Prognostic significance of high free T4 and low free T3 levels in non-thyroidal illness syndrome.

BACKGROUND: Non-thyroidal illness syndrome is characterized by decreased serum free T3 (FT3) level and associates with long term mortality. Serum free T4 (FT4) may affect on mortality with FT3 in course of chronic illness. This study performed to evaluate the association between both decreased FT3 with elevated FT4 levels and mortality risk. METHODS: This study is a retrospective cohort analysis and consisted up 1164 (571 male, 593 female) patients with a 36 months follow up period. Patients divided into four groups according to thyroid functions. Patients with euthyroidism were in Group A, elevated FT3 in group B, decreased FT3 in group C and both decreased FT3 and elevated FT4 levels in group D. The levels of thyroid hormones and all cause mortality were compared between four groups. RESULTS: Mortality rate was elevated between Groups A and B, A and C, A and D, B and C, B and D, C and D, (p < .001, p < .001, p < .001, p < .001, p < .001, p:0.019, respectively). A multivariate Cox proportional hazards model was performed to evaluate the mortality risk between groups. A close relationship was observed in Group C and D patients for the mortality risk (OR:1.561, 95% CI:1.165-2.090, p:0.003 and OR:2.224, 95% CI:1.645-3.006, p:0.0001, respectively). CONCLUSION: Both decreased FT3 and elevated FT4 levels are independent predictor for long term mortality risk in hospitalized chronic patients with non-thyroidal illness syndrome.

N-Terminal pro-B-Type Natriuretic Peptide Levels are Linked with Modified Child-Pugh Classification in Patients with Nonalcoholic Cirrhosis [NT-ProBNP and Liver Cirrhosis].

Excess N-terminal pro-brain natriuretic peptide secretion has been linked to cirrhosis in previously studies. The relationship of plasma N-terminal pro-brain natriuretic peptide levels and cardiac dysfunction determined by echocardiography were investigated in patients with nonalcoholic cirrhosis and a control group of chronic hepatitis. This study was designed as a cross-sectional study. Thirty-two men and thirty-three women who gave informed consent who were followed-up for chronic liver failure were enrolled. All patients gave clinical history, physical examination was carried out and information about ongoing medication has been obtained. Serum N-terminal pro-brain natriuretic peptide level was measured in all patients. The same cardiologist determined ejection fraction, end-diastolic left ventricular diameter, interventricular septum, and posterior wall on transthoracic echocardiography. Patients with extensive liver disease according to Child-Pugh classification from A to C had increasing N-terminal pro-brain natriuretic peptide levels in association (P < .001). According to the Child-Pugh classification there were no significant difference between groups for echocardiographic measurements (P > .05). N-terminal pro-brain natriuretic peptide may be an important marker for cardiac dysfunction in patients with chronic liver failure in accordance with Child-Pugh stage.

The prevalence of metabolic syndrome in different ethnic groups in Turkey.

OBJECTIVE: To determine the prevalence of metabolic syndrome and its risk factors in various ethnic groups in Istanbul, Turkey. METHODS: Study participants were aged ≥ 20 years. Risk factor components for metabolic syndrome were measured and its presence was determined in study participants. RESULTS: The study included 254 Greeks, 273 West Thracians, 275 East Turkistanis and 304 Armenians. The prevalence of metabolic syndrome was significantly different between groups (Greeks, 19.3%; West Thracians, 24.9%; East Turkistanis, 15.3%; Armenians, 20.4%), and increased with age in all groups. Low levels of high-density lipoprotein cholesterol (HDL-C) were found mainly in Greeks (females, 64.5%; males, 61.6%) and West Thracians (females, 75.8%; males, 73.1%). Among East Turkistanis, HDL-C and triglyceride levels were significantly higher compared with the other ethnic groups. Hypertension was the most frequently encountered component of metabolic syndrome in East Turkistanis. CONCLUSIONS: The prevalence of metabolic syndrome varied between ethnic groups living in the same geographical location. In Turkey, metabolic syndrome is common. It is important to determine differences between ethnic groups, as this will assist in identifying those at higher risk of developing coronary heart disease.

Tuberculosis in patients on hemodialysis in an endemic region.

Clinical presentation of tuberculosis is different in hemodialysis patients than in the general population. This study aimed to analyze hemodialysis patients with tuberculosis in Istanbul. Patients who were on a chronic hemodialysis program in Istanbul for more than 3 months and diagnosed to have tuberculosis at least 3 months after the start of hemodialysis were included. To discard the effect of immigration from other cities, we included only patients who had started their dialysis program in Istanbul. Their demographic and clinical data were analyzed using Statistical Package for Social Sciences for Windows ver. 13.0. Of the 925 patients screened from 7 different centers, 31 (3.35%) were found to have tuberculosis. The mean age was 52.3±13.5 years. The male/female ratio was 18/13. The mean duration of dialysis therapy and the duration of dialysis till the diagnosis of tuberculosis were 62.6±54.3 and 21.7±25.7 months, respectively. Extrapulmonary tuberculosis constituted 48.39%. Treatment ended with a cure in 18 (58.05%); was still ongoing in 12 (38.70%) patients; and 1 (3.25%) died of pulmonary tuberculosis. The lower incidence of tuberculosis compared with previous reports may be related to the differences in the diagnostic criteria and the decrease in the rate of tuberculosis during recent years. The demographic and clinical parameters of the patients were quite similar to the average dialysis population in Turkey. Hence, we cannot address a subpopulation with additional risk. It is important to prevent tuberculosis in hemodialysis patients due to difficulties in the diagnosis and treatment. Thus we recommend routine screening of hemodialysis patients and effective isolation and treatment of infected patients.

