Is It Safe to Initiate Peritoneal Dialysis Treatment Immediately After Percutaneous Catheter Placement?

In this retrospective study, the safety of initiating peritoneal dialysis (PD) immediately after percutaneous PD catheter insertion was evaluated. Patients who underwent peritoneal catheter insertion and then immediately began dialysis treatment were included in the study. Patient age, sex, treatment modalities, and method of catheter insertion were recorded.Acute PD was performed in 33 patients (age: 57.7 ± 16.7 years; 21 men, 12 women). Catheters were inserted percutaneously in 28 patients and surgically in 5 patients. The PD modalities used were continuous ambulatory PD in 18 patients, automated PD in 11 patients, and both modalities in 4 patients. Acute PD was started within 24 hours of catheter insertion. Leaks occurred in 8 patients who had catheters inserted percutaneously (28.5%). Peritonitis occurred in 1 patient. No complications were observed in 24 patients. Leaks were fully resolved for patients kept in a supine position, with fill volumes reduced to 500 mL - 700 mL and the dwell period decreased to 60 minutes from 120 minutes. Leaks were not observed in the patients when the fill volume was increased by 200 mL and the dwell period was increased by 30 minutes every 2 days to reach 1300 mL and 180 minutes by the 7th day.Immediate-start dialysis after percutaneous peritoneal catheter insertion seems safe when performed in a supine position with low-volume exchanges and short dwell times.

A Rare Complication During Percutaneous Peritoneal Dialysis Catheter Insertion: Intravesical Placement.

Peritoneal dialysis (PD) is one of the treatment options for patients with end-stage renal failure. To start PD treatment, a catheter must be placed for access to the abdominal cavity, and it can be placed using surgical, laparoscopic, or percutaneous methods. However, complications can develop during catheter placement.In the present case report, we describe a patient in whom treatment was pursued after an unusual complication rarely mentioned in the literature: a dialysis catheter accidentally inserted percutaneously into the bladder. Under ultrasonography guidance, the catheter was pulled from the urinary bladder and pushed into the intra-abdominal cavity. No complications resulted from the procedure, and the patient proceeded to PD treatment. This case is, to our knowledge, the only such report in the literature.

Treatment of a Dialysate Leak by Simultaneous Catheter Removal and Replacement in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis.

Continuous ambulatory peritoneal dialysis (PD) is one of the treatment methods used for end-stage renal failure. When mechanical complications occur with this treatment method, methods such as tomographic peritoneography, abdominal scintigraphy, and magnetic resonance peritoneography are used to uncover the problem. Here, we report the detection by tomographic peritoneography of a subcutaneous dialysate leak in a patient undergoing PD. The PD catheter was subsequently removed, and a new catheter was inserted. The patient then restarted continuous ambulatory PD without any problem.

Evaluation of nasal mucociliary activity in patients with chronic renal failure.

The ability of respiratory mucosal surfaces to eliminate foreign particles and pathogens and to keep mucosal surfaces moist and fresh depends on mucociliary activity. Chronic renal failure (CRF) is an irreversible medical condition that may result in important extrarenal systemic consequences, such as cardiovascular, metabolic, and respiratory system abnormalities. Although there are studies describing nasal manifestations of CRF, data are lacking concerning the effects of the condition on nasal mucosa. The goal of the current study was to evaluate nasal mucociliary clearance (NMC) time in patients with CRF. This prospective cohort study conducted in a tertiary referral center included 32 non-diabetic end-stage CRF patients and 30 control individuals. The control group consisted of voluntary participants who had been referred to our clinic for symptoms other than rhinological diseases. The mean NMC times in CRF patients and control individuals were 12.51 ± 3.74 min (range 7-22 min) and 8.97 ± 1.83 min (range 6-13 min), respectively. The mean NMC time in patients with CRF was significantly longer than that in control individuals (p < 0.001). Clinicians must keep in mind that NMC time in CRF patients is prolonged and must follow-up these patients more closely for sinonasal and middle ear infections.

