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Amaç: Kronik böbrek hastalığı (KBH) bulunanlarda morbidite ve mortalite oranları genel popülasyonla karşılaştırıldığında yüksektir. Kardiyovasküler hastalıklar KBH popülasyonunda oldukça sıktır ve mortalitenin en sık sebebidir. KBH bulunan hastalarda kardiyovasküler mortaliteyi etkileyen önemli faktörlerden birisi sıvı ve elektrolit dengesidir. Çalışmamızda hemodiyaliz hastalarında interdiyalitik kilo alımı (IDWG)’nın kardiyovasküler (KV) morbiditeye ve mortalite olan etkilerini saptamayı ve nutrisyonel parametrelerle olan ilişkisini incelemeyi amaçladık. Gereç ve Yöntemler: Hemodiyaliz merkezlerinde diyalize giren 111 hasta retrospektif olarak tarandı. Çalışmaya en az 6 ay boyunca haftada 3 defa hemodiyaliz olan hastalar dahil edildi. Hastaların kuru ağırlığı klinik bulgulara göre hesaplandı. Kuru ağırlık değerlendirilirken sıvı yüklenmesi durumunu gösteren ödem, kan basıncı yüksekliği, akciğer grafisinde kardiyotorasik indeks incelendi. Hastaların normotansif kaldığı diyaliz sonrası ağırlık, kuru ağırlık olarak kabul edildi. İnterdiyalitik kilo alımı diyaliz öncesindeki kilo ile sonrasında kuru ağırlığına eriştiği kilo arasındaki fark olarak hesaplandı. IDWG’nin diyaliz sonrası vücut ağırlığına bölünmesiyle IDWG’nin vücut ağırlığına oranı hesaplandı. Hastaların 0-6-12-18. ve 24. aylardaki IDWG değerleri kaydedildi. Hastaların dosyalarından aynı kişi tarafından yapılan ekokardiyografi değerlendirmeleri alındı. Bulgular: İki yıllık takipte 17 hastada mortalite gelişmişti Mortalite gelişen ve gelişmeyen hastalarda IDWG miktarı sırasıyla vücut ağırlığının %3.84 ve %3.67’si olarak bulundu(p=0.64). Çalışmamızda IDGW yüksek (diyaliz çıkış ağırlığının %4.8’inden fazla) olanlarda mortalite (5/18) %27, IDWG düşük olanlarda (12/93) %12 olarak saptandı (p=0.11). Mortalite grubunda sistolik ve diyastolik kan basınç ortalamaları sırasıyla 125 mmHg ve 75.8 mmHg iken (sistolik kan basıncı için p=0.96; diyastolik kan basıncı için p=0.82), mortalite gelişmeyen grupta ise sistolik ve diyastolik sırasıyla 125 mmHg ve 79 mmHg olarak saptandı. Sonuç: Çalışmamızda mortaliteyi etkileyen faktörler diyabet varlığı, Ejeksiyon Fraksiyonu (EF) ve ileri yaş olarak bulunmuştur. Hemodiyaliz hastaları yaş, hastalık, ve mortalite açısından değerlendirildiğinde iyi takip ve uygun tedavi hemodiyaliz hastalarının sonuçlarını iyi yönde etkilemektedir.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are systemic autoimmune diseases that may lead to renal failure due to the infiltration of mononuclear cells and the destruction of small- and medium-sized blood vessels. It has been shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger the presentation or exacerbation of autoimmune diseases. Crescentic glomerulonephritis (GN) has rarely been reported in patients with Coronavirus disease-2019 (COVID-19). We present rare two cases with AAV after a recent diagnosis of COVID-19. The first case was 26-year-old male patient, who was presented with acute kidney injury after COVID-19. Serum creatinine increased and active urine sediment was seen. Serological evaluation showed anti-myeloperoxidase antibody was at a level of 80.6 U/mL. Kidney biopsy showed necrotizing GN with cellular crescents. Methylprednisolone, cyclophosphamide and plasma exchange were administered. He was discharged with hemodialysis. Second case was a 36-year-old female who was hospitalized because of fever, cough and dyspnea. After she was diagnosed with COVID-19, she had total hearing loss, with cavitary lesions on bilateral lung parenchyma and an acute kidney injury. Serological evaluation showed an elevated anti-proteinase-3 with a level of 1:32. Kidney biopsy showed necrotizing GN with cellular crescents. Renal function improved after methylprednisolone and cyclophosphamide treatment. With a systematic review of the literature, we found four cases of new-onset AAV due to COVID-19. Herein, we discuss two cases and provide a literature review on cases of new-onset pauci-immune GN after COVID-19 infection.

Patients who were urgent start peritoneal dialysis (USPD) were evaluated in terms of complications.The data from 102 patients (43 males and 59 females, mean age 58.18 ± 15.3 years) who were on peritoneal dialysis with a placed catheter between January 2014 and June 2019 in our Nephrology clinic was evaluated. The patients were divided into three groups according to the starting time of peritoneal dialysis. The development of complications between the groups (peritonitis, leakage, hernia), hemodialysis return time and overall survival times were compared.There was no difference between the groups in terms of survival and complications. Diabetes, advanced age, albumin values were found to be risk factors for mortality, while no differences were found between the groups in terms of complications and mortality.USPD can be recommended for both because it provides a permanent dialysis option and because it leads to fewer complications than urgent start HD.

WOS: 000383902000015 PubMed: 27435174 Aim: Contrast medium-induced nephropathy is one of the major complications of intravenous contrast medium use. But its pathogenesis is unclear. Epithelial mesenchymal transition (EMT) is defined as the transformation of the primer epithelial cells to mesenchymal cells. EMT in tubular cells might cause tubulointerstitial damage. In this study, we investigated whether or not EMT has a role in radiocontrast-induced nephropathy. Radiocontrast medium might be triggering reversible EMT via serum and glucocorticoid-regulated kinase 1 (SGK 1). We investigated the effect of different concentrations of the contrast agent iopromide on human proximal tubule cell (HK-2) culture by measuring the level of SGK1, snail family zinc finger 1 (SNAIL1), connective tissue growth factor (CTGF), and collagen type I alpha 1 (COL1A1).Methods: We conducted a scratch assay and qPCR. HK-2 cells were cultured in the petri dishes/flasks and starved with serum-free medium. The 40, 20, and 10mg/mL doses of iopromide were administrated to cells. The scratches were photographed immediately and again at the 20th hour. The levels of gene expression of SGK1, SNAIL1, CTGF, and COL1A1 were measured using the real-time qPCR system at the end of the 24th hour.Results: Iopromide caused the breaking of intercellular connections, the disappearance of the cobblestone appearance of cells, and the migration of cells at the 20th hour in the scratch assay. It also increased the expression of SGK1, SNAIL1, CTGF, and COL1A1 genes.Conclusion: Our study concluded that certain important markers of EMT increase in different concentrations of the contrast agent. High osmolality might trigger EMT. The relationship between contrast agent and EMT has not been defined before. Further in vivo and in vitro studies are required. research foundation of Ondokuz Mayis University [PYO.TIP.1901.13.046] This study was supported by the research foundation of Ondokuz Mayis University [PYO.TIP.1901.13.046].

