RESUMEN
Histological evidence of osteodystrophy and osteopenia is encountered in most patients who have undergone successful renal transplantation. Renal transplantation may be beneficial for correcting uremia-related problems in end-stage renal disease patients; however, its benefit is limited in bone metabolism disorders. The present study aims to evaluate bone mass measurements and investigate the influencing factors in patients with renal transplant. One hundred and eighteen patients (83 males and 35 females) with a mean age of 40.2 ± 11.8 yr (range 20-67) were included in the present study. The laboratory and the clinical data of the patients were retrospectively analyzed. The association between bone mineral density (BMD) measurements and the demographic characteristics of the patients, serum creatinine, parathormone, calcium, phosphorous, alkaline phosphatase, 25-hydroxyvitamin D and the glomerular filtration rate were evaluated. Of the patients, 23.7% (n =28) had normal, 48.3% (nâ¯=â¯57) had osteopenic and 28% (nâ¯=â¯33) had osteoporotic BMD values. A significant positive correlation was determined between the body mass index (BMI) and the BMD measurement results (pâ¯=â¯0.001; râ¯=â¯0.385). A negative correlation was determined between the BMD values and the serum parathormone (pâ¯=â¯0.012; râ¯=â¯-0.237). BMD values were significantly lower in the group that had not received mammalian target of rapamycin (mTOR) inhibitor (pâ¯=â¯0.026). Conclusion: BMI values, mTOR inhibitor treatment and serum parathormone levels had an effect on the BMD measurement values.
Asunto(s)
Enfermedades Óseas Metabólicas , Trasplante de Riñón , Osteoporosis , Absorciometría de Fotón , Adulto , Anciano , Densidad Ósea , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hormona Paratiroidea , Estudios Retrospectivos , Serina-Treonina Quinasas TOR , Adulto JovenRESUMEN
Acute severe hypophosphatemia can be life threatening and is associated with mortality and impaired cardiac and respiratory function. Several conditions including decreased absorption or increased urinary phosphate excretion, shifts from the extracellular to intracellular compartments, and phosphate consumption by rapidly proliferating cells are known to induce moderate to severe acute hypophosphatemia. Although hypophosphatemia and/or phosphate depletion in patients with acute or chronic myeloid leukemia have been reported in the literature, hypophosphatemia due to acute lymphoblastic leukemia (ALL) is very rare. We report a case of history of ALL complicated by life-threatening hypophosphatemia manifesting as generalized muscle weakness, fatigue, acute shortness of breath, and difficulty in standing up and walking for 3 days. Serum inorganic phosphate levels were consistently low (0.06 mmol/L). The patient was hospitalized and thought to have a relapsed ALL.Anticancer agents and oral phosphate (660 mg twice daily) were administered. On the second day of treatment, the patient began to improve, and the patient gradually fully recovered within 5 days.We suggested that this hypophosphatemia was induced by a shift of phosphorus into leukemic cells that rapidly replicated in the tissues and excessive cellular phosphate consumption by rapidly proliferating cells. Serum phosphate levels should always be monitored,especially in suspected life-threatening manifestation in relapsed ALL.
Asunto(s)
Hipofosfatemia/diagnóstico , Hipofosfatemia/etiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológicoRESUMEN
Hypoparathyroidism is an uncommon disease and its coexistence with chronic renal failure is quite rare. Hypocalcemia and hyperphosphatemia are seen in both diseases. Diagnosis of hypoparathyroidism may be overlooked when parathormone response is not evaluated in patients with chronic renal failure. A 19-year-old female patient who had been receiving hemodialysis for 3 years because of chronic renal failure was diagnosed as idiopathic hypoparathyroidism and hashimoto thyroiditis. When her medical records on the first admission and medical history were evaluated, hypoparathyroidism and hashimoto thyroiditis were seen to be present also when she was started hemodialysis. Idiopathic hypoparathyroidism should be suspected in case as absence of parathormone response to hypocalcemia in patients with chronic renal failure. It should be taken into consideration that hashimoto thyroiditis may accompany and required analysis should be done.
