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Purpose: Vascular endothelial dysfunction in autosomal dominant polycystic kidney disease (ADPKD) may affect the retinal vascular parameters due to structural similarities of kidney and retina. We aimed to evaluate the microvascular changes of retina and optic disc and also corneal endothelial cell density in patients with ADPKD. Methods: Forty-six eyes of 23 patients with ADPKD (Group 1), and 46 eyes of 23 sex- and age-matched healthy controls (Group 2) were included in this cross-sectional study. Demographic and ophthalmic findings of participants were collected. Corneal endothelial cell density (CECD) measurements were obtained by noncontact specular microscopy. Foveal retinal thickness, peripapillary retinal nerve fiber layer (RNFL) thickness, vessel density in different sections of the retina and optic nerve head were analyzed by optical coherence tomography angiography. Results: The mean ages were 41 ± 11 years for Group 1 and 39 ± 10 years for Group 2 (P = 0.313). CECD values were significantly lower in group 1 when compared to group 2 (2653 ± 306 cells/mm2 and 2864 ± 244 cells/mm2, respectively, P < 0.001). The foveal retinal thickness and RNFL thickness were similar, but superior quadrant thickness of RNFL was significantly lower in Group 1 than Group 2 (126 ± 14 μm vs. 135 ± 15 μm, P = 0.003). In Group 1, whole image of optic disc radial peripapillary capillary densities were significantly lower compared to Group 2 (49.4 ± 2.04%, and 50.0 ± 2.2%, respectively, P = 0.043). There was no significant difference regarding superficial, deep retinal vessel densities, foveal avascular zone and flow areas between the groups (P > 0.05 for all). Conclusion: Lower CECD values and decreased superior quadrant RNFL thickness, and microvascular densities of optic disc were revealed in patients with ADPKD. Evaluation of CECD and retinal microvasculature may be helpful in the management of these patients.

Chronic kidney disease (CKD) is a disorder that affects millions worldwide, and current treatment options aiming at inhibiting the progression of kidney damage are limited. Long noncoding RNA (lncRNA) H19 is one of the first explored lncRNAs and its deregulation is associated with renal pathologies, such as renal cell injury and nephrotic syndrome. However, there is still no research investigating the connection between serum lncRNA H19 expressions and clinical outcomes in CKD patients. Therefore, we investigated the relation of serum lncRNA H19 expressions with routine biochemical parameters, inflammatory cytokines, oxidative stress and mineralization markers in advanced CKD patients. lncRNA H19 serum levels from 56 CKD patients and 20 healthy controls were analyzed with reverse-transcription quantitative polymerase chain reaction method. Serum tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), and osteocalcin (OC) levels were measured with enzyme linked-immunosorbent assay. Total antioxidant status (TAS) and total oxidative status (TOS) levels were evaluated by the routine measurement method. We found that lncRNA H19 expressions were upregulated in patients with CKD compared to the controls. Furthermore, lncRNA H19 relative expression levels showed a negative relationship with glomerular filtration rate (GFR) while it was positively correlated with ferritin, phosphorus, parathyroid hormone, TNF-α, IL-6, OC, TAS and TOS levels. lncRNA H19 expressions were increased in CKD stage 3–5 and HD patients, and elevated lncRNA H19 expressions were associated with decreased glomerular filtration rate, inflammation, and mineralization markers in these patients.

Yaşar, Erdoǧan ( Aksaray, Yazar ), Purpose: Fabry disease (FD) is characterized by a deficiency in α-galactosidase A activity that leads to the cumulative deposition of unmetabolized glycosphingolipids within organs, including the vascular endothelium and the eyes. The purpose of this study was to assess the effects of FD on the retinal microvasculature, foveal avascular zone (FAZ), macular thickness and retinal nerve fiber layer (RNFL) using optical coherence tomography angiography (OCT-A). Methods: Twenty-five patients (14 female and 11 male; mean age 33.16 ± 11.44) with genetically verified FD were compared with 37 age- and sex-matched healthy controls (mean age 32.36 ± 15.54). The vessel density (VD) values of the superficial and deep capillary plexuses (SCP and DCP), the area of the FAZ, the density of radial peripapillary capillaries (RPC), the macular thickness and the retinal nerve fiber layer thickness were measured by OCT-A examination. Results: The patients showed significantly lower VD values than controls in the foveal regions of both SCP and the DCP (21.15 ± 5.56 vs. 23.79 ± 4.64 (p = 0.048), 37.92 ± 6.78 vs. 41.11 ± 5.59 (p = 0.048), respectively). The FAZ was significantly larger in the FD group than in the control group (0.3 ± 0.1 vs. 0.24 ± 0.08 (p = 0.011)). No significant difference was identified in measurements of RPC density, peripapillary RNFL thickness or macular thickness between the two groups (p > 0.05 for all). Conclusion: Decreased VD and an enlarged foveal avascular area suggest possible changes in the retinal microvasculature of patients with FD. OCT-A can serve as a useful, noninvasive, quantitative tool for diagnosing FD and monitoring its progression.

Giriş ve Amaç: Magnezyum vücutta birçok önemli fonksiyonu olan eser elementlerden biridir. Magnezyum eksikliğinde en sık karşılaşılan klinik problemlerden birisi insülin direncidir. Diyabet son dönem böbrek hastalığının en sık nedenidir. Magnezyum eksikliği diyabetik hastalarda sık görülmektedir ve diyabet komplikasyonları ile ilişkili olduğu gösterilmiştir. Bu çalışmada diyabetik hastalarda serum magnezyum düzeyi ile glisemik regülasyon ve proteinüri arasında ilişki olup olmadığının araştırılması amaçlanmıştır. Gereç ve Yöntemler: Bu kesitsel çalışmaya 189 Tip 2 diabetes mellitus (DM) hastası alındı. Hastaların demografik ve klinik özellikleri ile kan basınçları kaydedildi. Hastalardan alınan serum örneklerinden glukoz, Hemoglobin A1c (HbA1c), BUN, kreatinin, elektrolitler, lipit profili, magnezyum, kalsiyum düzeyleri ve tam kan sayımı çalışıldı. 24 saatlik idrarda proteinüri bakıldı. Bulgular: Hipomagnezemi (, Objective: Magnesium is one of the trace elements with many functions in the body. One of the most common clinical problems in magnesium deficiency is insulin resistance. Diabetes is the most common cause of end-stage renal disease. Magnesium deficiency is common in diabetic patients and has been shown to be associated with diabetes complications. The aim of this study was to investigate the relationship between serum magnesium level and glycemic regulation and proteinuria in diabetic patients. Materials and Methods: This type of cross-sectional study included 189 patients with Type 2 diabetes mellitus (DM). Demographic and clinical characteristics and blood pressures were recorded. Glucose, Hemoglobin A1c (HbA1c), BUN, creatinine, electrolytes, lipid profile, magnesium, calcium levels and complete blood count were studied from serum samples. Proteinuria was measured in 24-hour urine. Results: Hypomagnesemia (

To investigate whether cornea verticillata affects corneal topography, tomography, densitometry, or biomechanics of Fabry patients with ocular manifestations and to compare these results with those obtained from healthy subjects. This prospective, cross-sectional study included 23 Fabry patients (Fabry group) with cornea verticillata and the 37 age- and sex-matched healthy subjects (control group). After comprehensive ophthalmological examinations, corneal topography, tomography, and densitometry measurements were taken using Pentacam HR and corneal biomechanics were captured via Corvis ST for all participants. All the investigated topographic and tomographic values were similar in the eyes with Fabry disease (FD) and the controls (P > 0.05). The corneal densitometry values of patients with FD were statistically significantly higher in all the concentric zones and layers, except posterior 0–2 mm and posterior 2–6 mm zones, compared to the controls (P

Acute kidney injury (AKI) is a common clinical syndrome characterized by rapid impairment of kidney function. The incidence of AKI and its severe form AKI requiring dialysis (AKI-D) has been increasing over the years. AKI etiology may be multifactorial and is substantially associated with increased morbidity and mortality. The outcome of AKI-D can vary from partial or complete recovery to transitioning to chronic kidney disease, end stage kidney disease, or even death. Predicting outcomes of patients with AKI is crucial as it may allow clinicians to guide policy regarding adequate management of this problem and offer the best long-term options to their patients in advance. In this manuscript, we will review the current evidence regarding the determinants of AKI outcomes, focusing on AKI-D.

