Cysteinyl 1 receptor antagonist montelukast, does not prevent peritoneal membrane damage in experimental chronic peritoneal dialysis model in rats.

BACKGROUND/AIMS: Continuous ambulatory peritoneal dialysis (CAPD) induces structural changes in the peritoneal membrane such as fibrosis, vasculopathy and angioneogenesis with a reduction in ultrafiltration capacity. Leukotriene (LT) receptor antagonists have been found to be effective to prevent fibrosis in some nonperitoneal tissues. The aim of this study is to investigate the possible beneficial effect of montelukast, a LT receptor antagonist, on peritoneal membrane exposed to hypertonic peritoneal dialysis in uremic rats. METHODS: Of the 48 male, 5/6 nephrectomized Wistar rats 29 remained alive and were included in the study. These studied rats were divided into 3 groups: Group I (n=7) was the control group, Group II (n=8) was treated with 20 ml hypertonic PDF intraperitoneally daily and Group III was treated with montelukast and similar PDF treatment protocol. The morphological and functional changes in the peritoneal membrane as well as cytokine expression were compared between groups. RESULTS: Submesothelial thickness and the severity of the degree of hyaline vasculapathy were more prominent in group III when compared to group I. There were no significant differences between group II and other groups in terms of submesothelial thickness and the severity of the degree of hyaline vasculapathy. Increased expressions of TGF-ß and VEGF in parietal peritoneal membrane were found in group II and group III when compared to group I. The amount of TGF-ß and VEGF expression were similar in group II and group III. CONCLUSION: This study suggests that montelukast treatment does not prevent the peritoneal membrane from deleterious effects of hyperosmolar PDF in the uremic environment.

Diagnosing latent tuberculosis infection in haemodialysis patients: T-cell based assay (T-SPOT.TB) or tuberculin skin test?

BACKGROUND: The international guidelines recommend screening haemodialysis (HD) patients for latent tuberculosis infection (LTBI). The aim of this study is to compare the diagnostic utility of tuberculin skin test (TST) with an interferon-γ-based assay (T-SPOT.TB) for the diagnosis of LTBI in HD patients. METHODS: A total of 411 patients [233 male (57%), mean age 56±16 years] in five HD centres were prospectively tested by TST and T-SPOT.TB assays. A total of 302 patients (75%) had Bacillus Calmette-Guerin vaccination scar. RESULTS: LTBI was detected in 39 and 61% of patients by one-step TST and T-SPOT.TB, respectively. The booster phenomenon determined additional 60 (25%) LTBI among 243 patients. Overall, 218 (53%) patients showed a positive reaction to TST after performing the two-step TST. Among 250 one-step TST negative patients T-SPOT.TB assay was positive in 118 (47%). Of 158 patients with a positive one-step TST, T-SPOT.TB was negative in 34 (22%). On the other hand, T-SPOT.TB was negative in 16 (27%) of boosted patients. T-SPOT.TB was negative in 50 (23%) of overall TST-positive patients and positive in 71 (39%) of TST negative ones. Multivariate logistic regression analysis revealed that male gender was independently associated with positive T-SPOT.TB, and positive T-SPOT.TB was inversely associated with the presence of BCG vaccine scar, serum albumin level and HD duration. Annual conversion rates were 12 and 32% for TST and T-SPOT.TB tests, respectively. CONCLUSION: Usage of T-SPOT.TB in HD patients with negative TST may enhance diagnosis of LTBI.

Toll-like receptor expression in monocytes in patients with chronic kidney disease and haemodialysis: relation with inflammation.