Familial Mediterranean fever (FMF) is an autosomal recessive genetic disease. Amyloidosis is the most important complication of FMF that determines the prognosis of the disease.In our study, we have investigated the relationship between the genetic mutations with the disease severity and the frequency of development of amyloidosis inpatients with FMF.A total of 148 patients with FMF were included this study. The relationship between disease activity score, clinical findings, response to treatment, and presence of amyloid and genetic mutations were evaluated.One hundred forty-eight patients (80 women (54%), 68 men (46%)) were enrolled over 18 years of age. The mean age of the patients was 30.98 ± 11.18 (18-67) years. In our study, the most frequently seen mutations are M694V, M680I, R202Q, and E148Q, respectively. The most common genotype is M694V/M694V mutation and this mutation has been found in 37 patients (25%). In 25 patients, M694V heterozygous have been found (16.8%). The third frequent mutationis M694V/M680I/R202Q has been found in13 patients (8.7%). In 23 patients, amyloidosis has been developed. Ten patients with amyloidosis have M694V homozygous mutations (27%) and 5 patients with amyloidosis M694V heterozygous (20%) mutations. The both of the two patients who carry the homozygous E148Q mutations have developed amyloidosis.In our study, the distribution of the frequency of mutations is consistent with other similar studies performed in Turkey. We found that patients with M694V mutation had a significantly higher rate of exacerbation, higher drug doses for treatment, and a close relationship with amyloidosis, as compared to patients with other mutations.

ResumoIntroduçãoColchicina é a viga‐mestra para o tratamento de FFM, que é uma doença autoinflamatória com polisserosite recidivante como principal manifestação. Apesar de doses diárias de 2mg ou mais/dia, aproximadamente 5%‐10% dos pacientes continuam a sofrer de seus ataques. Neste estudo, objetivamos investigar os aspectos da depressão e dos ataques em pacientes com FFM apresentando resistência à colchicina (RC).Pacientes e MétodosEm pacientes com FFM, RC foi definida como dois ou mais ataques nos últimos seis meses, quando em medicação com colchicina 2mg/dia. Dezoito pacientes (nove mulheres e nove homens) foram recrutados no grupo RC e 41 pacientes no grupo de controle (29 mulheres/12 homens). Foram avaliados os achados demográficos, clínicos e laboratoriais, a fidelidade ao tratamento e os escores do Beck Depression Inventory (BDI).ResultadosA idade de surgimento da FFM foi significativamente menor no grupo RC (12,3 anos vs. 16,9 anos, P=0,03). A duração da doença foi maior no grupo RC (p=0,01). Dores abdominais e nas pernas em decorrência do exercício foram significativamente mais frequentes no grupo RC versus controles (83% vs. 51%; p=0,02 e 88% vs. 60%; p=0,04, respectivamente). Pacientes com escores BDI>17 pontos foram mais frequentes no grupo RC versus controles (50% vs. 34,1%; p

Background Smoking can have negative effects on renal function in healthy individuals, which may result in kidney disease. To determine knowledge, behavior, and attitudes toward smoking cigarettes and using smokeless tobacco among patients with chronic renal failure, we sought to provide evidence for appropriate precautions and guidance for further research. Methods The study included 86.7% of 390 patients undergoing treatment for chronic renal failure who completed a 30-question instrument. Results Of the participants, 7.9% were smokers and 12.6% ex-smokers. Among the smokers, 61% said they wanted to quit and 45% said they needed help to quit. Of the participants, 9.5% were using Maras powder, a type of smokeless tobacco. Of the smokeless tobacco users, 55.6% noted that they wanted to give it up. The rate of the participants smoking cigarettes and/or using smokeless tobacco was 17.4%. In addition, 38.9% of the participants said that they started to use smokeless tobacco to quit smoking cigarettes. Of the participants, 62.6% thought smoking was harmful to the kidneys. The rate of the passive smokers was 30.2%. Of the participants, 66.3% explained that they were exposed to smoke at home. Conclusions Appropriate interventions should begin to help patients with chronic renal failure stop smoking and to prevent them from exposure to cigarette smoke. Smokers should be informed that using smokeless tobacco is not a way to stop smoking cigarettes. Education programs should be conducted to prevent people from using smokeless tobacco and to help smokeless tobacco users to quit their habit.

Real-time sonoelastography (RSE) is a relatively new imaging technique that visualizes relative difference in tissue hardness by evaluating changes in local strain in response to external stress. Our aim was to evaluate the ability of investigators to use sonoelastography to detect differences in renal cortical stiffness and assess the relationship between stiffness and clinical-Doppler parameters. In 42 adult renal transplant recipients, sonoelastography of kidney was performed to calculate the strain ratio (SR) of the central echo complex to the renal parenchyma. Resistive index (RI) and pulsatility index (PI) were also measured. Estimated glomerular filtration rate (eGFR) was calculated. Parenchymal stiffness showed significant positive correlation with RI and PI (r: 0.41 p = 0.007 and r: 0.48 p = 0.001, respectively). Parenchymal stiffness and eGFR did not have a significant correlation ( p = 0.42). Interobserver agreement, expressed as intraclass correlation coeffiicient was 0.47 (95% CI: 0.05–0.70). Parenchymal stiffness (SR) showed significant positive correlation with RI and PI but sonoelastography has also wide range intra- and low interobserver agreement in renal transplants. Further studies are warranted in larger patient groups to determine the reliability of sonoelastography in renal transplants.

