Program 10. celostátního diabetologického sympozia

Vnitr Lek 2008, 54(5):449  

Program 9. celostátního diabetologického sympozia

Vnitr Lek 2008, 54(5):451  

XXVII. dni mladých internistov. Martin, Slovenská republika, 22.-23. 5. 2008. Zborník abstraktov

Vnitr Lek 2008, 54(5):541-585  

Úvodní slovo

A. Šmahelová

Vnitr Lek 2008, 54(5):450  

Haemocoagulation and renal insufficiency, haemocoagulation and type 2 diabetes mellitus

J. Malý, M. Šimkovič, M. Pecka

Vnitr Lek 2008, 54(5):452-456  

Diabetes mellitus is a frequent cause of renal insufficiency. Renal insufficiency is associated with both haemorrhagic manifestations primarily caused by platelet functional disorders, and states of hypercoagulation resulting from significant hyperfibrinogenemia. Fibrinolysis is either increased or, often, decreased. Changes in haemostasis in renal insufficiency have been dealt with by many authors in relevant literature. However, the final stage of renal insufficiency is rather dominated by haemorrhagic diathesis. It is manifested by skin haemorrhage, mucosal manifestations, but also by retroperitoneal and cerebral haemorrhage. The main cause of a...

Urologic surgery in diabetes

M. Broďák, M. Romžová, J. Košina

Vnitr Lek 2008, 54(5):457-463  

Introduction:The diabetes mellitus is risk factor for urologic surgery. The best prevention of complications is excellent compensation of diabetes, appropriated management of anesthesia and good post surgery care. The diabetes is etiologic risk factor many urologic diseases including malignant. Urologic surgery:The diabetes is intensively evaluated in uro-oncology and it seems that renal cell carcinoma and bladder cancer incidence is higher in diabetic patients. The link between prostate cancer and diabetes is not clear, yet. The behavior of this cancer is more aggressive and it has worse prognosis. The diabetes is risk etiologic...

Tumours of kidneys, urinary bladder and prostate in obesity and diabetes

Š. Svačina

Vnitr Lek 2008, 54(5):464-467  

Relations of obesity and type 2 diabetes to urinary tract cancer were described. Occurrence of kidney cancer is more often in both obesity and type 2 diabetes. Bladder cancer has no relation to obesity but is more common in type 2 diabetic patients. Inverted relations were found in prostatic cancer. This disease is more common in obese patents but less common in type 2 diabetes. Diabetics are partly protected to this disease. Physical activity decreases the risk of kidney and bladder cancer but has no relation to bladder cancer. Urinary tract cancers have no relation to type 1 diabetes. We have found 3.9 time higher risk of kidney cancer in Czech diabetic...

Bariatric surgery and the kidneys

M. Fried

Vnitr Lek 2008, 54(5):468-471  

Overweight and obesity are connected with increased risk of obesity related co-morbidities, such as T2DM, hypertension, cardiovascular diseases, dyslipidaemia and others, as well as in higher risk of some malignant diseases. In obese population there is 2.5-3.3 fold increased risk of renal cell carcinoma in comparison with non-obese population of similar age. It has been proven in many studies that for severely obese patients there is no other more effective treatment of their obesity and co-morbidities than bariatric. Bariatric surgery decreases mortality risks, treat existing, obesity related co-morbidities, and can act as prevention of onset of...

The use of organ specific substrates in kidney disease in a diabetic patient

Z. Zadák

Vnitr Lek 2008, 54(5):472-474  

Diabetic nephropathy is one of the principal causes of chronic renal failure. The disease prevailingly develops in men. The incidence of diabetic nephropathy doubled from 1991 to 2001. There are different traditional dietary guidelines for the different states of diabetic nephropathy, as well as pharmacotherapy options, and, last but not least, also modern ways of application of nutritional pharmacology. Organ specific nutritional substrates - amino acids, polyunsaturated fatty acids and other components of nutrition with pharmacological effects have become indispensable in modern care for diabetic patients.

