Emphysematous pyelonephritis in a diabetic patient with kidney stone

Emphysematous pyelonephritis (EPN) is an acute necrotizing infection of the renal parenchyma, resulting in presence of gas within either the collecting system or perinephric tissue. Females and diabetics are more prone to the disease. We present a case with EPN caused by Escherichia coli sepsis. A 54-year-old woman was admitted to emergency service in a status of septic shock. Radiodiagnostic computed tomography revealed gas bubbles bilaterally in the renal parenchyma and also left ureter. Treatment consisted of antibiotics and intravenous fluids. She died at the second day of hospitalization because of urosepsis

Glomerular filtration rate: Which method should we measure in daily clinical practice?

Aim. In this study, we compared estimated glomerular filtration rate (eGFR) calculated with the formulas of Cockcroft-Gault (C&G), Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Mayo Clinic Quadratic (Mayo Q) and, GFR (mGFR) that was scintigraphically measured with creatinine clearance (CrC1) and technetium-99m di-ethylene triamine penta-acetic acid (99mTc-DTPA). Objective of this study was to define the correlations between the formulas, provide a reliable method for measurement and estimation of GFR in daily clinical practice and demonstrate the potential errors. Methods. C&G, CKD-EPI, Mayo Q and MDRD eGFR of 84(37 males, 47 females) patients diagnosed with chronic kidney disease were calculated. Values of 99mTc-DTPA based on mGFR were compared with eGFR values of the formulas. Results. Significant correlations were found with the values of 99mTc-DTPA mGFR, CrCl, MDRD, CKD-EPI, Mayo Q and C&G eGFR. The highest correlation was found between LBM (lean body mass) corrected C&G, MDRD-6, Mayo Q and CKD-EPI eGFR. The best estimate was made with MDRD-6 in the cases with 99mTc-DTPA mGFR<30 mL/min/1.73 m2 and with MDRD-4 in the cases with 99mTc-DTPA mGFR?30 mL/min/1.73 m2, while the worst estimate was made with uncorrected C&G formula in both groups. Conclusion. All eGFR formulas can be used in daily clinical practice. However, using MDRD-6 in the cases with GFR<30 mL/min/1.73 nil and MDRD-4 in the cases with GFR?30 mL/min/1.73m2 as well as using LBM for C&G eGFR or correction according to LBM when AW (actual weight) is used, might provide a more accurate estimation

Bioimpedance spectroscopy for the differential diagnosis of hyponatremia

Background: Hyponatremia is classified according to volume status with the help of physical examination, biochemical measures, urine and serum osmolalities, and echocardiography. Bioimpedance spectroscopy (BIS) has been getting popularity for revealing tissue compositions of various patient groups. The aim of this observational study was to investigate the role of BIS for the differential diagnosis of hyponatremia (ClinicalTrials.gov Identifier: NCT01838759). Patients and methods: Personal characteristics of age, sex, weight, height, and blood pressure were recorded. Body composition monitor (BCM) was used for hydration status for each individual. Primary outcome was investigated by the accuracy of volume status measured by BIS. Statistics: Kappa statistic (K) is a measure of agreement between two sources, which is measured on a binary scale (i.e., condition present/absent). K statistic can take values between 0 and 1: poor agreement: K < 0.20, fair agreement: 0.2.0-0.3.9, moderate agreement: 0.40-0.59, substantial: 0.60-0.79, very good agreement: 0.80-1.00. Results: Fifty-eight hyponatremia-diagnosed patients, 32 (55.2%) of male with the mean age of 65.2 ± 11 (40-89) years were included. Kappa statistic (K) were very good (K = 0.925) for male (p < 0.00), substantial agreement (K = 0.601) for female (p < 0.002) with the use of BIS for the differential diagnosis of either hypo or hypervolemia in hyponatremic patients compared with gold standard tests which were the combination of echocardiography, serum, and urine osmolality biochemical tests, and physical examination. Conclusion: Bioimpedance spectroscopy is a practical and an inexpensive method. This is the first study in the literature showing the role of BIS for the determination of the volume status and differential diagnosis of hyponatremia when compared with echocardiography. © 2015 © 2015 Informa Healthcare USA, Inc. All rights reserved

Influence of single hemodialysis session on serum paraoxonase-1, arylesterase activity, total oxidant status and total antioxidant status

