Analyses of subjects with hypokalemic metabolic alkolosis, Gitelman's and Bartter's syndrome.

The two most common forms of inherited normotensive hypokalemic metabolic alkalosis are Bartter's and Gitelman's syndromes. Bartter's is mostly seen in children, while Gittelman's is mostly seen in adolescents and adults. We analyze three subjects of adult-onset Gitelman's and Bartter's syndrome. The patients applied to our hospital due to severe hypokalemia with little clinical expression (paresthesia, cramp, polyuria, polydipsia, and/or weakness). All had normal blood pressure, hypokalemia, hyperreninemic hyperaldosteronism, and a decrease in the fractional chloride reabsorption. Key elements in differential diagnosis of chronic hypokalemia are blood pressure assessment, acid base equilibrium, serum calcium concentration, and 24-hour urine potassium and calcium excretion.

A rare complication of idiopathic membranous nephropathy: crescentic transformation.

INTRODUCTION: In this study, the cause of rapidly deteriorating renal functions in a follow-up period of a 65-year-old female patient, who applied with nephrotic syndrome findings and diagnosed as membranous nephropathy, is presented. CASE REPORT: A 65-year-old patient with findings of nephrotic syndrome had normal kidney size and serum complement level, and was negative for autoantibodies and viral serology. In histopathologic examination, 20 glomeruli were consistent with membranous glomerulonephritis. The patient, evaluated for idiopathic membranous nephropathy, was followed-up monthly with supportive treatment. In the second month of follow-up, a re-evaluation of the patient due to nausea and urine discoloration revealed 144 mg/dL urea, 6.3 mg/dL creatinine, and 2.5 g/dL albumin. Urine sediment revealed dysmorphic erythrocytes and granular silenders. Renal re-biopsy was done. Of 11 glomeruli, three global sclerosis and eight crescentic glomeruli with fibrosis and scarce cellular component were seen. The case was accepted as crescentic glomerulonephritis, a rare complication of idiopathic MN. Before the treatment, antiGBM, pANCA, cANCA, and ANA were negative. Pulse metil prednisolone and pulse cyclophosphamide treatment protocol was administered. Hemodialysis was needed nine times. At the end of first month of the treatment, hemodialysis was no longer needed. CONCLUSION: Due to a risk of spontaneous remission up to 30% of membranous nephropathy, there is no consensus on specific treatment applicable to all cases. However, crescentic GN should be investigated immediately when sudden and rapid deterioration of renal functions appeared.

Effects of different doses of hyperbaric oxygen on cisplatin-induced nephrotoxicity.

Cisplatin, an effective antineoplastic agent, frequently induces acute renal failure in animals and humans. Hyperbaric oxygen (HBO) has been shown to prevent cisplatin-induced nephrotoxicity in rats. This study investigated the effect of two different HBO regimes on renal functions, oxidative stress, and histopathological changes in rat kidneys after cisplatin treatment. Wistar rats were divided into five groups: control, HBO, cisplatin, cisplatin plus once daily HBO, and cisplatin plus twice daily HBO. Cisplatin was given as a single intraperitoneal dose of 6 mg/kg, and HBO was applied for 60 min at 2.5 atm for six days. HBO alone did not alter any biochemical parameters or histopathological findings compared with the control group. Cisplatin increased serum urea and creatinine levels and caused severe histopathological injury. In addition, cisplatin increased lipid peroxidation and impaired superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities in kidney tissue. Once daily HBO after cisplatin treatment slightly reduced serum urea and creatinine levels and attenuated histopathological injury. HBO also reduced lipid peroxidation and increased SOD and GSH-Px activities significantly. Although twice daily HBO was determined to be more effective than once daily HBO on oxidative stress parameters, it increased serum creatinine levels and histopathological injury compared with the cisplatin group. It was concluded that HBO alone does not induce nephrotoxicity and oxidative stress in rat kidneys; once daily HBO may prevent cisplatin-induced nephrotoxicity, an effect that is partially mediated by the modification of oxidant/antioxidant systems in the kidneys; and twice daily HBO potentiates cisplatin nephrotoxicity by a ROS-independent mechanism.

Effect of hyperbaric oxygen on cyclosporine-induced nephrotoxicity and oxidative stress in rats.

