The protective effect of paricalcitol, NAC and carvedilol therapies on peritoneal fibrosis: A comperative experimental study

Son dönem böbrek yetmezliği (SDBY) son yıllarda sıklığı giderek artmakta olan mortalitesi ve morbiditesi oldukça yüksek bir hastalıktır. Bu hastalarda önerilen altın standart tedavi şekli renal transplantasyon olmasına rağmen yeterli donör sayısına ulaşılamaması nedeniyle hastalar zorunlu olarak diyaliz tedavi yöntemlerinden biri ile tedavi edilmektedirler. Periton diyaliz son dönem böbrek yetmezliğinde sıklıkla ve başarı ile uygulanan bir tedavi yöntemidir. Uzun süre periton diyalizi yapan hastalarda ise kullanılan yüksek glukoz konsantrasyonuna sahip solüsyonlar, sık peritonit atakları ve diğer bir çok sebebe bağlı olarak periton yapısı bozulmaktadır. Periton zarında ortaya çıkan ve diyaliz yetersizliğine neden olan en önemli değişiklik periton zarında gelişen fibrozisdir. Bu çalışmada parikalsitol, karvedilol, N - asetil sisteinin periton fibrozisi gelişimi üzerideki önleyici etkisinin araştırılması amaçlanmıştır. Çalışmaya her grupta altışar rat olmak üzere 36 rat alındı. Çalışma süresi 21 gün olarak belirlendi. Periton fibrozisi oluşturmak için 10 ml/kg/gün %0,1'lik klorhexidin glukonat (CH) (Drogsan İlaçları AŞ. Balgat, Ankara) + %15 etanol + serum fizyolojik (SF) karışımı aseptik olarak hazırlanıp kullanıldı. Parikalsitol grubuna CH intraperitoneal enjeksiyonla beraber 0,2 mcg/kg/gün parikalsitol (P) (Zemplar® 2 mcg amp Abbott) 21 gün boyunca ratın ense bölgesine subkutan olarak enjekte edildi. N-asetil sistein grubuna CH intraperitoneal enjeksiyonla beraber 450 mg/kg/gün NAC içme suyuna katılarak 21 gün boyunca verildi ve günlük olarak ratların suyu yenilendi. Karvedilol (K) grubunada, CH intraperitoneal olarak uygulandı ve beraberinde oral gavaj ile 10 mg/kg/gün karvedilol 21 gün boyunca verildi. Çalışma sonunda ratların periyetal peritonları histopatolojik olarak incelendi ve ratların serumundan TGF-ß1 düzeyi çalışıldı. Çalışma sonuçlarında NAC'nin TGF-ß1 düzeyini anlamlı şekilde düşürdüğü saptandı (p<0.05). NAC ve karvedilolün periton kalınlığı, periton fibrozis, inflamasyon ve vaskülarizasyon skorlarında anlamlı olarak iyileşme sağladığı belirlendi. Parikalsitolün periton zar kalınlığında koruyucu etki sağlamasına rağmen histopatolojik skorlarda belirgin düzelme sağlamadığı izlendi. Bu çalışmanın sonuçları, NAC ve Karvedilol uygulamasının deneysel modelde geliştirilen periton fibrozisini önleme yönünde olumlu etkileri olduğunu ortaya koymaktadır. Bu bulgular, klinik çalışmalarla desteklenmesiyle birlikte periton diyalizi hastalarında, fibrozis gelişme sürecini yavaşlatıcı etkilerinde dolayı NAC ve karvedilolün daha sık kullanım alanı bulacağını düşündürmektedir.End stage renal disease (ESRD) is an increasing global health problem accompanied with high annual rates of mortality and cardiovascular morbidity. Although, renal transplantation is recommended as a gold standard therapy, lack of the sufficient greft donor for renal transplantation may cause dialysis modalities as a mandatory renal replacement therapies for these certain patient population. Peritoneal dialysis is succesfull treatment modality for ESRD patients. But peritoneal membrane structure may be diminished due to the long term use of high glucose concentrate peritoneal dialysis fluids due to the peritonitis attacks and other pathologies. Peritoneal fibrosis is the most important cause for the development of diminished peritoneal filtration barrier. Here in this tudy, we aimed to examine to compare the protective effect of paricalcitol, carvedilol and N-acetyl cystein (NAC) therapies against to the peritoneal fibrosis. A total of 36 rats were included this experimental protocol in a follow up period of 21 days by dividing six groups which included six rats in each subgroups. The mixed of 10 ml/kg/day %0,1 clorhexidin gluconate (CH) (Drogsan Drugs, Balgat, Ankara) + %15 ethanol + % 0.09 NACL solution were administered to develop peritoneal fibrosis in each rats. Durıng 21 days of study period, 0,2 mcg/kg/day paricalcitol were injected to the nape of the rats in paricalcitol group every day. 450 mg/kg/day NAC were administered via oral way by mixing drinking water in NAC subgroup and also 10 mg/kg/day carvedilol were administered orally in carvedilol group every day. At the end of the study period, serum samples were obtained to study TGF- ß1 levels. Also parietal peritoneal membrane samples were assessed histopathologically to demonstrate the magnitude of peritoneal fibrosis. Results; TGF- ß1 levels were significantly lower in NAC group compared the other subgroups (p<0.05). When we analysed the peritoneal samples as histopathologically, NAC and carvedilol subgroups showed significantly lower scores of peritoneal fibrosis, peritoneal thickness and vascularisation acompanied with lower inflammation. Although, lower levels of peritoneal thickness were observed in paricalcitol group, no distinctive protective effect were seen on other histopathologic structure. Here in this study, we have identified NAC and carvedilol therapies have favorable effects for the protection of peritoneal fibrosis. Further clinical studies are necessary to better understand the protective effects of NAC and carvedilol therapies on peritoneal fibrosis whether these certain agents may take place in rutin clinical practice as slowen therapies for peritoneal fibrosis in peritoneal dialysis patients

