The relationship between simple renal cysts and glomerular filtration rate in the elderly.

PURPOSE: This cross-sectional study aimed to examine the association between the presence of simple renal cyst and glomerular filtration rate (GFR) in a group of elderly patients. METHODS: This study included 207 elderly subjects residing in a nursing home. All subjects underwent ultrasonography examination as well as serum urea and creatinine measurements. Creatinine clearance was calculated according to Cockroft-Gault formula. In addition, demographic data were recorded. RESULTS: Sixty-six subjects had simple renal cysts, and cysts were more frequent among male patients (43.1 vs. 28.2 %, p = 0.047). In addition, patients with renal cysts were slightly older and had a slightly lower GFR. On the other hand, patients with or without renal cysts did not differ with regard to renal sizes. In univariate analysis, reduced GFR was associated with older age (81.2 ± 5.9 vs. 75.7 ± 5.1 years, p < 0.001) and was more frequent among females (69.2 vs. 52.9 %, p = 0.034). In addition, lower BMI, presence of cyst, lower mean renal length, and lower mean renal thickness were associated with impaired GFR (p < 0.05 for all); however, number or bilaterality of the cysts were not linked with deterioration of GFR. Multivariate analysis identified only female gender (OR 2.4, 95 % CI 1.1-5.1, p = 0.030), a small BMI (<25; OR 6.2, 95 % CI 2.4-15.5, p < 0.001), and advanced age as independent predictors of low GFR. Each year increase in age results in OR 1.2 (95 % CI 1.1-1.3, p < 0.001). CONCLUSION: Presence of simple renal cyst does not seem to have an effect on the decline in GFR in elderly patients. Age-related increase in the incidence of renal cysts appears to occur in geriatric population.

Literature review in the treatment of calciphylaxis: A case with uncontrolled and severe secondary hyperparathyroidism.

BACKGROUND: Calciphylaxis is a serious disorder often observed in dialysis patients and less frequently in chronic renal failure patients with secondary hyperparathyroidism. Mortality rate increases following the development of calciphylaxis, immediate application of parathyroidectomy along with other treatment options may be lifesaving. CASE PRESENTATION: A 44-year-old male patient had been on regular hemodialysis three times per week, with 4-hour sessions since December 2003. The etiology of his renal failure was unknown and the patient had no systemic disease when hemodialysis was started, painful, erythematous skin lesions were detected over and around the external malleolus of the right foot. In the next two months, erythematous skin lesions gained a necrosed character and spread into the malleolar and posterior tibial region and back of the ankle in both extremities. The patient showed no clinical signs of recovery and despite anti-biotherapy, debridement and protective measures, the skin lesions got infected and presented as intolerable, painful wounds. The patient was diagnosed with calcific uremic arteriolopathy (CUA) and hospitalized for parathyroidectomy. All parathyroid glands were removed after having checked quick PTH intraoperatively. A small amount of parathyroid tissue was intramuscularly auto-implanted into the right forearm .Skin lesions showed fast improvement in further follow-ups. Three months after parathyroidectomy, iPTH value was measured as 1197 pg/ml. After 6 months of medical treatment, iPTH was found as 970 ng/L and we decided to remove the implanted parathyroid tissue from the right forearm. CONCLUSION: In this article, we present a case of calciphylaxis accompanied by severe secondary hyperparathyroidism.

Demographic and clinical characteristics of primary glomerular diseases in Turkey.

BACKGROUND: The aim of our study was to delineate the demographic and clinical properties of primary glomerular diseases of adult population in our country in the light of global knowledge. METHODS: All over the country, a total of 25 centers entered data between May 2009 and July 2012 to the database created by 'Glomerulonephritis Study Group' of Turkish Society of Nephrology. Demographic and clinical characteristics, specific diagnoses of glomerular diseases and biopsy findings recorded to the database were analyzed. RESULTS: Among the 1,274 patients, who had renal biopsy within the defined time period, 55 % were male and 45 % were female. The mean age was 40.8 ± 14.6 years. The most frequent indication for biopsy was nephrotic syndrome (57.8 %), followed by nephritic syndrome including rapidly progressive glomerulonephritis (16.6 %) and asymptomatic urinary abnormalities (10.8 %). The most frequent primary glomerular disease was membranous nephropathy (28.8 %), followed by focal segmental glomerulosclerosis (19.3 %) and IgA nephropathy (17.2 %). CONCLUSION: The presented study displayed important data about the epidemiology of primary glomerular diseases among adults in our country. The predominance of membranous nephropathy in contrast to other countries, in which the most frequent etiology is IgA nephropathy, seems to be due to differences in the indications for renal biopsy.