[Zika virus infection in pregnancy]. / Zika-vírus-fertozés terhességben.

The Zika virus is a flavivirus spread by mosquitoes. Its primary vectors are the Aedes aegypti and the Aedes albopictus. Before 2007 it sporadically caused benign morbidity. Since 2015, it started spreading "explosively" in America, especially in Brazil. In August 2016 they reported cases from New York and Poland, too. Most of the infections don't produce any symptoms, but can cause grave complications. The most important lesion is microcephalia that forms in fetuses. Microcephalia's most serious consequence is mental retardation, which puts great burden on both the family and the society. The viral infection increases the incidence of Guillain-Barré syndrome. This is an acute autoimmune disease which causes demyelination and, in the worst cases, it can also be fatal. Yet we do not possess adequate and specific vaccination nor antiviral therapy, although, since July 2016, the effectiveness of a DNA based vaccine is being tested on humans. More than half of the world's population lives in areas contaminated by infected mosquitoes so there is a great need for the development of an effective method against the vector mosquitoes. Sadly, even the vector control strategies aren't effective enough to push back the epidemic. Pregnant or fertile women must take the highest precautions against mosquito bites, especially if they travel to regions ravaged by the epidemic. The safest solution would be to postpone both the trip and the childbearing. In Europe, the vectors aren't spread enough to cause major threat, except maybe the warmer regions bordered by the Mediterranean Sea. However, it is possible that in the near future other viruses spread by Aedes mosquitoes could appear. Naturally, the travellers and immigrants, who came from endemic regions can also contribute to the spread of the epidemic. Thanks to the changes in global weather, there were reported findings of mosquitoes of the Aedes albopictus species in Hungary, which are slowly invading the continent, although we do not have information about their settlement in the country. The doctors may encounter introduced cases and we do not have to fear the spreading of the epidemic to our country, but in the bordering Slovakia and Slovenia infections have been reported. The future of the Zika virus is yet unpredictable, although looking at the global spread of the Dengue and Chikungunya viruses, a worldwide spread is expectable in the near future. Orv. Hetil., 2017, 158(15), 563-571.

[Live birth resulting from abdominal pregnancy]. / Hasuri terhesség élo újszülöttel.

Advanced abdominal pregnancy is extremely rare. Symptoms are often nonspecific, and the diagnosis is frequently missed. Maternal mortality and morbidity are also very high especially if the condition is not diagnosed and managed properly. In abdominal pregnancy there is a high incidence of fetal malformations. We are presenting a case of a 38 year old primigravida with an undiagnosed advanced abdominal pregnancy carried beyond 36 weeks of gestation. We delivered a 2090 g baby from the abdomen. A relaparotomy was necessary on the third postoperative day because of abdominal bleeding. At the time of discharge both mother and baby were doing well. The publication also provides a literature overview, including definition, epidemiology, diagnosis and therapy. Orv. Hetil., 2017, 158(13), 508-511.

[Pregnancy and acute ischemic stroke]. / Terhesség és akut ischaemiás stroke.

Pregnancy-related ischemic strokes play an important role in both maternal and fetal morbidity and mortality. Changes in hemostaseology and hemodynamics as well as risk factors related to or independent from pregnancy contribute to the increased stroke-risk during gestation and the puerperium. Potential teratogenic effects make diagnostics, acute therapy and prevention challenging. Because randomized, controlled trials are not available, a multicenter registry of patients with gestational stroke would be desirable. Until definite guidelines emerge, management of acute ischemic stroke during pregnancy remains individual, involving experts and weighing the risks and benefits.

[Successful pregnancy in a patient with idiopathic pulmonary arterial hypertension. Case report]. / Idiopathiás pulmonalis artériás hypertonia mellett vállalt sikeres terhesség.

Idiopathic pulmonary arterial hypertension is characterized by progressive increase in pulmonary arterial pressure and pulmonary vascular resistance which lead to right ventricular failure and death. Pregnancy in patients with idiopathic pulmonary arterial hypertension is contraindicated because of the high maternal and fetal mortality. The authors present a case of successful pregnancy and delivery of a patient with idiopathic pulmonary arterial hypertension in Hungary for the first time. The aim of the report was to demonstrate that management and treatment of idiopathic pulmonary arterial hypertension in a pregnant woman is a complex and multidisciplinary task that should involve obstetrician, cardiologist and anesthesiologist. Those patients who become pregnant and do not wish to terminate the pregnancy must be referred to obstetric centers where a multidiciplinary approach is taken.

