Ghrelin and obestatin levels in end-stage renal disease.

Malnutrition is fairly common in end-stage renal disease (ESRD) patients, persistent lack of appetite being a major symptom. Ghrelin and obestatin are two hormones that are involved in appetite and energy homeostasis. The present study examined ghrelin and obestatin levels in 24 ESRD patients undergoing haemodialysis and 24 age-matched healthy controls. Serum and saliva ghrelin and obestatin levels in the ESRD patients were significantly higher compared with controls, while saliva ghrelin and obestatin levels in all study participants were significantly higher than serum levels. Saliva ghrelin correlated with serum ghrelin and saliva obestatin correlated with serum obestatin in all study participants, although there was no correlation between ghrelin and obestatin levels. In conclusion, the results suggest that the kidneys may have a role in the metabolism and/or clearance of obestatin, as they do for ghrelin. Further studies are needed to determine if elevated levels of these hormones in ESRD patients contribute to the malnutrition that is common in these patients.

Hypokalemic quadriparesis associated with renal tubular acidosis in a patient with Sjögren's syndrome.

Sjögren's syndrome is an autoimmune exocrinopathy that involves both glandular and extra-glandular systems. We report a 25-year-old woman who had rapidly progressive quadriparesis. Biochemical investigations showed severe hypokalemia with hyperchloremic metabolic acidosis diagnosed as distal renal tubular acidosis. Salivary gland biopsy revealed Sjögren's syndrome as the underlying cause. She recovered following from quadriparesis potassium and alkali replacement.

Strict fluid volume control and left ventricular hypertrophy in hypertensive patients on chronic haemodialysis: a cross-sectional study.

Left ventricular hypertrophy (LVH) is very common in haemodialysis patients. We measured left ventricular mass in three groups of haemodialysis patients: group A (n = 40) were normotensive and receiving a strict salt-restricted diet; group B (n = 23) were normotensive and receiving anti-hypertensive drugs; and group C (n = 43) were hypertensive despite anti-hypertensive drug treatment. The interdialytic weight gain in group B and group C was significantly higher than in group A; the mean left atrial index and left ventricular end-systolic and end-diastolic diameter indices were all higher in group B than in group A. The interventricular septum and posterior wall were significantly thicker in group B and group C than group A, resulting in a higher left ventricular mass index. Left ventricular systolic and diastolic function parameters were slightly better in group A than in the other groups. These results show that strict fluid volume control decreases blood pressure, reduces dilated cardiac compartments and corrects LVH more effectively than lowering blood pressure without correcting the volume overload.

Octreotide reduces ischaemia-reperfusion injury in the retina.

PURPOSE: To investigate the role of octreotide on retinal lipid peroxidation and histopathological changes during ischaemia/reperfusion (I/R). METHODS: Three groups of seven pigmented guinea pigs each were formed. These represented a control group, an ischaemia group and an ischaemia/octreotide group. One eye of each animal was selected for histopathological evaluation and the other for biochemical assay. Bilateral pressure-induced retinal ischaemia was instigated for 90 min and was followed by 24 hours of reperfusion. Animals in the ischaemia/octreotide and ischaemia groups received either 10 micro g/kg of octreotide or saline, repeated five times at 6-hourly intervals, with the first dose administered 15 min prior to the ischaemic insult. Retinal malondialdehyde (MDA) levels and the thickness of the retinal layers were measured. These were compared with equivalent measurements of the control group. RESULTS: The mean MDA level increased in the ischaemia group (p < 0.01) but not in the octreotide group (p > 0.05). Significant increases in the thickness of the overall retina (p < 0.01), inner retina (p < 0.05) ganglion cell layer (p < 0.01) inner plexiform layer (p < 0.01) and inner nuclear layer (p < 0.01) were observed in the ischaemia group. No significant difference in thickness was found in any of the layers in the ischaemia/octreotide group. CONCLUSION: Octreotide reduces the increases in retinal MDA levels and retinal thickness observed during I/R.

Spontaneous cerebrospinal fluid rhinorrhea associated with chronic renal failure--case report.

