RESUMO
BACKGROUND: The calcium sending receptor (CaSR) allows parathyroid and kidney tubular cells to regulate PTH secretion and tubular calcium reabsorption. In the present report, we examined the relationship between CaSR gene polymorphisms and parathyroid CaSR expression and serum calcium/parathyroid hormone (PTH) levels and clinical progress in ESRD patients in the Turkish population. METHODS: We genotyped the CaSR R990G and Q1011E variants in 192 end-stage renal disease (ESRD) patients by allele-specific PCR. CaSR expression in parathyroid tissues of operated 33 patients was quantified with quantitative reverse transcription-PCR. RESULTS: Compared with other genotypes, the ratio of both codon 990-AA and 1011-CC polymorphisms was found higher in operated patients (p = 0.001). In the total patient group PTH levels were found higher in patients with CC1011 genotype than those with CG1011 (1015.15 +/- 925.41 pg/ml; 523.84 +/- 544.6 pg/ml, respectively, p = 0.002). There were statistically important higher Ca2+ levels in the AA990 allele carrying cases than AG990 positive ones (9.3 +/- 1.0 mg/dl vs. 8.8 +/- 0.9, p = 0.006). On the other hand, the expression of CaSR in parathyroid tissue was found inversely proportional with serum PTH level (r = -0.71). CONCLUSION: Present data suggest that co-presence of CaSR gene AA990 and CC1011 alleles is a possible risk factor for bad prognosis in secondary hyperparathyroidism. Patients carrying this genotype have tendency to require operation early in their medical therapy period and need postoperative close follow up for possible recurrences.
Assuntos
DNA/genética , Falência Renal Crônica/genética , Polimorfismo Genético , Receptores de Detecção de Cálcio/genética , Adolescente , Adulto , Alelos , Cálcio/sangue , Sinalização do Cálcio , Seguimentos , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Humanos , Hiperparatireoidismo Secundário/sangue , Hiperparatireoidismo Secundário/genética , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Prognóstico , Radioimunoensaio , Receptores de Detecção de Cálcio/biossíntese , Diálise Renal , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Adulto JovemRESUMO
AIM: Anatomical landmark technique for central venous catheter insertion preoperatively during renal transplantation may result in serious complications. In this prospective study, we sought to evaluate the results of ultrasonography-guided central venous catheter insertion before renal transplantation. PATIENTS AND METHODS: Since March 2004 routine ultrasonography-guided central venous catheter insertion was performed before the operation for living related renal transplantation. Chest X-ray was used as a control after catheter insertion. Visual pain scale was evaluated after the procedure. We recorded the duration of the procedure, amount of local anesthetic, number of punctures, and complications, namely, hematoma, carotid artery puncture, hemorrhage, and hemo-pneumothorax. RESULTS: Since March 2004, 120 jugular venous catheters were inserted into renal transplant recipients preoperatively. Mean visual pain scale was 2.5 +/- 1.2 cm (range, 0.6-4.1 cm). Mean duration of the procedure was 9 +/- 3 minutes (range, 6-15 minutes); the amount of local anesthetic injected was 1.6 +/- 0.6 mL (range, 0.9-2.3 mL). There was no carotid artery puncture, hemo-pneumothorax, or hematoma. During the study period, 3 of the first 10 catheter insertions required more than 1 puncture, for the rest 1 puncture was sufficient for catheter insertion. There was no bleeding or intravenous fluid leakage from the catheter insertion site. CONCLUSION: Ultrasonography-guided jugular venous catheter insertion is a successful safe method. Routine ultrasonography-guided procedures before renal transplantation avoided the complications related to catheter insertion.
