Novel Faces of Fibroblast Growth Factor 23 (FGF23): Iron Deficiency, Inflammation, Insulin Resistance, Left Ventricular Hypertrophy, Proteinuria and Acute Kidney Injury.

FGF23 is a hormone that appears as the core regulator of phosphate metabolism. Great deal of data has accumulated to demonstrate increased FGF23 secretion from the bone to compensate for even subtle increases in serum phosphorus long before intact PTH. However, recent evidence points to the fact that actions and interactions of FGF23 are not limited solely to phosphate metabolism. FGF23 may be implicated in iron metabolism and erythropoiesis, inflammation, insulin resistance, proteinuria, acute kidney injury and left ventricular hypertrophy. In this review, we will summarize latest experimental and clinical data examining impact of FGF23 on aforementioned pathophysiologic pathways/disorders.

Hypomagnesemia Among Outpatient Long-Term Proton Pump Inhibitor Users.

Proton pump inhibitors (PPIs) are extensively prescribed drugs usually used for a long period. Recent reports linked PPI use with development of hypomagnesemia. However, there is still uncertainty regarding risk of hypomagnesemia in outpatients who were on long-term PPI use. Thus, we aimed to evaluate frequency of hypomagnesemia among a well-defined outpatient patient cohort with no other possible risk factors affecting serum magnesium levels. This was a case-control study carried out at the outpatient gastroenterology clinic of a University hospital. Patients who were on PPI therapy for at least 6 months without diuretic use and chronic kidney disease were included. Patients who were subjected to the same inclusion and exclusion criteria and not using PPI were included as control subjects. One hundred fifty-four patients and 84 control subjects were included. The mean duration of PPI use was 27.5 ± 2.5 months. Mean serum magnesium levels of PPI users and nonusers were 2.17 ± 0.20 mg/dL and 2.19 ± 0.15 mg/dL, respectively. None of the patient had a serum magnesium level below laboratory lower range of 1.7 mg/dL. Our results showed that for typical gastroenterology outpatient clinic patients with no other risk factors affecting serum magnesium levels, long-term PPI use did not affect serum magnesium levels.

Colchicine in Renal Medicine: New Virtues of an Ancient Friend.

Colchicine is a plant-derived alkaloid that disrupts the cell microtubule system and accumulates in neutrophils, inhibiting neutrophil adhesion and recruitment. Colchicine has been used extensively in the prevention and treatment of gouty arthritis attacks, familial Mediterranean fever attacks and resultant AA amyloidosis, and recurrent pericarditis. Colchicine also disrupts the intracellular traffic of additional inflammatory and fibrosis mediators. Renal fibrosis is the final common pathway of chronic renal disease. Colchicine had anti-fibrotic effects in experimental diabetic nephropathy, renal mass reduction, and cyclosporine nephrotoxicity among others and is undergoing clinical trials for non-diabetic metabolic syndrome and diabetic nephropathy. In this review, we summarize the anti-inflammatory and anti-fibrotic properties of colchicine in experimental and clinical studies in renal diseases or other fibrotic disease processes with renal consequences. We also discuss the potential future uses of colchicine in renal medicine and challenges faced with its use in patients with impaired kidney function.

The Association of Vitamin D Status and Vitamin D Replacement Therapy with Glycemic Control, Serum Uric Acid Levels, and Microalbuminuria in Patients with Type 2 Diabetes and Chronic Kidney Disease.