BACKGROUND: Inflammation is one of the main contributors to atherosclerosis in haemodialysis (HD) patients. Activation of Toll-like receptors (TLRs) leads to inflammatory response. In this study, we aimed to evaluate the expression of TLRs on monocytes and relate their expression with inflammation in chronic kidney disease (CKD) and HD patients. METHODS: Thirty-four age- and gender-matched controls and stage 3-4 CKD patients and thirty-two HD patients were included in each study group. The effect of HD on the expression of Toll-like receptor-2 (TLR-2) and Toll-like receptor-4 (TLR-4) on CD14( +) monocytes was determined at the beginning (baseline), during (120 min) and following (300 min and 24 h) HD and compared with control and stage 3-4 CKD groups. The HD procedure was performed by using low-flux polysulphone dialysers. In addition, serum IL-6 levels were evaluated in both groups at baseline and after a HD session. RESULTS: The percentage of CD14( +) monocytes expressing TLR-2 were similar in all of the study groups, whereas the percentage of CD14( +) monocytes expressing TLR-4 were significantly lower in both stage 3-4 CKD and HD patients at baseline than in controls. The mean fluorescence intensities (MFI) of TLR-2 were significantly lower in controls than in stage 3-4 CKD and HD patients at baseline. The MFI of TLR-4 was similar in all of the groups. The percentage of CD14( +) monocytes expressing TLR-2 did not change during and after HD. The MFI of TLR-2 decreased at 120 min of HD compared with baseline (1837 ± 672 vs 1650 ± 578, P < 0.05), and recovered back to baseline values at 300 min and at 24 h post-HD. MFI of TLR-4 increased at 24 h compared with baseline (941 ± 294 vs 1087 ± 441, P < 0.05). Serum IL-6 levels correlated with MFI of TLR-2 and TLR-4 in stage 3-4 CKD patients and in HD patients at baseline and after HD in univariate analysis. Stepwise multiple regression analysis revealed that MFI of TLR-2 was an independent determinant of serum IL-6 concentrations in stage 3-4 CKD and in HD patients at baseline, at 300 min and at 24 h post-HD. Conclusions. Our study demonstrates that TLR-2 is associated with the inflammatory response of non-dialysed and dialysed CKD patients.

Focal segmental glomerulosclerosis associated with idiopathic myelofibrosis.

A patient with idiopathic myelofibrosis with nephrotic syndrome is reported. Seven months after the initial diagnosis of myelofibrosis, the patient was presented with dyspnea, generalized edema, heavy proteinuria, massive pleural effusion, and ascites. Renal biopsy showed focal segmental glomerulosclerosis. After starting immunosuppressive therapy consisting of cyclosporine and steroids, his renal function and proteinuria improved and transfusion requirements decreased.

Histopathological changes and tumour necrosis factor-alpha, transforming growth factor-beta and tenascin expression in patients with primary type I membranoproliferative glomerulonephritis in remission.

AIM: Primary type I membranoproliferative glomerulonephritis (MPGN) is a rare cause of glomerular disease with a high relapse rate and poor prognosis. The aim of this study was: (i) to evaluate the histopathological findings associated with remission; and (ii) to document the possible clinical and histopathological factors predicting relapses. METHODS: Eleven type I MPGN patients (five men, six women; mean age, 38.8+/-13.5 years) who were in remission for at least 1 year after the cessation of immunosuppressive drugs were re-biopsied. The intensity of immunostaining for tumor necrosis factor (TNF)-alpha, transforming growth factor (TGF)-beta1, and tenascin was graded from 0 (no staining) to 3+ (maximum staining). RESULTS: Mean baseline mesangial cellularity score and tubulointerstitial infiltration score were reduced and mesangial matrix expansion score was increased at protocol re-biopsies compared to baseline. The glomerular and tubulointerstitial staining scores for TGF-beta1 and tenascin were higher than that of baseline. Reduced tubulointerstitial TNF-alpha expression was found in re-biopsy specimens compared to baseline. Patients have been followed for a mean time of 51.5+/-22.2 months after the protocol biopsy. Eight patients had a relapse. Mesangial cellularity score and glomerular tenascin expression at re-biopsy specimens were higher in relapsed patients compared to those without a relapse. CONCLUSION: Our study shows that mesangial cellularity and tubulointerstitial cell infiltration are reducing whereas mesangial matrix expansion, glomerular and tubulointerstitial TGF-beta1 and tenascin expression are increasing with remission. The higher mesangial cell proliferation and glomerular tenascin scores in remission are associated with the development of relapse.