Asunto(s)
Enfermedad de Hashimoto/complicaciones , Hipoparatiroidismo/complicaciones , Fallo Renal Crónico/complicaciones , Femenino , Humanos , Hiperfosfatemia/complicaciones , Hipocalcemia/complicaciones , Adulto JovenRESUMEN
Intravascular lymphoma (IVL) is a rare extra nodal subtype (usually of B-cell origin) presenting with infiltration of large neoplastic lymphocytes into lumina of blood vessels, leading to vascular occlusion. The early diagnosis is very crucial, however it is usually diagnosed postmortem investigation in most of the cases. A 56-year-old female presented with elevated creatinine level, and anasarca-type edema that superimposed with hard, indurated, erythematous plaques extending to inguinal region, abdomen, anterior aspect of chest, and face. B-cell IVL was confirmed with skin biopsy. The patient had some degree of clinical improvement following chemotherapy. B-cell IVL presenting with anasarca edema was not previously reported in the literature. Even if its rarity, IVL should be considered in the differential diagnosis of renal failure with anasarca edema.
Asunto(s)
Lesión Renal Aguda/etiología , Edema/etiología , Linfoma de Células B Grandes Difuso/patología , Neoplasias Cutáneas/patología , Neoplasias Vasculares/patología , Lesión Renal Aguda/patología , Edema/patología , Femenino , Humanos , Linfoma de Células B Grandes Difuso/complicaciones , Persona de Mediana Edad , Neoplasias Cutáneas/complicaciones , Neoplasias Vasculares/complicacionesRESUMEN
OBJECTIVES: To evaluate sexual function and psychological state and the factors affecting female sexual dysfunction in predialysis and hemodialysis patients. DESIGN AND METHODS: Forty-seven women with chronic renal failure including 22 predialysis patients, 25 hemodialysis patients, and 30 healthy controls were included in this study. Demographic and clinical variables of the patients were recorded. The sexual functions and psychological states of the patients, assessed by the Arizona Sexual Experiences Scale (ASEX) and Beck Depression Inventory (BDI), respectively, were compared between the groups. RESULTS: Total ASEX scores, ability to reach orgasm, and BDI scores were significantly higher in predialysis and hemodialysis patients than controls, reflecting sexual dysfunction. The patients in the predialysis group were 6 and 3.8 times more likely to develop depressive symptoms compared to the controls and hemodialysis patients, respectively. The predialysis patients who showed depressive symptoms were 24 times more likely to develop sexual dysfunction compared to those without depression. Serum FSH and LH levels were also positively correlated with arousal and erection/lubrication scores in the predialysis patients with depressive symptoms. CONCLUSION: Female predialysis rather than dialysis patients might be more likely to develop depression. Those patients with depressive symptoms may also be at greater risk of developing sexual dysfunction in which increased gonadotropin levels and age may also be contributing factors. Therefore, psychiatric and gynecologic consultations may be beneficial.
Asunto(s)
Hormona Folículo Estimulante/sangre , Fallo Renal Crónico/sangre , Hormona Luteinizante/sangre , Salud Mental , Diálisis Renal/psicología , Disfunciones Sexuales Fisiológicas/sangre , Disfunciones Sexuales Psicológicas/sangre , Adulto , Femenino , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/psicología , Fallo Renal Crónico/terapia , Persona de Mediana Edad , Calidad de Vida , Disfunciones Sexuales Fisiológicas/complicaciones , Disfunciones Sexuales Fisiológicas/psicología , Disfunciones Sexuales Psicológicas/complicaciones , Disfunciones Sexuales Psicológicas/psicologíaRESUMEN
BACKGROUND AND OBJECTIVE: Prolonged corticosteroid (CS) use induces osteoporosis; the pathogenesis of this condition is multifactorial and includes CS-induced hypercalciuria. We investigated the course of hypercalciuria and related markers of bone metabolism parameters during and after the CS treatment. MATERIALS AND METHODS: We recruited 42 patients who were taking at least 10 mg/day of methylprednisolone or an equivalent dose of CSs for at least 30 days. The 24-h urinary calcium and sodium, a spot urinary calcium/creatinine ratio, and urinary deoxypyridinoline were measured prior to the treatment, at day 7, at days 30-60, and after the cessation of the treatment. Additionally, the serum levels of phosphorus, calcium, alkaline phosphatase (ALP), albumin, creatinine, osteocalcin, and parathyroid hormone (PTH) were analyzed. RESULTS: The 24-h urinary calcium excretion was significantly increased at day 7 (182.2 ± 158.6 mg/day; p < 0.001) and at days 30-60 (196.9 ± 167.8 mg/day; p < 0.001) compared with baseline (98.7 ± 88.1 mg/day) and returned to basal level after the cessation of the CSs (118.9 ± 90.2 mg/day; p = 0.725). The urinary deoxypyridinoline level was significantly higher at days 30-60 compared with basal level. The serum osteocalcin level was decreased at days 30-60 when compared with day 7. No significant changes were detected in the PTH, phosphorus, creatinine, and ALP levels. CONCLUSIONS: CS treatment induces hypercalciuria just after starting the treatment until the end of it. CS-induced hypercalciuria promptly improved after cessation of the treatment. By days 30-60, the excretion of urinary deoxypyridinoline was accompanied by hypercalciuria. The serum osteocalcin level was decreased at days 30-60 when compared with day 7.
