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OBJECTIVES: This study aimed to investigate the prevalence of sexual disorders in stage 2 - 5 chronic kidney disease (CKD) during predialysis and its relationship with laboratory parameters. METHODS AND RESULTS: This cross-sectional study included 110 predialysis patients and 110 healthy controls admitted to clinics. The International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI) were used. Sexual dysfunction was detected in 76% of female patients and 31.4% of the control group, and the FSFI total and subscale scores of the patients were significantly lower than those of the control group. The frequency of erectile dysfunction in male patients and controls was 56.7% and 33.3%, respectively. The erectile function, sexual satisfaction, and overall satisfaction scores on the IIEF scale were significantly lower than those in the control group. Low glomerular filtration rate, high calcium levels, increased C-reactive protein, anemia, and metabolic acidosis in male and female patients, and testosterone deficiency in male patients were associated with sexual dysfunction. In multiple regression analysis, eGFR was the only independent variable associated with sexual dysfunction. Luteinizing hormone (LH) and prolactin levels increased as the disease progressed in men and women with sexual dysfunction, while testosterone levels decreased in male patients. Low testosterone levels were related to erectile dysfunction. The increase in parathormone and prolactin levels was related to loss of libido in the male and female patient groups. CONCLUSION: Metabolic acidosis and low eGFR appear to be the most important risk factors contributing to sexual disorders in patients with CKD.
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INTRODUCTION: With increased fluid intake and tolvaptan treatment, the growth rate of cysts can be theoretically decelerated in autosomal polycystic kidney disease. In this prospective study, it was planned to evaluate thirst sensation in these patients and the parameters affecting its intensity. METHODS: Forty-one ADPKD patients on tolvaptan and 40 ADPKD patients not on tolvaptan as the control group were evaluated for thirst distress sensation and intensity. The feeling of thirst and the discomfort caused by excessive fluid intake was assessed with Thirst Distress Scale-HF 12 questions (60/12). Thirst intensity was evaluated with a 100 mm visual scale. RESULTS: Of the whole group, 35.8% (29) were males, and 64.2% (52) were females. The mean age of the tolvaptan group was 39.17 ± 9.35 years and for the control group, it was 41.95 ± 12.29 years. There was a negative correlation between the thirst distress score of the patients and an increase in creatinine level after a year of tolvaptan treatment (r = - 0.335, p = 0.035). The patients not taking thiazide had higher thirst intensity scores (p = 0.004). There was no impact of tolvaptan dosage, total kidney volume, serum sodium, urinary osmolarity or eGFR on thirst distress and thirst intensity scores. DISCUSSION/CONCLUSION: Only thiazide co-treatment had a positive impact on thirst distress and intensity when given tolvaptan. Thirst Distress Scale for ADPKD patients can be used to classify patients before and during tolvaptan treatment.
