Zoltán Ondrik - Academia.edu (original) (raw)

Papers by Zoltán Ondrik

Zeitschrift Fur Gastroenterologie, Jun 21, 2006

Hypertonia és Nephrologia

Magyarországon becslések alapján körülbelül minden tizedik ember szenved krónikus vesebetegségben... more Magyarországon becslések alapján körülbelül minden tizedik ember szenved krónikus vesebetegségben (CKD). A CKD pontos ismerete kulcsfontosságú a megküzdési stratégiák, az önellátás, valamint a betegség progres - sziójának megelőzése szempontjából. A 28 kérdéses Kidney Disease Knowledge Survey 2011-ben Wright és munkatársai által a krónikus vesebetegség ismeretének mérésére kifejlesztett tudásteszt. Magyar nyelven jelenleg egyetlen validált CKD-tudásteszt sem érhető el, így tanulmányunk célja ezen kérdőív magyar nyelvű validálása, valamint összefüggéseinek vizsgálata szociodemográfiai és betegségváltozókkal. Keresztmetszeti kérdőíves kutatásunkban 149, krónikus vesebetegségben (1–5. stádium) szenvedő, predialízises beteg vett részt (64 férfi, 83 nő, átlagéletkor: 63,83 év). Feltáró faktoranalízis mellett a kérdőív konvergens és divergens validitását ellenőriztük. Eredményeink alapján a teszt belső konzisztenciája 0,641, amely a mérőeszköz elfogadható megbízhatóságát jelzi. A kérdőív ...

Zeitschrift für Gastroenterologie, 2006

Critical Care, 2017

Introduction: Ventricular septal rupture (VSR) is an unusual mechanical complication of myocardia... more Introduction: Ventricular septal rupture (VSR) is an unusual mechanical complication of myocardial infarction (MI) in the era of reperfusion therapy, but the mortality rate of patients who present with cardiogenic shock (CS) remains extremely high. Whereas current American and European guidelines recommend urgent surgical repair regardless of hemodynamic status, promising outcomes have been repeatedly reported with the use of circulatory support, enabling hemodynamic stabilization and delaying repair after consolidation of the infarct scar. Therefore, we analyzed our experience with the use of Veno-Arterial Extracorporeal Membrane Oxygenation (V-A ECMO) in post-infarction VSR. Methods: We conducted a retrospective search of institutional database of all patients presenting with post-infarction VSR from January 2007 to June 2016. Data of 33 consecutive patients were retrospectively reviewed and analyzed. Results: In our center, 7 out of 33 patients with post-MI VSR and refractory CS (despite vasopressor and intraaortic balloon pump therapy) received V-A ECMO support. V-A ECMO improved end-organ perfusion with lower lactate levels 24 hours after implantation (7.514 vs. 1.514, p < 0.005), normalized arterial pH (7.25 vs. 7.40, p < 0.036), improved mean arterial pressure (64 mm/Hg vs. 83 mm/Hg, p < 0.001) and lowered heart rate (115/min vs. 68/min, p < 0.001) in all patients. Mean duration of ECMO support was 12 days, 5 out of 7 patients underwent surgical repair, 4 were successfully weaned from ECMO, 3 survived 30 days and 2 survived more than 1 year. The most frequent complication (5 patients) as well as the cause of death (3 patients) was bleeding. Conclusions: Our experience suggest that V-A ECMO support in patients with VSR and refractory CS improves end-organ perfusion, provides hemodynamic stabilization and increases time for cardiovascular team decision. Bleeding complications are an important limitation of this method.