Tear function in patients with chronic renal failure undergoing hemodialysis.

OBJECTIVES: To evaluate dry eye symptoms and clinical tear film alterations in patients with chronic renal failure (CRF). MATERIALS AND METHODS: Thirty-five non-diabetic CRF patients undergoing hemodialysis, and 31 healthy individuals were enrolled. An ocular surface disease index questionnaire (OSDI) was administered, and after a complete ocular examination, Schirmer and tear break-up time (TBUT) tests were performed. RESULTS: OSDI scores were significantly higher (p<0.01) and TBUT tests were significantly lower (p=0.01) in CRF patients than in the control group. Schirmer test results were also lower in the CRF patients group, but lacked statistical significance (p=0.20). CONCLUSION: Patients with CRF should be advised to obtain an ophthalmic examination, especially for dry eye.

Serum lipid levels in patients with minor recurrent aphthous ulcers.

PURPOSE: To evaluate the possible association between minor recurrent aphthous ulcers (RAUs) and plasma lipid levels. METHODS: 85 patients (50 female, 35 male) with minor RAUs and another 80 patients (52 female, 28 male) without minor RAUs were included in the study. Body mass index (BMI), hemoglobin (HB), white blood cells (WBCs), platelets (PLT), glucose (GL), total cholesterol (TCH), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), creatinine (CR), alanine transaminase (ALT), and aspartate transaminase (AST) levels, as well as the gender and age of the patients in the groups were compared. RESULTS: Cumulative evaluation showed that HDL was statistically higher in the control group (P < 0.05). Except for WBCs, PLT, TG, and ALT, all parameters were significantly higher in the study group (P < 0.05). Correlations between minor RAUs and investigated parameters were observed with age, BMI, HB, GL, CR, TCH, HDL, LDL, and AST (P < 0.05). If gender was considered and the groups were compared, the greatest differences were seen between the female study group and the female control group (age, BMI, HB, GL, CR, TCH, TG, LDL, ALT; P < 0.05). Correlations were mostly observed between minor RAUs and parameters within the female group (P < 0.05).

Does decreased mean platelet volume predict inflammation in chronic renal failure, dialysis, and transplanted patients?

OBJECTIVES: Increased platelet activation contributes to cardiovascular mortality in chronic kidney disease patients (CKD). Larger platelets are more active and this increased activity had been suggested as a predictive biomarker for cardiovascular disease. In this study, we aimed to evaluate mean platelet volume (MPV) as an inflammatory marker in a broadened group of CKD patients. Our study is unique in literature as it covers all types of CKD including renal replacement therapies. MATERIALS AND METHODS: 200 patients (50 renal transplanted, 50 hemodialysis, 50 peritoneal dialysis, 50 chronic renal failure stages 3-4) were investigated who were between 18 and 76 years of age. The collected data included demographic properties, platelet count, MPV, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and hemoglobin. All of the patients had at least 12 month of therapy of either renal replacement modality. RESULTS: The mean CRP value was detected statistically significantly higher in hemodialysis (HD) patients compared to the resting three groups of patients (p < 0.01). Mean CRP level was detected significantly higher in the pre-dialysis group compared to transplanted and peritoneal dialysis (PD) patients (p < 0.01). There is no statistically significant difference detected among the mean MPV values of all patient groups (p > 0.05). CONCLUSIONS: ESR and CRP were significantly increased in hemodialysis patients compared to the other groups. We did not detect a significant difference among MPV between the groups. ESR was detected lowest in transplanted patients. Transplantation is coming forward as the favorable choice of renal replacement therapy which decreases inflammation.

Combined immune thrombocytopenic purpura and immunoglobulin A nephropathy: a similar pathophysiologic process?

