Aim: Although uric acid has antioxidant effects, hyperuricemia has been established as an indicator of increased cardiovascular mortality in various patient populations. Treatment of asymptomatic hyperuricemia in patients with acute myocardial infarction (MI) is not routinely recommended, and the efficacy of such treatment in terms of cardiovascular risk reduction remains doubtful. Materials & methods: In a prospective cohort study, we followed 5196 patients admitted for a MI between 2006 and 2018. We assessed the relationship between baseline uricemia and the incidence of all-cause death and cardiovascular mortality and the effect of long-term allopurinol treatment. Hyperuricemia was defined as serum uric acid >450 μmol/l in men and >360 μmol/l in women. Results: In the entire cohort, the 1-year all-cause and cardiovascular mortality rates were 8 and 7.4%, and the 5-year rates were 18.3 and 15.3%, respectively. Using a fully adjusted model, hyperuricemia was associated with a 70% increased risk of both all-cause death and cardiovascular mortality at 1 year, and the negative prognostic value of hyperuricemia persisted over the 5-year follow-up (for all-cause death, hazard risk ratio = 1.45 [95% CI: 1.23-1.70] and for cardiovascular mortality, hazard risk ratio = 1.52 [95% CI: 1.28-1.80], respectively). Treatment of asymptomatic hyperuricemia with allopurinol did not affect mortality rates. Conclusion: Hyperuricemia detected in patients during the acute phase of an MI appears to be independently associated with an increased risk of subsequent fatal cardiovascular events. However, hyperuricemia treatment with low-dose allopurinol did not prove beneficial for these patients.
- MeSH
- alopurinol terapeutické užití MeSH
- hyperurikemie * farmakoterapie epidemiologie MeSH
- infarkt myokardu * farmakoterapie epidemiologie MeSH
- kardiovaskulární nemoci * epidemiologie MeSH
- kyselina močová MeSH
- lidé MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.
- MeSH
- dna (nemoc) diagnóza diagnostické zobrazování epidemiologie patologie MeSH
- hyperurikemie diagnóza epidemiologie MeSH
- kyselina močová MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- rentgendiagnostika MeSH
- rizikové faktory MeSH
- synoviální tekutina MeSH
- ultrasonografie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- konsensus - konference MeSH
- směrnice pro lékařskou praxi MeSH
The purpose: To evaluate longitudinal trends in the prevalence of hyperuricaemia and chronic kidney disease (CKD) in Czech adults with and without arterial hypertension (HT).Materials and methods: Two independent cross-sectional surveys were performed in 2006-2009 and 2015-2018, each screening involving 1% population random sample of the general population of nine districts of the Czech Republic aged 25-64 years, stratified by age and gender. Hyperuricaemia was defined as serum uric acid ≥ 420 μmol/l in men, and ≥ 360 μmol/l in women. CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73 m2 and/or albumin/creatinine ratio ≥ 3 mg/mmol.Results: Final analyses included 3504 individuals examined in 2006-2009, and 2309 in 2015-2018. The overall prevalence of hyperuricaemia increased from 16.4% to 25.2% in men (p < 0.001), and from 7.6% to 10.9% in women (p < 0.001), whereas the overall prevalence of CKD declined from 6.8% to 3.6% in men (p = 0.001), and from 7.6% to 4.8% in women (p < 0.001). There was no interaction between HT and hyperuricaemia in either gender; the increase in hyperuricaemia prevalence was observed both in hypertensive and normotensive adults and was accompanied by the increased prevalence of abdominal obesity. Contrarily, there was an interaction between HT and CKD in both men (p < 0.001) and women (p = 0.011); the CKD prevalence declined only in hypertensive individuals, specifically in those using antihypertensive medication and was accompanied by the increased use of renin-angiotensin-aldosterone system (RAS) inhibitors and calcium channel blockers (CCBs).Conclusions: Over the period of 10 years, the overall prevalence of hyperuricaemia increased, while the prevalence of CKD decreased. An increase in the prevalence of hyperuricaemia was observed both in hypertensive and normotensive individuals and was accompanied by an increase in the prevalence of abdominal obesity. A decline in the prevalence of CKD was only observed in hypertensive individuals and was accompanied by the increased use of RAS inhibitors and CCBs.
- MeSH
- chronická renální insuficience komplikace epidemiologie patofyziologie MeSH
- dospělí MeSH
- hypertenze komplikace patofyziologie MeSH
- hyperurikemie komplikace epidemiologie patofyziologie MeSH
- krevní tlak MeSH
- lidé středního věku MeSH
- lidé MeSH
- longitudinální studie MeSH
- prevalence MeSH
- průřezové studie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Dna je nejčastější zánětlivá artropatie u dospělé populace. Její prevalence zejména v rozvinutých zemích narůstá. Jde současně o onemocnění enormně bolestivé a těžce postihující kvalitu života a zejména svým vztahem ke kardiovaskulárním komplikacím i životní výhled nemocného. V poslední době se změnilo paradigma terapie jak akutní dnavé artritidy, tak hypourikemické terapie mimo záchvat. Významné místo v komplexní terapii mají nefarmakologická doporučení, která nezahrnují jen dietu, ale rovněž další aspekty životního stylu (pohyb, redukce nadváhy, omezení kouření). Komplexní terapie dny musí obsahovat i kontrolu systémových rizik choroby.