Introduction: Apelin is secreted from white fat tissue, and it is an adipokine. Increased apelin levels were observed in kidney biopsy of rats formed nephropathy throughout glomerular basal membrane. Thus, the purpose of this study was to evaluate the difference of apelin-13 levels in patients with glomerulonephritis and healthy patients. Materials and Methods: This study included 107 subjects, comprising 53 glomerulonephritis patients that were newly diagnosed and under continuing treatment and 54 healthy individual used as control group. Demographic data and laboratory findings were recorded from hospital information file system. Apelin-13 levels were compared between the patient and control group. Furthermore, relationship between apelin-13 levels and arterial blood pressure, mass body index, proteinuria, albumin, creatinine was evaluated in the patient group. Results: Apelin-13 level exhibited averages of 1863 ± 1783 pg/ml in patient group and 2392 ± 1846 pg/ml in control group. No significant differences were found between groups. Apelin levels between the glomerulonephritis patients with proteinuria and glomerulonephritis patients without proteinuria were compared, patients with proteinuria had 1784 ± 1756 pg/ml and patients without proteinuria had 2274 ± 1896 pg/ml apelin-13. Between the two groups there was not a significant difference. Discussion: In summary, our findings indicate that apelin-13 levels showed no significant difference between the patients with glomerulonephritis and healthy control group.

Epidemiological studies indicate that in chronic HD patients, bacterial and viral infection rank second place in mortality and morbidity, behind cardiovascular disease. Chronic hepatitis C virus (HCV) is very prevalent in some Hemodialysis (HD) centers. We have investigated lymphocyte subtype count and immunoglobulin levels in hemodialyzed patient with HCV. We studied 55 patients with end stage renal disease (ESRD) on chronic HD and 21 healty subjects. Patients group included 34 female and 21 male with mean age 46.5±16.1(18-77) years. Serum concentrations of IgG, IgM, IgA, CD4, CD8, CD19, CD16-56 lymphocytes were measured. Kt/V values were calculated according to DOQI guideline. Lymphocyte and lymphocyte subgroups values of HD patients were significant lower than healty persons. IgG, IgM and ALT levels of HCV positive HD patients compared with significant higher than HCV negative HD patients. CD4/CD8 ratios within groups were no differences. Lymphocyte subtype count of between HCV positive and HCV negative HD patients was no differences. IgG and IgM levels of HCV positive HD patients were higher than HCV negative HD patients. High Ig levels were also associated with ALT levels

Compared with the general population, patients with chronic renal failure have increased tuberculosis (TB) prevalence and mortality rates. In this study, we aimed to investigate tuberculin skin test (TST) positivity rates in hemodialysis (HD) and peritoneal dialysis (PD) patients and the factors influencing TST positivity. Ninety-two HD patients and 44 PD patients who had been on HD and PD treatment for at least 3 months were recruited into the study. TST was administered in all patients. Positivity was defined as an induration diameter >10 mm. At least 5 mm of induration following skin testing together with a chest radiography indicating previous infection was defined as latent TB infection. TST positivity rates, diameter of TST indurations, and serum albumin levels in HD patients were higher than the PD patients. TST induration size was not correlated with any other parameters in both HD and PD groups. TST-positive patients had higher albumin levels and lower leukocyte count than the TST-negative patients. In TST-positive patients, albumin level was correlated with the duration of dialysis but TST induration size was not correlated with the lymphocyte count and albumin level. In our study, TST positivity of patients was found in 30.4% of HD patients, 9% of PD patients, and 23.5% of total patients. It is still recommended to use TST for the screening test of TB. We found a significant relationship between TST and albumin level. It should be remembered that TST response may be lower in PD patients, especially in cases in which TB is suspected.

Aim: Uremia is often associated with a large array of thoracic complications. Radiological examinations have great importance in diagnosis of thoracic diseases. The main focus of this retrospective study was to document the multidedector computed tomography (MDCT) findings involving thoracic complications in hemodialysis patients. Method: Twenty-nine hemodialysis patients who had one or more of the following complaints; dyspnea, cough, malaise, weight loss, fever were included undergone MDCT in this study. Result: The MDCT and chest x-ray findings in our patients were as follows; cardiomegaly (13 vs. 12), ground-glass opacity (10 vs 0), pleural effusion (10 vs 9), parenchymal infiltration (9 vs. 2), scarring-fibrosis (9 vs. 3), pleural thickening (6 vs. 3), mediastinal and/or hilar lymphadenopathy (6 vs 0),’tree in bud’ appearance (5 vs. 0) atelectasis (4 vs. 0) , and emphysema (1 vs. 0) respectively . Conclusion: Our findings suggest that MDCT revealed many pathologic findings that chest x-ray could not detect.

The prevalence of restless legs syndrome (RLS) ranging from 6.6% to 83% has been reported in different case series. The pathophysiology of RLS in uremia is still unclear. The aim of this study was to assess the frequency of RLS in the hemodialysis patients and to explore depression and associated detrimental impact on quality of life. The diagnosis of RLS was made using the criteria of the International Restless Legs Study Group. The polyneuropathy was diagnosed according to clinical signs and symptoms. Each subject completed three questionnaires: Beck Depression Inventory, Short Form-36 Quality of Life Scale, and the Epworth Sleepiness Scale (ESS). Biochemical parameters including hemoglobin, serum ferritin, and Kt/V index were collected. The data of the patients with and without RLS or clinical polyneuropathy (PNP) were compared. There were 41 male and 40 female patients. RLS, PNP, and high ESS scores were seen in 12%, 47%, and 7% of hemodialysis patients, respectively. Beck depression inventory scores were high in patients with RLS when compared to those without (28.9 ± 9, p = 0.007). General health score in the RLS patients, physical functioning score in the PNP patients were significantly lower (GH, 20.7; p = 0.036; PF, 10.5; p

WOS: 000327884500012 Hypertension is an important health problem. Informative counseling is required for patients to completely understand the importance of non-pharmacologic treatments. Lifestyle changes such as restriction of salt intake, exercise, restriction of alcohol intake, diet, and weight loss are included in all hypertension treatment guidelines. However, serious motivation is required from the patient and the physician to succeed in this. Although the decrease in blood pressure may be limited with these measures, lifestyle modifications should be continued. Turkish Society of Hypertension and Renal Diseases Publication costs for this article were supported by the Turkish Society of Hypertension and Renal Diseases, a nonprofit national organization in Turkey.