[Outcomes of childbearing and pregnancy in women with multiple sclerosis--a literature review]. / Gyermekvállalás és szüléskimenetel sclerosis multiplexben a nemzetközi irodalom tükrében.

In the last few years more studies indicated that although sclerosis multiplex frequently manifests in young adulthood, it should not be considered as contraindication for pregnancy in women affected with the disease. In fact, despite controversial literature data, pregnancy appears to be a protective factor to the disease without a harmful effect on the fetus. However, the use of immunomodulatory therapy during pregnancy needs a careful evaluation process and experts of this field may contribute to family happiness of the affected mother.

[Risk of maternal and fetal disease among women older than 40 years]. / Magzati és anyai betegségek kockázata 40 évesnél idosebb édesanyák esetén.

A rising trend in advanced maternal age has been observed over the last few decades. Several studies have assessed the association between advanced maternal age and adverse pregnancy outcome, including miscarriage, stillbirth, pre-eclampsia, gestational hypertension, gestational diabetes mellitus, preterm birth, delivery of a small- or large-for-gestational-age neonates and elective or emergency Cesarean section. These studies reported contradictory findings. The aim of the present paper is to summarize the evidence-based information regarding advanced maternal age and pregnancy outcomes.

[Psychosocial aspects of preeclampsia]. / A praeeclampsia pszichoszociális vonatkozásai.

Distress conditions during pregnancy may contribute to the development of preeclampsia by altering functions of the neuroendocrine and immune systems, e.g. activation of the hypothalamic-pituitary-adrenal axis and increase in plasma proinflammatory cytokines. Preeclampsia may also precipitate mental health problems due to long-term hospitalization or unpredictable and uncontrollable events such as preterm labor and newborn complications. Besides, preeclampsia may induce persistent neurocognitive complaints with a negative impact on patients' quality of life. As growing evidence indicates that poor maternal mental health has an adverse effect on pregnancy outcome and fetal development, psychosocial interventions may be beneficial for women with preeclampsia.

[Effects of the designer drug methylenedioxypyrovalerone on the developing brain in experimental animal model]. / A dizájner drog metiléndioxi-pirovaleron hatása a fejlodo idegrendszerre kísérletes állatmodellben.

INTRODUCTION: The designer drug methylenedioxypyrovalerone is a frequently used psychoactive drug of abuse. AIM: The aim of this study was to determine the effect of methylenedioxypyrovalerone, administrated from the 8th to the 14th day of the gestation, on the development of central nervous system and on the behaviour of offspring mice. METHOD: Pregnant mice were treated during this period either with subcutaneous injection of 1×10 mg/kg body weight methylenedioxypyrovalerone or vehicle (saline). Maternal behaviour (pup retrieval test), locomotor activity (open field test) and motor coordination (grip strength test) of dams were evaluated. Locomotor activity at the 7th and 21st postnatal day (open field test) and motor coordination at the 21st postnatal day (grip strength test) were examined. RESULTS: Reduced maternal behaviour among treated animals was observed. There was no difference in the results of the open field test between treated and control groups. Decrease of locomotor activity was observed in the pups of the methylenedioxypyrovalerone treated dams. CONCLUSIONS: The results suggest that cathinones (in particular methylenedioxypyrovalerone) may adversely affect neural integrity of the developing central nervous system.

[Early diagnosis of ectopic pregnancy]. / A méhen kívüli fogamzás korai diagnosztikája.

Ectopic pregnancy is a high-risk condition that occurs in 2% of reported pregnancies. This percentage is fivefold higher than that registered in the 1970s. Since 1970 there has been a two-fold increase in the ratio of ectopic pregnancies to all reported pregnancies in Hungary and in 2012 7.4 ectopic pregnancies per thousand registered pregnancies were reported. Recently, the majority (80%) of cases can be diagnosed in early stage, and the related mortality objectively decreased in the past few decades to 3.8/10,000 ectopic pregnancies. If a woman with positive pregnancy test has abdominal pain and/or vaginal bleeding the physician should perform a work-up to safely exclude the possibility of ectopic pregnancy. The basis of diagnosis is ultrasonography, especially vaginal ultrasound examination and measurement of the ß-subunit of human chorionic gonadotropin. The ultrasound diagnosis is based on the visualization of an ectopic mass rather than the inability to visualize an intrauterine pregnancy. In some questionable cases the diagnostic uterine curettage or laparoscopy may be useful. The actuality of this topic is justified by practical difficulties in obtaining correct diagnosis, especially in the early gestational time.