Elevated plasma levels of PAI-1 predict cardiovascular events and cardiovascular mortality in prevalent peritoneal dialysis patients.

BACKGROUND: Elevated plasminogen activator inhibitor-1 (PAI-1) levels are associated with increased cardiovascular (CV) risk in the general population. It has been shown that peritoneal dialysis (PD) patients have increased plasma levels of PAI-1. The aim of this study was to investigate whether PAI-1 independently predicted CV outcome in PD patients. MATERIAL AND METHODS: Seventy-two PD patients (53% females, mean age 49.9 +/- 16.1 years) were studied. Twelve patients who underwent kidney transplantation and 14 patients who transferred to hemodialysis during follow-up were excluded from the analysis. The remaining 46 patients (54% female, mean age 54 +/- 16 years, dialytic age 42 +/- 30 months) were followed a mean time of 45.4 +/- 19.4 months (range 8-71 months). Baseline PAI-1, clinical, and laboratory parameters were assessed in all patients. Survival analyses were made with Kaplan-Meier and Cox regression analysis, with all-cause mortality and CV mortality and CV events (CVEs) as clinical end points. RESULTS: During the follow-up, 29 patients died (17 from CV causes), and 28 fatal and non-fatal CVEs were recorded. The patients were divided according to plasma PAI-1 levels (i.e., 41 ng/mL). The significant independent predictors of all-cause of mortality were age (60 years; p = 0.018), CRP (5 mg/L; p = 0.015), and serum albumin (<3.5 g/L; p = 0.011). Multivariable Cox regression analysis showed that plasma PAI-1 41 ng/mL was independently predictive of higher CV mortality (p = 0.021) and CVEs (p = 0.001). The only other independent predictor of CV mortality was only CRP (5 mg/L; p = 0.008). CONCLUSIONS: Plasma levels of PAI-1 41 ng/mL is a significant predictor of CV mortality and CVEs in PD patients.

Tacrolimus rescue therapy in resistant or relapsing cases of primary glomerulonephritis.

BACKGROUND: Patients with resistant or relapsing primary glomerulonephritis (PGN) after conventional immunosuppressive treatment have a worse renal outcome, and treatment of these patients remains problematic. In this study we aimed to determine the effect of tacrolimus in these patients. METHODS: We prospectively studied 15 patients with PGN (3 membranous nephropathy, 6 membranoproliferative GN, 4 focal segmental glomerulosclerosis [FSGS], 1 IgA nephropathy and 1 IgM nephropathy) who were either resistant (n=7) or relapsing (n=8) after or during conventional immunosuppressive therapy. Tacrolimus was started at a dosage of 0.05 mg/kg per day. Prednisolone was either maintained or added to the tacrolimus regimen. RESULTS: The mean duration of tacrolimus treatment was 28.9 +/- 2.4 months. Proteinuria decreased from 6.3 +/- 5.0 g/day to 0.5 +/- 0.6 g/day at the end of follow-up (p=0.001). Complete or partial remission was achieved by 60% and 40% of patients, respectively. Relapse occurred in only 2 patients with FSGS under tacrolimus treatment. There was no significant change in serum creatinine at the end of follow-up (from 1.4 +/- 1.0 mg/dL to 1.2 +/- 0.6 mg/dL, p=0.3). Serum albumin increased from 3.2 +/- 0.5 g/dL to 4.3 +/- 0.3 g/dL (p=0.0001). There were 6 relapses among 10 patients after the withdrawal of tacrolimus. CONCLUSIONS: These data suggest that the combined therapy of tacrolimus and low-dose prednisolone may have a promising role to obtain long-term remission in resistant or relapsing PGN.

The blockade of the renin-angiotensin system reverses tacrolimus related cardiovascular toxicity at the histopathological level.

