Effect of Transplant on Platelet Function Markers (P-Selectin and Platelet Aggregation) and Adiponectin in Renal Transplant Patients.

OBJECTIVES: In chronic kidney disease, both bleeding and thrombotic complications are observed, although with expected recovery after a successful transplant. Adiponectin has protective properties with respect to atherogenesis and inflammation. Plasma adiponectin levels are markedly elevated among patients with end-stage renal disease and are lower after kidney transplant. However, this topic is still debated in the literature. Here, we evaluated the effect of transplant on platelet function markers (P-selectin and platelet aggregation) and adiponectin in renal transplant patients. MATERIALS AND METHODS: Our study included 14 renal transplant patients. Preoperative and week 1, month 1, month 6, year 1, and year 2 samples after transplant were studied. In addition to plasma adiponectin, P-selectin levels, and platelet aggregation tests, biochemical tests and coagulation parameters were also studied. RESULTS: We observed a significant decrease in adiponectin levels 2 years after transplant. Platelet function tests with ADP and collagen were significantly improved, and no changes in P-selectin, ristocetin, and epinephrine levels were observed. CONCLUSIONS: According to our findings, glomerular filtration rate has an important effect on platelet function, but adiponectin levels became normal only in the second year after transplant. Late improvement of low-density lipoprotein cholesterol and adiponectin after transplant suggested to us that patients with kidney transplant may still have risk of cardiovascular events, especially in the first years.

Renal protection by brief liver ischemia in rats.

BACKGROUND: In this study, we evaluated the beneficial effect of brief ischemia and reperfusion, which was shown to have local effects on liver previously, on kidney as a remote organ in rats. METHODS: Male Wistar rats were divided into three groups: group I, sham; group II, renal ischemia for 45 min; and group III, 10 min of brief hepatic ischemia and 10 min of reperfusion after 45 min of renal ischemia. Biochemical determination, tumor necrosis factor (TNF)-alpha and tissue thiobarbituric acid-reactive substances (TBARS) levels, and histopathologic findings were evaluated at 45 min and 24 hr of reperfusion. RESULTS: Although blood urea nitrogen and creatinine levels were similar at 45 min in groups II and III, these levels were lower in group III at 24 hr. Creatine clearance values were higher and fraction excretion of sodium values were lower in group II than in group III at 24 hr. Lactate dehydrogenase levels of groups III and II were similarly elevated at 45 min, whereas group III values decreased more rapidly than those of group II at 24 hr. At 45 min of reperfusion, TNF-alpha and tissue TBARS levels were found lower in group III than in group II. Histopathologic parameters including congestion and tubular vacuolization, tubular cell detachment, and necrosis were significantly reduced in group III as compared with results of group II 45 min after ischemia. All histopathologic parameters were defined as statistically better in group II at 24 hr. CONCLUSIONS: The beneficial effect of brief ischemia of liver on renal ischemia as a remote organ was confirmed by biochemical, histopathologic, and ultrastructural findings.

Effect of leptin on healing of colonic anastomoses in rats.

BACKGROUND/AIMS: Anastomotic leaks are continuing to be the source of major morbidity in colorectal surgery. Previous studies have shown that leptin acts as a growth factor for several cell types. The aim of this study was to evaluate the effect of leptin on healing of colonic anastomoses in rats. METHODOLOGY: Forty-eight rats were divided into 5 groups. Group I (n=8) sham; group II (n=10) control; right colonic anastomosis, group III (n=10); following right colonic anastomosis, treated with leptin twice-daily 1 mg/kg intraperitoneally, group IV (n=10); before right colonic anastomosis, 45 min of colonic ischemia has been created, group V (n=10); following 45 min of colonic ischemia and right colonic anastomosis, leptin was given twice-daily 1 mg/kg intraperitoneally. On the 7th postoperative day relaparotomy was performed. Bursting pressure (BP), tissue hydroxyproline concentrations (THPC), and histopathologic properties of anastomoses; vascular tissue proliferation (VTP), collagen tissue proliferation (CTP), polymorphonuclear leukocyte infiltration (PMNLI), mononuclear leukocyte infiltration (MNLI) were analyzed and results were compared statistically. RESULTS: BP and THPC were found to be significantly higher in group III and group V in comparison with group II and group IV respectively (P<0.05). Histopathologically, leptin significantly increased VTP, CTP, MNLI (P<0.001), and significantly decreased PMNLI (p<0.05) on non-ischemic and ischemic colonic anastomoses. CONCLUSIONS: Leptin can be used safely in colorectal surgery since it accelerates the healing of colonic anastomoses.

Unusual case of calciphylaxis associated with primary hyperparathyroidism without coexistent renal failure.

