Arkadiusz Lubas
Research interests
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InterestsHypertension
Publications
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Renal autoregulation in medical therapy of renovascular hypertension.
Archives of medical science : AMS. 12/2010; 6(6):912-8.
Renovascular hypertension (RVH) is caused by renal ischaemia associated with haemodynamically significant renal artery stenosis (RAS). The choice of optimal treatment of atherosclerotic RAS is still controversial. Increase in the renal resistive index (RI) value after captopril administration is con... [more] Renovascular hypertension (RVH) is caused by renal ischaemia associated with haemodynamically significant renal artery stenosis (RAS). The choice of optimal treatment of atherosclerotic RAS is still controversial. Increase in the renal resistive index (RI) value after captopril administration is considered to indicate preserved renal autoregulation. The objective of the study was to assess the effect of medical therapy of RVH on renal autoregulation efficiency in patients with atherosclerotic RAS. 19 persons (38 kidneys) in 2 groups: 1) study: with RVH and stenosis of 1 renal artery - 8 patients; 2) control: - 11 healthy volunteers. Doppler captopril test with RI measurements and estimation of creatinine clearance (CCr) were performed in both groups at baseline, and after a period of controlled medical therapy (CMT) only in the study group. ABPM was evaluated in controls at baseline, and in the study group at the end of CMT. In the study group the mean period of CMT was 8.3 ±2.7 months, the number of antihypertensive drugs was 4.1 ±1.0, and mean 24-hour blood pressure was 138/74 mmHg. Mean CCr was stable during the study. Significant increase of RI after captopril was found only in controls. At baseline, in the group of kidneys with a non-stenotic renal artery, significant lowering of RI was observed, and ΔRI differed significantly from controls. After CMT, ΔRI increased in non-stenotic kidneys in comparison to the baseline, and did not differ from controls. Adequate medical therapy of RVH preserved renal function and improved renal autoregulation efficiency in non-stenotic kidneys.
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Renal vascular response to angiotensin II inhibition in intensive antihypertensive treatment of essential hypertension.
Archives of medical science : AMS. 08/2010; 6(4):533-8.
High blood pressure (BP) leads to target organ damage. It is suggested that regression of early organ lesions is possible on condition of BP normalization. The study objective was to assess whether permanent reduction of BP to the recommended values modifies renal vascular response to acute angioten... [more] High blood pressure (BP) leads to target organ damage. It is suggested that regression of early organ lesions is possible on condition of BP normalization. The study objective was to assess whether permanent reduction of BP to the recommended values modifies renal vascular response to acute angiotensin II inhibition in the Doppler captopril test (DCT) in patients with essential hypertension (EH). Twenty-nine persons (58 kidneys) were found eligible for the study: 18 patients with EH and 11 healthy volunteers constituting the control group. Glomerular filtration rate estimation (eGFR), 24-h ambulatory BP monitoring (ABPM) and DCT with evaluation of renal resistive index change (ΔRI) were performed before and after a 6-month period of intensive antihypertensive therapy (IAT). Additional ABPM was performed at the end of IAT. The mean IAT period was 8.5 ±2.4 months. The mean 24-h values of systolic and diastolic BP in the EH group were significantly lower in the IAT period than at the beginning and at the end of the study. Significantly lower systolic and diastolic BP (p < 0.05) and improvement of renal function (eGFR 121 ±38 vs. 139 ±40 ml/min, p < 0.001) were found after IAT as compared to initial values. Before IAT, ΔRI was significantly lower in the EH group as compared to the controls, but no such differences were found after IAT. In EH patients, intensive BP lowering to the recommended values was associated with improvement of renal function and normalisation of renal vascular response to acute angiotensin II inhibition.
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Peritoneal dialysis as a therapeutic approach in congestive heart failure resistant to pharmacological treatment: case report.
Polskie archiwum medycyny wewnȩtrznej. 12/2009; 119(12):834-7.