Presentation of Diffuse Large B-Cell Lymphoma Relapse as a Penile Mass

WOS: 000392282500022PubMed: 27095140

INVESTIGATION OF PLATELET FUNCTIONS IN PSEUDOTHROMBOCYTOPENIA

22nd Congress of the European-Hematology-Association -- JUN 22-25, 2017 -- Madrid, SPAINWOS: 000404127006220…European Hematol Asso

AN INVESTIGATION ABOUT WEIGHT GAIN WITH TREATMENT OF IRON DEFICIENCY ANEMIA: CHANGES OF GHRELIN AND HEPCIDIN LEVELS WITH TREATMENT

22nd Congress of the European-Hematology-Association -- JUN 22-25, 2017 -- Madrid, SPAINAnkarali, Handan Camdeviren/0000-0002-3613-0523WOS: 000404127003298…European Hematol Asso

BILATERAL CHYLOTHORAX, B SYMPTOMS AND DYSPROTEINEMIA: AN ANGIOIMMUNOBLASTIC T CELL LYMPHOMA CASE

8th International Eurasian Hematology Oncology Congress (EHOC) -- OCT 18-21, 2017 -- Istanbul, TURKEYWOS: 000416742600141

Assessment of Nutritional Status and Metabolic Syndrome in Peritoneal Dialysis Patients: A Pilot Study

Sanlier, Nevin/0000-0001-5937-0485WOS: 000406370100010Aim: Nutritional deficiencies and metabolic syndrome ( MS) is challenge in chronic kidney disease patients with peritoneal dialysis(PD). This study was planned in order to assess the nutritional status and metabolic syndrome in PD patients. Methods: This study was performed on clinically stable patients that were undergoing PD therapy. Energy and nutrient intakes were determined with consequently three days dietary record. The statement of MS was identified according to MS criteria adopted for PD patients. Results: The prevalence of MS was found 64.3%. The mean duration of PD in with-MS(35.4 +/- 25.23mo.) was lower than without- MS(44.3 +/- 30.99mo.) (p> 0.05). Patients with MS had significantly greater systolic/ diastolic blood pressure and lower high- density- lypoprotein cholesterol levels (HDL-C) ( p< 0.05). According to the body mass index (BMI), the 83.3% of patients' with- MS and 30% without- MS were found overweight and body fat mass was significant higher in patients with- MS(p< 0.05). The mean daily protein intakes per kilograms of body weight determined lower with- MS patients (0.8 +/- 0.25g/kg) than without- MS (0.9 +/- 0.29 g/kg). Conclusion: The prevalence of MS is remarkably high. The daily dietary energy and protein intakes were found under the recommended levels. Inadequate energy and protein intake increase loss of muscle mass and also excessive energy intake leads to obesity. Monitoring of nutritional status of PD patients is important both in prevention and progression of MS

A Case of Nephrotic Syndrome With Pneumocystis Jirovecii Infection

WOS: 000487340900025Pneumocystis jirovecii pneumonia (commonly called Pneumocystis pneumonia or PCP) is an opportunistic infection that occurs in immunocompromised individuals. 26 year-old male patient admitted to nephrology department for hypervolemic hyponatremia and consulted to our clinic due to the desaturation. He has been diagnosed with collapsing glomerulonephritis and he was using cyclosporine and prednisolone. Postero-anterior chest X-ray showed a blunt left cardiodiaphragmatic sinus. After ten days the patient's hypoxia deepened. Repeated chest X-ray showed bilateral perihilar heterogeneous opacity. Pneumocystis jirovecii was detected in lavage culture. We presented a case of Pneumocystis Jirovecii pneumonia secondary to cyclosporin toxicity because of a rare case