by dysregulation of the complement alternative pathway, and associated with mutations in genes of complement components and regulators. In the recent years several studies have been published describing these mutations, however, no data is available from the Central and Eastern European region. In this study we present a detailed genetic analysis of our 30 patients, hospitalized with the diagnosis of aHUS in the past 7 years. We analyzed the genetic variants of genes CFH, CFI, CD46, THBD, CFB and C3; furthermore the possible effect of mutations that may alter the function or level of factor H protein was also investigated. We identified 27 (12 novel and 15 previously described) potentially disease-causing mutations in the candidate genes in 23 patients. Genetic analysis of family members revealed that in most cases the disease develops in individuals with multiple genetic risk factors, which may explain the low penetrance of the mutations. Here we showed that two novel mutations (p.W198R, p.P1161T) and a previously reported one (p.R1215Q) in CFH caused impaired regulation as indicated by increased lysis in hemolytic test, while four CFH mutations (p.V609D, p.S722X, p.T1216del and p.C448Y) were associated with decreased factor H protein level in serum as determined by allele-specific immunoassay. These results further point to the necessity of complete genetic workup of patients with aHUS and to the importance of functional characterization of novel variations.
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http://dx.doi.org/10.1016/j.molimm.2016.01.003DOI Listing
March 2016

Clinical outcomes of ANCA-associated vasculitis in elderly patients.

Int Urol Nephrol 2014 Aug 23;46(8):1595-600. Epub 2014 Apr 23.

Nephrology Department, Szent Margit Hospital, 132 Bécsi Street, Budapest, 1032, Hungary,

Background: Older age is independently associated with mortality in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). We hypothesized that a reduced-dose immunosuppressive treatment would result in similar effectiveness and comparable treatment-related morbidity in elderly patients as the regular dose in younger patients. We also postulated that the higher baseline comorbidities may contribute to the higher mortality of the elderly subjects.

Methods: Ninety-three consecutive patients with AAV between 1998 and 2012 were retrospectively analyzed. Forty-one individuals were defined as "elderly" (age >65 years) and 52 as "younger" (age <65 years). All cause and cardiovascular mortality, death due to vasculitis and infections, and effectiveness of "reduced-dose" immunosuppressive treatment in the elderly group were compared to the effects of "full-dose" treatment in younger individuals.

Results: Mortality in the elderly group was higher (p = 0.007). Cardiovascular death was significantly increased (p = 0.002) in the elderly, but mortality due to vasculitis or infections was comparable. Treatment effectiveness was also similar in elderly and younger patients. At the end of the first follow-up year, 37 % of the elderly and 27 % of the younger patients died (p = 0.22). In univariate Cox regression analyses, being older than 65 year, having cardiovascular disease at baseline, need for dialysis at diagnosis, and lower serum albumin were associated with an increased hazard of mortality.

Conclusions: Delivering reduced dose of immunosuppression for elderly patients was associated with satisfactory outcome and favorable treatment-related complication profile. The higher mortality in the elderly could be attributed mainly to baseline cardiovascular morbidity.
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http://dx.doi.org/10.1007/s11255-014-0717-yDOI Listing
August 2014

Acute and long-term effects of corticosteroid therapy on bone metabolism in patients with kidney diseases.

Clin Nephrol 2012 Jul;78(1):17-23

Szent Margit Hospital Nephrology Department, Budapest, Hungary.

Aim: The aim of our study was to examine parameters of bone metabolism during pulse and long-term methylprednisolone (MP) treatment in patients with kidney diseases.

Methods: In 13 patients with RPGN, treated with intravenous MP pulses, followed by tapering oral doses, osteocalcin (OC) and β-CrossLaps (β-CL) were measured before treatment, after the 3rd pulse, then 1 and 3 months later ("acute study"). In a separate set of analyses serum markers of bone metabolism and bone mineral density (BMD) were studied in 40 patients on maintenance MP therapy ("chronic study").