Reactive oxygen species have been suggested to be involved in cyclosporine nephrotoxicity. Hyperbaric oxygen is known to induce the generation of reactive oxygen species in tissues. The aim of this study was to investigate whether the use of hyperbaric oxygen concurrently with cyclosporine potentiates cyclosporine nephrotoxicity by inducing oxidative stress in kidneys. The study consisted of four groups of rats: a control group, a cyclosporine group (15 mg/kg/day intraperitoneally for 14 days), a hyperbaric oxygen group (60 min. every day for five days at 2.5 atmosphere absolute), and a cyclosporine + hyperbaric oxygen group (cyclosporine 15 mg/kg/day intraperitoneally for 14 days + hyperbaric oxygen for 60 min at 2.5 atmosphere absolute every day for five days on the last five days of cyclosporine treatment). Oxidative stress was determined by measuring renal thiobarbituric acid-reactive substances content, renal superoxide dismutase, and glutathione peroxidase activities. Cyclosporine increased serum urea and creatinine levels, indicating the development of nephrotoxicity, and induced significant oxidative stress in rat kidneys. Hyperbaric oxygen alone did not alter any of the biochemical and oxidative stress parameters compared to the control group. When used concurrently with cyclosporine, hyperbaric oxygen significantly reduced cyclosporine-induced oxidative stress, but it neither attenuated nor aggravated cyclosporine-induced nephrotoxicity. These results suggest that reactive oxygen species are involved in cyclosporine nephrotoxicity, but are not the direct cause of the toxicity. Although concurrent use of cyclosporine and hyperbaric oxygen did not exacerbate cyclosporine nephrotoxicity in this model, we recommend that the renal functions of patients be monitored periodically when these treatments are used concurrently.

Relationship between P-wave dispersion and effective hemodialysis in chronic hemodialysis patients.

OBJECTIVE: To investigate whether or not P-wave dispersion (PWD) can be used as a good indicator of effective hemodialysis. SUBJECTS AND METHODS: The study included 35 patients (20 males, 15 females, mean age 61 +/- 10 years) who regularly received hemodialysis treatment for chronic renal failure. Following hemodialysis, the patients whose hemodynamic parameters were preserved and who reached dry body weight were included. Twelve-lead resting electrocardiogram (ECG) at a speed of 25-50 mm/s, the value of total body fluid (TBF) and bioelectric impedance using bipedal bioelectric impedance equipment were obtained before and immediately after hemodialysis. Blood samples were also taken for the assessment of blood electrolytes, urea and creatinine. PWD was defined as the difference between the maximum and minimum P-wave duration calculated on a standard 12-lead ECG before and after dialysis. RESULTS: The following parameters were obtained before and after hemodialysis: blood pressure 132 +/- 21 vs. 130 +/- 10 mm Hg (p > 0.05), TBF 33.9 +/- 6 vs. 32 +/- 5.6 liters (p = 0.001), impedance 499 +/- 110 vs. 596 +/- 136 Omega (p = 0.001), P-max 103.1 +/- 8.9 vs. 106.3 +/- 12.7 ms (p > 0.05), P-min 70.2 +/- 11 vs. 72.5 +/- 7.9 ms (p > 0.05), PWD 32.2 +/- 11.9 vs. 33.8 +/- 13.4 ms (p > 0.05). Although statistically significant decreases were observed in urea and creatinine levels after hemodialysis, no such changes were observed in blood electrolytes. CONCLUSION: The P-max and PWD did not change significantly after hemodialysis, hence these two parameters can be used as an indicator of effective hemodialysis.

Hyperbaric oxygen therapy attenuates renal ischemia/reperfusion injury in rats.

OBJECTIVE: Renal ischemia/reperfusion (I/R) injury occurs in both native and transplanted kidneys. Hyperbaric oxygen (HBO) has been shown to prevent I/R injury in different tissues. The aim of this study was to evaluate the effect of HBO on renal I/R injury in rats. MATERIALS AND METHODS: Sprague-Dawley rats were randomly assigned to one of three groups. The Control group (n = 6) received right nephrectomy. The I/R (n = 6) and I/R+HBO groups (n = 6) received 30 min left renal ischemia followed by 24 h of reperfusion after right nephrectomy. The I/R+HBO group (n = 6) received additional HBO therapy for 60 min at 2.5 absolute atmospheres starting at the initial 15th minute of reperfusion. RESULTS: In the I/R group, blood urea nitrogen (BUN) and creatinine levels increased significantly compared with the Control and I/R+HBO groups (p < 0.05). BUN and creatinine levels were similar in the Control and I/R+HBO groups. Kidney samples from I/R group rats revealed severe tubular damage and neutrophil infiltration at histopathological examination. The animals treated with HBO showed markedly improved lesions and less neutrophil infiltration compared with the I/R group (p < 0.05). CONCLUSIONS: HBO exhibited marked protection against I/R injury in this study as measured using BUN and creatinine levels and renal histopathology. However, further studies are needed to clarify the renoprotective effect of HBO on I/R injury.

