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Dynamic thiol/disulphide homeostasis plays a critical role in numerous intracellular enzymatic pathways including antioxidant defence and detoxification. In this study, we sought to investigate dynamic thiol/disulphide homeostasis in patients with masked hypertension (MHT) and its relationship with blood pressure. Forty patients (23 men, 17 women) with newly diagnosed MHT and not yet on medical therapy, and 40 healthy volunteers (21 men, 19 women) were enrolled. Blood thiol/disulphide homeostasis was measured in both groups. Serum native and total thiol levels were measured using the novel, fully automated colorimetric method developed by Erel et al. Serum disulphide level was calculated as (serum total thiol - serum native thiol)/2. Native and total thiol levels (p = 0.001) and native thiol/total thiol ratio (p = 0.023) were found to be lower in patients with MHT when compared to those of the control group. Disulphide level and ratios of disulphide/native thiol and disulphide/total thiol were higher in patients with MHT than in the control group (p = 0.001). A positive correlation of systolic blood pressure (SBP) and diastolic blood pressure (DBP) was observed with disulphide/native thiol ratio (p

To investigate the nature of dyslipidemia and its diversity in patients with systemic AA amyloidosis.The reports of the kidney biopsies performed due to nephrotic proteinuria (3.5 g/day/1.73 m(2)) with preserved renal function [glomerular filtration rate (GFR)60 mL/min/1.73 m(2)] were reviewed. Clinical and laboratory data of the patients with systemic AA amyloidosis and primary glomerulonephritis (PG) were analyzed.A total of 104 (systemic AA amyloidosis: 43, PG: 61) patients were included in the study. Proteinuria and GFR levels were similar in both the groups. Patients with systemic AA amyloidosis group had lower serum albumin (p = 0.002), lower hemoglobin levels (p = 0.001), higher platelet counts (p = 0.002) and higher C-reactive protein levels (p = 0.001) compared to patients in PG group. Although the frequency of dyslipidemia was similar in the groups (86.0 vs. 93.4%), patients with systemic amyloidosis had both lower values of LDL-C (4.56 ± 2.05 vs. 5.49 ± 2.23 mmol/L, p = 0.028) and HDL-C (1.19 ± 0.36 vs. 1.35 ± 0.39 mmol/L, p = 0.035). Serum lipid levels were correlated with serum total protein, albumin and proteinuria levels in PG group. However, in the systemic amyloidosis group, only one clear correlation between serum lipid and hemoglobin levels was estimated. A multivariate analysis demonstrated that LDL-C was independently associated with the etiology of nephrotic proteinuria, serum total protein, serum albumin (inversely) and hemoglobin levels.Although dyslipidemia is closely associated with serum total protein, albumin and proteinuria in patients with PG, there is no clear such association in patients with systemic amyloidosis. Correlation between serum lipid and hemoglobin levels in this group and other findings point out that probably complex mechanisms take place in dyslipidemia of nephrotic syndrome caused by systemic AA amyloidosis.

We aimed to evaluate the levels of oxidative stress (OS) parameters such as total antioxidant status or TAS, total oxidant status (TOS), OS index (OSI), paraoxonase 1 (PON1), arylesterase, and total thiol in hypertensive patients with and without asymptomatic organ damage (AOD), and to determine the relationship between these parameters and AOD.Sixty-six patients (21 men, 45 women) with AOD and 66 patients without AOD (21 men, 45 women) were enrolled in the study. Serum OS parameters were measured by colorimetric method.The OSI levels were found to be higher while PON1, PON1/high-density lipoprotein, and arylesterase levels were found to be lower in patients with AOD compared with those in the patients without AOD. Stepwise regression analysis showed high 24-h mean systolic blood pressure, OSI, and low arylesterase level to be independent predictors of AOD.OS level was found to be higher in hypertensive patients with AOD compared with the patients without AOD. However, it is not clear whether increased OS leads to AOD or AOD increases the level of OS. For this purpose, OS level needs to be decreased by antioxidant therapies and patients need to be followed up for a longer duration.

