The Relation Between Blood Pressure Reverse-Dipping and Neutrophil to Lymphocyte Ratio in Hypertensive Patients

Reverse dipper hypertension and neutrophil to lymphocyte ratio (NLR) has been investigated as a predictor for cardiovascular risk. The relationship between NLR and other circadien blood pressure (BP) patterns has been showed. The aim of this study was to investigate the relation between NLR and BP reverse dipper pattern in patients with hypertension. 144 hypertensive patients (66 males, 78 females) were enrolled the study. BP patterns were evaluated with 24-h ambulatory BP monitoring (ABPM). Baseline NLR was measured by dividing neutrophil count to lymhocyte count. There was significantly increased NLR in reverse dippers (2,36±1,68 ) than dippers (1,81±0,69) of hypertension (p=0,040 ). NLR was negatively correlated with the decline rate of nocturnal systolic BP(r=-0,193;p=0.021) and diastolic BP( r=-0,160; p=0,057). Our study provides a possible association between NLR and reverse dipper pattern, but to report NLR as an independent predictor of reverse dipper pattern further studies are requiredRevers dipper hipertansiyon ve nötrofil/lenfositoranı(NLR),kardiyovasküler risk öngördürücüsü olarak araştırılmaktadır.NLR ve diğer sirkadyen kanbasıncı paternleri arasındaki ilişki gösterilmiştir.Bu çalışmanın amacı hipertansif hastalarda nötrofil lenfosit oranı ile revers dipper kan basıncı paterni arasındaki ilişkiyi değerlendirmektir.Çalışmaya 144 (66erkek,78kadın) hipertansif hasta alındı.Kan basıncı paternleri 24 saat ambulatuar kan basıncı ile değerlendirildi.Nötrofil lenfosit oranı,nötrofil sayısı lenfosit sayısına bölünerek ölçüldü.Revers dipper hipertansiyonlularda dipper hipertansiyonlulara göre nötrofil lenfosit oranında anlamlı artış vardı. (sırasıyla2.36±1,68ve1,81±0,69,p=0,040). Nötrofil lenfosit oranı ile sistolik (r=-0,193;p=0.021vediyastolik(r=-0,160;p=0,057)kan basıncı düşme oranları arasında negatif korelasyon vardı.Çalışmamız NLR ve revers dipper patern arasında olası bir ilişki sunmaktadır ancak nötrofil lenfositoranını,revers dipper paternin bağımsız öngörücüsü olarak rapor etmek için daha ileri çalışmalar gereklidir

Comparison of the Clinical and Laboratory Presentations of Primary and Secondary Glomerular Diseases

Objective: To investigate the clinicopathologic correlation of the glomerular diseases and to compare the presentations of primary and secondary glomerular diseases. Methods: Two hundred and sixty adult patients (men = 56.2%, mean age = 39.9 +/- 16.0 years) who had undergone renal biopsy and been diagnosed with glomerular disease were retrospectively investigated. The information about the demographic and clinical characteristics of the patients, the indications for biopsy, the laboratory parameters, and the pathological results of the biopsies were obtained from the medical records. Primary and secondary glomerulonephritis (GN) groups were compared in terms of their demographic characteristics, indications for biopsy, and laboratory parameters. Results: Percent of patients with primary and secondary GN were 63.5% and 36.5%, respectively. The most common indication for biopsy was nephrotic syndrome (53.8%) in all patients. It was found that presentation with impaired renal function was more prevalent in the secondary GN group when compared with the primary GN group (54.7% vs. 35.8%, p < 0.05). Among the inflammation parameters, the levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found to be significantly higher in the secondary GN group when compared with the primary GN group (ESR = 85.2 +/- 30.4 mm/h vs. 56.3 +/- 30.7 mm/h, p < 0.001; CRP = 42.1 +/- 39.6 mg/L vs. 21.7 +/- 40.2 mg/L, p < 0.001). Conclusions: The clinicopathologic correlation of GN was found similar with the larger studies in the literature. This study also indicated that the rate of patients with secondary GN was not low, and the inflammation parameters were higher in the secondary GN groups

Potassium Abnormalities in Current Clinical Practice: Frequency, Causes, Severity and Management