Background: Pulmonary hypertension (PH) has been reported to be high among end-stage renal disease (ESRD) patients. Objectives: The aim of this study was to investigate the role of arteriovenous fistula (AVF) flow in the pathogenesis of PH and the prevalence of PH in patients with chronic renal failure (CRF) and to suggest other possible etiologic factors. Methods: The prevalence of PH was prospectively estimated by Doppler echocardiography in 116 ESRD patients on regular hemodialysis (HD). Laboratory and clinical variables were compared between patients with and without PH (groups 1 and 2, respectively). PH was defined as systolic pulmonary artery pressure (SPAP) over 30 mm Hg. Patients with PH underwent further evaluation by 2 pulmonologists. AVF flow was measured by Doppler ultrasonography. Blood tests including arterial blood gases, hemoglobin, serum calcium, phosphorus and parathyroid hormone were determined. Results: PH was found in 25 (21.6%) patients (group 1) with an SPAP of 37.9 ± 2.8 mm Hg. Mean AVF flow was increased (1,554 ± 207.60 ml/min) in group 1. Left ventricular ejection fraction (LVEF) was significantly different between the 2 groups (55.3 ± 11.5 and 64.4 ± 40, respectively; p < 0.05). Neither significant primary lung disease nor parenchymal lesions were detected in group 1. PH showed a significant difference for cigarette smoking (p < 0.05). In group 1 the prevalence of cigarette smoking was higher. The main etiology of CRF was diabetes mellitus with a ratio of 44% in group 1. Conclusion: Our study demonstrated a surprisingly high prevalence of PH among patients receiving long-term HD. PH was related to high AVF flow, low LVEF and cigarette smoking. AVF flow and cigarette smoking are important correctable causes of PH. Early detection is important in order to avoid the serious consequences.

Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP/HUS) is a multisystem disorder characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, renal function abnormalities, and fever. Coexistence of TTP/HUS and adult onset Still's disease (ASD) is extremely rare. We report the case of a 46-year-old woman who presented with fever, arthritis, myalgias, petechia on skin and confusion five years after the onset of ASD. Thrombocytopenia, renal failure, marked elevation lactate dehydrogenase, and red cell fragmentation on peripheral blood smear were observed. We made a diagnosis of TTP/HUS associated with ASD, according to physical examination and characteristic laboratory data. She recovered from the TTP/HUS following daily sessions of therapeutic plasma exchange with fresh frozen plasma replacement and glucocorticoid therapy. Awareness of the possible development of TTP/HUS in ASD is important for early diagnosis and treatment.

By the time patients require dialysis replacement therapy, nearly all chronic kidney diseases (CKD) patients are affected with uremic bone diseases. High-turnover osteodystrophy can be prevented; patients with CKD should be monitored for imbalances in calcidiol (25 OH vitamin D), calcium, and phosphate homeostasis. We aimed to determine the effect of a monthly oral 300,000 IU vitamin D(3) (cholecalciferol) supplementation on the uremic bone diseases (UBD) markers such as iPTH and alkaline phosphatase in CKD patients. Among a total of 70 patients under treatment in the nephrology unit, 40 predialysis CKD patients (mean age of 49 +/- 14, male/female 20/20) were included the study. The patients were randomly divided into two groups. Treatment group included 20 patients (mean age of 51 +/- 14, male/female 9/11), and the control group comprised 20 patients (mean age of 47 +/- 14, male/female 9/11). Treatment group patients were given a single dose of Devit3 ampoule (300,000 U cholecalciferol) per month orally way. Patients in the control group did not take any vitamin D for a month. The level of calcidiol was lower than normal range in two groups. After a month, treatment group patient's calcidiol increased statistically significant (6.8 +/- 3.5 to 17.8 +/- 21.4 ng/mL, p < 0.001). After a month, iPTH level decreased in the treatment group statistically significantly (368 +/- 274 to 279 +/- 179 pg/ml, p < 0.001). At the 30(th) day of the treatment, in 9/20 of the treatment group patients (45%), the iPTH value decreased at least 30% (p < 0.001). We suggest that oral depot cholecalciferol treatment causes a statistically significant decrease of serum iPTH level but does not cause a statistically significant change in Ca, P, ratio of Ca x P, or urinary calcium creatinine rate in UBD predialysis CKD. This treatment can be used safely for the predialysis CKD patients, along with the cautious control of serum calcium and phosphor.

Background. Chronic kidney disease (CKD) and hemodialysis (HD) patients who cannot restrict sodium consumption in their diets sometimes develop significant saline excess and hypertension between dialyses. This study assessed the effect of relatively low sodium dialysate dialysis on changes of echocardiography in hemodialysis patients. Methods and Results. Eighteen patients with end stage renal failure on chronic HD were studied (8 females, 10 males) with a mean age 48.3 +/- 14.6 (24-70) years. The mean time on HD was 30.8 +/- 14.0 (12-60) months. Patients with hematocrit levels under 24% were excluded from the study. In all patients, echocardiography was performed thrice weekly before and after eight-week HD treatment with low sodium dialysate hemodialysis by the same operator (135 mEq/L for patients with sodium levels less than 137, 137 for patients with sodium levels over 137). Left atrium (LA) and left ventricle (LV) volumes and ejection fractions were measured, specifically: LV systolic diameter (LVSD), LV diastolic diameter (LVDD), interventricular septum (IVS), tricuspid regurgitation (TR), mitral regurgitation (MR), pulmonary artery pressure (PAP), and inferior vein cava diameter (IVCD). Results. In terms of echocardiographic parameters, LVSD, TR, PAP, and IVCD were statistically decreased after low-sodium dialysate treatments (p = 0.002, 0.04, 0.013, and 0.00, respectively). Predialysis systolic and diastolic blood pressure (BP), post-dialysis systolic blood pressure, and interdialytic weight gain was statistically decreased when compared to basal levels (p = 0.00, p = 0.011, p = 0.022, p = 0.001, respectively). Conclusion A reduction of the dialysate sodium concentration based on the predialysis sodium levels of the patients could reduce the systolic BP and decrease the volume load on the heart as assessed by echocardiography. Within this short period, postdialysis diastolic BP could not be lowered. The effect of this approach should be studied in broad and lengthy series.

