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

Soluble TNF-Like weak inducer of apoptosis as a new marker in preeclampsia: A pilot clinical study

WOS: 000371089200001PubMed ID: 26989294Introduction. All findings of preeclampsia appear as the clinical consequences of diffuse endothelial dysfunction. Soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) was recently introduced as a TNF related cytokine in various inflammatory and noninflammatory disorders. sTWEAK was found to be related to endothelial dysfunction in patients with chronic kidney disease. In our study we aimed to compare sTWEAK levels in women with preeclampsia to corresponding levels in a healthy pregnant control group. Materials and Methods. The study was undertaken with 33 patients with preeclampsia and 33 normal pregnant women. The concentration of sTWEAK in serum was calculated with an enzyme linked immunosorbent assay (ELISA) kit. Results. Serum creatinine, uric acid, LDH levels, and uPCR were significantly higher in the patient group compared to the control group. sTWEAK levels were significantly lower in preeclamptic patients (332 +/- 144 pg/mL) than in control subjects (412 +/- 166 pg/mL) (p = 0.04). Discussion. Our study demonstrates that sTWEAK is decreased in patients with preeclampsia compared to healthy pregnant women. There is a need for further studies to identify the role of sTWEAK in the pathogenesis of preeclampsia and to determine whether it can be regarded as a predictor of the development of preeclampsia

Otozomal dominant polikistik böbrek hastalığında ürogenital kistlerin semen parametreleri üzerine etkisi var mı ?

WOS: 000374928100006OBJECTIVE: Autosomal dominant polycystic kidney disease (ADPKD) is a systemic disease with cysts in many organs including the urogenital tract. The aim of the study was to evaluate the relationship between urogenital cysts, semen pathologies and infertility in ADPKD. MATERIAL and METHODS: Male ADPKD patients aged 18-60 with creatinine clearance years higher than 60 ml/min were included. All patients had magnetic resonance imaging of the urinary system and pelvis, scrotal Doppler ultrasonography and sperm analysis. The results were compared with those of a healthy control group. RESULTS: 27 patients and 17 volunteers were included. Seminal vesicle and prostate cysts were detected in four (15%) and six (22%) patients, respectively. Five of the 23 married patients (21%) had infertility and this rate was higher than in the control group (p=0.044). The ratio of sperms with normal morphology and progressive motility was lower, and the rate of hypospermia, oligozoospermia, azospermia, asthenozoospermia and teratozoospermia were higher in the patient group. There was no significant difference between patients with/without urogenital cysts regarding seminal pathologies. CONCLUSION: Seminal abnormalities and infertility are more frequent in patients with ADPKD. Defects in spermatogenesis and sperm motility may be related to urogenital cysts as well as ciliary pathologies. There is a need for further studies evaluating the role of urogenital cysts in semen pathologies.AMAÇ: Otozomal dominant polikistik böbrek hastalığı (ODPBH) ürogenital sistemle birlikte birçok organda kist oluşumuna neden olabilen sistemik bir hastalıktır. Çalışmada, ODPBH olan bireylerde ürogenital kistler ile semen patolojileri ve infertilite ilişkisi değerlendirilmiştir. GEREÇ ve YÖNTEMLER: Çalışmaya 18-60 yaşları arasında, kreatinin klirensi 60 ml/dakika/1.73 m2’nin üzerinde, ODPBH olan erkekler dahil edildi. Tüm hastalara üriner sistem ve pelvik manyetik rezonans(MR) inceleme, skrotal Doppler ultrasonografi ve semen analizi yapıldı. Sonuçlar sağlıklı kontrol grubu ile karşılaştırıldı. BULGULAR: Yirmiyedi hasta ve 17 gönüllü çalışmaya dahil edildi. Seminal vezikül kisti 4(%15), prostat kisti 6 (%22) hastada tespit edildi. Kontrol grubundan daha sık olarak, evli olan 23 hastanın 5’inde (%21) infertilite mevcuttu (p=0.044). Normal morfolojili sperm oranları ve ileri motilite daha düşük, hipospermi, oligozoospermi, azospermi, asthenozoospermi ve teratozoospermi oranları hasta grubunda daha yüksekti. Ürogenital kisti olan/olmayan hastalarda semen patolojileri açısından anlamlı fark yoktu. SONUÇ: Seminal anormallikler ve infertilite ODPBH olanlarda daha sıktır. Spermatogenez ve sperm motilite defektleri siliar patolojiler gibi urogenital kistlerle ilişkili olabilir. Ürogenital kistlerin semen patolojilerindeki rolünü değerlendirmek için ileri çalışmalara ihtiyaç vardır