[Epigenetic mechanisms in physiologic and pathologic pregnancies]. / Epigenetikai mechanizmusok élettani és kóros terhességben.

Epigenetic factors are nowadays in the focus of scientific interest in medicine including obstetrics. The environment in utero and early neonatal life may induce a permanent response in the fetus and the newborn leading to enhanced susceptibility to later diseases. There is now growing evidence that the effects of developmental programming may also manifest themselves in the next generations without further suboptimal exposure. The so-called fetal programming may also highlight a tight connection between pathological conditions in pregnancy, environmental factors and the development of chronic diseases in adulthood. Investigation of epigenetic factors may yield new possibilities for the prevention of chronic diseases affecting a significant part of the population.

[Urgent cesarean section in a pregnant woman with carbon monoxide poisoning]. / Sürgosségi császármetszés szén-monoxid-mérgezésben.

Recognition of carbon monoxide is difficult due to its plain physical-chemical properties. Carbon and gas operating heating systems may cause severe poisoning. Carbon-monoxide intoxication may generate severe hypoxic damage and it may cause death. The authors present the case of severe carbon monoxide poisoning affecting one young child and five adults, including a pregnant woman. Because the availability of hyperbaric oxygen therapy is limited in Hungary, urgent cesarean section was performed to avoid intrauterine hypoxic damage. The authors note that there are no standardized non-invasive methods for measuring fetal carbon-monoxide level and that the level of carbon monoxide accumulation is higher and the clearance is longer in the fetus than in the mother. The pathophysiology of carbon monoxide intoxication and therapeutic options in pregnancy are discussed.

[Fetus, small for gestational age]. / A kis súlyú magzat.

A small for gestational age foetus is defined by the foetal weight below the 10th centile for the corresponding gestational age. However, the vast majority of these cases has no apparent underlying abnormality, while in other cases a serious causative pathological condition can be identified. The detection, follow-up and treatment of an intrauterine growth retarded, compromised foetus has great obstetric and neonatologic relevance. In this review, the causes, clinical aspects and screening methods of intrauterine growth retardation are summarized based on the most recent international guidelines. Furthermore, recommendations regarding the monitoring and the optimal timing of the labour induction of pregnancies complicated with intrauterine growth retardation are discussed.

[Treatment of pregnancy-associated breast cancer]. / A terhességgel összefüggo emlodaganatok kezelése.

CASE REPORT: A 25-year-old primipara, in the thirty-second week of her pregnancy observed a nodule in the upper outer quadrant of her left breast during self-examination. Complex breast examination revealed calcification with 4 cm of diameter. Ductal malignant cells (C5) were identified by fine-needle aspiration biopsy, while core biopsy verified invasive ductal carcinoma, grade III (B5b). No manifestations of metastases were presented. After pregnancy termination wide excision with additional axillary sentinel lymph node biopsy was performed. Because of its positivity block dissection of axillary lymph nodes was carried out. The surgical therapy was followed by adjuvant chemo-, radio- and hormonal therapy. Later an angiomyxoma appeared in the right inguinal region, which was excised in toto. DISCUSSION: The incidence of pregnancy related malignant diseases is increasing, of which breast cancer predominates. Breast cancer, which is diagnosed during pregnancy or within the first year of delivery is called pregnancy-associated breast cancer. Because of the physiological changes in pregnancy the recognition of the disease is difficult. Therapy is complex, as besides the treatment of the mother, the safety of the fetus should be emphasized. The treatment strategies are different in the three trimesters. The surgical treatment can be performed during the whole pregnancy. The use of radiotherapy is controversial, because of teratogenic effects, while chemotherapy is permitted in the second and third trimesters. Nearly three years after the operation, our patient does not have any symptoms, her son is healthy.

[The impact of thyroid function in women of reproductive age: infertility, pregnancy and the postpartum period]. / A pajzsmirigymuködés jelentosége fertilis korú nokben: meddoség, terhesség és a post partum idoszak.