Asunto(s)
Biomarcadores/metabolismo , Huesos/metabolismo , Glucocorticoides/efectos adversos , Hipercalciuria/metabolismo , Metilprednisolona/efectos adversos , Osteoporosis/inducido químicamente , Adolescente , Adulto , Anciano , Aminoácidos/orina , Huesos/efectos de los fármacos , Calcio/orina , Creatinina/sangre , Creatinina/orina , Relación Dosis-Respuesta a Droga , Femenino , Glucocorticoides/administración & dosificación , Humanos , Hipercalciuria/inducido químicamente , Masculino , Metilprednisolona/administración & dosificación , Persona de Mediana Edad , Osteocalcina/sangre , Osteoporosis/metabolismo , Hormona Paratiroidea/sangre , Factores de Riesgo , Sodio/orina , Adulto JovenRESUMEN
Rhabdomyolysis is defined as a pathological condition of skeletal muscle cell damage leading to the release of toxic intracellular components into the circulation. Several factors may lead to rhabdomyolysis. Fenofibrate is a fibric acid derivative agent that is used in the treatment of hyperlipidaemia. Although several case reports of rhabdomyolysis have been reported due to the combination of statin and fenofibrate, fenofibrate alone rarely causes rhabdomyolysis. When administering fenofibrate in chronic renal failure, dose should be adjusted. Here, we report a case with fenofibrate-induced rhabdomyolysis in a patient with chronic renal failure.
Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Fenofibrato/efectos adversos , Fallo Renal Crónico/complicaciones , Rabdomiólisis/inducido químicamente , Diagnóstico Diferencial , Femenino , Fenofibrato/uso terapéutico , Humanos , Hipolipemiantes/efectos adversos , Fallo Renal Crónico/diagnóstico , Persona de Mediana Edad , Rabdomiólisis/diagnósticoRESUMEN
OBJECTIVE: To characterise the relationship between visfatin levels and various clinical and biochemical parameters in peritoneal dialysis patients. METHODS: The case-control study was conducted at the Medical Faculty Hospital, Yuzuncu Yil University, Van, Turkey, between May 2007 and December 2008, and involving 41 patients on peritoneal dialysis, 20 haemodialysis patients and 20 healthy controls. Fasting visfatin level was measured with enzyme-linked immunosorpent assay (ELISA) method, and patients on peritoneal dialysis were separated into two groups according to the visfatin levels - high and low. The groups were compared in terms of some clinical (height, weight, body mass index, waist circumference, hip circumference, waist/hip ratio, heart rate, systolic and diastolic blood pressure and the kt/V and CrCI (creatanine clearance) parameters which are indicative of the dialysis adequacy) and biochemical parameters (glucose, triglycerides, cholesterol, low density lipoprotein, high density lipoprotein, aspartate aminotransferase, alanine transminase, blood urea nitrogen, creatinine, total protein, albumin, globulin, sodium, potassium, magnesium, calcium, phosphorus, ferritin, venous blood gas, parathyroid hormone and insulin). SPSS 15 was used for statistcal analysis. RESULTS: No statistically significant difference in the visfatin levels was found between the patients and controls (7.71 +/- 4.04, 7.36 +/- 3.71, 7.70 +/- 1.61, respectively, p = 0.63). The triglyceride level of the high-visfatin group was significantly higher than that of the low-visfatin group (243.8 +/- 133.2, 150.8 +/- 65.8, respectively, p<0.05). However, there was no correlation between visfatin and triglyceride levels. No difference in the other clinical and biochemical parametres was observed between the two groups of peritoneal dialysis patients. CONCLUSIONS: No significant difference in the serum visfatin levels of peritoneal dialysis patients compared to haemodialysis patients or healthy individuals was noticed. Further studies are needed to confirm the effect of visfatin on triglyceride levels, and, if confirmed, the mechanism of this relation.
