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Aims Focal segmental glomerulosclerosis (FSGS) is the common cause of chronic renal disease worldwide. Although there are many etiologic factors which have common theme of podocyte injury conclusive etiology is not clearly understood. In this study, we aimed to explore the role of autophagy in the pathogenesis of podocyte injury, which is the key point in disease progression, and the roles of intrarenal microRNAs and the prorenin receptor (PRR) in the 5/6 nephrectomy and adriamycin nephropathy models of FSGS. Main methods For experimental FSGS model, 5/6 nephrectomy and adriamycin nephropathy models were created and characterized in adult Sprague Dawley rats. Microarray analysis was performed on FSGS and control groups that was confirmed by q-RT-PCR. Beclin1, LC3B, PRR, ATG7 and ATG5 expression were evaluated by western blotting and immunohistochemistry. Also, Beclin1 and PRR expression were measured by ELISA. Glomerular podocyte isolation was performed and autophagic activity was evaluated in podocytes before and after transfection with miRNA mimic and antagonists. Key findings Glomerular expression of Beclin1, LC3B, PRR, ATG7 and ATG5 were significantly lower in the 5/6 nephrectomy than adriamycin nephropathy group and in both groups lower when compared to control groups. Western blot results were consistent with immunohistochemical data. Electron microscopy revealed signs of impaired autophagy in FSGS. Autophagic activity decreased significantly after miR-214, miR-132 and miR-34c mimics and increased after transfection with antagonists. Significance These results showed that the role of autophagic activity and decreased expression of PRR in FSGS pathogenesis and miR-34c, miR-132 and miR-214 could be a potential treatment strategy by regulating autophagy.

Aim/Scope Contrast-induced nephropathy (CIN) is a common complication of diagnostic/therapeutic procedures. Serum creatinine levels are sensitive but often lead to diagnostic delays in acute kidney injury and potential misclassification of actual injury status. Kidney injury molecule (KIM-1) is a novel early marker of acute kidney injury. The aim of our study was to evaluate the KIM-1 levels in patients with CIN. We performed a single-center, nested case-control study. Materials and Methods Three thousand two hundred patients who had undergone coronary angiography were included in the study. Thirty-two patients were diagnosed with CIN. Twenty patients who had undergone coronary angiography but did not have CIN were evaluated as a control group (n = 20). The diagnosis of CIN was performed according to the KDIGO 2012 Acute Kidney Injury Guideline criteria. Urinary KIM-1 levels were measured by enzyme-linked immunosorbent assay before as well as on the 6th and 48th hours of contrast exposure. Serum creatinine levels were measured before as well as on the 24th and 48th hours after angiographic procedure. Results We demonstrated that KIM-1 levels increased in the patients with CIN significantly on the sixth hour when compared with the baseline ( P < 0.01; median levels, 0.27 and 0.70 mg/dL) but not in the controls ( P = 0.107). The precontrast and 48th-hour KIM-1 levels were median ones and were also significantly different ( P = 0.001, the median levels were 0.27 and 0.60 mg/dL, respectively). Conclusions Because creatinine is a sensitive but a late marker of CIN, KIM-1 may be used for early diagnosis and early initiation of treatment and may reduce risk for morbidity.

Endocan, a cysteine-rich dermatan sulfate proteoglycan expressed by endothelial cells, is seemed to be a new biomarker for endothelial dysfunction. Pre-eclampsia (PE) is characterized by the new onset of hypertension, proteinuria after 20 weeks of gestation, placental vascular remodeling, systemic vascular inflammation and endothelial dysfunction. The aim of this study was to investigate the relationship of PE and its severity with serum endocan levels.A cross-sectional study was performed. Serum was collected from women with PE and normotensive controls. Serum endocan and tumor necrosis factor alpha (TNF-α) concentrations were measured by a specific enzyme linked immunosorbent assay.Patients with PE had significantly higher median (interquartile range) endocan and mean TNF-α concentrations than controls [20.04 (12.26) ng/mL vs 15.55 (6.19) ng/mL, p 0.001 for endocan; 26.49 ± 12.14 pg/mL vs 14.62 ± 5.61 pg/mL, p 0.001 for TNF-α; respectively]. Serum endocan concentrations were positively correlated with systolic blood pressure (r = 0.618, p 0.001), diastolic blood pressure (r = 0.608, p 0.001), the amount of 24-h proteinuria (r = 0.786, p 0.001) and TNF-α (r = 0.474, p 0.001) in women with PE. In subgroup analysis, patients with severe PE had significantly higher endocan concentrations than those with mild PE. Receiver operating characteristic analysis of endocan was used to identify the patients with PE and also discriminating between mild and severe PE.Serum endocan concentrations were significantly elevated in women with PE versus normotensive controls, and concentrations seem to be associated with the severity of the disease.

