Hlavní téma – klinická nefrologie

prof. MUDr. Josef Zadražil, CSc.

Vnitr Lek 2025, 71(7):403  

ANCA-associated vasculitides - diagnostic and therapeutic options

Zdenka Hrušková, Vladimír Tesař

Vnitr Lek 2025, 71(7):408-413 | DOI: 10.36290/vnl.2025.076  

Granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis are three rare diseases ranked among ANCA-associated vasculitides. The most commonly affected organs include the ENT area, lungs and kidneys. The diagnosis is based on the clinical picture, positivity of ANCA antibodies (directed against proteinase 3, PR3-ANCA, or myeloperoxidase, MPO-ANCA) and/or biopsy verification. Early recognition of the disease and prompt initiation of therapy are crucial for the patients´ prognosis. Nowadays, treatment usually consists of corticosteroids and either cyclophosphamide or rituximab, or both. In severe forms...

What should an internist understand about acute kidney injury

Nadežda Petejová, Josef Zadražil, Vladimír Teplan, Arnošt Martínek

Vnitr Lek 2025, 71(7):415-423 | DOI: 10.36290/vnl.2025.077  

Acute kidney injury (AKI) is a significant concern in routine clinical practice, as it requires prompt and thorough differential diagnosis to identify its causes and initiate appropriate treatment. Patients with AKI are often heterogeneous, and their clinical presentation can be greatly affected by underlying conditions such as infections, heart failure, endocrine disorders, or diseases of the liver or lungs. This article aims to provide a rapid assessment for differential diagnosis across various internal medicine specialties, with the goal of enhancing the care of critically ill patients with AKI and achieving optimal recovery of renal function,...

Indications, efficacy, and safety of NOACs in patients with CKD

Marie Vanková, Kateřina Oulehle, Oskar Zakiyanov, Jan Vachek, Vladimír Tesař

Vnitr Lek 2025, 71(7):425-430 | DOI: 10.36290/vnl.2025.078  

Chronic kidney disease (CKD) represents a significant and independent risk factor for cardiovascular morbidity and mortality. Patients with CKD frequently present with atrial fibrillation and venous thromboembolism, creating a clinical need for optimal anticoagulation strategies that balance efficacy and safety. However, the selection of an appropriate anticoagulant in this population is challenging, owing both to the increased risk of bleeding complications and to the altered pharmacokinetics of renally excreted agents. Over the past decade, non-vitamin K antagonist oral anticoagulants (NOACs) have emerged as a widely adopted alternative to warfarin...

Dual effect of keto amino acids and SGLT2 receptor inhibitors in seniors with chronic kidney disease: three years clinical monitoring

Vladimír Teplan, Naděžda Petejová, Ivo Valkovský

Vnitr Lek 2025, 71(7):432-440 | DOI: 10.36290/vnl.2025.079  

In last decades, there is growing number of seniors over 65 years with chronic kidney disease (CKD). Beside of development in technology of dialysis and kidney transplantation there is a lot of patients who are not indicated for succefull management in dialysis - transplantation programme due to serious other organ damages. In our previous studies we have confirmed long-term effectivity of conservative management of CKD 3b-4 on modified low-protein diet (LPD) supplemented with keto amino acids (KA) in old patients over 80 years. In last decade, there were published very important studies supporting protective effect of SGLT2 receptor inhibitors (dapagliflozin...

Risk of gastrointestinal bleeding with oral anticoagulants: actual review and influencing factors

Antonín Bartusek, Radek Kroupa

Vnitr Lek 2025, 71(7):443-450 | DOI: 10.36290/vnl.2025.080  

Gastrointestinal bleeding is the most common bleeding complication in users of oral anticoagulants and is associated with significant morbidity and mortality. Warfarin is gradually being replaced by direct thrombin inhibitors (dabigatran etexilate) and factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban). Total number of users of all oral anticoagulants increased by 60% during last 10 years. Conclusions from early randomized controlled trials showed a 23-60 % higher risk of gastrointestinal bleeding in users of direct oral anticoagulants compared to warfarin. Recent meta­‑analyses and observational studies from real­‑world clinical...

Hypersensitivity pneumonitis: a comprehensive overview of pathogenesis, diagnostics and therapeutic options

Martina Doubková

Vnitr Lek 2025, 71(7):451-455 | DOI: 10.36290/vnl.2025.081  

Hypersensitivity pneumonitis, formerly known as extrinsic allergic alveolitis, is an immune-mediated interstitial lung disease triggered by repeated inhalation of organic or inorganic antigens. Current classification distinguishes between non-fibrotic and fibrotic forms, with the fibrotic phenotype associated with worse outcomes. Diagnosis requires a multidisciplinary approach. Management is based on antigen avoidance, with glucocorticoid therapy cosiderec in symptomatic patients; antifibrotic treatment may be appropriate for progressive fibrotic diseasse. Early diagnosis and identification of the causative antigen remain crucial for optimizing patient...