IgA nephropathy is one of the most common forms of glomerulopathies. It is an immune complex-mediated glomerulonephritis diagnosed by the presence of mesangial IgA deposits that are often associated with mesangial cell proliferation. The IgG, C3, IgM, or other immunoglobulin light chains may be co-existed with IgA. Its pathogenesis suggested that it is responsible for enhancing the production of proinflammatory cytokines, chemokines, and growth factors. Platelet-derived growth factor (PDGF) has also been implicated as a modulator of disease activity. Immune thrombocytopenic purpura (ITP) is a bleeding disorder caused by thrombocytopenia that is not associated with a systemic disease. Its pathogenesis suggested an autoimmune disease in which IgG is thought to damage megakaryocytes, which are the precursors of platelet cells. Several studies reported that PDGF levels were higher in normal subjects than in patients with ITP. Moreover, ITP is a disease related to the antibody. Thus, our aim is to examine whether a similar pathophysiological relationship exist between ITP and IgAN that may be mediated by PDGF and/or IgG.

The biochemical and histopathological investigation of amlodipine in ethylene glycol-induced urolithiasis rat model.

BACKGROUND: Urinary calculi are a common and severe problem, which are formed by urolithiasis or by the formation of calcium oxalate (CaOx) crystals in the kidneys. Many treatment options such as drugs, various herbal preparations, surgical removal of the stones, and extracorporeal shock wave lithotripsy have been applied for this condition. The aim of this study is to assess the effects of the drug amlodipine in an experimentally induced urolithiasis rat model. MATERIALS AND METHODS: The effect of 5 mg/kg amlodipine was studied in rats that were first treated with 1% ethylene glycol and 1% ammonium chloride for 21 days to induce urolithiasis. The weight differences and the levels of calcium, magnesium, and phosphate were measured in serum and urine. In addition, urine CaOx level was defined and histopathological analyses were performed on the kidneys. RESULTS: Urolithiasis caused a significant increase in both serum and urine parameters compared with healthy rats. Urolithiasis plus amlodipine administration increased the levels of these same parameters. Urine CaOx level was high in urolithiasis rats and was also increased by urolithiasis plus amlodipine administration. The weight of the rats decreased in the urolithiasis plus amlodipine group when compared with the urolithiasis group. Histopathological examinations revealed extensive intratubular crystal depositions and degenerative tubular structures in the urolithiasis group and the amlodipine treatment group. CONCLUSION: We showed that amlodipine may increase susceptibility to urolithiasis by raising hyperoxaluria and hypercalciuria. Further studies should be performed to elucidate the urolithiasis activity of amlodipine and to confirm the data.

Investigation of features of patients in renal transplantation waiting list: Who wants much more of what for renal transplantation?

BACKGROUND AND OBJECTIVE: Renal transplant is the best form of treatment for most patients with end-stage renal disease (ESRD), because that therapy improves quality of life, prolongs survival, and is cost-effective. The objective of the study being reported was to compare the sociodemographic characteristics and registration status for renal transplantation of ESRD patients in Turkey who were registered for transplant or not. METHODS: The study was conducted between June and September 2012 on patients of several Dialysis Centers. They all were informed in a one on one interview about the risks and benefits of renal transplants; they were also asked to fill out the questionnaires given to them. The study questionnaire was designed with the help of already published reports to include among others the patient's age, sex, waiting time and educational status. RESULTS: Patients who had been registered in the cadaver kidney waiting list were aged 43.85±13.48 in the average, with a balanced sex ratio, average dialysis duration 57.30±51.46 months. Of these patients 45 had finished high school, 87 lived in rural areas and 67 had an income equivalent to expenses. CONCLUSION: There was a significant difference among the groups depending on the patients' residence in an urban or rural environment. Such a difference might be following the greater ease of obtaining relevant information in the urban areas.

Prevalence of nasal Staphylococcus aureus carriage in the patients undergoing hemodialysis and evaluation of risk factors and laboratory parameters.