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Riñón Poliquístico Autosómico Dominante , Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Tolvaptán/uso terapéutico , Riñón Poliquístico Autosómico Dominante/tratamiento farmacológico , Antagonistas de los Receptores de Hormonas Antidiuréticas , Estudios Prospectivos , SedRESUMEN
AIM: This study aimed to explore the role of peritoneal ultrafiltration (UF) in cardiorenal syndrome (CRS) patients for fluid and metabolic control. BACKGROUND: Peritoneal UF is safely and efficiently used for the management of CRS. It has been shown to provide efficient UF in hypervolemic patients. METHODS: Thirty (20 males and 10 females) CRS patients were treated by peritoneal dialysis (PD) and UF. The baseline data of the patients (demographics, causes of heart failure, the presence of pacemaker or implantable cardioverter-defibrillator, the need for extracorporeal UF or paracentesis or thoracentesis, comorbidity, drugs, left ventricular ejection fraction [LVEF] and pulmonary artery systolic pressure [PAPs], pericardial effusion, physical examination, body weight, NYHA class, dialysis regime, urine output, N-terminal pro-B-type natriuretic peptide [NT-proBNP] level, hemoglobin, estimated glomerular filtration rate [eGFR], and other routine biochemical determinations) were recorded at the onset, every 6 months, and then annually. Echocardiograms were performed at baseline and after 6 and 12 months. The time points of complications associated with PD, the need for hemodialysis, the day of death, and causes of death were documented. RESULTS: Mean age was 69 ± 8 years (range 49-84 years). The average PD duration was 18.25 ± 14.87 months. According to the CKD-EPI, initial mean GFR was 34.34 ± 11.9 mL/min/1.73 m2 (range 16.57-59.0), and this increased to 45.48 ± 26.04, 45.10 ± 28.58, and 41.10 ± 25.68 mL/min/1.73 m2 in the third, sixth, and twelfth months, respectively. There was a significant increase in the first 3 months and a significant decrease between the third and twelfth months (respectively, p = 0.018 and p = 0.043). There was no difference in eGFR levels between baseline and the end of the first year (p = 0.217). In the first 3 months, there was a significant decline in urea levels to 79.38 ± 36.65 from 109.92 ± 42.44 mg/dL and this was maintained until the end of the first year of PD therapy (after 3 months, p = 0.002; after 1 year, p = 0.024). However, there was no significant change in creatinine levels within the first year (p = 0.312). There was a significant increase in hemoglobin level up to the end of the first year of PD (after 3 months, p = 0.000; after 12 months, p = 0.013). There was a marked decrease in NT-proBNP levels in the first 6 months (p = 0.011). Functional capacity (according to NYHA classification) improved in all patients by the third month of PD treatment (p < 0.001). This early improvement was maintained in many patients during the following 12 months (p < 0.001). There was a marked decrease in NT-proBNP levels in the first 6 months (p = 0.011). At the end of the first year, there was an approximate 15% reduction in NT-proBNP levels (p = 0.647). Hospitalizations decreased to 6 ± 15 days/patient-year (range 18-122 days) from 62 ± 24 days/patient-year (p = 0.000). CONCLUSION: Peritoneal UF is a treatment method that maintains renal function and electrolyte balance, improves cardiac function, and reduces hospitalizations in CRS patients. We observed that this treatment significantly increased functional capacity and quality of life and significantly reduced hospital admissions.
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Insuficiencia Cardíaca , Fallo Renal Crónico , Anciano , Anciano de 80 o más Años , Diuréticos/uso terapéutico , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/terapia , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Volumen Sistólico , Ultrafiltración , Función Ventricular IzquierdaRESUMEN
PURPOSE: The recognition of acute kidney injury (AKI) as early as possible is important in the intensive care unit. This study proposes that serum and urine levels of neutrophil gelatinase-associated lipocalin (NGAL) may be used for this purpose. METHODS: One hundred and seven critically ill adult patients with no previous renal failure were included. NGAL levels were measured during the first 48 hours after admission; NGAL levels were followed for 7 days and classified based on Risk, Injury, Failure, Loss, and End-Stage Renal Failure criteria. RESULTS: The AKI incidence was 35.5%, and serum NGAL (sNGAL) and urinary NGAL (uNGAL) levels were higher in the AKI group. The area under the receiver operating characteristic curve was 0.76 (P<.001) for sNGAL and 0.75 (P<.001) for uNGAL. Seventy-one percent of AKI cases were observed within 48 hours, with 11 additional cases in the ensuing 7 days. The mean serum creatinine levels in the 11 patients were not different from non-AKI levels (P=.197), but the NGAL values were different, and the area under the receiver operating characteristic curve for sNGAL uNGAL was 1.00 (P=.014) and 0.93 (P=.02), respectively. CONCLUSIONS: Most AKI cases were diagnosed within the first 48 hours after admission, and NGAL was useful for predicting upcoming AKI.