Results: Immediately after the 3rd MP pulse serum OC decreased to 38 ± 23%, β-CL increased to 200 ± 121% of the baseline (p = 0.002 for OC and p = 0.003 for β-CL, respectively), and the OC/β-CL ratio decreased from 55 ± 35 to 9 ± 7 (p = 0.002). OC remained below and β-CL above baseline even at 3 months post pulse steroid treatment. Patients in the "chronic study" who were on maintenance oral steroid therapy received 13,844 ± 7,454 mg MP over 53 ± 47 months. BMD at the end of follow-up revealed reduced bone mineral density in 72.5% of the participants. Z-scores both at the hip and at the lumbar spine were significantly correlated with duration of steroid treatment and also with the cumulative steroid dose.

Conclusion: MP pulse causes immediate, profound suppression of osteoblast function, and significant increase of osteoclast activity, suggesting uncoupling of bone formation and resorption. Prolonged high dose steroid treatment causes significant bone loss in patients with chronic kidney disease. Appropriate systematic follow up of bone metabolism, preventive measures and therapy when needed would be important for the bone health of this patient population.
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http://dx.doi.org/10.5414/cn107181DOI Listing
July 2012

[Role of plasmapheresis in immunological kidney diseases. Experience from 1050 completed plasmapheresis treatment sessions].

Orv Hetil 2011 Jul;152(28):1110-9

Fővárosi Önkormányzat Szent János Kórháza és Észak-budai Egyesített Kórházai Szent Margit Kórház Nefrológia Osztály, Plazmaferézis Részleg Budapest Bécsi út 132. 1032.

Unlabelled: Plasmapheresis is an effective treatment modality in several immunological kidney diseases. It is also indicated in certain neurological and hematological abnormalities, and some other diseases.

Aims: In this study the indications and outcomes of the plasma exchange treatments performed in the Plasmapheresis Unit of the authors during the last 12 years are summarized, and the findings are compared to those published in the literature. The procedure, mechanisms of action and adverse effects are also briefly discussed.

Methods: Between 1999 and 2010 authors completed 1050 plasma exchanges in 195 patients with an average 5.4 (1-20) treatments/person. In the 78 males and 117 females (age 57±16 years) the indications were as follows: 47% anti-cytoplasmic antibody-associated vasculitis, 4% anti-glomerular basement membrane disease, 3% rapidly progressing immunocomplex glomerulonephritis, 11% severe complications of systemic lupus erythematosus, 1% treatment resistant focal segmental glomerular sclerosis, 5% hemolytic uremic syndrome, 13% complications of multiple myeloma, 4% HELLP syndrome, 10% neurological diseases, and 2% other abnormalities.

Results: Plasmapheresis, completed as part of combined immunosuppressive treatment, resulted in remarkable improvements in patients with anti-cytoplasmic antibody-associated vasculitis. Out of the 91 patients, 54 needed urgent dialysis on admission, and renal replacement therapy could be discontinued in 44% of them. Renal functions in those patients who did not need dialysis also improved significantly, and pulmonary hemorrhage ceased in all affected subjects. Survival of the patients with anti-glomerular basement membrane diseases was 100%. The treatment significantly improved the renal function in rapidly progressive lupus nephritis, and all the 5 cases of lupus cerebritis were successfully cured. The results showed less effectiveness in therapy resistant focal segmental glomerular sclerosis and in rapidly progressing immunocomplex glomerulonephritis. Plasmapheresis proved to be very efficient in cases with the primary hemolytic uremic syndrome, and each patient with HELLP syndrome recovered completely. The outcome of those with multiple myeloma was less favorable, although hyperviscosity was rapidly and effectively decreased by the plasmapheresis. The treatment improved the conditions of almost all patients with neurological diseases.