This report describes the use of continuous peritoneal dialysis (PD) as an alternative to hemodialysis (HD) in a patient with type 2 cardiorenal syndrome in the course of congestive heart failure resistant to standard pharmacological treatment. A 39-year-old man presented with a 24-year history of p... [more] This report describes the use of continuous peritoneal dialysis (PD) as an alternative to hemodialysis (HD) in a patient with type 2 cardiorenal syndrome in the course of congestive heart failure resistant to standard pharmacological treatment. A 39-year-old man presented with a 24-year history of progressive heart failure. Ineligibility for heart transplant and previous inefficient treatment with different modifications of HD reduced his treatment options to PD. After 7 months of continuous PD (1 overnight exchange with icodextrin and 2 daily standard continuous ambulatory PD exchanges) his overall condition significantly improved compared with his status while on HD. An increase from NYHA class IV to class II, increase in left ventricular ejection fraction from 50% to 55%, decrease in right ventricular systolic pressure from 73 to 53 mmHg, and improvement in the quality of life enabled him to resume his daily activities.
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Atypical clinical presentation of Churg-Strauss syndrome with rapidly progressive glomerulonephritis: case report.
Polskie archiwum medycyny wewnȩtrznej. 12/2009; 119(12):830-3.
The case of a 48-year-old man presented in this paper illustrates an atypical clinical course of Churg-Strauss syndrome with rapidly progressive glomerulonephritis with no signs of bronchial asthma.... [more] The case of a 48-year-old man presented in this paper illustrates an atypical clinical course of Churg-Strauss syndrome with rapidly progressive glomerulonephritis with no signs of bronchial asthma.
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[Advances in diagnosis and treatment of AL amyloidosis].
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):340-5.
AL amyloidosis is a systemic disease characterized by extracellular amyloid deposition in tissues, causing progressive dysfunction of affected organs. The main clinical syndroms include nephrotic-range proteinuria with or without renal dysfunction, congestive heart failure, hepatomegaly and peripher... [more] AL amyloidosis is a systemic disease characterized by extracellular amyloid deposition in tissues, causing progressive dysfunction of affected organs. The main clinical syndroms include nephrotic-range proteinuria with or without renal dysfunction, congestive heart failure, hepatomegaly and peripheral or autonomic neuropathy. The aim of therapy is the reduction of monoclonal light chains, by suppressing the underlying plasma cell dyscrasia. Recent therapeutic strategies involve intermediate-dose chemotherapy or high-dose melphalan supported by peripheral blood stem cell transplantation. Alternative therapeutic approaches include thalidomide, lenalidomide, iododoxorubicin, etanercept and rituximab. This paper reviews the pathogenesis, diagnosis and therapy of the AL amyloidosis, focusing on clinico-morphological symptoms of renal involvement, monitoring of treatment response and supportive therapy.
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[Influence of controlled hypotensive therapy on renal autoregulation efficiency in the doppler captopril test in patients with chronic glomerulonephritis].
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):289-92.
Regulation of renal vascular resistance is one of main mechanisms of the renal autoregulation. Renal vascular resistance is expressed in the Doppler sonography as a resistance index (RI). Estimation of renal resistance index variability in the Doppler Captopril Test in patients with chronic glomerul... [more] Regulation of renal vascular resistance is one of main mechanisms of the renal autoregulation. Renal vascular resistance is expressed in the Doppler sonography as a resistance index (RI). Estimation of renal resistance index variability in the Doppler Captopril Test in patients with chronic glomerulonephritis and hypertension in the course of controlled hypotensive therapy. 21 patients (13 men + 8 female, age 40 +/- 14.5 years) with chronic glomerulonephritis and hypertension were enrolled to the study. Twice, in about 6 months period of intensive hypotensive treatment, the Doppler Captopril Test was performed and variability of RI (deltaRI) was estimated. Significant rise of deltaRI 0.11 (-11.86:2.83) vs 1.15 (-3.86:7.11); p < 0.05 was found, after 5.8 +/- 2.4 months of hypotensive therapy, and by preserved renal function. Controlled hypotensive therapy significantly improves efficiency of renal vascular autoregulation expressed as the variability of renal resistance index in the Doppler Captopril Test.
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[Treatment of renal anemia with intravenous erythropoietin in patients in the program of continuous ambulatory peritoneal dialysis].
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):312-5.