OBJECTIVE: To evaluate the relationship of vitamin D status and vitamin D replacement therapy with glycemic control, serum uric acid (SUA) levels, and microalbuminuria (MAU) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD). Subjectsand Methods: A total of 1,463 patients with T2DM and CKD (aged 14-88 years), 927 females and 536 males, were included in this study. The serum data of 25-hydroxyvitamin D, i.e., 25(OH)D, level, SUA, hemoglobin (Hb)A1c, creatinine, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio (UACR) were obtained from the medical records. The Mann-Whitney U test, the χ2 test, the Mantel-Haenszel test, and linear regression models were used for data analysis. RESULTS: Vitamin D deficiency and insufficiency were evident in 770 (52.0%) and 357 (24.0%) patients, respectively. Median HbA1c levels (7.3 [IQR 3.9] vs. 6.5 [IQR 2.3]%; p < 0.01) were significantly higher in patients deficient in vitamin D than in those with a normal vitamin D status. A significantly low level of vitamin D was noted with a high UACR (ß -0.01; 95% CI -0.01 to -0.001; p = 0.017) and HbA1c (ß -1.1; 95% CI -1.6 to -0.6; p < 0.001), but with low levels of SUA (ß 1.3; 95% CI 0.5-2.2; p = 0.002). Vitamin D replacement was associated with a significantly low level of HbA1c (7.4 [2.7] vs. 6.7 [1.9]%; p < 0.001]. CONCLUSION: In this study, there was a high prevalence of hypovitaminosis D among T2DM patients with CKD, with a higher UACR, higher HbA1c, and lower SUA being noted as playing a role in predicting a decrease in vitamin D levels and potential benefits of vitamin D replacement therapy on glycemic control in T2DM management.

Effects of Coenzyme Q10 Supplementation on Exercise Performance and Markers of Oxidative Stress in Hemodialysis Patients: A Double-Blind Placebo-Controlled Crossover Trial.

Coenzyme Q10 (CoQ10) supplementation has been shown to decrease oxidative stress in a number of clinical settings. However, there are mixed results regarding the role of CoQ10 supplementation on exercise performance. Chronic kidney disease is recognized as an inflammatory state, and hemodialysis patients have low level of exercise performance. We aimed to evaluate the effect of CoQ10 supplementation on oxidative stress markers and exercise performance measures. This was a prospective, double-blind, placebo-controlled, crossover study in which all patients received placebo and oral CoQ10 200 mg/d. Participants underwent 6-minute walking test and cycle ergometer. Blood samples were drawn to determine malondialdehyde, oxidized low-density lipoprotein, superoxide dismutase, and glutathione peroxidase. Walking distance in 6-minute walking test and estimated maximal oxygen consumption (VO2max) were recorded. Twenty-eight patients were randomized, but 23 patients completed the study protocol. Serum CoQ10 level significantly increased with supplementation compared with basal values (P < 0.05). Neither walking distance nor estimated VO2max was different between the placebo and CoQ10 groups (P > 0.05). Serum malondialdehyde levels significantly increased in both groups compared with baseline values just after the exercise (P < 0.05). There was no difference in markers of oxidative stress and antioxidant system between placebo and CoQ10 supplementation with exercise (P > 0.05). The results of this study showed no significant effect of CoQ10 supplementation on exercise performance measures and oxidative system markers compared with placebo in maintenance hemodialysis patients.

Drug Dose Adjustment in Dialysis Patients Admitted in Clinics Other Than Internal Medicine.

Many drugs that are administered during hospitalization are metabolized or excreted through kidneys, consequently require dosage adjustment. We aimed to investigate inappropriate prescription of drugs requiring renal dose adjustment (RDA) in various surgical and medical inpatient clinics. We retrospectively determined dialysis patients hospitalized between January 2007 and December 2010. Inpatient clinics, including cardiology, pulmonary medicine, neurology, infectious diseases (medical clinics) and cardiovascular surgery, orthopedics, general surgery, obstetrics and gynecology, and neurosurgery (surgical clinics), were screened via electronic database. Total and RDA medications were determined. RDA drugs correctly adjusted to creatinine clearance were labeled as RDA-A (appropriate), otherwise as RDA-I (inappropriate). Renal doses of RDA medications were based on the "American College of Physicians Drug Prescribing in Renal Failure, fifth Edition." Two hundred seventeen hospitalization records of 172 dialysis patients (92 men and 80 women) were included in the analysis. Mean age of patients was 59.4 ± 14.6 years, and the mean hospitalization duration was 8.5 ± 7.8 days. In total, 247 (84.3%, percentage in drugs requiring dose adjustment) and 175 (46.2%) drugs have been inadequately dosed in surgical and medical clinics, respectively. The percentage of patients to whom at least 1 RDA-I drug was ordered was 92% and 91.4% for surgical and medical clinics, respectively (P > 0.05). Nephrology consultation numbers were 8 (7.1%) in surgical and 32 (30.4%) in medical clinics. The most common RDA-I drugs were aspirin and famotidine. A significant portion of RDA drugs was ordered inappropriately both in surgical and medical clinics. Nephrology consultation rate was very low. Measures to increase physician awareness are required to improve results.

