A case of primary hypoparathyroidism presenting with acute kidney injury secondary to rhabdomyolysis

Hypoparathyroidism is the most common cause of symmetric calcification of the basal ganglia. Herein, a case of primary hypoparathyroidism with severe tetany, rhabdomyolysis, and acute kidney injury is presented. A 26-year-old male was admitted to the emergency clinic with leg pain and cramps, nausea, vomiting, and decreased amount of urine. He had been treated for epilepsy for the last 10 years. He was admitted to the emergency department for leg pain, cramping in the hands and legs, and agitation multiple times within the last six months. He was prescribed antidepressant and antipsychotic medications. He had a blood pressure of 150/90 mmHg, diffuse abdominal tenderness, and abdominal muscle rigidity on physical examination. Pathological laboratory findings were as follows: creatinine, 7.5 mg/dL, calcium, 3.7 mg/dL, alanine transaminase, 4349 U/L, aspartate transaminase, 5237 U/L, creatine phosphokinase, 262.000 U/L, and parathyroid hormone, 0 pg/mL.There were bilateral symmetrical calcifications in basal ganglia and the cerebellum on computerized tomography. He was diagnosed as primary hypoparathyroidism and acute kidney injury secondary to severe rhabdomyolysis. Brain calcifications, although rare, should be considered in dealing with patients with neurological symptoms, symmetrical cranial calcifications, and calcium metabolism abnormalities

Hypophoshatemia incidence in patients with chronic kidney disease treated with intravenous ferric carboxymaltose and factors related to hypophosphatemia

Amaç: Çalışmamızda kronik böbrek hastalığı (KBH) olanlarda ferrik karboksimaltoz (FKM) tedavisinin hipofosfatemi insidansını ortaya çıkarmayı ve hipofosfatemi gelişimini öngörücü faktörleri irdelemeyi amaçladık.Yöntemler: Tek merkezli ve retrospektif olan pilot çalışmamızaOcak 2018-Ocak 2019 arasında nefroloji polikliniğine başvurupFKM tedavisi alan toplam 43 erişkin hasta alındı. Diyalize girmeyen 32 KBH hastası KBH grubunu oluştururken, demireksikliği anemisi tanısıyla FKM tedavisi verilen ve böbrek fonksiyon bozukluğu olmayan 11 hasta kontrol grubunuoluşturdu. Tedavi öncesi ve sonrası serum fosfor düzeylerine ulaşılamayan hastalar dışlandı.Bulgular: Hasta grubunun yaş ortalaması 68,8±10,2 (%69 kadın) idi. Serum kreatinin ve tahmini glomerüler filtrasyonhızı ortalamaları sırasıyla 2,3±1,1 mg/dL ve 29,7±17,6 mL/dk/1,73 m2 bulundu. FKM sonrası 1. haftada kontrol grubundaki 11 hastadan beşinde (%44,5) ve KBH grubundaki 32 hastadan üçünde (%9,4) hipofosfatemi gelişti (p=0,008). Lineer regresyon analizine göre bazal fosfor düzeyi hipofosfateminin tek öngörücüsü olarak tespit edildi (p=0,006).Sonuç: Çalışmamız KBH hastalarında FKM tedavisi ilişkili hipofosfatemi sıklığının literatür ile uyumlu oranlarda olduğunu göstermiştir. Bazal fosfor düzeyi düşük hastalarda FKM tedavisi sırasında dikkatli olunmalıdır.Aim: We aimed to find the incidence of hypophoshatemiaand to investigate predictive factors for the development ofhypophospahtemia in patients with chronic kidney disease (CKD)treated with intravenous ferric carboxymaltose (FCM).Methods: In our single center retrospective study, we included43 adult patients who were given FCM therapy after nephrologyclinic admission. Thirty-three non-dialysis CKD patients constitudedthe CKD group. Control group consisted of 11 patients with thediagnosis of iron deficiency anemia and normal renal function.Patients with missing data on serum phosphorus level before andafter treatment were excluded.Results: The average age of CKD group was 68.8±10.2 years(69% female). The average serum creatinin level and andestimated glomerular filtration rate were 2.3±1.1 mg/dL and29.7±17.6 mL/min/1.73m2, respectively. After the first weekfollowing FCM treatment, five of 11 patients in the controlgroup (44.5%) and three of 32 patients in the CKD group (9.4%)developed hypophosphatemia (p=0.008). On linear regressionanalysis, it was found that baseline phosphorus level was thesingle predictor of hypophosphatemia (p=0.006).Conclusion: Our study demonstrated that the incidence ofhypophosphatemia associated with FCM treatment in CKDpatients was compatible with the rates in the literature. Cliniciansshould be careful in FCM treatment especially in patients havinglow baseline phosphorus level

