Is It Safe to Initiate Peritoneal Dialysis Treatment Immediately After Percutaneous Catheter Placement?

In this retrospective study, the safety of initiating peritoneal dialysis (PD) immediately after percutaneous PD catheter insertion was evaluated. Patients who underwent peritoneal catheter insertion and then immediately began dialysis treatment were included in the study. Patient age, sex, treatment modalities, and method of catheter insertion were recorded.Acute PD was performed in 33 patients (age: 57.7 ± 16.7 years; 21 men, 12 women). Catheters were inserted percutaneously in 28 patients and surgically in 5 patients. The PD modalities used were continuous ambulatory PD in 18 patients, automated PD in 11 patients, and both modalities in 4 patients. Acute PD was started within 24 hours of catheter insertion. Leaks occurred in 8 patients who had catheters inserted percutaneously (28.5%). Peritonitis occurred in 1 patient. No complications were observed in 24 patients. Leaks were fully resolved for patients kept in a supine position, with fill volumes reduced to 500 mL - 700 mL and the dwell period decreased to 60 minutes from 120 minutes. Leaks were not observed in the patients when the fill volume was increased by 200 mL and the dwell period was increased by 30 minutes every 2 days to reach 1300 mL and 180 minutes by the 7th day.Immediate-start dialysis after percutaneous peritoneal catheter insertion seems safe when performed in a supine position with low-volume exchanges and short dwell times.

A Rare Complication During Percutaneous Peritoneal Dialysis Catheter Insertion: Intravesical Placement.

Peritoneal dialysis (PD) is one of the treatment options for patients with end-stage renal failure. To start PD treatment, a catheter must be placed for access to the abdominal cavity, and it can be placed using surgical, laparoscopic, or percutaneous methods. However, complications can develop during catheter placement.In the present case report, we describe a patient in whom treatment was pursued after an unusual complication rarely mentioned in the literature: a dialysis catheter accidentally inserted percutaneously into the bladder. Under ultrasonography guidance, the catheter was pulled from the urinary bladder and pushed into the intra-abdominal cavity. No complications resulted from the procedure, and the patient proceeded to PD treatment. This case is, to our knowledge, the only such report in the literature.

Treatment of a Dialysate Leak by Simultaneous Catheter Removal and Replacement in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis.

Continuous ambulatory peritoneal dialysis (PD) is one of the treatment methods used for end-stage renal failure. When mechanical complications occur with this treatment method, methods such as tomographic peritoneography, abdominal scintigraphy, and magnetic resonance peritoneography are used to uncover the problem. Here, we report the detection by tomographic peritoneography of a subcutaneous dialysate leak in a patient undergoing PD. The PD catheter was subsequently removed, and a new catheter was inserted. The patient then restarted continuous ambulatory PD without any problem.

The relationship between neutrophil-to-lymphocyte ratio and albuminuria in type 2 diabetic patients: a pilot study.

INTRODUCTION: Diabetes mellitus (DM) has become a global economic burden due to treatment costs and attendant complications. Albuminuria is the precursor of end stage renal failure and is an inflammatory process. In the recent past, it has been reported that the neutrophil/lymphocyte ratio (NLR), which is a cost-effective and accessible marker, may be a favorable indicator of the inflammatory status. The aim of this study was to investigate the relationship between the neutrophil/lymphocyte ratio and the presence and level of diabetic nephropathy (DN). MATERIAL AND METHODS: A total of 112 patients with type-2 DM who were followed by our internal medicine and nephrology clinics between February 2013 and June 2014 were included in this pilot study and were retrospectively evaluated. All participants had a 24-hour urinary albumin excretion (UAE) record. Demographic parameters, biochemical parameters and albuminuria levels were recorded. Patients were divided into three groups according to their level of albuminuria. RESULTS: Significant differences were detected between the groups in terms of NLR (p < 0.001). There was a linear increase in NLR in parallel to the increase in 24-hour UAE mean values (p < 0.001). A positive correlation was detected between NLR and C-reactive protein, urea, creatinine, and red cell distribution width. However, 24-hour UAE was negatively correlated with lymphocyte count (p < 0.001). CONCLUSIONS: A high degree of correlation was determined among albuminuria, glomerular filtration rate and NLR levels. These results may suggest the notion that diabetic nephropathy involves an inflammatory process.