Renal Drug Dosage Adjustment According to Estimated Creatinine Clearance in Hospitalized Patients With Heart Failure.

It is of clinical importance to determine creatinine clearance and adjust doses of prescribed drugs accordingly in patients with heart failure to prevent untoward effects. There is a scarcity of studies in the literature investigating this issue particularly in patients with heart failure, in whom many have impaired kidney function. The purpose of this study was to determine the degree of awareness of medication prescription as to creatinine clearance in patients hospitalized with heart failure. Patients hospitalized with a diagnosis of heart failure were retrospectively evaluated. Among screened charts, patients with left ventricular ejection fraction <40% and an estimated glomerular filtration rate (eGFR) of ≤50 mL/min were included in the analysis. The medications and respective doses prescribed at discharge were recorded. Medications requiring renal dose adjustment were determined and evaluated for appropriate dosing according to eGFR. A total of 388 patients with concomitant heart failure and renal dysfunction were included in the study. The total number of prescribed medications was 2808 and 48.3% (1357 medications) required renal dose adjustment. Of the 1357 medications, 12.6% (171 medications) were found to be inappropriately prescribed according to eGFR. The most common inappropriately prescribed medications were famotidine, metformin, perindopril, and ramipril. A significant portion of medications used in heart failure requires dose adjustment. Our results showed that in a typical cohort of patients with heart failure, many drugs are prescribed at inappropriately high doses according to creatinine clearance. Awareness should be increased among physicians caring for patients with heart failure to prevent adverse events related to medications.

Clinical value of ambulatory blood pressure: Is it time to recommend for all patients with hypertension?

Hypertension is a very common disease, and office measurements of blood pressure are frequently inaccurate. Ambulatory Blood Pressure Monitoring (ABPM) offers a more accurate diagnosis, more detailed readings of average blood pressures, better blood pressure measurement during sleep, fewer false positives by detecting more white-coat hypertension, and fewer false negatives by detecting more masked hypertension. ABPM offers better management of clinical outcomes. For example, based on more accurate measurements of blood pressure variability, ABPM demonstrates that taking antihypertensive medication at night leads to better controlled nocturnal blood pressure, which translates into less end organ damage and fewer clinical complications of hypertension. For these reasons, albeit some shortcomings which were discussed, ABPM should be considered as a first-line tool for diagnosing and managing hypertension.

Novel Masters of Erythropoiesis: Hypoxia Inducible Factors and Recent Advances in Anemia of Renal Disease.

Anemia seen in patients with chronic kidney disease is a particular form of 'anemia of chronic disease'. Although multifactorial in origin, erythropoiesis-stimulating agents (ESAs) and adjuvant iron therapy represent the primary treatment for anemia in chronic kidney disease. Subsequent clinical observations revealed that these ESA hyporesponsive patients often had increased systemic inflammation as a consequence of their comorbidities. Use of high ESA doses to overcome this ESA hyporesponsiveness posed some concerns regarding associated adverse events of therapy and increased mortality in this special patient population. Recognizing the pivotal roles of hypoxia inducible factors (HIFs) in orchestrating elements of erythropoiesis opened new avenues in the management of renal anemia. Several phase 1 and 2 studies confirmed the results of early experimental studies supporting the beneficial role of augmenting HIFs for erythropoiesis. In this review, we describe the physiologic functions of HIF in erythropoiesis with special emphasis on interactions with iron and hepcidin metabolism and inflammation.

Comparison of serum sodium levels measured by blood gas analyzer and biochemistry autoanalyzer in patients with hyponatremia, eunatremia, and hypernatremia.