Objectives: This study aimed to evaluate whether aspirin therapy is effective in protecting against hepatitis C virus (HCV) infection in maintenance hemodialysis patients, one of the high-risk groups for HCV infection. Materials and Methods: This retrospective cross-sectional study included 408 patients with end-stage renal failure who underwent maintenance hemodialysis for at least 3 months in four private hemodialysis units in Hatay, Turkey, in January 2017. The patients were classified into two groups according to their aspirin exposure status: non-users (n=228) and regular aspirin users (n=180). The proportion of patients with hemodialysis-related chronic hepatitis C (CHC) was compared between the groups. Irregular aspirin users, patients infected with HBV or diagnosed with CHC before initiation of hemodialysis therapy were excluded from the study. Results: The prevalence of hemodialysis-related CHC was 3.9% among the 408 patients. Hemodialysis-related CHC was not seen in any of the 180 regular aspirin users. Regular aspirin users showed a significantly lower prevalence of hemodialysis-related CHC than non-users (p, Amaç: Bu çalışmada hepatit C virüs (HCV) enfeksiyonu için yüksek risk gruplarından biri olan rutin hemodiyaliz hastalarında aspirin tedavisinin HCV enfeksiyonuna karşı korunmada etkili olup olmadığının değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Bu retrospektif kesitsel çalışma, Ocak 2017’de Hatay’da bulunan 4 özel hemodiyaliz merkezinde son dönem böbrek yetmezliği nedeniyle en az 3 ay süre ile rutin hemodiyaliz tedavisi almış olan 408 hastayı içermekte idi. Hastalar aspirin kullanım durumlarına göre iki gruba ayrıldı: İlk grup hemodiyaliz başlangıcından itibaren hiç aspirin kullanmamış 228 hastadan, ikinci grup ise hemodiyaliz başlangıcından itibaren düzenli aspirin kullanmakta olan 180 hastadan oluşmakta idi. Hemodiyaliz ilişkili kronik hepatit C (KHC) oranları gruplar arasında karşılaştırıldı. HBV ile enfekte, hemodiyaliz tedavisi öncesinde KHC tanısı almış olan, düzensiz aspirin kullanan hastalar çalışmaya dahil edilmedi. Bulgular: Hemodiyaliz ilişkili KHC prevalansı toplam 408 hastada %3,9 idi. Düzenli aspirin kullanımı olan 180 hemodiyaliz hastasının hiçbirinde hemodiyaliz ilişkili KHC görülmedi. Düzenli aspirin kullanıcılarında hemodiyaliz ilişkili KHC prevalansı hiç aspirin kullanmamış hastalarla karşılaştırıldığında anlamlı oranda daha düşük bulundu (p

AMAÇ: Tip 2 diyabetli hastalardaki elektrolit değişikliklerini ve bunların glisemi regülasyonu ile ilişkisini değerlendirmektir. GEREÇ ve YÖNTEMLER: Çalışmada, 01.02.2015-30.12.2015 tarihleri arasında hastanemiz Endokrinoloji ve Metabolizma polikliniği ve Nefroloji polikliniklerine değişik nedenlerle başvuran 30- 90 yaş arası diyabet tanısı olan hastaların kayıtları değerlendirildi. Tip 1 Diabetes Mellitus, diüretik, renin anjiotensin aldosteron sistemi blokeri veya bunların kombinasyonunu alanlar, diyare ve kusması olanlar, ciddi kalp yetmezliği, karaciğer sirozu, aktif malignitesi olanlar, tahmini glomerüler filtrasyon hızı, OBJECTIVE: The aim of the was is to evaluate electrolyte changes and the relationship between electrolytes and glucose regulation in type 2 diabetic patients. MATERIAL and METHODS: Data of diabetic patients aged 30-90 years who came to the Endocrinology and Metabolism and the Nephrology outpatient clinics between 01.02.2015 and 30.12.2015 for any reason were reviewed. Patients with type 1 diabetes mellitus, using diuretics, renin-angiotensin-aldosterone system blockers or combination of these drugs, or calcium, magnesium, vitamin D supplementation, patients with vomiting and diarrhea, serious heart failure, cirrhosis, active malignancy, estimated glomerular filtration rate

*Erdal, Hüseyin ( Aksaray, Yazar ), Introduction: The aim of this study was to investigate the relationship between Helicobacter pylori occurrence and, Cytotoxin-associated gene A (CagA) seropositivity with hemodialysis (HD) duration, Serum C-reactive protein (CRP) and hemogram parameters in hemodialysis patients. Materials and Methods: This study included 165 prevalent HD patients. Blood samples were collected before dialysis treatment of the patients. The samples were then centrifuged at 1500 x g for 10 min. immediately after collection. The presence of serum IgG antibody for H. pylori was determined using commercial ELISA kits. Serum anti-CagA IgG antibody of H. pylori positive patients was determined by ELISA method using commercial ELISA kits. CRP levels were measured by nephelometric method, and hemogram parameters were analyzed using fully automated hematology analyzer. Results: We found that the CRP levels of the patients having H. pylori were significantly high. However, there was no significant difference between CRP levels of long-term hemodialysis (LTHD) and short -term hemodialysis (STHD) patients. The possibility of being seropositive of CagA for STHD patients having H. pylori was found to be 2.3 times higher than that of LTHD patients. In addition to that, the periodicity of gastrointestinal (GI) bleeding was significantly high in STHD patients. Conclusion: In conclusion, we found no relationship between dialysis duration and H. pylori prevalence. However, we observed significantly higher odds ratio for CagA seropositivity in patients receiving STHD. These findings suggest that longer dialysis treatment can cause improving effects on H. pylori virulence. Further studies are needed to verify these findings.

Purpose: To evaluate retinal thicknesses and retinal microcirculation in healthy controls and in diabetic patients with or without microalbuminuria. Methods: Eighty-six diabetic patients without diabetic retinopathy (DR) (44 normoalbuminuric, 42 microalbuminuric) and 51 healthy controls were enrolled in this cross-sectional, prospective study. Optical coherence tomography (OCT) and OCT angiography (OCTA) were performed. Correlations between OCTA parameters with mean urinary albumin levels were evaluated. Results: The mean vessel densities of superficial capillary plexus (SCP), whole disc, and peripapillary area were significantly decreased in patients with microalbuminuria compared to patients with normoalbuminuria and controls (p < 0.05 for all). The mean vessel density of deep capillary plexus was significantly reduced in patients with microalbuminuria compared to controls (p < 0.05 for all). There were no significant differences in retinal thickness between groups (p > 0.05). Both duration of diabetes and urinary albumin levels were significantly and moderately correlated with mean vessel density of whole SCP in diabetic patients (r = 0.330, p = 0.021; r = 0.356, p = 0.017, respectively). Conclusion: Diabetic eyes without clinically detectable DR show impaired retinal microcirculation. Microalbuminuria is associated with alterations of retinal microcirculation in diabetic patients without DR. Evaluation of retinal microcirculation is likely useful for detecting early changes related to microvascular complications in type 2 diabetic patients.

