High-sensitive troponin T increase after hemodialysis is associated with left ventricular global longitudinal strain and ultrafiltration rate

Background: Circulating troponin levels are both stable and higher in patients with end-stage renal disease, even in the absence of acute coronary syndrome. These patients commonly have underlying cardiac problems that frequently cause troponin elevation. The effect of hemodialysis (HD) on troponin levels has not been well elucidated. Thus, investigated herein is the relationship between the changes in troponin levels along with left ventricular deformation and volume depletion in patients with end-stagerenal disease.Methods: Patients included were between 18 and 85 years of age and were receiving hemodialysis for at least 6 months. High sensitive cardiac troponin T (hs-cTnT) levels were studied in blood samples taken at the beginning and end of HD. Two-dimensional speckle tracking strain imaging was used to evaluate myocardial contractility.Results: Seventy patients (50.7 ± 16.9 years of age, 27 women) were included in study. The mean volume of ultrafiltration was 3260 ± 990 mL. A significant increase in circulating hs-cTnT levels was observed, as well as a prominent decrease in left ventricular global longitudinal strain (GLS) after HD (52.4 ± 40.2 ng/L vs. 66.8 ± 48.5 ng/L, p < 0.001 and 20.1 ± 3.6% vs. 16.8 ± 3.8% p < 0.001, respectively). Moreover, ultrafiltration rate and GLS were found as the strongest independent variables in relation to the relative increase in hs-cTnT.Conclusions: Hemodialysis can cause a significant increase in hsTnT. This can jeopardize the accuracy of clinical diagnoses based on hs-TnT measurements. GLS may be used as a determinant of this hs-TnT increase. The influence of HD on the cardiovascular system should be kept in mind to prevent unnecessary interventions

Hipertansiyon ve Böbrek Hastalıkları Çalışma ve Derlemeler

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Dirençli Nefrotik Sendromlarda Ofatumumab Deneyimi

Dirençli Nefrotik Sendromlarda Ofatumumab DeneyimiBurak Özbaş1, Özant Helvacı1, Ülver Derici1, Selim Turgay Arınsoy1, 1Gazi Üniversitesi Tıp Fakültesi, Nefroloji, AnkaraGiriş: Dirençli Kronik Lenfositik Lösemi/Lenfoma’da kullanılmak üzere geliştirilen bir Anti-CD20 monoklonal antikor olan Ofatumumab’la ilgili olarakRitüksimab direnci veya allerjisi öyküsü olan Lupus nefriti, Fokal SegmentalGlomerüloskleroz (FSGS) ve Minimal Değişiklik Hastalığı ile takipli hastalarda kullanıldığında olumlu sonuçlar alındığına dair yayınlar mevcuttur.Biz bu bildiride benzer endikasyonlarda Ofatumumab tedavisi verdiğimizhastalarımızın sonuçlarını paylaşmayı amaçladık.Yöntem: Her ikisi de biyopsi tanılı olan, birisi post-transplant nüks etmişRitüksimab dirençli FSGS, diğeri de Ritüksimab allerji öyküsü olan primerMembranöz Glomerulonefrit (MGN) tanılarıyla takip ettiğimiz nefrotik düzeyde proteinürisi olan iki hastamıza 700 mg/1,73 m² dozundan 2 haftaarayla Ofatumumab verildi. Yanıt değerlendirilmesi amacıyla 0, 3 ve 6. aydaCD19 (+) B lenfosit düzeylerine, böbrek fonksiyon testlerine, 24 saatlik idrarda protein miktarlarına bakılması planlandı. Hastalardan tedavi öncesihepatit belirteçleri, EBV/CMV DNA görüldü. Akciğer grafileri muhtemelenfeksiyonlar açısından incelendi ve profilaktik haftada 3 gün 400/80 mgko-trimoksazol verildi.Bulgu: FSGS ile takipli 41 yaşındaki erkek hastanın tedavi öncesi kan üreazotu (BUN) 21 mg/dl, serum kreatinin 1,43 mg/dl, glomerüler filtrasyonhızı (eGFR) 60,4 mL/dk/1.73m², serum albümin düzeyi 2,2 g/dl, 24 saatlikidrarda protein 8,1 gr ve CD19(+) B-Lenfosit oranı %2,5 geldi. Tedavinin 3.ayında bakılan BUN 20 mg/dl, serum kreatinin düzeyi 1,4 mg/dl, eGFR 62mL/dk/1.73m², serum albümin düzeyi 3 g/dl, 24 saatlik idrarda protein 8,5gr ve CD19(+) B-Lenfosit oranı %1 geldi. MGN ile takipli olan 19 yaşındakierkek hastanın ise tedavi öncesi BUN 38 mg/dl, serum kreatinin düzeyi 2,48mg/dl, eGFR 36 mL/dk/1.73m², serum albümin düzeyi 2,6 g/dl, 24 saatlikidrarda protein 13,6 gr iken, CD19(+) B-Lenfosit oranı %7,5 geldi. 3. aydabakılan BUN 37 mg/dl, serum kreatinin düzeyi 2,41 mg/dl, eGFR 37 mL/dk/1.73m², serum albümin düzeyi 3,4 g/dl, 24 saatlik idrarda protein 14,1gr ve CD19(+) B-Lenfosit oranı %1 geldi. Hastalarda infüzyona bağlı herhangi bir allerjik reaksiyon gelişmezken, MGN ile takipli hasta solunum yoluenfeksiyonu nedeniyle parenteral antibiyotik tedavisi aldı.Sonuç: Anti-CD20 bazlı tedavilerde yanıt 6.aya kadar gecikebilmekle beraber, bizim hastalarımızda 3.ayın sonunda proteinüride anlamlı azalma henüz görülmemiştir. Olası nedenler olarak ilaç dozunun yetersizliği ve tedaviöncesi GFR kaybının başlaması gösterilebilir. Ofatumumab’ın daha yüksekdozda ve henüz GFR kaybının başlamamış olduğu hastalarda uygulanmasıdurumunda olumlu yanıt alınabilmesi olasıdır.Anahtar Kelimeler: Ofatumumab, Nefrotik Sendrom</p