BACKGROUND: Blood gas analyzer (BGA) electrolyte measurements are frequently used in emergency departments (EDs) pending biochemistry laboratory autoanalyzer (BLA) results. There is lack of data in the literature in terms of agreement of these 2 measurement methods of sodium. We aimed to comprehensively evaluate the agreement in hyponatremia, eunatremia, and hypernatremia groups. METHODS: Retrospectively, adult subjects who presented to ED of a tertiary care teaching hospital and had simultaneous BGA and BLA results were included in the study. Blood pairs were grouped into hyponatremia, eunatremia, and hypernatremia according to BLA results. Agreement of sodium measurements between the methods were evaluated by Bland-Altman plots and Passing and Bablok regression analysis. RESULTS: A total of 2557 blood pairs (1326 males [51.8%]) were included. Median age of the patients was 66 years (18-103). The numbers of patients with hyponatremia, eunatremia, and hypernatremia were 487 (19%), 1943 (76%), and 127 (5%), respectively. The minimum and maximum serum sodium levels measured by biochemistry analyzer were 106 and 171 mmol/L, respectively. The Pearson linear correlation coefficient between BGA and BLA for sodium measurements were 0.574, 0.358, and 0.562 in hyponatremia, eunatremia, and hypernatremia groups, respectively. The absolute mean difference for the 3 groups was greater than 4 mmol/L. Biochemistry laboratory autoanalyzer tended to measure serum sodium higher than BGA in all sodium groups. Passing and Bablok regression analysis showed significant differences between the 2 methods in all sodium groups. CONCLUSION: This is the first comprehensive evaluation of agreement between BGA and BLA in distinct sodium groups. Significant differences should be taken into account when these patients are managed in the ED.

Agreement of serum potassium measured by blood gas and biochemistry analyzer in patients with moderate to severe hyperkalemia.

PURPOSE: Several studies investigated the agreement between central laboratory biochemistry analyzers and blood gas analyzers for potassium measurements. However, data are scarce when the potassium level is moderate to severely high. We aimed to evaluate the agreement between central laboratory biochemistry analyzers and blood gas analyzer in terms of serum potassium level measurement because differences in potassium at this level translate into very different clinical actions. BASIC PROCEDURES: This was a retrospective medical record review study in which patients who presented to the emergency department and had serum potassium levels ≥6mmol/L were included. Patients who did not have simultaneous potassium measurement by blood gas analyzer were excluded. We included all patients meeting potassium criteria irrespective of their underlying disease or comorbidities. We evaluated agreement between the measurement methods with Pearson correlation, Bland-Altman plot, and Sign test. MAIN FINDINGS: A total of 118 blood sample pairs were included. The mean serum potassium level measured by biochemistry analyzer was 6.78±0.79mmol/L, whereas it was 6.16±0.86mmol/L by blood gas analyzer (P<.001, Sign test). There was a strong correlation (P<.001, r=0.864) between the 2 methods, but agreement was relatively poor. Blood gas analyzer tended to measure potassium significantly lower than measured by biochemistry analyzer. The mean difference between the methods was 0.62±0.43mmol/L. PRINCIPAL CONCLUSIONS: In patients with moderate to severe hyperkalemia, blood gas analyzer and biochemistry analyzer gives significantly different serum potassium results which may be clinically important.

Renal functional reserve and renal hemodynamics in hypertensive patients.