INTRODUCTION: Glomerulonephritis is still the primary cause among the diseases causing end stage renal disease. Helicobacter pylori (HP), also having a local proinflammatory effect on gastric mucosa, can trigger a local and systemic inflammatory response, and consequently have a role in the development of extragastrointestinal defects. MATERIAL AND METHODS: The study was composed of patients diagnosed with primary glomerulonephritis who had dyspeptic complaints throughout the diagnosis. Patients who received endoscopic biopsy upon the determination of pathologic findings in their upper gastrointestinal endoscopy were HP positive in their biopsy material. A triple eradication therapy was initiated for HP. RESULTS: The study included 14 female and 19 male patients, 33 in total, whose biopsy material was determined to be HP positive. Before the eradication for HP, we found serum albumin to be 34.0 (19.0-51.0) g/l, serum total protein 58.6 ±12.9 g/l, serum creatinine 0.9 (0.5-1.2) and proteinuria 3069 (652-12392) mg/day in 24-hour urine. After the eradication, however, serum albumin was found to be 40 (20-52) g/l, serum total protein 62.3 ±11.1 g/l, serum creatinine 1.02 (0.6-1.29) mg/dl and proteinuria was 2850 (172-15181) mg/day in 24-hour urine. A comparison of the results showed that a statistically significant difference is established between the serum albumin, total protein and creatinine values (p = 0.001, p = 0.001 and p = 0.021, respectively), but not between proteinuria values in 24-hour urine (p = 0.990). CONCLUSIONS: Patients with primary glomerulonephritis, HP eradication treatment has an effect on serum albumin levels.

Icodextrin may be used as an alternative to glucose as the osmotic agent in peritoneal dialysis with ultrafiltration failure. In general, icodextrin is known to be safe and well tolerated, but it can also cause hypersensitivity reactions such as skin rashes. Allergic rashes are generally defined as erythematous, itchy and maculopapular, visible over the trunk and the extremities. When a rash occurs, it generally develops early in therapy, is self-limited, and resolves without sequelae after the discontinuation of icodextrin. Although the safety and efficacy of icodextrin peritoneal dialysis solution is well documented, clinicians should be aware of the possibility of severe adverse cutaneous reactions to it. We report the case of a 23-year-old female who developed a skin rash following the use of icodextrin.

Acute pancreatitis can be encountered as a rare complication of thrombotic thrombocytopenic purpura and it has been associated with recurrent thrombotic thrombocytopenic purpura. In this report, we present a case of thrombotic thrombocytopenic purpura closely followed for recurrent acute pancreatitis attacks and having a lethal clinical picture due to splenic vein rupture in spite of plasmapheresis and steroid treatments.

Hypertension is an important cardiovascular risk factor in renal transplant recipients. Elevated blood pressure variability (BPV) during 24-h ambulatory blood pressure monitoring (ABPM) is associated with increased risk of target organ damage and cardiovascular events, independent of mean blood pressure levels. We aimed to evaluate the relationship between endothelial function, blood pressure levels obtained by various measurement methods, and BPV in renal transplant recipients.In total, 73 hypertensive renal transplant recipients were included in the study. Office blood pressure measurements, central blood pressure measurements, home blood pressure measurements and 24-h ABPM were obtained from the subjects. BPV was calculated using the average real variability index. All patients underwent brachial flow-mediated vasodilatation tests. Predictive values of blood pressures obtained by different measurement techniques and BPV on endothelial functions were investigated.Endothelial dysfunction was present in 68.5% of the patients. No difference was found between the group with and without endothelial dysfunction with regard to office systolic or diastolic blood pressure, central blood pressure or home systolic blood pressure. In the group with endothelial dysfunction, 24-h ambulatory systolic blood pressure and night-time ambulatory systolic blood pressure were higher. In patients with endothelial dysfunction, the 24-h systolic, diastolic and mean BPV were all higher. There was also a negative correlation between the percentage of flow-mediated vasodilatation with 24-h mean and systolic BPV.Patients with endothelial dysfunction had significantly higher ambulatory blood pressure values and higher BPV. There was a significant negative correlation between endothelial function and BPV.

