Aldosterone Resistance Due to Tacrolimus: A Case Report.

Although more common with tacrolimus, it is known that calcineurin inhibitors may induce the development of electrolyte disorders such as hyponatremia and hyperkalemia by causing a hyporeninemic hypoaldosteronism-like syndrome. We present a 32-year-old female renal transplant patient who admitted to clinic with hyponatremia and hyperkalemia. Normal anion gap metabolic acidosis and renal tubular dysfunction were detected and after other reasons were excluded, it was considered as electrolyte disorder due to tacrolimus. No response was detected after tacrolimus conversion to everolimus and considering tubular dysfunction due to aldosterone resistance, we initiated fludrocortisone therapy and electrolyte disorders rapidly improved. Fludrocortisone therapy should be considered when hyponatremia and/or hyperkalemia due to tacrolimus are detected in renal transplant patients.

Can eculizumab be discontinued in aHUS?: Case report and review of the literature.

BACKGROUND: The management of atypical hemolytic uremic syndrome (aHUS) has evolved into better control of thrombotic microangiopathy (TMA) and recovery of renal functions since the recent introduction of the terminal complement cascade blocker, eculizumab, into clinical use. Better characterization of genotype-phenotype relations has become possible with genetic and clinical studies. However, these advances brought up some important issues, such as the possibility and timing of discontinuation of eculizumab and strategy of follow-up that need to be enlightened. CASE SUMMARY: One of our aHUS cases with a novel complement factor H mutation, who developed unusual laboratory findings (thrombocytopenia and mild creatinine elevation without other features of TMA) following discontinuation of eculizumab was presented. Literature and case reports relevant to discontinuation of eculizumab in aHUS patients were reviewed. CONCLUSION: Limited experience suggests that the risk of recurrence of TMA following discontinuation of eculizumab is relatively low for patients with MCP mutations, homozygous CFHR3/R1 deletions, anti-CFH antibodies, CFI mutations, and no identifiable mutations, whereas there is a major risk for patients with CFH mutations. Early detection of TMA recurrence and prompt retreatment with eculizumab seem to be efficient in controlling of TMA and restoration of kidney functions.

Test of the recommended dialysis dose on one-year mortality of nondiabetic maintenance hemodialysis patients; observations from a single dialysis unit.

BACKGROUND: The optimal delivered dialysis dose has been of a great interest for the last three decades, though a clear cut point has not been reached yet. We aimed to evaluate the relationship between one-year mortality and the delivered dialysis dose, which was recommended by Kidney Disease Outcomes Quality Initiative (KDOQI), in our maintenance hemodialysis (MHD) patients. METHODS: This was a single center, prospective observational study with one year of follow-up. Patients with extremes of age, BMI, residual renal function, diabetes mellitus, severe infection malignancy, and recent hospitalization within the last three months were excluded. Demographic, anthropometric, laboratory, and outcome data (mortality as the primary) were prospectively collected. Patients were classified into two groups according to baseline spKt/V levels; group 1 (n = 20): spKt/V ≤ 1.4, group 2 (n = 60): spKt/V > 1.4. RESULTS: Median (IQR) age and hemodialysis vintage of all patients (M/F: 41/39) were 49.5 (29) years and 60 (94) months, respectively. Both groups had similar characteristics, with the exception of significantly higher BMI (24 vs. 21.7, p = 0.012), serum creatinine and uric acids, and lower spKt/V (1.30 vs. 1.71, p < 0.001) in group 1. Overall death occurred in seven (8.75%) patients (5 from group 1 and 2 from group 2). Patients in group 1 had significantly higher one-year mortality rate and shorter survival time (25% vs. 3.3%, p = 0.003 and 43.9 vs. 47.3 weeks, p = 0.003, respectively). CONCLUSIONS: Higher spKt/V (>1.4) was associated with a lower one-year mortality in this small cohort of patients.

Serum uric acid levels and inflammatory markers with respect to dipping status: A retrospective analysis of hypertensive patients with or without chronic kidney disease.