Functional iron deficiency (FID) incidence is gradually increasing in hemodialysis (HD) patients. Recently, high levels of GDF-15 supressed the iron regulatory protein hepcidin and GDF-15 expression increased in iron-deficient patients. The relationship between FID, GDF-15, and hepcidin is currently unknown. The present study aimed to evaluate the association between GDF-15, hepcidin, and FID in chronic HD patients. Serum GDF-15 and hepcidin concentrations were measured in 105 HD patients and 40 controls. FID is defined as serum ferritin >800 ng/mL, TSAT

Galectin-3 (gal-3) is an emerging prognostic biomarker in heart failure (HF). Clinical and experimental studies suggest that gal-3 is an important mediator of HF. Here we aimed to examine the relationship between gal-3 and diastolic dysfunction in patients undergoing maintenance hemodialysis (HD). We examined the relationship between plasma gal-3 levels and left ventricular diastolic function. Plasma gal-3 was measured in 87 subjects with chronic HD and in 45 healthy controls using biochemical evaluations. Conventional echocardiography and pulsed tissue Doppler assessment were performed in all patients. Left ventricular diastolic dysfunction (LVDD) was defined as E’

Primary cause of late arteriovenous fistula (AVF) dysfunction is venous stenosis as result of neointimal hyperplasia. The mechanism of AVF stenosis is not exactly understood. But inflammation is a contributing factor for development of AVF stenosis. Neutrophil-lymphocyte ratio (NLR) reflects systemic inflammation, and it was investigated in many diseases. The aim of this study was to investigate the relationship between NLR and AVF stenosis in chronic hemodialysis patients.Of 593 patients applied to the department of interventional radiology between January 2011 and November 2012, a total of 108 patients meeting the appropriate criteria were included in this study. All patients were assessed with Color Doppler ultrasonography and then digital subtraction angiography was used for the patients with abnormal results. Sixty-four patients were classified as patients with AVF stenosis (group 1) and 44 patients without AVF stenosis (group 2). Routine biochemical and complete blood count values measured six months ago were recorded for all patients.Mean NLR (3.47 ± 0.46 vs. 2.27 ± 0.22; p 0.001) was higher in group 1 compared to group 2, whereas high-density lipoprotein (HDL; 31.8 ± 12.6 mg/dL vs. 51.5 ± 11.9 mg/dL; p 0.001) was lower in group 1. NLR level was correlated with degree of AVF stenosis (r = 0.625; p 0.01). Receiver operating characteristic curve analysis showed that NLR (optimal-cut-off = 2.70) was a useful parameter in prediction of AVF stenosis (AUC = 0.893, sensitivity = 98.4% and specificity = 75%; p 0.001). NLR level and HDL 30 mg/dL in logistic regression analysis are independent predictors of AVF stenosis.For hemodialysis patients with increased level of NLR and decreased level of HDL, regular monitoring with regard to the development of AVF stenosis may be beneficial. Our study suggests that the mechanism of AVF stenosis might have similarities to that of atherosclerosis.

Increased carotid intima–media thickness (CIMT) was shown to be an independent predictor of cardiovascular (CV) mortality in dialysis patients and the general population. Growth differentiation factor 15 (GDF-15), a member of the transforming growth factor superfamily, is produced by cardiomyocytes and atherosclerotic lesions under stress conditions such as inflammation. We assessed associations between serum concentrations of GDF-15, mortality, and CIMT for subclinical atherosclerosis in hemodialysis (HD) patients. A total of 87 patients on maintenance hemodialysis and 45 sex- and age-matched healthy controls were included in this prospective study. Serum GDF-15 levels were measured by ELISA. CIMT was assessed by Doppler ultrasonography. The association between serum GDF-15 levels and mortality was assessed using Cox regression analysis with serum levels categorized into two groups according to the median value (328.18 pg/ml). Patients were followed for 2 years and cause-specific and all-cause mortality were determined. The median level of serum GDF-15 was significantly higher in HD patients than controls [328 (198–522) vs. 176 (101–289) pg/ml, p