Objective: The incidence of diabetes and its complications are greatly increasing world-wide. Diabeticnephropathy (DN) is the main cause of end-stage renal disease and is associated with high morbidity and mortality. It is important to predict patients with high risk for DN in the early stage. We selected the genes which have an important role on diabetic kidney disease. We aimed to investigate the association between DNA methylation levels of targeted genes and albuminuria in patients with early DN. Methods: We collected the clinical data of patients with type 2 diabetes mellitus. We measured spot urine albumin creatinine ratio to calculate albuminuria level. We divided patients into two groups based on albumin excretion as patients with (n = 69) and without DN (n = 27). We performed methylation profiling after bisulfite conversion by pyrosequencing method. The mean value of percent methylation level of each gene was calculated. Results: We compared targeted genes (TIMP-2, AKR1B1, MMP-2, MMP-9, MYL9, SCL2A4, SCL2A1, SCL4A3) methylation levels and albuminuria. We found significant negative correlation between TIMP-2 and AKR1B1 gene methylation levels and albuminuria levels. Conclusions: The present study provided evidence that hypomethylation of TIMP-2 and AKR1B1 genes can be associated with albuminuria in patients with early DN. We may speculate that the hypomethylation of TIMP-2 and AKR1B1 genes may be an early surrogate marker of DN.

Obesity has grown into an epidemic across the globe. Mirroring this growth in the number of obese individuals in the general population, the prevalence of obesity and extremely morbid obesity (body mass index >50 kg/m2) is similarly rising in patients with end-stage renal disease (ESRD). Obesity, and more so, extremely morbid obesity, creates additional challenges for clinicians aiming at providing the best treatment options to patients with ESRD. Although literature is available regarding renal replacement therapy (RRT) for obese patients, literature about challenges facing clinicians managing ESRD in the extremely obese patients is lacking. Furthermore, the optimal strategies and goals for managing these patients with ESRD are not well defined. To our knowledge, no study has been done evaluating RRT options available to extremely morbid obese patients and the challenges associated with these options. Here, we report a case series and discuss the potential challenges faced by extremely obese patients with ESRD requiring RRT.

Ultrasonography (US) is an inexpensive, noninvasive and easy imaging procedure to comment on the kidney disease. Data are limited about the relation between estimated glomerular filtration rate (e-GFR) and all 3 renal US parameters, including kidney length, parenchymal thickness and parenchymal echogenicity, in chronic kidney disease (CKD). In this study, we aimed to investigate the association between e-GFR and ultrasonographic CKD score calculated via these ultrasonographic parameters. One hundred and twenty patients with stage 1–5 CKD were enrolled in this study. The glomerular filtration rate was estimated by the Chronic Kidney Disease Epidemiology Collaboration equation. US was performed by the same radiologist who was blinded to patients’ histories and laboratory results. US parameters including kidney length, parenchymal thickness and parenchymal echogenicity were obtained from both kidneys. All 3 parameters were scored for each kidney, separately. The sum of the average scores of these parameters was used to calculate ultrasonographic CKD score. The mean age of patients was 63.34 ± 14.19 years. Mean kidney length, parenchymal thickness, ultrasonographic CKD score and median parenchymal echogenicity were found as 96.2 ± 12.3, 10.97 ± 2.59 mm, 6.28 ± 2.52 and 1.0 (0–3.5), respectively. e-GFR was positively correlated with kidney length (r = 0.343, p

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were established showing the poor prognosis in some diseases, such as cardiovascular diseases and malignancies. The risk of mortality in patients with end-stage renal disease (ESRD) was higher than normal population. In this study, we aimed to investigate the relationship between NLR, PLR, and all-cause mortality in prevalent hemodialysis (HD) patients.Eighty patients were enrolled in study. NLR and PLR obtained by dividing absolute neutrophil to absolute lymphocyte count and absolute platelet count to absolute lymphocyte count, respectively. The patients were followed prospectively for 24 months. The primary end point was all-cause mortality.Mean levels of neutrophil, lymphocyte, and platelet were 3904 ± 1543/mm(3), 1442 ± 494/mm(3), 174 ± 56 × 10(3)/mm(3), respectively. Twenty-one patients died before the follow-up at 24 months. Median NLR and PLR were 2.52 and 130.4, respectively. All-cause mortality was higher in patients with high NLR group compared to the patients with low NLR group (18.8 vs. 7.5 %, p = 0.031) and in patients with higher PLR group compared to patients with lower PLR group (18.8 vs. 7.5 %, p = 0.022). Following adjusted Cox regression analysis, the association of mortality and high NLR was lost (p = 0.54), but the significance of the association of high PLR and mortality increased (p = 0.013).Although both NLR and PLR were associated with all-cause mortality in prevalent HD patients, only PLR could independently predict all-cause mortality in these populations.

WOS: 000392937800028 PubMed ID: 28006774 Background/Aims: Fabry disease is a treatable cause of chronic kidney disease (CKD) characterized by a genetic deficiency of a-galactosidase A. European Renal Best Practice (ERBP) recommends screening for Fabry disease in CKD patients. However, this is based on expert opinion and there are no reports of the prevalence of Fabry disease in stage 1-5 CKD. Hence, we investigated the prevalence of Fabry disease in CKD patients not receiving renal replacement therapy. Methods: This prospective study assessed a-galactosidase activity in dried blood spots in 313 stage 1-5 CKD patients, 167 males, between ages of 18-70 years whose etiology of CKD was unknown and were not receiving renal replacement therapy. The diagnosis was confirmed by GLA gene mutation analysis. Results: Three (all males) of 313 CKD patients (0.95%) were diagnosed of Fabry disease, for a prevalence in males of 1.80%. Family screening identified 8 aditional Fabry patients with CKD. Of a total of 11 Fabry patients, 7 were male and started enzyme replacement therapy and 4 were female. The most frequent manifestations in male patients were fatigue (100%), tinnitus, vertigo, acroparesthesia, hypohidrosis, cornea verticillata and angiokeratoma (all 85%), heat intolerance (71%), and abdominal pain (57%). The most frequent manifestations in female patients were fatigue and cornea verticillata (50%), and tinnitus, vertigo and angiokeratoma (25%). Three patients had severe episodic abdominal pain attacks and proteinuria, and were misdiagnosed as familial Mediterranean fever. Conclusions: The prevalence of Fa bry disease in selected CKD patients is in the range found among renal replacement therapy patients, but the disease is diagnosed at an earlier, treatable stage. These data support the ERBP recommendation to screen for Fabry disease in patients with CKD of unknown origin. (C) 2016 The Author(s) Published by S. Karger AG, Basel Sanofi Genzyme Corporation; Intensificacion ISCIII and REDINREN [RD012/0021] We are indebted to our patients and their families for volunteering to contribute their medical information to the physicians who are dedicated to their care. This work was supported by grants from Sanofi Genzyme Corporation. The lead investigator had full access to all data in the study. All investigators take responsibility for the accuracy of the individual data that they entered in the system provided by FMF Arthritis Vasculitis and Orphan disease Research (FAVOR). AO was supported by Intensificacion ISCIII and REDINREN RD012/0021.