BACKGROUND: In this study, we aimed to determine the nasal carriage rate of Staphylococcus aureus and risk factors in hemodialysis (HD) patients. METHODS: One hundred eighty-four HD patients were evaluated. A second sample was taken from the subjects, the wipe samples of whom were isolated as S. aureus. And subjects whose second samples' results were the same were deemed as S. aureus carriers. RESULTS: Fifty-two (28.3%) patients were identified as S. aureus carriers. In the control group, S. aureus carriage has been found out as 14.9% in 116 healthy subjects. The isolation rate of S. aureus has been found statistically significantly high in the age group of 41-61 years. But, methicillin-resistant S. aureus (MRSA) isolation ratio has been statistically high in the group over the age of 61 years. Sepsis history and gastrointestinal system disease development is closely related to bacterial isolation. MRSA isolation ratios have been found high in chronic lung disease patients, diabetic patients, patients with infection history, and patients with impaired general state of health. The carriage ratios have been found higher in the patients who are settled in urban areas, are subjected to dialysis for more than 10 years, and are hospitalized in the past year. However, the difference between the other groups is not statistically significant. CONCLUSIONS: S. aureus carriage must be screened on regular intervals in HD patients. Nasal S. aureus carriage follow-up and treatment is a process that will protect patients from more severe clinical pictures.

Multiple renal arteries: variations demonstrated by multidetector computed tomography angiography.

OBJECTIVE: To present a case of a rare variation of the renal artery and multiple (7) renal arteries by multidetector computed tomography (MDCT) angiography. CLINICAL PRESENTATION AND INTERVENTION: A 36-year-old male patient was admitted to our hospital as a potential living donor for renal transplantation. An MDCT angiography was performed using a 16-detector row CT scanner to obtain a detailed image of vascular structures and associated pathologies. The MDCT clearly revealed the presence of 3 right and 2 left renal arteries arising from the abdominal aorta. Additionally, the accessory renal artery arose from the inferior mesenteric artery on the left side and from the common iliac artery on the right side. CONCLUSION: This case highlights the importance of awareness of renal artery variations if surgical procedures are indicated in this region.

Evaluation of glucose tolerance status in patients with asthma bronchiale.

BACKGROUND: Asthma is characterized by inflammation and airway hyperesponsiveness, which results in episodic airflow obstruction. A relationship between inflammation and insulin resistance (IR) has been previously characterized, and asthma is known to correlate with increasing IR. Thus, we tested whether patients with asthma bronchiale exhibited abnormally low glucose tolerance. The aim of this study was to compare the occurrence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), two precursors of type 2 diabetes mellitus (DM), in patients with asthma bronchiale and paired control patients. PATIENTS AND METHODS: We examined patients diagnosed with asthma bronchiale. We excluded patients taking any medications other than inhaler broncodilators, patients with a history of other systemic illness, and patients with any diabetic risk factors. Age- and sex-matched healthy volunteers were included as the control group in this study. History, physical examination, and laboratory analyses were performed for both study and control groups. RESULTS: Mean age of the study group was 40.3 +/- 7.8 (F/M: 32/19), and mean BMI of the study group was 26.7 +/- 2.2. Mean age of the control group was 39.5 +/- 6.7 (F/M: 25/15) and mean BMI of the control group was 26.0 +/- 2.1. Fasting blood glucose (FBG), Pg2hBG, Plasma insulin, Homeostasis Model Assessment-Insulin Resistance (HOMA IR), IFG, IGT, both IFG and IGT and (LDL) C levels were significantly higher in the asthmatic group, while HDL C levels were significantly higher in the control group. CONCLUSION: Our results suggest that disturbance of the glucose metabolism caused by inflammation-induced insulin resistance may occur in asthmatic patients and that this phenomenon may increase the risk of diabetes mellitus in these individuals.

Increased frequency of prediabetes in patients with irritable bowel syndrome.