A 39-year-old woman was admitted with complaints of headache and nasal discharge on the left for 3 months which was later on proved to be cerebrospinal fluid (CSF). Neurological examination found no abnormalities except bilateral papilledema. Neuroimaging demonstrated enlargement of the lamina cribrosa foramina through which the olfactory nerves pass, as well as empty sella and cerebral cortical atrophy. Bone mineral densitometry showed osteopenia. CSF Ca++ and blood parathyroid hormone levels were elevated. CSF pressure was 280 mmH2O. Bilateral frontal craniotomy was performed to expose the anterior fossa. Foraminal enlargement at the lamina cribrosa was confirmed, and islands of extra-osseous calcifications on the arachnoid membrane were identified. The base of the anterior fossa was repaired intradurally with fascial graft and fibrin glue on both sides. No CSF leakage was noted at 1-year follow up. Spontaneous CSF leakage probably resulted from enlargement of the foramina at the lamina cribrosa due to Ca++ mobilization from bones and pseudotumor cerebri not to the extent of hydrocephalus caused by poor CSF absorption at the arachnoid granulations obliterated by extra-osseous calcareous accumulation.

Effect of Octreotide on experimental corneal neovascularization.

PURPOSE: To examine the ability of subcutaneously administered Octreotide ( a long acting somatostatin analoque) to serve as an inhibitory agent for corneal neovascularization in eyes of Wistar Albino rats. METHODS: Neovascular growth into the corneas of all the animals was induced by silver nitrate cauterization. Half of the animals which were randomly selected for the Octreotide group received 30 micrograms systemic Octreotide for 7 days. The treatment was initiated on the same day as chemical cauterization. The rest of the animals (control group) received no treatment. Slit lamp and histopathologic examination of the corneas of both groups were performed at the end of the study period. RESULTS: It was observed that the corneal neovascularization and histopatologic scores of the Octreotide group were significantly lower than those of the control group (p < 0.001, p < 0.01). CONCLUSION: Systemic administration of Octreotide inhibits the corneal neovascular response in a rat model.

The effect of L-carnitine on insulin resistance in hemodialysed patients with chronic renal failure.

We investigated the effect of L-carnitine in seven patients, four female and three male (mean age 44.4 +/- 6.0 years) with chronic renal failure. Six patients, four female and two male (mean age 49.3 +/- 2.2 years) with chronic renal failure were given a placebo (0.9% sodium chloride) as control. After the basal data were obtained, patients received a single intravenous dose of L-carnitine (1 g) or placebo and two hours later insulin sensitivity was studied by the intravenous insulin tolerance test. No change was observed in biochemical data and K(itt) values in the placebo group. K(itt) increased significantly with carnitine (from 2.99 +/- 0.3 to 3.54 +/- 0.2%/min, p < 0.03) compared to the control group (p < 0.02). This result suggests that L-carnitine may improve the insulin resistance common among uremic patients.

Intravenous alfacalcidol improves insulin resistance in hemodialysis patients.

We have examined the effect of a four-week intravenous treatment with 1 alpha-hydroxyvitamin D3 on insulin sensitivity in 14 patients on chronic hemodialysis compared with 10 healthy control subjects by the insulin tolerance test. Compared to controls, the uremic patients have featured increased levels of parathyroid hormone (1085.0 +/- 822.1 vs 74.2 +/- 8.7 pg/ml, p < 0.001), insulin resistance (the rate constant for plasma glucose disappearance, K(in): 3.1 +/- 0.5 vs 4.5 +/- 0.4%/dk, p < 0.002), increased levels of insulin (30.5 +/- 7.3 vs 20.4 +/- 2.8 microIU/ml, p < 0.04) and increased levels of C-peptide (6.0 +/- 2.1 vs 3.9 +/- 12, ng/ml, p < 0.001). Following treatment with 1 alpha-hydroxyvitamin D3, levels of parathyroid hormone decreased from 1085.0 +/- 822.1 to 772.1 +/- 620.1 pg/ml (p < 0.004), the K(in) values increased significantly (from 3.1 +/- 0.5 to 4.1 +/- 0.4%/dk, p < 0.004) and reached the level near to that of controls, the insulin concentrations decreased from 30.5 +/- 7.3 to 28.7 +/- 9.2 microIU/ml (p > 0.05) and C-peptide concentrations increased from 6.0 +/- 2.1 to 7.5 +/- 2.5 ng/ml (p < 0.02). In summary, uremic patients with secondary hyperparathyroidism developed insulin resistance and hyperinsulinemia. Intravenous 1 alpha-hydroxyvitamin D3 treatment has improved insulin sensitivity directly or by reducing secondary hyperparathyroidism in uremic patients on chronic hemodialysis.