This article reviews the management and diagnosis of thyroid dysfunction during pregnancy and postpartum, which was published by any of the endocrine societies in 2012. The author presents human data based on these clinical practice guidelines, however, there are also many unresolved questions. Especially, there are inconsistencies about screening using plasma TSH measurement. In pregnancy the main causes of hyperthyroidism are Graves's disease and gestational transient thyrotoxicosis. Generally, gestational transient thyrotoxicosis does not require medication, whereas Graves's disease needs antithyroid drug therapy. Postpartum thyroiditis occurs more frequently in antithyroid peroxidase-positive women, who should be screened using serum thyrotropin measurements at 6 to 12 gestation weeks and at 3 and 6 months postpartum. Because overt maternal hypothyroidism, due to autoimmune pathophysioloical mechanisms, negatively affects the fetus, timely recognition and treatment are important. The subclinical form of maternal hypothyroidism should also be treated. A link between thyroid dysfunction and infertility has been warranted.

[Acute pancreatitis after cesarean section]. / Akut hasnyálmirigy-gyulladás császármetszést követoen.

The prevalence of acute pancreatitis in pregnancy is low; similarly to the non-pregnant population, the outcome varies from mild to fatal forms. Occurrence of the disease in pregnancy is mostly in the third trimester or the postpartum period. The most common cause of acute pancreatitis is cholelithiasis but hypertriglyceridemia, fatty diet, obesity and alcohol consumption are further predisposing factors. A 27-year-old twin-pregnant woman developed acute severe pain 2 days after a cesarean section. Labor tests showed elevated amylase (1080 U/L) and lipase (2670 U/L) serum levels. For the purpose of pain relief, we inserted an epidural catheter and indicated an abdominal computer tomography examination. The abdominal imaging did not show morphological disorder of the pancreas or cholangial obstruction. We performed conservative therapy, early per os feeding, pain relief and fluid resuscitation. On the postpartum 7. day, the serum pancreas enzyme levels decreased to normal and the patient - with her babies - was discharged home. Though acute pancreatitis is a rare event in pregnancy, we should consider it in cases with acute, typical or non-typical pain. It is challenging to differentiate the disease from the acute syndromes of pregnancy. Orv Hetil. 2023; 164(31): 1231-1234.

[Emergency contraception.] / Esemény utáni fogamzásgátlás.

INTRODUCTION: Emergency contraception is an effective and safe solution for preventing unwanted pregnancies. Many methods of emergency contraception are used, which have different mechanisms of action and time frames. OBJECTIVE: Providing information to healthcare professionals and decision-makers based on the literature data about the target populations of emergency contraception, evidence-based modern methods, their effectiveness, and practical application for the purpose of reducing the incidence of unintended pregnancies. METHODS: We conducted a systematic literature search in MEDLINE (PubMed), Embase and Scopus databases based on relevant keywords, for publications that were published between 1960 and 2023. RESULTS: 23 clinical professional publications were selected that examined the effectiveness of oral and long-term usable contraceptives as emergency contraceptives. Our research results were interpreted in terms of weight, breastfeeding, time elapsed since the intercourse and future contraceptive plans, which help to select the most appropriate emergency contraceptive for healthcare professionals. CONCLUSION: Based on the literature data, our systematic review provides assistance for choosing between the available oral levonorgestrel, ulipristal acetate, and intrauterine contraceptive devices available in Hungary based on effectiveness, target population, and accessibility. We support the healthcare governance in creating up-to-date professional guidelines to improve the availability of emergency contraception and, consequently, enhance reproductive health. Orv Hetil. 2023; 164(44): 1736-1748.

[Successful pregnancy of a patient with primary sclerosing cholangitis awaiting liver transplantation]. / Primer szklerotizáló cholangitisben szenvedo, májtranszplantációra váró beteg sikeres várandóssága.