1 Ankara Numune Education and Research Hospital, Clinic of Nephrology, Ankara, Turkey 2 Ankara Numune Training and Research Hospital, Clinic of Nephrology Internal Medicine, Ankara, Turkey 3 Ankara Numune Training and Research Hospital, Clinic of Biochemistry, Ankara, Turkey 4 Hacettepe University Faculty of Medicine, Department of Infectious Diseases, Ankara, Turkey doi: 10.5262/tndt.2013.1002.07

Background/Aims: We aimed to evaluate the impact of low- or high-flux haemodialysis (HD) and online haemodiafiltration (OL-HDF) on inflammation and the lipid profile in HD patients. Methods: 50 HD patients were assigned to two groups for HD with low-flux (n = 25) or high-flux (n = 25) polysulphone dialysers for 6 weeks. Subsequently, all patients were haemodialysed with a low-flux polysulphone dialyser for 6 weeks, then transferred to OL-HDF for another 6 weeks. Blood samples for lipids and inflammatory markers (IL-6, IL-8, TNF-α, hs-CRP) were obtained at baseline and every 6 weeks. Results: Changes in inflammatory markers and lipids from baseline to the 6-week dialysis period did not differ between low- and high-flux groups. When patients were transferred from low-flux HD to OL-HDF, IL-6, IL-8, and TNF-α levels significantly decreased whereas HDL and LDL cholesterol significantly increased. Conclusion: Low- and high-flux polysulphone membranes had similar effects on lipids and inflammatory markers, whereas OL-HDF potently reduced pro-inflammatory cytokines.

This study aimed to examine the relationship between the ratio of monocyte frequency to high-density lipoprotein (HDL) cholesterol level (the monocyte/HDL ratio (MHR)) and asymptomatic organ damage (AOD) in primary hypertension (PHT). A total of 366 participants were enrolled in the study, including 275 cases currently being followed up after a diagnosis of PHT in our clinic and 91 healthy volunteers. The MHR was higher in patients with PHT than in individuals in the control group. In the PHT group, the MHR was higher in patients with AOD (AOD+) than in patients without AOD (AOD-). In the correlation analyses performed in the PHT group, there were positive correlations between the MHR and the following AOD indicators: carotid intima media thickness, left ventricular mass index, urinary protein levels and urinary albumin levels. In a multivariate linear regression analysis, the MHR was found to be an independent risk factor associated with these indicators of AOD. In conclusion, our study shows that MHR is associated with AOD in patients with PHT.

A 27-year-old male patient on CAPD presented to our clinic with a 2-day history of nausea, abdominal pain and cloudy peritoneal fluid. Intraperitoneal (ip) ceftazidime and vancomycin were empirically initiated based on the diagnosis of peritonitis. Microbiological examination of peritoneal fluid showed that Kytococcus sedentarius was the causative agent. On day 3, ceftazidime was discontinued. After 14 days of vancomycin treatment the patient was discharged with complete recovery.

