Frequency of Euthyroid Sick Syndrome before and after renal transplantation in patients with end stage renal disease and its association with oxidative stress.

OBJECTIVE: In this study, we aimed to evaluate the frequency of euthyroid sick syndrome (ESS) before and after renal transplantation in patients with end-stage renal disease (ESRD), and its association with oxidative stress (OS) by evaluating thiol-disulfide levels. METHODS: Free triiodothyronine (fT3), free thyroxine (fT4) thyroid stimulating hormone (TSH), and thiol and disulfide levels were recorded before and after renal transplantation in patients with ESRD. ESS was diagnosed in patients with unresponsive TSH to low fT3 and/or fT4 levels. RESULTS: A total of 121 patients were included in the study. Of these, 69 (57%) were males and 52 (43%) were females. The mean age was 45 ± 12.61 years. ESS was detected in 39 (32%) of 121 patients. Of 39 patients, 24 (61%) had ESS before transplantation and 15 (39%) after transplantation. Sixteen of 24 (66.7%) patients with ESS before transplantation reached normal thyroid functions after transplantation. In post transplantation period, patients with ESS had significantly higher urea and creatinine (p = 0.025 and p = 0.009, respectively) compared to patients without ESS. Furthermore, thiol-disulfide levels of 20 patients with ESS at any time compared with 68 patients without ESS. It was found that native thiol and total thiol were significantly lower in patients with ESS (p = 0.025 and p = 0.044, respectively). CONCLUSION: The present study is an initial evaluation of the OS and antioxidant status in the etiology of ESS in patients with renal transplantation. These patients have markedly low levels of antioxidant products, which support the possible role of OS in ESS.

Quality of life and correlation with musculoskeletal problems, hand disability and depression in patients with hemodialysis.

OBJECTIVES: The aims of this study were to assess the health-related quality of life (HRQOL) in patients with hemodialysis using the Kidney Disease Quality of Life (KDQOL™) and to determine its relationships with conventional clinical measures, musculoskeletal problems, hand disability and depression. MATERIALS AND METHODS: This study was conducted in our tertiary hospital's dialysis unit. Fifty patients under hemodialysis treatment were included in the study. HRQOL, disability, pain and depression were assessed using KDQOL-36, Duruoz hand index (DHI), visual analog scale (VAS) and Beck Depression Inventory (BDI). RESULTS: It was seen that all of the patients included had one or more musculoskeletal problems, the most common of which were muscle cramps, myalgias and arthralgias. Depression was the second most common accompanying disease. It was also seen that older patients had much poorer physical functioning scores, DHI scores and BDI scores than younger patients. DHI score was found to be significantly lower in men than in women. Educational level, presence of arthrosis, myalgia, bone pain, arthralgia, CTS, VAS-hand and VAS-upper extremities scales, DHI and BDI scores significantly affected both physical and mental areas of KDQOL-36, whereas age, shoulder periarthritis, mobilization scores and presence of hypertension only had effects on physical areas. CONCLUSION: Physical functioning depends mainly on the age, severity of comorbid conditions, depression, locomotor findings and hand disability of hemodialysis patients. The KDQOL-36 is related to the clinical status and functional ability of hemodialysis patients and it can be used as a sensitive health status measure for clinical evaluation.

The role of salivary gland elastosonography in Sjögren's syndrome: preliminary results.

AIM: There is a need for a reliable, noninvasive radiological method for the assessment of salivary gland changes in Sjögren's syndrome (SS). The aim of this study was to evaluate the role of elastosonography as a noninvasive, sonographic modality evaluating tissue stiffness for salivary gland involvement in SS. METHOD: We examined the stiffness in parotid and submandibular glands of 23 patients diagnosed with SS and 20 healthy volunteers. Elasticity scores of the salivary glands were classified into four groups according to the degree of the elasticity of the glands. RESULTS: The elasticity scores of the parotid and submandibular glands did not show a statistically significant difference between the patients with SS and the healthy volunteers. On the other hand, there was a significant relationship between the duration of the symptoms and the elasticity score of the parotid glands and left submandibular glands (P < 0.05). Patients with higher duration of symptoms had higher elasticity scores. CONCLUSION: The results might suggest that with the progression of the SS, the elasticity scores of the parotid glands increase gradually, indicating that ultrasonic elastosonography has the potential to demonstrate the progression of the disease. The utility of elastosonography in the follow-up of SS needs to be evaluated with larger studies.

Concomitance of Gitelman syndrome and familial Mediterranean fever: a rare case presentation.

We report a case that has Gitelman syndrome (GS) and familial Mediterranean fever (FMF) presenting with recurrent arthritis of right knee and heel pain. Investigations showed hypokalemia and hypomagnesemia with urinary magnesium wasting. Genetic analysis revealed the presence of heterozygous E148Q mutation in the MEFV gene. Management with potassium, magnesium supplements, spironolactone for GS, and colchicine for FMF resulted in a significant improvement in symptoms. To the best of our knowledge, this is the first report of association between GS and FMF. Further studies are needed to identify if there is an association between these two diseases and the genes responsible for these diseases.