Short Term Effects of Diltiazem on Renal Functions: A Controlled Clinical Study

OBJECTIVE: We aimed to study acute effects of diltiazem on renal functions and its renoprotective effects in patients with chronic kidney disease (CKD).\ud MATERIAL and METHODS: Among patients with CKD followed-up in our unit, fifty patients using diltiazem as a part of their treatment(the treatment group) and fifty patients not using diltiazem (the control group) were selected. Besides demographic parameters; blood pressures, creatinine, proteinuria and creatinine clearance levels at the baseline, first week, and third and sixth months were recorded.\ud \ud RESULTS: The groups were matched for the mean creatinine clearance at baseline. The course of mean creatinine clearance were similar in both groups (p=0.29). There was no significant change in serum creatinine or creatinine clearance after initiation of diltiazem in the treatment group. Baseline proteinuria was higher in treatment group (p=0.012). Proteinuria at the sixth month was significantly higher in the control group compared with basal and first week levels (p<0.001 and p=0.007, respectively). But there was no change in the treatment group regarding proteinuria. Serum albumin levels were not statistically significantly different in the groups (p=0.69).\ud \ud CONCLUSION: Diltiazem has no acute effect on serum creatinine and creatinine clearance in patients with CKD. It may prevent the probable increase in proteinuria

Flow-Mediated Dilatation and Asymmetric Dimethylarginine Do Not Predict Mortality in Peritoneal Dialysis Patients

Aim: Asymmetric dimethylarginine (ADMA) is associated with increased coronary artery disease risk through endothelial dysfunction in dialysis patients. We aimed to investigate the role of flow-mediated dilatation (FMD), a non-invasive indicator of endothelial function, and ADMA in mortality in peritoneal dialysis (PD) patients. Methods: PD patients aged 18-80 years; with dialysis duration of at least three months were included. FMD measurement and ADMA levels were recorded. Outcome of the patients on the third year were analyzed with binary logistic analyses. Results: The mean age of the 55 patients was 53±15 years and the mean follow-up duration was 36 months. Mean FMD and ADMA levels were 10.6±6.4% and 81.8±48.0 mol/L, respectively. Eighteen patients died during follow-up. Age, presence of diabetes mellitus and ischemic heart disease, ultrafiltration amount and serum albumin level were related with mortality while gender, weekly Kt/V and ADMA levels were not. There was no significant relationship between ADMA level and FMD (p=0.873). FMD was negatively correlated with systolic and diastolic blood pressures (p=0.001, p<0.001, respectively). Hypertension was found to be the most important single factor determining FMD (p=0.037). Conclusion: Estimating endothelial function by FMD or measuring serum ADMA levels may not be useful for predicting mortality in PD patients

Intraperitoneal Hemorrhage in a Peritoneal Dialysis Patient Using Dabigatran: A Case Report

Dabigatran is used for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. It is still unclear whether the use of dabigatran leads to more bleeding compared with warfarin. In this paper, we present a case of intraperitoneal hemorrhage in a 54-years-old male peritoneal dialysis patient using dabigatran for paroxysmal atrial fibrillation because international normalized ratio level could not be kept at target levels during follow-up. The use of dabigatran in atrial fibrillation has become widespread in recent years. Despite the low risk of intracranial hemorrhage, clinicians should be careful in patients with chronic kidney disease because coagulation monitoring is not possible