Presentation antineutrophil cytoplasmic autoantibody negative-associated granulomatosis with polyangiitis with pyuria

Pulmonary renal syndrome is a rare but serious complication of systemic vasculitis. The majority the cases are antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis. In this case, a 58 years old female case having aworsening clinical picture of probable urinary infection and acute renal failure was presented. By means of proteinuria, pyuria, hematuria and unexplained acute renal failure, we review the relevant literature on pulmonary renal syndrome associated with granulomatosis with polyangiitis (GPA) with negative serum ANCA serology. This report demonstrates the difficulty of diagnosing granulomatosis with polyangiitis (GPA) until renal biopsy was done while initial diagnostic serological negative ANCA testing

A case of quadriparesis due to renal tubular acidosis accompanied by vitamin D deficiency in Sjögren’s syndrome

Renal tubular acidosis (RTA) is metabolic acidosis disorder with a normal anion gap that occurs resulting from bicarbonate reabsorption or disorder in the hydrogen excretion from the kidney. A variety of tests are required to be administered in a stepwise fashion for the diagnosis and characterization of RTA. Correct diagnosis involves careful evaluation, including exclusion of other entities causing acidosis. The patients were treated with potassium and bicarbonate supplementation. A fifty-one years old female patient presented to the emergency department with quadriparesis dependent on hypokalemia and vitamin D deficiency, was diagnosed with distal renal tubular acidosis (dRTA) combined with Sjögren's Syndrome (SS). We submitted this case in order to draw attention to the presentation of the RTA with SS

Interrupted Aortic Arch in an Adult with Polycystic Kidney Disease

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease and is responsible for 8–10% of patients with end-stage renal failure. The major extrarenal complications of ADPKD are cardiovascular abnormalities. Interrupted aortic arch (IAA) is a lethal congenital cardiac abnormality seen with a frequency of 3/1000000 births and is defined as a segment of the arcus aorta being atresic. In the literature, there are no any reports showing that polycystic kidney disease and interrupted aortic arch occur together. In this study, we present a rare case in which the patient has polycystic kidney disease and IAA together and discuss whether IAA is a complication of ADPKD

Role of the VEGF 936 gene polymorphism and VEGF-A levels in the late-term arteriovenous fistula thrombosis in patients undergoing hemodialysis

WOS: 000341430800022PubMed: 24748065Vascular access is vital for hemodialysis patients. A major factor that facilitates arteriovenous (AV) fistula failure is stenosis and thrombosis due to intimal hyperplasia developing in the venous segment of AV fistula. It has been reported that VEGF accelerated re-endothelialization, reduction in intimal thickening, and/or mural thrombus formed in the injured vascular structures. In this study, we aimed to identify the effect of the VEGF 936 gene polymorphism and vascular endothelial growth factor-A (VEGF-A) levels in the late period of AV fistula loss in hemodialysis patients. The study was carried out with a patient group of 42 individuals who experienced two or more fistula thrombosis in the late period after the AV fistula operation and also a control group of 38 patients who have not had any AV fistula thrombosis history for 3 years or more. All participants were assessed for VEGF-936C/T gene polymorphism and VEGF-A levels. VEGF-936C/T genotypes were determined in the large proportion in the control group (31.6 %), while VEGF-936C/C genotypes were determined in a large proportion in the patient group (90.5 %). Individuals carrying the VEGF-936C/C genotype had an increased risk of 5.54 for getting AV fistula thrombosis. The VEGF-A levels of patient group (27.3 +/- A 43.5 pg/ml) were significantly lower than those of the control group (70.7 +/- A 53.1 pg/ml). There is an increased risk of AV fistula thrombosis in individuals carrying the VEGF-936C/C genotype. The other renal replacement modalities should be considered in patients with this genotype. As a result, it will be possible to prevent the morbidity and mortality due to fistula failure

