The Relationship Between Dietary Intakes and Total Kidney Volume in Patients with Autosomal Dominant Polycystic Kidney Disease Dietary Intake and Polycystic Kidney Volume

Aim: There is a need to understand autosomal dominant polycystic kidney disease (ADPKD) patients’ dietary habits since dietary interventions may have potential effects on ADPKD. In this study, we aimed to analyze the relationship between dietary nutrient intake and total kidney volume (TKV). Methods: This cross-sectional study was conducted on 54 ADPKD patients recruited from the Nephrology outpatient clinic between June and July 2014. TKV was determined by magnetic-resonance imaging and general characteristics, biochemical and urinary parameters were determined. The nutrient intakes of patients were calculated using the three-day dietary records obtained on three consecutive days. Results: The total kidney-volume median was found to be 1407 mL. Patients’ total dietary energy and protein intakes were 25.8±9.4 kcal/kg, 0.9±0.3 g/kg, respectively. The percentage of carbohydrates, protein, and fat in energy was 49±7%, 14±3%, 37±7%, respectively. The mean intakes of thiamin, riboflavin, B6, calcium, magnesium, and zinc were sufficient, the mean dietary potassium intake was insufficient; and sodium intake was excessive in both sexes. In females, there was a negative but weak correlation between dietary vitamin C intake and TKV. In males, a negative but weak correlation was found between TKV and dietary intake of fiber, water, vitamin B6, vitamin K, magnesium, and iron. Conclusions: Dietary micronutrient intake may affect TKV according to sex. © 2022, Galenos Publishing House. All rights reserved

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

Role of Peritoneal Ultrafiltration in Heart Failure Treatment

Cardiorenal syndrome (CRS) is a general term that can reflect different clinical conditions in which cardiac and renal dysfunctions coexist. The main pathogenetic mechanisms playing a role in heart failure (HF) and CRS are neurohumoral adaptation, right ventricular dilatation and dysfunction and systemic inflammation. Persistence of these factors cause focal and segmental glomerulosclerosis, and tubulointerstitial fibrosis in the renal parenchyma. Diuretics, beta blockers, renin-angiotensin-aldosterone system inhibitors, and vasodilators are the main medical treatments besides conventional approach, such as salt and water restriction and quitting smoking, in HF treatment. Diuretic resistance is the main problem emerging during diuretic treatments. Two renal replacement treatments have become prominent for removal of excess fluids via ultrafiltration in HF patients with diuretic resistance extracorporeal ultrafiltration with hemodialysis and peritoneal dialysis (PD). Herein, the role of these two ultrafiltration modalities, especially peritoneal ultrafiltration (PUF) in the treatment of HF is discussed. The main studies and advantages of PUF in HF treatment were discussed. Moreover, effects of PD on glomerular filtration rate, hospitalization and mortality were investigated. In conclusion, PD is an alternative cheap, practical and convenient therapy in reducing cardiac volume burden in HF patients who do not respond well to standard treatments and/or require frequent hospitalization

Effect of Blood Glucose Monitored Before Dialysis on Hypoglycemia During Dialysis in Adult Acute Hemodialysis Patients: A Multicenter Study

Aim: Individuals receiving hemodialysis treatment may observe glucose fluctuations due to decreased plasma glucose concentration and insulin level. The aim of this study was to evaluate pre-dialysis blood glucose measurements in acute hemodialysis patients to reduce complications that may occur during this process. Methods: The study design was an observational-retrospective one. A total of 200 files belonging to the last 3 months in three centers were scanned between August 1, 2022, and September 30, 2022. While the files were being scanned, the 30-question “Hypoglycemia in Hemodialysis” patient form was used, and the IBM Statistical package for the social sciences 26.0 statistical program was used to evaluate the data. Results: Hypoglycemia developed during hemodialysis in 4 of 104 patients whose blood glucose was checked before hemodialysis and in 2 of 96 patients whose blood glucose was not measured. It was determined that there was no significant difference (p>0.05) in terms of the rate of development of hypoglycemia between patients whose blood glucose levels were checked before hemodialysis and those who did not. Conclusion: The study’s results suggest that acute hemodialysis patients’ pre-dialysis hypoglycemia does not influence the hypoglycemia that develops during the session

A Lethal Complication of Endoscopic Therapy: Duodenal Intramural Hematoma

Duodenal intramural hematoma (DIH) usually occurs in childhood and young adults following blunt abdominal trauma. It may also develop in the presence of coagulation disorders and may rarely be an iatrogenic outcome of endoscopic procedures. Management of DIH is usually a conservative approach. A case of intramural duodenal hematoma that developed following endoscopic epinephrine sclerotherapy and/or argon plasma coagulation and that was nonresponsive to conservative therapy in a patient with chronic renal failure who died from sepsis is being discussed in this report. Clinicians should be aware of such possible complications after endoscopic hemostasis in patients with coagulation disorders

Factors effective on peritoneal phosphorus transport and clearance in peritoneal dialysis patients