Elderly individuals, worldwide, are on the rise, posing new challenges to care providers. Hypertension is highly prevalent in elderly individuals, and multiple challenges face care providers while managing it. In addition to treating hypertension, the physician must treat other modifiable cardiovascular risk factors in patients with or without diabetes mellitus or chronic kidney disease to reduce cardiovascular events and mortality. This review discusses some of the unique characteristics of high blood pressure in the elderly and provides an overview of the challenges facing care providers, as well as the current recommendations for management of hypertension in the elderly.

Hypertension is a multi-organ disease, and kidneys play a central role in the development of hypertension, although the kidneys are also being a target organ for hypertension-induced damage. The association between hypertension and chronic kidney disease (CKD) is well known. The prevalence of hypertension increases and control of hypertension becomes more difficult as kidney functions decline. Understanding of the pathophysiology of hypertension is critical for the management of hypertension in CKD. However, there are large gaps in our understanding of pathogenesis and treatment of CKD-related hypertension. Basically, high blood pressure is caused by an increase in cardiac output and/or increase of total peripheral resistance. Both can be deteriorated by a variety of different mechanisms in CKD. Sodium retention and extracellular volume expansion are important, but not the only factors contributing to hypertension seen in CKD. Humoral factors such as renin-angiotensin-aldosterone system, endothelin, and non-humoral factors such as mineral bone disorders may also play a major role in the pathogenesis of hypertension in CKD.

Background: Chronic kidney disease (CKD) patients who experience superimposed acute kidney injury (AKI) have been shown to be at higher risk of long-term sequelae of AKI when compared to those who do not experience AKI. It remains unclear whether the need for temporary dialysis intervention following superimposed AKI in patients with CKD has any effect on the long-term major adverse cardiovascular events (MACE). This study examines the relationship between temporary dialysis therapy following AKI and long-term major cardiovascular events in patients with background CKD. Methods: The study population consists of adults who developed AKI while on admission at the University of Virginia Medical Center between January 1, 2002 and December 31, 2012, and who had preadmission estimated glomerular filtration rate (eGFR) between 20 and 60 mL/min/1.73 m2 and survived beyond 30 days of AKI. Demographic and baseline clinical variables were used to generate propensity score. Survivors who had temporary dialysis were matched to those managed conservatively according to the propensity score in a ratio of 1:3. Results: Overall, 6,634 (n = 381 and 6,253 in the temporary dialysis-requiring AKI and non-dialysis AKI groups respectively) met entry criteria for the full cohort. Of these, 381 (5.7%) received temporary dialysis. There were 3,147 (47.4% of all patients) MACE events during the study period. The crude incidence for MACE after 30 days of AKI was similar in both dialyzed and non-dialyzed patients. After the propensity score matching, the adjusted hazard ratio for MACE in dialyzed versus non dialyzed patients was 1.162 (95% CI 0.978-1.381). Conclusions: Treatment of AKI with temporary dialysis in hospitalized patients with baseline eGFR between 20 and 60 mL/min/1.73 m2 was not associated with an increased risk for subsequent admission for MACE. If confirmed by prospective studies, clinicians may not need to worry that the dialysis procedure may contribute to additional risk for long-term MACE in CKD patients with superimposed AKI.

3,4-methylenedioxymethamphetamine (MDMA), popularly known as “ecstasy”, is a synthetic, psychoactive drug. MDMA has been reported to have several severe adverse effects including rhabdomyolysis, acute renal failure, liver failure and even sudden death. Herein, we present the case of a young man who presented with severe rhabdomyolysis and renal failure after taking 2 ecstasy pills. The patient initially received supportive care but he eventually needed hemodialysis. kEy words: Ecstasy, Rhabdomyolysis, Acute renal failure

Background: Regional citrate anticoagulatio∂n (RCA) is being used increasingly in critically ill patients who require continuous renal replacement therapy (CRRT). RCA may be avoided in patients with liver disease be- cause of perceived increased risk of metabolic com- plications. The study compares the circuit lifespan and metabolic complications using RCA for CRRT at vary- ing levels of liver dysfunction. Methods: Data was collected retrospectively including the number of days on CRRT, number of circuit (re)ini- tiations within that time and serum ionized and total calcium, bicarbonate, and sodium, repeatedly during treatment. Model for end-stage liver disease (MELD) scores were calculated and patients were divided into 4 groups according to MELD score quartiles. Results: A total of 697 patients were included in the present study. The median circuit survival time was not different between groups. The median minimum serum ionized calcium levels during treatment were significantly lower in groups 3 and 4 (p

OBJECTIVE: The effect of uric acid and obesity on diurnal blood pressure variation in hypertensive patients is unknown. We aimed to investigate the specific relationship between uric acid, obesity and nocturnal dipping status essential hypertensive patients with normal renal function. MATEriAl and METhOdS: Two hundred sixty-nine patients with newly diagnosed essential hypertension or on antihypertensive treatment underwent 24-hour ambulatory blood pressure monitoring, biochemistry analysis and urine testing. rESulTS: Patients were classified as either dippers (108 patients, 40%) or nondippers (161 patients, 60%). Uric acid levels were higher in nondippers than in dippers (6.5 +/1.2 mg/dL vs. 5.5 +/1.1 mg/dL, p==0.001). In the same line, body mass index is significantly higher in nondippers compared to dippers (29.9±3.9 kg/m2 vs. 27.8±3.9kg/m2, p=0.01). CONCluSION: This study demonstrates that increased serum uric acid levels and body mass index are associated with nondipping blood pressure patterns in patients with essential hypertension. kEY wOrdS: Hypertension, Obesity, Uric acid, Blood pressure, Non-dipping doi: 10.5262/tndt.2011.2001.06

Background: An elevated serum uric acid level is strongly associated with endothelial dysfunction and inflammation, both of which are common in chronic kidney disease (CKD). We hypothesized that endothelial dysfunction in subjects with CKD would correlate with uric acid levels. Materials and Methods: We evaluated the association between serum uric acid level and ultrasonographic flow-mediated dilatation (FMD) in 263 of 486 patients with recently diagnosed CKD (stage 3–5) (48% male, age 52 ± 12 years). To minimize confounding, 233 patients were excluded because they were diabetic, had established cardiovascular complications or were taking drugs (renin-angiotensin system blockers, statins) interfering with vascular function. Results: Serum uric acid level was significantly increased in all stages of CKD and strongly correlated with estimated glomerular filtration rate (eGFR-MDRD); FMD was inversely associated with serum uric acid (r = –0.49, p < 0.001). The association of serum uric acid with FMD remained after adjustment for age, gender, smoking, LDL cholesterol, eGFR, high-sensitivity C-reactive protein, systolic blood pressure, proteinuria, and homeostatic model assessment index (β = –0.27, p < 0.001). Conclusion: Increased serum uric acid is an independent predictor of endothelial dysfunction in subjects with CKD.