Chronic pancreatitis is a rare cause of oxalate nephropathy. The aim of this case report was to present a patient hospitalized with acute kidney injury who was diagnosed with oxalate nephropathy and concurrent chronic pancreatitis on further investigation. A 48-year-old diabetic male patient was hospitalized with the diagnosis of acute kidney injury. Renal biopsy was performed. Biopsy findings were in favor of oxalosis and acute tubular necrosis. A careful medical history revealed alcohol abuse, episodic epigastric pain, chronic diarrhea and weight loss. After detecting signs of chronic pancreatitis and a cyctic lesion on abdominal computed tomography images, he underwent surgery for suspected malignancy. Histological findings were suggestive of chronic pancreatitis. The patient was diagnosed with secondary hyperoxaluria and oxalate nephropathy associated with chronic pancreatitis and was discharged on hemodialysis. Although secondary hyeroxaluria and DM are among known complications of chronic pancreatitis, the coexistence of these two disorders in the same patient is a rare entity. There is no consensus about renal biopsy indications in type 2 diabetes mellitus patients. Medical history and clinical features are particularly important in terms of the renal biopsy decision in these patients, as in our case. kEy wORDS: Acute kidney injury, Oxalate nephropathy, Chronic pancreatitis, Diabetes mellitus

Primary lymphedema is a rare disease caused by a disorder of lymphatic system. Clinical presentation and age at onset are variable. AA amyloidosis is usually due to chronic inflammatory diseases, malignant tumors or less frequently chronic infectious diseases. The appearance of AA amyloidosis is rare in the course of inflammatory skin diseases, and chronic leg ulcers have been rarely reported to cause AA type amyloidosis. We report here two cases of AA amyloidosis that presented with renal failure and nephrotic syndrome in patients with primary lymphedema-induced chronic leg ulcers. We aimed to reveal that there is a relation between lymphedema, chronic leg ulcers, AA amyloidosis and chronic kidney disease. KEY wORDS: Secondary renal amyloidosis, Primary lymphedema, Chronic leg ulcers, Chronic kidney disease

Aim Internal jugular vein (IJV) catheterization is often required to gain access for haemodialysis. Use of ultrasound guidance has reduced the complication rates of this procedure. We hypothesized that nephrologists may perform IJV cannulation with a high technical success and low immediate complication rates under real-time ultrasound guidance. Methods We prospectively analyzed 323 patients (186 male, 137 female) who underwent IJV cannulation with real-time ultrasound guidance. The number of needle punctures, technical success, the time between injection of local anaesthetic and entry into the IJV, and immediate complications were recorded. Patients with a history of multiple catheter insertions, previous difficulties during catheterization, poor compliance, obesity, impaired consciousness, skeletal deformity, disorder of haemostasis were regarded as high-risk group. Results Cannulation of IJV was achieved in all patients. Of the 323 catheters, 125 (38.7%) were placed in high-risk patients. Average number of puncture was 1.26 (range, 1-4). IJV was entered on the first attempt in 261 (80.8%) patients. Only ten complications (10/323, 3.2%) developed; five (2.5%) in the normal-risk group, and five (4.0%) in the high-risk group. Cannulation of IJV took a longer time in the high-risk group than in the normal-risk group. The number of needle punctures, percent of successful cannulation on the first attempt, and the frequency of complications were similar between the high- and normal-risk groups. Conclusions Cannulation of IJV under real-time ultrasound guidance is very safe with high technical success rates. Nephrologists can use this technique with ease and with minimal complications in normal- and high-risk patients.

Cardiovascular diseases are the leading causes of mortality in hemodialysis patients. Uremia induced hypertriglyceridemia; increased levels of lipoprotein remnants and low high-density lipoprotein are the main features of cardiovascular risk factors. Also, elevated oxidative stress and inflammation are the main contributors of endothelial dysfunction. Even statin based interventional trials failed to improve mortality in dialysis patients, and different treatment options have been proved to be useful. We aimed to evaluate the effect of dialyzer type on uremia-associated dyslipidemia and endothelial dysfunction. In total 312 patients were enrolled. The initial and 6(th) month blood samples were obtained from the non-arteriovenous fistula arm on the day before the first hemodialysis session of the week. Flow mediated dilatation of the patients was measured from the same arm before obtaining the blood samples. Patients were on hemodialysis therapy for 76.43 ± 52.7 months. According to their dialyzer type, there has been a statistically significant improvement noted in terms of total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol and triglyceride levels. The flow mediated dilatation of the patients are measured as 4.3 ± 0.5 and 4.4 ± 0.4 in baseline measurements of the low flux and high flux groups, respectively. Sixth month values of the patients were measured as 4.34 ± 0.4 and 4.62 ± 0.6. The improvement in low flux groups was not statistically significant but in the high flux group the endothelial dysfunction was significantly improved. Our results show that high-flux dialyzers improved dyslipidemia and endothelial dysfunction in hemodialysis patients. These findings provide a new insight on the selection of high efflux in hemodialysis.