INTRODUCTION: In this study, we investigate the toxic effects of tacrolimus (FK506) on the cardiovascular system at the histopathological level in a rat model and whether these effects can be reversed by the blockade of the renin-angiotensin system (RAS) by either an angiotensin-converting enzyme inhibitor (ACE-inhibitors) or an angiotensin receptor antagonist (ARB). METHODS AND RESULTS: Thirty-one Wistar rats were divided into four groups. FK506 group was treated with FK506 intraperitoneally (i.p.), FK506+ACE-inhibitors and FK506+ARB groups were treated with either quinapril or valsartan orally in addition to FK506. Control group was treated with saline i.p. Histological and immunohistochemical staining of cardiovascular tissue in the FK506 group showed increased vacuolar degeneration (11.2 vs. 5.8, p=0.008), arterial hyalinosis (10.7 vs. 6.3, p=0.036), transforming growth factor-beta (TGF-beta) (12.2 vs. 4.8, p=0.001) and vascular endothelial growth factor expression (VEGF) (10.7 vs. 6.3, p=0.036), elastic van Gieson (11.5 vs. 5.5, p=0.004), and periodic acid Schiff stain scores (12.5 vs. 4.5, p<0.001) compared to the control group. Immunohistochemical scores showed that expression of TGF-beta is up-regulated, and bone morphogenic protein (BMP-7) is down-regulated with FK506 toxicity. Adding RAS blockade with either an ACE-inhibitor or an ARB could reverse FK506 induced changes. Both FK506+ACE-inhibitors and FK506+ARB groups demonstrated decrease in arterial hyalinosis (22.1 vs. 14.4 (FK506+ACE-inhibitor) and 13.6 (FK506+ARB), p=0.09) and vacuolar degeneration (23.1 vs. 16.1 (FK506+ACE-inhibitor) and 12.4 (FK506+ARB), p=0.006) scores compared to the FK506 group. CONCLUSION: Blockade of RAS could reverse the histopathological signs of FK506 induced cardiac toxicity in a rat model.

Simple provocative maneuvers in renal transplant scintigraphy for detecting urine leak.

Urine leak in the early postoperative period following renal transplantation is a serious complication requiring early identification and aggressive intervention, which significantly reduces the morbidity and mortality. Renal transplant scintigraphy is a noninvasive method to evaluate the perfusion and function of a transplanted kidney and urinary drainage including urine leak. Here, we reported two cases in which the standard transplant renogram failed to demonstrate urine leak. The cases were referred for a diethylenetriaminepentaacetic acid renogram following the transplantation to evaluate the cause of symptoms or elevated serum creatinine level. In both the cases, urine leak was successfully detected following simple maneuvers such as diuretic administration or Foley catheter irrigation. Renal transplant scintigraphy is an effective and safe technique and the use of these simple maneuvers can enhance the diagnostic sensitivity of the transplant renogram in the detection of urine leak.

Renal artery stenting in solitary functioning kidneys: technical and clinical results.

OBJECTIVE: To evaluate the clinical and technical results of renal artery stenting for the treatment of renovascular hypertension and renal failure in patients with solitary functioning kidney. MATERIALS AND METHODS: Fifteen patients with solitary functioning kidney underwent renal artery stenting and were followed up for 12-60 months. Before the procedures, systolic and diastolic blood pressures and serum creatinine levels were measured and the number of antihypertensive drugs was recorded and followed up after stenting. In case of restenosis, either in-stent percutaneous transluminal renal angioplasty or stent-in-stent placement was performed. RESULTS: Primary technical success rate was 100%. One lesion was nonostial while 14 were ostial. Primary patency rates were 100% for 6 months, 92.3% for 12 months, and 69.2% for 24 months. The secondary patency rate at 24 months was 100%. The differences between the baseline and postprocedural values of systolic blood pressures, diastolic blood pressures and the number of antihypertensive drug were statistically significant (P < 0.05), except the values of serum creatinine. Hypertension was cured in 1 (6.7%) patient, improved in 4 (26.6%) and stabilized in 10 (66.7%) patients. Renal function improved in 9 (60%), stabilized in 4 (26.6%), and deteriorated in 2 (13.4%) patients. Minor complication rate was 13.4% and major complication rate was 13.4%. CONCLUSION: Revascularization of renal artery stenosis using stent in solitary functioning kidneys is a safe and efficient procedure with high primary technical results, low restenosis rates and acceptable complication rates. It has an improving and controlling effect on blood pressure and renal functions.