BACKGROUND: The aim of this study was to evaluate serum uric acid levels, inflammatory markers [C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)] and mean platelet volume (MPV) among hypertensive patients with or without chronic kidney disease (CKD) with respect to dipping status. METHODS: A total of 432 hypertensive patients with (n = 340) or without (n = 92) CKD who had ambulatory blood pressure monitoring recordings were included. Correlation of serum uric acid levels with inflammatory markers (CRP, PLR, NLR) was evaluated as was the logistic regression analysis for determinants of nondipper pattern. RESULTS: Nondipper pattern was noted in 65.2% and 79.7% of non-CKD and CKD patients, respectively. Multivariate logistic regression analysis revealed that only serum uric acid (OR, 2.69; 95% CI, 1.60 to 4.52; p = 0.000), MPV (OR, 1.81; 95% CI, 1.30 to 2.53; p = 0.000), PLR (OR, 0.98; 95% CI, 0.97 to 0.99; p = 0.000), and serum albumin (OR, 0.42; 95% CI, 0.19 to 0.93; p = 0.031) were significant determinants of nondipper pattern in the overall study population. CONCLUSION: In conclusion, our findings revealed higher prevalence of nondipper pattern in hypertensive patients with than without CKD and significantly higher levels for uric acid, CRP, MPV, PLR, and NLR among nondipper than dipper hypertensive patients with CKD. High levels for uric acid and MPV and lower levels for PLR and serum albumin were noted as significant determinants of nondipper pattern among hypertensive patients.

Comparison of Long-term Complications in Patients on Haemodialysis and Peritoneal Dialysis Longer than 10 Years.

INTRODUCTION: Depending on developments in dialysis techniques and new treatment strategies for comorbid diseases, life expectancy has increased. As a result, dialysis related long term complications could be seen more frequently. We investigated and compared long term complications of the Haemodialysis (HD) and Peritoneal Dialysis (PD) in patients with history if either mode at least 10years. MATERIALS AND METHODS: A 13HD & 16PD patients were included to the study. Basic demographic parameters and prevalence of cardiovascular diseases (CVD), uraemic peripheral neuropathy (PNP), parathyroid adenoma, parathyroidectomy and acquired cystic disease (ACD) were assessed. RESULTS: HD patients were older than PD patients (p=0.035) and duration of dialysis was longer in HD patients (p=0.001). CVD was present in 18 patients (9 HD, 9 PD). There was no difference in presence of CVD between HD and PD patients (p=0.455). Valvular diseases (n=15), diastolic dysfunction (n=8), left ventricular hypertrophy (n=5), ischemic heart disease (n=3) and congestive heart failure (n=1) were investigated. Uraemic peripheral neuropathy was observed in 14 of the patients (8 HD, 6 PD patients). Eight patients had mixed type sensory motor neuropathy and 3 patients had mixed type sensorial neuropathy, 2 patients had demyelinating PNP, 1 patient had axonal PNP and 3 of them had CTS related to peripheral neuropathy. Parathyroid adenoma was detected in 4 patients (2 HD, 2 PD) and 3 patients (1 HD, 2 PD) had history of parathyroidectomy. Serum phosphate and iPTH levels were higher in HD patients (p=0.003, p=0.04, respectively). ACD was detected in 14 patients (7 HD, 7 PD). There was no difference between PD and HD patients (p=0.75). CONCLUSION: HD patients were older than PD patients and had longer duration of dialysis. The prevalence of long term complications was similar in HD and PD modalities. CVD especially valvular diseases were common complication in both modalities.

Persistent left superior vena cava: Two case reports and a review from nephrologists' perspective.

Thoracic venous anomalies without congenital heart anomalies are present in minority of the population, but they are frequent enough to be encountered while placing hemodialysis catheters through the jugular or subclavian veins. Persistent left superior vena cava is the most commonly seen anomaly and it is rarely noticed before the observation of an unusual course of hemodialysis catheter or guidewire on chest X-ray. We present two patients with previously unspotted persistent left superior vena cava and uncomplicated hemodialysis catheter insertions through the internal jugular veins with good catheter functions. Review of the relevant literature from a nephrologists' perspective with technical aspects is provided.