Discussion: According to these findings plasmapheresis treatment, introduced by proper indications, effectively improves the outcomes of several diseases. Early diagnosis and immediate introduction of the plasmapheresis are very important - in conjunction with the appropriate therapy of the underlying diseases.
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http://dx.doi.org/10.1556/OH.2011.29155DOI Listing
July 2011

[Severe hyponatremia and comatose state during colonoscopy preparation].

Orv Hetil 2010 May;151(20):828-31

Fovárosi Onkormányzat Szent János Kórháza és Eszak-budai Egyesített Kórházai, Szent Margit Kórház, Nefrológia Osztály, Budapest Bécsi út 132. 1032.

Authors present a case of an 83 years old female, who suddenly became unconscious and had seizures, during bowel preparation for colonoscopy, but before taking the sodium phosphate purgative. Laboratory investigations revealed severe hyponatremia. Hypertonic saline infusion was administered, the electrolyte disturbance returned to normal, the patient slowly regained her consciousness and her disorientation started to improve gradually. Hyponatremia was likely induced by stress provoked ADH secretion, due to the patients' fear for bowel cleansing and colonoscopy, and by large fluid intake consumed as "misunderstanding" of the instructions. The aim of this case presentation is to call attention to the risks of colonoscopy preparation, which threaten those patients who follow the physicians' instructions exorbitantly, and to demonstrate the treatment of the acute hyponatremia.
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http://dx.doi.org/10.1556/OH.2010.28855DOI Listing
May 2010

Effect of plasmapheresis on serum beta-endorphin levels.

Blood Purif 2005 24;23(2):141-3. Epub 2005 Jan 24.

Polyclinic, Hospitaller Brothers of St. John of God, Budapest, Hungary.

Objectives: The aim of this study was to examine the effects of plasmapheresis on serum beta-endorphin (BE) levels.

Method: The serum BE levels of 12 patients with various autoimmune or hematological disorders were monitored during plasmapheresis therapy.

Results: BE levels increased after the initial session in 8 of 12 patients; in the remaining 4 patients no change (n = 2) or a decline (n = 2) in BE levels was found. However, no further changes were observed during subsequent therapy. During the last session, an elevation in the BE level was detected in 5 patients, with no change in 1 and a decrease in BE level in another 5 patients.

Conclusion: Our findings suggest that although plasmapheresis results in an elevation in serum BE levels initially, this change does not persist during subsequent sessions.
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http://dx.doi.org/10.1159/000083587DOI Listing
July 2005

Biochemical effects of high dialysate calcium in hemodialysis patients with hyperparathyroidism: a 10 month study.

ASAIO J 2003 Jan-Feb;49(1):70-3

Division of Nephrology, Toronto General Hospital, University of Toronto, EN13-232, 200 Elizabeth St., Toronto, Ontario, Canada M5G 2C4.

In the past 15 years, there has been a trend to decrease dialysate calcium concentrations to prevent hypercalcemia. However, low dialysate calcium can provoke hyperparathyroidism. The time course of the effect of increasing dialysate calcium is not well characterized, and the effect on calcium-phosphate product is unclear. Therefore, we studied the effect of increasing dialysate calcium from 1.5 to 1.75 mM in 21 stable patients on hemodialysis who had serum phosphate of less than 2 mM and serum calcium of less than 2.4 mM. Over 10 months, parathyroid hormone levels fell from 39.6 to 16.6 pM (p < 0.0001), whereas serum calcium increased from 2.27 to 2.41 mM. There were no significant changes in serum phosphate or the calcium-phosphate product. Three patients became hypercalcemic when their parathyroid hormone levels were suppressed to less than 10 pM. We conclude that in carefully selected patients, increasing dialysate calcium can safely treat hyperparathyroidism with minimal risk of complications. This treatment has the advantage over the use of vitamin D therapy of being less expensive, independent of patient compliance, and less likely to cause increases in serum phosphate or calcium-phosphate product.
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http://dx.doi.org/10.1097/00002480-200301000-00011DOI Listing
July 2003
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