Reproducibility of technetium-99m mercaptoacetyltriglycine clearance in patients with impaired renal function.

BACKGROUND: The aim of this study was to determine the reproducibility of technetium-99m mercaptoacetyltriglycine (99mTc-MAG3) clearance in patients with a 99mTc-MAG3 clearance below 100 ml/min/1.73 m2. METHODS: Two separate multi-sample clearance studies were performed in 16 patients at a 1 week interval. The clearances were calculated according to the open two-compartment model of Sapirstein et al., accepting the 90, 120 and 180 min samples as the last points of the biexponential curve. The clearance measurements were also performed according to the single-sample methods of Russell et al. and Bubeck using the fitted value at 44 min. RESULTS: There was no significant difference between the two clearance measurements for all five samples (P>0.05). There was a systematic increase in clearance measurements of 8.0+/-2.7% from the 180 to 120 min samples and 4.8+/-2.0% from the 120 to 90 min samples. Both single-sample methods (Bubeck and Russell et al.) gave more divergent results than multi-sample methods. The mean and standard deviation (%) of the normalized differences between two successive tests were -3.9+/-12.6, -2.4+/-13.1, -1.9+/-14.9, -4.1+/-53.5 and -13+/-82.1 for 90, 120 and 180 min samples and the Russell et al. and Bubeck methods, respectively. CONCLUSION: Single-sample methods give very poor reproducibility and accuracy and should not be used in patients with poor renal function. The reproducibility of 99mTc-MAG3 clearance using the multi-sample method (90 min) in patients with impaired renal function is 12.6%, which is similar to that in patients with good renal function and that obtained with other tubular agents. Whether this level of reproducibility is satisfactory for documenting serial changes in an individual patient with a 99mTc-MAG3 clearance below 100 ml/min/1.73 m2 depends on the expectation of the clinician.

Acute renal failure due to crush syndrome during Marmara earthquake.

During the earthquake in Marmara, Turkey (August 17, 1999), 87 of 476 victims (18.3%) admitted to Marmara University Hospital (Istanbul, Turkey) experienced renal failure caused by crush injuries. Fifty-nine patients (68%; 40 men, 19 women) required renal replacement therapy (RRT), whereas 28 patients (32%; 20 men, 16 women) recovered renal function under conservative treatment. The aim of the present study is to compare clinical and laboratory data from patients with crush syndrome who needed RRT with those who could be maintained on conservative medical treatment. Data for demographic, clinical, and laboratory findings of patients who had renal problems were collected retrospectively and analyzed. The proportion of men was significantly greater (68% versus 42%; P < 0.05), and time spent under the rubble was significantly shorter (9.4 +/- 6.9 versus 19.1 +/- 22.5 hours; P < 0.05) among patients who required RRT compared with those who recovered under conservative treatment. Patients who required RRT had significantly less urine output in the first 24 hours, underwent more fasciotomies, and needed more blood and fresh frozen plasma transfusions (P < 0.05). Blood urea nitrogen, creatinine, potassium, creatine kinase, and aspartate aminotransferase levels were significantly greater compared with patients managed conservatively both on admission and for the mean of values obtained during the first 2 weeks (P < 0.05). Furthermore, fasciotomies were the most powerful predictors of a later need for RRT. In a similar disaster in the future, these factors should be taken into consideration for priority in referral to medical centers with dialysis facilities.

Angiotensin converting enzyme I/D, angiotensinogen T174M-M235T and angiotensin II type 1 receptor A1166C gene polymorphisms in Turkish hypertensive patients.