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Lesión Renal Aguda/sangre , Lipocalina 2/sangre , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/orina , Adulto , Anciano , Área Bajo la Curva , Biomarcadores/sangre , Biomarcadores/orina , Cuidados Críticos , Enfermedad Crítica , Diagnóstico Precoz , Femenino , Humanos , Unidades de Cuidados Intensivos , Lipocalina 2/orina , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: In uremic patients, depending on their type, the T-cells produce a range of pro-inflammatory and anti-inflammatory cytokines. The aim of this study was to compare the effects of chronic kidney disease (CKD) and two different therapy methods of dialysis [hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD)] on adiponectin, TNF-alpha, and hs-CRP levels in human serum. METHODS: We measured the serum levels of hs-CRP, adiponectin, and TNF-alpha in 37 patients with CKD on conservative treatment, 34 patients maintained on CAPD, 35 HD patients, and 25 healthy volunteers. The statistical analysis of the obtained results was performed by commercial statistics PC software. RESULTS: The mean TNF-alpha levels were found to be significantly higher in patients in the predialysis, CAPD, and the HD groups, than in the control group (17.24 +/- 9.22, 31.57 +/- 10.56, 24.34 +/- 5.32, 7.64 +/- 4.12 pg/mL, respectively, p < 0.001). The mean TNF-alpha levels in the predialysis group were significantly lower than in both the CAPD and the HD group (p < 0.001). The mean TNF-alpha levels in the CAPD group were significantly higher than in the HD group (p = 0.001). The mean adiponectin levels in the control group were significantly lower than in the predialysis, CAPD, and HD groups (2.54 +/- 2.30, 4.10 +/- 3.12, 7.69 +/- 8.35, 5.97 +/- 6.20 ng/mL, respectively, p < 0.05). Furthermore, the mean adiponectin levels in the predialysis groups were significantly lower than in the CAPD group (p < 0.05). The mean hs-CRP levels were found to be significantly higher in patients in the predialysis, CAPD, and HD groups than in the control group (0.65 +/- 0.57, 0.82 +/- 0.71, 1.14 +/- 1.45, 0.30 +/- 0.19 mg/dL, respectively, p < 0.05). CONCLUSIONS: According to the results of this study, the levels of adiponectin, hs-CRP, and TNF-alpha were increased for all patients with chronic renal failure (CRF). Along with this, the highest level of increase in TNF-alpha levels were observed in patients with CAPD.
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Adiponectina/sangre , Proteína C-Reactiva/metabolismo , Fallo Renal Crónico/terapia , Diálisis Peritoneal Ambulatoria Continua/métodos , Factor de Necrosis Tumoral alfa/sangre , Adulto , Anciano , Femenino , Humanos , Fallo Renal Crónico/sangre , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJECTIVE: To assess the effects of percutaneous transluminal angioplasty and stenting (PTRA/S) on arterial blood pressure and renal function. METHODS: A retrospective chart review of patients undergoing PTRA/S at our institution between December 2003 and September 2006 was done. Follow-up data were derived from hospital records. Estimated glomerular filtration rate (EGFR) was used as the marker of renal function. To evaluate the pre- and post-procedure values in individual patients the paired t test and Wilcoxon signed-rank tests were used. RESULTS: Thirty-six patients (16 women, 30 men; mean age 59+/-15 years, range: 25-83 years) underwent 43 PTRA/S interventions at our institution. The mean duration of follow-up was 9.3+/-8.6 (range 2-28) months. We observed no significant change in EGFR from pre-procedure to that obtained at follow-up (71.4+/-40.2 mL/min vs.73.3+/-39.0 mL/min; p=0.483). Mean arterial blood pressure (MABP), however, was reduced significantly: pre-procedure MABP-123+/-22 mmHg; post-procedure follow-up value of 101+/-14 mmHg (p<0.001). The mean number of antihypertensive medications used at the time of intervention was 2.1+/-1.0 (range: 0-4), whereas at follow-up, this number had decreased to 1.3+/-1.0 (range: 0-4; p<0.001). In patients with renal impairment (EGFR < or =59 mL/min), 41% showed improvement, 29% showed no change and 29% demonstrated deterioration in EGFR. CONCLUSION: PTRA/S may preserve renal function, especially in patients with pre-procedural impaired renal function.