Asunto(s)
Nicotinamida Fosforribosiltransferasa/sangre , Diálisis Peritoneal , Adulto , Análisis de Varianza , Antropometría , Biomarcadores/sangre , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadísticas no Paramétricas , TurquíaRESUMEN
Increased oxidative stress is a well-known phenomenon in dialysis patients. However, the contribution of hypertension to the oxidative stress in peritoneal dialysis patients has not yet been assessed. The present study aimed to investigate if hypertension had an additional effect on oxidative stress in peritoneal dialysis patients. A total of 50 patients treated with peritoneal dialysis were divided into two groups: The patients with mean of last three blood pressure results as 135/90 mmHg and above were considered hypertensive, the patients with lower blood pressure were considered normotensive. The control group included 25 healthy individuals. Serum malondialdehyde (MDA), advanced oxidation protein product (AOPP), myeloperoxidase (MPO), catalase (CAT) and glutathione peroxidase (GSH-Px) levels were measured in all groups. MDA level, an indicator of lipid peroxidation, was significantly higher in the hypertensive group compared to the control group, while the increase in the normotensive group was not significant. However, the difference between the hypertensive and normotensive groups was significant. The levels of AOPP, an indicator of protein oxidation level, and MPO, an indicator of neutrophil activation, were not different between the groups, while the activities of antioxidant CAT and GSH-Px decreased in both normotensive and hypertensive groups compared to the control group, and there was no significant difference between the patient groups. This study shows that both normotensive and hypertensive peritoneal dialysis patients have increased-oxidative stress and decreased antioxidant levels and hypertension might have an additional effect on oxidative stress by increasing MDA level in peritoneal dialysis patients.
Asunto(s)
Hipertensión/sangre , Estrés Oxidativo , Diálisis Peritoneal , Antioxidantes/metabolismo , Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Catalasa/sangre , Femenino , Glutatión/sangre , Glutatión Peroxidasa/sangre , Humanos , Hipertensión/fisiopatología , Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Peroxidación de Lípido , Masculino , Malondialdehído/sangre , Persona de Mediana Edad , Activación Neutrófila , Oxidación-Reducción , Peroxidasa/sangre , Superóxido Dismutasa/sangreRESUMEN
BACKGROUND: Calcineurin inhibitor cyclosporine A (CsA) is a potent immunosuppressive agent. The side effects of CsA include nephrotoxicity, hypertension, hypertrichosis, infection, hyperpotassemia, and, to a lower extent, neuropathy. OBJECTIVES: In this case report, we aimed to present a renal transplant patient with polyneuropathy (PNP) due to the use of CsA and with improvement when switched to rapamycin. METHODS: In electromyography, axonal sensory PNP was detected. CsA was stopped and rapamycin was begun. RESULTS: His complaints rapidly improved after using rapamycin. CONCLUSIONS: Patients using CsA should be closely monitored for peripheral neuropathy and in case of toxicity, alternative immunosuppressive agents should be considered.
