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.

Pathology teach and tell: central nervous system atypical teratoid/rhabdoid tumor.

Atypical teratoid/rhabdoid tumor (AT/RT) is extremely malignant, highly aggressive primitive central nervous systemneoplasm of infancy with very poor prognosis. Histologically, AT/RT is defined as a polymorphous neoplasm often featuring rhabdoid, PNET, mesenchymal, and epithelial components. We report the clinical history, radiological, and pathological findings in a child affected bycentral nervous system AT/RT.

Relationship between different body size indicators and hernia development in CAPD patients.

AIMS: A small body size may increase the risk for hernia development in patients on continuous ambulatory peritoneal dialysis (CAPD). The present study investigates whether there is a relationship between body size and hernia development in CAPD patients. MATERIAL AND METHODS: The records of 78 patients on CAPD were reviewed retrospectively. Body mass index (BMI), body surface area (BSA) and total body water (TBW) were calculated in all patients. Correlations between different body size indicators (BMI, BSA and TBW) and hernia development were assessed using analysis of covariance in which we adjusted for sex. RESULTS: A total of 14 patients (17.9%) with no physical evidence of hernia before catheter insertion developed hernias. Body size was significantly lower in CAPD patients with hernias than those without hernias when adjusted for sex. CONCLUSIONS: We conclude that patients with small body size tend to have an increased risk for hernia development. A simple estimation of patients' height, weight, body surface area and total body water would be helpful to predict development of hernias or other complications related to increased intraperitoneal pressure in CAPD patients.

Case report. Candida lusitaniae peritonitis in a patient on continuous ambulatory peritoneal dialysis.

We report a case of Candida lusitania peritonitis in continuous ambulatory peritoneal dialysis. Since fluconazole therapy was not successful in this patient, the peritoneal catheter was removed and antifungal therapy continued, and the patient was then converted to haemodialysis. This treatment protocol was successful. We suggest that early peritoneal catheter removal should be considered in such cases.

Horner's syndrome secondary to internal jugular catheterization.

We present three cases of people who developed Horner's syndrome following repeated attempts for catheterization of the internal jugular vein for hemodialysis. Any other neurologic finding or evidence of mass lesions in the neck or pulmonary apex could not be determined. Horner's syndrome should be considered a possible complication of percutaneous internal jugular vein catheterization for hemodialysis.

Patient to patient transmission of hepatitis C virus in hemodialysis units.

AIMS: In dialysis patients, blood transfusions and long-term dialysis are well known risk factors for transmission of hepatitis C virus. In this study the impact of use of dedicated hemodialysis (HD) units on the anti-HCV conversion rates was studied in patients of two different hemodialysis units in a city, Kayseri, between October 1995, and March 1999. MATERIALS AND METHODS: In the HD Unit of Erciyes University (HUEU), anti-HCV-positive and -negative patients were dialyzed on the dedicated machines in the same big room and seropositive patients for HBsAg in isolated rooms. In the HD Unit of Kayseri State Government Hospital (HUSH) only seronegative for anti-HCV and hepatitis B patients were treated. If a patient became positive, the patient was transferred to HUEU. Seventy-five patients have been receiving hemodialysis therapy in HUEU. Thirteen HBsAg-positive and 62 HBsAg-negative patients were dialyzed in separate rooms. Of 62 HBsAg-negative patients, 22 (35.5%) were already positive for HCV antibody when they started dialysis or before the study period. Forty seronegative patients (64.5%) for anti-HCV (23 males, 17 females) were treated with 22 anti-HCV-positive patients in the same room in HUEU. The mean duration of dialysis treatment was 24.7 +/- 21.0 months (range 4 to 96 months). Of the 40 patients, 28 (70%) became positive during the study period. Of 28 patients who became seropositive, 10 (35.7%) had a history of blood transfusion. Fifty-four patients (21 males, 33 females) were treated in HUSH during the study period. The mean duration of dialysis treatment was 19.3 +/- 9.6 months (range 5 41). Eight patients (14.8%) became anti-HCV-positive. Of these, 7 had received blood transfusion (88%). RESULTS: The seroconversion rate of patients in HUEU was higher than that of HUSH (odds ratio 3) (p < 0.05). Data derived from our patients showed that contamination appeared to be both transfusional and nosocomial and that there is a possibility of transmitting HCV infection in hemodialyzed patients never submitted to blood or blood products transfusion. Nosocomial spread of HCV in HD units which both seropositive and seronegative patients treated together was higher than that of dedicated unit. This is true even though we separated anti-HCV-positive dialysis machine.

Effects of long-term erythropoietin therapy on the hypothalamo-pituitary-testicular axis in male CAPD patients.