In the face of non fully correctable renal anemia in patients on continuous ambulatory peritoneal dialysis (CAPD) injecting erythropoetin subcutaneously by themselves, we compared the effectiveness of renal anemia compensation as well as potentially positive influence on the clinical course of CAPD ... [more] In the face of non fully correctable renal anemia in patients on continuous ambulatory peritoneal dialysis (CAPD) injecting erythropoetin subcutaneously by themselves, we compared the effectiveness of renal anemia compensation as well as potentially positive influence on the clinical course of CAPD erythropoietin alpha (EPOalpha) given intravenously 1 or 2 times weekly, by PD-nurse at patients home with the same protocol of erythropoietin beta (EPObeta) given subcutaneously by patient himself or by family helper. There were 2 groups of CAPD patients qualified in years 2003-2005 to the 6 months study. Group 1 consisted of 12 patients who were receiving EPOalpha intravenously (7 women and 5 men; aged 57.8 +/- 14.0 years) and group 2 consisted of 12 patients who were given EPObeta subcutaneously by themselves (7 women and 5 men; age 58.0 +/- 12.5 years). In the course of home visits the nurses supervised the correctness of CAPD program performed by patient or family helper. The results were as follows: we observed significant increase of the Hgb level in the group 1 between 3-rd and 6-th month of the study without significant increase of EPO dose. With respect to the course of CAPD program we found significantly higher frequency of peritonitis (1/11 vs 1/68 patient months; p < 0.05) and longer mean time of hospitalization (2.33 +/- 1.97 vs 1.17 +/- 1.03 days/pt; p < 0.05) in the group 2 in comparison with group 1. Mean peritonitis-free survival time was significantly longer in the group 1 in comparison with the group 2 (22.14 +/- 6.41 vs 16.51 +/- 9.70 weeks; p < 0.05). We conclude that EPOalpha given intravenously by PD-nurse in patient home enabled maintenance of recommended Hgb level. The additional benefit from nurse assisted PD was reduction of peritonitis rate as well as duration of hospitalization from various reasons.
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[Atherosclerotic or hypertensive nephropathy--case report]
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 09/2004; 17(98):155-7.
Atherosclerotic nephropathy is actually taken into consideration as a potential cause of chronic renal failure of unknown origin in older patients with advanced systemic atherosclerosis (ATS), but this diagnosis is often ignored in young patients without evident symptoms of systemic ATS. On the case... [more] Atherosclerotic nephropathy is actually taken into consideration as a potential cause of chronic renal failure of unknown origin in older patients with advanced systemic atherosclerosis (ATS), but this diagnosis is often ignored in young patients without evident symptoms of systemic ATS. On the case of 45 years old female with occasionally recognised renal failure, significant proteinuria and hypertension, without clinical symptoms of ATS we present problem of differentiation of atherosclerotic and hypertension cause of nephropathy.
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[Renal resistive index--does it extend diagnostic possibilities in nephrology?]
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 09/2004; 17(98):173-5.
In the last years progress of Doppler ultrasonography improved diagnosis of kidney diseases by measurement of intrarenal blood flow parameters. Among them renal resistive index appears to be the most useful in contemporary nephrology. This paper is a review of diagnostic and prognostic advantages re... [more] In the last years progress of Doppler ultrasonography improved diagnosis of kidney diseases by measurement of intrarenal blood flow parameters. Among them renal resistive index appears to be the most useful in contemporary nephrology. This paper is a review of diagnostic and prognostic advantages resulting from estimation and careful interpretation of renal resistive index in nephrology.
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[Effectiveness of subcutaneous and intravenous epoetin alpha in haemodialysed patients]
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 08/2004; 17(98):143-7.
According to recommendations of exclusively intravenous administration of erythropoietin alpha (EPOalpha) produced in Europe (Eprex-Janssen-Cilag), we compared the effectiveness of EPOalpha during 6 months of the therapy after conversion from s.c. to i.v. route in 21 hemodialysed patients. MATERIAL ... [more] According to recommendations of exclusively intravenous administration of erythropoietin alpha (EPOalpha) produced in Europe (Eprex-Janssen-Cilag), we compared the effectiveness of EPOalpha during 6 months of the therapy after conversion from s.c. to i.v. route in 21 hemodialysed patients. MATERIAL AND METHODS: The inclusion criteria were as follows: stable blood morphology over the 3 months before conversion; haemoglobin concentration > 10.0 g/dl; transferrin saturation > 20% and serum ferritin > 200 microg/l. Dose of EPOalpha was verified every month in the course of the study, depending on actual haemoglobin concentration. RESULTS: There were no significant differences in haemoglobin concentration and EPOalpha dose in all monitored time intervals. We didn't find any differences in transferrin saturation, serum albumin concentration and haemodialysis adequacy between starting values and results after 6 months of the therapy. Only values of CRP, serum ferritin concentration and iPTH were significantly higher after 6 months of i.v. EPOalpha therapy comparing to the initial data. Conclusion: in hemodialysed patients with adequate iron stores and stable values of haemoglobin change of the route of EPOalpha administration from s.c. to i.v. is not connected with the increase of the dose of EPOalpha to maintain the haemoglobin values in the target range.