Gout is the most common inflammatory arthritis in adult populations. Its prevalence is growing, especially in developed countries. Gouty arthritis is a extremely painful disease severely affecting the quality of life and with its relationship to cardiovascular risks gout is also life-threatening disease. In recent times has changed the paradigm of the treatment of acute gouty arthritis and also long- term hypouricemic therapy. An important place in the complex treatment plays non-pharmacological treatment, which include not just a diet, but also other aspects of lifestyle (exercise, overweight). Complex therapy of gout must contain also control of systemic risks of the disease.
- MeSH
- dnavá artritida diagnóza epidemiologie terapie MeSH
- hyperurikemie * diagnóza epidemiologie terapie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Chronické onemocnění ledvin (CKD) je definováno jako abnormality ledvinné struktury nebo funkce, které jsou přítomny déle než tři měsíce a ovlivňují zdraví. Nejčastějšími CKD jsou v současnosti diabetická nefropatie, hypertenzní (ischemická) nefropatie, glomerulární onemocnění a dědičné nefropatie. Glomerulární filtrace (GFR) je všeobecně akceptována jako nejlepší marker funkce ledvin, v současnosti využíváme odhad GFR podle vzorce CKD‑EPI. Samotná hodnota sérového kreatininu není vhodná k posouzení úrovně funkce ledvin. Epidemiologická data svědčí o významu albuminurie pro vznik kardiovaskulárních onemocnění, albuminurie navíc často předchází pokles GFR. K posouzení chronických onemocnění ledvin je nutné vyšetřit poměr koncentrací albuminu a kreatininu ve vzorku ranní moči. Nefrolog má vyšetřit nemocné s eGFR < 30 ml/min (< 0,5 ml/s). Změna vyhlášek o preventivních prohlídkách a dispenzární péči má za cíl zvýšit záchyt chronických onemocnění ledvin v rizikových populacích diabetiků a u pacientů s kardiovaskulárními onemocněními.
Chronic kidney disease is defined as abnormalities in renal function or structure present after more than 3 months, affecting health. Currently, the most common CKDs are diabetic nephropathy, hypertensive (ischemic) nephropathy, glomerular disease and hereditary nephropathy. Glomerular filtration (GFR) is generally accepted as the best marker of renal function, currently we use the GFR estimate of CKD‑EPI. Serum creatinine alone is not suitable for assessing renal function. Epidemiological data suggest the importance of albuminuria for cardiovascular disease, and albuminuria often precedes GFR decline. To assess chronic kidney disease, the ratio of albumin and creatinine concentrations in the morning urine sample should be investigated. The nephrologist should examine patients with eGFR <30 ml / min (<0.5 ml / s). Changing regulations on preventive examinations and follow‑up care aims to increase the detection of chronic kidney disease in high‑risk populations of diabetics and patients with cardiovascular diseases.
- MeSH
- albuminurie diagnóza MeSH
- chronická renální insuficience * diagnóza epidemiologie etiologie patologie MeSH
- diabetes mellitus 2. typu farmakoterapie MeSH
- diabetické nefropatie diagnóza MeSH
- glifloziny farmakologie terapeutické užití MeSH
- hodnoty glomerulární filtrace MeSH
- hypertenze farmakoterapie MeSH
- hyperurikemie epidemiologie prevence a kontrola MeSH
- kuchyňská sůl normy MeSH
- lidé MeSH
- moč cytologie MeSH
- nízkoproteinová dieta normy MeSH
- progrese nemoci MeSH
- proteinurie epidemiologie MeSH
- renin-angiotensin systém účinky léků MeSH
- sekundární prevence metody normy organizace a řízení MeSH
- životní styl MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- hyperurikemie * epidemiologie genetika MeSH
- lidé MeSH
- metabolické nemoci MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- úvodní články MeSH
- MeSH
- antiuratika farmakologie terapeutické užití MeSH
- dnavá artritida farmakoterapie MeSH
- hypertenze epidemiologie MeSH
- hyperurikemie * epidemiologie komplikace MeSH
- komorbidita MeSH
- léková kontraindikace MeSH
- lidé MeSH
- metabolický syndrom epidemiologie patofyziologie MeSH
- nefrolitiáza epidemiologie etiologie MeSH
- obezita epidemiologie komplikace MeSH
- prevalence MeSH
- Check Tag
- lidé MeSH
- MeSH
- ankylózující spondylitida epidemiologie genetika MeSH
- autoimunitní nemoci genetika imunologie MeSH
- diagnostické techniky molekulární MeSH
- dna (nemoc) epidemiologie genetika MeSH
- dnavá artritida epidemiologie genetika MeSH
- genetická predispozice k nemoci epidemiologie genetika MeSH
- hyperurikemie epidemiologie genetika metabolismus MeSH
- incidence MeSH
- lidé MeSH
- psoriatická artritida epidemiologie genetika MeSH
- revmatické nemoci * genetika imunologie MeSH
- revmatoidní artritida epidemiologie genetika MeSH
- systémový lupus erythematodes epidemiologie genetika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- cholesterol izolace a purifikace klasifikace metabolismus MeSH
- diabetes mellitus * diagnóza etiologie klasifikace MeSH
- diagnostické techniky a postupy trendy využití MeSH
- genetická predispozice k nemoci MeSH
- hyperurikemie epidemiologie etiologie komplikace MeSH
- kardiovaskulární nemoci epidemiologie etiologie MeSH
- kauzalita * MeSH
- lidé MeSH
- mendelovská randomizace MeSH
- pití alkoholu metabolismus MeSH
- randomizované kontrolované studie jako téma * MeSH
- statistika jako téma MeSH
- vitamin D metabolismus terapeutické užití MeSH
- Check Tag
- lidé MeSH