The efficacy of n-acetylcysteine in preventing contrast-induced nephropathy in type 2 diabetic patients without nephropathy.

BACKGROUND: N-acetylcysteine (NAC) is reported to have potential for prevention of contrast-induced nephropathy(CIN), however, there is not enough data related to its effects on diabetic patients without nephropathy. METHODS: A total of 45 diabetic patients without nephropathy undergoing a computerized tomography (CT) investigation and who would be receiving radio-opaque medication (300 mg iohexaol/100 mL) were enrolled. They were randomized to have either high-dose NAC (1200 mg) plus saline hydration (Group 1, n=25) or only saline hydration (Group 2; n=20). Serum creatinine levels were determined 72 hours post-contrast. CIN was defined as 0.3 mg/dL elevation of creatinine from baseline and/or an increment of 20% over baseline creatinine and/or 20% decrement of estimated GFR. RESULTS: In Group 1, serum creatinine decreased from 0.83 to 0.79 mg/dL, whereas serum creatinine increased from 0.81 to 0.94 mg/dL in Group 2 (not significant for both groups). However there was a significant difference between the creatinine variation of two groups (p=0.031). Furthermore, the groups were analyzed according to overall incidence of CIN. The increase of serum creatinine and decrement of estimated GFR in Group 2 were significantly higher than in Group 1. CONCLUSION: Adding NAC to saline hydration seems more beneficial than saline hydration alone in preventing contrast-induced renal function deterioration in type 2 diabetic patients without nephropathy.

The relationship between peritoneal leukocyte count, fluid cultures, and clinical results in peritonitis among peritoneal dialysis patients: is there a geographic or ethnic difference?

We investigated peritoneal leukocyte count (PLC) and culture results for correlations with inflammation, nutrition, microbiologic parameters, and the effects of peritonitis on peritoneal equilibration tests (PETs) and clinical outcomes in peritoneal dialysis (PD) patients. The study group consisted of patients who had experienced peritonitis for the first time and who had been on PD for at least 6 months, with a PET performed both before and after the peritonitis episode. Only patients with an increased PLC were analyzed. In the 70 patients analyzed (35 men; mean age: 45.1 +/- 13.5 years), 7 (10.0%) underwent PD catheter removal, 60 (85.7%) responded well to treatment, and 3 (4.3%) died. Cultures of peritoneal fluid were positive in 25 patients (35.7%), and these patients had a significantly higher PLC than did the culture-negative patients. After the peritonitis episode, C-reactive protein (CRP) increased significantly in affected patients. Residual urine declined after peritonitis. We observed no significant difference in PET results. Clearly, more micro-organisms are present in the peritoneal fluid in patients with a positive culture than in those with a negative culture, meaning that they have severe peritonitis, which responds poorly to treatment. Beyond a consideration of possibly inappropriate culturing techniques, the variations in effluent culture results might reflect geographic or ethnic differences. Positive culture results and a high PLC should be considered risk factors for catheter loss and mortality in PD. Moreover, culture results might show geographic and ethnic differences. In peritonitis follow-up, CRP may be a better marker than erythrocyte sedimentation rate is.

Study of ACEI versus ARB in managing hypertensive overt diabetic nephropathy: long-term analysis.

BACKGROUND: There is, to our knowledge, no study that has directly compared angiotensin-converting enzyme inhibitor (ACEI) with angiotensin receptor blocker (ARB) in hypertensive patients with overt diabetic nephropathy (DNP). We tried to analyze the outcomes of hypertensive patients with overt type 2 DNP who used only ACEIs or ARBs. METHODS: The patients who had an estimated creatinine clearance <90 ml/min and hypertension or had been using antihypertensive drug(s) at presentation were included in the study. The patients were classified as ACEI group and ARB group. RESULTS: A total of 100 patients (55 men and 45 women, mean age 61.8 +/- 9.16 years) were included in the study. Mean duration of follow-up was 24.6 +/- 14.1 months. Baseline demographics, biochemical analyses and blood pressures were similar. Renal functions and proteinuria of both groups did not show any significant changes during follow-up. Blood pressure courses were also similar. Although the mean doubling time of creatinine in the ARB group was shorter than the ACEI group, it was not statistically significant. During the follow-up period, 4 patients died (2 in the ACEI group, 2 in the ARB group) and 10 patients were started on dialysis (7 in the ACEI group, 3 in the ARB group). Serum creatinine and the amount of proteinuria were the baseline parameters which were related to the initiation of dialysis. CONCLUSION: ACEIs and ARBs have similar outcomes in overt DNP. Their renoprotective effects can be observed in spite of uncontrolled hypertension.