Peritoneal dialysis (PD) is a treatment modality for patients with renal failure. Peritoneal fibrosis is one of the most serious complications after long-term continuous ambulatory peritoneal dialysis (CAPD). Histological studies in both humans and animals show that chronic peritoneal dialysis results in fibrosis of the peritoneal membrane. In our study, we investigated the effect of colchicine on peritoneal alterations induced by hypertonic PD solution in rats. Sprague-Dawley rats intraperitoneally received saline (control group) once daily, for 28 days, or 3.86% glucose (PDF group), or 3.86% glucose plus colchicine (colchicine group). Animals from each group were sacrificed after 28 days with anesthetized ketamine (60 mg/kg BW). For the PD fluid assessment, 1 h before the sacrifice of animals, 10 mL PD fluid of 2.27% glucose was given, and this fluid was obtained after the sacrifice. The levels of transforming endothelial growth factor beta (TGF-beta), tumor necrosis factor alpha (TNF-alpha) and albumin were investigated both in the peritoneal dialysate and blood, and the levels of malondialdehyde (MDA) were investigated only in peritoneal dialysate. The peritoneal membrane was evaluated histologically by light microscopy. When groups were compared in terms of body weight change, the colchicine group significantly lost weight compared to controls and PDF group (-4.7% + 4.5, 3.5% +/- 7.2, 3.0% +/- 1.3, respectively, p = 0.018). Also, the blood albumin level was significantly lower for these in the colchicine group compared to those in the PDF group (2.7 +/- 0.35 versus 3.2 +/- 0.3 g/dL, respectively, p = 0.048). The blood TGF-beta level was significantly lower in the control group, and no difference was observed between the PDF and colchicine groups (294.4 +/- 67.5 versus 787.4 +/- 237.4 versus 615.3 +/- 235.1 pg/mL, respectively, p = 0.004). The mesothelial thickness found in groups was as follows: control group 102 +/- 18.9 microm, PDF group 128.33 +/- 33.1 microm, colchicine group 117 +/- 35.6 microm (p = 0.34). In conclusion, a rat model for peritoneal dialysis associated peritoneal derangement without fibrosis could be induced. Colchicine could not prevent peritoneal derangement in this model.

Apelin is an adipokine secreted by the adipose tissue and by the endothelial cells in various parts of the body. Apelin is also expressed by the glomerular arteriolar rectus and glomerular capillary cells. We evaluated the relationship between the initial serum levels of apelin 13 with the trend of glomerular filtration rate (GFR) during a 1-year follow-up of patients with chronic kidney disease (CKD).Ninety-nine patients with CKD in the predialysis stages were included and completed the study. The demographic data, medications, and comorbidities of the patients were recorded. The relationship between the baseline apelin 13 levels and the 1-year GFR loss was evaluated. Results. The mean 1-year GFR loss 1.6 mL/min for those with CKD stage 3, 5.1 mL/min for those with CKD stage 4, and 2.6 mL/min for those with CKD stage 5. Fifty-eight patients (58.6%) had a GFR loss less than 5 mL/min and 41 (41.4%) had a GFR loss of 5 mL/min and greater, for whom the mean apelin 13 levels were 2169 ± 1807 mL/min and 2513 ± 1920 mL/min, respectively (P = .36). There was no significant correlation between the apelin 13 levels and GFR loss (P = .35).To our knowledge, this study was the first that clinically examined the relationship between apelin 13 and CKD progression. Apart from the diabetic nephropathy, several factors causing comorbidity and progression may have probably masked this potential relationship.

We lack information about the role of late diagnosis of end-stage renal disease (ESRD), late nephrological referral and its impact on biochemical variables and first hospitalization in East Anatolia, Turkey.For a total of 101 ESRD patients, dialysis was initiated between January 1998 and December 2002 at the Yuzuncu Yil University Hospital. Early referral (ER) and late referral (LR) were defined as the time of first referral or admission to a nephrologist greater or less than 12 weeks, respectively, before initiation of haemodialysis (HD).The need for urgent dialysis was less among the early referral cases compared with the late referral cases (P = 0.03). Patients with LR started dialysis with lower levels of haemoglobin (8.6 vs 9.5 g/dL, P0.05) bicarbonate (16 vs 12 mEq/lt, P0.03) and albumin (2.9 vs 3.29 mg/dL, P0.02) and with higher serum levels of blood urea nitrogen (173 vs 95 mg/dL, P0.001), creatinine (10 vs 7.9 mg/dL, P0.001) and potassium (5.3 vs 4.8, P0.04). Hospitalization duration beginning at dialysis was significantly longer in the LR group (27.3 +/- 24) compared with the ER group (13.4 +/- 7.5, P0.001). When the groups were compared in terms of distance between the patients home and hospital, there were significantly more patients living far away from hospital (i.e.100 km) in the LR group compared with the ER (P0.0001) group.Early referral to a nephrology unit and/or early diagnosis of ESRD results in better biochemical variables, shorter first hospitalization length and a higher percentage of elective construction of AVF and the availability to start with an alternative dialysis modality (i.e. CAPD).

Lactic acidosis (LA) associated with hematologic malignancies is uncommon, life-threatening, and generally occurs in adults. Its pathogenesis is poorly understood. This is a case report of LA due to leukemic transformation that occurred in a patient with non-Hodgkin's lymphoma (NHL). A 24-year-old man with NHL was admitted to the hospital with dyspnea. Venous blood gas analysis revealed metabolic acidosis (pH 7.05; HCO3 6 mEq/L; BE 22 mmol/L; anion gap 28 mEq/L); the patient had an elevated plasma lactate concentration (12 mmol/L) and low glucose concentration (38 mg/dL). There was no reason other than leukemia-such as infection, circulatory failure, or drug use-for the development of severe LA. This case report shows that in patients with NHL, leukemic transformation may give rise to LA.

Angiotensin-converting enzyme inhibitors (ACEIs) were accepted as a potential cause of inadequate epoetin response in chronic kidney disease (CKD) patients. We aimed to determine the effects of valsartan, an angiotensin receptor blocker (ARB), on serum ertyhropoietin levels and on certain biochemical and haematological parameters in hypertensive CKD patients. Twenty-two stage III-IV CKD patients (mean age; 56.8 +/- 8.9 years, 12 male 10 female) were included in the study. Before initiating the treatment, current anti-hypertensive treatments (if any) were discontinued, and blood samples were collected after a washout period of 3 weeks. Valsartan 80 mg/day was started, and additional anti-hypertensive agents were given according to study protocol if needed. One way Anova and paired t-tests were used for statistical comparisons. Serum blood urea nitrogen (BUN), creatinine, uric acid, potassium, haemoglobin and erythropoietin values were measured, and glomerular filtration rates were calculated before and 3, 6 and 90 days after valsartan treatment, a significant reduction in EPO level was observed at 3rd (19.6 +/- 24.0 vs. 13.8 +/- 8.5, p = 0.010), 6th (12.1 +/- 7.6, p = 0.009), and 90th days (8.3 +/- 5.4, p = 0.007). When pre-treatment values were compared with 90th day results, no significant change was observed in terms of hgb, htc, serum BUN, creatinine, uric acid, potassium, and GFR values. In conclusion, valsartan, an ARB, did not decrease haemoglobin levels in stage III-IV CKD patients despite significant reduction in serum erythropoietinlevels, so ARBs may be preferred to ACEIs in CKD patients when indicated.