Objective We aimed to investigate the prevalence and etiology of potassium abnormalities (hypokalemia and hyperkalemia) and management approaches for hospitalized patients. Subjects and Methods Over a 4-month period, all hospitalized patients at Hacettepe University Medical Faculty Hospitals who underwent at least one measurement of serum potassium during hospitalization were included. Data on serum levels of electrolytes, demographic characteristics, cause(s) of hospitalization, medications, etiology of potassium abnormality and treatment approaches were obtained from the hospital records. Results Of the 9,045 hospitalized patients, 1,265 (14.0s%) had a serum potassium abnormality; 604 (6.7s%) patients had hypokalemia and 661 (7.30s%) had hyperkalemia. In the hypokalemic patients, the most important reasons were gastrointestinal losses in 555 (91.8s%) patients and renal losses in 252 (41.7s%) patients. The most frequent treatment strategies were correcting the underlying cause and replacing the potassium deficit. Of the 604 hypokalemic patients, 319 (52.8s%) were normokalemic at hospital discharge. The most common reason for hyperkalemia was treatment with renin-angiotensin-aldosterone system blockers in 228 (34.4s%) patients, followed by renal failure in 191 (28.8s%). Two hundred and ninety-eight (45.0s%) patients were followed without any specific treatment. Of the 661 hyperkalemic patients, 324 (49.0s%) were normokalemic at hospital discharge. Conclusion This study showed a high prevalence of potassium imbalance among hospitalized patients. Although most of the potassium abnormalities were mild/moderate, approximately half of the patients treated for hypokalemia or hyperkalemia were discharged from the hospital with ongoing dyskalemia.PubMedWoSScopu

Relationship between renal volume and atherosclerosis in nondiabetic hypertensive patients with normal glomerular filtration rate

Background: The association between cystatin C (CysC) and atherosclerosis has been shown in numerous studies in hypertensive patients and in various patient groups with high cardiovascular risk. The study examining the association between renal volume and atherosclerosis is very limited. This study aimed to investigate whether there is an association between the presence of atherosclerosis with CysC and renal volume in hypertensive patients. Methods: 133 hypertensive patients and 80 healthy volunteers were evaluated. CysC level was studied in the blood sample taken from all participants. Carotid intima media thickness (CIMT) and renal volume were measured with ultrasound always by the same radiologist. Laboratory findings, CysC, CIMT, and renal volume measurements of the groups were compared statistically. Results: There was no significant difference in mean renal volume values between hypertension and control groups. There was no significant correlation between renal volume with albuminuria and proteinuria. CIMT was significantly higher in hypertension group than in control group (p = .003). There was a significant correlation between renal volume and CIMT, which is an indicator of subclinical atherosclerosis (r = 0.213, p = .001). Renal volume was found to be an independent predictor of CIMT when corrected with variables such as age, BMI, serum LDL-cholesterol level, creatinine, CysC, and albumin-to-creatinine ratio. Conclusion: Ultrasonographic renal volume measurement, which is easy to perform and does not take a long time, can be a useful method for predicting the presence of atherosclerosis in hypertensive patients with GFR >60 ml/min

Major Barriers Against Renin-Angiotensin-Aldosterone System Blocker Use in Chronic Kidney Disease Stages 3-5 in Clinical Practice: A Safety Concern?

Renin-angiotensin-aldosterone system (RAAS) blockers are underutilized in patients with chronic kidney disease (CKD). We aimed to determine barriers against the use of RAAS blockers in these patients. Patients with stage 3-5 CKD referred to Hacettepe University Hospital Nephrology Unit during a 1 year period were evaluated for RAAS blocker use. Two hundred and seventy-nine patients (166 male, 113 female) were analyzed. The mean age of the patients was 56.7 +/- 15.2 years, mean serum creatinine was 2.45 +/- 1.44 mg/dL, and mean glomerular filtration rate was 33.3 +/- 15.1 mL/min. The mean follow-up time was 22.0 +/- 21.9 months and the clinical visit number was 4.0 +/- 3.5. Angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers were used by 68.8% of all patients and 67.7% of diabetic patients at the time of analysis. In 82.1% of patients, RAAS blockers had either been used earlier or were being used. Hyperkalemia was the principal reason for both not starting and also discontinuing these drugs in patients with CKD. In 37.4% of patients, reasons for not starting RAAS blockers were unclear. This study showed that hyperkalemia is the major barrier against the use of RAAS blockers in patients with CKD. There was, however, a subset of patients who did not receive RAAS blockers even without clear contraindications.Wo

Association of neutrophil-to-lymphocyte ratio and microalbuminuria in patients with normal eGFR

Aims. The aim of this study was to evaluate the association between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and microalbuminuria in patients with normal estimated glomerular filtration rate (eGFR)