Search

Purpose: The effect of subclinical thyroid pathologies on erythropoietin (EPO) treatment has not been well defined. The aim of the study is to compare the frequency and dose of EPO administration in patients with subclinical thyroid pathology and euthyroid hemodialysis patients. Methods: A cross‐sectional and retrospective study was conducted with 210 patients. Special conditions were excluded, a total of 191 patients were included. Patients were divided into three groups. Results: The incidences of subclinical hypothyroidism, subclinical hyperthyroidism and euthyroidism were 10.5%, 3.1%, and 86.4%, respectively. Statistically significant difference was found between subclinical hypothyroid and euthyroid patients in terms of the number of patients using EPO (p = 0.0207), monthly total EPO doses (p = 0.003), and total monthly EPO doses per weight (p = 0.001). Conclusion: The EPO dose required to achieve similar hemoglobin levels in hemodialysis patients was significantly higher in subclinical hypothyroid patients than in euthyroid patients. [ABSTRACT FROM AUTHOR]

Background. Cardiovascular autonomic dysfunction, which leads to hemodynamic disorders, is commonly observed in patients with Parkinson's disease (PD). Central aortic pressure (CAP) is the systolic blood pressure (SBP) at the root of the aorta. In young people, CAP is lower than peripheral arterial blood pressure. In older people, the difference between CAP and peripheral arterial blood pressure decreases depending on the extent of arterial stiffness (AS). In patients with AS, CAP increases. CAP is thus regarded as an indicator of AS. Objective. To compare CAP and other hemodynamic parameters for AS between patients with Parkinson's disease and control group. We also aimed to evaluate changes in these hemodynamic parameters after the levodopa (LD) intake. Methods. We included 82 patients with PD and 76 healthy controls. Age, sex, disease duration, disease subtype, Hoehn–Yahr stage (H&Y), and nonmotor symptoms (NMS) were documented. TensioMed Software v.3.0.0.1 was used to measure CAP, peripheral arterial blood pressure, pulse pressure (PP), heart rate (HR), mean arterial pressure (MAP), augmentation index (AI), pulse wave velocity, and ejection time. All patients were being treated with LD, and measurements were performed 1 h before and 1 h after LD intake. Results. Baseline peripheral arterial blood pressure and CAP values were significantly higher in the PD group than in the control group (p < 0.001 and p = 0.02 , respectively). Most cardiac hemodynamic parameters, including peripheral arterial blood pressure and CAP, decreased significantly (p < 0.02 and p < 0.001 , respectively) after LD intake in the PD group. Disease subtype, duration, and severity did not affect any of the hemodynamic parameters. When NMS were evaluated, patients with psychosis and dementia showed higher baseline parameters. Conclusion. Loss of postganglionic noradrenergic innervation is well-known with PD. Several cardiac hemodynamic parameters were affected, suggesting cardiac autonomic dysfunction in these patients. The data obtained were independent of disease severity, duration, and subtype. After LD intake, most of these parameters decreased, which might have a positive effect on the vascular burden. [ABSTRACT FROM AUTHOR]

This article discusses the case of a 28-year-old woman with Fabry disease (FD) who successfully underwent enzyme replacement therapy (ERT) during two pregnancies. FD is an X-linked lysosomal storage disease characterized by the accumulation of sphingomyelin in lysosomes. The safety of ERT during pregnancy for women with FD is still uncertain, but this case study suggests that continuing ERT during pregnancy may be safe and does not lead to complications such as hypertension, diabetes, or renal dysfunction. The authors conclude that pregnancy may not affect the course of FD and that ERT can be safely continued during pregnancy for women with FD. [Extracted from the article]

Our aim was to determine the relationship between the modality of renal replacement therapy and inflammation markers, BP control, and quality of life (QoL). Sixteen hemodialysis, 17 peritoneal dialysis patients, and 27 kidney transplant receivers (KTr) have been included in this study. Short Form‐36 (SF‐36) for the evaluation of QoL and ambulatory BP monitoring were performed on the same day. Erythrocyte sedimentation rate, CRP, IL‐6, and IL‐10 were measured. While the mean IL‐10, IL‐6, and CRP levels were the highest in the dialysis groups, there were no significantly differences any parameters for all groups. QoL was better in the KTr almost as in healthy controls but worse in the dialysis patients. It should be taken into account that hypertension may occur at night even if the daytime BP is normal in KTr. [ABSTRACT FROM AUTHOR]