Asunto(s)
Ciclosporina/efectos adversos , Inmunosupresores/efectos adversos , Trasplante de Riñón , Polineuropatías/inducido químicamente , Electromiografía , Humanos , Masculino , Persona de Mediana Edad , Polineuropatías/diagnósticoRESUMEN
PURPOSE: We report the successful management of a pregnancy with preexisting nephrotic syndrome due to biopsy-proven primary membranoproliferative glomerulonephritis type I. METHODS: A 21-year-old Turkish woman with membranoproliferative glomerulonephritis type I was followed up by the obstetrics and gynecology, and nephrology departments of a university hospital throughout her pregnancy starting from the 25th week of gestation. RESULTS: Due to progression of intrauterine growth retardation and fetal distress, a cesarean section was performed in the 33rd week of gestation. Although creatinine was unchanged, proteinuria increased with relatively stable albumin levels 3 months after delivery and her treatment was adjusted accordingly. CONCLUSIONS: If the mother is not suffering from hypertension or renal insufficiency, specific therapy for membranoproliferative glomerulonephritis type I during pregnancy provided by a nephrologist together with regular obstetric care may allow the patient to have a viable fetus, which might be growth retarded if proteinuria is increased.
Asunto(s)
Glomerulonefritis Membranoproliferativa , Complicaciones del Embarazo , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Embarazo , Adulto JovenRESUMEN
By the time patients require dialysis replacement therapy, nearly all chronic kidney diseases (CKD) patients are affected with uremic bone diseases. High-turnover osteodystrophy can be prevented; patients with CKD should be monitored for imbalances in calcidiol (25 OH vitamin D), calcium, and phosphate homeostasis. We aimed to determine the effect of a monthly oral 300,000 IU vitamin D(3) (cholecalciferol) supplementation on the uremic bone diseases (UBD) markers such as iPTH and alkaline phosphatase in CKD patients. Among a total of 70 patients under treatment in the nephrology unit, 40 predialysis CKD patients (mean age of 49 +/- 14, male/female 20/20) were included the study. The patients were randomly divided into two groups. Treatment group included 20 patients (mean age of 51 +/- 14, male/female 9/11), and the control group comprised 20 patients (mean age of 47 +/- 14, male/female 9/11). Treatment group patients were given a single dose of Devit3 ampoule (300,000 U cholecalciferol) per month orally way. Patients in the control group did not take any vitamin D for a month. The level of calcidiol was lower than normal range in two groups. After a month, treatment group patient's calcidiol increased statistically significant (6.8 +/- 3.5 to 17.8 +/- 21.4 ng/mL, p < 0.001). After a month, iPTH level decreased in the treatment group statistically significantly (368 +/- 274 to 279 +/- 179 pg/ml, p < 0.001). At the 30(th) day of the treatment, in 9/20 of the treatment group patients (45%), the iPTH value decreased at least 30% (p < 0.001). We suggest that oral depot cholecalciferol treatment causes a statistically significant decrease of serum iPTH level but does not cause a statistically significant change in Ca, P, ratio of Ca x P, or urinary calcium creatinine rate in UBD predialysis CKD. This treatment can be used safely for the predialysis CKD patients, along with the cautious control of serum calcium and phosphor.
Asunto(s)
Colecalciferol/administración & dosificación , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/etiología , Hiperparatiroidismo Secundario/tratamiento farmacológico , Hiperparatiroidismo Secundario/etiología , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/diagnóstico , Absorciometría de Fotón , Administración Oral , Adulto , Densidad Ósea/efectos de los fármacos , Conservadores de la Densidad Ósea/administración & dosificación , Calcifediol/administración & dosificación , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/prevención & control , Preparaciones de Acción Retardada/administración & dosificación , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Hiperparatiroidismo Secundario/fisiopatología , Fallo Renal Crónico/terapia , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Hormona Paratiroidea/metabolismo , Probabilidad , Estudios Prospectivos , Valores de Referencia , Diálisis Renal/efectos adversos , Diálisis Renal/métodos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Twenty-four-hour urinary calcium excretion is normally the equivalent of daily calcium intake, and varies between 200-300 mg/dL with a calcium/creatinine ratio of 0.07-0.15. In this study, we aimed to investigate the diurnal rhythm of calcium excretion in healthy individual. Forty subjects (30 male, 10 female) were involved into the study. The spot urine samples were taken at 08:00, 14:00, and 22:00 together with a 24-hour collection. Mean spot urinary calcium levels at 08:00, 14:00, and 22:00 were 12.39 +/- 8.19, 12.97 +/- 8.37, and 16.95 +/- 10.39 mg/dL, with calcium/creatinine ratios of 0.104 +/- 5.261, 0.119 +/- 7.85, and 0.133 +/- 8.17, respectively. Twenty-four-hour urinary calcium excretion was 12.74 +/- 7.31 mg/dL with a calcium/creatinine ratio of 0.111 +/- 5.41. The values at 08:00, 14:00, and of 24-hour collection were statistically similar (p > 0.05), but the nighttime values were significantly elevated (p < 0.05). In conclusion, calcium excretion is increased at night, and urinary calcium measurements should be interpreted accordingly.