Periton diyalizi hastalarında ADMA düzeyi ile kardiyovasküler parametreler arasındaki ilişki: Bir biyoimpedans çalışması

WOS: 000456923400005Objective: Asymmetric dimethylarginine (ADMA) is known as a non-traditional risk factor for cardiovascular disease. Considering the increased prevalence of hypervolemia and heart failure in patients with peritoneal dialysis (PD), we aimed to investigate the relationship of ADMA with other biochemical parameters, echocardiographic findings, and results of bioimpedance analysis, which is a method for the determination of body fluid distribution in detail. Methods: The study was conducted on 21 patients with chronic PD. Bioimpedance was evaluated by Body Composition Monitor H02.201.1 (R). ADMA level was analyzed by an ELISA kit. Results: The mean ADMA level was 87.6 +/- 58.2 (18.54-247.34) mu mol/L. The mean ADMA level in patients with hypertension was significantly higher than those with normal blood pressure (95.8 +/- 58.8 mu mol/L and 41.0 +/- 27.9 mu mol/L, respectively; p=0.045). In univariate analysis, the parameters associated with serum ADMA levels were uric acid (r=0.681, p=0.001), left ventricular end-systolic diameter (LVESD) (r=0.509, p=0.019), intracellular water (ICW) (r=0.606, p=0.004), extracellular water (r=0.471, p=0.031), dialysate-to-plasma (D/P) creatinine ratio (r=0.452, p=0.04), body surface area (r=0.52, p=0.016), total body water (r=0.581, p=0.006), and lean tissue mass (r=0.528, p=0.014). In multivariate analysis, only uric acid level, ICW, LVESD, and D/P creatinine were found to be significantly associated with ADMA. Conclusion: Serum ADMA level may be a useful marker to detect cardiovascular risk in patients with PD. Serum uric acid and LVESD are important parameters related to ADMA levels in patients with PD. Bioimpedance spectroscopy findings support the association of ADMA with body fluid volume.Amaç: Kardiyovasküler hastalıklar diyaliz hastalarında mortalitenin en sık nedenidir. Asimetrik dimetilarginin (ADMA) düzeyleri ile aterogenezin ilk basamağı olan endotelyal disfonksiyon arasındaki ilişki gösterilmiş olup, ADMA kardiyovasküler hastalıklar için geleneksel olmayan bir risk faktörü olarak kabul edilmektedir. Periton diyalizi (PD) hastalarında hipervolemi ve kalp yetmezliği prevalansının yüksek olduğunu göz önüne alarak, çalışmamızda ADMA ile diğer biyokimyasal parametreler, ekokardiyografi bulguları ve vücut sıvı dağılımının belirlenmesinde geçerli bir yöntem olan biyoimpedans analizi sonuçları ile ilişkisini araştırmayı hedefledik. Yöntemler: Kronik PD tedavisi gören 21 hasta çalışmaya alındı. Biyoimpedans analizi için BCM (Body Composition Monitor H02.201.1®) cihazı kullanıldı. ADMA düzeyleri ELISA kiti ile çalışıldı. Bulgular: Yirmi bir hastanın 13’ü kadın 8’i erkek idi. PD modalitesi 12 hastada CAPD, 5 hastada APD ve 4 hastada CCPD idi. Hastaların 18’i (%85) hipertansif, 9’u ise (%42) dislipidemik idi. Son dönem böbrek yetmezliğinin etyolojisi 8 hastada (%38) diyabetik nefropati idi. 13 hastanın günlük idrar volümLeri ortalama 1402±636 mL iken, geri kalan 8 hasta ise anürik idi. Ortalama sistolik ve diyasyolik kan basınçları sırasıyla 124,5±36,8 mmHg ve 79,8±11,7 mmHg idi. Hastaların ortalama ADMA düzeyi 87,6±58,2 μmol/L (18,54-247,34 μmol/L) bulundu. Ortalama ADMA seviyesi hipertansif hastalarda normotensif olanlara göre istatistiksel açıdan anlamLı olarak daha yüksek tespit edildi (95,8±58,8 μmol/L ve 41,0±27,9 μmol/L; p=0,045). Tek değişkenli analizde ADMA düzeyi ile ilişkili bulunan parametreler, ürik asit (r=0,681, p=0,001), sol ventrikül diyastol sonu çapı (LVESD) (r=0,509, p=0,019), intrasellüler sıvı miktarı (r=0,606, p=0,004), ekstrasellüler sıvı miktarı (r=0,471, p=0,031), diyalizat/plazma kreatinin oranı (r=0,452, p=0,04), vücut yüzey alanı (r=0,52, p=0,016), total vücut suyu (r=0,581, p=0,006) ve yağsız vücut kitlesi (r=0,528, p=0,014) olarak saptandı. Çok değişkenli analizde ise sadece ürik asit düzeyi, intrasellüler su, LVESD ve diyalizat/plazma kreatinin oranı istatistiksel olarak ADMA düzeyi ile ilişkili bulundu. Sonuç: PD hastalarında kardiyovasküler riskin belirlenmesinde ADMA düzeyi yararlı bir marker olarak kullanılabilir. Serum ürik asit düzeyi ve LVESD, ADMA düzeyi ile yakından ilişkilidir. Biyoimpedans analizi sonuçları ADMA düzeyi ile total vücut sıvısı arasındaki ilişkiyi desteklemektedir