ObJEctIVES: Kidney biopsy is a valuable tool for both diagnosis and to guide treatment of renal diseases. In this report, we aimed both clinical and pathological evaluation of the kidney biopsies in our institution. MAtErIAl and MEtHODS: Kidney biopsies in adult patients performed between 2002-2011 at the Department of Nephrology were analyzed. Biopsies were performed with the guidance of ultrasonography, and 16 and 18 G needles for two cores were used. At least seven glomeruli and one artery was accepted as adequate for diagnosis. rESultS: Five hundred thirty six kidney biopsy reports was evaluated. The mean age of the patients at presentation was 42.80±16.66 years (16-85 years old), and 55.4% of the patients was male. The most frequent indication of the kidney biopsies were nephrotic range proteinuria with 63.43%. The most common histopathological diagnosis in primary and secondary glomerular diseases was membranous nephropathy (n=88, 16.4%) and amyloidosis (n=96, 17.9%) respectively. The most frequent diagnosis of the biopsies performed due to acute kidney injury was rapidly progressing glomerulonephritis (n=20, 3.7%). The major complication rate was low (0.18%). cOncluSIOn: Nephrotic range proteinuria was the most frequent indication for the kidney biopsy in our institution. Membranous nephropathy and amyloidosis were the most frequent primary and secondary glomerular diseases. Complication rate in percutaneous kidney biopsy with the guidance of ultrasonography is low. kEY wOrDS: Acute kidney injury, Chronic kidney disease, Glomerulonephritis, Proteinuria, Renal biopsy doi: 10.5262/tndt.2012.1002.11

In glomerular diseases, the occurence of lymphoma is mostly observed in the form of both minimal change disease and Hodgkin’s lymphoma. The coocurrence of Membranous nephropathy and membranoproliferative glomerulonephritis are generally associated with non-Hodgkin’s lymphoma. While Ig A nephropathy-lymphoma association is rare, it is generally observed in the form of nonHodgkin’s lymphoma, and there are also cases proposed the cooccurence of Ig A nephropathy and cutaneous T-cell lymphoma. In this case, it is emphasized that IgA nephropathy presented with cresentric glomerulonephritis should be considered in patients with hodgkin’s lymphoma who have sudden renal disorder.

Sclerotherapy, in which an irritant solution is administered, is a method used to treat venous failure that results in complete venous destruction due to endothelial reaction and fibrosis. In recent years, foam sclerotherapy, in which a sclerosing agent (aethyl sclerole) and air are mixed until they turn into foam and the resultant mixture is injected into noticeable veins directly and into other veins under ultrasonography in doses depending on the diameters of the varices, has been introduced. The drugs or gases used in foam sclerotherapy can cause local or systemic complications. Foam affects vessel endothelial cells and causes severe spasm in the vessel. It has been reported that endothelin-1 levels are high after foam sclerotherapy compared to the initial levels and that neurological complications vary with the endothelin levels. In this report, we present a case of acute kidney injury due to acute tubular necrosis probably caused by endothelin release following foam sclerotherapy.