The aim of this study was to compare the occurrence of prediabetes [impaired fasting glucose and/or impaired glucose tolerance are considered to be precursors to type 2 diabetes mellitus (DM)] in irritable bowel syndrome (IBS) cases and matched controls. Ninety-two patients with IBS and 104 healthy matched controls were included in this study. Type 2 DM was considered an exclusion criterion in both groups. Fasting blood glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride levels were examined; after 1 night of fasting, an oral glucose tolerance test with 75 g glucose was administered, and the blood glucose levels after 2 hours were examined. Although there were no significant differences in the triglyceride levels, significant differences were found for total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels (P < 0.001, 0.001, and <0.001, respectively). These measures were found to be elevated in the IBS group compared with the control group. The frequency of prediabetes, which is regarded as the first stage of type 2 DM, was also found to be significantly higher in the IBS group (P < 0.001). After adjusting for potential confounders, such as age, lipid levels, and anthropometric measures in the analysis of covariance models, prediabetes was significantly more frequent in the IBS group than in the control group (P < 0.001). Thus, given the higher prediabetes occurrence in IBS, IBS may indirectly indicate a higher risk of DM. Further investigations will be necessary to fully elucidate the mechanisms behind these observations.

Relationship between pregnancy-associated plasma protein-A and lung cancer.

BACKGROUND: : Pregnancy-associated plasma protein-A (PAPP-A) has insulin-like growth factor (IGF)-dependent IGFBP-4 protease activity and plays an important role in amplifying local IGF-1 activity in wound healing, vascular repair, and bone remodeling. We postulated that PAPP-A may contribute to the availability and activity of IGFs, which affect lung cancer. Therefore, we determined the levels of PAPP-A in patients with lung cancer and their possible clinical significance. METHODS: : The study population consisted of 83 patients with lung cancer and 33 healthy subjects as a control group. Serum PAPP-A levels were determined using an ultrasensitive enzyme-linked immunosorbent assay. RESULTS: : The serum PAPP-A levels were higher in patients with lung cancer [median (interquartile range) 10.7 (7.6-14.2) ng/mL] than in the control group [6.2 (5.2-9.8) ng/mL, P < 0.001]. There was a significant negative correlation between the serum PAPP-A levels and Karnofsky performance status (r = -0.330; P < 0.001) and a positive correlation with patient age (r = 0.358; P < 0.001). CONCLUSION: : PAPP-A is a proatherosclerotic metalloproteinase that is also thought to be an inflammatory marker. We found that the serum PAPP-A levels increased in patients with lung cancer and postulated that PAPP-A levels may be a prognostic factor in such cases.

Cerebrovascular manifestations of Behçet's disease.

Behçet's disease (BD) is a systemic inflammatory disease commonly characterized by oral and genital ulcerations, with skin and eye involvement. Its cause is still unknown, but vasculitis is the major pathologic feature. BD is a rare condition, seen more commonly in Turkey, as well as in Middle Eastern, Mediterranean and Far Eastern countries. Neurological involvement is reported to manifest as brainstem or corticospinal tract syndromes, increased intracranial pressure mostly related to venous sinus thrombosis or aseptic meningitis, isolated behavioral symptoms or isolated headache. This report presents a 34-year-old BD patient with secondary cerebral infarction due to head trauma. The clinical and central nervous system findings of BD are discussed.

Evaluation of risk factors and seroprevalence of hepatitis B and C in diabetic patients in Kutahya, Turkey.