Asunto(s)
Calcio/orina , Ritmo Circadiano , Creatinina/orina , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: The relationship between increased serum enzyme activity of prolidase and increased rate of collagen turnover in the arterial wall has been asserted in previous studies. Collagen reflects much of the strength to the connective tissue involved in the arterial wall. Atherosclerosis is very common vessel disease and oxidative stress plays a pivotal role in the etiopathogenesis. Our objective was to examine the serum enzyme activity of prolidase and its possible relationships with oxidative stress parameters in obese subjects. METHODS: Our present study was conducted 27 obese subjects and 26 age-matched healthy control subjects. The serum enzyme activity of prolidase in all study population was evaluated spectrophotometrically. Oxidative stress levels in obese subjects were analyzed with total antioxidant capacity (TAC) and total oxidant status (TOS) as well as oxidative stress index (OSI). RESULTS: Obese subjects have higher serum TOS and OSI indicators as well as prolidase activity than those in control subjects (for all; p<0.001). Moreover, obese subjects have lower levels of TAC than in those in healthy subjects (p<0.001). In the Pearson's correlation analysis, enzyme activity of prolidase was positively related with TOS (p<0.001, r=0.529) and OSI (p<0.001, r=0.519) as well as BMI (p<0.001, r=0.692) and inversely related with TAC (p<0.05, r=-0.405) in obese subjects. CONCLUSIONS: Increased serum prolidase activity and decreased antioxidant levels are likely to be a results of increased of oxidative stress levels in obese subjects. The significantly correlation between increased oxidative stress and increased prolidase activity may play a pivotal role in etiopathogenesis of atherosclerotic cardiovascular diseases in obese subjects.
Asunto(s)
Dipeptidasas/sangre , Obesidad/sangre , Obesidad/metabolismo , Estrés Oxidativo , Adulto , Biomarcadores/metabolismo , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Obesidad/enzimologíaRESUMEN
BACKGROUND: End stage renal disease is related to increased cardiovascular mortality and morbidity. Hypertension is an important risk factor for cardiovascular disorder among hemodialysis (HD) patients. The aim of this study was to investigate the effect of low-sodium dialysate on the systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels detected by ambulatory BP monitoring (ABPM) and interdialytic weight gain (IDWG) in patients undergoing sustained HD treatment. PATIENTS AND METHODS: The study included 46 patients who had creatinine clearance levels less than 10 mL/min/1.73 m(2) and had been on chronic HD treatment for at least 1 year. After the enrollment stage, the patients were allocated low-sodium dialysate or standard sodium dialysate for 6 months via computer-generated randomization. RESULTS: Twenty-four hour SBP, daytime SBP, nighttime SBP, and nighttime DBP were significantly decreased in the low-sodium dialysate group (P<0.05). No significant reduction was observed in both groups in terms of 24-hour DBP and daytime DBP (P=NS). No difference was found in the standard sodium dialysate group in terms of ABPM. Furthermore, IDWG was found to be significantly decreased in the low-sodium dialysate group after 6 months (P<0.001). CONCLUSION: The study revealed that low-sodium dialysate leads to a decrease in ABPM parameters including 24-hour SBP, daytime SBP, nighttime SBP, and nighttime DBP and it also reduces the number of antihypertensive drugs used and IDWG.
