Clinical and electrophysiological correlation of patients with chronic renal failure: The contributions of quantitative neurological scores

Neuropathy is the most common neurological consequence of uremia and has the scarce symptoms and definition. Therefore the sensitivity/specificity of clinical scores the neuropathy symptom score (NSS) and the neuropathy disability score (NDS) were evaluated for uremic neuropathy in the present study. 38 hemodialysis patients (23 males, 15 females) and 15 age-sex matched healthy subjects were enrolled. Neurological interrogation and examination of the subjects has been performed before neurophysiological examinations. After the usual 2 days interval in dialysis, electrophysiological studies (EPS) have been performed. Before the EPS, blood samples has been taken before a midweek dialysis; hemoglobin, Hct, and albumin concentrations were measured. The Kt/V value was taken as the average of previous 12 sessions Kt/V values. The mean NSS was 1.66 ± 2.2, mean NDS was 5.02 ± 6.9 in the patient group. According to EPS, 25 patients (65.8%) were diagnosed as having neuropathy [Np (+)] and 13 (34.2%) were normal [Np (-)]. The mean values of median, sural nerve sensory, common peroneal and posterior tibial nerve motor conduction velocities were lower in the patient group compared to controls. Np (+) patients was older than that of Np (-) subjects (50.1 ± 13.8 versus 36 ± 13.6; p = 0.006). Age was the only significant predictor of neuropathy (OR = 1.08, 95% CI, 1.017 to 1.150; p = 0.013). Logistic regression analysis revealed that both NSS (OR = 2.651, 95% CI, 1.1 to 6.4; p = 0.03) and NDS (OR = 1.26, 95% CI, 1.001 to 1.6; p = 0.049) were significantly associated with increased risk of neuropathy. The current study showed that both NSS and NDS are sensitive and specific in the diagnosis of uremic neuropathy and could be used at least as a first step before turn towards the elecrophysiologic studies

Yatan hastalarda böbrek fonksiyon bozukluğu tipleri, seyirleri ve sonuçları: Tek merkez deneyimi

Aim: The aim of this study was to determine how to eliminate the treatment uncertainties, and correct and prevent inappropriate treatment in patients with renal failure. Material and Methods: We retrospectively evaluated the biochemistry department’s records of 438 patients with creatinine values >1.5 mg/dL that were followed-up at our hospital for the last five years. Demographics, type of renal dysfunction, related risk factors (use of nephrotoxic agents, surgical procedures, comorbidity, etc.), dialysis treatment, complications, and clinical outcome of these patients were recorded and analyzed. Results: The most important result of the study is that the quality of the medical data recorded was very poor. The most common type of acute renal injury was prerenal acute renal injury. Among the cases, the most common etiological factors were dehydration and use of nephrotoxic agents. Surgical procedures and comorbid conditions facilitated the development of renal dysfunction, and all complications observed were more common and serious in the elderly patients. Among the patients with chronic renal injury, more of those with diabetic nephropathy required hospitalization. Interestingly, nosocomial infections were the most common cause of mortality in the patients hospitalized due to renal dysfunction. Conclusion: Only a few medical records were suitable for retrospective evaluation. We think that if the quality of hospital data collection/storage systems could be improved, the quality of research data obtained in such studies would likewise improve and these data will bring preventive and corrective approach to mortality and morbidity. © 2019, Duzce University Medical School. All rights reserved.Amaç: Bu çalışmanın amacı, böbrek hasarı olan hastalarda tedavi belirsizliklerinin nasıl giderileceğinin belirlenmesi ve tedavideki uygunsuzlukların düzeltilmesi ve önlenebilmesidir. Gereç ve Yöntemler: Kreatinin değeri >1,5 mg/dL olan ve hastanemizde son beş yılda takip edilen 438 hastanın biyokimya anabilim dalı kayıtları geriye dönük olarak değerlendirilmiştir. Hastaların demografik özellikleri, böbrek fonksiyon bozukluğu tipleri, ilişkili risk faktörleri (nefrotoksik ajanların kullanımı, cerrahi prosedürler, komorbidite, vb.), diyaliz tedavisi, komplikasyonlar ve klinik sonuçları kayıt altına alındı ve analiz edildi. Bulgular: Çalışmanın en önemli bulgusu, kaydedilmiş olan tıbbi verilerin kalitesinin çok düşük olmasıdır. En sık görülen akut böbrek hasarı tipi prerenal akut böbrek hasarı idi. Olgular arasında en yaygın etiyolojik faktörler dehidratasyon ve nefrotoksik ajanların kullanımı idi. Cerrahi işlemlerin ve eşlik eden hastalıkların böbrek fonksiyon bozukluğu gelişimini kolaylaştırdığı, gözlenen tüm komplikasyonların yaşlı hastalarda daha sık ve ciddi seyirli olduğu belirlendi. Kronik böbrek hasarı olan hastalar arasında, diyabetik nefropatisi olanların çoğunun hastaneye yatması gerekiyordu. İlginç olarak, böbrek fonksiyon bozukluğu ile izlenen yatan hastalarda en önemli mortalite nedeninin nozokomiyal infeksiyonlar olduğu belirlendi. Sonuç: Retrospektif değerlendirme için sadece birkaç tıbbi kayıt uygundu. Hastane veri toplama/depolama sistemlerinin kalitesinin iyileştirilebilmesi durumunda, bu tür çalışmalarda elde edilen araştırma verilerinin kalitesinin de aynı şekilde gelişeceğini ve bu verilerin mortalite ve morbidite konus

Parents of ataxia-telangiectasia patients display a distinct cellular immune phenotype mimickingATM-mutated patients

Background Heterozygous relatives of ataxia-telangiectasia (AT) patients are at an increased risk for certain AT-related manifestations. We also show that there is an increase of infection frequency in parents of AT patients. Thus, we hypothesized that the parents might exhibit immune alterations similar to their affected children. Methods Lymphocyte phenotyping to enumerate T- and B-cell subsets was performed. Functional analyses included in vitro quantified gamma-H2AX, poly (ADP-ribose) polymerase (PARP) and caspase-9 proteins. Chromosomal instability was determined by comet assay. Results We analyzed 20 AT patients (14F/6M), 31 parents (16F/15M), and 35 age-matched healthy controls. The AT patients' parents exhibited low frequency of naive CD4(+)T- (n = 14, 45%) and recent thymic emigrants (n = 11, 35%) in comparison with the age-matched healthy donors. Interestingly, parents with low naive T cells also demonstrated high rate of recurrent infections (9/14, 64%). In comparison with age-matched controls, parents who had recurrent infections and low naive T cells showed significantly higher baseline gamma-H2AX levels and H2O2-induced DNA damage as well as increased cleaved caspase-9 and PARP proteins. Conclusion Parents of AT patients could present with recurrent infections and display cellular defects that mimic AT patients. The observed immunological changes could be associated with increased DNA double-strand breaks