To investigate the frequency and risk factors of ED in haemodialysis patients (HDps) and kidney transplantation (KTx) recipients (KTxRs). HDps and KTxRs between the ages of 18–65 were compared in terms of ED. IEFF‐15 (International Index of Erectile Function) score was used to evaluation of ED. Fifty‐seven male HDps and 52 male KTxRs with a mean age of 45.6 ± 10.4 years were included in our study. DM, CAD, hyperlipidaemia, smoking and beta blocker use were higher HDps (p = 0.037, p < 0.001, p = 0.001, p = 0.001 and p = 0.031 respectively). There was no ED in five (8.8%) HDps and 27(51.9%) KTxRx. Severity of ED was significantly higher in HDps (p < 0.001). In multiple logistic regression analysis, KTx was found the most relevant associated factor with ED. KTxRs had decreased risk for ED (OR = 0.09, 95% CI 0.02–0.30, p < 0.001). ED is significantly more common in HDps than KTxRs. Known risk factors for ED, HT, DM, CAD, HL, smoking, obesity and beta‐blocker use were not related to ED in the HDps and KTxRs, and the KTx was positively effective for ED in patients undergoing renal replacement therapy. [ABSTRACT FROM AUTHOR]

Continuous ambulatory peritoneal dialysis (CAPD) is one of the treatment modalities used in end‐stage renal disease. The most common cause of failure is catheter‐related complications. Dialysate leak represents a major noninfectious complication of PD. Here, we aimed to present the results of patients who had pericatheter dialysate leak following PD catheterization and who were administered a hemostatic agent (HaemoCer Plus, BioCer, Germany) around the catheter and the tunneled segment under the subcutaneous tissue under local anesthesia. We performed a local procedure on six patients in total. No major complications developed in any of the patients at postoperative follow‐up. Five patients started to receive PD uneventfully within postoperative 3 days with no dialysate leak. We believe that this practice is effective in the management of peritoneal dialysate leak. The hemostatic agents administered in the present study can manage dialysate leak and ensure safe use of the catheter. [ABSTRACT FROM AUTHOR]

Background: Membranous nephropathy (MN) is the most common cause of nephrotic syndrome in nondiabetic adults. M‐type phospholipase A2 receptor (PLA2R), thrombospondin type‐1 domain‐containing 7A (THSD7A) are known as target podocyte antigens in membranous nephropathy (MN). Antibodies against these podocyte antigens are used in the initiation of treatment and response monitoring. However, the relationship between renal podocyte antigens and treatment response is not clear yet. We evaluated the relationship between immunohistochemical PLA2R, THSD7A and IgG4 staining, clinical findings and treatment response in kidney biopsies. Methods: Fifty‐eight patients with MN were included in this retrospective study. In the renal biopsy samples of the patients, PLA2R, THSD7A and IgG4 were stained immunohistochemically and evaluated by light microscopy. The clinical, laboratory and treatment results of the patients were obtained from the hospital records. Results: The study included a total of 58 patients with MN and a mean follow‐up period of 32.3 ± 19.7 months. In patients with primary MN; PLA2R, THSD7A and IgG4 were positive in 57.1% (n = 28), 12.2% (n = 6) and 69.4% (n = 34), respectively. Only PLA2R staining was distinctly higher in patients with primary MN than secondary MN (P =.025). Dual positivity (PLA2R + THSD7A) was detected in five (10.2%) of patients with primary MN. We did not determine any relationship between the PLA2R, THSD7A and IgG4 staining patterns and treatment response of the patients. Conclusion: It was found no correlation between PLA2R, THSD7A and IgG4 staining in kidney tissue and treatment response. Interestingly, dual positivity (PLA2R + THSD7A) was detected only in primary MN. [ABSTRACT FROM AUTHOR]

