Serum sodium identifies patients with cirrhosis at high risk of hepatorenal syndrome.

BACKGROUND: Although the precipitating events of hepatorenal syndrome (HRS) development have been well characterized, the actual baseline risk of these events resulting in HRS is much less studied. AIM: To assess the predictive value of hyponatremia in the development of HRS. PATIENTS AND METHODS: We performed a retrospective observational cohort study including consecutive patients with decompensated liver cirrhosis and normal creatininemia admitted to tertiary center in Slovakia. Patients were censored at two months, development of renal failure, classified either as HRS or renal failure not fulfilling criteria of HRS, was the main outcome. RESULTS: Out of 202 patients 18 developed HRS and 14 renal failure not fulfilling the HRS criteria. A significant difference was found between patients with and without HRS in serum sodium (135.76 ± 5.01 vs. 130.78 ± 3.574 mmol/l; p < 0.0001), creatinine, (81 ± 20.11 vs. 98.18 ± 25.032 µmol/l; p = 0.006), bilirubin (90.4 ± 104.82 vs.175.42 ± 174.12 µmol/l; p < 0.0001), MELD (15.17 ± 5.52 vs. 21.61 ± 6.0; p < 0.0001) and MELD-Na score (19.96 ± 6.0 vs. 25.89 ± 4.96; p < 0.0001). Sodium, creatinine, bilirubin, MELD, MELD-Na score were found to be significant predictors of HRS in univariate analysis. Multivariate analysis two prediction models (Model 1: Bilirubin, creatinin, sodium and Model 2: Sodium, MELD) showed that sodium together with creatinine are the strongest HRS predictors, followed by bilirubin or MELD score. CONCLUSION: Serum levels of sodium, creatinine and parameters of liver function are important predictors of hepatorenal syndrome.

A renal transplant patient with intractable hiccups and review of the literature.

Intractable hiccups in transplanted patients may be caused by various medical conditions including infections. We report a case of a 44-year-old man who suffered from intractable hiccups after cadaveric kidney transplantation. We identified 3 different hiccup periods with different causes: 1) steroid and anesthetics use, 2) severe ulcerose herpetic and mycotic esophagitis, and 3) pleuropneumonia caused by nosocomial methicillin-resistant Staphylococcus epidermidis and pulmonary abscess requiring thoracic surgery.

[Nitrate contaminated drinking water from private wells has an impact on the size and functional state of the thyroid gland in schoolchildren]. / Nitrátmi kontaminovaná pitná voda z domácich studní ovplyvnuje vel'kost' a funkcný stav stítnej zl'azy u skolopovinných detí.

UNLABELLED: The authors compared the size of the thyroid gland, assessed by ultrasonographic examination of its volume and the functional state of the thyroid by examination of the serum level of TSH and anti-TPO antibodies in 492 pupils aged 10 and 13 years in two close agricultural areas. The areas differed above all as to the nitrate content of drinking water. In communities where the source of drinking water were private wells (nitrate area), as much as 68.1% of the water samples had a nitrate content > 50 mg/l and 46.4% samples > 100 mg/l. In communities where the source of drinking water was a water main with a known source (control area) the water samples did not exceed 50 mg/l (73.7% > 15 mg/l and 26.3% > 50 mg/l. RESULTS: Pupils from the nitrate area had a larger thyroid gland similarly as older pupils from the control area. A volume above 7 ml/m2 in the nitrate area was recorded in the group of 10-year olds in 25/99 (27.7%) and in the group of 13-year-old ones in 33/154 (21.4%), while in the control area it was in the 10-year-old ones 11/92 (11.9%) and in the 13-year-old ones 16/156 (10.2%, P < or = 0.01). In the nitrate area TSH > 5 mIU/l was recorded in 5.6% and higher anti-TPO antibodies in 2.6% pupils. In the control area the corresponding figure was 1.1% pupils, P < or = 0.01.