OBJECTIVE Recent studies revealed that inflammation plays a critical role in bone remodeling and the pathogenesis of postmenopausal osteoporosis, a major health concern. Neutrophil-lymphocyte ratio (NLR) is a cost-effective marker of inflammation that has been linked with several diseases. This study aimed to compare NLR and C-reactive protein (CRP) levels in osteopenic, osteoporotic, and control subjects and to assess the correlation between NLR levels, CRP, and bone mineral density (BMD) in postmenopausal women. METHODS In this cross-sectional study, the relationship between NLR, CRP, and BMD in 438 women was investigated using uni- and multivariate analyses. BMD (g/cm²) was measured by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine and femur. Complete blood count (CBC), CRP, glucose/lipid metabolism, and established risk factors were determined. RESULTS In the osteoporotic group, NLR and CRP levels were found to be elevated as compared to the osteopenic and control groups (NLR: 4.68 ± 0.72, 3.17 ± 0.43, 2.01 ± 0.54; CRP: 12.3 ± 4.1, 4.1 ± 2.7, 3.2 ± 2.1, respectively). A negative correlation was present between NLR and the lumbar spine (L2-L4) and femoral neck BMD after adjusting other risk factors. There was no correlation between CRP levels and BMD after adjusting other risk factors. NLR was significantly associated with L2-L4 BMD (s = -0.653, p

The aim of this study was to analyze associations between serum cancer antigen 125 (CA 125) levels and left ventricular (LV) function in patients with end-stage renal disease on maintenance hemodialysis (HD).CA 125 levels, pro-brain natriuretic peptide (pro-BNP) and biochemical parameters were measured, and echocardiography was performed for 110 patients and 47 healthy controls.The mean CA 125 level in patients, 38.78 ± 35.48 U/mL, was significantly higher than that found in healthy controls (9.20 ± 4.55 U/mL; p = 0.003). Patients with elevated CA 125 levels (n = 40) had significantly lower levels of albumin and reduced relative wall thickness, LV ejection fraction (EF) and fractional shortening but significantly higher levels of pro-BNP and a greater left ventricular end-diastolic diameter (LVEDd) and -systolic diameter (LVESd). CA 125 levels were positively correlated with pro-BNP (r = 0.596, p 0.05) and C-reactive protein (CRP) levels (r = 0.439, p 0.05), as well as LVEDd (r = 0.599, p 0.001), LVESd (r = 0.750, p 0.001) and LV mass index (r = 0.378, p 0.05). In contrast, serum CA 125 levels were negatively correlated with albumin (r = -0.513, p 0.05) and hemoglobin (r = -0.475, p 0.05) as well as the EF (r = -0.878, p 0.0001). A depressed EF (β = -1.121, p 0.0001) and increased CRP levels (β = 0.247, p = 0.035) were independent predictors of high CA 125 levels in the whole group in the multivariate-model.Our study is the first to demonstrate an association between serum CA 125 levels and LV systolic dysfunction via inflammation in patients on maintenance HD.

We have demonstrated that caspase-1 is a mediator of both cisplatin-induced acute kidney injury (AKI) and ischemic AKI. As caspase-1 is activated in the inflammasome, we investigated the inflammasome in cisplatin-induced and ischemic AKI. Mice were injected with cisplatin or subjected to bilateral renal pedicle clamping. Immunoblot analysis of whole kidney after cisplatin-induced AKI revealed: 1) an increase in apoptosis-associated Speck-like protein containing a caspase recruitment domain (ASC), the major protein that complexes with nucleotide-binding oligomerization domain, leucine-rich repeat and pyrin domain containing proteins (NLRP) 1 or 3 to form the inflammasome ; 2) an increase in caspase- 1 activity, caspase-5, and NLRP1, components of the NLRP1 inflammasome ; and 3) a trend toward increased NLRP3. To determine whether the NLRP3 inflammasome plays an injurious role in cisplatin- induced AKI, we studied NLRP knockout (NLRP3(-/-)) mice. In cisplatin-induced AKI, the blood urea nitrogen, serum creatinine, acute tubular necrosis score, and tubular apoptosis score were not significantly decreased in NALP3(-/-) mice compared with wild-type mice. We have previously demonstrated the injurious role of caspase-1 in ischemic AKI. NLRP3, but not ASC or NLRP1, is increased in ischemic AKI. NLRP3(-/-) mice with ischemic AKI had significantly lower blood urea nitrogen, serum creatinine, and acute tubular necrosis and apoptosis scores than the wild-type controls. The difference in protection against cisplatin-induced AKI compared with ischemic AKI in NLRP3(-/-) mice was not explained by the differences in proinflammatory cytokines interleukin (IL)-1β, IL-6, chemokine (C-X-C motif) ligand 1, or tumor necrosis factor α. NLRP3 inflammasome is a mediator of ischemic AKI but not cisplatin-induced AKI, and further investigation of the NLRP1 inflammasome in cisplatin-induced AKI should prove interesting.