OBJECTIVE: Gonadal dysfunction has been recognized for a long time in uremic male patients. The present study assesses the hypothalamo-pituitary-testicular axis and growth hormone status in male continuous ambulatory peritoneal dialysis (CAPD) patients, before and after recombinant human erythropoietin (rHuEPO) therapy. DESIGN: Single-center prospective study. SUBJECTS: Ten anemic male patients with chronic renal insufficiency, and 11 healthy volunteers with normal renal function, matched for age, were included in the study. All patients were on CAPD therapy and none had received rHuEPO treatment previously. MAIN OUTCOME MEASURES: Blood samples were collected between 0800 and 0900 hr from all patients for the determination of basal follicle stimulating hormone (FSH), luteinizing hormone (LH), and growth hormone (GH) levels. A luteinizing hormone-releasing hormone (LH-RH) stimulation test was carried out using LH-RH 100 microg intravenous as a bolus injection. Blood for FSH, LH, and GH determinations was drawn every 30 minutes during the 3-hour test period. Human chorionic gonadotropin (hCG) test was performed after 48 hours. After estimations of basal serum total and free testosterone levels, 2000 IU hCG was administered intramuscularly and repeated 48 hours later. Total and free testosterone levels were measured in blood samples collected before and 48 hours after two injections of hCG. After improvement in anemia with exogenous rHuEPO, LH-RH and hCG tests were repeated. RESULTS: Baseline FSH concentrations before and after rHuEPO treatment were slightly higher in CAPD patients than in healthy volunteers (p = 0.85 and p = 0.70, respectively). Areas-under-the-curve (AUCs) for FSH secretion before and after rHuEPO treatment were also slightly higher in patients than in healthy volunteers (p = 1.00 and p = 0.75, respectively). The pretreatment basal LH levels in patients were significantly higher than in controls (p < 0.001). After the improvement in anemia with rHuEPO, serum LH levels declined significantly (p < 0.05). The AUCs for LH secretion before and after rHuEPO treatment were significantly higher in patients than in controls (p < 0.05). All patients had elevated basal levels of GH with paradoxical response to LH-RH. Baseline GH levels in patients were significantly higher than those in healthy subjects (p < 0.001) before rHuEPO treatment. After treatment with rHuEPO, basal GH levels declined but did not normalize, and baseline levels of free testosterone increased significantly (p < 0.05). CONCLUSION: Anemic uremic male patients on CAPD have normal levels of testosterone with normal response to hCG administration, elevated basal levels of GH, and elevated basal levels of LH, with exaggerated response to LH-RH administration. Improvement in anemia with rHuEPO reduced the basal levels of LH and GH, but exaggerated the LH response; paradoxical GH response to LH-RH administration persisted. These results indicate a defect at the level of the hypothalamus and pituitary gland in uremic male patients undergoing CAPD, and that the improvement in anemia with rHuEPO partially restores some of these endocrine abnormalities.

Transformation of hepatitis B virus-related membranous glomerulonephritis to crescentic form.

We report a case of hepatitis B virus-(HBV) related membranous glomerulonephritis which progressed to crescentic transformation after withdrawal of immunosuppressive treatment. Immunosuppressive therapy probably enhanced HBV replication, and its withdrawal led to a return of immune competence resulting in progression of the glomerulonephritis. Prior screening of all patients for hepatitis B surface antigen, before using immunosuppressive therapy may prevent this complication. The usage of immunosuppressive therapy as a first-line choice in HBV-related glomerulonephritis may result in harmful complications.

Granulomatous interstitial nephritis in extrapulmonary sarcoidosis.

Sarcoidosis is a multisystem disorder in which the lungs or intrathoracic lymph nodes are involved in more than 90% of patients with the disease. It occasionally involves kidneys most commonly due to disordered calcium metabolism. Granulomatous interstitial nephritis is a distinct renal pathology in sarcoidosis. Renal dysfunction due to granulomatous interstitial nephritis is rare. We recently encountered a sarcoidosis patient without hypercalcemia and any evidence of pulmonary involvement which is distinctly unusual.

The prevalence of thyroid dysfunction among elderly subjects in an endemic goiter area of Central Anatolia.

The prevalence of thyroid dysfunction in the elderly is reported to be markedly high, at least in some Western countries in which iodine intake is sufficient or increased because of recent supplementation of iodine for public health. We therefore wished to investigate the prevalence of thyroid dysfunction among elderly people in an endemic goiter area. The study included 198 subjects over the age of 55 years. It was carried out in two towns 20-30 km, south of Kayseri, Central Anatolia. Questioning on medical history, physical examination and grading of thyroid gland size were performed. Serum TSH was measured by a sensitive immunoradiometric assay. Serum free thyroid hormones and thyroid autoantibodies were measured in the subjects with TSH concentrations below 0.4 mu IU/ml or above 4.5 mu IU/ml on the initial screen. Drinking water was also analysed for iodine content. Twenty-five (12.6%) subjects had either elevated (6.5%) or suppressed (6.1%) serum TSH levels. No patient had clinical hypothyroidism (high TSH and low free thyroxine and free triiodothyronine). Three (1.5%) subjects had clinical hyperthyroidism (low TSH and high free thyroxine and free triiodothyronine). Only one subject was positive for antimicrosomal and antithyroglobulin antibodies. The prevalence of goiter was 25.8%. The iodine level in drinking water was found to be 3 micrograms/L. In conclusion, we believe that the prevalence of thyroid dysfunction in the elderly may depend on the iodine status in the environment. We think that hyperthyroidism due to multinodular goiter is more important than hypothyroidism for elderly people living in an endemic goiter area, probably due to the low frequency of autoimmune thyroid disorders.