Aim. Chronic kidney disease(CKD) and hemodialysis (HD) are associated with increased oxidative stress. Cardiovascular diseases (CVD) are the most important cause of mortality in these patients. Increased cardiovascular risk is associated with oxidative stress. The aim of this study was to evaluate whether the duration of single session hemodialysis may affect oxidative stress parameters on the patients with end-stage renal disease (ESRD). Methods. Total oxidant status (TOS) and oxidative stress index (OSI) as oxidative markers and total antioxidant status (TAOS), paraoxonase1 (PON1) and arylesterase (ARES) as antioxidant markers were compared hemodialysis therapy before and after the treatment. Results. TOS levels before hemodialysis were found as 4.4±2.4 µmol H2O2 Equiv/L, TAOS 2.1±0.3 µmol trolox Equiv./L, OSI 0.2±0.1%, PON1 levels 58.5±35.6 U/L and ARES levels 22±0.2 U/L while after the HD the respective values were 1.4±1.2 µmol H2O2 Equiv/L, 1.4±0.5 µmol trolox Equiv./L, 0.1±0.1%, 54.3±31.3 U/L, 21.8±0.1 U/L. A significant decreasing was observed in TOS TAOS OSI and ARES values before the HD compared to after the HD (P=0.0001, P=0.0001, P=0.0001, P=0.031, respectively). Conclusion. This study shows oxidant (TOS, OSI) and antioxidant (TAOS, ARES) markers were found to be significantly decrease after the HD compared to pre-hemodialysis. Although reverse is expected it is found that oxidants (indirectly ROS) did not increase and antioxidant reserve decreased in HD

Evaluation of association between atherogenic index of plasma and intima-media thickness of the carotid artery for subclinic atherosclerosis in patients on maintenance hemodialysis

Incidence of cardiovascular diseases in the patients having chronic kidney disease (CKD) is between 25% and 60%. This increased rate is proposed to be associated with "accelerated atherosclerosis." Increased carotid intima-media thickness (CIMT) is a subclinical atherosclerosis marker. Small-dense low-density lipoprotein particles are a strong risk factor for atherosclerosis. It was shown that atherogenic index of plasma (AIP = log(TG/HDL-c)) is correlated with size of the lipoprotein particles. We investigated the correlation between AIP and CIMT which is a subclinical atherosclerosis marker, in hemodialysis (HD) patients. A total of 62 persons with 31 patients under HD therapy and 31 volunteers were included in the study. In all the participants, CIMT was measured and AIP were calculated. AIP and CIMT values of the participants were compared with blood pressures, lipid profiles and the other risk factors. AIP (0.39±0.32) and CIMT (0.57±0.13) were found significantly higher in the patient group than in the controls (0.04±0.36 and 0.45±0.119, respectively); (P = 0.0001 and 0.0001, respectively). There was a significant correlation between AIP and increased CIMT in the patient group (P = 0.0001, r = 0.430). Among the lipid parameters, the strongest correlation was found between CIMT and AIP. We demonstrated the significant increase of AIP and CIMT in HD patients. A correlation was found between AIP and CIMT. AIP was found to show a correlation with a greater number of risk factors, both classical and CKD specific, than CIMT. These data suggest that AIP might be a method which can be used both in diagnosis of subclinical atherosclerosis and in deceleration processes of its progression. © 2013 The Authors. Hemodialysis International © 2013 International Society for Hemodialysis

The effects of strict salt control on blood pressure and cardiac condition in end-stage renal disease: Prospective-study

Introduction: Overhydration is the main contributory factor of left ventricular hypertrophy and closely associated with cardiovascular events in end stage renal disease (ESRD) patients. The aim of this prospective-study was to investigate the impact of strict salt and volume control on hypertension and cardiac condition in ESRD patients. Methods: A total of 12 peritoneal dialysis (PD) and 15 prevalent hemodialysis (HD) patients were enrolled. All patients either PD or HD were allocated to intervention of strict salt restriction according to basal hydration state of empty abdomen in PD and midweek predialysis HD which were estimated by body composition monitor (BCM) and echocardiography. Results: Mean ages were 48.3±16.7 years for PD, and 48.8±18 for HD patients. Extracellular water/height was 10.04±2.70 and 10.39±1.53L/m in PD and HD groups. Systolic blood pressures decreased in PD and HD from 133.1±28 and 147.3±28.5 to 114.8±16.5 and 119.3±12.1mmHg, respectively, (p0.05). LVMI and LAI were not increased in both groups. Conclusion: Strict salt and volume control in ESRD patients after assessment of hydration status with either using BCM or echocardiography provides better management of volume control leading to more precise cardiovascular protection. © 2013 Informa Healthcare USA, Inc