Essential hypertension is a multifactorial disease in which genetic and enviromental factors play an important role. These factors differ in each population. As there are no existing data for the Turkish population, we investigated four Renin Angiotensin System (RAS) gene polymorphisms, the angiotensin converting enzyme (ACE), angiotensinogen (AGN) M235T/T174M and angiotensin II type 1 receptor A1166C polymorphism in 109 hypertensive and 86 normotensive Turkish subjects. Polymerase Chain Reaction (PCR) and Restriction Fragment Length Polymorphism (RFLP), and agarose gel electrophoresis tecniques were used to determine these polymorphism. The frequencies of person that carry ACE D allel (DD+ID) was significantly higher in hypertensive group (99.1%) than controls (80%) (P 0.000). M235T TT genotype was also found significantly higher in hypertensives than control group (20% vs 2.7%; P 0.001). The frequency of AGN 174M allele was higher in the hypertensive group than control subjects (8.76% vs 4.81%). Frequency of ATR1 C allele (AC+CC genotypes) was found higher hypertensives than controls (39.4% vs 25.9%; P = 0.054). Our results suggest that an interaction exists between the RAS genes and hypertension in Turkish population.

Effects of captopril and losartan on lipid peroxidation, protein oxidation and nitric oxide release in diabetic rat kidney.

Increased oxidative stress has an important role in the pathogenesis of diabetic nephropathy. The aim of this study was to evaluate the effects of renin-anigiotensin system blockage, either by angiotensin-converting enzyme inhibition or angiotensin receptor blockage, on oxidative stress and nitric oxide release in diabetic rat kidneys. After induction of diabetes, six rats were given captopril, six rats were given losartan, and six rats served as diabetic controls. Six healthy rats were also included. At the end of an 8-week period nitric oxide release, lipid peroxidation and protein oxidation were measured in kidney cortices, and urinary albumin excretion (UAE) was determined in 24-h urine samples. Losartan- and captopril-treated diabetic rats had lower levels of UAE than diabetic controls. Diabetic rats had higher levels of lipid peroxidation and protein oxidation compared to healthy rats. NO release was significantly lower in diabetic groups than healthy controls. UAE levels showed a positive correlation with lipid peroxidation and a negative correlation with NO release. Inhibition of lipid peroxidation could be one of the protective mechanisms of renin-angiotensin axis inhibition in diabetic kidney tissues.

Association of FMF-related (MEFV) point mutations with secondary and FMF amyloidosis.

BACKGROUND: Familial Mediterranean fever (FMF) is the major cause of AA amyloidosis in Turkey. M694V mutation in MEFV gene was suggested to be associated with severe clinical features and amyloidosis of FMF. METHODS: In this study, the frequencies of three FMF-related MEFV mutations (M694V, M680I and V726A) were investigated in FMF patients with (AA-FMF, n = 37) and without amyloidosis (non-AA-FMF, n = 35), in patients with secondary amyloidosis related to non-FMF inflammatory conditions (S-AA, n = 19) and in a non-inflammatory control group (n = 185) by molecular genetic studies using polymerase chain reaction with the ARMS (amplification refractory mutation system) method. RESULTS: Both AA and non-AA-FMF patients had significantly higher MEFV mutations compared to non-inflammatory controls (81 and 62.7% respectively vs. 4.2%, p = 0.0001). AA-FMF patients carried significantly more MEFV mutations than non-AA-FMF patients (p = 0.01). M694V was the most common mutation in both FMF groups (63.5 vs. 51.4%), however allele frequency (p = 0.17) and the number of homozygous patients for this mutation did not differ between the groups (p = 0.77). Although lower compared to FMF patients, S-AA patients also had a significantly higher incidence of MEFV mutations than non-inflammatory controls (21 vs. 4.2%) (p = 0.0002). M694V was the only MEFV mutation in this group. CONCLUSION: MEFV mutations are found to be increased both in FMF and non-FMF associated secondary amyloidosis in our study; however, no clear association between M694V and amyloidosis is observed, except in the non-FMF group. Our results suggest that MEVF mutations may also serve as a severity marker for other inflammatory conditions.

A prospective study: inflammation, infection and comorbidity in patients on long-term dialysis.