Many studies have investigated preexistent renal disease during pregnancy. However, insufficient data regarding the new onset of glomerulonephritis in the course of gestation, especially in patients with preeclampsia, exist. The aim of this study was to investigate underlying renal disease in preeclamptic Turkish women with persistent proteinuria after delivery.Between 2005 and 2010, 463 patients with preeclampsia were admitted to our hospital. The symptoms of proteinuria persisted in 34 women (0.7 %). Thirteen of these patients refused a kidney biopsy. Seven of these patients had a history of documented kidney disease. Kidney biopsies were performed on 14 women who were diagnosed with persistent proteinuria in the postpartum period and the specimens were examined by light and immunofluorescence microscopy.Ten of 14 patients (71 %) were diagnosed with underlying renal disease. Four patients were diagnosed with idiopathic preeclampsia (29 %). Histopathological findings existed for ten patients with underlying renal disease; four patients (29 %) were diagnosed with membranoproliferative glomerulonephritis (MPGN), four patients (29 %) were diagnosed with IgA nephropathy (IgAN), one patient (7 %) was diagnosed with focal segmental glomerulosclerosis (FSGS), and one patient (7 %) was diagnosed with amyloidosis. Hematuria was detected in eight patients (57 %), and high serum creatinin levels were observed in five (36 %).Persistent proteinuria is the most important predictor of underlying renal disease after delivery. All patients with preeclampsia should be evaluated with respect to continuing proteinuria, persistent hematuria, or impaired renal functions after postpartum period and a percutaneous renal biopsy should be performed in those patients who have positive signs of underlying renal disease.

Vitamin D is mainly known for its traditional role in the bone mineralization and calcium homeostasis. Recent studies have shown that vitamin D receptors (VDR) are present in almost all the tissues and cells in the human body. In addition, several studies have revealed that vitamin D is important in immunomodulation, regulation of inflammation and cytokines, cell proliferation, cell differentiation, apoptosis, angiogenesis, muscle strength, and muscle contraction. Patients with sepsis have high mortality rate and high deficiency in vitamin D. In addition, septic patients have decreased vitamin D binding-protein (DBP) levels which further exacerbate the vitamin D deficiency. The role of vitamin D treatment in sepsis syndrome has been evaluated in animal model of sepsis where 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] administration was associated with improved blood coagulation parameters in sepsis associated with a disseminated intravascular coagulation. Vitamin D treatment in vitro has also been demonstrated to modulate levels of the systemic inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6), as well as inhibit the lipopolysaccharide (LPS)-induced activation and vasodilation of vascular endothelium. Vitamin D may enhance the induction of the antimicrobial peptides, cathelicidin and b-defensin, which have been described on mucosal and epithelial surfaces acting as the body's first line of defense against viral and bacterial pathogens. Vitamin D supplementation may divert attention from relatively simple, natural, and low-costmethods of preventing severe sepsis and septic shock. Further prospective, randomized and controlled clinical trials of adjunctive vitamin D therapy in patients who are vitamin D deficient are needed in the management of human sepsis syndrome.

Pneumatosis intestinalis is a rare entity, characterized by multiple air cysts in the wall of the gastrointestinal tract. Free intraperitoneal air (gas) develops in pneumatosis intestinalis whenever one of the subserosal gas cysts ruptures. We present a case of pneumatosis intestinalis associated with massive peritoneal free air that mimicked intestinal perforation. This case highlights the importance of recognizing pneumatosis intestinalis as a cause of possible massive intraabdominal free air. Key words: Pneumatosis Intestinalis; Intestinal Perforation; Air Cyst.

