A rare cause of hypercalsemia: Acute adrenal failure

Bu çalışma, 19-23 Mayıs 2021 tarihlerinde düzenlenen 42. Türkiye Endokrinoloji ve Metabolizma Hastalıkları Kongresi‘nde bildiri olarak sunulmuştur.Adrenal yetmezlik milyonda 35-60 arasında görülebilen nadir bir hastalıktır. Akut adrenal yetmezlik veya adrenal kriz hayatı tehdit eden ve acil müdahale gerektiren bir durumdur. Akut adrenal yetmezlik sırasında çeşitli elektrolit bozukluklar görülebilirse de hiperkalsemi nadiren oluşmaktadır. Bu yazıda bilinç bulanıklığı nedeni ile başvurup hiperpigmentasyon, hipotansiyon ve hipoglisemi saptanarak adrenal yetmezlik ve adrenal yetmezlik ile ilişkili ciddi hiperkalsemi tanısı konulan bir vakayı sunduk.Adrenal insufficiency is a rare disease that can be seen 35-60 per million. Acute adrenal insufficiency or adrenal crisis is a life threatening situation that requires urgent intervention. Although acute adrenal insufficiency is accompanied by various electrolyte disturbances, hypercalcemia rarely occurs. In this article, we present a case admitted to the hospital with confusion that was diagnosed with adrenal insufficiency after the detection of hyperpigmentation, hypotension and hypoglycemia. and severe hypercalcemia associated with adrenal insufficiency

Tip 2 diyabetli hastalarda dapagliflozin tedavisinin trombosit fonksiyonları ve inflamasyon üzerine etkisi

Dapagliflozin kardiyovasküler hastalıklarda güvenli ve yararlı olduğu gösterilen bir oral anti-diyabetik (OAD) ilaçtır. Dapagliflozinin kardiyovasküler olumlu etkilerinin kesin mekanizması tam olarak bilinmemektedir. Bu çalışmada, dapagliflozin kullanan hastalarda tedavinin trombosit fonksiyonunu gösteren ortalama trombosit hacmi (OTH) ve yeni inflamatuar belirteçler olan nötrofil lenfosit oranı (NLO) ve trombosit lenfosit oranı (TLO) üzerine etkilerini araştırmayı amaçladık. Daha önce OAD veya OAD+insülin tedavisi almakta iken tedaviye dapagliflozin eklenen, 18 yaş üstü tip 2 diyabeti olan hastaların dosyaları incelenerek, dapagliflozin tedavisi başlamadan önce ve tedaviden sonra 3-6 ay içindeki laboratuar verileri kaydedildi. Dapagliflozin tedavisi ile birlikte glukoz ve A1c değerleri anlamlı olarak azalırken (her iki p<0.001), hemoglobin, hematokrit ve NLO değerleri anlamlı olarak arttı (sırasıyla p=0.005, p=0.001 ve p=0.032). Ayrıca nötrofil sayısı anlamlı olarak artarken, lenfosit sayısı anlamlı olarak azaldı (p=0.029 ve p=0.019). Dapagliflozin etkili bir OAD olup vücuttaki inflamasyon üzerine etkileri bulunmaktadır. Bu etkinin nasıl ve neden olduğunun anlaşılmasına ihtiyaç vardır.Dapagliflozin is an oral anti-diabetic drug (OAD) that has been shown to be safe and useful in cardiovascular diseases. The exact mechanism of cardiovascular positive effects of dapagiflozin is not fully understood. In this study, we aimed to investigate the effects of dapagliflozin treatment on mean platelet volume (MPV) as the marker of platelet function, and neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) as new anti-inflammatory markers. Laboratory data were recorded before and 3-6 months after the treatment of patients with type 2 diabetes over age of 18 years who received dapagliflozin when receiving OAD or OAD + insulin. Glucose and A1c values were significantly decreased (both p <0.001) and hemoglobin, hematocrit and NLR values were significantly increased with dapagliflozin treatment (p=0.005, p=0.001 and p=0.032, respectively). In addition, neutrophil count increased significantly and lymphocyte count decreased significantly (p=0.029 and p=0.019). Dapagliflozin is an effective OAD and affects inflammation in the body. There is a need to understand how and why this effect occurs

Membranous nephropathy in Turkey: Turkish society of nephrology glomeruler diseases (TSN-Gold) database results

...ERA EDT

Clinical and pathologic features of primary membranous nephropathy in Turkey: A multicenter study by the Turkish Society of Nephrology Glomerular Diseases Working Group

Background: We aimed to evaluate the features of primary membranous nephropathy (MNP) in Turkish people. Methods: This is a retrospective analysis of patients with biopsy-proven primary MNP. We obtained the data collected between 2009 and 2019 in the primary glomerulonephritis registry of the Turkish Society of Nephrology Glomerular Diseases Study Group (TSN-GOLD). Patients with a secondary cause for MNP were excluded. Clinical, demographic, laboratory, and histopathological findings were analyzed. Results: A total of 995 patients with primary MNP were included in the analyses. Males constituted the majority (58.8%). The mean age was 48.4 ± 13.9 years. The most common presentation was the presence of nephrotic syndrome (81.7%) and sub nephrotic proteinuria (10.3%). Microscopic hematuria was detected in one-third of patients. The median estimated glomerular filtration rate (eGFR) was 100.6 mL/min/1.73 m2 (IQR, 75.4–116.3), and median proteinuria was 6000 mg/d (IQR, 3656–9457). Serum C3 and C4 complement levels were decreased in 3.7 and 1.7% of patients, respectively. Twenty-four (2.4%) patients had glomerular crescents in their kidney biopsy samples. Basal membrane thickening was detected in 93.8% of cases under light microscopy. Mesangial proliferation and interstitial inflammation were evident in 32.8 and 55.9% of the patients, respectively. The most commonly detected depositions were IgG (93%), C3 complement (68.8%), and kappa and lambda immunoglobulin light chains (70%). Although renal functions were normal at presentation, vascular, interstitial, and glomerular findings were more prominent on biopsy in hypertensive patients. No significant effect of BMI on biopsy findings was observed. Conclusions: Despite some atypical findings, the main features of primary MNP in Turkey were similar to the published literature. This is the largest MNP study to date conducted in Turkish people