OBJECTIVE: To report a case of calciphylaxis in a patient with primary hyperparathyroidism without coexistent renal failure. METHODS: The clinical, laboratory, and radiographic details of this case are reviewed, and the pathogenesis of calciphylaxis and the associated prognosis are discussed. RESULTS: A 52-year-old woman had progressive fatigue, cachexia, severe osteoporosis, and necrotizing skin lesions. Her serum calcium level was 16 mg/dL, serum phosphorus level was 2.13 mg/dL, and parathyroid hormone level was 2,257 pg/mL (reference range, 15 to 65). On physical examination, gangrenous skin lesions with black crusts were noted on her legs, abdomen, and gluteal region. A mass lesion was detected in the parathyroid region by both ultrasonography and a parathyroid scan. The patient underwent a bilateral neck exploration, and a parathyroid adenoma measuring 3.5 by 1.5 by 1.2 cm was found on pathologic examination. After the operation, biochemical findings normalized, and the skin lesions progressively improved. CONCLUSION: Severe primary hyperparathyroidism may be a factor leading to calciphylaxis, even in the absence of renal failure and a high calcium-phosphate product. This potentially life-threatening condition should not be left untreated if the levels of serum calcium and parathyroid hormone are severely elevated.

The Marmara earthquake: admission laboratory features of patients with nephrological problems.

BACKGROUND: Earthquakes are major causes of morbidity and mortality. North-western Turkey was struck by a devastating earthquake in August 1999, which caused several thousand deaths. Among the most important morbid events in survivors were acute nephrological problems. METHODS: Within the first week of the disaster, specific questionnaires asking about 63 clinical and laboratory parameters were sent to 35 reference hospitals that were treating the victims. Of the registered 639 victims, 423 were admitted within the first 3 days of the disaster; the admission laboratory data of these 423 patients are the subject of this analysis. RESULTS: In the 423 patients (233 males, mean age 31.3+/-14.4 years), time under the rubble was 10.7+/-10.4 h. Mean values at admission were as follows: serum potassium 5.4+/-1.3 mEq/l, creatine phosphokinase 58205+/-77889 IU/l, albumin 2.6+/-0.7 g/dl, phosphorus 5.2+/-1.8 mg/dl, haematocrit 35.0+/-9.3%, leukocyte count 14945+/-6614/mm(3), platelet count 183975+/-134012/mm(3), blood urea nitrogen 55.1+/-28.9 mg/dl, and creatinine 3.9+/-2.3 mg/dl. Serum potassium above 6.5 mEq/l was noted in 91 patients (22.7%), an alarming finding for risk of fatal arrhythmias. Non-survivors were characterized by higher figures of serum potassium (P=0.001), as well as lower haematocrit (P=0.028), platelets (P<0.001), and serum albumin (P=0.003). In a multivariate analysis model of admission laboratory parameters, serum creatinine (P<0.001, o.r.=2.19), potassium (P=0.001, o.r.=3.64), and phosphorus (P=0.004, o.r.=1.78) predicted dialysis needs, whereas serum albumin (P=0.028, o.r.=0.23) and creatinine (P=0.039, o.r.=0.60) were related to mortality. CONCLUSIONS: Admission laboratory data may be useful for predicting dialysis needs and survival chance of disaster victims. High incidences of some life-threatening abnormalities dictate the need for empirical therapy even in the field.

Renal replacement therapies in the aftermath of the catastrophic Marmara earthquake.

BACKGROUND: Renal replacement therapy is of vital importance in the treatment of crush syndrome victims, who are frequently encountered after catastrophic earthquakes. The Marmara earthquake, which struck Northwestern Turkey in August 1999, was characterized by 477 victims who needed dialysis. METHOD: Within the first week of the disaster, questionnaires containing 63 clinical and laboratory variables were sent to 35 reference hospitals that treated the victims. Information considering the features of dialyses obtained through these questionnaires was submitted to analysis. RESULTS: Overall, 639 casualties with renal complications were registered, 477 of whom (mean age 32.3 +/- 13.7 years, 269 male) needed dialysis. Among these, 452 were treated by a single dialysis modality (437 intermittent hemodialysis, 11 continuous renal replacement therapy and 4 peritoneal dialysis), while 25 victims needed more than one type of dialysis. In total, 5137 hemodialysis sessions were performed (mean 11.1 +/- 8.0 sessions per patient) and mean duration of hemodialysis support was 13.4 +/- 9.0 days; this duration was shorter in the non-survivors (7.0 +/- 8.7 vs. 10.0 +/- 9.8 days, P = 0.005). Thirty-four victims who underwent continuous renal replacement therapy had higher mortality rates (41.2 vs. 13.7%, P < 0.0001). Only eight victims were treated by peritoneal dialysis, four of whom also required hemodialysis or continuous renal replacement therapy. The mortality rate in the dialyzed victims was 17.2%, a significantly higher figure compared to the mortality rate of the non-dialyzed patients with renal problems (9.3%; P = 0.015). CONCLUSION: Substantial amounts of dialysis support may be necessary for treating the victims of mass disasters complicated with crush syndrome. Dialyzed patients are characterized by higher rates of morbidity and mortality.