Clinical and pathological details of the investigated Hungarian AS/FBH families.</p

List of the identified mutations in our Hungarian AS/FBH cohort.</p

A, Families with X-linked AS. B, Families with autosomal AS. C, Families with FBH. Open ... more A, Families with X-linked AS. B, Families with autosomal AS. C, Families with FBH. Open squares indicate males and open circles indicate females. An oblique bar indicates a deceased individual. White symbols indicate individuals without clinical sings of the AS/FBH disease. Filled black symbols denote individuals with hematuria and/or proteinuria, hypoacusis or renal failure. The segment shaded circles and squares indicate carriers for a Chromosome 2 (COL4A3 or COL4A4) mutation. A circle that has a dot inside indicates a COL4A5 mutation carrier. The plus signs indicate the index patients whose DNA was analyzed by NGS. The identified mutation(s) for each family is shown.</p

Journal of Hypertension, 2019

Objective: Recent data have associated blood pressure variability (BPV) with subclinical renal da... more Objective: Recent data have associated blood pressure variability (BPV) with subclinical renal damage, acute renal injury and progression of chronic kidney disease but not in the setting of an acute coronary event. The aim of this study is to determine the impact of in-hospital short-term BPV on future renal impairment in patients suffering an acute myocardial infarction (AMI). Design and method: A total population of 63 AMI patients [87.3% male; mean age: 65.1 years; 76.2% hypertensives; 19% chronic kidney disease (GFR<60 ml/ min on admission); 52.4% STEMI] who underwent 24-h ambulatory BP measurement during their hospitalization were followed-up at one year for assessment of their present renal function. Renal impairment was defi ned as a reduction of GFR > or = 25% between discharge and one-year visit according to the RIFLE criteria, calculated using the Cockcroft-Gault Equation. The parameters of BPV analyzed were: a) the 24-h standard deviation (SD), b) the coeffi cient of variation (CV) and c) the average real variability (ARV) of systolic and diastolic BP. Results: After analysis of BPV indices, one-year renal impairment was significantly associated with increased in-hospital SBP CV (hazard ratio, 1.489; CI, 0.200-2.778; p = 0.024). Therefore, a multivariate regression analysis was conducted, in which SBP CV maintained a signifi cant prognostic role of renal impairment [odds ratio, 1.414; CI, 0.013-2.816 (P = 0.048)], independently of age, gender, body mass index (BMI), history of hypertension, DM, ejection fraction (EF) and the type of MI. Conclusions: In the setting of AMI, assessment of in-hospital BPV using SBP CV has a prognostic role in the future development of renal dysfunction. This observation, if confi rmed by further studies, could infl uence the therapeutic approach of ACS in terms of BP management.

Nephrology Dialysis Transplantation, 2005

It has been described that the jejuno-ileal bypass for the treatment of morbid obesity, can produ... more It has been described that the jejuno-ileal bypass for the treatment of morbid obesity, can produce renal calculi early after surgery. Calculi formation is mediated by an increased urinary oxalate output, due to a reduced concentration of intestinal calcium which occurs in malabsorptive states. The aim of our study was to analyse the lithogenic profile in a group of morbid obese patients who underwent a biliopancreatic diversion. We studied 35 patients and determined urinary excretion of calcium, phosphate, uric acid, oxalate and citrate before and 6 and 12 months after surgery. We also recorded familial and personal history of lithiasis and its incidence after bariatric surgery. The mean age of the group was 39.9 ± 12.13 years (80% female and 20% male). Only 2 of them had familial history of renal calculi and one had suffered from lithiasis. Results are shown in the following table. Before 6 m after surgery 12 m after surgery BMI 47.2 ±6 35.5±6.7 32.8±6.6 Ca urine (24 h) 179.9±99.1 99.12±36.6* 117.2±66.7* P urine (24 h) 983.3±441.4 721.5±222.1* 1027.4±361.7 Uric acid urine (24h) 612.8±354.1 415.4±140.9* 496.9±187.7 Oxalate urine (24h) 59±37.5 60.6±34.7 65.5±36.2 Citrate urine (24h) 363.9±180.2 178.3±134.3* 324.6±414.4 The biliopancreatic diversion induces urinary changes during the first 6 months after surgery, which normalize 1 year later. The decrease in urinary calcium and citrate excretion, that is transient, with the increase in oxaluria does not translate into an increase of kidney stones production. MP231 COX-2 SPECIFIC INHIBITION AND RENAL WATER EXCRETION IN ELDERLY SUBJECTS WITH CHRONIC RENAL IMPAIRMENT

