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

Lipid Profile and Inflammation in Degenerative Valvular Disease

Aim: Degenerative valvular heart disease (DVHD) may cause serious cardiac problems and mortality. Determination of the factors related to DVHD may render possible the prevention and/or slowing down the progression of DVHD. In this study, we evaluated the relationship of DVHD with lipid profile, microalbuminuria and high sensitive C-reactive protein (hsCRP) levels. Methods: 50 patients (age=65.6±12.4 years) with DVHD were compared with the control group including 20 patients (age=57.3±13.9 years) with left ventricle hypertrophy, but no DVHD. Microalbuminuria, blood lipid parameters and hsCRP levels were measured besides routine biochemical tests. Clinical, laboratory and echocardiographic findings were compared between the groups. Results: Total cholesterol, HDL-cholesterol and LDL-cholesterol levels were significantly higher in DVHD group (215.26±48.59 mg/dL vs. 177.45±22.47 mg/dL, p=0.001; 45.04±11.03 mg/dL vs. 38.90±11.82 mg/dL, p=0.043 and 138.49±40.69 mg/dL vs. 114.26±16.07 mg/dL, p=0.001) compared with control group. hsCRP and microalbuminuria levels were relatively higher in DVHD group. Conclusion: Hyperlipidaemia is related to DHVD development, and the progress of DHVD may be related to the inflammatory process. Elevated hsCRP levels may be an indicator of pathologies active in DVHD development. Routine echocardiographic analysis in hypertensive patients with high hsCRP and LDL-cholesterol levels might be useful for screening of DVHD. (The Medical Bulletin of Haseki 2015; 53: 62-6

Aging kidney: Senescence or disease? Yaşlanan böbrek: Yaşlanma mi, hastalik mi?

With the increased life expectancy of humans, the physicians are faced to more and more elderly patients. Kidneys change both structurally and functionally with age. Hyalinosis of arterioles and fibrous intimal thickening of the arteries leading to sclerosis, decreased number of nephrons, increased percentage of sclerotic glomeruli, progressive interstitial fibrosis, increased renal vascular resistance, decreased glomerular filtration rate, increased filtration pressure, podocyte damage, decreased concentration ability and hyporeninemic hypoaldosteronism are among these changes. The major clinical reflections of these changes are globally decreased renal function, mild proteinuria, distorted fluid and electrolyte balance with mild polyuria, hyponatremia and hyperkalemia. It is still unclear whether aging alone is responsible for decline in renal function in elderly; or this deterioration is due to comorbidities common in this population. Pathogenesis of aging-related changes in renal function is not fully elucidated; but genetic factors, recurrent attacks of acute kidney injury, aggressive strategies to lower blood pressure, accumulation of advanced glycosylation end products, decreased PPAR-γ expression, increased endothelin-1 expression, reduced nitric oxide generation and accumulation of asymmetric dimethylarginine were reported to have a role in the mechanism. Whatever this mechanism is; it is vital to treat elderly patients with great caution knowing that overtime these possible changes might occur with kidney functions

Evaluation of the Importance of Patient Education in Peritoneal Dialysis

Aim: Peritoneal dialysis is the type of renal replacement therapy which requires active participation of the patient; therefore, the education of the patient is of major importance. We aimed to evaluate objectively the importance of continuation of education in patients on peritoneal dialysis (PD). Methods: Thirty patients included in our study were asked to perform two questionnaires before and after an education session lasting about 45 minutes. The questions were about the functions of the kidneys, renal failure and PD techniques in the first one, and peritonitis, hypervolemia and nutrition in the second questionnaire. The numbers of correct answers before and after the education were compared. Results: The mean number of correct answers raised from 5.48±1.7 to 6.26±1.6 with the education in the first (p=0.002) and from 5.14±1.5 to 7.14±0.9 in the second questionnaire (p<0.001). Although there was a significant improvement with education, it was more obvious in the second questionnaire, suggesting better performance of both the teaching nurses and patients. In the first questionnaire, fifteen patients’ results improved with the education, while correct answers did not change in six of them. The number of correct answers increased in nineteen patients, while in three of them it did not change in the second questionnaire. Conclusion: The success rate of about only 60% in a test performed during the following months of treatment, in spite of a dense education program at the beginning of the dialysis, shows that this education must be repeated regularly. (The Medical Bulletin of Haseki 2010; 48: 14-7

Acute Kidney Injury and Chronic Kidney Disease: A Bidirectional Road

Acute kidney injury (AKI) and chronic kidney disease (CKD) have many common points regarding risk factors, etiology, clinical and laboratory factors. We aimed in this review to discuss the outcome, the risk of CKD, cardiovascular and overall mortality risk after AKI, and the mechanisms underlying the relationship between AKI and CKD

Delftia Acidovorans Peritonitis in a Patient Undergoing Peritoneal Dialysis

Peritonitis is the most common complication of peritoneal dialysis. Peritoneal dialysis associated peritonitis caused by Delftia acidovorans has been reported only once in the literature before. Here, we present the second case of D. acidovorans peritonitis in a 60-year old male patient undergoing peritoneal dialysis. The patient was treated with intraperitoneal ceftazidim and oral ciprofloxacin, to which the organism was sensitive. The catheter was removed because of refractory peritonitis