Familial Mediterranean Fever is associated with abnormal ventricular repolarization indices / La fiebre mediterránea familiar se asocia a anomalías en la repolarizacıón ventricular

Background: Cardiac arrhythmias can be a part of cardiovascular involvement in some rheumatic diseases, but data about familial Mediterranean fever (FMF) are conflicting. Aim: To search for abnormalities in ventricular repolarization indices in FMF patients. Patients and Methods: Seventy seven FMF patients and 30 age/gender comparable healthy controls were included. All patients were attack free and subjects with disease or drugs that are known to alter cardiac electrophysiology were excluded. Electrocardiographic data were obtained and analyzed. Results: Twelve FMF patients had amyloidosis. QT and QTc intervals were within the normal ranges and similar between FMF patients and healthy controls. QT dispersion, peak to end interval of T wave (Tpe), Tpe/QT and Tpe/QTc ratios were significantly higher in FMF patients than in healthy controls. Patients with amyloidosis had significantly higher QT dispersion, Tpe, Tpe/QT and Tpe/QTc than their counterparts without FMF. Levels of proteinuria were moderately correlated with QT dispersion, Tpe, Tpe/QT and Tpe/QTc. Conclusions: FMF patients may have an increased risk for arrhythmias.

Antecedentes: Las arritmias cardíacas pueden ser parte del compromiso cardíaco en enfermedades reumáticas, sin embargo, no se sabe con certeza si esto ocurre en la fiebre mediterránea familiar (FMF). Objetivo: Buscar anomalías en la repolarización ventricular en pacientes con FMF. Pacientes y Métodos: Sesenta y siete pacientes como FMF y 30 controles sanos pareados por edad y género fueron estudiados. Todos los pacientes estaban en período intercrítico y no usaban medicamentos o tenían enfermedades concomitantes que pudieran causar anomalías electrocardiográficas. Se analizaron los electrocardiogramas de estos participantes. Resultados: Veinte pacientes con FMF tenían amiloidosis. Los intervalos QT y QTc eran normales y similares entre pacientes y controles. La dispersión del intervalo QT, el intervalo desde el peak al final de la onda T (Tpe), las razones Tpe/QT y Tpe/QTc fueron significativamente más altos en los pacientes que en los controles. Los pacientes con amiloidosis tenían una dispersión de QT, Tpe, Tpe/QT y Tpe/QTc mayores que sus pares sin la condición. Los niveles de proteinuria se correlacionaron moderadamente con los parámetros antes mencionados. Conclusiones: Los pacientes con FMF tienen mayor riesgo de arritmias.

Clinical outcomes and mortality in elderly peritoneal dialysis patients.

OBJECTIVES: To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis. METHODS: We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed. RESULTS: Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival. CONCLUSIONS: Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of comorbid diseases, increased episodes of peritonitis, use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis.

Clinical outcomes and mortality in elderly peritoneal dialysis patients

OBJECTIVES: To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis. METHODS: We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed. RESULTS: Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival. CONCLUSIONS: Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, ...

Familial Mediterranean Fever is associated with abnormal ventricular repolarization indices.

BACKGROUND: Cardiac arrhythmias can be a part of cardiovascular involvement in some rheumatic diseases, but data about familial Mediterranean fever (FMF) are conflicting. AIM: To search for abnormalities in ventricular repolarization indices in FMF patients. PATIENTS AND METHODS: Seventy seven FMF patients and 30 age/gender comparable healthy controls were included. All patients were attack free and subjects with disease or drugs that are known to alter cardiac electrophysiology were excluded. Electrocardiographic data were obtained and analyzed. RESULTS: Twelve FMF patients had amyloidosis. QT and QTc intervals were within the normal ranges and similar between FMF patients and healthy controls. QT dispersion, peak to end interval of T wave (Tpe), Tpe/QT and Tpe/QTc ratios were significantly higher in FMF patients than in healthy controls. Patients with amyloidosis had significantly higher QT dispersion, Tpe, Tpe/QT and Tpe/QTc than their counterparts without FMF. Levels of proteinuria were moderately correlated with QT dispersion, Tpe, Tpe/QT and Tpe/QTc. CONCLUSIONS: FMF patients may have an increased risk for arrhythmias.