AIM: To assess the prevalence of hepatitis B and C viruses among Turkish patients with type 1 and type 2 diabetes mellitus and to determine the risk factors affecting the prevalence in these patient groups. METHODS: This study included 630 diabetic and 314 nondiabetic patients. Serologic testing for anti-hepatitis C virus (anti-HCV) and HbsAg was done using a third-generation commercial enzyme-linked immunosorbent assay, and samples positive for anti-HCV and HbsAg were confirmed by a polymerase chain reaction assay. Diabetic patients were classified by HbsAg and anti-HCV status and were evaluated according to demographic features, diabetic characteristics and nondiabetic general risk factors, harmful habits, and aminotransferase (alanine aminotransferase and aspartate aminotransferase) levels. RESULTS: HbsAg and anti-HCV seropositivity rates were 5.1% and 3.2% in diabetic patients and were 3.8% and 1.3% in control group, respectively. There was no statistically significant difference between the 2 groups with respect to either marker. Shared risk factors for both hepatitis infections were increased aminotransferase levels and history of hospital admission. In addition, long duration of diabetes mellitus, poor diabetic regulation, and insulin treatment usage were found to relate to HbsAg, whereas a history of blood transfusions and surgical procedures were found to associate with anti-HCV seropositivity. CONCLUSIONS: We determined that hepatitis B virus and hepatitis C virus infections were slightly but not significantly higher in diabetic patients compared with a normal population. If it is considered that different results might be obtained in various countries or even in various regions of same country, it may be concluded that multicenter and comprehensive studies are needed to elucidate true infection rates and to identify other risk factors affecting the prevalence of these infections.

Cyanocobalamin may be beneficial in the treatment of recurrent aphthous ulcers even when vitamin B12 levels are normal.

OBJECTIVE: To evaluate the efficacy of cyanocobalamin treatment in patients having recurrent aphthous ulcers (RAUs) with normal or decreased serum vitamin B12 (cobalamin) levels. METHODS: Seventy-two patients with RAU were included in the study. In addition to serum cobalamin levels, hemanitic and biochemistrical parameters were measured. Patients with serum cobalamin levels < 140 pg/mL were defined as the cobalamin deficient group (CDG) whereas patients with cobalamin levels > or = 140 pg/mL were defined as the cobalamin normal group (CNG). The degree of aphthous ulcer healing was determined according to serum cobalamin levels at the first and sixth month after cyanocobalamin treatment protocol. RESULTS: Of the 72 participants, 37 were in the CDG whereas 35 were considered to have normal cobalamin levels. In the first admission the cobalamin levels were 215.8 +/- 116.90 pg/mL in CNG and 107.43 +/- 29.35 pg/mL in the CDG. The frequency of aphthous ulcers was defined numerically according to monthly occurrence of the lesions. The mean aphthous ulcer frequency in CNG group was 1.9 +/- 0.7, whereas it was 2.4 +/- 0.9 in the CDG. A significant increase in cobalamin levels was observed after cyanocobalamin treatment in both groups. A significant decrease in aphthous ulcer frequency was also concurrently observed. 96% of the patients showed good response to replacement treatment, 4% of the study population did not respond to the treatment. CONCLUSION: Cyanocobalamin treatment maybe beneficial for patients with RAU even when serum cobalamin levels are normal. We suggest that higher serum cobalamin levels should be attained in patients with RAU for mucosal protection.

The role of erythropoietin in hemorrhagic shock-induced liver and renal injury in rats.

INTRODUCTION: The aim of the present study was to evaluate the role of erythropoietin (EPO) in liver and renal injury following hemorrhagic shock (HS) after inhibition of tyrosine kinase activity in rats.. METHODS: Forty-eight Sprague-Dawley rats were assigned to six groups: (I) HS alone; (II) HS followed by retransfusion; (III) EPO and genistein followed by HS; (IV) EPO and genistein followed by HS, followed by retransfusion; (V) HS followed by EPO and genistein; and (VI) HS followed by EPO and genistein, followed by retransfusion. HS was induced for 60 minutes after withdrawal of 30% of the calculated total blood volume of each rat from the left femoral artery. Blood and tissue samples (from the kidney and liver) were obtained 60 minutes after HS in Group I, III, and V; blood and tissue samples were obtained 60 minutes after retransfusion in Group II, IV, and VI. In Group III and IV, EPO was given 60 minutes before HS, and genistein 30 minutes before HS. In Group V and VI, EPO and genistein were given 30 minutes after HS. RESULTS: Liver and renal injury were significantly attenuated with EPO and genistein administration. CONCLUSION: These results suggest that EPO is effective in attenuating liver and renal injury in HS, even with inhibition of tyrosine kinase activity with genistein.