Crystalopathy - underestimated entity in nephrology.

Crystal is a solid particle with a geometric shape because its atoms, ions, or molecules are arranged in a regular ordered structure. However, in case of accidental order of the particles, we are talking about the amorphous substances which can also form crystallike particles. Crystallopathy is a disease that involves crystals of crystallike particulate matter in the pathogenesis of tissue injury. Generally, several predominant pathophysiological mechanisms are involved in the formation of crystallopathies: necroinflammation, chronic remodeling of tissues leading to their atrophy and scarring, and obstruction of ducts, cavities or vessels by larger crystalline masses or stones. The basic distribution of crystallopathies in nephrology is as follows: renovascular crystallopathy (type 1), tubular crystallopathy (type 2), and finally urolithiasis (type 3) (tab. 1). Nowadays, the issue of crystallopathies in general medicine is omitted frequently not only among a wide range of professionals in the field of internal medicine but also in the field of specialists - nephrologists, urologist etc. One of the possible reasons may be the complexity and difficulty of grasping a wideranging topic, so it is our intention to provide an overview of the latest findings and possible approaches to this problem.

Current status of dietary measures in patients with advanced-stage chronic renal failure.

For patients with advanced chronic kidney disease (CKD) appropriately chosen and timely initiated dietary measures, as a complement to drug therapy, may slow the progression of the disease and delay the need for dialysis treatment. According to the results, dietary protein restriction may play a very important in management of such a patient. The effect of low protein diet is given by the early initiation and well cooperation of patients. The low protein diet with supplementation of ketoanalogues of amino acids is an attractive intervention to help maintain good nutritional status of patients and also have a positive role in calcium phosphate metabolism. Depending on the level of CKD´s progression it should not be forgotten either the fluid balance and the limitation of the intake of salt and phosphorus in the diet which may also have an unfortunate effect on the course of the disease.

What are the blood pressure targets for patients with chronic kidney disease?

Cardiovascular (CV) diseases remain the main reason for mortality and morbidity among patients with or without chronic kidney disease (CKD) and hypertension represents one of their risk factor. Despite the lack of definitive evidence that intensive blood pressure (BP) lowering improves kidney function outcomes, we agree with the recommendation of target BP.