Association between malnutrition-inflammation score and risk of subsequent self-reported bone fractures in prevalent kidney transplant recipients.

Chronic inflammation and protein energy wasting (PEW) syndrome are common in kidney transplant recipients (KTR). The presence of inflammation and PEW syndrome can directly affect bone resorption and bone formation, leading to bone loss and fractures. We showed PEW is independently associated with new clinically detected bone fractures in prevalent KTR. INTRODUCTION: Kidney transplant recipients (KTR) have a 4-fold higher risk of fracture compared to the general population. Chronic inflammation and PEW syndrome are common in KTR and are associated with poor outcomes. We hypothesized that the Malnutrition-Inflammation Score (MIS), a validated measure of PEW, is associated with higher risk of bone fractures in KTR. METHODS: This prospective cohort study included 839 prevalent KTR from a Central European academic center. MIS, a semiquantitative instrument of PEW, was calculated at the study entry. Self-reported history of fractures was recorded during the 2-year follow-up period. The association between MIS and bone fractures was examined in logistic regression analyses with adjustment for age, gender, eGFR, smoking habits, history of pre-transplant bone fractures, and acute rejection. RESULTS: Mean age was 51 ± 13 years, and 56% of patients were males with median (interquartile range) transplant vintage 69 (38-112) months, estimated glomerular filtration rate 55 ± 21 ml/min/1.73 m2, and calculated MIS 3 (2-4) at enrollment. Fifty-five (7%) patients experienced self-reported bone fractures during the 2-year follow-up period. Higher MIS score showed linear association with increased risk of fracture. Each one-point higher MIS was associated with 23% higher risk of bone fractures (odds ratio (OR) and 95% CI 1.23, 1.12-1.34), which remained significant after multivariable adjustments (OR 1.17, 95% CI 1.06-1.29). CONCLUSION: The MIS is independently associated with new clinically detected bone fractures in prevalent KTR.

Spontaneous retroperitoneal hemorrhage presenting as hemoperitoneum secondary to renal cyst rupture in a peritoneal dialysis patient with acquired cystic kidney disease.

Spontaneous retroperitoneal hemorrhage (SRH) is a rare and potentially fatal condition. Acquired cystic kidney disease (ACKD) may cause SRH in hemodialysis patients. However, presentation of retroperitoneal hematoma as hemoperitoneum in peritoneal dialysis (PD) patients is exceedingly rare. We report a 44-year-old male PD patient who presented with hemoperitoneum secondary to retroperitoneal hematoma. The reason of SRH was rupture of the cysts of ACKD. The patient underwent unilateral nephrectomy with subsequent disappearance of hemoperitoneum. The importance of this case lies in the fact that the patients who have been receiving dialysis for a long time should be under surveillance in terms of ACKD development and potential associated complications such as cyst hemorrhage and malignancy.

Nephropathy, but not Angiographically Proven Retinopathy, is Associated with Neutrophil to Lymphocyte Ratio in Patients with Type 2 Diabetes.

BACKGROUND: Type 2 Diabetes Mellitus is a leading cause of end stage renal disease in the worldwide. Inflammation is regarded as one of the main reasons for the progression of diabetes complications. We aimed to evaluate the association of neutrophil to lymphocyte ratio (NLR) as indicator of systemic inflammation with diabetic retinopathy and nephropathy. PATIENTS AND METHODS: This is a cross-sectional study of 114 prevalent type 2 diabetic subjects. All of the patients underwent detailed examination for the presence of diabetic retinopathy and nephropathy. Diabetic retinopathy was approved and classified according to findings based on flouresceint fundal angiography results. Estimated glomerular filtration rate (eGFR) and microalbumin to creatinine ratio were calculated to establish the diabetic nephropathy. NLR was calculated as ratio of absolute neutrophil count to absolute lymphocyte count. RESULTS: Retinopathy was present in 55 (48.2%) out of 114 patients, whereas nephropathy was present in 62 patients (54.3%). NLR was significantly higher in patients with nephropathy than in patients without nephropathy. NLR was also positively correlated with CRP (p=0.017, r=0.224) and microalbuminuria (p=0.016, r=0.257) whereas negatively correlated with eGFR (p<0.001, r=-0.337) values in the whole cohort. NLR was independent predictors for diabetic nephropathy, whereas it did not appear as an independent associate of diabetic retinopathy. CONCLUSION: NLR and diabetic nephropathy have an independent association between them whereas there was no independent association between NLR with retinopathy in type 2 diabetic patients.

[A giant ureteral stone: case report and literature review].

The article reports a case of a 68-year-old female patient with a giant ureteral stone of 12 cm in length, localized at the upper and middle third of the right ureter. The patient had undergone right ureterolithotomy with DJ-stent placement. Her postoperative period was uneventful. The distinctive feature of this case was that the patient had neither obstruction of urine flow through the urinary tract, nor metabolic disorders that could cause the formation of the giant ureteral stone.

Peri-aortic fat tissue and malnutrition-inflammation-atherosclerosis/calcification syndrome in end-stage renal disease patients.

PURPOSE: Thoracic peri-aortic fat tissue (PFT) is considered as a metabolically active organ in atherosclerosis. Malnutrition, inflammation and atherosclerosis/calcification (MIAC) are the most commonly encountered risk factors of cardiovascular disease in end-stage renal disease (ESRD) patients. Calcification of the aorta was found to be an important cardiovascular risk marker predicting future events, morbidity and mortality in this population. We aimed to investigate the relationship between PFT, MIAC syndrome and thoracic aortic calcification (TAC) in ESRD patients. METHODS: Seventy-nine ESRD patients receiving hemodialysis (HD) or peritoneal dialysis (PD) and 20 control subjects were enrolled in this cross-sectional study. PFT and TAC were assessed using a 64-MDCT scanner. Patients with serum albumin <3.5 g/dL were defined as patients with malnutrition; those with serum C-reactive protein level >10 mg/L had inflammation, and those with coronary artery calcification score (CACS) >10 had atherosclerosis/calcification. RESULTS: TAC and PFT were significantly higher in ESRD patients compared with control subjects. There was a statistically significant relationship between PFT and TAC in ESRD patients (r = 0.458, p < 0.0001). PFT was found to be significantly increased when the MIAC components increased. PFT was positively associated with age, BMI, uric acid, hemoglobin and CAC. The multivariate analysis revealed that age and uric acid were independent predictors of increased PFT. Twenty-four (30.4 %) patients had none, 30 (37.9 %) had one component, 17 (21.5 %) had two components, and 8 (10.2 %) had all MIAC components. PFT was highest among patients having all three components (28.6 cm(3)) and lowest among those who do not have the MIAC syndrome (8.54 cm(3)). TAC was highest among patients having all three components (179.2 HU) and lowest among those who do not have the MIAC syndrome (0 HU). CONCLUSIONS: We found a relationship between PFT and MIAC syndrome in ESRD patients.