In women, primary sclerotising cholangitis (PSC) associated with ulcerative colitis and intrahepatic cholestasis is a rare disease. To date, there are no data from Hungary on the fertility and pregnancy outcome of women with this chronic liver disease. Our aim is to present the favorable pregnancy outcome of a woman with PSC associated with ulcerative colitis, intrahepatic cholestasis and postpartum colectomy, and review of the literature. A young nulligravida was first diagnosed with ulcerative colitis. Five years later, PSC developed with progressive fibrosis and cholestasis necessitating liver transplantation. While on waiting list, spontaneous conception occurred. Except for pregnancy-induced hypertension, pregnancy uneventfully progressed until the third trimester when 8 g oral cholestyramine/day was administered to lower high maternal (over 100 µmol/L) total bile acid (TBA) level. In the 36th week of gestation acute exacerbation of ulcerative colitis resulted in maternal fever and chorioamnionitis leading to fetal distress. Elective delivery of the eutrophic neonate followed by emergency cesarean section. In the early puerperium, colitis progressed to septic pancolitis resistant to medical treatment. 12 days after laparoscopic subtotal colectomy, the patient was discharged in good health condition. 3 months later, ileostomy was closed and she got back on the transplantation waiting list. Our data correspond with previous reports and suggest that women with PSC with underlying ulcerative colitis and cholestasis have a good chance for favorable pregnancy outcome. However, both PSC and underlying colitis might progress during pregnancy and puerperium. Oral cholestyramin is an effective and safe treatment for high maternal TBA levels. Orv Hetil. 2023; 164(6): 234-240.

Difficulties in the differential diagnosis of proteinuria during pregnancy / A várandósság során jelentkezo proteinuria differenciáldiagnosztikájának nehézségei

Even during normal pregnancy, significant morphological, functional and hemodynamic changes take place in the kidneys, resulting in a slightly increased proteinuria. However, an abnormal increase, especially if accompanied by hypertension or impaired renal function, requires close maternal and fetal follow-up, as it may predict severe perina-tal complications. Differential diagnosis of proteinuria is diverse, and the primary consideration in clarifying the etiol-ogy is to differentiate between preeclampsia and other possible primary kidney disease. We list all the diseases on the etiological palette that may even mimic the symptoms of preeclampsia, making it difficult to make an accurate diag-nosis. In the case of a 31-year-old gravida, we review the differential diagnosis of progressive proteinuria observed during pregnancy. In addition to the diagnosis of postpartum preeclampsia, renal malignancy was confirmed. We are also looking for the answer whether malignant kidney cancer can be blamed for the clinical presentation that includes hypertension, progressive proteinuria.

Rare abdominal bleeding from the branches of the splenic vein during pregnancy / Ritka hasuri vérzés a vena lienalis ágrendszerébol várandósság alatt.