The relationship between zonulin and metabolic syndrome in renal transplant patients

Background: Levels of zonulin, a surrogate marker of intestinal permeability, are elevated in various disorders including insulin resistance, obesity, celiac disease, and inflammatory bowel disease. We aimed to elucidate the association of zonulin levels and metabolic syndrome (MS) in renal transplant recipients. Methods: Seventy-nine renal transplant recipients were enrolled. Diagnosis of MS was established employing the Adult Treatment Panel III (ATP III) criteria. Serum zonulin level was determined using the double antibody sandwich ELISA method. Results: MS was encountered in 37 (41.6%) of the 79 patients. Serum zonulin level was significantly higher in patients with MS compared to those without MS (p < 0.001). Serum zonulin level correlated with presence of MS (r: 739, p < 0.001), abdominal obesity (r: 514, p < 0.001), fasting glucose level (r: 361, p: 0.001), presence of fasting glucose/diabetes criterion of MS (r: 316, p: 0.005), presence of low HDL criterion of MS (r: 266, p: 0.018), and BMI (r: 527, p < 0.001). Conclusions: A Zonulin-mediated increase in intestinal permeability may play a role in the pathogenesis of metabolic syndrome. We propose that zonulin may be a suitable surrogate marker of MS in renal transplant recipients.Turkish Society of Nephrolog

Immunosuppressive treatment results in patients with primary iga nephropathy in Türkiye: A nationwide study

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Role of ankle brachial index measured by simple automatic sphygmomanometers in predicting postoperative kidney function in patients undergoing major cardiac surgery

Introduction: Ankle-brachial pressure index is an objective, noninvasive test for predicting subclinical atherosclerotic diseases. We investigated the role of ankle-brachial pressure index measured with automated sphygmomanometer devices in the prediction of the development of acute kidney injury in patients undergoing major cardiac surgery. Methods: This single-centered, cross-sectional, and observational study was performed on 80 (66 males and 14 females, 58 +/- 10 years) patients undergone cardiac surgery. Complete anamnesis, laboratory tests, intravenous fluids, medications, blood products, and all perioperative procedures were recorded in all patients before the surgery. Two automated sphygmomanometer devices giving equivalent results were used for measuring Ankle-brachial pressure index. The data in the first two days after the surgery were used for analysis. The criteria of AKIN were used in the diagnosis of acute kidney injury. Results: Twenty-one (23%) patients developed acute kidney injury in the postoperative period. None of the patients needed renal replacement therapy or died. There was no significant difference between mean ankle-brachial pressure index levels of patients with and without acute kidney injury (1.04 +/- 0.17 and 1.06 +/- 0.19, respectively, p=0.554). The mean ankle-brachial pressure index was significantly lower in patients with perioperative complications that cause hemodynamic instability (1.07 +/- 0.14, 0.96 +/- 0.13, p=0.016). On the multivariate analysis model, only perioperative hemodynamic complication development was found to be related to postoperative acute kidney injury. Conclusion: Anklebrachial pressure index may have a role in predicting perioperative hemodynamic complications, which may cause acute kidney injury in patients undergoing major surgery. Simple automatic blood pressure devices can be used in daily practice for ankle-brachial pressure index measurement instead of complex and expensive doppler devices

HCV POZİTİF RENAL TRANSPLANT HASTALARINDA POSTTRANSPLANT DİYABET GELİŞİMİ RİSKİ ARTMIŞ MIDIR?

