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Purpose: The purposes of this study were to investigate the association between arm circumference and body mass index (BMI) and to discuss problems, mainly arm circumference and cuff size mismatch, that could affect the reliability of home blood pressure monitoring (HBPM) among peritoneal dialysis (PD) and hemodialysis (HD) patients., Methods: 525 PD and 502 HD patients from 16 centers were included in the study. A two-part questionnaire was used to gather information from the participants. Arm circumferences were categorized into four groups according to the British Hypertension Society cuff size recommendations., Results: Mean BMI and arm circumference of all participants were 25.0 kg/m(2) and 27.6 cm, respectively. There was a significant correlation between BMI and arm circumference. The mean BMI and arm circumference values were higher in PD patients than in HD patients. Requirement of a large-sized adult cuff was more common among PD patients compared to HD patients (14 % vs 8 %, p = 0.002)., Conclusions: Since HBPM is a useful tool for clinicians to improve BP control, nephrologists should be aware of the problems related to HBPM in dialysis patients and take an active role to increase the reliability of HBPM.

Background: The aims of the present report were to document our experience of the prevalence of tuberculous peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients, mode of presentation, diagnosis and outcome and to discuss the current published data about catheter removal., Methods: A retrospective study of CAPD patients with tuberculous peritonitis was done. A minimum of three specimens of peritoneal fluid were examined for acid-fast bacilli smears. The BACTEC 9000 Blood Culture Series of instruments were used for the culture of Mycobacterium tuberculosis. After 2005, patients were treated with anti-tuberculous treatment, and catheter retention was started in our patients., Results: There were eleven patients (2.6 %) with tuberculous peritonitis among 414 CAPD patients. M. tuberculosis accounted for 4.47 % of all peritonitis episodes. The incidence of tuberculous peritonitis was 1/794 months. There were eight males and three females. The mean age was 49 years. Intestinal obstruction was reported in two patients, and two patients were treated for antecedent peritonitis. One of them had a simultaneous fungal peritonitis. One patient each developed a peritoneo-cutaneous fistula and ultrafiltration failure. Three were successfully treated without the removal of catheter., Conclusion: Based on the analysis of all published reports of tuberculous peritonitis, there was no significant difference in patient survival between patients in whom CAPD catheter was removed or retained. Tuberculous peritonitis should be considered in patients with neutrophilic 'sterile' peritonitis with no response to antibacterial medications, predominance of lymphocytic peritonitis and in bacterial peritonitis not responding to antibiotics. After an early diagnosis, with close monitoring, an effort to retain the catheter after 5 days of anti-tuberculous therapy may be attempted.

Amyloidosis is the most common and devastating complication of familial Mediterranean fever (FMF). Renal transplantation is the choice of treatment of in most end-stage renal disease (ESRD). We report our experience on the outcomes in eight patients who underwent renal transplantation for ESRD due to FMF secondary to amyloidosis, and we provide a discussion on the current evidence on this topic of study. The clinical charts of eight renal transplant patients (seven male, one female) who underwent ESRD due to FMF-related amyloidosis were investigated. Five patients underwent living-donor renal transplantation and three patients underwent deceased-donor renal transplant. The mean follow-up period was 35 months (range 3-72). All patients were on triple immunosuppressive treatment and received colchicine. All allografts are currently functioning well with a mean serum creatinine level of 1.4 (range 0.7-2.6) mg/dL. Posttransplantation complications included acute rejection (n = 4), chronic rejection (n = 1), severe gastroenteritis (n = 2), and erythrocytosis (n = 5). None of the patients had proteinuria. During follow-up, we did not observe clinically severe FMF attack, septicemia, rhabdomylosis, symptoms related to vasculitis, and clinical neuropathy. The clinical outcome of the patients in this cohort was similar to that of other renal transplant patients with ESRD due to other causes. This study shows favorable prognosis of eight ESRD patients due to amyloidosis caused by FMF after renal transplantation. Renal transplantation is a safe procedure for ESRD patients having amyloidosis due to FMF. Regular use of colchicine after transplantation should be mentioned.

