Once More - Still Another Disaster: The Van Earthquake

The article is about the contributions of the Turkish Society of Nephrology Renal Disaster Group to saving and providing help to the earthquake victims and to the treatment of survivors. The lessons learned from the earthquake and the experiences that may provide examples to other associations are summarized and presented to those working in Healthcare Services

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

Once More - Still Another Disaster: The Van Earthquake

The article is about the contributions of the Turkish Society of Nephrology Renal Disaster Group to saving and providing help to the earthquake victims and to the treatment of survivors. The lessons learned from the earthquake and the experiences that may provide examples to other associations are summarized and presented to those working in Healthcare Services

AGING KIDNEY: SENESCENCE OR DISEASE?

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-gamma 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

Pseudoephedrine-induced Ventricular Tachycardia

Here, we report an unusual cause of ventricular tachycardia which had developed following pseudoephedrine intake. A 55 year old male patient was admitted to the emergency department with complaints of sustained palpitation. Monitorization records revealed ventricular tachycardia of 214 beats per minute. He had been suffering upper respiratory tract symptoms for the last two days. Palpitation had started an hour later following the ingestion of cold remedy drug, which included pseudoephedrine, and serious dyspnea gradually occurred. He had ischemic heart disease and peripheral arterial disease but he did not have a history of arrhythmia, any palpitation, diabetes mellitus or hypertension. Initially, lidocaine and later amiodorone infusion was administered but medical cardioversion was not successful. Sinus rhythm was provided after electrical cardioversion with 200 joule. Thereafter the patient was stable

A comparison of end-stage renal disease and Alzheimer's disease in the elderly through a comprehensive geriatric assessment

The percentage of patients receiving haemodialysis (HD) treatment and of patients with Alzheimer's disease (AD) within the elderly population is increasing day by day. Functional dependence, malnutrition, cognitive impairment or depression impairs the quality of life and increases mortality in both diseases. This study aims to assess HD and AD patients through comprehensive geriatric assessment (CGA) and compare their results

Study of ACEI versus ARB in Managing Hypertensive Overt Diabetic Nephropathy: Long-Term Analysis

Background: There is, to our knowledge, no study that has directly compared angiotensin-converting enzyme inhibitor (ACEI) with angiotensin receptor blocker (ARB) in hypertensive patients with overt diabetic nephropathy (DNP). We tried to analyze the outcomes of hypertensive patients with overt type 2 DNP who used only ACEIs or ARBs. Methods: The patients who had an estimated creatinine clearance ! 90 ml/min and hypertension or had been using antihypertensive drug(s) at presentation were included in the study. The patients were classified as ACEI group and ARB group. Results: A total of 100 patients (55 men and 45 women, mean age 61.8 +/- 9.16 years) were included in the study. Mean duration of follow-up was 24.6 +/- 14.1 months. Baseline demographics, biochemical analyses and blood pressures were similar. Renal functions and proteinuria of both groups did not show any significant changes during follow-up. Blood pressure courses were also similar. Although the mean doubling time of creatinine in the ARB group was shorter than the ACEI group, it was not statistically significant. During the follow-up period, 4 patients died (2 in the ACEI group, 2 in the ARB group) and 10 patients were started on dialysis (7 in the ACEI group, 3 in the ARB group). Serum creatinine and the amount of proteinuria were the baseline parameters which were related to the initiation of dialysis. Conclusion: ACEIs and ARBs have similar outcomes in overt DNP. Their renoprotective effects can be observed in spite of uncontrolled hypertension. Copyright (c) 2009 S. Karger AG, Base

RELATION OF DEMOGRAPHIC, CLINIC AND BIOCHEMICAL PARAMETERS TO PERITONITIS IN PERITONEAL DIALYSIS

The relation of various demographic, clinical and biochemical parameters of peritoneal dialysis patients with peritonitis and other infections was evaluated. The age, gender, peritoneal dialysis (PD) period, educational status, peritonitis, exit site score, serum albumin, C-reactive protein (CRP), and triglyceride levels at the beginning and the last visit were recorded. Mean age of 32 patients was 45.1 years; PD period was 13.1 months. Albumin level was inversely proportional to the frequency of peritonitis. Patients with peritonitis had albumin levels that were lower at the last visit, and were independent of the CRP values at the start of PD and during follow-up. Significant correlation was detected between females and exit site scores. There was significant correlation between educational status and peritonitis. Albumin level at first visit was a factor that reduced the likelihood of peritonitis, and low levels obtained during follow-up constituted a risk for peritonitis. It was also shown that peritonitis risk tended to decrease inversely with education level