HCV POZİTİF RENAL TRANSPLANT HASTALRINDAPOSTTRANSPLANT DİYABET GELİŞİMİ RİSKİ ARTMIŞ MIDIR?Abdullah Şumnu1, Erol Demir2, Ozan Yeğit3, .mmü Korkmaz3, Yaşar Çalışkan2, Nadir Alpay4,Halil Yazıcı2, Aydın Türkmen21İstanbul Medipol Üniversitesi, Nefroloji2İstanbul Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Nefroloji Bilim Dalı3İstanbul Tıp Fakültesi, İç Hastalıkları Anabilim Dalı4Kırklareli Devlet Hastanesi, NefrolojiGiriş: Artan kanıtlar HCV enfeksiyonunun posttransplant diyabet gelişimi ileilişkisini g.stermektedir. Biz de kendi merkez verilerimiz üzerinden bu ilişkiyiaraştırdık.Yöntem: İ.T.F. Nefroloji Bilim Dalı Transplantasyon Polikliniği tarafından takipedilen ve pretransplant d.nemde diyabeti olmayan toplam 289 hastanın (95HCV, 194 non-HCV) dosyaları retrospektif olarak taranarak posttransplantdiyabet gelişimi a.ısından değerlendirildi. Veriler SPSS 20.0 istatistik veritabanına aktarıldı.Sonuçlar: Hastaların yaş ortalaması 44.3Å}11.3; %41’i kadın %59’u erkek idi.Ortalama takip süresi 119Å}73 ay iken, kalsin.rin inhibit.rü (KNİ) kullanımsüresi ise 102Å}67 ay idi. HCV ve non-HCV grupları arasında yaş, cinsiyet, don.r(canlı, kadavra), b.brek yetersizliği etyolojisi, KNİ kulanma yüzdesi (iki gruptada yaklaşık %95) a.ısından fark yok iken HCV hastalarının takip süresi (163’ekarşı 97 ay) ve dolayısıyla KNİ kullanım ayı (132’ye karşı 89 ay) non-HCVhastalara g.re daha yüksekti. Bununla birlikte non-HCV grubunda takrolimuskullanım oranı HCV grubuna g.re anlamlı olarak daha yüksekti (%55’e karşı%13). Posttransplant diyabet gelişim oranı HCV grubunda %12 (12 hasta) ikennon-HCV grubunda ise %3.5 (7 hasta) bulundu (p = 0.005).Tartışma: Her ne kadar takip süresi anlamlı olarak daha fazla olsa da,posttransplant diyabet gelişim riski siklosporine g.re daha fazla olan takrolimuskullanım yüzdesinin belirgin olarak daha düşük olduğu HCV grubunda diyabetgelişiminin anlamlı olarak daha fazla bulunması literatür ile uyumlu olarak HCVenfeksiyonun diyabet gelişimindeki muhtemel rolünü desteklemektedir

Otozomal dominant polikistik böbrek hastalığında ürogenital kistlerin semen parametreleri üzerine etkisi var mı ?

WOS: 000374928100006OBJECTIVE: Autosomal dominant polycystic kidney disease (ADPKD) is a systemic disease with cysts in many organs including the urogenital tract. The aim of the study was to evaluate the relationship between urogenital cysts, semen pathologies and infertility in ADPKD. MATERIAL and METHODS: Male ADPKD patients aged 18-60 with creatinine clearance years higher than 60 ml/min were included. All patients had magnetic resonance imaging of the urinary system and pelvis, scrotal Doppler ultrasonography and sperm analysis. The results were compared with those of a healthy control group. RESULTS: 27 patients and 17 volunteers were included. Seminal vesicle and prostate cysts were detected in four (15%) and six (22%) patients, respectively. Five of the 23 married patients (21%) had infertility and this rate was higher than in the control group (p=0.044). The ratio of sperms with normal morphology and progressive motility was lower, and the rate of hypospermia, oligozoospermia, azospermia, asthenozoospermia and teratozoospermia were higher in the patient group. There was no significant difference between patients with/without urogenital cysts regarding seminal pathologies. CONCLUSION: Seminal abnormalities and infertility are more frequent in patients with ADPKD. Defects in spermatogenesis and sperm motility may be related to urogenital cysts as well as ciliary pathologies. There is a need for further studies evaluating the role of urogenital cysts in semen pathologies.AMAÇ: Otozomal dominant polikistik böbrek hastalığı (ODPBH) ürogenital sistemle birlikte birçok organda kist oluşumuna neden olabilen sistemik bir hastalıktır. Çalışmada, ODPBH olan bireylerde ürogenital kistler ile semen patolojileri ve infertilite ilişkisi değerlendirilmiştir. GEREÇ ve YÖNTEMLER: Çalışmaya 18-60 yaşları arasında, kreatinin klirensi 60 ml/dakika/1.73 m2’nin üzerinde, ODPBH olan erkekler dahil edildi. Tüm hastalara üriner sistem ve pelvik manyetik rezonans(MR) inceleme, skrotal Doppler ultrasonografi ve semen analizi yapıldı. Sonuçlar sağlıklı kontrol grubu ile karşılaştırıldı. BULGULAR: Yirmiyedi hasta ve 17 gönüllü çalışmaya dahil edildi. Seminal vezikül kisti 4(%15), prostat kisti 6 (%22) hastada tespit edildi. Kontrol grubundan daha sık olarak, evli olan 23 hastanın 5’inde (%21) infertilite mevcuttu (p=0.044). Normal morfolojili sperm oranları ve ileri motilite daha düşük, hipospermi, oligozoospermi, azospermi, asthenozoospermi ve teratozoospermi oranları hasta grubunda daha yüksekti. Ürogenital kisti olan/olmayan hastalarda semen patolojileri açısından anlamlı fark yoktu. SONUÇ: Seminal anormallikler ve infertilite ODPBH olanlarda daha sıktır. Spermatogenez ve sperm motilite defektleri siliar patolojiler gibi urogenital kistlerle ilişkili olabilir. Ürogenital kistlerin semen patolojilerindeki rolünü değerlendirmek için ileri çalışmalara ihtiyaç vardır