Leptospirosis in Istanbul, Turkey: a wide spectrum in clinical course and complications.

Patients with high fever and multiorgan involvement were investigated for the determination of frequency, clinical course and complications of leptospirosis in Istanbul. Leptospirosis was determined in 22 cases among the 35 hospitalized patients that were pre-diagnosed as leptospirosis according to 'Probable Leptospirosis Diagnosis and Follow-up' form. Among the leptospirosis cases 19 were male and 16 were military staff. Mean age was 35.6 y. Dark field examination (DFE), latex agglutination test (LAG), ELISA IgM, leptospirosis culture (LC) and microscopic agglutination test (MAT) were performed to confirm the diagnoses. The most frequent initial symptoms and findings were fever, fatigue, headache, nausea-vomiting and increased muscle sensitivity. Jaundice was noted only in 2 cases. A 74-y-old female patient died after the recurrence of the disease with severe rhabdomyolysis and pulmonary failure. Sagittal sinus thrombosis, perimyocarditis and chronic renal failure were major complications in another 3 patients. ELISA IgM, LC, DFE, LAG and MAT tests were positive in 68, 72, 82, 100 and 100% of the patients, respectively. As a conclusion, diagnosis of leptospirosis is usually overlooked. Clinical awareness, use of probable leptospirosis diagnosis forms and the application of different laboratory methods in the diagnosis of suspected cases may offer the chance to diagnose the leptospirosis accurately.

The role of prolidase activity in the diagnosis of uremic bone disease.

The derangements in bone metabolism in patients with chronic renal failure (CRF) are summarized as uremic bone disease (UBD). In this study, we planned to determine the serum prolidase to compare it with the other biochemical markers. This study was performed on 44 patients (19 females, 25 males, mean age = 56.8 +/- 15.6 years) with endstage renal disease (ESRD). The patients were divided into three groups according to serum bone alkaline phosphatase (bAP) levels. The patients whose bAP was > or =77 U/L were accepted as having high-turnover UBD (n=18), the patients whose bAP was < or =50 U/L were accepted as having low-turnover UBD (n=14), and the patients whose bAP levels were between these two values were accepted as having bone disease with normal turnover (n=12). The serum prolidase levels did not increase in patients with ESRD. There were no significant differences between the serum prolidase levels of patients according to types of the UBD (p > 0.05). Kidney is the most prolidase-rich tissue of the human body. The serum prolidase activity is low in all patients with ESRD, irrespective of the type of UBD. Therefore, we concluded that prolidase had no value in the diagnosis of UBD.

Risk factors for the infections caused by temporary double-lumen hemodialysis catheters.

BACKGROUND: Temporary hemodialysis catheters are important devices used in dialysis practice but may be the source of infection in hemodialysis patients. METHODS: We investigated the infectious complications in 70 hemodialysis patients using 113 hemodialysis catheters. RESULTS: The frequency of catheter-related bacteremia was 23.9%, of which Staphylococci were the most frequently growing organism (96.3%). Exit-site infection was observed in one patient. No cases were lost due to the infectious complications. The risk for the development of catheter-related bacteremia was increased after the 24th day of catheterization and after the second venous puncture. CONCLUSIONS: There was a positive correlation between hypoalbuminemia and bacteremia. Internal jugular venous catheterization and hypoalbuminemia were determined as risk factors for the development of catheter-related bacteremia. The risk factors for catheter-related bacteremia in patients with hemodialysis catheter should be determined and modified in order to decrease infectious complications.

Investigation of the effect of hyperbaric oxygen on experimental cyclosporine nephrotoxicity.

Hyperbaric oxygen interacts with drugs which patients use concurrently with hyperbaric oxygen treatment, which may cause in potentiation or inhibition of both therapeutic and toxic effects. We examined the effect of hyperbaric oxygen therapy on experimental cyclosporine A nephrotoxicity. The study comprised four groups of rats: a control group, a cyclosporine A group (25 mg/kg/day intraperitoneally for four days), a hyperbaric oxygen group (60 min. every day for four days at 2.5 atmospheric pressure), and a cyclosporine A+hyperbaric oxygen group (CsA 25 mg/kg/day intraperitoneally for four days+hyperbaric oxygen for 60 min. every day for four days at 2.5 atmospheric pressure). Hyperbaric oxygen did not alter biochemical parameters. Cyclosporine A increased serum urea and serum creatinine levels and decreased creatinine clearance. In the cyclosporine A+hyperbaric oxygen group serum urea level increased more than in the cyclosporine A group. Cyclosporine A increased tubular epithelial cell apoptosis and necrosis score values. The numbers of apoptotic cells in proximal tubule epithelial cells in the cyclosporine A+hyperbaric oxygen group were significantly higher than those of the cyclosporine A group. We recommend that renal functions of the patients receiving cyclosporine A should be monitored during hyperbaric oxygen therapy.