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Angioplastia de Balón/métodos , Tasa de Filtración Glomerular/fisiología , Obstrucción de la Arteria Renal/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Antihipertensivos/uso terapéutico , Aterosclerosis/cirugía , Presión Sanguínea , Creatinina/sangre , Femenino , Estudios de Seguimiento , Humanos , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , StentsRESUMEN
Nocardiosis is a rare disease generally caused by members of Nocardia asteroides complex, particularly in immunosupressed patients. Nocardia cyriacigeorgica is a newly described member of this complex. In this article, a case of pulmonary nocardiosis with a large solitary cavitary nodule caused by N. cyriacigeorgica, in a patient receiving corticosteroid therapy was presented. A 29 years old male patient receiving prednisolone for 5 months was admitted to our hospital with fever, cough, right thoracic pain and night sweats. Computed tomography scan of chest demonstrated a large solitary cavitary nodule in the right lower lobe. Gram stained smear of the sputum revealed gram-positive, beaded, branched filamentous bacilli. On the third day of his admission, a catalase positive, oxidase negative and immotile bacilli, compatible with Nocardia spp., were isolated from the sputum sample taken at the day of admission. The isolated bacterium was identified as N. cyriacigeorgica by reference laboratory (Lyon, France). Oral trimethoprim (320 mg/day) and sulfamethoxazole (1600 mg/day) therapy given for three months, resulted in complete cure of the lesion without any sequela. This was the fourth case of pulmonary nocardiosis caused by N. cyriacigeorgica reported from Turkey. Microbiological examination of sputum is the most important tool for the diagnosis. Treatment with appropriate antibiotics may achieve complete cure even in large cavitary lesions. In conclusion, pulmonary nocardiosis should be considered in differential diagnosis of solitary cavitary nodules, especially in immunocompromised patients.
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Glucocorticoides/uso terapéutico , Huésped Inmunocomprometido , Nocardiosis/microbiología , Nocardia/clasificación , Prednisolona/uso terapéutico , Nódulo Pulmonar Solitario/microbiología , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Nocardia/aislamiento & purificación , Nocardiosis/diagnóstico por imagen , Nocardiosis/inmunología , Nódulo Pulmonar Solitario/diagnóstico por imagen , Nódulo Pulmonar Solitario/inmunología , Esputo/microbiología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND/AIMS: A close relationship exists between inflammation and vascular calcification. Although fetuin-A is known to be an inhibitor of calcification, studies correlating levels of this glycoprotein to markers of inflammation are limited. To understand these relationships, we investigated the relationship between serum fetuin-A and proinflammatory cytokine levels in patients with chronic renal failure (CRF). METHODS: Thirty-two patients on haemodialysis (HD), 32 conservatively managed chronic kidney disease (CKD) patients and a control group of 25 subjects with normal renal function were enrolled in this study. Serum fetuin-A, IL-1beta, IL-6 and TNF-alpha levels were measured by ELISA. Correlations between serum fetuin-A and IL-1beta, IL-6 and TNF-alpha concentrations were investigated by the Spearman correlation test. RESULTS: In 64 CRF patients (on HD and with CKD), serum fetuin-A was significantly and inversely related to IL-1beta (P<0.001), IL-6 (P=0.025) and TNF-alpha levels (P=0.007), respectively. The serum fetuin-A levels of the control subjects were not significantly correlated to levels of the inflammatory markers IL-1beta, IL-6 and TNF-alpha (P=0.551, 0.985 and 0.984, respectively). CONCLUSION: The negative correlation between serum fetuin-A and cytokine concentrations in CRF patients supports the hypothesis of inflammation-dependent down-regulation of fetuin-A expression.