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[Usefulness of ultrasonographic renal resistive index in monitoring efficacy of hypotensive in haemodialysed patients--case report]
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 12/2002; 13(77):403-5.
On the basis of a 29-year-old haemodialysed male patient with poorly controlled hypertension refractory to multidrug hypotensive therapy, we present the usefulness of ultrasonographic evaluation of the renal resistive index in the monitoring of hypotensive therapy efficacy.... [more] On the basis of a 29-year-old haemodialysed male patient with poorly controlled hypertension refractory to multidrug hypotensive therapy, we present the usefulness of ultrasonographic evaluation of the renal resistive index in the monitoring of hypotensive therapy efficacy.
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[Influence of parathormone level on the doses of human recombinant erythropoietin in haemodialysed patients]
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 11/2002; 13(77):373-5.
The purpose of the study was to determine the doses of rHuEPO, which are necessary to obtain the same correction of renal anaemia in chronically haemodialysed patients with different levels of iPTH. 25 haemodialysed patients with stable values of iPTH for at least 6 months (mean age 58 +/- 15.6 year... [more] The purpose of the study was to determine the doses of rHuEPO, which are necessary to obtain the same correction of renal anaemia in chronically haemodialysed patients with different levels of iPTH. 25 haemodialysed patients with stable values of iPTH for at least 6 months (mean age 58 +/- 15.6 years; 6 females and 19 males on haemodialysis from 1 to 126 months) were divided into 3 groups: group 1 (7 patients) with iPTH < 100 pg/ml, group 2 (12 patients) with iPTH 100-300 pg/ml and group 3 (6 patients) with iPTH > 300 pg/ml. In all groups adequacy of haemodialysis (HD) measured by Kt/V was similar. Every month the following data were determined: Ca, P, CaxP product, HCT, HGB, Fe, transferrin saturation (TSAT) and weekly dose of rHuEPO. Patients with chronic infections, neoplastic diseases or those after blood transfusions were excluded from the study. Significantly higher weekly dose of rHuEPO was needed in patients with iPTH > 300 pg/ml to obtain similar correction of renal anaemia in comparison with patients with iPTH from 100 to 300 pg/ml. There were no statistically significant differences between the groups with respect to other data except significantly higher values of Cas in the group with iPTH > 300 pg/ml. CONCLUSION: Higher doses of rHuEPO to obtain the same correction of renal anaemia are necessary only in patients with iPTH > 300 pg/ml.
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[Doppler sonography assessment of renal arteries against the cardiovascular risk factors in young men--preliminary report]
Polskie archiwum medycyny wewnȩtrznej. 11/2001; 106(5):1007-12.
The purpose of this study was to find out a relationship between cardiovascular risk factors (CVRF) and abnormal results of Duplex Doppler sonography (DD), suggesting renal artery stenosis (RAS). The group of 30 potentially healthy men (age: 35.5 +/- 7.9) randomly selected from population of 200 you... [more] The purpose of this study was to find out a relationship between cardiovascular risk factors (CVRF) and abnormal results of Duplex Doppler sonography (DD), suggesting renal artery stenosis (RAS). The group of 30 potentially healthy men (age: 35.5 +/- 7.9) randomly selected from population of 200 young men, underwent DD of renal arteries. Abnormal results of DD study, suggesting RAS were found in 19 of 30 men (63%). In this group, occurrence of 3 or more CVRF was significantly higher (15/19) than in the group with normal results of DD (5/11; p < 0.05). The significantly higher (77%; p < 0.05) occurrence of the abnormal DD and the significantly longer (p < 0.001) duration of habitual tobacco smoking were also found out in the group with RR > or = 130/85 mm Hg, in comparison to the group with RR < 130/85 mm Hg. Emphasizing preliminary character of this study and the need of confirmation on larger population, it seems reasonable to consider the assessment of renal arteries with DD in the population of men with cardiovascular risk factors.
Following (1)
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Agnieszka Próchnicka
Military Iinstitution in Warsaw
Topics (2)