Aims: Transport characteristics of phosphorus are different from other small solutes that are evaluated in routine peritoneal equilibration test ( PET) in peritoneal dialysis (PD) patients. We aimed to evaluate peritoneal phosphorus clearance and permeability, and their relationship with peritoneal membrane transport type and creatinine clearance as well as factors affecting peritoneal phosphorus clearance. Methods: 70 adult patients on a PD program were included in our study. Phosphorus transport status was classified according to dialysate/plasma (D/P) phosphorus at the 4th hour of PET as slow transporter ( 0.67). We evaluated the relationship of peritoneal phosphorus clearance and transport type with PD regime, phosphorus level, and presence of residual renal function in addition to investigating factors that are effective on peritoneal phosphorus clearance. Results: D/P phosphorus and peritoneal phosphorus clearance were positively correlated with D/ P creatinine and peritoneal creatinine clearance, respectively. Automated PD and continuous ambulatory PD patients were similar regarding phosphorus and creatinine clearances and transport status based on D/ P phosphorus. The major determinant of peritoneal phosphorus clearance was anuria status. Anuric patients had higher dialysate volume (11.6 +/- 3.0 L vs. 8.4 +/- 2.1 L, p < 0.001) and therefore higher peritoneal phosphorus clearance (61.7 +/- 15.1 L/week/1.73 m(2) vs. 48.4 +/- 14.0 L/week/1.73 m(2), p = 0.001). Hyperphosphatemia was present in 40% and 11% of anuric patients and those with residual renal function, respectively (p = 0.005). Conclusions: Peritoneal phosphorus transport characteristics are similar to that of creatinine. Although increased dialysis dose may increase peritoneal phosphorus clearance, it may be insufficient to prevent hyperphosphatemia in anuric patients

A comparison of antineutrophil cytoplasmic antibody prevalence in patients treated and untreated for hyperthyroidism

We aimed to compare the prevalence of antineutrophil cytoplasmic antibody (ANCA) and its subgroups between on-treatment (with anti-thyroid drugs; propylthiouracil, methimazole) and untreated patients with hyperthyroidism in our unit. Overall 78 consecutive patients were enrolled in the study; 45 patients were on-treatment (female/male 31: 14) and 33 were newly diagnosed (female/male 20: 13). We have studied ANCA, perinuclear-ANCA (p-ANCA), cytoplasmic-ANCA (c-ANCA), myeloperoxidase-ANCA (mpo-ANCA), and proteinase 3-ANCA (pr3-ANCA) in sera of all the patients. The data about clinical status, laboratory tests, and physical examination and mean duration of treatment in treated group were recorded. There was no statistically significant difference between the two groups for ANCA, c-ANCA, and pr3-ANCA (P = 0.13, P = 0.07, and P = 0.63 respectively). p-ANCA and mpo-ANCA prevalences were significantly higher in on-treatment group than in untreated group (P = 0.04 and P = 0.01, respectively). The mean duration of treatment was 17 months in on-treatment group. The use of antithyroid drugs (propylthiouracil, methimazole) seems to be correlated with increased prevalence of ANCA. These drugs may especially increase p-ANCA and mpo-ANCA positivity

The feasibility of anthropometric measurements for evaluation of abdominal obesity in patients with autosomal dominant polycystic kidney disease: a cross-sectional study

Introduction: total kidney volume (TKV) increases in patients with autosomal dominant polycystic kidney disease (ADPKD), which perturbs anthropometric measurements. Objectives: the primary objectives were to investigate the accuracy of waist circumference (WC) and waist-to-hip ratio (WHR) for determining abdominal obesity in patients with ADPKD by comparison with magnetic resonance images. The secondary objectives were to investigate the associations of energy/macronutrient intake with WC and WHR. Methods: sixty patients with ADPKD were recruited from a nephrology outpatient clinic in this cross-sectional study. Main outcome measures were: TKV, total subcutaneous fat (TSF), total intraperitoneal fat (TIF), WC, WHR, body mass index (BMI), skinfold thickness (SFT), and energy/ macronutrient intake. Results: mean age was 48.6 ± 11.3 years, 38 of 60 were women, median TKV was 1486 (IQR, 981-2847) mL. The patients classed as obese by the BMI had higher WC, TSF, TIF, and SFT than did non-obese; however, WHR was similar in obese and non-obese men. In the all-patients group, the WHR of obese and non-obese patients were also similar. TKV was positively correlated with WC and WHR in women, but not in men. In the multivariate analysis, TKV was an independent factor affecting WC and WHR in women. Dietary fat intake was similar in groups with and without abdominal obesity according to WC and WHR. Conclusions: in women with ADPKD, WC and WHR may not be accurate anthropometric measurements for evaluation of abdominal obesity; however, they may be associated with TKV. © 2022 SENPE y Arán Ediciones S.L

Paroxysmal Nocturnal Hemoglobinuria and Acute Kidney Injury: A Case Report

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare cause of hemolytic anemia. The major outlines of clinical presentation comprises findings of hemolysis, venous thrombosis and findings of bone marrow failure. The presentation of the disease with acute kidney injury (AKI) is not frequent. Massive hemoglobinuria following a serious attack of hemolysis during the course of PNH may lead to AKI by way of causing acute tubular necrosis. Hemoglobin casts and accumulation of hemosiderin in the proximal tubule may be seen in renal biopsy. The treatment is not different from that of acute tubular necrosis. Herein, we present a case who was admitted to our clinic with AKI and diagnosed to have PNH during hospitalization