BACKGROUND: The goal of this study was to identify inflammatory and infectious markers and their roles in mortality. METHODS: We enrolled 111 patients on haemodialysis (HD) and collected data at three time points (baseline, 33 and 76 months). RESULTS: Rates of Chlamydophila pneumoniae IgG, CRP ≥3 mg/l, ESR >50 mm/hour and fibrinogen >4 g/l were, respectively, 63.1%, 60.4%, 48.6% and 42.3%. Mortality was 21.6% and 43.2% at 33 and 76 months where 58.3% of all deaths were cardiocerebrovascular (CCV) related. Non-survivors were older than survivors. Univariate analysis showed diabetes mellitus (DM) and cerebrovascular accident (CVA) as important for the 33-month all-cause mortality, and CRPlog , fibrinogen, ESR >50 mm/hour, cardiovascular disease (CVD) and DM for the 76-month all-cause mortality. CVA was meaningful for the 33-month CCV mortality, and CVD, DM and ESR >50 mm/hour for the 76-month CCV mortality. Kaplan-Meier revealed poorer survival for patients with ESR >50 mm/hour at 76 months. Cox regression showed CVD, CVA and age as mortality predictors. CONCLUSION: Age, CVD and CVA are predictors for mortality in patients on HD patients, but the presence of C. pneumoniae IgG and inflammation are not.

Paraoxonase 1 polymorphisms in patients with primary glomerulonephritis: a single-center study in Turkey.

INTRODUCTION: Human paraoxonase 1 (PON1) is an enzyme related with high-density lipoprotein cholesterol. The link between genetic polymorphisms of PON1 and hyperlipidemia and increased lipid oxidation may explain these complications in the course of glomerular diseases. In this study, we aimed to investigate PON1 192 and PON1 55 polymorphisms in patients with primary glomerulonephritis and healthy individuals. MATERIALS AND METHODS: Eighty-six patients with biopsy-proven primary glomerulonephritis and 50 healthy controls were included in the study. Clinical characteristics, lipid profile, paraoxonase activity, and PON1 genotypes (PON1 192 and PON1 55) of all of the participants were studied. RESULTS: Histopathological diagnoses of the patients were membranoproliferative glomerulonephritis (53.5%), focal segmental glomerulosclerosis (33.7%), and membranous nephropathy (12.8%). The patients had lower PON1 activity levels than the healthy controls. No differences were observed in PON1 192 genotypes between the two groups. However, the controls were more likely to carry PON1 55 LM genotype (odds ratio, 4.10; 95% confidence interval, 1.96 to 8.61; P < .001) and M allele (odds ratio, 3.0; 95% confidence interval, 1.45 to 6.19; P = .003) compared to the patients with primary glomerulonephritis. There was a marked elevation in the frequency of PON1 55 LL genotype in the patients compared to the controls (odds ratio, 0.33; 95% confidence interval, 0.16 to 0.68; P = .003). CONCLUSIONS: This preliminary study shows that the LL genotype might be a risk factor for the development of primary glomerulonephritis and the M allele might be a protective factor against its progression.

Associations between apolipoprotein E gene polymorphism and plasminogen activator inhibitor-1 and atherogenic lipid profile in dialysis patients.

BACKGROUND: Apolipoprotein-E (ApoE) gene polymorphism has an important role in lipoprotein metabolism and could participate in the development of cardiovascular diseases (CVD). Plasminogen activator inhibitor-1 (PAI-1) is also regarded as a risk factor for CVD. The aim of the present study is to further investigate the possible link(s) between ApoE gene polymorphism and plasma PAI-1 antigen and serum lipid profile in peritoneal dialysis (PD) and hemodialysis (HD) patients. MATERIAL AND METHODS: We studied 72 PD patients (38 female, mean age 49.9 +/- 16.1 years), 72 HD patients (22 female, mean age 57.4 +/- 14.6 years), and 42 healthy subjects (21 female, mean age 50.1 +/- 18.6 years). Serum lipid parameters, plasma PAI-1 levels, and ApoE genotypes were determined in all subjects. RESULTS: The distribution of ApoE genotypes and alleles frequencies was similar in dialysis patients and healthy controls. In PD patients, total cholesterol (TC), low-density lipoprotein (LDL)-C, and ApoB levels were significantly higher than that of HD patients. HD patients with E3/4 genotype had elevated TC, LDL-C and ApoB levels compared with E3/3 genotype. TC and triglyceride levels were also higher in E3/4 genotype than that of E2/3 genotype. PD and HD patients showed a significantly increased PAI-1 levels compared with controls, whereas PAI-1 levels were highest in HD patients. There was no significant relation between ApoE genotypes and PAI-1 levels. CONCLUSIONS: The present study suggests that ApoE polymorphism significantly affects serum lipid profile in HD patients and epsilon4 allele carriers are more susceptible to have atherogenic lipid profile.