RESUMEN
The risk of transmission of hepatitis C virus (HCV) infection is an important problem for the health care worker. HCV transmission by blood splashing into eyes is very rare. In a hemodialyses department, a 23-year-old female nurse splashed blood from a patient who was anti-HCV positive into her eyes. She washed her eyes with water immediately and reported to the infection control department. She had never used intravenous drugs nor received transfusions. At the time of exposure, there was no abnormality in her laboratory tests. Her anti-HCV and HCV-RNA tests produced negative results. She was followed up for anti-HCV and alanine aminotransferase activity. After 6 months, she presented with sore throat, nausea, vomiting, fatigue, and weight loss. She had icterus and hepatomegalia. In laboratory tests, alanine aminotransferase level was 504 U/L, aspartate aminotransferase level was 388 U/L, and anti-HCV and HCV-RNA tests produced positive findings. She was treated with interferon alfa-2a for a 1-year period. After treatment, an HCV-RNA test produced negative results and transaminase levels were normal. In conclusion, splashing blood from patients who are HCV positive into the face or eyes is a risk for health care workers. They should be educated to prevent a nosocomial acquisition of bloodborne infection and they should observe protective precautions.
Asunto(s)
Conjuntiva/virología , Infección Hospitalaria/etiología , Hepatitis C/transmisión , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Enfermedades Profesionales/etiología , Adulto , Alanina Transaminasa/metabolismo , Antivirales/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Femenino , Hepacivirus/genética , Hepacivirus/crecimiento & desarrollo , Hepacivirus/inmunología , Hepatitis C/tratamiento farmacológico , Hepatitis C/etiología , Anticuerpos contra la Hepatitis C/sangre , Humanos , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Enfermeras y Enfermeros , Enfermedades Profesionales/tratamiento farmacológico , Enfermedades Profesionales/virología , ARN Viral/sangre , Proteínas Recombinantes , Factores de RiesgoRESUMEN
OBJECTIVES: Some studies have indicated the pathophysiological importance of reactive oxygen species (ROS) in patients with nephrotic syndrome. Myeloperoxidase (MPO) is a leukocyte-derived enzyme-generating ROS that has been proposed to exert a wide array of pro-atherogenic effects throughout all stages of the atherosclerotic process. The aim of this study was to investigate the serum malondialdehyde (MDA) levels, MPO and catalase activities in patients with adult nephrotic syndrome. PATIENTS AND METHOD: s Twenty-four patients with nephrotic syndrome and 24 healthy controls were enrolled. Serum MPO activity, catalase activity, and MDA levels were assessed. RESULTS: Serum MPO activity and MDA levels were significantly higher in patients with nephrotic syndrome than controls (both, P<0.001), while catalase activity was significantly lower (P<0.001). Serum catalase activity was found to be significantly correlated with MPO activity (r=-0.417, P=0.003) and MDA levels (r=-0.532, P=0.007). The serum MDA levels were also found to be significantly correlated with MPO activity (r=0.419, P=0.003). CONCLUSIONS: We concluded that serum MPO activity and oxidative stress were increased and that serum catalase activity was decreased in patients with adult nephrotic syndrome. In addition, these results indicate that increased MPO activity is associated with an oxidant-antioxidant imbalance that may contribute to atherosclerosis in patients with adult nephrotic syndrome.
Asunto(s)
Catalasa/sangre , Malondialdehído/sangre , Síndrome Nefrótico/sangre , Estrés Oxidativo , Peroxidasa/sangre , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome Nefrótico/fisiopatologíaRESUMEN
AIM: We aimed to evaluate the frequency of catheter-related internal jugular vein (IJV) thrombosis, associated factors, and the anatomical variations of IJV in hemodialysis patients. MATERIAL AND METHODS: Hemodialysis patients were evaluated with B-mode ultrasonography (USG). Participants in the prospective group were evaluated using USG prior to catheter insertion, 10 days after catheter insertion, at the time of catheter removal, and 15 days after removal. RESULTS: The rate of thrombosis was increased correlated with the number of catheter insertions. These rates were 14%, 15%, and 47% in those undergoing catheter insertion once, twice, and three times, respectively (P < .05). The anatomical variations of IJV were 21% in the retrospective cases. No significant relationship was found between anatomical variations and thrombosis and between some biochemical parameters and thrombosis. CONCLUSION: Catheter-related IJV thrombosis is frequent in hemodialysis patients. Long catheter remaining time and repeated catheterization increase the thrombosis rate.