Inaccuracy of home sphygmomanometers is a common, neglected and often ignored problem. The aims of this review are to emphasize the advantages of self-measurement of blood pressure (BP) at home, to summarize basic features of automated home BP measurement devices, to point out the distinction between validation, calibration and accuracy of home sphygmomanometers and to discuss some practical points for the improvement of BP control in chronic kidney disease (CKD) patients for nephrologists. Four features of automated sphygmomanometers need to be emphasized: measurement site, cuff-size, validation status and accuracy. The validation protocols do not guarantee the accuracy of a particular device for an individual patient. Special patient groups such as those with early stages of CKD or diabetic nephropathy or patients having extraosseous/vascular calcifications may require specific validation tests. Active guidance by nephrologists in all steps of self-measurement of BP at home will improve the control of BP and will increase the quality of patient care in CKD. Health care providers must urgently reimburse the cost of accurate home sphygmomanometers for patients with CKD in countries where CKD is considered a major public health problem.

Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent inflammatory febrile attacks, abdominal, chest or joint pain, myalgia, and erysipelas-like skin lesions. Several types of vasculitis are associated with FMF such as polyarteritis nodosa and Henoch-Schönlein purpura. We aimed to determine microvascular abnormalities in FMF patients via nailfold capillaroscopy using a dermoscope. Thirty-one FMF patients were assessed; capillary enlargement, tortuosity, avascular areas and microhemmoraghes were investigated. Capillary enlargement was found in five patients and microhemorrhages in one patient. Our study supports that nailfold capillary abnormalities, which are nonspecific, can be seen in FMF patients, but more studies are needed to clarify the importance of these findings.

Familial Mediterranean fever (FMF) shares a number of features with Behçet's disease (BD), such as their common ethnic origin, etiopathogenetic mechanisms, symptoms, and treatment. Pathergy reaction is accepted as a major criterion in BD. We aimed to determine the frequency of pathergy positivity in FMF patients and compared clinical features between FMF and BD. Pathergy test was performed in patients with FMF, BD, and healthy controls. Diagnostic criteria for FMF and BD were screened in both groups. None of the FMF patients or healthy controls yielded positive pathergy test. Pathergy test was positive in 13 out of 31 (41.9%) of the patients with BD. None of the FMF patients fulfilled the International Study Group criteria for BD. None of the BD patients fulfilled the Livneh diagnostic criteria for FMF. BD and FMF are associated with neutrophilic dermatoses and neutrophil hyper-reactivity. Although pathergy test and erysipelas-like erythema share some histological findings, pathergy test was negative among FMF patients.

Behçet's disease (BD) related amyloidosis is relatively rare. Serum amyloid A protein (SAA) protein gene polymorphism is one of the factors implicated in the pathogenesis of AA type amyloidosis. The aim of this study is to investigate SAA1 gene polymorphism in different patient groups: (1) BD related amyloidosis, (2) BD without amyloidosis, and (3) healthy controls. One hundred eleven patients from three main groups were included in the study: (1) BD related amyloidosis (n = 9), (2) BD without amyloidosis (n = 39), and (3) healthy controls (n = 63). Homozygous alpha/alpha is present in 78% of patients with BD and amyloidosis. The SAA1 alpha/alpha genotype is significantly more common among patients with BD and amyloidosis. This study demonstrated increased frequency of alpha/alpha genotype in BD related amyloidosis. To our knowledge, the relationship between alpha/alpha genotype and BD related amyloidosis was not studied previously. In conclusion, the SAA1 alpha/alpha genotype is a risk factor for amyloidosis in BD.

Background: Amyloidosis, mainly AA type, is one of the common diseases in nephrology clinics in Turkey. AA type amyloidosis is a complication of various chronic infections or inflammatory diseases such as familial Mediterranean fever (FMF), rheumatoid arthritis (RA), tuberculosis and bronchiectasis. A controversy exists in the literature regarding the relationship between SAA1 genotypes and AA type amyloidosis. This study aimed to investigate SAA1 gene polymorphism in different patient groups: 1) amyloidosis, 2) FMF and 3) healthy controls., Methods: Eighty-two patients from the three groups were included in the study: 1) amyloidosis, 2) FMF without amyloidosis, and 3) healthy controls. SAA1 genotypes were studied by the polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP) method., Results: The homozygous alpha/alpha genotype is the most common SAA1 genotype among patient groups with amyloidosis, and the alpha/alpha genotype frequency is significantly higher than in healthy controls (68 vs. 38%, p<0.05)., Conclusions: The SAA1 alpha/alpha genotype is a risk factor for AA type amyloidosis in Caucasoid populations and more studies are needed to investigate why the gamma/gamma genotype is associated with AA type amyloidosis in Japan.