The occurrence of acute renal-vein thrombosis (RVT) is a possible but rarely described complication of systemic lupus erythematosus (SLE). It has not been reported to occur as the initial presentation in lupus patients. We hereby describe a 17-year-old female with renal vein thrombosis due to SLE on initial presentation. The patient presented with flank pain, flank tenderness and fever. She was treated with anticoagulation, the mainstay of therapy for RVT in general. With appropriate diagnosis and anticoagulation therapy, our patient had a benign course during 6 months of follow-up.

Psoriasis is a hereditary, chronic inflammatory disorder of the skin. Generally, the psoriatic process is limited to the skin; however, internal organs such as the kidneys may be involved in the course. Several glomerular diseases have been distinguished due to renal histological findings of psoriatic patients to date. The underlying pathogenetic mechanisms of these associations remain unclear because of the limited number of cases. We report a case of primary membranoproliferative glomerulonephritis (MPGN) in a psoriatic patient. This is the first reported case that demonstrates the coexistence of MPGN and psoriasis.

Kidneys and thyroid are two basic organs that interact with each other, and when one of them becomes ill, functions of the other are affected. Although electrolyte disturbances are the most common symptoms reported due to hypothyroidism, some are case reports in the literature suggested that acute kidney injury developed due to hypothyroidism. Despite this, we doubt that this information comes into mind in routine clinical practice. To report a case of reversible hypothyroidism-induced acute kidney injury, and review those two clinical conditions, which are often overlooked in the nephrology practice, in the light of the literature. We reported a 75-year-old female patient who admitted for acute kidney injury associated with deep hypothyroidism, required hemodialysis, and underwent a renal biopsy since no etiological factors were detected for acute kidney injury. We emphasized that the patient’s creatinine concentrations gradually returned to normal following hormone replacement therapy. Renal dysfunction in presence of hypothyroidism is a known, but frequently overlooked entity. Hypothyroidism should not be overlooked as the cause of reversible kidney injury since it is easy to treat, and there is almost complete response to treatment in terms of renal failure.

We aimed to investigate the thiol/disulphide homeostasis in patients with newly diagnosed primary hypertension with a novel and automated method. Blood thiol/disulphide homeostasis, which consists of native thiol/disulphide exchanges, was investigated in 45 patients with primary hypertension and 45 healthy controls. The levels of native thiol, total thiol, and native thiol/total thiol ratio were lower while the disulphide level and disulphide/native thiol and disulphide/total thiol ratios were higher in patients with primary hypertension when compared with those in the control group. Positive correlation was detected between 24-hour systolic and diastolic blood pressure levels and disulphide/native thiol ratio. With reference to the stepwise multiple linear regression model; increase in disulphide/native thiol ratio and log(24-hour urine microalbumin) and decrease in native thiol/total thiol ratio are independent predictors of 24-hour systolic and diastolic blood pressure. This study demonstrated that thiol/disulphide homeostasis was shifted toward disulphide formation in patients with primary hypertension.

We hereby describe a 46-year woman with nephrotic syndrome and new-onset breast cancer. This patient admitted to our hospital with peripheral edema and a mass in her right breast. Membranous glomerulonephritis (MGN) was the etiology of nephrotic syndrome. MGN has been reported in association with a wide variety of solid neoplastic diseases, although rarely occurs as a complication of breast carcinoma. We report a rare and a resistant case of MGN, who was concomitant diagnosed with breast cancer and there was no improvement in proteinuria although breast cancer was under-controlled with cheomotheraphy and surgery.

Erythropoiesis-stimulating agents (ESAs) play an important role in the management of anemia in patients with chronic kidney disease, but the goals cannot be reached in 5% to 10% of the patients despite high-dose ESA treatment. In case of ESA resistance, all causes of anemia encountered in the general population should be carefully reviewed. We present a patient examined for ESA resistance that was diagnosed with systemic lupus erythematosus and subsequently showed improvement of anemia with systemic corticosteroids.