Oral yeast colonization in peritoneal dialysis and hemodialysis patients and renal transplant recipients.

OBJECTIVE: We aimed to investigate the frequency of oral yeast colonization (OYC) and the risk factors for patients who received continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (HD) or were renal transplant recipients (RTRs). The patients admitted to the Nephrology Clinic at Ataturk University Medical School from January through April 2013 were included in the study. A questionnaire about risk factors was filled out, and swab cultures were taken from the tongue surface of each participant. OYC was detected in 32.1% of the RTRs, 40% of the HD patients, 20.9% of the CAPD patients, and 18% of the healthy control (HC) group. Of the 42 yeast strains isolated from the renal replacement therapy groups, 26 strains (61.9%) were Candida albicans, nine (21.4%) were Candida glabrata, two (4.7%) were Candida krusei, two (4.7%) were Candida kefyr, one (2.38%) was Candida parapsilosis, and two (4.7%) were Geotrichum candidum. Risk factors for OYC in the RTRs group included antibiotic use and the presence of dental prostheses; however, in patients with chronic renal failure undergoing CAPD, only the presence of dental prostheses was found to be a statistically significant risk factor. Although OYC was mostly detected in patients with chronic kidney disease (undergoing HD, a variety of isolated yeast strains in the RTRs was noted. The rates of OYC and isolated Candida species in CAPD were similar to those of the HC group.

Evaluation of nasal mucociliary activity in patients with chronic renal failure.

The ability of respiratory mucosal surfaces to eliminate foreign particles and pathogens and to keep mucosal surfaces moist and fresh depends on mucociliary activity. Chronic renal failure (CRF) is an irreversible medical condition that may result in important extrarenal systemic consequences, such as cardiovascular, metabolic, and respiratory system abnormalities. Although there are studies describing nasal manifestations of CRF, data are lacking concerning the effects of the condition on nasal mucosa. The goal of the current study was to evaluate nasal mucociliary clearance (NMC) time in patients with CRF. This prospective cohort study conducted in a tertiary referral center included 32 non-diabetic end-stage CRF patients and 30 control individuals. The control group consisted of voluntary participants who had been referred to our clinic for symptoms other than rhinological diseases. The mean NMC times in CRF patients and control individuals were 12.51 ± 3.74 min (range 7-22 min) and 8.97 ± 1.83 min (range 6-13 min), respectively. The mean NMC time in patients with CRF was significantly longer than that in control individuals (p < 0.001). Clinicians must keep in mind that NMC time in CRF patients is prolonged and must follow-up these patients more closely for sinonasal and middle ear infections.

Serum lipid levels in patients with minor recurrent aphthous ulcers.

PURPOSE: To evaluate the possible association between minor recurrent aphthous ulcers (RAUs) and plasma lipid levels. METHODS: 85 patients (50 female, 35 male) with minor RAUs and another 80 patients (52 female, 28 male) without minor RAUs were included in the study. Body mass index (BMI), hemoglobin (HB), white blood cells (WBCs), platelets (PLT), glucose (GL), total cholesterol (TCH), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), creatinine (CR), alanine transaminase (ALT), and aspartate transaminase (AST) levels, as well as the gender and age of the patients in the groups were compared. RESULTS: Cumulative evaluation showed that HDL was statistically higher in the control group (P < 0.05). Except for WBCs, PLT, TG, and ALT, all parameters were significantly higher in the study group (P < 0.05). Correlations between minor RAUs and investigated parameters were observed with age, BMI, HB, GL, CR, TCH, HDL, LDL, and AST (P < 0.05). If gender was considered and the groups were compared, the greatest differences were seen between the female study group and the female control group (age, BMI, HB, GL, CR, TCH, TG, LDL, ALT; P < 0.05). Correlations were mostly observed between minor RAUs and parameters within the female group (P < 0.05).

Tear function in patients with chronic renal failure undergoing hemodialysis.