Internal Jugular vein (IJV) thrombosis is a rare entity. It is usually secondary to various etiologies such as catheter, malignancy, trauma, infection and hypercoagulable status. Associated malignancies, either known or occult, are also uncommon and not well documented in the etiology of IJV thrombosis. We reported IJV thrombosis with two different pathologies i.e. malignacy and congestive heart failure. The diagnosis of IJV thrombosis was established with Doppler ultrasound and CT scan. These patients were treated low-molecular-weight heparin and oral anticoagulation. Early diagnosis and appropriate management is important to prevent potentially fatal complications from internal jugular vein thrombosis.

The frequency of chronic renal insufficiency among cancer patients is unclear. The aim of this study was to determine the frequency of impaired renal function within a population of cancer patients. One thousand two hundred seventeen patients (563 women, 654 men) with cancer underwent serum creatinine concentration and glomerular filtration rate (GFR) evaluations. The Cockcroft-Gault formula was used to estimate the GFR from the creatinine clearance (Cl-cr). Renal insufficiency was defined as a GFR 1.2 mg/dL). According to the Cockcroft-Gault formula evaluations, however, 330 (27.1%) of the patients had an estimated GFR

Uremia induces a suppression of the immune status. A large clinical literature suggests that estradiol (E-2) plays a critical role in immune function. A large proportion of women hemodialysis patients faced early menopause and inadequate estrogen levels. The aim of the present study is to evaluate the effect of hormone replacement therapy on immune function in terms of CD4(+) numbers (inducer/helper T cells), CD8(+) numbers (cytotoxic/ suppressor T cells), CD4(+)/CD8(+) ratio, and IgG, IgM, IgA levels in woman hemodialysis patients. In our study, 15 female hemodialysis patients (median age 32.6 range 24-45) were treated with triphasic estrogen/progesterone preparation (estradiol 2 mg for 10 days, and afterwards estradiol 2 mg+norethisterone 1 mg for another 10 days, and at the end estradiol 1 mg for 6 days) for 6 months. CD4(+) numbers, CD8(+) numbers, and IgG, IgA, and IgM levels were determined before and after HRT. The "paired-samples T" test was used for statistical analysis of pretreatment and posttreatment values. A significant increase was observed for CD4(+) numbers (582 +/- 435 versus 637 +/- 445, p=0.04) and CD4(+)/CD8(+) ratio (1.4 +/- 0.16 to 2.4 +/- 0.3, p

BACKGROUND: Indapamide is an antihypertensive agent similar to thiazides, but with some different effects. Thiazide and thiazide-like diuretics are useful in preventing recurrent urinary stone formation due to their hypocalciuric effects. OBJECTIVE: To determine the hypocalciuric and other effects on certain laboratory parameters of indapamide 1.5 mg in different patient groups. METHODS: Four groups of patients recruited from urology and nephrology outpatient departments were experiencing non-hypercalciuric urinary stone disease (group 1), idiopathic hypercalciuria (group 2), urinary stone disease with hypercalciuria (group 3), and essential hypertension (group 4). In all patients, fasting serum uric acid, calcium, sodium, potassium, cholesterol, triglyceride, parathyroid hormone (PTH) values, and morning second-spot urine calcium and creatinine levels were assessed before and 8 weeks after treatment with indapamide. RESULTS: Urinary calcium excretion was reduced significantly in all groups: group 1 from 0.10 ± 0.02 to 0.07 ± 0.03 (mean ± SD; 30% reduction; p < 0.001), group 2 from 0.30 ± 0.15 to 0.15 ± 0.10 (50% reduction; p < 0.001), group 3 from 0.35 ± 0.15 to 0.20 ± 0.10 (43% reduction; p < 0.001), and group 4 from 0.10 ± 0.03 to 0.08 ± 0.02 (20% reduction; p < 0.0010). These results should be interpreted with caution since no control group was included in this study. Mean serum uric acid and triglyceride levels were significantly increased, and mean PTH and potassium levels and diastolic and systolic blood pressure were significantly decreased in all groups. Few temporary adverse effects, such as dizziness and fatigue, were noticed and none of them caused discontinuation of treatment. CONCLUSIONS: Indapamide 1.5 mg/day is effective in decreasing calciuria in patients with non-hypercalciuric urinary stone disease, idiopathic hypercalciuria, urinary stone disease with hypercalciuria, and essential hypertension. This could be achieved with few adverse effects similar to those of thiazides and indapamide 2.5 mg. Indapamide decreased the PTH levels in all groups. Long-term clinical benefits of these effects should be evaluated prospectively with further randomized studies.

Aim: Behcet’s disease is a chronic, progressive disease with an unknown etiology and involves many organs and systems. Although the disease can be encountered at different regions on earth, prevalence and clinical findings of the disease may demonstrate differences due to local and geographical specifications. Methods: We report epidemiological and clinical characteristics of 65 patients with Behcet disease during four years in Van and vicinity. Results: The patients, mean age was 32.8 years (16- 72 years) and the disease was more common between 21 and 40 years. The sex ratio was 1.4 (38 men -27 women). Frequencies of the clinical features were as follows: oral aphthae (100%), genital ulcer (84.6%), cutaneous findings (61.1%), ocular (40%) neurological (27.6%), articular (52.3%), vascular (16.9%), gastrointestinal (27.6%), epididymitis (3%) and positive pathergy test (46.1%). Conclusion: We thought that, this first description of data about BD in Van and vicinity might be helpful for researchers.