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Citocinas/sangre , Fallo Renal Crónico/sangre , alfa-Fetoproteínas/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Gentamicinas/uso terapéutico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Imipenem/uso terapéutico , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/microbiología , Sphingomonas , Líquido Ascítico/microbiología , Gentamicinas/administración & dosificación , Humanos , Imipenem/administración & dosificación , Fallo Renal Crónico/terapia , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Peritoneo/microbiología , Peritonitis/etiología , Sphingomonas/patogenicidadRESUMEN
BACKGROUND: Serum levels of adipocytokines such as leptin and adiponectin are significantly elevated in patients with chronic renal failure (CRF). The effect of such adipocytokines on malnutrition in the CRF population has been of substantial interest. We sought to determine the relationship between plasma leptin and adiponectin levels and malnutrition-inflammation status in end-stage renal disease patients. METHODS: Thirty patients (15 women and 15 men; mean [+/-SD] age, 50 +/- 14 years) on hemodialysis, and 30 patients (12 women and 18 men; mean [+/-SD] age, 47 +/- 16) on continuous ambulatory peritoneal dialysis, were enrolled in this study. Adipocytokine levels were measured by enzyme-linked immunosorbent assay. Inflammatory markers, such as high-sensitivity serum C-reactive protein (hs-CRP), ferritin, and a nutritional inflammatory scoring system known as the malnutrition-inflammation score (MIS), were also measured in all patients. RESULTS: Serum leptin had negative correlations with ferritin (r = -0.33, P = .016) and MIS (r = -0.39, P = .003). Adiponectin had a weak positive correlation with MIS (r = 0.26, P = .050), indicating that an increased level of serum adiponectin was associated with a worse nutritional status. Levels of hs-CRP, serum albumin, cholesterol, and triglycerides did not correlate with nutritional status. CONCLUSIONS: Serum leptin concentration seems to be a marker of good nutritional status, rather than an appetite-suppressing uremic toxin, in patients with CRF. However, the positive correlation between serum adiponectin and worse nutritional-inflammatory status suggests that elevated adiponectin levels may contribute to the pathogenesis of malnutrition in such patients.
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Adiponectina/sangre , Inflamación/sangre , Fallo Renal Crónico/sangre , Leptina/sangre , Desnutrición Proteico-Calórica/sangre , Adipoquinas/sangre , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Estado Nutricional , Diálisis Peritoneal Ambulatoria Continua , Diálisis Renal , Albúmina Sérica/análisisRESUMEN
BACKGROUND/AIMS: Cytokine secretion is known to play an important role in the pathophysiology of depression, and levels of proinflammatory cytokines are increased in chronic renal failure (CRF) patients. The objective of this study was to examine the correlation between levels of proinflammatory cytokines in CRF patients and degree of depression. METHODS: 31 patients on hemodialysis, 31 patients on continuous ambulatory peritoneal dialysis, and 31 conservatively managed chronic kidney disease (CKD) patients were enrolled in this study. Depressive symptoms were measured with the Beck Depression Inventory (BDI), and 'elevated symptoms of depression' were defined as a BDI score > or =17. IL-6 and TNFalpha cytokine levels were measured by ELISA. RESULTS: 'Elevated symptoms of depression' occurred in 37 of 93 patients (40%). IL-6 and TNFalpha levels were not significantly different among CRF patients with and without elevated depressive symptoms (p = 0.937 and p = 0.414, respectively). When analyzed by treatment subgroup, proinflammatory cytokine levels were not significantly different in patients with and without elevated symptoms of depression. CONCLUSION: In patients with CRF, elevated symptoms of depression were not associated with increased cytokine levels.