OBJECTIVES: To evaluate dry eye symptoms and clinical tear film alterations in patients with chronic renal failure (CRF). MATERIALS AND METHODS: Thirty-five non-diabetic CRF patients undergoing hemodialysis, and 31 healthy individuals were enrolled. An ocular surface disease index questionnaire (OSDI) was administered, and after a complete ocular examination, Schirmer and tear break-up time (TBUT) tests were performed. RESULTS: OSDI scores were significantly higher (p<0.01) and TBUT tests were significantly lower (p=0.01) in CRF patients than in the control group. Schirmer test results were also lower in the CRF patients group, but lacked statistical significance (p=0.20). CONCLUSION: Patients with CRF should be advised to obtain an ophthalmic examination, especially for dry eye.

Combined immune thrombocytopenic purpura and immunoglobulin A nephropathy: a similar pathophysiologic process?

IgA nephropathy is one of the most common forms of glomerulopathies. It is an immune complex-mediated glomerulonephritis diagnosed by the presence of mesangial IgA deposits that are often associated with mesangial cell proliferation. The IgG, C3, IgM, or other immunoglobulin light chains may be co-existed with IgA. Its pathogenesis suggested that it is responsible for enhancing the production of proinflammatory cytokines, chemokines, and growth factors. Platelet-derived growth factor (PDGF) has also been implicated as a modulator of disease activity. Immune thrombocytopenic purpura (ITP) is a bleeding disorder caused by thrombocytopenia that is not associated with a systemic disease. Its pathogenesis suggested an autoimmune disease in which IgG is thought to damage megakaryocytes, which are the precursors of platelet cells. Several studies reported that PDGF levels were higher in normal subjects than in patients with ITP. Moreover, ITP is a disease related to the antibody. Thus, our aim is to examine whether a similar pathophysiological relationship exist between ITP and IgAN that may be mediated by PDGF and/or IgG.

Does decreased mean platelet volume predict inflammation in chronic renal failure, dialysis, and transplanted patients?

OBJECTIVES: Increased platelet activation contributes to cardiovascular mortality in chronic kidney disease patients (CKD). Larger platelets are more active and this increased activity had been suggested as a predictive biomarker for cardiovascular disease. In this study, we aimed to evaluate mean platelet volume (MPV) as an inflammatory marker in a broadened group of CKD patients. Our study is unique in literature as it covers all types of CKD including renal replacement therapies. MATERIALS AND METHODS: 200 patients (50 renal transplanted, 50 hemodialysis, 50 peritoneal dialysis, 50 chronic renal failure stages 3-4) were investigated who were between 18 and 76 years of age. The collected data included demographic properties, platelet count, MPV, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and hemoglobin. All of the patients had at least 12 month of therapy of either renal replacement modality. RESULTS: The mean CRP value was detected statistically significantly higher in hemodialysis (HD) patients compared to the resting three groups of patients (p < 0.01). Mean CRP level was detected significantly higher in the pre-dialysis group compared to transplanted and peritoneal dialysis (PD) patients (p < 0.01). There is no statistically significant difference detected among the mean MPV values of all patient groups (p > 0.05). CONCLUSIONS: ESR and CRP were significantly increased in hemodialysis patients compared to the other groups. We did not detect a significant difference among MPV between the groups. ESR was detected lowest in transplanted patients. Transplantation is coming forward as the favorable choice of renal replacement therapy which decreases inflammation.

Investigation of features of patients in renal transplantation waiting list: Who wants much more of what for renal transplantation?

BACKGROUND AND OBJECTIVE: Renal transplant is the best form of treatment for most patients with end-stage renal disease (ESRD), because that therapy improves quality of life, prolongs survival, and is cost-effective. The objective of the study being reported was to compare the sociodemographic characteristics and registration status for renal transplantation of ESRD patients in Turkey who were registered for transplant or not. METHODS: The study was conducted between June and September 2012 on patients of several Dialysis Centers. They all were informed in a one on one interview about the risks and benefits of renal transplants; they were also asked to fill out the questionnaires given to them. The study questionnaire was designed with the help of already published reports to include among others the patient's age, sex, waiting time and educational status. RESULTS: Patients who had been registered in the cadaver kidney waiting list were aged 43.85±13.48 in the average, with a balanced sex ratio, average dialysis duration 57.30±51.46 months. Of these patients 45 had finished high school, 87 lived in rural areas and 67 had an income equivalent to expenses. CONCLUSION: There was a significant difference among the groups depending on the patients' residence in an urban or rural environment. Such a difference might be following the greater ease of obtaining relevant information in the urban areas.