Additional value of carotid artery intima-media thickness in cardiovascular risk assessment by Framingham risk-score in Type 2 diabetes: a retrospective cohort study.

BACKGROUND: The intima-media thickness (IMT) of the carotid artery is highly correlated with cardiovascular events in Type 2 diabetes mellitus (T2DM). The aim of the present study was to undertake a cardiovascular risk assessment in a group of patients (n = 102) who had been followed-up for 10 years. METHODS: Framingham risk score (FRS), IMT, and various other clinical parameters were evaluated retrospectively using Student's t-test, regression analysis, and χ² tests. Primary endpoints were defined as cardiovascular death, non-fatal myocardial infarction, angina, and ischemic stroke. RESULTS: The IMT (1.09 ± 0.32 vs 0.89 ± 0.25; P < 0.001) and percentage coronary risk as determined by the FRS (24.33 ± 11.07 vs 16.54 ± 8.35; P = 0.001) were significantly higher in patients presenting with any of the primary endpoints compared with patients in whom no cardiovascular morbidity or mortality was recorded. Other factors that significantly predicted cardiovascular mortality and morbidity included diastolic blood pressure and urinary albumin excretion (UAE; P < 0.001). The likelihood of primary endpoints could be predicted by UAE >30 mg/day, carotid artery IMT ≥0.9 mm, and FRS ≥20 (odds ratios 8.800, 3.377, and 2.807, respectively). CONCLUSION: Although FRS predicts 10-year risk for cardiovascular mortality and morbidity in T2DM, we suggest that UAE and carotid artery IMT should also be considered in risk assessments.

Amyloidosis in a patient with autosomal dominant polycystic kidney disease and tuberculosis: a case report.

Autosomal-dominant polycystic kidney disease is an inherited disorder characterized by the development and growth of cysts in the kidneys. Urinary protein excretion is generally less than 1 g/day, and the association of the nephrotic syndrome with this condition is considered rare. A 39-year-old man with autosomal-dominant polycystic kidney disease and nephrotic-range proteiuria is described. During admission, he had general edema and a diagnosis of pulmonary tuberculosis. The patient had hyperlipidemia, hypoalbuminemia, and 11.8 g/day proteinuria. The gingiva and rectum biopsies were performed in order to evaluate the etiology of nephrotic syndrome, and revealed AA amyloidosis thought to be secondary to pulmonary tuberculosis. We maintained the antituberculous treatment and began colchicine at a dose of 2 g/day and candesartan 8 mg/day. To our knowledge, this is the first autosomal-dominant polycystic kidney disease case with nephrotic syndrome due to amyloidosis secondary to pulmonary tuberculosis.

Alkaptonuria and renal failure: a case report.

In alkaptonuria, the absence of homogentisic acid oxidase (HGO) results in the accumulation of homogentisic acid (HGA) in the body. Associated renal failure is rare and usually occurs in the later stages of the disease. We report a 33-year-old male who presented, initially, with renal failure, but no past history of illness. He had pigmentation of sclerae and ear helices, intervertebral disk calcifications and mild mitral insufficiency. His disease was confirmed by HGA detection in the urine. As size and thickness of renal parenchyma seen on ultrasonography were normal, renal biopsy was performed and it showed glomerular sclerosis, diffuse tubular atrophy and interstitial fibrosis with inflammation. Wall thickening of small arteries and pigment deposits were identified in some kidney tissue elements. He progressed to end-stage renal disease despite supportive therapy.

Pancreatic involvement in Von Hippel-Lindau disease.

BACKGROUND: Involvement of the pancreas in Von Hippel-Lindau disease that is a tumor predisposing syndrome mentioned in literature with some morbid and mortal progression. AIMS: For evaluation the faith of the pancreatic involvement in VHL disease we analysed our patient population with VHL disease. MATERIALS AND METHODS: 12 of the 56 patients that were evaluated in our institute with the diagnosis of Von Hippel-Lindau disease had pancreatic involvement. They are periodically examined for 5 years follow up period. Their retrospective analysis was accomplished. RESULTS AND CONCLUSIONS: Pancreatic involvement in our patient population disclosed lesions that were multicysts or serous cystadenomas. During follow up period, we did not observe significant morbidity related to pancreatic involvement. Repeated radiological examination of pancreatic lesions disclosed insignificant modifications such as slight increase or decrease in size. Whereas we considered morbidity and mortality related to renal and central nervous system pathologies in VHL disease. Shortly, even pancreatic involvement in VHL disease requires close clinical follow up, morbidity and mortality in this case is not severe as in renal and the central nervous system involvement.