association of vitamin D status and vitamin d replacement therapy with glycemic control, serum uric acid levels, and microalbuminuria in patients with type 2 diabetes and chronic kidney disease

Objective: To evaluate the relationship of vitamin D status and vitamin D replacement therapy with glycemic control, serum uric acid [SUA] levels, and microalbuminuria [MAU] in patients with type 2 diabetes [T2DM] and chronic kidney disease [CKD]

Subjects and Methods: A total of 1,463 patients with T2DM and CKD [aged 14-88 years], 927 females and 536 males, were included in this study. The serum data of 25-hydroxyvitamin D, i.e., 25[OH]D, level, SUA, hemoglobin [Hb]A1[c], creatinine, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio [UACR] were obtained from the medical records. The Mann-Whitney U test, the chi[2] test, the Mantel-Haenszel test, and linear regression models were used for data analysis

Results: Vitamin D deficiency and insufficiency were evident in 770 [52.0%] and 357 [24.0%] patients, respectively. Median HbA1[c] levels [7.3 [IQR 3.9] vs. 6.5 [IQR 2.3]%; p < 0.01] were significantly higher in patients deficient in vitamin D than in those with a normal vitamin D status. A significantly low level of vitamin D was noted with a high UACR [beta -0.01; 95% CI -0.01 to -0.001; p = 0.017] and HbA1[c] [beta -1.1; 95% CI -1.6 to -0.6; p < 0.001], but with low levels of SUA [beta 1.3; 95% CI 0.5-2.2; p = 0.002]. Vitamin D replacement was associated with a significantly low level of HbA1[c] [7.4 [2.7] vs. 6.7 [1.9]%; p < 0.001]

Conclusion: In this study, there was a high prevalence of hypovitaminosis D among T2DM patients with CKD, with a higher UACR, higher HbA1[c], and lower SUA being noted as playing a role in predicting a decrease in vitamin D levels and potential benefits of vitamin D replacement therapy on glycemic control in T2DM management

Co-existing proteinase 3-antineutrophil cytoplasmic antibody-associated vasculitis with immunoglobulin A nephropathy

No abstract available.

The role of neutrophil lymphocyte ratio to leverage the differential diagnosis of familial Mediterranean fever attack and acute appendicitis

BACKGROUND/AIMS: Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by attacks of fever and diffuse abdominal pain. The primary concern with this presentation is to distinguish it from acute appendicitis promptly. Thus, we aimed to evaluate the role of neutrophil lymphocyte ratio (NLR) to leverage the differential diagnosis of acute FMF attack with histologically proven appendicitis. METHODS: Twenty-three patients with histologically confirmed acute appendicitis and 88 patients with acute attack of FMF were included in the study. NLR, C-reactive protein and other hematologic parameters were compared between the groups. RESULTS: Neutrophil to lymphocyte ratio was significantly higher in patients with acute appendicitis compared to the FMF attack group (8.24 +/- 6.31 vs. 4.16 +/- 2.44, p = 0.007). The performance of NLR in diagnosing acute appendicitis with receiver operating characteristic analysis with a cut-off value of 4.03 were; 78% sensitivity, 62% specificity, and area under the curve 0.760 (95% confidence interval, 0.655 to 0.8655; p < 0.001). CONCLUSIONS: This study showed that NLR, the simple and readily available inflammatory marker may have a useful role in distinguishing acute FMF attack from acute appendicitis.

hepatitis C-positive patient with new onset of nephrotic syndrome and systemic amyloidosis secondary to common variable immunodeficiency

Common variable immunodeficiency [CVID] is a heterogenous group of predominantly antibody-deficiency disorders that make up the greatest proportion of patients with symptomatic primary hypogammaglobulinemia. The rare coincidence of amyloidosis and hypogammaglobulinemia has been reported previously. Contrary to the usual insidious, slowly progressive disease following hepatitis C infection, a rapidly progressive cirrhotic form can develop in hypogammaglobulinemic patients. We report a HCV-positive patient with a new onset of nephrotic syndrome and systemic amyloidosis secondary to CVID. Blood analyses showed serum creatinine of 1.8 mg/dL and serum albumin of 3.1 gm/dL; 24-h urinary protein was 11 800 mg/day. Serum immunoglobulin levels were IgG 340 mg/dL, IgM 18 mg/dL, IgA 11 mg/dL. Duodenal biopsy revealed AA-type amyloidosis with potassium permanganate and Congo red staining. After a month of antiproteinuric therapy, the proteinuria was reduced to 3350 mg/day