The renal functional reserve (RFR) is the ability of the kidneys to increase renal plasma flow and glomerular filtration rate (GFR) in response to protein intake. It is a measure of functional and anatomic integrity of nephrons. It is not known what relation between RFR and kidney Doppler parameters. We aimed to study the relation between the RFR and renal hemodynamic parameters in hypertensive patients with and without nephropathy who had normal kidney function. Twenty-four hypertensive subjects with nephropathy (HTN-n, n = 10) and hypertension without nephropathy (HTN, n = 14) were included in the study. Control group included 11 healthy subjects. Baseline GFR (GFR1) and GFR after intake of egg protein 1 mg/kg of body weight were determined (GFR2). RFR was calculated by the following formula: (GFR2-GFR1)/GFR1 × 100%. Doppler ultrasonography was performed. Arterial blood pressure (BP), body mass index (BMI), and estimated GFR were also recorded. HTN and HTN-n groups had impaired levels of RFR compared with controls (p < 0.05), significantly decreased value of flow velocity parameters (Vmax, Vmin), and increased RRI compared with controls. There was significant negative correlation of RFR with blood pressure levels (sBP, r = -0.435, p = 0.009; dBP, r = -0.504, p = 0.002), RRI (r = -0.456, p = 0.008), micro albuminuria (MAU, r = -0.366, p = 0.031) and positive correlation with Vmax and Vmin (r = 0.556, p = 0.001 and r = 0.643, respectively, p < 0.001). Linear regression showed that RRI and MAU were independent predictors of decreased RFR. RFR is lower in hypertensive patients despite near-normal level of kidney function and is related to particular level of BP. RRI and MAU were independent predictors of decreased RFR.

Serum uric acid may predict development of progressive acute kidney injury after open heart surgery.

OBJECTIVES: Acute kidney injury (AKI) is a common complication of cardiac surgery developing in 25-35% cases. Recently, neutrophil gelatinase-associated lipocalin (NGAL) was shown to predict AKI development earlier than serum creatinine. Some studies demonstrated the predictive role of post-operative serum uric acid (SUA) as an early marker of AKI. We aimed to study the role of serum and urine NGAL as well as SUA to predict progression of AKI. DESIGN AND METHODS: This is a prospective observational study of patients undergoing cardiac surgery. Blood and urine samples for measurement of uric acid, serum and urine NGAL levels were collected prior to cardiac surgery (0 h), and in the time course at 2nd and 24th hours after surgery. Patients who developed AKI were divided into two subgroups as progressing and non-progressing AKI. RESULTS: Sixty patients (42 males, 18 females) were included. After cardiac surgery, 40 patients developed AKI, 20 of whom non-progressing AKI, and 20 progressing AKI. All of the markers significantly increased in AKI patients. A receiver operator characteristics (ROC) curve analysis showed higher predictive ability of SUA for progressing AKI compared with serum and urine NGAL. When compared markers obtained at the second hour after surgery, UA had significantly large AUC than NGAL to predict AKI developed at 24 and 48 h, particularly in patients, who require renal replacement therapy (RRT). CONCLUSION: Uric acid seems to predict the progression of AKI and RRT requirement in patients underwent cardiac surgery better than NGAL.

Neutrophil gelatinase-associated lipocalin in prediction of mortality in patients with hepatorenal syndrome: a prospective observational study.

BACKGROUND & AIMS: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis which is characterized by renal dysfunction and associated with poor survival. Neutrophil gelatinase-associated lipocalin (NGAL) is a troponin-like biomarker for human acute kidney injury. We aimed to investigate levels of plasma and urine NGAL in HRS and predictive ability of these markers for all-cause mortality, in HRS, stable cirrhosis and control subjects. METHODS: A total of 64 patients with cirrhosis (8 patients with type 1 HRS, 22 with type 2 HRS, and 34 without HRS) and 23 control subjects were included in the study. Blood and urine samples were measured with Human NGAL sandwich ELISA. Patients were followed up prospectively. RESULTS: Patients with type 1 and type 2 HRS had significantly higher plasma and urine NGAL levels compared with stable cirrhosis and control subjects. Cox regression analysis showed that plasma NGAL and MELD-Na scores were independent predictors of mortality. ROC-curve analysis showed that the plot of the plasma NGAL, urine NGAL, MELD-Na and Child-Turcot-Pugh score could predict all-cause mortality in cirrhotic patients' area under the curve (AUC 0.819, 0.686, 0.807 and 0.795 respectively). CONCLUSIONS: NGAL could predict mortality in patients with HRS independent of other commonly used risk factors.

Uric acid level and erectile dysfunction in patients with coronary artery disease.