Journal of the American Society of Nephrology, 2006

Journal of Hypertension, 2015

Objective: We investigated the changes of spontaneous baroreflex sensitivity (BRS) in patients wi... more Objective: We investigated the changes of spontaneous baroreflex sensitivity (BRS) in patients with chronic hemodialysis (HD) treatment. We did not focus on the basic disease at the background of HD treatment. Design and method: Spontaneous BRS were calculated immediately before and after a regular HD session in the Haemodiyalsis Center of the 1st Dept. of Med. in Szeged. Twenty-three dialysed patients on continuous antihypertensive medication (7 male, 16 female, number of HD: 268 ± 26, age: 62 ± 7 yrs; means ± SD) were investigated. The continuous finger blood pressure and ECG data were recorded with the Finometer (FMS, Arnhem, Netherlands) device. The data were analysed with the Nevrokard BRS (v. 5.1.3 Medistar) software. We calculated the time-domain up- and down-BRS and the frequency-domain alpha-index (a) in the low-frequency (LF) and high-frequency (HF) spectra both in a 10 minute-long resting supine position and in a 10 minute-long standing position. Further we calculated the...

Molecular and Cellular Probes, 2011

The Col4A3, Col4A4 and Col4A5 collagen type IV genes are found to be mutated in Col IV nephropath... more The Col4A3, Col4A4 and Col4A5 collagen type IV genes are found to be mutated in Col IV nephropathy. In males with a mutation in the Col4A5 gene (X-linked Alport syndrome: XL-AS), progressive renal disease always develops. Female carriers with a mutation in the Col4A5 gene can develop thin basement membrane nephropathy (TBMN). Males and females who carry 1 Col4A3 or Col4A4 mutation usually manifest TBMN with nonprogressive hematuria. In the event of 2 Col4A3 or Col4A4 gene mutations, the autosomal recessive AS will develop. We examined the cosegregation pattern of hematuria in 20 families. The renal biopsies led to diagnoses of AS in 7 families, and of TBMN in 6 families. In 7 others, the diagnosis of familial hematuria (FHU) was based on the clinical symptoms. Markers of the ColA3/Col4A4 and Col4A5 loci (Col4A3: CA11 and D2S401; Col4A4: HaeIII/RFLP; and Col4A5: DXS456, 2B6 and 2B20) were used to assess their linkage to the clinical symptoms and morphological alterations. Maximum likelihood and the FASTLINK version of the linkage program were applied to compute logarithm of the odds (LOD) scores. A linkage to the Col4A3/Col4A4 genes was identified in 5 families (FHU in 3, AS in 2 families, 25%, LOD score range: 0.20-3.51). The XL-AS pattern of inheritance seemed likely with Col4A5 in 9 families (45%, LOD: 0.43-4.20); we found 4 disease-causative mutations by high-resolution melting curve analysis (LC480) and sequencing in this group. In 2 FHU families, the linkage to chromosomes 2 and X was precluded. Knowledge of the genetic background of Col IV nephropathy is essential to avoid the misdiagnosis of FHU and early AS. The allele frequencies, heterozygosity content and polymorphism information content of the applied STR markers on unrelated Hungarian normal and affected chromosomes 2 and X were also calculated.

Journal of Contemporary Psychotherapy, 2021

There is an increasing body of evidence proving that transplanted patients’ perceptions of their ... more There is an increasing body of evidence proving that transplanted patients’ perceptions of their disease and their emotional state may have an influence on their physical recovery, but there are relatively few psychological interventions specifically developed to support their healing process. The aim of our study was to explore the effectiveness of a positive psychology intervention programme on the pre- and postoperative psychological state of kidney transplant patients. Clinical trial registration number: NEP-PSZICH-001, 13.15.2014. A total of 40 kidney transplant patients were assessed using the Spielberger Anxiety Inventory, Beck’s Depression Inventory, Transplanted Organ Questionnaire, Brief Illness Questionnaire and the Posttraumatic Growth Inventory during a 1-year follow-up. Medical parameters were collected throughout the 1-year period after transplantation. Compared to the control group, patients in the intervention group had lower anxiety and depression, and higher Posttraumatic Growth scores, and they had shown more positive attitude toward the transplant and their illness. We consider it as our most outstanding result that the estimated glomerular filtration rate and serum creatinine levels were significantly better among patients receiving positive psychology intervention, both after 6 months and after one year following their kidney transplantation. The findings show that mental functioning and general well-being of kidney transplant patients improved after our positive psychology intervention programme, and these improvements were also associated with better kidney functions in the long run.