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Depresión/sangre , Interleucina-6/sangre , Fallo Renal Crónico/psicología , Factor de Necrosis Tumoral alfa/sangre , Adulto , Análisis de Varianza , Comorbilidad , Depresión/diagnóstico , Depresión/etiología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Persona de Mediana Edad , Diálisis Peritoneal/psicología , Escalas de Valoración Psiquiátrica , Diálisis Renal/psicología , Estadísticas no ParamétricasRESUMEN
To evaluate the effect of citalopram treatment on quality of life (QoL) and depression in 141 patients with chronic renal failure (CRF), QoL was measured by means of the Short Form 36 (SF-36). Patients diagnosed with depression were treated with citalopram for eight weeks and evaluated for the effect of treatment on depressive symptoms and QoL. Thirty-four of 141 patients (24.1%) had depression and treatment with citalopram decreased Beck Depression Inventory Scores and increased the emotional role limitation and the mental health subscale scores of SF-36. This study suggests that citalopram can treat depression and improve QoL in patients with CRF.
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Antidepresivos/uso terapéutico , Citalopram/uso terapéutico , Depresión/tratamiento farmacológico , Fallo Renal Crónico/psicología , Calidad de Vida , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diálisis RenalRESUMEN
OBJECTIVE: Cardiac arrhythmias commonly occur in hemodialysis patients. QT dispersion (QTd=QTmax-QTmin) reflects heterogeneity of cardiac repolarization, and increased QTd is known to predispose the heart to ventricular arrhythmias and sudden cardiac death. The aim of our study was to assess the association of iron stores, reflected by transferrin saturation (TSAT) and ferritin, with the dispersion of corrected QT intervals (QTc) in patients undergoing hemodialysis. METHODS: This cross-sectional, case-controlled study included 40 patients (23 men and 17 women) with renal failure undergoing hemodialysis (Patient group) and 27 subjects (10 men and 17 women) with normal renal function (Control group). In all patients and control subjects, QT intervals were measured on electrocardiogram, and QTc intervals and QTc dispersion were calculated. Electrolyte, hemoglobin and serum TSAT and ferritin levels were also determined. RESULTS: Hemodialysis patients had significantly greater QTc dispersion compared to that of control subjects (61.7+/-23.0 msec vs. 46.0+/-15.7 msec; p=0.001). Though serum iron levels were significantly associated with greater QTc dispersion (r=0.324, p=0.042), other electrolyte levels, duration of dialysis, TSAT and serum ferritin levels were not. CONCLUSION: Although hemodialysis patients have greater QTc dispersion than control subjects, their levels of iron stores as reflected by TSAT and ferritin levels, does not correlate with the degree of QT dispersion.
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Arritmias Cardíacas/fisiopatología , Sobrecarga de Hierro/fisiopatología , Diálisis Renal , Adulto , Arritmias Cardíacas/etiología , Estudios de Casos y Controles , Estudios Transversales , Femenino , Ferritinas/sangre , Sistema de Conducción Cardíaco , Humanos , Sobrecarga de Hierro/sangre , Sobrecarga de Hierro/complicaciones , Masculino , Persona de Mediana Edad , Transferrina/metabolismoAsunto(s)
Citocinas/sangre , Depresión/metabolismo , Estado Nutricional/fisiología , Diálisis Peritoneal , Depresión/mortalidad , Femenino , Humanos , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/psicología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Diálisis Peritoneal/mortalidad , Diálisis Peritoneal/psicologíaRESUMEN
BACKGROUND: Depression, which is the most common psychological disorder among patients with end-stage renal disease (ESRD), is commonly associated with poor oral intake which can aggravate anemia and malnutrition in chronic dialysis patients. The objective of this study is to explore the association between depression and C-reactive protein (CRP), ferritin, serum albumin and hemoglobin/hematocrit in patients with chronic kidney disease (CKD) and ESRD. METHODS: Sixty-eight patients on hemodialysis (HD), 47 patients on continuous ambulatory peritoneal dialysis (CAPD) and 26 patients with CKD on conservative management were enrolled in this study. All patients were evaluated for the presence of depression using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders-Clinician Version (SCID-CV). The severity of depression was evaluated by means of the Beck Depression Inventory (BDI). Serum CRP (nephelometric method), ferritin (immunometric method), albumin (bromcresol green technique), hemoglobin, and hematocrit levels were measured. RESULTS: A total of 34 of 141 patients (24.1%) had depression. The mean BDI score was higher in depressive patients compared to nondepressive patients. In HD patients the frequency of depression and CRP and ferritin levels were higher than in other groups. Patients with depression had lower hemoglobin, hematocrit and serum albumin levels and higher CRP and ferritin levels than patients without depression. The BDI score showed a positive correlation with serum CRP and ferritin levels, but a negative correlation with the serum albumin level. CONCLUSIONS: We observed that CKD and ESRD patients with anemia, hypoalbuminemia and higher serum CRP and ferritin concentrations should be evaluated for depression after potential somatic causes have been eliminated.