INTRODUCTION: Erectile dysfunction (ED) is a frequent complaint of elderly subjects and is closely associated with endothelial dysfunction and cardiovascular disease (CVD). Uric acid is also associated with endothelial dysfunction, oxidative stress, and CVD, raising the hypothesis that an increased serum uric acid might predict ED in patients who are at risk for coronary artery disease (CAD). AIM: This study aims to evaluate the association of serum uric acid levels with presence and severity of ED in patients presenting with chest pain of presumed cardiac origin. METHODS: This is a cross-sectional study of 312 adult male patients with suspected CAD who underwent exercise stress test (EST) for workup of chest pain and completed a sexual health inventory for men survey form to determine the presence and severity of ED. Routine serum biochemistry (and uric acid levels) were measured. Logistic regression analysis was used to assess risk factors for ED. MAIN OUTCOME MEASURES: The short version of the International Index of Erectile Function questionnaire diagnosed ED (cutoff score ≤ 21). Serum uric acid levels were determined. Patients with chest pain of suspected cardiac origin underwent an EST. RESULTS: One hundred forty-nine of 312 (47.7%) male subjects had ED by survey criteria. Patients with ED were older and had more frequent CAD, hypertension, diabetes and impaired renal function, and also had significantly higher levels of uric acid, fibrinogen, glucose, C-reactive protein, triglycerides compared with patients without ED. Uric acid levels were associated with ED by univariate analysis (odds ratio = 1.36, P = 0.002); however, this association was not observed in multivariate analysis adjusted for estimated glomerular filtration rate. CONCLUSION: Subjects presenting with chest pain of presumed cardiac origin are more likely to have ED if they have elevated uric acid levels.

Colchicine toxicity in end-stage renal disease patients: a case-control study.

Colchicine has been used in a number of disorders. Because colchicine is partially excreted from the kidney, there is a need for dose reduction in case of renal functional impairment. There are no data with regards to safe dosing schedule of colchicine in hemodialysis patients. We aimed to evaluate adverse effects of colchicine use in a hemodialysis cohort. We screened hemodialysis patients who were using colchicine for any reason. All patients were interviewed regarding possible toxicities of colchicine use and were examined with a special focus on neuromuscular system. Creatine kinase and myoglobin were used to detect any subclinical muscle injury or rhabdomyolysis, respectively. Twenty-two maintenance hemodialysis patients who were on colchicine for more than 6 months and 20 control hemodialysis patients not using colchicine were included in the study. Four of 22 patients were using 0.5 mg/day, 4 patients were using 1.5 mg/day, and 14 patients were using 1 mg/day colchicine. Mean duration for colchicine use was 8.9±8.2 years. There was no difference between the groups in terms of myoneuropathic signs and symptoms and blood counts except for white blood cell count, which was significantly higher in patients on colchicine. Serum creatine kinase (56.3±39.5 and 52.1±36.1 for colchicine and control groups, respectively, P=0.72) and myoglobin (191.4±108.8 and 214.6±83.5 for colchicine and control groups, respectively, P=0.44) levels were not different between the groups. We conclude that in a small number of haemodialysis patients who were apparently tolerating colchicine, detailed assessment revealed no evidence of sublinical toxicity when compared with controls.

Allopurinol as a kidney-protective, cardioprotective, and antihypertensive agent: hype or reality?

Numerous experimental and clinical studies suggest that uric acid might have pathobiologic implications in the development and progression of hypertension, kidney disease, and coronary heart disease, among others, resulting in renewed interest in uric acid as a potential pathogenic mediator in these clinical conditions. Despite encouraging animal studies showing beneficial roles of allopurinol, clinical studies and randomized controlled trials remain scarce, and, despite available clinical evidence supporting a therapeutic role for allopurinol, multiple issues remain before routine use of allopurinol can be recommended for use in patients with hyperuricemia and hypertension, kidney disease, or coronary heart disease. These include a need for more robust clinical trial data that evaluate efficacy on hard clinical outcomes, optimal dose, duration of treatment, and the potential for serious allergic reactions. In this article we review the current available evidence describing the effects of allopurinol in hypertension, kidney disease, and coronary heart disease, highlighting unresolved issues surrounding allopurinol use for uric acid lowering in individuals without gout.