Nutrition for the diabetic patient with kidney disease

L. Sobotka, V. Bláha, E. Mistrík, A. Šmahelová, S. Dusilová Sulková

Vnitr Lek 2008, 54(5):475-477  

Malnutrition is a major problem in chronically ill patients. The combination of diabetes and renal insufficiency increases the risk of malnutrition, also due to dietary interventions associated with the two diseases. Resulting malnutrition intensifies inflammatory activity and further compromises nutrition intake. This results in a vicious circle which significantly reduces the quality of life of the affected patients and increases their mortality. Proper nutritional care for such patients is an integral part of their treatment.

Mucosal immunity with emphasise on urinary tract immunity and diabetes

J. Krejsek, M. Kudlová, M. Koláčková, J. Novosad

Vnitr Lek 2008, 54(5):478-481  

Protective immune response in urinary tract is frequently impaired in patients with diabetes. Immunity in this mucosal compartment displays unique characteristics; e.g. absence of physiological microflora and lack of mucus. Pathogens are identified by the PRR receptors expressed on both epithelial and immune cells. Inflammatory response characterised by the acumulation of granulocytes is followed. Both protective and harm characteristics of inflammatory response are inseparable linked and delineated by gene polymorphisms in PRR receptors.

Visceral diabetic neuropathy of the urogenital tract

J. Olšovský

Vnitr Lek 2008, 54(5):482-484  

The article deals with issues of diabetic autonomous neuropathy (DAN) in the urogenital tract (UGT), and brings attention to the ethiopathogenesis of diabetic polyneuropathy. It provides a synopsis of autonomous neuropathy and deals, in more detail, with its manifestations in the UGT. The different symptoms of the disorder are addressed, the need for timely diagnosis is pointed out as the prerequisite for a successful therapy, and the necessity for interdisciplinary cooperation in dealing with this health issue is exposed.

Erectile dysfunction, its relation to diabetes and its management in 2007

P. Navrátil

Vnitr Lek 2008, 54(5):485-487  

Medical know-how today allows for thorough examination and assessment of erection disorders. The doctor carrying out the examination focuses on detecting the underlying disease of which erectile dysfunction (ED) is a marker and the nature of which may be much more significant than ED itself. However, the detecting and treating of the disease associated with ED usually does not resolve the problem. The management of ED as such is based on the options which there are for the patient in line with the principle of choosing a less invasive therapy as the preferred option. Diabetes (DM) is one of the metabolic syndrome (MS) diseases which have a high rate...

Epidemiology of diabetic nephropathy

I. Rychlík

Vnitr Lek 2008, 54(5):488-493  

The epidemiology of diabetic nephropathy (DN) should be approached from two angles: a) incidence of diabetic nephropathy in patients with diabetes, and b) epidemiology of chronic renal failure (CHRF) in diabetic patients. According to data from different sources, DN affects, in all its stages, about one third of patients irrespective of the type of diabetes they suffer from, with the peak rate of incidence after 15 years of duration of the illness. It is estimated that the rate of DN prevalence is 4-8% of patients monitored in diabetes centres. In addition, a significant portion of diabetics, especially the type 2 diabetic patients, are affected by...

Examination of the kidneys in a diabetic patient

V. Tesař

Vnitr Lek 2008, 54(5):494-498  

Diabetic nephropathy is the most frequent cause of terminal renal failure in the Czech Republic today. Diabetic patients should be screened for diabetic kidney disease on an annual basis, starting 5 years after diabetes was diagnosed in type 1 diabetes patients and immediately after diagnosis in type 2 diabetes patients. The screening includes determining the albumin/creatinine ratio from a urine sample, and of serum creatinine, and the calculation of glomerular filtration rate. In patients in whom microalbuminuria and/or proteinuria were found, measures should be taken to reduce cardiovascular risk and to slow down the progression of renal disease....

Diabetes mellitus, hypertension and kidney

V. Monhart

Vnitr Lek 2008, 54(5):499-507  

The correlations co-exist among diabetes mellitus, hypertension and the kidney. Renal injury will develop in 35% type 1 and type 2 diabetes mellitus patients. Diabetic nephropathy is the key factor for the occurence of hypertension in type 1 diabetes mellitus. In case of type 2 diabetes mellitus with prevalent essencial hypertension the diabetic nephropathy is supporting factor for the development of hypertension. Untreated or inadequately treated hypertension accelerates the progression of diabetic renal impairment. The presence of diabetes mellitus as well as hypertension or proteinuria is significant cardiovascular risk factor. The goal of treatment...