Depression is common in patients with end-stage renal disease (ESRD) and is associated with increased mortality and morbidity. Several investigators have estimated that depression occurs in about 20% to 30% of dialysis patients. The aim of this study was to investigate the relationship between depression, some laboratory parameters, and quality of life (QOL) in hemodialysis patients. Forty-three hemodialysis patients (mean age 40.5 +/- 15.2; M = 28, F = 15) were included in the study. Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and short form with 36 (SF-36) were used for evaluation. Subsequently, patients were divided into two groups according to HAMD scores: group 1, those who had a low HAMD score (between 0 and 7), and group 2, those who had a high HAMD score (over 7). The two groups were compared in terms of anxiety scores, QOL scores, and some laboratory parameters. The group 2 patients (n = 21; M = 13, F = 8) had lower levels of hemoglobin than the group 1 patients (9.5 +/- 1.7 vs. 10.7 +/- 1.4 g/dL, respectively; p < 0.01). Group 2 patients also had lower SF-36 scores than group 1 patients (91.5 +/- 21.3 vs. 74.9 +/- 13.6, respectively; p = 0.03). On the contrary, the patients of group 2 had higher HAMA scores than group 1 patients (16.6 +/- 6.9 vs. 6.3 +/- 3.5, respectively; p < 0.01) and CRP level (10.7 +/- 4.6 vs. 4.5 +/- 3.8, respectively; p < 0.001). A significant correlation was found between depression scores and C-reactive protein (CRP) (r = 0.57, p < 0.001) and HAMA scores (r = -0.43, p < 0.05). In contrast, a negative correlation was found between HAMD scores and albumin (r = -0.43, p< 0.05), hemoglobin (r = -0.38, p = 0.015) and SF-36 scores (r = 0.39, p = 0.032). These findings demonstrate that there is a relationship among high depression score, low levels of hemoglobin and albumin, high CRP level, low SF-36 score, and high anxiety score. Evaluation of psychiatric status should be part of the care provided to hemodialysis patients.

Breast cancer is a hormone-dependent neoplasm. Conflicting results regarding the clinical correlation between breast cancer and thyroid diseases have been reported. The aim of this study was to determine the goiter prevalence, thyroid hormones and antithyroid antibody levels in patients with breast cancer. For this purpose, thyroid ultrasonography was performed and serum levels of free triiodothyronine (FT3 ), free thyroxine (FT4 ), thyroid-stimulating hormone (TSH), anti-thyroid peroxidase antibodies (anti-TPO ab) and anti-thyroglobulin antibodies (anti-TG ab) were determined in 50 operable breast cancer patients at the time of diagnosis and 30 healthy individuals as control group. Goiter prevalence was found to be significantly higher in the study group (50% vs 10%). FT3 , FT4 , and TSH levels of patients were not different compared to controls, whereas anti-TPO ab and anti-TG ab levels were significantly higher in patients than in the control group. In conclusion, goiter prevalence and thyroid antibody levels were found to be increased in breast cancer patients and thyroid functions should be monitored.

To report a case of colchicine-induced myopathy in a teenager with familial Mediterranean fever (FMF).A 15-year-old boy of Turkish origin, diagnosed as having FMF at the age of 14 years, was treated with colchicine 1.5 mg/d. He had experienced only 2 mild peritonitis attacks with fever within 1 year. The patient used the recommended dose regularly, and he described progressive proximal muscle weakness and generalized myalgias, which started 1 month before presentation. Physical examination showed proximal muscle weakness in his arms and legs. Laboratory tests revealed elevated serum creatine kinase, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase. All other laboratory values were within normal range. Electromyographic investigation revealed a myopathic pattern in proximal muscles without any neuropathic changes. A biopsy of the deltoid muscle showed vacuolar degeneration of striated muscle fibers with no inflammatory findings.Colchicine, the most important drug in treatment of FMF, can cause myopathy in patients with impaired renal and hepatic function. In our patient, an objective causality scale showed that therapeutic doses of colchicine for FMF were the definite cause of myopathy, even though his renal and hepatic function were normal. The treatment of FMF attacks in patients who cannot use colchicine is an important problem. There are insufficient data about the use of immunosuppressive agents in the treatment of FMF attacks; however, we now successfully control the attacks with colchicine 0.5 mg/d and azathioprine 2 mg/kg/d.Colchicine-induced myopathy should be excluded in patients with FMF who present with generalized muscle weakness. Clinicians should be aware that myopathy can occur in patients with FMF who have normal renal and hepatic function.

WOS: 000345626000016, PubMed ID: 25269407, The aim of our study was to delineate the demographic and clinical properties of primary glomerular diseases of adult population in our country in the light of global knowledge. All over the country, a total of 25 centers entered data between May 2009 and July 2012 to the database created by 'Glomerulonephritis Study Group' of Turkish Society of Nephrology. Demographic and clinical characteristics, specific diagnoses of glomerular diseases and biopsy findings recorded to the database were analyzed. Among the 1,274 patients, who had renal biopsy within the defined time period, 55 % were male and 45 % were female. The mean age was 40.8 +/- A 14.6 years. The most frequent indication for biopsy was nephrotic syndrome (57.8 %), followed by nephritic syndrome including rapidly progressive glomerulonephritis (16.6 %) and asymptomatic urinary abnormalities (10.8 %). The most frequent primary glomerular disease was membranous nephropathy (28.8 %), followed by focal segmental glomerulosclerosis (19.3 %) and IgA nephropathy (17.2 %). The presented study displayed important data about the epidemiology of primary glomerular diseases among adults in our country. The predominance of membranous nephropathy in contrast to other countries, in which the most frequent etiology is IgA nephropathy, seems to be due to differences in the indications for renal biopsy., Turkish Society of Nephrology, Financial supports have been obtained from Turkish Society of Nephrology and logistic support from the authors' affiliation departments. None of authors have conflict of interest.

In this case report, we present a female patient with neutrophilic dermatosis (ND) occurring as palpable purpura after using montelukast. Neutrophilic dermatoses (NDs) are characterized by skin lesions in which mature neutrophils are predominantly located in the epidermis and dermis in the absence of any infective pathology. Classification of the NDs is based upon the recognition of clinical and pathologic features, as well as the identification of associated diseases, like Sweet's syndrome, pyoderma gangrenosum, generalized pustular psoriasis, and Behcet's disease. Cutaneous findings in NDs are variable and can include vesiculopustules, plaques, nodules, or ulcerations. Drug-induced NDs are not uncommon, but ND with palpable purpura is uncommon. The current patient appeared with a rare presentation as palpable purpura without vasculitis regarding ND. It is important that this is the first case report.