Masked hypertension in renal transplant recipients.

PURPOSE: Arterial hypertension is a risk factor affecting graft function in renal transplant recipients (RTRs). In pediatric RTRs, high prevalence of masked and nocturnal hypertension was reported. Most of the RTRs had a history of hypertension and some of them were normotensive at outpatient visits whereas home blood pressure (BP) levels were higher. Masked hypertension (MHT) is defined as a normal office BP but an elevated ambulatory BP. Previous reports have demonstrated the detrimental role of MHT in clinical outcomes in hypertensive patients. However, the true prevalence of MHT in RTRs is yet to be defined. METHODS: A total of 113 RTRs (mean age 44 ± 16 years, 72 males, 41 females) with normal office BP (< 140/90 mmHg) were enrolled to the study from the outpatient renal transplantation clinic. Ambulatory BP monitoring (ABPM) was performed in all participants for a 24-h period. Average daytime BP values above 135 mmHg systolic and 85 mmHg diastolic were defined as MHT. RESULTS: The prevalence of MHT in our cohort was 39% (n = 45). Fasting glucose and C-reactive protein levels were higher in patients with MHT compared with normal BP group (p = 0.02 and p = 0.04, respectively). RTRs with deceased donor type had higher prevalence of MHT than RTRs with living donor (40% vs 19%, p = 0.003). In multivariate analysis, deceased donor type could predict the MHT independent of age, gender, office systolic BP level, diabetes mellitus, serum creatinine, C-reactive protein, and glucose levels (OR = 3.62, 95% CI 1.16-11.31, p = 0.03). CONCLUSION: We demonstrated an increased prevalence of MHT in a typical renal transplant cohort. In addition, transplantation from a deceased donor may be a predictor of MHT. The prevalence of MHT may help to explain high rate of cardiovascular events in RTRs. Therefore, routine application of ABPM in RTRs may be plausible, particularly in RTRs with deceased donor type.

The relationship between uric acid and erectile dysfunction in hypertensive subjects.

BACKGROUND: Endothelial dysfunction plays a major role in erectile dysfunction (ED). Uric acid (UA) is a marker of endothelial dysfunction. We hypothesized that increased UA levels may be associated with ED and aimed to investigate whether there is a relationship between, UA and ED in hypertensive patients. METHODS: A total of 200 hypertensive patients who have a normal treadmill exercise test were divided into two groups based on the Sexual Health Inventory for Men (SHIM) test (< 21 defined as ED n = 110, and ≥ 21 defined as normal erectile function n = 90). The differences between the ED and normal erectile function groups were compared and determinants of ED were analyzed. MAIN RESULTS: The prevalence of ED was found to be 55.0%. Office blood pressure level was comparable between groups. UA levels were significantly increased in the ED group (6.20 ± 1.56 vs 5.44 ± 1.32, p = 0.01). In a regression model, age [odds ratio (95% confidence interval): 1.08 (1.04-1.14), p = 0.001], smoking [odds ratio: 2.33 (1.04-5.20), p = 0.04] and UA [odds ratio: 1.76 (1.28-2.41), p = 0.04] were independent determinants of ED. An UA level of > 5.2 mg/dl had 76.2% sensitivity, 43.7% specificity, 62.9% positive and 59.4% negative predictive value for determining ED. CONCLUSION: UA is an independent determinant of ED irrespective of blood pressure control and questioning erectile function for hypertensive patients with increased UA levels may be recommended.

Temporary left ventricular dysfunction in mushroom poisoning: report of three cases.

Mushroom poisoning can result in acute kidney injury and fulminant hepatic failure as well as gastrointestinal and neurological disorders. The effects of mushroom poisoning on cardiac functions have not been known well. Only a few case reports have been published to date (1-3). We report 3 patients out of 45 patients who were followed due to acute kidney injury and hepatic injury secondary to naturally growing mushroom ingestion between 2009 and 2012. These three cases suffered from transient impairment in cardiac systolic function in addition to other manifestations of mushroom poisoning.