Background: Primary glomerulonephritis (PGN) has a significant part in non‐diabetic kidney disease (NDKD) in diabetes mellitus (DM) patients. In our study, we compared the clinical, demographic and laboratory features of patients with biopsy‐proven diabetic nephropathy (DN) and PGN with type 2 DM. Methods: In our retrospective study, type 2 DM patients who underwent kidney biopsy between 2011 and 2019 were included. Demographic, clinical and laboratory characteristics of DN and PGN patients were compared. Results: Seventy patients with a mean age of 55.7 ± 9.4 and 43 (61.4%) males were included. About 38 (54.3%) of the patients had DN and 32 (45.7%) had PGN. In the PGN, membranous GN (20, 62.5%) was most common. In DN patients, diabetes duration was longer; complications such as retinopathy, neuropathy, hypertension, coronary artery disease, heart failure were more frequent. At the time of renal biopsy, blood sugar, HbA1C, blood pressure, serum albumin and proteinuria values were similar in two groups. The pathological damage findings of kidney biopsy in DN patients were more severe. In the first year after kidney biopsy decrease in eGFR was higher in DN patients, whereas eGFR did not change in PGN patients. Conclusion: In a diabetic patient, fasting blood sugar, hbA1C, serum albumin and proteinuria did not differ in the differential diagnosis of DN and PGN, whereas complications of DM (retinopathy, neuropathy, hypertension, coronary artery disease) were more characteristic in differentiation. Detection of PGN in a diabetic patient is crucial for the success of the treatment, according to DN. [ABSTRACT FROM AUTHOR]

Background: Secondary hyperparathyroidism (SH) is major problem in chronic renal failure. There are studies to examine proliferation and apoptosis associated biomarkers expressions in parathyroid lesions to reveal specific features. In this study, we evaluated the expression of some growth factors and their receptors in parathyroid gland of patients with SH or primary hyperparathyroidism (PH). Materials and Methods: A total of 49 patients had been operated for PH and 26 for SH. Parathyroid tissue samples were evaluated histopathologically and immunohistochemically using antibodies to human p53, Kİ-67, anti-human p21, antitransforming growth factor (TGF) α, CPP32 (caspase 3), and epidermal growth factor receptor (EGFR). Results: Adenoma was higher in PH compared with SH as 48/49 and 3/26, respectively (P = 0.000). Parathyroid hyperplasia was found in 23/26 patients with SH and 1/49 patient with PH. In parathyroid tissue there were no difference between PH and SH for p53, Ki-67, caspase, EGFR expressions; while there were significantly difference for TGFα (P = 0.047) and borderline significant difference for p21 (P = 0.06) expressions. Conclusion: Adenoma was priority present in PH patients, hyperplasia was present in SH. There were no differences between primary and SH or adenoma and hyperplasia for expressions of cycline-dependent kinase inhibitor p21, p53, EGFR, Ki67, caspase; while TGFα expression was found to be different. [ABSTRACT FROM AUTHOR]

In large patient populations, it has been established that calculated (c) and measured (m) plasma levels of low-density lipoprotein cholesterol (LDL-C) were comparable, but this issue is not known to be tested in renal transplant recipients (RTRs). Herein we aimed to compare the plasma levels of LDL-C that was calculated by Friedewald formula (FF) and direct measurement in RTRs. Methods: LDL-C was measured by direct method and by FF in 193 fasting venous blood samples obtained from 103 RTRs. Patients had triglyceride (TG) levels <400 mg/dL. Patients were treated with prednisolone, calcineurin inhibitors (CNIs), and/or sirolimus and everolimus. Results: The mean plasma levels of LDL-C for calculated and direct measurement were 100.81 ± 32.79 mg/dL and 107.82 ± 33.23 mg/dL, respectively ( p < 0.01). The differences between cLDL-C and mLDL-C were similar according to usage of angiotensin receptor blockers (ARB)/angiotensin-converting enzyme inhibitors (ACEI), CNI, or mammalian target of rapamycin inhibitor (mTOR), tacrolimus or cyclosporine, and serum creatinine levels. mLDL-C and cLDL (FF) were highly correlated ( r = 0.977). The mLDL-C level was calculated by following formula: LDL-C = 8.018 + (0.99 × FF cLDL-C) and the mean difference was 0 for last formula. Conclusion: The LDL-C can be calculated by the following formula: LDL-C = 8.018 + (0.99 × FF LDL-C). The coefficient of determination correlation ( r) for this regression was 0.977, which indicates that the calculated LDL-C levels can be used in RTRs with TG lower than 400 mg/dL. mLDL-C was significantly higher than cLDL-C. We observed that difference between cLDL-C and mLDL-C levels were not affected by serum creatinine levels and usage of CNIs, sirolimus, everolimus, ACEI, and ARB in RTRs. [ABSTRACT FROM AUTHOR]