Role of transforming growth factor-beta(2) in, and a possible Transforming Growth Factor-beta(2) gene polymorphism as a marker of, renal dysfunction in essential hypertension: A study in Turkish patients

WOS: 000231920000002PubMed: 24672129Background: Many studies have shown that transforming growth factor (TGF)-beta has a major role in renal scarring in many renal diseases and hypertension. Objectives: The primary aim of this study was to investigate both the relationship between hypertension and serum and urinary levels of TGF-beta(2) (a more sensitive isoform for glomeruli than TGF-beta(1))), and the effects of combination therapy with perindopril + indapamide on microalbuminuria, which becomes an early indicator of hypertensive benign nephropathy, and serum and urinary TGF-beta(2) levels in patients with mild to moderate essential hypertension. In addition, we examined the possible relationship between TGF-beta(2) gene polymorphism and essential hypertension. Methods: This study was conducted at the Department of Nephrology, Medical Faculty, Gazi University, Ankara, Turkey. Patients aged >= 18 years with newly diagnosed mild to moderate essential hypertension (systolic/diastolic blood pressure [SBP/DBP] > 120/> 80 mm Hg) who had not previously received antihypertensive treatment were included in the study. Patients with stage I hypertension received perindopril 2 mg + indapamide 0.625 mg (tablet), and patients with stage 11 hypertension received perindopril 4 mg + indapamide 1.125 mg (tablet). All study drugs were given OD (morning) PO with food for 6 months. Serum and urinary TGF-beta(2) and creatinine levels and serum and urinary albumin levels were measured before and after perindopril + indapamide administration. Amplified DNA fragments of the TGF-beta(2) primer region were screened using amplification refractory mutation system polymerase chain reaction analysis, and the number of ACA repeats was confirmed by DNA sequencing. Genetic studies were performed using a commercial TGF-beta(2) kit. Results: Forty patients were enrolled in the study, and 38 patients (27 women, 11 men; mean [SD] age, 46.3 [6.5] years) completed it. SBP and DBP were significantly decreased from baseline with perindopril/indapamide (both, P < 0.001). Microalbuminuria and urinary TGF-beta(2) levels also decreased significantly from baseline (P = 0.04 and P < 0.001, respectively), whereas the serum TGF-beta(2) level did not change significantly. Three patients, all of whom were found to have TGF-beta(2) gene mutations, had increased urinary TGF-beta(2) levels despite good blood pressure control. Conclusions: The results of this study in patients with mild to moderate hypertension suggest that, despite good clinical control of blood pressure, the persistence of microalbuminuria and high urinary TGF-beta(2) levels might predict renal impairment. When treating these patients, genetic tendencies and possible polymorphisms on the TGF-beta(2) locus should be kept in mind