Familial mediterranean fever-related nephrotic syndrome and successful full-term pregnancy.

Familial Mediterranean fever (FMF) is a systemic disease with an autosomal recessive inheritance. The most serious complication of FMF is renal amyloidosis. Pregnancy may adversely affect renal function in FMF patients with amyloidosis and nephrotic syndrome. A 20-year-old woman with FMF related nephrotic syndrome became pregnant while receiving colchicine therapy. Colchicine treatment was continued during pregnancy with close observation. She gave birth to a 2400 g healthy female newborn at the 38th week of gestation. Pregnancy and neonatal outcome were uneventful. It is advisable to continue colchicine treatment during conception and pregnancy in FMF patients with amyloid related nephrotic syndrome. Colchicine treatment with bed rest, protein reinforcement, acetylsalicylic acid administration and close follow-up may improve the outcome of pregnancy in FMF patients.

Ulcerative necrosis of the glans penis resulting from polyarteritis nodosa.

Polyarteritis nodosa (PAN) may be systemic or isolated in distribution and may involve virtually any organ or tissue in the body. We report an unusual case of PAN with the clinical features of both penile and renal involvement in a 21-year-old man diagnosed incidentally by pathologic examination of the nephrectomized left kidney. Systemic and surgical therapeutic procedures were applied and his symptoms resolved within 6 weeks. Penile ulceration is a rare but serious manifestation of PAN that needs prompt and aggressive treatment.

Renal arteriographic data of young male patients with suspected renovascular hypertension.

The aim of the study was to determine whether the anatomical variant in which one or more renal vessels arose from the aorta was associated with hypertension in young male patients. We investigated the renal arteriographic data of 73 young male patients (age: 27.4 +/- 7.4, blood pressure: 162.7 +/- 17.5/104.6 +/- 10.1 mmHg) with grade-II hypertension. All studied patients underwent angiography to exclude renal artery stenosis. The patients were divided into two groups on the basis of their renal angiograms. We determined no abnormal findings in 33 renal arteriograms (45.2%). Twenty three (31.5%) patients had an additional renal artery without renal artery stenosis or renal anatomical variations. In conclusion, although the significance of this form of hypertension is still largely obscure, we believe that the presence of additional renal arteries may be associated with hypertension.

Investigation of the role of hyperbaric oxygen therapy in cisplatin-induced nephrotoxicity in rats.

Cisplatin (CP) is an effective chemotherapeutic agent used in the treatment of a variety of solid tumours. The most frequently observed side-effect of the use of CP is nephrotoxicity. Recently, evidence has been demonstrated that reactive oxygen species forming in the tubular epithelium play an important role in CP-linked nephrotoxicity. The aim of the study was to observe the effect of hyperbaric oxygen (HBO) therapy on CP nephrotoxicity, a subject which has not been studied previously. Wistar rats were treated with CP (a single intraperitoneal (IP) dose of 0.6 mg/100 g) alone and in combination with HBO (60 min every day for seven days at 2.5 x atmospheric pressure). Effects of the treatment on renal function and histology were determined. In analyses at the end of the study it was observed that serum urea, creatinine, and daily urinary protein excretion levels of the CP group were higher than at the start of the study, and that the creatinine clearance level had fallen (P < 0.05). There was no significant difference between the CP+HBO group and HBO group serum urea, creatinine, creatinine clearance, and daily urinary protein excretion levels at the beginning and end of the study (P > 0.05). Histopathological examination showed that the necrosis score in the proximal tubule epithelial cells and average apoptitic cell numbers in the CP group were higher than those in the CP+HBO and HBO groups (P < 0.05). There was no statistical difference between the CP+HBO group and the HBO group in terms of necrosis score in the proximal tubule epithelial cells and the percentage of distal tubules containing hyaline casts in the lumen. In conclusion, in this study it was observed that in experimental study of CP nephrotoxicity the synchronous application of HBO therapy with CP prevents kidney damage.