Immunoglobulin M (IgM) nephropathy is described as mesengial proliferative glomerulonephritis with diffuse mesengial IgM deposition. We report a patient diagnosed with IgM nephropathy and concomitant autoimmune hemolytic anemia syndrome associated with cold-reacting autoantibodies. Complete remission was achieved with systemic corticosteroid and plasmapheresesis.

Accepted : 07.08.2012 dosis. In clinical practice, renal involvement most often presents as proteinuria or nephrotic syndrome. However, primary amyloid deposition can be limited to the vessels or tubules and such patients present with progressive renal failure. Apart from the kidney, the liver, spleen and heart are frequently involved in systemic amyloidosis. Amyloid infi ltration may be seen in endocrine glands but it does not always cause dysfunction. Primary adrenal insuffi ciency rarely occurs in amyloidosis, but if it occurs, life-threatening complications may develop. In this report, we describe a patient that presented as symptomatic adrenal failure due to amyloidosis and was on a regular hemodialysis programme.

There may be different clinical presentations of kidney involvement in the course of paroxysmal nocturnal hemoglobinuria, within a spectrum of acute kidney injury, generally due to hemolysis, to chronic kidney disease. Herein we discuss a case of PNH with recurrent hematuria and acute kidney

Thrombotic thrombocytopenic purpura (TTP) is an uncommon cause of hematological and renal abnormalities in the postoperative period. An association between TTP and orthopedic surgery, a rare entity, has been reported in the literature. It has the strong possibility of being fatal and therefore should be treated immediately, mostly by plasmapheresis. We report a 15-year-old girl of TTP following a high tibial valgus osteotomy (HTO).

C1q nephropathy is a rare cause of idiopathic nephrotic syndrome seen in children and young adults. Mesangial proliferation with deposition of C1q in the mesangium on immunofluorescence examination is the main pathological feature of the disease. Diagnosis is made by ruling out systemic lupus erythematosus with clinical and laboratory investigation. In this report, we discussed a patient presenting with nephrotic syndrome and C1q nephropathy with a review of the relevant literature. keY words: C1q nephropathy, Glomerulonephritis, Nephrotic syndrome doi: 10.5262/tndt.2012.1002.18 Yazisma Adresi: Serhan PiskinPasa S.B. Ankara Numune Egitim ve Arastirma Hastanesi, Nefroloji Klinigi, Ankara, Turkiye Tel : + 90 505 221 52 14 E-posta : svppasa@yahoo.com Gelis Tarihi : 23.08.2011 Kabul Tarihi : 02.10.2011 bacaklarda sislik sikâyeti ile basvurdu. Sistem sorgulamasinda ates, oral aft, artralji, dokuntu, tekrarlayan karin agrisi olmadigi ogrenildi. Fizik muayenesinde; kan basinci: 130/85 mmHg, vucut isisi: 36,6 °C saptandi. Alt ekstremitede bilateral gode birakan odem varligi disinda, tum sistem muayeneleri normaldi. Laboratuvar tetkiklerinde; serum ure: 45 mg/dL, kreatinin: 0,7 mg/dL, Na: 136 mmol/L, K: 4,4 mmol/L, protein: 45 g/L, albumin: 22 g/L, glukoz: 79 mg/dL, eritrosit sedimentasyon hizi: 32 mm/saat, Hb: 13,3 g/dL, beyaz kure: 6500/mm3, trombosit: 249 000/mm3, tam otomatik idrar tetkikinde dansite:1015, protein: 500 mg/dL, beyaz kure: 13/HPF (High power field), kirmizi kure: 1/HPF, spot idrar protein/kreatinin: 1980/204 (9.7) mg/mg olarak tespit edildi. AntiHIV: (-), AntiHCV: (-) ve HBsAg: (-) saptandi. IgG, IgA ve IgM normaldi. ANA:(-), anti-ds-DNA:(-), C3: 114 mg/ dL (N:79-152), C4: 17,3 mg/dL (N:16-38), giris C1q nefropatisi; mezengial proliferasyon ile birlikte, immunfloresan degerlendirmede mezenjial C1q depolanmasi ile karakterize, nadir gorulen idiyopatik nefrotik sendrom nedenidir (1). Hastalik siklikla cocuklarda ve genc eriskinlerde ortaya cikmaktadir, literaturde prevalans %0,2-2,5 arasinda bildirilmektedir (2-4). Hastalik siklikla nefrotik sendrom klinigi ile tani almaktadir. Klinikopatolojik olarak minimal degisim hastaligi (MDH)/fokal segmental glomeruloskleroz (FSGS) ile, immunkompleks glomerulonefriti spektrumunda ozellikler gosterebilmektedir (2-4). Tani kriteri olarak patolojik ozelliklerin yani sira, sistemik lupus eritematozusun (SLE) klinik ve laboratuvar bulgulari ile ekarte edilmesi gerekmektedir (1).