Role of ankle-brachial index measured with simple automated blood pressure devices in predicting the postoperative kidney functions in non-cardiac patients with low renal risk

Objective: Ankle-brachial index indirectly shows subclinical atherosclerosis in extremity vessels. No study investigated the role of ankle-brachial index measured with simple automated devices in the prediction of postoperative acute kidney injury in non-cardiac surgery patients with a low risk of acute kidney injury. Methods: The single-center, cross-sectional, observational study included patients who were scheduled for operation under general anesthesia. The preoperative ankle-brachial index was measured with two Omron M2 Basic (Hem 7120-E) automatic sphingomanometry devices for the detection of the arm and leg systolic blood pressure values. The ratio of ankle higher systolic blood pressure to brachial higher systolic blood pressure was recorded as ankle-brachial index. Results: A total of 100 (48 women, mean age of 57.5 +/- 14.1 years) patients were included. The median ankle-brachial index value was 1.12 (right ABI: 1.11 +/- 0.09 and left ABI: 1.12 +/- 0.10). The level of ankle-brachial index in patients with acute kidney injury was not significantly different than in patients without acute kidney injury. Serum creatinine value was increased on the second day compared to baseline in 38 (38%) of patients. There was no difference in terms of ankle-brachial index levels in patients with and without an increase in creatinine levels. In the linear regression model including the parameters that were found to be related to the change in the second-day serum creatinine in univariate analyses, left ankle-brachial index showed a negatively significant relationship with the second-day serum creatinine change. Conclusion: Ankle-brachial index is useful in the assessment of perioperative renal function and acute kidney injury risk in non-cardiac surgery patient populations

Evaluation of the Relationship of Hepcidin Levels with Anemia and Inflammatory Markers in Patients on Peritoneal Dialysis: A Controlled Study

OBJECTIVE: Hepcidin, a small peptide hormone synthesized in the liver, plays a central role in the regulation of iron metabolism. In addition, it acts as an intermediary in body defense and inflammation. Our aim in this study was to investigate the relationship of hepsidin levels with inflammation and iron indices in patients on peritoneal dialysis (PD). MATERIAL and METHODS: Nondiabetic PD patients were involved. Primary kidney disease, biochemical parameters, complete blood count, iron, total iron binding capacity (TIBC), ferritin, high sensitive C-reactive protein (hsCRP), fibrinogen, parathormone, interleukin (IL)-6 and hepcidin levels were recorded as well as demographic parameters. RESULTS: Twenty-one PD patients (mean age 47.7±12.1 years) and 17 healthy volunteers (mean age 54.0±7.2 years) were involved. HepCidin levels were higher in the PD group (148.2±35.0 vs. 93.8±21.9; p<0.001). There was a positive correlation of hepcidin with urea, creatinine, phosphorus, ferritin, fibrinogen, IL-6 and parathormone; and a negative correlation with albumin, transaminases, calcium, TIBC, GFR, hemoglobin and hematocrit levels. CONCLUSION: Hepcidin levels increase with deepening anemia and show a positive correlation with inflammatory markers. Theurapeutic interventions regarding the effects of hepcidin on inflammatory status may play a role in the treatment of anemia due to inflammation. It may be beneficial to measure hepcidin levels together with ferritin, especially in patients with functional iron defficiency