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

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

Background and Aim: Due to increasing evidence suggesting a link between hyperphosphatemia and cardiovascular disease (CVD), mediated through vascular calcification in patients on dialysis, the following question arises: At what stage of chronic kidney disease (CKD) does the relationship between elevated phosphate levels, vascular calcification and increased cardiovascular mortality begin? Therefore, the purpose of the current study was to critically review the current literature regarding this issue. Methods: We performed a systematic search of the National Library of Medicine and the Cochrane Library databases from January 1985 to February 2008 to identify clinical studies examining the effects of plasma phosphate on cardiovascular outcome, mortality and progression of kidney disease in subjects with and without CKD who have not yet received dialysis. The primary outcome measure was the development of CVD, mortality and progression of kidney disease. Results: Twelve clinical trials investigated the role of serum phosphate levels and adverse outcome (9 studies examining CVD outcome and 3 examining progression of kidney disease). After adjustment for risk factors for mortality, adverse cardiovascular outcome and progression of kidney disease, all studies found a graded independent significant association between phosphate levels and mortality, development of CVD and progression of kidney disease. There was no such association with plasma calcium levels. Conclusions: There is a graded independent association between serum phosphate levels and mortality, mainly cardiovascular events, and the progression of renal disease in subjects with and without definable (loss of glomerular filtration rate) CKD.

Oxidative stress has been considered as one of the possible mechanisms of ischemia/ reperfusion (I/R) injury in the kidney. The aim of this study was to analyze the possible protective effect of dietary ginger (Zingiber officinals Rosc), a free radical scavenger, on renal I/R injury in rats. The protective effect of ginger against the damage inflicted by reactive oxygen species (ROS) during renal I/R was investigated in Wistar albino rats using histopathological and biochemical parameters. Thirty rats were randomly divided into five experimental groups (i.e., control, sham-operated, ginger, I/R, and I/R + ginger groups, n = 6 each). The ginger and I/R + ginger groups were fed on the test diet containing 5% ginger. The rats were subjected to bilateral renal ischemia followed by reperfusion in I/R and I/R + ginger groups. At the end of the reperfusion period, rats were sacrificed, and kidney function tests, serum and tissue oxidants and antioxidants, and renal morphology were evaluated. Serum urea, creatinine, and cystatin C (CYC) levels were significantly elevated in the ischemia group, but these levels remained unchanged in the ginger + I/R group compared to the I/R group. Reduction of glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) enzyme activity was significantly improved by the treatment with ginger compared to I/R group. Administration of ginger resulted in significant reduction levels of tissue malondialdehyde (MDA), NO, protein carbonyl contents (PCC) in the ginger + I/R group compared with the I/R group. Ginger supplementation in the diet before I/R injury resulted in higher total antioxidant capacity (TAC) and lower total oxidant status (TOS) levels than I/R group. The ginger supplemented diet prior to I/R process demonstrated marked reduction of the histological features of renal injury. The findings imply that ROS play a causal role in I/R-induced renal injury, and ginger exerts renoprotective effects probably by the radical scavenging and antioxidant activities.

Individuals who do not have a 10% to 20% reduction in blood pressure (BP) during the night are known as ‘nondippers’. Non-dipping patterns in hypertensive patients have been shown to be associated with an excess of target organ damage and other adverse outcomes. The present study was designed to investigate the relationship between nocturnal BP pattern, defined on the basis of the ambulatory blood pressure monitoring (ABPM) recording, and cardiac and renal target organ damage in a population of at least one year treated essential hypertensive subjects. The present analysis involved 123 patients with treated essential hypertension attending the outpatient clinic of our centre. Each patient was subjected to the following procedures: blood sampling for routine blood chemistry, spot urine for proteinuria, 24-hour periods of ABPM, and echocardiography. In the ABPM period, a dipping pattern was observed in 65 of the 123 patients, and a non-dipping pattern in 58 patients. Body mass index was higher in the non-dippers (26 ± 4 versus 28 ± 4, p

Aim The aim of this study is to evaluate the effect of erythropoietin and hemodialysis (HD) on serum Endotheli-1 (ET-1) and intraocular pressure (IOP) levels in HD patients. Methods The study group was composed of 34 chronic HD patients undergoing erythropoietin (EPO) treatment, while the control group was composed of 16 chronic HD patients without EPO treatment. Serum samples for measuring levels of ET-1 were taken 1 h before and after HD. Endothelin-1 levels were determined using a commercially available Elisa kit. IOP was measured with a calibrated Goldmann applanation tonometer in the right eyes of patients 1 h before and after HD just after blood samples were taken. Results In the EPO group, serum ET-1 levels were significantly higher than those of the control group both before and after HD. Despite increased ET-1 levels in the EPO group, there was no statistically significant difference in pre- and post-dialysis IOP measurements between the erythropoietin and control groups (P > 0.05). In both the HD and control groups, the IOP levels significantly decreased following HD (P < 0.05). Conclusion EPO treatment caused an increase in plasma ET-1 concentration compared to the control group, while there was no related increase in IOP with EPO treatment. The role of ET-1 in glaucoma development must involve a mechanism other than increased IOP.