Posterior reversible encephalopathy syndrome (PRES), is a clinical-radiological entity that is caused by various etiological factors, usually associated with vasogenic edema in the posterior parietal and occipital regions, and the magnetic resonance imaging findings are diagnostic. Although treatment of the underlying cause provides clinical and radiological healing, cases have been reported with recurrence and rarely mortality. In this article, we reviewed the literature together with a patient who had chronic kidney disease and loss of consciousness and was diagnosed as PRES after the investigations. key woRDs: Posterior reversible encephalopathy syndrome, Chronic kidney disease, Consciousness doi: 10.5262/tndt.2012.1002.13 Yazisma Adresi: ezgi YeNiGuN COsKuN Numune Egitim ve Arastirma Hastanesi, Nefroloji Klinigi, Ankara, Turkiye Tel : + 90 505 355 71 51 E-posta : drezgi_76@hotmail.com Gelis Tarihi : 14.06.2011 Kabul Tarihi : 28.09.2011 penik purpura, sistemik lupus eritematozus, hemolitik uremik sendrom, organ transplantasyonu, losemi ya da lenfoma gibi immun sistem bozuklugu ile iliskili olan hastaliklarin seyrinde PRES tablosu gorulebilir (3,4). Bu olgu sunumunda, kronik bobrek hastaligi nedeniyle izlenen ve bilinc bulanikligi ile basvuran, klinik ve nororadyolojik bulgular ile tanisi koyulan ve fatal seyreden bir PRES olgusu, literatur esliginde tartisilmaktadir.

We aimed to investigate the role of cathepsin D, an inflammatory and atherosclerotic mediator, in endothelial dysfunction in chronic kidney disease. The study included 65 patients with stage 2ndash;4 chronic kidney disease (35 females, 30 males; mean age, 55.8plusmn;15.6 years). Serum creatinine and cathepsin D levels and glomerular filtration rates (GFRs) were determined, and brachial flow-mediated dilation (FMD) percentage was measured by two-dimensional gray scale and color flow Doppler and vascular imaging. FMDle;6% was considered to indicate endothelial dysfunction. Mean GFR, median creatinine levels, and median cathepsin D levels were 40.2plusmn;11.2mL/min/1.73m2, 1.7mg/dL, and 819.75ng/mL, respectively. Endothelial dysfunction was present in 30 of the 65 patients (46.2%). There was a significant difference between groups with and without endothelial dysfunction in terms of cathepsin D (p=0.001) and creatinine (p=0.03) levels, and negative and significant correlations were found between brachial artery FMD% and cathepsin D (r=minus;0.359, p=0.003) and creatinine (r=minus;0.304, p=0.014) levels. Cathepsin D, which is known to be associated with atherosclerosis, may play a role in the process of endothelial dysfunction. Further studies are essential to determine the exact function of cathepsin D in endothelial dysfunction in chronic kidney disease and to determine its value as a tool for early diagnosis and target for treatment of cardiovascular diseases in patients with chronic kidney disease.