OBJECTiVES: Oxidative stress plays a role in the pathogenesis of diabetic nephropathy. It has been reported in many studies that antioxidant therapy may decrease complications related to diabetes mellitus. We aimed to evaluate the protective effects of erdostein on diabetic renal injury in diabetic rats. maTERial and mETHOdS: Thirty rats were randomly divided into 5 experimental groups (Group 1: control, group 2: erdostein, group 3: alloxan, group 4: alloxan+erdostein, and group 5: alloxan+insulin, n=6 each). Rats were made diabetic using alloxan injection intraperiteonally. Erdostein (10 mg/kg/day) orally and insulin two times a day (3 g/kg) intraperitoneally were administered for four weeks. All rats were then sacrificed and kidney histopathological examinations were performed by light microscopy. RESulTS: The diabetic rats had diabetic nephropathic changes in the kidney on histological examination but the rats treated with erdostein showed significantly less histopathological changes, similar to the control group compared with the diabetic rats not treated with erdostein (p 0.05). COnCluSiOn: Based on the present data, we conclude that erdostein may show protective effects on renal injury due to diabetes mellitus. KEY WORdS: Diabetic nephropathy, Erdostein, Renal failure, Alloxan Yazisma Adresi: Faruk TuRGuT Fatih Universitesi Tip Fakultesi, Nefroloji Bilim Dali, Ankara, Turkiye Gsm : 0 505 642 17 12 E-posta : turgutfaruk@yahoo.com Gelis Tarihi : 07.06.2010 Kabul Tarihi : 25.08.2010 Faruk TuRGuT1 ayse CaRliOglu2 Rabia alKan3 derya aKdEnIz3 Hacer HalTas4 ozlem saHIn BalCiK5 Ebru uz1 omer Faruk KaRaTas6 1 Fatih Universitesi Tip Fakultesi, Nefroloji Bilim Dali, Ankara, Turkiye 2 Fatih Universitesi Tip Fakultesi, Endokrinoloji Bilim Dali, Ankara, Turkiye 3 Fatih Universitesi Tip Fakultesi, Ic Hastaliklari Anabilim Dali, Ankara, Turkiye 4 Fatih Universitesi Tip Fakultesi, Patoloji Anabilim Dali, Ankara, Turkiye 5 Fatih Universitesi Tip Fakultesi, Hematoloji Bilim Dali, Ankara, Turkiye 6 Fatih Universitesi Tip Fakultesi, Uroloji Anabilim Dali, Ankara, Turkiye Turgut F ve ark: Diyabetik Nefropatide Erdostein Etkisi Cilt/Vol: 19, No: 3, 2010, Sayfa/Page: 157-161 158 Turk nefroloji diyaliz ve Transplantasyon dergisi Turkish Nephrology, Dialysis and Transplantation Journal

Respiratory functions are affected during hemodialysis. The strength of respiratory muscles, ultrafiltration rate, and acid-base balance have been suggested as important factors. L-carnitine is crucial for energy producing, utilization of fatty acid, and possible amino acids. A lack of carnitine in hemodialysis patients is caused by insufficient carnitine synthesis and especially by its loss during dialysis. This study was performed to investigate the chronic effects of L-carnitine treatment on respiratory functions in adults receiving chronic hemodialysis therapy.A total of 20 hemodialysis patients were scheduled to take L-carnitine supplementation (20 mg/kg three times/week) (group 1), and the rest of 20 hemodialysis patients served as the control group and were observed without supplementation with L-carnitine (group 2). Pre- and post-dialytic L-carnitine levels and post-dialytic respiratory functions tests were performed in both groups at baseline and after six months.The average concentration of free and total carnitine levels increased significantly after six months of supplementation (p0.01). While a statistically significant increase between postdialytic forced expiratory volume in one second/forced vital capacity values after treatment period (77.10 +/- 12.15 and 83.00 +/- 14.49, before and after treatment, respectively, p0.05) was observed, the increase of vital capacity, forced expiratory volume in one second, and forced expiratory flow between 25-75% of expired vital capacity were not significant in the treatment group (p0.05).Intravenous L-carnitine supplementation could contribute to the management of respiratory dysfunction in chronic hemodialysis patients by improving FEV1/FVC. The mechanism by which LC causes these effects merits further investigation.

We aimed to investigate the glomerular hyperfiltration due to pregnancy in women with more parities.Five hundred women aged 52.57 +/- 8.08 years, without a history of hypertension, diabetes mellitus or complicated pregnancy were involved in the study. They were divided into three groups. Group 1: women with no or one parity (n = 76); group 2: women with two or three parities (n = 333); group 3: women with four or more parities (n = 91). Laboratory parameters and demographical data were compared between the three groups.Mean age, serum urea and serum creatinine were similar between three groups. Patients in group 3 had significantly higher GFR values compared to groups 1 and 2 (109.44 +/- 30.99, 110.76 +/- 30.22 and 121.92 +/- 34.73 mL/min/1.73 m(2) for groups 1, 2 and 3, respectively; P = 0.008 for group 1 vs group 3; P = 0.002 for group 2 vs group 3).In our study, we suggest that glomerular hyperfiltration due to pregnancy does not have adverse effects on kidney in women with more parities. Pregnancy may have possible protective mechanisms for kidney against adverse effects of glomerular hyperfiltration.

OBJECTIVE Anemia is a major clinical problem in patients receiving dialysis therapy and has a substantial impact on morbidity and mortality. Iron metabolism is impaired in chronic kidney disease. Hepcidin functions as a key regulator of iron metabolism. The aims of this study were to compare the serum pro-hepcidin levels in patients with either peritoneal dialysis (PD) or hemodialysis (HD) and control subjects and to evaluate pro-hepcidin and C-reactive protein (CRP), iron parameters, and hemoglobin levels in PD and HD patients with normal serum CRP levels. METHODS We studied 85 PD patients, 43 HD patients on regular follow-up, and a control group that was comprised of 41 volunteers in this cross-sectional study. Pro-hepcidin and CRP were studied using commercially available kits. Iron status was assessed by measuring serum iron, transferrin saturation, and ferritin. RESULTS Pro-hepcidin levels were significantly higher in dialysis patients than the control subjects (p

Hypertension, diabetes, hyperlipidaemia, obesity and smoking are known to be the most important modifiable risk factors for cardiovascular disease (CVD). Because the elderly population has been increasing globally, CVD may become a more important public health problem in the future. This report examines the prevalence of cardiovascular risk factors in the elderly in Ankara, Turkey. This was a cross-sectional survey and included a total of 2720 individuals living in the Ankara district. Trained research staff administered a standard questionnaire in the participants’ homes and worksites. The questionnaire collected information on clinical and demographic characteristics and a self-reported medical history, including past history of hypertension, diabetes, hyperlipidemia, coronary artery disease, coronary artery by-pass graft operation, and cerebrovascular accident. The mean age of the study participants was 69.5 ± 7.2 years. The study identified 1298 women (78.1%) and 753 men (71.2%) with hypertension, and the overall prevalence of hypertension was 75.4%. A total of 739 (27.2%) people had diabetes mellitus, and, of these people, 603 (81.6%) were hypertensive. A total of 1361 people had hyperlipidemia, and 1103 of these patients were also hypertensive. The overall prevalence of obesity was 27.2%. A total of 553 (20.3%) people were smokers. Our findings indicate that cardiovascular risk factors are very common in the elderly. To maximize risk reduction, physicians must take aggressive measures to decrease cardiovascular risk factors.