We report on a new method for the repair of spigelian hernia, in which we combined the step-by-step local anesthesia and open preperitoneal mesh repair techniques. After initial infiltration of local anesthetics, we incised the attenuated fascia and slightly enlarged the fascial defect to facilitate easy return of hernial content into the abdominal cavity. We injected preperitoneally, in a radial fashion around the peritoneal sac, more saline solution, consisting of 1:200,000 epinephrine (g:g) and 1/3 bupivacain (v:v). We dissected the peritoneum away from the anterior abdominal wall to create a preperitoneal pocket of sufficient size. We spread open a 9 x 9-cm polypropylene mesh in the area, as if we were doing a GPRVS of Stoppa. We followed up our four patients for an average of 32 months. All four cases had an uneventful recovery and were discharged in an average of 3.5 days. They returned to normal daily activity on the 9th day after surgery. We suggest that the preperitoneal mesh repair of a spigelian hernia under local anesthesia is a simple and feasible technique with favorable early and late postoperative results and deserves further investigation in larger series.

Anemia associated with ACE inhibitors is rare but it may cause problems especially in patients with renal disease. This study assessed the acute effect of trandolapril, an ACE inhibitor, on serum erythropoietin (EPO) levels in uremic and hypertensive patients. Trandolapril 2 mg/day was given orally for three days and blood samples were collected on the first and third day. Trandolapril led to a significant decrease in serum EPO in patients with chronic renal failure. Although the drug lowered serum EPO in hypertensive patients, this effect was not statistically significant. This drop in serum EPO levels may be one of the mechanisms by which ACE inhibitors cause anemia, or worsen anemia, in uremic patients and further studies are needed to clarify this point.

Hepatitis C virus (HCV) is the major cause of posttransfusion non-A, non-B hepatitis. Haemodialysis patients carry the risk of HCV infection. The aim of this study is to compare the morphological changes related to chronic HCV infection found in haemodialysis and nonuraemic patients. Liver biopsies from nine haemodialysis patients and 37 patients with normal renal function were studied. This study shows that haemodialysis patients may have less active and progressive chronic hepatitis C than patients with normal renal function. The number of patients in this study is limited, therefore further studies are needed for definite conclusion.

In order to assess the clinical value of six tumour markers in pre-dialysis patients with chronic renal failure as well as in patients on regular haemodialysis, we studied these markers in 35 predialysis patients, 35 patients on chronic haemodialysis and 35 healthy controls. Serum squamous cell antigen (SCC), CA 19.9, and CA 125 levels were found to be elevated in the uraemic groups as compared to the normal controls. Carcinoembryonic antigen (CEA), alpha foetoprotein (AFP), and prostate-specific antigen (PSA) levels were within normal limits in all groups.

Anaemia of end-stage chronic renal failure improves following successful kidney transplantation. However, erythrocytosis occurs in 6.8-17.3% of transplanted patients. Mechanism of post-transplant erythrocytosis (PTE) and its erythropoietin (Epo) dependence are still controversial. Firstly, we compared basal serum Epo levels of 10 PTE patients, 14 non-erythrocytosic renal transplant (non-PTE) patients and 12 healthy blood donors. Then we performed venesection in PTE patients and healthy blood donors and compared their Epo response to venesection 5 hours later. The mean basal serum Epo of 24.3 mU/ml was significantly higher in the PTE group than the 10.8 mU/ml in the non-PTE and 8.6 mU/ml in the healthy blood donor group (p < 0.01). Epo levels in the non-PTE group did not differ significantly from those of healthy blood donors (p > 0.05). Following venesection the mean serum Epo levels increased significantly in both groups, from 24.3 mU/ml to 67.7 mU/ml (p < 0.001) in the PTE group and from 8.6 to 12.1 mU/ml (p < 0.01) in the healthy blood donor group, but the increment in the PTE group was more marked. We conclude that PTE patients have elevated basal serum Epo levels and there is a feedback regulation of Epo secretion in these patients like in healthy blood donors, but in an exaggerated way.