System rennin-aldosterone in fat tissue and other organ and tissues

Š. Svačina

Vnitr Lek 2008, 54(5):508-510  

Important mechanism of pathogenesis of hypertension in obesity is renin-aldosterone system in adipose tissue. Adrenal cells can be also stimulated to aldosterone secretion by local adrenal fat cells and also by other factors from fat tissue (lipids, endocrine disruptors). Local system renin-aldosteron is active also in other tissues and organs in obesity related hypertension. Feed back is closed by recently investigated fact that aldosteron hypersecretion can cause metabolic syndrome. Between systemic approach to obesity a new phenomenon of organ obesity is coming - adipokines from local fat cells can influence organ and tissue function e.g. in essential...

Diabetes, dyslipidaemia and kidney diseases

R. Češka, V. Tesař

Vnitr Lek 2008, 54(5):511-517  

Dyslipidemia (DLP) is the most significant risk factor for cardiovascular diseases (CVD). Similarly, the relevance of diabetes mellitus (DM) as a CVD risk indicator is so high that it is attributed the same significance as the secondary prevention of CVD in different systems of global cardiovascular risk assessment. Most recently, also kidney disorders have been increasingly referred to as a risk factor for the manifestation of CVD. According to some guidelines, patients with kidney disorders are at the same risk as the patients with manifest IHD (or another manifestation of atherosclerosis), and patients with DM. This paper does not pretend to resolve...

Specific issues of dialysed diabetics in outpatient practice

S. Dusilová Sulková

Vnitr Lek 2008, 54(5):519-522  

Approximately 40% of patients on dialysis have diabetes mellitus (DM). The basic characteristic of those patients are numerous associated organ complications, especially heart and artery diseases. These and other associated complications in dialysed diabetic patients have a modified pathogenetic and clinical picture and contribute to their poorer prognosis. Anaemia, immunodeficiency as well as malnutrition are manifested earlier and in a more significant manner. Dialysis therapy has the same rules for diabetic and non-diabetic patients. Tolerance to ultrafiltration is lower and haemodynamic instability is easier to provoke in diabetics than in non-diabetic...

Specific aspects of peritoneal dialysis in diabetic patients

S. Opatrná, J. Klaboch

Vnitr Lek 2008, 54(5):523-529  

Together with hemodialysis and renal transplantation, peritoneal dialysis is an established method of renal replacement therapy. While evolving in parallel with hemodialysis worldwide, it was not until 1990 that peritoneal dialysis, as we know it today, was introduced to this country when high-quality disposables also became available. In the early 1990s, after adequately increasing the throughput of our dialysis and transplant centers, renal replacement therapy became available to all patients requiring it, that is, also to those with diabetes and other patients with comorbidities in this country. The mortality rates of dialysis-dependent patients...

Education of diabetic patients with chronic kidney disease and after transplantation

A. Jirkovská

Vnitr Lek 2008, 54(5):530-534  

Despite recent advances in the management of diabetes, diabetic nephropathy is the most frequent cause of end-stage renal disease. Even when diabetic nephropathy is established, patient's care should be optimized to delay progression of nephropathy or other diabetic complications. Evidence exists for the effectiveness of diet intervention, blood pressure and diabetes control and treatment of metabolic syndrome. We emphasize the need for closer co-operation not only between diabetologists, primary care physicians and nephrologists, but with educated diabetic patients, too. At referral to nephrologist, many patients' care is suboptimal and referral is...

Metformin and kidneys

A. Šmahelová

Vnitr Lek 2008, 54(5):535-540  

Metformin is currently recommended as the first-line drug for type 2 diabetic patients once the disease has been diagnosed. In addition to antihyperglycaemic effect, it has other effects which have a positive effect on cardiovascular risk. The greatest risk of metformin treatment is lactate acidosis, but its incidence is very low if the contraindications are observed. In spite of the fact that not all contraindications are observed in practice, the incidence of lactate acidosis demonstrably provoked by metformin does not grow. In spite of ongoing discussion on the subject, contraindications still include all states involving the risk of lactacidosis...