Renal ischemia/reperfusion (I/R) injury is a major cause of acute renal failure. Silymarin is extracted from Silybum marianum and Cynara cardunculus seeds and fruits. The aim of this study is to investigate whether silymarin administration prevents the damage induced by I/R in rat kidneys. Thirty male Wistar rats were randomly divided into five experimental groups (n = 6, each) as follows; control group, sham-operated group, I/R group, silymarin group, and I/R + silymarin group. In the I/R and I/R + silymarin groups, both renal arteries were occluded using nontraumatic microvascular clamps for 45 min. Then, at the end of 24 h of reperfusion, the animals were killed. Kidney function tests, the serum and tissue antioxidant enzymes and oxidant products were determined. Animals that were subjected to I/R exhibited significant increase in serum urea, creatinine, and cystatin C levels compared with the rats treated with silymarin prior to the I/R process (P

Although dyspepsia is very common in uremic patients, there is not much data on the prevalence of dyspepsia undergoing continuous ambulatory peritoneal dialysis (CAPD). The aims of this study are to assess the prevalence of dyspepsia, Helicobacter pylori, and the association between dyspeptic symptoms and diabetes. One hundred and thirty CAPD patients were included in the study. The presence or absence of dyspepsia was assessed by using the Hong Kong Index of Dyspepsia (HKID) Questionnaire. A score of ≥16 indicates the presence of dyspepsia. The patients who were diagnosed with dyspepsia had endoscopic examination and were judged to be infected with H. pylori if the organism was demonstrated in the biopsy. Sixty-four of 130 CAPD patients (49.2%) had a HKID score of 16 or more. H. pylori was identified in 17 of 64 CAPD patients with dyspepsia (26.6%). Thirty-four patients (25.8%) were diabetic, and there was no association between diabetes and dyspepsia (P = 0.68). The most frequent finding in patients with dyspepsia was gastritis or gastric ulcer in endoscopic evaluation. The mean serum albumin level was also not statistically significantly different between the two groups. Dyspepsia is common and the prevalence of H. pylori infection is 26.6% in our CAPD patients with dyspepsia. Dyspepsia is not associated with the presence of H. pylori and diabetes in CAPD patients. Large-scale studies are needed to elucidate dyspepsia related risk factors and physiopathological mechanisms.

Nocturia, a common and bothersome symptom of benign prostatic hyperplasia (BPH), may cause sleep disturbances. Patients with nocturia may have difficulty returning to their normal sleep after repeated episodes of waking and voiding. Therefore, nocturia may have an impact on the circadian rhythm of blood pressure (BP). The association between nocturia and the circadian rhythm of BP was investigated in this study.A total of 100 male patients who had been diagnosed with BPH and 53 healthy male subjects were included in the study. Nocturnal urinary frequency was assessed by means of a questionnaire and recorded in both groups. Ambulatory BP monitoring was performed in all patients over a 24-h period.Patient characteristics and laboratory parameters were similar in both groups. Seventy-five patients (75%) in the BPH group and 20 subjects (37.7%) in the control group were non-dippers, i.e. they did not have a normal nocturnal fall in BP, and this difference was statistically significant (p=0.001). Eighty-nine patients in the BPH group and 13 in the control group had nocturia. Seventy-one patients (79.8%) with nocturia were non-dippers and the difference compared to the patients without nocturia in the BPH group was significant (p=0.003), whereas four patients with nocturia (30.8%) were non-dippers in the control group.Our findings indicate that non-dipping was more prevalent in elderly men with BPH and nocturia. BPH and nocturia may be etiological factors in the pathogenesis of non-dipping, which is an indicator of early cardiovascular disease. Further studies must focus on this relationship and, especially, on whether treatment of nocturia and BPH helps to treat non-dipping or not.

Nephrotoxicity is the main secondary effect of cyclosporine A (CsA) treatment. The antioxidant action of Nigella sativa oil (NSO) may explain the protective effect of these agents against various hepatotoxic and nephrotoxic models in vivo and in vitro. This study was designed to investigate the possible protective effects of NSO, in prevention of chronic CsA-induced nephrotoxicity in rats. Animals were randomly divided into four experimental groups: the control group received sunflower oil, the other groups were treated with CsA (25 mg/kg/day b.w. orally) or NSO (2 ml/kg orally) or CsA + NSO, respectively. Urine and serum creatinine levels, tissue superoxide dismutase, glutathione peroxidase and catalase enzyme activities, and nitric oxide and malondialdehyde levels were measured, and histological examination was performed. In our study, CsA caused a significant deterioration in the renal function, morphology and gave rise to severe oxidative stress in the kidney. NSO significantly improved the functional and histological parameters and attenuated the oxidative stress induced by CsA. In conclusion, our study demonstrated for the first time that NSO protects kidney tissue against oxygen free radicals, preventing renal dysfunction and morphological abnormalities associated with chronic CsA administration.

Objective To compare ultrafiltration under continuous ambulatory peritoneal dialysis (CAPD) and automated PD (APD), disclosing potential effects on serum B-type natriuretic peptide (BNP) levels and echocardiographic findings. Patients and Methods This cross-sectional clinical study included 32 patients on CAPD and 30 patients on APD without clinical evidence of heart failure or hemodynamically significant valvular heart disease. Peritoneal equilibration tests, BNP levels, and echocardiographic measurements were performed in each subject. BNP measurements were also performed in 24 healthy control subjects. Results Patients on APD had lower ultrafiltration and higher values of BNP and left ventricular mass index (LVMI) compared with patients on CAPD (respectively: 775 ± 160 vs 850 ± 265 mL, p = 0.01; 253.23 ± 81.64 vs 109.42 ± 25.63 pg/mL, p = 0.001; 185.12 ± 63.50 vs 129.30 ± 40.95 g/m2, p = 0.001). This occurred despite higher mean dialysate glucose concentrations and far more extensive use of icodextrin in the APD group. Conclusion Treatment with APD is associated with higher plasma BNP levels and LVMI compared to CAPD. This may be the result of chronic fluid retention caused by lower ultra-filtration in APD patients.

Hyperuricemia has been associated with the development of hypertension, cardiovascular, and renal disease. However, there is no data about the effect of lowering uric acid level on hypertension, renal function, and proteinuria in patients with glomerular filtration rate (GFR)60 ml/min. We therefore conducted a prospective study to investigate the benefits of allopurinol treatment in hyperuricemic patients with normal renal function.Forty-eight hyperuricemic and 21 normouricemic patients were included in the study. Hyperuricemic patients received 300 mg/day allopurinol for three months. All patients' serum creatinine level, 24-h urine protein level, glomerular filtration rate, and blood pressure levels were measured at baseline and after three months of treatment.A total of 59 patients completed the three-month follow-up period of observation. In the allopurinol group, serum uric acid levels, GFR, systolic and diastolic blood pressure, and C-reactive protein (CRP) levels significantly improved (P0.05). However, urine protein excretion remained unchanged (P0.05). No correlation was observed between changes in GFR and changes in CRP, or blood pressure in the allopurinol group. No significant changes were observed in the control group (P0.05).We bring indirect evidence that hyperuricemia increases blood pressure, and decreases GFR. Hence, management of hyperuricemia may prevent the progression of renal disease, even in patients with normal renal function, suggesting that early treatment with allopurinol should be an important part of the management of chronic kidney disease (CKD) patients. Long-term follow-up studies are warranted to identify the benefits of uric acid management on renal function and hypertension.