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.

Although complete blood count is routinely ordered in most upper urinary tract infections (UTI), and information regarding the patient's platelet indices is made available without added cost, the relationship between platelet count and mean platelet volume (MPV) and specific platelet responses to different infectious agents has not been extensively characterized in UTI. The objectives of this study were to examine platelet counts and platelet indices in children with culture-proven upper UTI to determine if there are organism-specific platelet responses. A retrospective analysis of data from all pediatric urine samples processed at Fatih University Medical School microbiology laboratory was undertaken for a period of two years (January 1, 2005, to December 31, 2006). Of the 200 patients with positive urine cultures, 146 (73%) were infected with gram-negative bacteria and 54 (27%) grew gram-positive bacteria. The platelet count during the episode of upper UTI and the incidence of thrombocytosis was significantly higher with the gram-positive infections than with the gram-negative infections or controls (p < 0.05). A statistically significant higher MPV was detected in the subjects with upper UTI (p < 0.05). Also, our data showed a statistically significant increase in MPV with gram-positive infections compared with the other groups (p < 0.05). In conclusion, based on the importance of the hemostatic component in the pathophysiology of infections, our findings of platelet count and MPV and predictivity of the type of the organism would suggest the usefulness of the routine measurements in children with upper UTI.

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.

Our study was undertaken to evaluate the levels of thrombin-activatable fibrinolysis inhibitor (TAFI) antigen and also its relationship with other hemostasis markers in a group of patients affected with polycystic ovary syndrome (PCOS)-under Diane-35 (ethinyl estradiol 0.035 mg/cyproterone acetate 2 mg) treatment or not-as compared with a group of healthy controls.Forty-two women with PCOS and 30 age-matched healthy controls were involved in the study. Group A were on Diane-35 for at least 6 months; group B did not take any drug; group C served as a control group.TAFI antigen levels of groups A and B were significantly higher than in controls, but no difference was observed between them. All of the other coagulation and fibrinolysis parameters (including prothrombin time, activated partial thromboplastin time, fibrinogen and D-dimer) were comparable between the three groups.The evidence presented herein suggests that women with PCOS have impaired fibrinolysis, as reflected by increased TAFI. This impairment can contribute to the risk of cardiovascular disease in PCOS. Elucidation of the modifiable mechanisms in PCOS can represent an opportunity for preventive therapy of the cardiovascular risks associated with PCOS.

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.

P-selectin, E-selectin, and mean platelet volume are markers associated with platelet reactivity that have been demonstrated to be increased in diabetes. We were particularly interested to see if there was a difference in mean platelet volume and selectins between diabetics and nondiabetics, and in diabetics with and without nephropathy, and whether there was a correlation between mean platelet volume and selectins. One hundred and fourteen diabetic patients and 31 healthy controls were investigated. Plasma levels of P-selectin and E-selectin were higher in the diabetic group than in controls ( P = .001 and P = .007, respectively) and in diabetic patients with proteinuria than in patients without proteinuria ( P = .002 and P = .004, respectively). Protein excretion was lower in patients with low mean platelet volume values ( P = .004). In conclusion, elevated platelet volume and high selectin values may play a role in the development of vasculopathies and complications in diabetes mellitus. Further studies are needed to prove these results.

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.

Among the different cardiovascular risk factors, lipid abnormalities dominate the high mortality in chronic ambulatory peritoneal dialysis patients. So far, no data comparing the effect of standard glucose-containing, amino acid-containing, and icodextrin-containing peritoneal dialysis solutions on serum lipid concentrations in a chronic ambulatory peritoneal dialysis population are available. To determine the effect of peritoneal dialysis solutions on parameters of lipid metabolism, 67 subjects who had continued their usual dialysis for the last six months were enrolled in the study. Group A consisted of 18 patients who were receiving only glucose-based peritoneal dialysis solutions, group B consisted of 18 patients who were receiving glucose and amino acid-based peritoneal dialysis solutions, and group C consisted of 31 patients who were receiving glucose and icodextrin-based peritoneal dialysis solutions. Serum lipid parameters including total cholesterol, low-density lipoprotein, high-density lipoprotein, triglyceride, and lipoprotein (a) were determined in all groups. No significant difference in serum lipid parameters was found between groups A, B, and C. These results demonstrate the lack of the effect of amino acid or icodextrin-based peritoneal solutions on dyslipidemia of CAPD patients.