Diyaliz hastalarında lipid peroksidasyon ve antioksidan kapasitesi: farklı diyaliz membranları ile yapılan tek bir diyaliz seansının etkileri

Amaç: Bu çalışmanın amacı diyaliz hastalarının lipid peroksidasyon ve antioksidan savunma kapasitelerini tespit etmek ve değişik tipteki diyaliz membranlarının bu parametreler üzerine etkilerini göstermektir. Metot: Çalışmaya 54 diyaliz hastası ve kontrol grubu olarak 30 sağlıklı birey alındı. 54 diyaliz hastasının 10’u periton diyalizi, 44’ü hemodiyaliz hastasından oluşmaktaydı. Hemodiyaliz hastaları polikarbonat (n10) ya da hemophan membran (n34) kullanılarak hemodiyalize alınmaktaydı. Polikarbonat membran kullanılan grupta, sonraki diyaliz seansında membranlar vitamin-E kaplı dializer ile değiştirildi. Antioksidan savunma kapasitesi ve lipid peroksidasyonunu belirlemek için total antioksidan durumu ve malondialdehid seviyeleri diyaliz öncesi ve diyaliz sonrasında çalışıldı. Sonuçlar: Kontrol grubu ile karşılaştırıldığında tüm diyaliz hastalarında plazma total antioksidan seviyesi daha düşük (1.510.2 mmol/L ‘ye karşı 1.750.20 mmol/L p0.05) ve malondialdehit seviyesi daha yüksek (2.21.17 nmol/mL’ ye karşı 0.600.20nmol/mL p0.05) bulundu. Bir hemodiyaliz seansı sonrasında tüm diyaliz membranları için parametrelerde anlamlı değişiklik tespit edilmedi. Sonuç: Tüm diyaliz hastaları artmış bir oksidatif duruma sahiptirler. Farklı tipte diyaliz membranları ile yapılan tek bir diyaliz seansı oksidan ve anti-oksidan seviyelerini anlamlı olarak değiştirmiyor gibi gözükmektedir.Objective: To estimate lipid peroxidation and the antioxidant defense capacity of dialysis patients and the effects of different types of dialysis membranes on these parameters. Methods: Fifty-four dialysis patients and 30 healthy controls were included in this study. Ten of the dialysis patients were on continuous ambulatory peritoneal dialysis treatment and the rest were on hemodialysis with either polycarbonate membrane (n10) or hemophan membrane (n34). Polycarbonate membranes were switched with a vitamin E-coated dialyzer in the subsequent dialysis session. Total antioxidant status and malondialdehyde levels were studied to determine the antioxidant defense capacity and lipid peroxidation, respectively, before and after the dialysis session. Results: Plasma total antioxidant status levels were lower (1.51±0.2 mmol/l vs. 1.75±0.20 mmol/l p<0.05) and malondialdehyde levels were higher (2.2±1.17 nmol/ml vs. 0.60±0.20 nmol/ml p<0.05) in all dialysis patients compared to the control group. After one hemodialysis session, there were no significant alterations in parameters for either type of dialysis membrane. Conclusion: All dialysis patients have an increased oxidative status. A single hemodialysis session with different dialysis membranes does not seem to significantly change the oxidant or antioxidant levels