Cardiac valvular calcification is frequent among hemodialysis (HD) patients. The presence of valvular calcification can help identify HD patients with a higher risk for cardiovascular diseases. Our aim was to determine the prevalence of valvular calcification (VC) in our maintenance hemodialysis (HD) population and to examine some possible etiologic factors for its occurrence. We studied forty-four patients on hemodialysis (23 women and 21 men; mean age 57 ± 18 year; mean HD duration 34 ± 28 months). Valvular calcification (VC) was observed in 21 patients (48%). Of these patients, 6 patients (13%) had mitral valvular calcification, 9 patients (20%) had aortic valvular calcification, and 6 patients (13%) had calcification of both valves. The patients with VC were older than patients without VC (66±14 vs. 50±18). The patients with aortic calcification had longer HD duration than others (48±29 vs. 27±24 months). Patients with VC had higher systolic and diastolic blood pressures than patients without VC. The patients with mitral calcification had higher C-reactive protein (CRP) levels (14 ± 13 vs. 7 ± 7). No significant differences were found with respect to calcium, phosphorus, parathyroid hormone, alkaline phosphatase and mean Ca × P product. Our study confirmed that there is an increased prevalence of VC in HD patients. Age is a risk factor for cardiac VC in HD patients. Longer HD duration was associated with aortic valve calcification. In addition, elevated level of CRP is associated with mitral valve calcification in HD patients.

Background: Peritonitis is an important cause of morbidity and mortality in patients receiving peritoneal dialysis (PD). However, there are no data about the comparison of the incidence of peritonitis among PD solution types. The aim of the present study was to compare the incidence of peritonitis among PD solutions in PD patients treated either with Nutrineal or with Extraneal or with conventional glucose solutions. Materials and Methods: A total of 147 patients (60 female and 87 male) who underwent PD were included in the study. Of these patients, 47 used only glucose solutions (group I), 79 used glucose solutions combined with Extraneal (group II) and 21 used glucose solutions combined with Nutrineal (group III). The laboratory values and demographics of the patients were noted. Results: There was no significant difference in the frequency of peritonitis among the three groups. Peritonitis occurred in 14 of 47 patients (29.8%) in group I, in 28 of 79 patients (35.4%) in group II and in 6 of 21 patients (28.6%) in group III. Patients with serum albumin levels below 3 g/dl had a significantly higher peritonitis rate than patients with serum albumin levels above 3 g/dl (p < 0.05). Conclusion: We have shown that a low serum albumin level is an important risk factor for the development of peritonitis in CAPD patients. The PD solution does not appear to be a risk factor for the development of peritonitis in CAPD patients, although this question should be studied further with larger numbers.

It is well known that epoetin alfa increases serum endothelin (ET)-1 and blood pressure. No data are available, however, on the effects of darbepoetin alfa on serum ET-1 and blood pressure. This study was conducted to compare the effects of darbepoetin alfa and epoetin alfa on serum ET-1 and blood pressure in patients on hemodialysis (HD). A total of 42 patients on HD were included in the study. Serum samples for measuring levels of ET-1 were taken 30 min after administration of epoetin alfa. After blood samples had been taken from all patients, epoetin alfa was changed to darbepoetin alfa. Three months after the start of darbepoetin alfa treatment, blood samples were taken to measure the same parameters. Mean arterial blood pressure was measured before recombinant human erythropoietin (EPO) administration and 30 min after EPO administration while patients were taking epoetin alfa or darbepoetin alfa. Injection of epoetin alfa or darbepoetin alfa significantly increased serum ET-1 levels compared with levels in those patients who were not on EPO therapy (P.05). When the effects of epoetin alfa on serum ET-1 level were compared with those of darbepoetin alfa, the 2 types of EPO were found to increase serum ET-1 levels similarly (P.05). Administration of epoetin alfa or darbepoetin alfa increased systolic and diastolic blood pressures significantly over values in the control group (P.05). Serum systolic and diastolic blood pressures increased similarly after injection of epoetin alfa or darbepoetin alfa. Administration of darbepoetin alfa increased blood pressure in patients on HD in a way that was positively correlated with enhanced ET-1 release; a similar correlation was noted with epoetin alfa.

Oral alendronate, risedronate, and raloxifene are effective treatment options in the management of postmenopausal osteoporosis. There is little previously reported about the renal safety profiles of these three agents in osteoporosis. We aimed to assess the risk of renal toxicity associated with oral alendronate, risedronate, and raloxifene in the treatment of osteoporosis, prospectively.One hundred and twenty-seven patients with osteoporosis and osteopenia according to lumbar or femoral-neck bone mineral density t score were enrolled in the study. The patients were randomized to alendronate 70 mg once weekly (n = 47), risedronate 35 mg once weekly (n = 44), or raloxifene 60 mg per day (n = 36) for one year. Preliminary screening included medical history, physical examination, lumbar and femoral bone mineral densitometry measurement, and blood biochemical tests, including renal function tests. The biochemical markers were then assessed at the end of 12 months.There was no significant difference between basal and final renal function parameters of each group. Also these parameters did not differ between the three groups after 12 months of treatment period.These results demonstrate that alendronate, risedronate, and raloxifene are all safe drugs for renal functions in the treatment of osteoporosis.

Currently, the pathogenesis of nondipper hypertension remains largely unclear in patients without any renal or endocrine pathology. It is well known that overt hypothyroidism is strongly associated with diastolic hypertension. However, no study has addressed the pathogenic role of TSH, free T3 (FT3), and free T4 (FT4) in nondipper hypertension. The aim of the present investigation is to evaluate if higher TSH, low FT3 and FT4 would be associated with a nondipper hypertension profile, in patients with normal renal function and without any overt thyroid hormone disorder. 131 subjects were screened and those who met the following inclusion criteria were enrolled: (1) glomerular filtration rate (GFR) >60 ml/min; (2) no history of thyroid disorders; (3) no history of thyroid hormone medication. All subjects underwent 24-hour ambulatory blood pressure monitoring on a usual working day. Of the total population, 59 patients (45%) were classified as dippers and 72 (55%) were classified as nondippers. The only significant differences between dipper and nondipper patients appear to be related to FT3 levels and GFR. Nondipper patients had lower FT3 levels (4.5 ± 0.6 vs. 4.0 ± 0.9 pmol/l, p = 0.02) and low GFR (80.5 ± 12.2 vs. 86.9 ± 16.9 ml/min, p = 0.03), compared to dipper patients. The final regression model included serum TSH, FT3 levels, and GFR; the only independent predictor of nondipper hypertension was FT3 (p = 0.04). In conclusion, even if the mechanisms of our findings remain incompletely understood, we demonstrate a graded independent relation between lower level of FT3 and the risk of nondipping. Further studies are warranted to confirm this relationship and to elucidate the pathogenetic mechanisms of this relationship.

Background and Aims: In patients with renal disease, an association between abnormal circadian blood pressure profile and abnormalities in bone and mineral metabolism, including vascular calcifications, is well known. However, such a link has not yet been reported in hypertensive patients with normal renal function. We aimed to evaluate if higher serum phosphate, calcium, parathyroid hormone (PTH) level and the calcium×phosphate (Ca×P) product would be associated with a nondipper hypertension, in patients with normal renal function and without any PTH disorder. Methods: 190 hypertensive subjects with the following inclusion criteria were enrolled: (1) normal phosphate and PTH levels; (2) glomerular filtration rate (GFR) >60 ml/min, and (3) no history of calcium, phosphate, vitamin D medication and hyperparathyroidism. Results: Of the total population, 76 patients (40%) were classified as dippers and 114 (60%) as nondippers. Nondipper patients had higher levels of phosphate (3.70 ± 0.61 vs. 3.35 ± 0.44 mg/dl, p = 0.001), Ca×P product (35.4 ± 6.5 vs. 31.5 ± 5.0, p = 0.001) and PTH (75.7 ± 28.8 vs. 46.6 ± 17.1 pg/ml, p = 0.000) compared to dipper patients. Independent predictors (multiple regression) for nondipper hypertension were PTH (β = 0.43, p = 0.001) and phosphate (β = 0.9, p = 0.03). Conclusion: We demonstrate a graded independent relation between higher levels of phosphate, PTH, Ca×P product and the risk of nondipping in hypertensive patients with an estimated GFR of >60 ml/min and normal mineral metabolism.