Renal blood flow detection with Doppler ultrasonography in patients with hepatic cirrhosis.

BACKGROUND: Hepatorenal syndrome, a well-recognized complication of established liver disease, is characterized by early renal vasoconstriction before clinically recognized renal disease. Renal vasoconstriction causes increased renal vascular resistance, which can be detected noninvasively by Doppler ultrasonography. OBJECTIVE: To detect early renal hemodynamic changes in patients with hepatic cirrhosis who had clinically normal renal functions. PATIENTS: Twenty patients with hepatic cirrhosis and ascites, 11 patients with hepatic cirrhosis without ascites, and 23 healthy control subjects. All cirrhotic patients had normal serum urea nitrogen and creatinine values. MAIN OUTCOME MEASURES: Peak systolic, peak diastolic, and mean flow velocities; pulsatile index; resistive index; and peak systolic velocity/peak diastolic velocity ratio as measured by renal Doppler ultrasonography. RESULTS: Peak diastolic flow velocity was significantly lower in cirrhotic patients with ascites than in cirrhotic patients without ascites and control subjects (P < .02 and P < .004, respectively), but the peak systolic flow velocity/peak diastolic flow velocity ratio (P < .007 and P < .001, respectively), pulsatile index (P < .007 and P < .001, respectively), and resistive index (P < .007 and P < .001, respectively) were significantly higher in cirrhotic patients with ascites than in cirrhotic patients without ascites and controls. CONCLUSION: Renal Doppler ultrasonography can noninvasively identify a subgroup of nonazotemic patients with hepatic cirrhosis who are at high risk for subsequent development of renal dysfunction and hepatorenal syndrome.

Short term reduction of left ventricular mass in primary hypertrophic cardiomyopathy by octreotide injections.

Growth factors have been shown to be associated with primary hypertrophic cardiomyopathy. Octreotide, a long acting somatostatin analogue, can prevent the stimulating effect of growth factors and decrease the left ventricular mass in patients with acromegaly. In the light of these results, three patients with primary hypertrophic cardiomyopathy were treated with subcutaneous octreotide (50 micrograms three times a day during the first week and 100 micrograms twice a day for the following three weeks). Initially, two patients were in New York Heart Association class II in and one was in class III. At the end of a four week treatment session all were in class I. There were significant decreases in left ventricular posterior wall thickness, interventricular septum thickness, and left ventricular mass in all three patients. Both left ventricular end diastolic and end systolic diameters had increased in all of the patients at the end of the fourth week. Two of three patients showed improved diastolic filling: their hyperdynamic systolic performance returned to normal. No side effects were observed during octreotide treatment. The considerable improvement obtained with the short term octreotide treatment in patients with primary hypertrophic cardiomyopathy seems promising.

Effect of topical apraclonidine on flow properties of central retinal and ophthalmic arteries.

To investigate the acute effects of topically administered 1% apraclonidine hydrochloride on blood velocity and resistance parameters of central retinal and ophthalmic arteries, the vessels were studied by color Doppler ultrasonography during baseline and at the time of peak effect of apraclonidine in 20 healthy volunteers. After medication, significant decrease in peak systolic, peak diastolic, mean flow velocities and increase in resistive and pulsatility indices of ophthalmic artery were observed. Blood velocity and resistance parameters of central retinal artery didn't change significantly. In conclusion, topically used apraclonidine was thought to change the blood velocity and resistance parameters of ophthalmic artery as a result of its local vasoconstrictory effect on the anterior segment branches of ophthalmic artery.