Illness Perception and Hopelessness in Hemodialysis

Background: Illness perception is useful in understanding the impact of hopelessness on ESRD patients. This perception has been found to be an important determinant of behavior and has been associated with a number of important outcomes such as treatment adherence and functional recovery and quality of life. Aim: The aims of this study were to determine, the level of hopelessness and to evaluate whether illness perception is related to hopelessness among End-stage Renal Disease (ESRD) patients on hemodialysis (HD). Methods: The study was conducted on patients with end stage renal disease who received treatment in the dialysis units and who volunteered to participate in the study. A total of 83 HD patients completed the Revised Illness Perception Questionnaire (IPQ-R) and Beck Hopelessness Scale (BHS) to measure the level of hopelessness. Results: Result shows that there was significant relationship found between hopelessness and illness perception. Five components of illness perception which included consequences, personal control, treatment control, illness coherence, emotional response and causes were significantly correlated with hopelessness. HD patients believing that their illness was chronic and due to illness occurs most of stress-worry. Conclusions: Interventions aimed at providing more knowledge about ESRD and dialysis, and provision of skills to coping with the illness and its consequences may reduce hopelessness in dialysis patients. The way the patients feels and believes regarding one self, the disease and also the treatment will usually affect his or her life. Additionally, the relationship between the five components of illness and&nbsp; hopelessness provide support for pursuing further examination of the holistic outcomes in persons with ESRD patients undergoing haemodialysis.</p

Factors Related to Microalbuminuria in Patients with Chronic Obstructive Pulmonary Disease

WOS: 000346149200011PubMed: 25491689Background. Chronic obstructive pulmonary disease (COPD) is characterized by inhaled particles and gases inducing chronic inflammation of the airways accompanied by a not fully reversible airflow limitation. Systemic inflammation has an important role in the pathogenesis of COPD. In parallel, several comorbidites can be observed. Microalbuminuria is related to endothelial dysfunction. Microalbuminuria was increased in exacerbation periods of COPD. Objectives. The aim of the study was evaluate to the presence of microalbuminuria (MA) in patients with chronic obstructive pulmonary disease (COPD) and its relationship to inflammation, arterial blood gas parameters and 24-hour ambulatory blood pressure alterations. Material and Methods. Seventy COPD patients and 40 healthy volunteers were enrolled in the study. 24-h ambulatory blood pressure monitoring (ABPM) results, including pressure and pulse rates of the subjects were recorded and the cases were classified as "dipper" if a normal fall of more than 10% in blood pressure was observed at night and "non-dipper" if not. Routine renal function tests were performed, C-reactive protein (CRP) values were examined and urine samples were obtained to scrutinize the presence of MA. Patients were allocated into two groups, those with and without MA. The spirometry and arterial blood gas results of the patients were recorded. Results. The urinary albumin creatinin ratio (64.8 +/- 91.8), CRP (21 +/- 14.8), nocturnal systolic and diastolic blood pressure (118 +/- 14 and 72 +/- 10), nocturnal and diurnal pulse (87 +/- 17 and 90 +/- 14), nocturnal pulse pressure (49 +/- 11), mean pulse (89 +/- 15), mean pulse pressure (48 +/- 10) and the number of non-dipper subjects (65) were found significantly higher in the COPD group than in the control group (10.6 +/- 6, 5.4 +/- 2.4, 105 +/- 6 and 68 +/- 7, 70 +/- 10 and 78 +/- 11, 42 +/- 1, 75 +/- 11, 42 +/- 7 and 5, respectively); (p < 0.001, < 0.001, < 0.001 and 0.041, < 0.001 and < 0.001, < 0.001, < 0.001, < 0.001 and < 0.001, respectively). Nocturnal pulse (89 +/- 17) and CRP (23.5 +/- 14.8) were found to be significantly higher in COPD patients with MA than in COPD patients without MA (78 +/- 8 and 8.8 +/- 6.3, respectively); (p = 0.021 and < 0.001, respectively). Conclusions. The facts that CRP, a systemic inflammation marker, and mean nocturnal pulse pressure values were significantly higher in the group with MA among COPD patients, and that ambulatory blood pressure values did not differ between COPD patients with and without MA, suggest both a possible role of inflammation in MA development in COPD patients and a relationship between MA and increased heart rate

Spontaneous Tumour Lysis Syndrome in a Multiple Myeloma

The tumor lysis syndrome (TLS) is a collection of metabolic abnormalities that occur in consequence of the release of intracellular contents following lysis of tumor cells. TLS occurs spontaneously or after chemotherapy. Spontaneous TLS is uncommon occurrence in multiple myeloma (MM). We define a case of a 70-year-old woman patient who was found to have MM with spontaneous TLS, following a compression fracture of the T-12 vertebrae. While serum uric acid and phosphorous levels were high, low calcium levels were identified. There were also acute kidney injury and metabolic acidosis. Upon the diagnosis of TLS, she was treated with hydration, allopurinol, sodium bicarbonate, and calcium gluconate. The improvement of her laboratory data was observed. We submitted this case in order to draw attention to the presentation of MM with spontaneous TLS