Increased arterial stiffness is strongly associated with cardiovascular diseases, while thrombotic events are more common than hemorrhagic events in hypertensive patients. Markers of a hypercoagulable state may also predict future cardiovascular events in hypertensive patients. Here, we speculated that increased arterial stiffness might lead to the development of a hypercoagulable state that can play a role in the thrombotic complications of hypertension. Soluble endothelial protein C receptor (sEPCR) is one such marker of hypercoagulation. The ambulatory arterial stiffness index (AASI) could be accepted as a non-invasive measure of arterial stiffness. The aim of this study was to investigate association of AASI with levels of sEPCR in newly diagnosed hypertensive patients.The study included 263 newly diagnosed essential hypertensive patients and 55 healthy normotensive controls. All subjects underwent 24 h ambulatory blood pressure monitoring (ABPM); the AASI was derived from ABPM tracings. Plasma sEPCR was measured by ELISA.Hypertensive patients (n = 263) had higher AASI, C-reactive protein (CRP) and sEPCR versus the normotensive healthy group (n = 55). Univariate analysis showed that AASI was positively associated with age (r = 0.212, p 0.001) body mass index (r = 0.412, p 0.001), pulse pressure (r = 0.350, p 0.001), plasma sEPCR (r = 0.894, p 0.001), 24-h heart rate (r = 0.176, p = 0.001) and inversely related to high-density lipoprotein (HDL) (r = -0.293, p 0.001). Multivariate analyses revealed that sEPCR and HDL are independently correlated to AASI.We suggest that increased AASI is associated with elevated sEPCR. It might be responsible for subsequent thrombotic events in newly diagnosed hypertensive patients.

Non-alcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease worldwide. The aims of this study were to assess Neutrophil-Lymphocyte Ratio (NLR) and C-reactive protein (CRP), and their association with liver histology in patients with non-alcoholic steatohepatitis (NASH), chronic hepatitis B (HBV), and hepatitis C (HCV).We studied 38 consecutive patients with biopsy-proven NASH, 19 patients with HCV, 45 patients with HBV, and 35 healthy controls who were similar for age and gender. The stage of fibrosis was measured using a 6-point scale.NLR was significantly higher in NASH patients compared to controls, HBV, and HCV patients (p0.001, p0.001, and p0.001, respectively). NLR was positively associated with NAFLD activity scores (r=0.861, p0.001). NLR was associated with hepatocyte ballooning degeneration (r=0.426, p=0.024), lobular inflammation(r=0.694, p0.001), steatosis(r=0.498, p=0.007), and fibrosis stage(r=0.892, p0.001) in NASH patients. Univariate and multivariate analyses showed that NLR was significantly associated with liver fibrosis and NAS (β=0.631, p0.001 for liver fibrosis; β=0.753, p0.001 for NAS in the multivariate model); however, CRP had no association with liver fibrosis and NAS CONCLUSION: NLR is a promising and inexpensive inflammation marker that correlates with histological grade and fibrosis stage in NASH patients.

Objective. Subclinical hypothyroidism and vitamin D defi ciency are common. Th e diastolic function of patients with both subclinical hypothyroidism and vitamin D defi ciency remains unknown. Th is study aimed to investigate diastolic dysfunctio n in patients with both subclinical hypothyroidism and vitamin D defi ciency. Subjects and Methods. Th is study included 254 patients. All patients underwent standard Doppler echocardiography. Patients who had risk factors for diastolic dysfunction or had used L-thyroxine and vitamin D within the previous 3 months were excluded. Vitamin D defi ciency was defi ned as a 25-OH-vitamin D level lower than 20 ng/ml, and vitamin D suffi ciency was defi ned as a 25-OHvitamin D level ≥30 ng/ml. Subclinical hypothyroidism was defi ned as a TSH level of 4.5-10 mU/l when the free T4 concentration was normal. Results. Th e patients were divided into 4 groups. Group 1 (n=71) included patients with subclinical hypothyroidism and vitamin D defi ciency; Group 2 (n=66) included patients with subclinical hypothyroidism and vitamin D suffi ciency; Group 3 (n=65) included euthyroid patients with vitamin D defi ciency; and Group 4 (n=52) included euthyroid patients with vitamin D suffi ciency. LAVI (31.3±3.2, 28.7±3.0, 28.4±3.4, and 27.9±3.9; p