Barriers to smoking cessation in patients with diabetes mellitus

Marika Koželuhová, Jana Malinovská, Natália Michalcová, Sofia Talalaievska, Jan Brož

Vnitr Lek 2025, 71(7):456-460 | DOI: 10.36290/vnl.2025.082  

Although the prevalence of smoking is lower among people with diabetes mellitus (DM) than in the general population, it remains an important issue that requires targeted smoking-cessation interventions. Smoking worsens metabolic control, increases insulin resistance, and accelerates the progression of both macrovascular and microvascular complications. The treatment of tobacco dependence in patients with DM is complicated by specific barriers, including lack of knowledge about the effects of smoking on DM, concerns about weight gain, psychological burden associated with the disease, and the risk of glycemic variability. Effective treatment combines...

Endovascular method of arteriovenous fistula creation

Katarína Tokarčíková, Ján Tokarčík, Tibor Varga ml., Ondrej Zahornacký

Vnitr Lek 2025, 71(7):E7-E12 | DOI: 10.36290/vnl.2025.085  

Arteriovenous fistulas are considered the preferred vascular access for patients requiring long-term hemodialysis. Their excellent patency, combined with low rates of infection and reintervention compared to central venous catheters and arteriovenous grafts, makes them the ideal access option for many patients with end-stage renal failure. The traditional method of creating arteriovenous fistulas is surgical. The development of two systems - WavelinQ™ (Becton, Dickinson and Company; Franklin Lakes, NJ) and Ellipsys® (Medtronic, Minneapolis, MN) - has led to a minimally invasive endovascular method of creating arteriovenous fistulas. Given...

Drug-Drug interaction between rivaroxaban and amiodarone: A systematic review

Pavol Fülöp, Štefan Tóth2, Tibor Porubän3, Zuzana Fülöpová4, Mariana Dvorožňáková

Vnitr Lek 2025, 71(7):E1-E6 | DOI: 10.36290/vnl.2025.087  

Background: The concurrent use of rivaroxaban and amiodarone in cardiovascular patients raises concerns about potential drug-drug interactions and increased bleeding risk. Objective: This systematic review aimed to evaluate the impact of combining amiodarone with rivaroxaban on bleeding events compared to rivaroxaban monotherapy in cardiovascular patients. Methods: We systematically reviewed observational studies and clinical trials examining bleeding outcomes in patients receiving rivaroxaban with or without concurrent amiodarone therapy. Studies were included if they reported clinical bleeding outcomes, included both combination therapy and monotherapy...

Diagnosis and therapy of hepatitis B virus infection: Czech national guidelines

Petr Husa, Jan Šperl, Petr Urbánek, Soňa Fraňková

Vnitr Lek 2025, 71(7):E13-E29 | DOI: 10.36290/vnl.2025.086  

The new recommendations reflect the increase in knowledge that has been reported since the release of previous Czech guidelines in September 2017. The base for these guidelines were European Association for the Study of the Liver (EASL) guidelines from May 2025. According to qualified estimates, there are 254 million people with chronic hepatitis B (HBV) infection worldwide. The Czech Republic is among the countries with a low prevalence of HBV infection. HBV infection can cause serious, life-threatening liver damage - fulminant hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). The main goal of treatment is to prolong life and improve...

Our first experience with caplacizumab in TTP

Eva Drbohlavová, Kristýna Datinská

Vnitr Lek 2025, 71(7):462-467 | DOI: 10.36290/vnl.2025.083  

Thrombotic thrombocytopenic purpura (TTP) is a rare disease with high mortality. Its prognosis depends on early diagnosis and timely initiation of treatment when there is reasonable suspicion of this disease. Until 2021, the gold standard was a combination of immunosuppression and therapeutic plasma exchange (TPE) (1,2). Caplacizumab is now available as a first-line treatment, significantly changing the rate of therapeutic response in patients with acquired TTP (3-5). The case of our patient demonstrates how early initiation of treatment with caplacizumab, together with immunosuppression and TPE, brought her back to life.

Evaluation of the effect of allergen immunotherapy for practice

Jiří Nevrlka

Vnitr Lek 2025, 71(7):468-472 | DOI: 10.36290/vnl.2025.084  

Specific allergen immunotherapy represents an effective treatment modality for respiratory allergies with the potential for sustained effects persisting many years after cessation of therapy. To achieve this long-term benefit, it is administered continuously for a minimum of 3 years or repeatedly in pre/co-seasonal regimens. Proper and early evaluation of its efficacy after the first year or season of treatment is crucial for the identification of non-responders, optimization of care, and minimization of unnecessary costs. The assessment of allergen immunotherapy efficacy and its standardization are addressed in the European Academy of Allergy and...