Hypertonia és Nephrologia

Nephrology Dialysis Transplantation

INTRODUCTION: The indication to repeat renal biopsy in patients with lupus nephritis (LN) flare i... more INTRODUCTION: The indication to repeat renal biopsy in patients with lupus nephritis (LN) flare is still controversial. In the last years studies with protocol biopsies had shown a mismatch between clinical and pathological remission, giving even more importance to repeated biopsies. The aim of our study was to evaluate the pathological changes in patients with LN who had a repeated renal biopsy. METHODS: We analyzed 107 patients with LN biopsied between 1990 and 2018. Of these patients, we selected 26 patients (24.29%) who had had 2 or more renal biopsies. All biopsies were classified according to the ISN/RPS classification. RESULTS: The mean age at the diagnosis of LN was 29.663.2 years, 73.1% of the patients were female and 73.1% caucasic. At first biopsy 30.76% of the patients were class II, 7.7% class III, 38.5% class IV, 11.5% class V and 11.53% mixed class (III/ IV+V). Cyclophosphamide (CFM) and steroids (S) were used as induction treatment in 53.8% of patients and mycophenolate (MMF)+S in 23.1%. Time between both biopsies was 71.5610.7 months. Proteinuria was the most common reason to perform a second biopsy (73.1%). At second biopsy, patients had lower SLEDAI (12 (8, 16) vs 16 (12.5, 25), p 0.004) and less number of patients had anti-dsDNA antibodies positive (46.2 vs 73.1%, p 0.039). There were no differences in serum creatinine (SCr), proteinuria or complement levels. At second biopsy 88.5% of patients were with immunosuppression (19.2% S+MMF, 19.2% S+MMF+tacrolimus, 7.7% S+azathioprine and 38.46% only S). The majority of patients (73.1%) change of class at repeat biopsy; 38.46% to a higher and 34.61% to a lower class. There were no differences in any analytical data between patients who changed class and those who did not. Most patients (75%) with class II changed to a proliferative class (III, IV and III/IV+V). While only 16.66% of patients with proliferative classes change to non-proliferative and 16.66% to a mixed class. There was an increased in chronicity index score (CI) between biopsies (1 (0, 2) vs 3 (2, 4.25), p<0.001), while there was no difference in activity index score. At the end of follow up (mean 163.61616 months), 38.5% patients had chronic kidney disease (CKD) and 19.2% end stage renal disease. The difference between patients with or without CKD was more percentage of glomerulosclerosis (% GE) at first biopsy (8.7863.92% vs 1.2561.25, p 0.02) and higher CI at second biopsy (4 (3, 5.25) vs 2 (1,,3), p 0.006) in patients with CKD. They also had less rate of complete remission at 12 months (0% vs 37.5%, p 0.02) and higher SCr (1.7760.26 vs 0.9360.09 mg/dl, p 0.004) and proteinuria (3.0660.7 vs 4.5660.68 g/24h, p 0.02) at second biopsy. CONCLUSIONS: Our study suggests the utility of repeated renal biopsies in LN patients as 38.46% of patients changed to a higher class without relevant clinical expression. The percentage of complete remission at 12 month, % GE and CI were the main prognosis factors for the development of CKD.

Zeitschrift Fur Gastroenterologie, Jun 21, 2006

Hypertonia és Nephrologia

Zeitschrift für Gastroenterologie, 2006

Critical Care, 2017

Clinical and pathological details of the investigated Hungarian AS/FBH families.</p

List of the identified mutations in our Hungarian AS/FBH cohort.</p

Journal of Hypertension, 2019

Nephrology Dialysis Transplantation, 2005

Journal of the American Society of Nephrology, 2006

Journal of Hypertension, 2015

Molecular and Cellular Probes, 2011

Journal of Contemporary Psychotherapy, 2021

Hypertonia és Nephrologia

Nephrology Dialysis Transplantation