Volume and nutritional status evaluated by bioimpedance affected by body positions

Objective: Body composition analysis is useful technique for assessing hydration, nutritional status and predicting clinical outcomes. Bioimpedance analysis (BIA) is a cheap and noninvasive tool for monitoring body composition but needs some improvements regarding measurement methods. We aimed to find out if body position has an effect on the BIA results. Material and Methods: Personal characteristics including age, gender, height, weight and blood pressure were recorded. Hydration and nutritional status measured by body composition monitor in supine and standing positions consequently for each individual. Results: Two hundred and one populations from various region in Turkey, 61% (n: 123) male, mean age was 46.3±12 years (18-76) of age, participated in this crossectional study. From supine to standing positions overhydration and extracellular water (ECW) were increased from 0.04±1.08 and 17.69±2.92 to 0.46±1.05 L and 17.84±2.90 L while intracellular water (ICW) decreased from 22.55±4.35 to 22.04±4.28 L significantly. Systolic and diastolic blood pressures were 131.3±18.1 and 75.1±12 decreased to 127.0±16.0 and 72.2±9.0 mmHg in supine to standing positions (p> 0.05). Conclusion: Supine and standing positions could affect the volume parameters of BIA due to shift of ECW and ICW by gravity but nutritional parameters also changes significantly. Protocols should be re evaluated in order to get more accurate results in bioimpedance measurements

Bioimpedance and echocardiography used interchangeably in volume comparison of dialysis patients

Background: Euvolemia is a major issue in chronic kidney disease. The present study compares cardiac condition and volume status in peritoneal dialysis (PD) and hemodialysis (HD) patients and points out importance of volume control. Methods: From a single-center center, 81 PD and 89 HD patients were enrolled. Echocardiography and body composition analysis using bioimpedance spectroscopy (BIS) technique were performed. Overhydration (OH) and extracellular water (ECW) in liters and OH/ECW % were used as volume indices. Results: Patients were younger (47.6±14. 5 and 53.1±11.8 years, p&lt; 0.05), daily urine volume higher (1068±926 vs 290±444 ml, p &lt;0.001) and dialysis vintage was shorter (30.1±18.6 vs 53.6±35.4 months, p&lt;0.001), systolic blood pressure was lower (127.5±15.4 vs 140.3±18.9 mmHg, p&lt;0.001) in PD than HD group respectively. Volume indices were (OH, OH/ECW %, ECW/height, ECW to Intracellular Water ratios (E/I) (p&lt;0.05)) significantly higher in HD patients compared to PD patients. Over all 66 of 170 patients (39%) had OH/ECW % &lt;5 and OH/ECW % ratio was positively correlated with Left atrium index (R2:0.105, p&lt;0.05). Interventricular septum diameter and Left ventricular mass index (1.41±0.24 and 159.6±48.2 vs. 1.27±0.17 cm and 115.8±37 g/m2, p&lt;0.001) were increased in HD than in PD group. After multivariate adjustment OH/ECW increased with: HD and diabetic patients. LVH increased with: HD group, OH/ECW (%) and SBP significantly. Conclusion: Overhydration was more common among HD. Excess fluid may lead adverse effect in organ functions especially cardiac condition. This indicates that the current clinical and technical tools to achieve euvolemia are insufficient and that an additional tool, such as BIS, could be useful in the diagnosis of overhydration

Ultrafiltration is not superior than diuretics in type 4 cardiorenal sydrome

Objective: Cardiorenal syndrome (CRS) describes a dysregulation of the heart and kidneys affecting each other. Recently hemodialysis treatments were used more frequently. Aim was to analyze the effects of conventional diuretic and UF treatments. Material and Methods: Thirty-four Type 4 CRS diagnosed patients were included. Baseline characteristics were recorded. Echocardiography measured at the admission and at the end of the treatment. Results: The mean age 67.4±9.3 (51-93) years and follow-up period were 15.9±11.5 months. The patients were grouped as diuretic group, n=12 and UF group, n=22. At the beginning mitral valve A wave, blood urea nitrogen and creatinine values were higher in the UF group while creatinine values were higher in the UF group compared to diuretic group at the end of the study. Although basal ejection fraction (EF) values were not different, it was higher in the UF group at the end of the study (42.38±12.70 % and 29±3.67 %, p 0.05). Conclusion: In Type 4 CRS, mortality and hospital admissions were not reduced by UF treatment but cardiac function assessed by EF was significantly improved suggesting this therapy to be beneficial in appropriate patients