[Endovascular treatment of renal artery stenosis: Technical and clinical results]. / Renal arter darliklarinin stent ile endovasküler tedavisi: teknik ve klinik sonuçlar.

PURPOSE: To determine the primary success rate and follow-up results of renal artery stenting in controlling renovascular hypertension and renal failure in patients with renal artery stenosis. MATERIALS AND METHODS: Balloon expandable stents were placed in 40 renal arteries of 35 patients (16 men, 19 women; mean age 60, 1). Indications for treatment were hypertension alone in 11 patients, disturbed renal functions alone in 12 patients and hypertension associated with renal failure in eight patients. Four of the patients were diagnosed during angiography due to peripheral arterial diseases. Blood pressures and serum creatinine levels were measured before the operation and after stenting. RESULTS: The primary technical success rate was 100%. Mean percent stenosis was 81%. The lesions were ostial in 28 patients, proximal in 10 patients and distal in 2 patients. In those patients having at least one year of follow up, the primary patency at one year was 93% (14/15). Hypertension was cured in 7 (20%) patients, improved in 17 (48.5%) patients and did not respond in 11 (31.5%) patients. Of 21 patients with disturbed renal function, 12 (57.2%) patients improved, 3 (14.3%) patients deteriorated and 6 (28.5%) patients were stabilized. CONCLUSION: Revascularization of renal artery stenosis is a simple, efficient and safe procedure with high primary technical results, low restenosis rates and acceptable complication rates. It has a beneficial effect on blood pressure control and a non-deleterious effect on renal function.

Inferior vena cava diameter determines left ventricular geometry in continuous ambulatory peritoneal dialysis patients: an echocardiographic study.

BACKGROUND: Changes in left ventricular (LV) geometry are frequent in patients with continuous ambulatory peritoneal dialysis (CAPD). Geometric adaptation of LV to various stimuli was reported to have adverse prognosis. This study aimed to identify independent risk factors, which contribute to the development of LV geometric remodelling in CAPD patients. METHODS: The left ventricles of 69 CAPD patients were classified echocardiographically into four different geometric patterns on the basis of LV mass and relative wall thickness. With respect to volume factor, we measured inferior vena cava (IVC) diameter and its decrease on deep inspiration [collapsibility index (CI)] by echocardiography. We modelled a stepwise multiple regression analysis to determine the predictors of LV geometry. RESULTS: All four geometric models of LV were identified in our group of 69 CAPD patients. Eccentric left ventricular hypertrophy (eLVH) was observed in 32 (46%), concentric LVH (cLVH) in 19 (28%), normal geometry (NG) in 10 (14%) and concentric remodelling (CR) in eight (12%) CAPD patients. Mean IVC index of the eLVH group (10.72 +/- 2.19 mm/m(2)) was significantly higher than corresponding indexes of NG (7.90 +/- 1.54 mm/m(2)), CR (8.51 +/- 1.28 mm/m(2)) and cLVH (8.04 +/- 2.00 mm/m(2)) groups (P < 0.001 for each comparisons). The eLVH group also had significantly lower mean CI value (0.48 +/- 0.11) than CR (0.58 +/- 0.09) and cLVH (0.57 +/- 0.07) groups (ANOVA P = 0.008). Stepwise multiple regression analysis revealed that IVC index, CI and haemoglobin were the independent predictors of LV geometric stratification (R2 = 0.36, P < 0.001). CONCLUSION: Hypervolaemia, identified by IVC index and CI, and anaemia contribute independently to LV geometry in CAPD patients. Echocardiography as a non-invasive tool is not only useful to determine LV geometry, but also to assess the volume status of CAPD patients.