Cardiovascular problems are a major cause of morbidity and mortality in patients with autosomal dominant polycystic kidney disease (ADPKD). Endothelial dysfunction (ED), which is an early manifestation of vascular injury, has been shown in patients with ADPKD. However, the association between ambulatory blood pressure and ED has not been investigated in these patients. Forty-one patients with ADPKD having well-preserved renal function were included in the study. Ambulatory blood pressure monitoring was performed in all patients. Patients were divided into dipper and non-dipper groups. Endothelial function of the brachial artery was evaluated by using high-resolution vascular ultrasound. Endothelial-dependent dilatation was expressed as the percentage change in the brachial artery diameter from baseline to reactive hyperemia. The mean 24-hour systolic blood pressure was similar in both groups (125.5 +/- 10.7 mmHg in dippers and 121.2 +/- 14.3 in non-dippers, p0.05). There was also no significant difference between the mean 24-hour diastolic blood pressures in both groups (82.3 +/- 9.6 mmHg in dippers and 77.1 +/- 8.6 mmHg in non-dippers, p0.05). The nocturnal fall rate in systolic blood pressure was 11.1 +/- 1.2% in dippers and 0.98 +/- 0.9% in non-dippers (p = 0.001). The nocturnal fall rate in diastolic blood pressure was 14.0 +/- 0.9% in dippers and 3.8 +/- 0.8% in non-dippers (p = 0.001). Endothelial-dependent dilatation was significantly higher in dippers compared to non-dippers (6.22 +/- 4.14% versus 3.57 +/- 2.52%, p = 0.025). Non-dipper patients with ADPKD show significant ED, which has an important impact on cardiovascular morbidity and mortality.

Background: Bisphenol A (BPA) has been implicated as an ‘endocrine disruptor'. We aimed at exploring the association between serum BPA levels and patient characteristics, particularly the presence of diabetes mellitus, and laboratory parameters in hemodialysis patients. Methods: This study included 47 chronic hemodialysis patients. Patient characteristics were recorded. Blood was drawn before and after hemodialysis session. Serum BPA levels were measured by the high-performance-liquid-chromatography and laboratory parameters were measured by using standard methods. Results: In hemodialysis patients, postdialysis serum BPA levels were significantly higher than predialysis after a single hemodialysis session (5.57 ± 1.2 vs. 4.06 ± 0.73, p < 0.0001). Predialysis serum BPA levels were significantly higher in patients with diabetes than non-diabetics (4.4 ± 0.6 vs. 3.9 ± 0.7, p = 0.025). No association was found between serum BPA levels and patient characteristics, and particularly laboratory parameters. Conclusion: Serum BPA levels were rising significantly after a single dialysis session. Diabetic hemodialysis patients had higher predialysis serum BPA levels.

Biventricular diastolic dysfunction in patients with autosomal-dominant polycystic kidney disease. Background Left ventricular diastolic dysfunction has been shown in patients with autosomal-dominant polycystic kidney disease (ADPKD). However, there is no study evaluating right ventricular functions in these patients. Methods In the present study, diastolic functions of both ventricles in normotensive and hypertensive ADPKD patients with well-preserved renal function were investigated. Fifteen hypertensive and 16 normotensive patients with ADPKD with well-preserved renal function, 16 patients with essential hypertension, and 24 healthy subjects were included in the study. Conventional left and right ventricular echocardiographic measurements were performed in all subjects. Left and right ventricular functions were investigated both by myocardial performance index (MPI) [calculated by dividing the sum of isovolumic contraction time and isovolumic relaxation time (IVRT) by ejection time] and by tissue Doppler imaging (TDI). Results Left ventricular deceleration time and IVRT were significantly prolonged in hypertensive patients with ADPKD compared with patients with essential hypertension and even in normotensive patients with ADPKD compared with healthy subjects. Left and right MPIs were significantly higher in patients with ADPKD compared with healthy subjects, showing systolic and diastolic dysfunction. Moreover, by using TDI, the peak early diastolic mitral annular velocity (Em) to peak late diastolic mitral annular velocity (Am) ratio and the peak early diastolic tricuspid annular velocity (Et) to peak late diastolic tricuspid annular velocity (At) ratio were decreased in patients with ADPKD, suggesting biventricular diastolic dysfunction. Conclusion Both hypertensive and normotensive patients with ADPKD show significant biventricular diastolic dysfunction, suggesting cardiac involvement very early in the course of ADPKD.

Cardiovascular problems are a major cause of morbidity and mortality in patients with autosomal dominant polycystic kidney disease (ADPKD). Endothelial dysfunction (ED) and intima-media thickness (IMT) are predictors for the development and progression of atherosclerosis. In the present study, ED and IMT were investigated in patients with ADPKD.Fifteen hypertensive and 16 normotensive patients with ADPKD with preserved renal function, 16 patients with essential hypertension, and 24 healthy subjects were included in the study. Endothelial function of the brachial artery was evaluated by means of high-resolution vascular ultrasound. Endothelial-dependent dilatation (EDD) was assessed by establishing reactive hyperemia, and endothelial-independent dilatation was determined by using sublingual isosorbide dinitrate. Carotid IMT was measured by means of high-resolution vascular ultrasound.EDD was significantly worse in hypertensive patients with ADPKD compared with patients with essential hypertension (9.1% +/- 4.1% versus 12.4% +/- 4.6%; P0.05) and even in normotensive patients with ADPKD compared with healthy subjects (13.1% +/- 5.2% versus 18.1% +/- 8.1%; P0.01). Moreover, carotid IMT was significantly greater in both hypertensive (0.71 +/- 0.10 mm; P0.01) and normotensive (0.57 +/- 0.14 mm; P0.001) patients with ADPKD compared with healthy subjects (0.45 +/- 0.10 mm).Both hypertensive and normotensive patients with ADPKD show significant ED and increased IMT, which are predictors of atherosclerosis.

Lactic acidosis generally occurs in those who have kidney, liver, lung or heart dysfunction. Herein, a 73-year-old woman diagnosed as type B lactic acidosis due to metformin without any organ dysfunction was presented.

Background Oral isotretinoin is currently the most effective therapy for acne, but is associated with numerous adverse effects. To investigate the cardiac effects of isotretinoin, acne patients receiving isotretinoin for 6 months were studied. Methods Twenty-six patients with acne vulgaris were enrolled in the study. The patients were treated with a dose of 0.8 mg/kg/day of isotretinoin (Roaccutane, Hoffman-La Roche, Basle, Switzerland) for 6 months. All participants were assessed pretreatment and at the third month of therapy with 24-h Holter monitoring of electrocardiography. Results Twenty-two patients completed the study (19 females and three males). Initial 24-h Holter monitoring showed normal sinus rhythm in all patients, with a mean heart rate of 79 beats/min (lowest, 63 beats/min; highest, 97 beats/min). At the third month of therapy, 24-h Holter monitoring showed normal sinus rhythm in all patients, with a mean heart rate of 81 beats/min (lowest, 67 beats/min; highest, 91 beats/min). All patients were in sinus rhythm throughout the recording period. None of the patients had supraventricular tachycardia or atrial arrhythmia. Conclusion In this study, 6 months of isotretinoin therapy significantly improved acne and did not cause any cardiac adverse effects at a dose of 0.8 mg/kg/day.