The objective of this study was to investigate the effects of types of dialysis treatments on hepatitis C virus infection and the epidemiologic properties of hepatitis C virus (HCV) infection at three Baskent University hospitals, in Ankara, Adana, and Izmir, Turkey, in 655, 326, and 118 patients with end-stage renal disease, respectively. One hundred thirty patients with HCV viremia among 271 patients with end-stage renal disease seropositive for HCV were included in this cross-sectional study. HCV RNA-positive patients were classified according to the renal replacement therapies (hemodialysis or continuous ambulatory peritoneal dialysis), and viral load, transaminase levels, and distribution of genotypes were compared between these subgroups. In the continuous ambulatory peritoneal dialysis group, 26 of 165 patients (16%) were serum anti-HCV positive, and 11 of 26 patients (42%) were serum HCV RNA positive. Twenty-six percent of the patients undergoing hemodialysis were anti-HCV positive, and 49% were HCV RNA positive. The prevalence of genotype 1b was 68% and 73% for patients in the continuous ambulatory peritoneal dialysis and hemodialysis groups, respectively. No significant differences were found between the genotype 1b and the non-1b groups or between different dialysis types with regard to age and sex and serum aspartate transaminase, alanine aminotransferase, and HCV RNA levels. We conclude that HCV seropositivity may differ between different types of dialysis treatments, although viral load and genotypes may be similar in persons with end-stage renal disease and those without.

Background: Peritoneal membrane permeability is of major importance for adequate dialysis and fluid balance in peritoneal dialysis (PD) therapy. The peritoneal capillary endothelium plays a key role in peritoneal transport. Nitric oxide derived from endothelial cells is related to the maintenance of vascular permeability. We investigated the relationship between the endothelial nitric oxide synthase (ENOS) gene polymorphism, the renin-angiotensin system (RAS) gene polymorphisms, and initial peritoneal transport type in PD patients. Methods: This study included 74 incident continuous ambulatory PD patients. The ENOS gene polymorphism was identified at the 4a/b variable number of tandem repeats in intron 4. Genetic polymorphisms of the renin-angiotensin system were performed for the angiotensin-converting enzyme I/D, angiotensinogen M235T, and angiotensin II type 1 receptor A1166C and type 2 receptor C3123A by polymerase chain reaction. Patients were divided into two groups according to the initial peritoneal equilibration test results performed within 3 months of PD therapy: group 1 consisted of high/high average transporters (n = 41), and group 2 consisted of low/low average transporters (n = 33). Results: Demographic, clinical, and laboratory data were similar between the two groups (p > 0.05). Group 1 had a significantly higher prevalence of the ENOS b/b genotype than group 2 (78% vs. 48.5%, p < 0.008). In contrast, group 2 had a significantly greater prevalence of the ENOS a/a+a/b genotype than group 1 (51.5% vs. 22%, p < 0.008). Genetic polymorphisms of the renin-angiotensin system were not associated with initial peritoneal transport type (p > 0.05). Conclusions: Modulation of the nitric oxide activity via the ENOS a/b polymorphism may have a considerable effect on the basal peritoneal permeability.

Acetaminophen (APAP) induced toxicities have been a major problem in clinical practice. The aim of the present study was to demonstrate a possible protective role of erdosteine, a mucolytic agent having antioxidant properties via its active metabolites, on APAP induced renal damage in rats. Female Wistar Albino rats were divided into groups including control, erdosteine (150 mg/kg, oral), APAP (1 g/kg, oral) APAP+erdosteine (150 mg/kg, oral) and APAP+erdosteine (300 mg/kg, oral). APAP treatment caused lipid peroxidation as well as high NO level in renal tissue. Also, APAP treated rats had decreased activities of CAT and GSH-Px, but not SOD. In addition, tubular epithelial degeneration, vacuolization and cell desquamation were clearly observed in the APAP treated rats. The cellular debris in the proximal tubules and cortical interstitial congestions were prominent in the kidneys of APAP treated rats. BUN and creatinine levels were increased after APAP administration. All these pathological changes were reversed after erdosteine treatments. Erdosteine treated APAP groups showed milder tubular degeneration, epithelial vacuolization in the proximal tubules, lesser cellular desquamation and better morphology when compared with APAP groups. In conclusion, erdosteine may be a choice of preventive treatment against APAP induced nephrotoxicity.