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Proteína C-Reactiva/análisis , Depresión/etiología , Ferritinas/sangre , Hemoglobinas/análisis , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Albúmina Sérica/análisis , Enfermedad Crónica , Femenino , Humanos , Inflamación/sangre , Inflamación/complicaciones , Enfermedades Renales/sangre , Enfermedades Renales/complicaciones , Enfermedades Renales/terapia , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Estado Nutricional , Diálisis Peritoneal Ambulatoria Continua , Estudios Prospectivos , Diálisis RenalRESUMEN
OBJECTIVES: To evaluate the diagnostic significance of serum cystatin C levels in clinical practice. DESIGN AND METHODS: Serum (99m)Tc-DTPA clearance was compared with serum cystatin C, creatinine, beta(2)-microglobulin levels and creatinine clearance in a group of patients aged 42.61 +/- 7.55 years with glomerular filtration rates of 10-60 mL/min/1.73 m(2) (n = 52) and healthy controls aged 43.90 +/- 12.06 years (n = 52). RESULTS: No effect of sex on serum cystatin C levels was observed, but average levels increased with age. No significant difference was evident between the mean cystatin C levels of three blood samples taken at 1 month intervals from healthy subjects. Reference clearance was correlated with creatinine clearance (r = 0.957), cystatin C (r = 0.828), beta(2)-microglobulin (r = 0.767) and creatinine (r = 0.682). 60 mL/min/1.73 m(2) was chosen as the borderline for receiver-operating characteristics analysis. The values for the cut-off point, sensitivity, specificity and the area under curve were determined for cystatin C as 1.36 mg/L, 98%, 99% and 0.99 +/- 00.1, respectively; for creatinine, the values were 103 micromol/L, 80%, 100% and 0.97 +/- 0.01, respectively, and for beta(2)-microglobulin, the values were 2.51 mg/L, 86%, 92% and 0.94 +/- 0.02, respectively. CONCLUSION: Serum cystatin C level can be used as a marker for renal damage.
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Cistatinas/sangre , Enfermedades Renales/sangre , Enfermedades Renales/fisiopatología , Riñón/fisiopatología , Adulto , Anciano , Biomarcadores/sangre , Estudios de Casos y Controles , Creatinina/sangre , Cistatina C , Femenino , Tasa de Filtración Glomerular/fisiología , Humanos , Masculino , Persona de Mediana Edad , Caracteres Sexuales , Estadísticas no Paramétricas , Pentetato de Tecnecio Tc 99mRESUMEN
We report the use of a metallic stent in a transplant ureteral stenosis. A 28-year-old man with chronic renal failure due to chronic pyelonephritis, who received a living-donor renal transplant, presented with transplant ureteral stenosis. The stenosis was unresponsive to balloon dilation and was treated by antegrade placement of a self-expanding Memotherm stent. The stented ureter stayed patent for 3 years. It may be reasonable to treat post-transplant ureteral stenosis resistant to balloon dilation with self-expanding metallic stents. However, long-term follow-up is required to evaluate the efficacy of this treatment.