The biochemical and histopathological investigation of amlodipine in ethylene glycol-induced urolithiasis rat model.

BACKGROUND: Urinary calculi are a common and severe problem, which are formed by urolithiasis or by the formation of calcium oxalate (CaOx) crystals in the kidneys. Many treatment options such as drugs, various herbal preparations, surgical removal of the stones, and extracorporeal shock wave lithotripsy have been applied for this condition. The aim of this study is to assess the effects of the drug amlodipine in an experimentally induced urolithiasis rat model. MATERIALS AND METHODS: The effect of 5 mg/kg amlodipine was studied in rats that were first treated with 1% ethylene glycol and 1% ammonium chloride for 21 days to induce urolithiasis. The weight differences and the levels of calcium, magnesium, and phosphate were measured in serum and urine. In addition, urine CaOx level was defined and histopathological analyses were performed on the kidneys. RESULTS: Urolithiasis caused a significant increase in both serum and urine parameters compared with healthy rats. Urolithiasis plus amlodipine administration increased the levels of these same parameters. Urine CaOx level was high in urolithiasis rats and was also increased by urolithiasis plus amlodipine administration. The weight of the rats decreased in the urolithiasis plus amlodipine group when compared with the urolithiasis group. Histopathological examinations revealed extensive intratubular crystal depositions and degenerative tubular structures in the urolithiasis group and the amlodipine treatment group. CONCLUSION: We showed that amlodipine may increase susceptibility to urolithiasis by raising hyperoxaluria and hypercalciuria. Further studies should be performed to elucidate the urolithiasis activity of amlodipine and to confirm the data.

Topical effects of nebivolol on wounds in diabetic rats.

OBJECTIVE: Recently, it has reported that nebivolol might be useful in the treatment of diabetes mellitus foot ulcers. The aim of this study was to examine treatment of the wounds in streptozotocin-induced diabetic rats with topical nebivolol. METHODS: Two 15 × 15 mm-sized wounds were created in 56 streptozotocin-induced rats. A total of 56 diabetic wounds were studied in eight groups (n=7). No treatment was administered to the first and second groups. The third and fourth groups consisted of diabetic rats that were administered 1:1 mixture of lanolin and vaseline for 7 and 14 days, respectively. Five percent nebivolol plus 1:1 mixture of lanolin and vaseline was administered to rats in the fifth and sixth groups for 7 and 14 days, respectively, and 10% nebivolol plus 1:1 mixture of lanolin and vaseline was administered to rats in the seventh and eighth groups for 7 and 14 days, respectively. On days 7 and 14, wound healing was observed, and the percent of wound healing was determined by measuring its size and histopathologic examination. The ratio was calculated by the formula, healing ratio (%)=100 ×(1-wound area/initial wound area). Statistical analysis was performed by ANOVA with Tukey's HSD test and Mann-Whitney U test, using SPSS 15.0 software. RESULTS: On days 7 and 14, rates of wound healing in the fifth, sixth, seventh, and eighth groups were 57.42%, 89.16%, 60.80%, and 91.80%, respectively. Multiple comparison showed that rates of wound healing were significantly higher in rats administered 5% and 10% nebivolol than those in rats administered a mixture of lanolin and vaseline and in the untreated group (P<0.05). CONCLUSION: Topical nebivolol therapy may be useful for wound healing in diabetic rats. Further studies are needed to support these data.

A case of urinary tract infection due to Salmonella enterica serovar Virchow and review of the related literature.

Nontyphoid salmonella (NTS) serotypes can cause gastroenteritis, bacteriemia, and focal infections. However, these focal infections, including urinary tract infections (UTI), are occasionally observed; in particular, the presence of several predisposing factors, such as immunodeficiency and structural abnormality in the urinary tract, increase the possibility of the occurrence of infection. We present a case of UTI caused by Salmonella enterica serovar Virchow in an elderly and debilitated patient with benign prostatic hyperplasia (BPH). Administration of appropriate antibiotic treatment resulted in recovery of the patient's clinical course.