Kidney biopsy in the elderly: diagnostic adequacy and yield

Purpose: The number of kidney biopsies (KB) performed in elderly patients has been increasing. Safety and usefulness of elderly KB have been well established, whereas much less is known about diagnostic adequacy and yield in this patient population. Methods: We performed a retrospective study of KBs in 428 patients from April 2015 to December 2017 at an academic institution. We compared KB from 50 patients aged over 64 (elderly) with KB from 378 patients aged between 18 and 64. Results: Gender ratio, body mass index, systolic and diastolic BP, creatinine values, incidences of AKI at the time of biopsy, INR/aptt values, and platelets were similar between the two groups. eGFR and number of transplant biopsies were lower in the elderly biopsy group. The glomerular yield was similar between the two groups (22 ± 14 vs. 22 ± 13, p = 0.869). The likelihood of obtaining more than ten glomeruli was 87% and 88%, respectively, without a significant difference. Inadequate samples were encountered in 6% of the elderly and 5.6% of the non-elderly KB, again without a significant difference. Samples taken by nephrologist had higher glomerular yield for both groups (25 ± 13 vs. 18 ± 12 overall, 26 ± 14 vs. 18 ± 14 for elderly, p < 0.001 both). Inadequate biopsies were lower in the nephrologist group when all patients were considered (3% vs. 9%, p = 0.025). Results were numerically similar for the elderly patients, but the difference was not statistically significant (2% vs. 8%, p = 0.322). No deaths occurred in both arms. Minor complications were not different for each group (4.5% vs. 4%). There were no major complications in elderly patients. However, the difference did not reach statistical significance. Conclusion: The world is aging, leading to an increased number of KB in older patients. KB in the elderly is a safe, effective, and an indispensable tool for the nephrologist. This study suggests there is no need to fear lower diagnostic adequacy in the decision making of a KB for an elderly patient

High-sensitive troponin T increase after hemodialysis is associated with left ventricular global longitudinal strain and ultrafiltration rate.

Circulating troponin levels are both stable and higher in patients with end-stage renal disease, even in the absence of acute coronary syndrome. These patients commonly have underlying cardiac problems that frequently cause troponin elevation. The effect of hemodialysis (HD) on troponin levels has not been well elucidated. Thus, investigated herein is the relationship between the changes in troponin levels along with left ventricular deformation and volume depletion in patients with end-stage renal disease

Severe vitamin D deficiency in chronic renal failure patients on peritoneal dialysis

The aim of this study was to evaluate the prevalence of vitamin D deficiency in chronic renal failure (CRF) patients on peritoneal dialysis (PD) and to correlate the findings with various demographic and renal osteodystrophy markers. Method: This cross-sectional, multicenter study was carried out in 273 PD patients with a mean age of 61.7 +/- 10.9 years and mean duration of PD 3.3 +/- 2.2 years. It included 123 female and 150 male patients from 20 centers in Greece and Turkey, countries that are on the same latitude, namely, 36 - 42 degrees north. We measured 25(OH)D-3 and 1.25(OH)(2)D-3 levels and some other clinical and laboratory indices of bone mineral metabolism. Results: Of these 273 patients 92% (251 patients) had vitamin D deficiency i.e. serum 25(OH)D-3 levels less than 15 ng/ml, 119 (43.6%) had severe vitamin D deficiency i.e. serum 25(OH)D-3 levels, less than 5 ng/ml, 132 (48.4%) had moderate vitamin D deficiency i.e. serum 25(OH)D3 levels, 5 - 15 ng/ml, 12 (4.4%) vitamin D insufficiency i.e. serum 25(OH)D3 levels 15 - 30 ng/ml and only 10 (3.6%) had adequate vitamin D stores. We found no correlation between 25(OH)D-3 levels and PTH, serum albumin, bone alkaline phosphatase, P, and Ca x P. In multiple regression analyses, the independent predictors of 25(OH)D-3 were age, presence of diabetes (DM-CRF), levels of serum calcium and serum 1.25(OH)(2)D-3- Conclusion: We found a high prevalence (92%) of vitamin D deficiency in these 273 PD patients, nearly one half of whom had severe vitamin D deficiency. Vitamin D deficiency is more common in DM-CRF patients than in non-DM-CRF patients. Our findings suggest that these patients should be considered for vitamin D supplementation