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Trasplante de Riñón , Stents , Obstrucción Ureteral/terapia , Adulto , Cateterismo , Humanos , Masculino , Ultrasonografía Intervencional , Obstrucción Ureteral/diagnóstico por imagenRESUMEN
OBJECTIVES: Cardiovascular disease is the major cause of mortality in patients receiving hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) due to chronic renal failure. Increased lipid peroxidation and depletion of antioxidants may contribute to increased risk of atherosclerosis. We have therefore assessed the effect of hemodialysis and CAPD on oxidant and antioxidant status. DESIGN AND METHODS: Plasma malondialdehyde (MDA), Glutathione (GSH) levels and glutathione peroxidase (Gpx) activities were determined in 20 healthy persons (control), 20 patients on HD, 16 patients on CAPD. RESULTS: MDA was elevated in posthemodialysis and CAPD patients in comparison to prehemodialysis and control groups (posthemodialysis 1.39 +/- 0.38 nmol/mL, CAPD 1.26 +/- 0.27 nmol/mL, prehemodilaysis 0.83 +/- 0.22 nmol/mL, controls 0.72 +/- 0.21 nmol/mL p < 0.0001). With respect to antioxidants, glutathione levels were significantly lower in prehemodialysis, posthemodialysis and CAPD groups than those in control group (prehemodialysis 16.82 +/- 6.73 mg/dL RBC, posthemodialysis 31.43 +/- 11.88 mg/dL RBC, CAPD 40 +/- 12.72 mg/dL RBC, controls 62.26 +/- 24.01 mg/dL RBC, p < 0.0001). While erythrocyte GSH levels were significantly lower in the prehemodialysis patients than those in posthemodialysis and CAPD patients (p < 0.0001), it was significantly lower in posthemodialysis patients than those in CAPD patients (p < 0.05). There were no significant differences with respect to erythrocyte Gpx levels among the groups (p > 0.05). CONCLUSIONS: These findings indicate oxidative stress in patients with chronic renal failure which is further exacerbated by hemodialysis and CAPD, as evidenced by increased lipid peroxidation and low antioxidant levels.
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Eritrocitos/metabolismo , Glutatión Peroxidasa/sangre , Glutatión/sangre , Fallo Renal Crónico/sangre , Malondialdehído/sangre , Diálisis Peritoneal Ambulatoria Continua , Diálisis Renal , Adulto , Anciano , Interpretación Estadística de Datos , Eritrocitos/enzimología , Femenino , Humanos , Fallo Renal Crónico/metabolismo , Fallo Renal Crónico/terapia , Peroxidación de Lípido/fisiología , Masculino , Persona de Mediana Edad , Estrés OxidativoRESUMEN
Effects of the angiotensin II type 1 (AT1) receptor antagonist valsartan and the angiotensin-converting enzyme (ACE) inhibitor enalapril were studied in streptozotocine (STZ)-induced diabetes in rats on the basis of microalbuminuria (Ma) and renal morphology. Five groups of Wistar rats were used, one group was the non-diabetic control, one group consisted of untreated STZ-diabetics and 3 groups of STZ-diabetics were treated with either enalapril and/or valsartan for 30 days. Blood glucose (BG) and Ma levels, body and kidney weight and glomerular size were measured. Immunohistochemical staining with an anti-transforming growth factor-beta1 (TGF-beta1) antibody was performed as well. In STZ-diabetics, BG and Ma levels were significantly increased when compared with the non-diabetic group. Although Ma levels in the valsartan-treated group was found to be higher than those in the non-diabetics group after 15 days of treatment, in all treated diabetic groups Ma levels were significantly decreased as compared with STZ-diabetics at the end of the experiment. Thickening of the glomerular and tubular basement membranes, increased mesangial matrix and glomerular size were found in the untreated diabetic group. All these changes were less in the treated groups. A significant increase in TGF-beta1 immunoreactivity was found in glomeruli of untreated STZ-diabetics as compared with non-diabetics. Again, TGF-beta1 expression was decreased in the treated groups as compared with untreated STZ-diabetics. We conclude that valsartan and enalapril have renoprotective effects in diabetic nephropathy. A combined therapy has an advantage because lower dosages of these drugs can be used. Their beneficial effects are related to a blockade of the renin-angiotensin system (RAS) and a decrease in TGF-beta1 expression in glomeruli.