In this study, serum and urinary VEGF levels and VEGF expression in PBMNC were correlated with daily proteinuria, renal function tests, and renal histopathologic findings in untreated patients with different glomerulonephritis and with the course of renal function and proteinuria for one year. Forty-five untreated patients with different glomerulonephritis and 11 healthy persons comprised the study and control groups, respectively. VEGF mRNA expression was detected by RT- PCR in peripheral blood mononuclear cells (PBMNC), and VEGF levels were measured by ELISA in serum and urine samples simultaneously. Male/female ratio was 24/21 and mean ages were 34.49 ± 14.98. Serum and urinary VEGF levels, VEGF expressions in PBMNC, and the ratios of urine VEGF/urine creatinine were found to be similar in patients and controls. There were important correlations between urinary VEGF levels and baseline serum Cr (p = 0.035) and ESR (p = 0.022). There was also a marginal correlation between urinary VEGF levels and baseline CCr (p = 0.072). There was no correlation between serum and urinary VEGF levels and PBMNC mRNA expression and pathological findings such as with or without glomerular sclerosis, tubulointerstitial fibrosis (TIF), periglomerular fibrosis, and mesangial cell proliferation in renal biopsy. Serum and urinary VEGF levels or VEGF expression in PBMNC in patients with renal amyloidosis or proliferative or nonproliferative glomerulonephritis were similar with that of healthy controls and each other. Serum and urinary VEGF levels and PBMNC VEGF mRNA expression in untreated patients with different glomerulonephritis and controls were similar. We found only one important correlation, that between urinary VEGF levels and baseline serum creatinine levels in patients with different glomerulonephritis. Urinary VEGF can be an important pathogenesis of glomerular disease or a simple proteinuria. Serum and urinary VEGF levels and PBMNC VEGFmRNA did not change by periglomerular sclerosis, periglomerular fibrosis, or tubulointerstitial fibrosis on renal biopsy. PBMNC VEGF mRNA expression decreased in patients undergoing remission. In addition to the important correlation between urinary VEGF and serum creatinine, we also found an important correlation between erythrocyte sedimentation rate and urinary VEGF. This finding was interesting because we could not find a similar conclusion in other studies. [ABSTRACT FROM AUTHOR]

Retroperitoneal fibrosis (RF) is a clinical entity characterized by the progressive proliferation of connective tissue that rarely forms a mass involving the periaortic area of the abdomen, which may be idiopathic as well as a result of an inflammatory process after aneurysmal dilatation of the aorta.[1] This fibrotic tissue may cover both aorta and iliac arteries, reach the retroperitoneum and surrounding ureters, and cause serious obstructions and renal insufficiency in three-quarters of patients.[2] Most of the patients are known to have atherosclerosis and local inflammation against the antigens of the plaques.[3] A systemic autoimmune disease presenting with retroperitoneal fibrosis seems to be pronounced more frequently nowadays because of the elevated acute-phase reactant levels, positive autoantibodies, and concurrent autoimmune diseases affecting other organs in majority of the diagnosed patients.[4,5] Ultrasonography, computed tomography, magnetic resonance imaging, positron emission tomography, and retroperitoneal biopsy are useful in diagnosing and assessing the full extent of the disease.[6] Surgical interventions such as ureterolysis and aneurysm repair are frequently performed, but medical therapy including steroids and immunosuppressants is often needed because of the inflammatory and chronic-relapsing nature of the disease.[7] In this paper, we described two cases diagnosed with RF secondary to hemilaminectomy and hypothyroidism, and we summarized the literature related to RF. [ABSTRACT FROM AUTHOR]

To investigate the effect of cyclosporine A (Cyc A) on the development of fibroadenomas, 30 renal transplant patients and 20 chronic renal failure patients on dialysis were breast examined with ultrasonography and/or mammography. Of the renal transplant patients, 17 were receiving Cyc A-based combination therapy for immunosuppression. All patients were female with the age range of 29.7 ± 9.2 years in the transplant group and 33.95 ± 9.91 in the dialysis group. Eight of the 17 patients receiving Cyc A had fibroadenomas, 5 of them having bilateral lesions. None of the other patients, those on dialysis and on non-Cyc A combination therapy had fibroadenomas. A significant difference for fibroadenoma incidence in patients receiving Cyc A combination immunosuppression was found. [ABSTRACT FROM AUTHOR]