Most hemodialysis patients show hemoglobin fluctuations between low-normal and high levels. This hemoglobin variability may cause left ventricle hypertrophy and may increase mortality as well. Recently, many studies were designed to evaluate the effect of hemoglobin variability on mortality but results were conflicting. We aimed to investigate the effect of hemoglobin variability on mortality and some cardiovascular parameters in hemodialysis population.Hundred and seventy-five prevalent hemodialysis patients classified into three hemoglobin variability groups according to their hemoglobin levels throughout 24 month observation period: Low-Normal, Low-High, Normal-High. Groups were compared in terms of laboratory, demographical data and mortality rates, initial and the end of 24 month echocardiographic data. Initial and last echocardiographic data were compared within groups in terms of left ventricle mass index increase.Mortality rates and cardiovascular risk factors such as coronary heart disease, diabetes mellitus and hypertension that may affect mortality were same between three groups. There was no significant difference between three groups in terms of echocardiographic and laboratory parameters. Only Low-High group showed significant increase on left ventricle mass index when initial and last echocardiographic parameters were compared.Consistent with previous studies, we found that most of the patients exhibited hemoglobin variability and our study is consistent with some of the studies that did not find any relationship between hemoglobin variability and mortality. Firstly, in this study based on objective data, it was shown that hemoglobin variability has adverse effect on left ventricle geometry independent from anemia.

Because of immunity defect, patients with end-stage renal disease are at increased risk of developing infections, tuberculosis (TB) in particular. The incidence of TB is higher in dialysis patients than in general population. We retrospectively reviewed the charts of dialysis patients with TB in our facility. A total of 287 dialysis patients (153 male, 134 female, 223 haemodialysis (HD), 64 continuous ambulatory peritoneal dialysis (CAPD) patients, mean age 46 +/- 15) were reviewed from October 1997 to January 2002. TB developed in 30 patients (17 male, 13 female, 24 HD and six CAPD). Thirteen patients with TB presented with fever of unknown origin (FUO) and four of them subsequently developed military lesions on chest X-ray. Nine patients had pulmonary TB (four with pleural effusions), five patients had TB lymphadenits, two patients had TB peritonitis and one patient had vertebral TB. TB was presented mostly as FUO among dialysis patients in a region under poor socio-economic conditions. In such areas with endemic TB, dialysis patients who present with FUO should be carefully evaluated for the presence of TB, and test therapy for TB should be performed in otherwise unexplained FUO.

OBJECTIVE: It is known that glucose concentrations of peritoneal dialysis solutions are detrimental to the peritoneal membrane. In order to determine the effect of glucose concentration on cytokine levels of peritoneal fluid of continuous ambulatory peritoneal dialysis (CAPD) patients, a cross-sectional study was performed. METHODS: Nine non-diabetic CAPD patients participated in two 8-h dwell sessions of overnight exchanges in consecutive days, with 1.36% and 3.86% glucose containing peritoneal dialysis solutions (Baxter-Eczacibas). Peritoneal dialysis fluid tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 levels were measured. RESULTS: TNF-alpha levels after 1.36% and 3.86% glucose used dwells were 23+/-14 pg/ml and 28+/-4 pg/ml, respectively (p=0.78). The IL-6 levels were 106+/-57 pg/ml and 115+/-63 pg/ml (p=0.81), respectively. CONCLUSION: In our in vivo study we found that the glucose concentration of the conventional lactate-based CAPD solution has no effect on basal IL-6 and TNF-alpha levels of peritoneal fluid. Further in vivo studies with non-lactate-based CAPD solutions are needed in order to determine the effect of glucose concentration per se on cytokine release.

Valvular abnormalities frequently occur in patients with chronic kidney failure. This study evaluated the prevalence of heart valve calcification (HVC) in hemodialysis patients and factors associated with it.Medical charts of 129 hemodialysis patients were reviewed retrospectively. Demographic features and laboratory analysis of the patients were systematically recorded. Echocardiographic findings were collected, including ejection fraction, aortic valve calcification (AVC), mitral valve calcification (MVC), left ventricle mass, left ventricle mass index, and pulmonary artery pressure.Valvular abnormalities were found in 43 patients (33.3%); 30 patients (23.3%) had MVC, 28 (21.7%) had AVC, and 15 (11.6%) had both MVC and AVC. Patients with HVC were older than other patients (P.001). On echocardiography, higher left ventricle mass, left ventricle mass index, and pulmonary artery pressure levels were found in patients with HVC. Regarding the lipid profile, serum calcium, serum phosphorus, calcium-phosphorus product, and parathyroid hormone concentrations, there were no significant differences between patients with and without HVC. Ejection fraction levels were significantly lower in patients with HVC (P = .002) and serum albumin level of patients with HVC was significantly diminished.This study failed to show an association between HVC in hemodialysis patients and calcium-phosphorus product and parathyroid hormone levels; however, age and diabetes mellitus could be regarded as risk factors. In addition, HVC may lead to increased left ventricle mass index and pulmonary artery pressure and decreased ejection fraction, and low albumin levels may be attributable to inflammation.

Nonspecific increased inflammatory response is an important feature of Behçet's disease (BD). The skin pathergy reaction (SPR) which tests this hyperreactivity in the skin is frequently used as a diagnostic tool. This study aims to investigate the argon laser photocoagulation (ALP)-induced cutaneous inflammation in BD patients and controls and also to compare the results with the skin pathergy test (SPT). The study group consisted of 35 patients with BD and 28 healthy volunteers. The ALP was applied to the left forearms of all cases from 20-cm distance (2,000 mW, 100 microm) with exposure times ranging from 0.2 to 0.7 s with 0.1-s increments. Also, a SPT with three prics was performed to both forearms of all cases. The ALP-induced cutaneous inflammation and SPT were evaluated and scored with the same method at 48 h, and the SPR scores of 2+ and above was accepted as positive. Positive results as defined above were found in eight cases (23%) with the ALP and in nine (26%) with the SPT in patients with BD. There was no clear correlation between the ALP and SPT results and also between the exposure time to laser beam and SPR scores. The preliminary results of this study reveal that ALP can induce a skin hyperreactivity similar to the needle prick-induced SPR in patients with BD. We, herein, showed that ALP can induce skin inflammation with its thermal effect and without any inoculation of antigen in BD. This method would help to develop another experimental method to investigate the cutaneous inflammation in BD.