Összefoglaló. Az "akut has", mint kórkép, a várandósság során mind diagnosztikailag, mind terápiásan nagy kihívást jelent a szülész számára a megváltozott anatómiai viszonyok és a képalkotó eljárások korlátozott használhatósága miatt. Közleményünkben bemutatjuk egy harmadik trimeszterbeli gravida hasi vérömlenyének az esetét, melynek vérzésforrása irodalmi ritkaság, a vérzés típusát a felkeresheto irodalomban még nem írták le terheseknél. Az esettanulmány megírása a páciens orvosi dokumentációi és az ellátásában résztvevo klinikusok, patológusok leletei és beszámolói alapján történt. A várandósságának 33. hetében járó gravida akut hasi tünetegyüttessel jelentkezett klinikánkon, anamnézisébol trauma kizárható volt. Az anya romló kardiorespiratorikus állapota miatt sürgosségi császármetszéssel élo, koraszülött magzatot segítettünk világra. A mutét során kb. 1500 ml vért találtunk a hasüregben, melynek okát általános sebész bevonásával kerestük. Aktív vérzésforrásként a lép ereinek területérol vénás jellegu szivárgó vérzést találtunk, ezért splenectomia mellett döntöttünk. Az eltávolított szervkomplexum teljes szövettani feldolgozása helyenként a kisebb léphilusi vénaágak izomfalának felrostozódását és fokozatos eltunését igazolta, a patológus a vérzés okát a meggyengült érfal endothelen keresztüli vérszivárgásának véleményezte, definitív érfalszakadásra utaló elváltozás nem volt azonosítható. A haemoperitoneum várandósság alatt kifejezetten ritka kórkép, azonban mortalitása mind az anyára, mind a magzatra nézve rendkívül magas. Irodalmi adatok alapján a vérzésforrás leggyakrabban a kismedencei szervek területén jelentkezik. Ritkán a lépartéria aneurysmájának rupturája is elofordul terhességben, a lépvénás eredetu vérzés viszont irodalmi ritkaságnak számít, és az összes feldolgozott és közölt esetben az ér szakadásos sérülése volt a fo ok, az esetünkben leírt, ismeretlen etiológiájú, érfalvesztéses hemorrhágiát sehol nem említik. A várandósunk ellátásánál ellátásánál kulcsfontosságú volt a gyorsan elvégzett exploratív laparotomia, mely a kórkép okát felderítette és megszüntette, lehetové téve az anya és gyermeke túlélését és felépülését. Esetünk rámutat arra, hogy a várandóssági hasuri vérömlenyek kóroktana akár irodalmi ritkaságokat is rejthet, azaz a pontos ok kiderítésével, lumenes vérzésforrás keresésével nem szabad szükségtelen idot veszteni az édesanya és gyermeke életmento ellátásának rovására. Orv Hetil. 2022; 163(8): 328-332. Summary. Acute abdomen during pregnancy is a major challenge for physicians, due to the altered anatomical conditions and the limited use of medical imaging. We present a pregnant woman with a rare form of abdominal bleeding. This case study is based on the patient's medical documentations and interviews with her physicians. A woman in the 33rd week of her pregnancy was admitted to our department with acute abdomen, trauma was ruled out. Due to the deteriorating cardiorespiratory status we performed an emergency caesarean section delivering a living premature newborn. A general surgeon was present, and 1500 ml of blood was evacuated from the abdomen. Active venous type bleeding was present from the splenic vessels, therefore we performed a splenectomy. The histopathological analysis of the whole organ complex showed that the media layer segmentally and progressively disappeared in the splenic hilar veins, giving rise to the high probability that the bleeding was caused by a diathesis-type leakage through the endothelium and to the weakened media layer in the absence of a luminal-type vessel rupture. Hemoperitoneum during pregnancy is an exceptionally rare condition, however its mortality rate is high both for the mother and the fetus. The bleeding usually originates from the pelvis. On rare occasions the bleeding occurs from the splenic vessels although most of them are arterial bleedings from an aneurysm.In our case the emergency laparotomy was essential for the correct diagnosis and the treatment, which resulted in saving and recovering both the mother and the fetus. Orv Hetil. 2022; 163(8): 328-332.

Therapy-resistant hypertension in pregnancy after live donor kidney transplantation / Élo donoros vesetranszplantációt követo terhességben kialakult terápiarezisztens hypertonia.

Összefoglaló. A veseátültetés a legnagyobb reményt nyújtja a végstádiumú vesebetegségben szenvedo nok számára, akik teherbe kívánnak esni. A veseátültetett beteg terhessége továbbra is kihívást jelent az immunszuppresszív gyógyszerek mellékhatásai, az allograftfunkció romlásának kockázata, a praeeclampsia és a magas vérnyomás káros anyai szövodményeinek rizikója, valamint a koraszülés, az alacsony születési súly kockázata miatt. A terhesség alatt nagy a magas vérnyomás kialakulásának kockázata, a szérum-kretaininszint emelkedik, és a terhesség végére proteinuria is kialakulhat. Az ajánlott fenntartó immunszuppresszió terhes noknél a kalcineurininhibitorok (takrolimusz/ciklosporin) és alacsony dózisú szteroid adása, melyek biztonságosnak tekinthetok. Fontos, hogy a gyermekvállalási tanácsadás már a vesetranszplantáció elott megkezdodjön, és a transzplantációt követoen minden klinikai kontroll megtörténjen. Orv Hetil. 2021; 162(23): 924-926. Summary. Kidney transplantation offers the best hope to women with end-stage renal disease who wish to become pregnant. Pregnancy in a kidney transplant recipient continues to remain challenging due to side effects of immunosuppressive medication, risk of deterioration of allograft function, risk of adverse maternal complications of preeclampsia and hypertension, and risk of adverse fetal outcomes of premature birth, low birth weight, and small for gestational age infants. The factors associated with poor pregnancy outcomes include the presence of hypertension, serum creatinine greater than normal range and proteinuria. The recommended maintenance immunosuppression in pregnant women is calcineurin inhibitors (tacrolimus/cyclosporine) and low-dose steroid which are considered safe. It is important that counseling for childbearing should start as early as prior to getting a kidney transplant and should be done at every clinic visit after transplant. Orv Hetil. 2021; 162(23): 924-926.