Hidradenitis Suppurativa: a lesser-known cause of AA amyloidosis.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, disabling skin disease. The estimated prevalence is 1-4 % worldwide. HS is a systemic inflammatory disease and can cause AA amyloidosis. The first report of HS-related amyloidosis dates back to 1966; since then, sporadic cases have been reported. Our work will be the first case series on HS and AA amyloidosis. CASE SERIES: We report eight HS cases complicated with amyloidosis. Six patients were male. The median age was 44 years, and the median disease duration before the amyloidosis diagnosis was 15.5 years. In a mean follow-up of 18 ± 6 months, we achieved favorable renal responses in four of the eight cases (50 %). All cases had a dermatologic response, with four complete and four partial remissions. CONCLUSION: HS is a systemic inflammatory disorder that may cause AA amyloidosis. Aggressive treatment of HS may halt the progression of amyloidosis. HIPPOKRATIA 2020, 24(1): 33-37.

Successful Treatment of Cutaneous Blastomycosis in a Renal Transplant Patient With BK Virus Infection: A Case Report.

This is the first case report from Turkey to describe a renal transplant complicated by subcutaneous blastomycosis and BK infection. The cutaneous lesions were successfully treated with amphotericin B and fluconazole. The presence of BK infection led to graft failure. Infections with uncommonly seen organisms should be kept in mind due to the impaired T-cell immunity in transplantation.

Long-term prognostic value of coronary flow velocity reserve in renal transplant recipients.

BACKGROUND: In this prospective study, we sought to investigate the long-term prognostic value of coronary flow reserve (CFR) and carotid intima media thickness (IMT) estimates in renal transplant recipients without known coronary artery disease. METHODS: The 20 renal transplant recipients included in this study underwent CFR recordings performed by trans-thoracic Doppler echocardiography (TTDE) and carotid IMT measured by carotid Doppler ultrasonography. RESULTS: During a 3-year follow-up only one patient experienced a cardiac event. The baseline CFR and carotid IMT values of the patients were 1.77 ± 0.47 and 0.67 ± 0.15 mm, respectively. After 3 years of follow-up, there were no significant differences compared with baseline measurements with regard to CFR and IMT values. CFR values at the third year of follow-up showed significant correlation with age as well as IMT at baseline and at the third year. Upon multivariate analysis, baseline carotid IMT (ß = -0.562; P = .05) was a significant independent predictor of CFR at the third year. CONCLUSION: Carotid IMT showed a greater predictive value for impaired CFR in renal transplant recipients. CFR was not an independent predictor for cardiovascular events among renal transplant recipients within the first 3 years of follow-up measurements.

The effect of taurine on renal ischemia/reperfusion injury.

Ischemia-reperfusion (I/R) injury is one of the most common causes of renal dysfunction. Taurine is an endogenous antioxidant and a membrane-stabilizing, intracellular, free beta-amino acid. It has been demonstrated to have protective effects against I/R injuries to tissues other than kidney. The aim of this study was to determine whether taurine has a beneficial role in renal I/R injury. Forty Wistar-Albino rats were allocated into four groups as follows: sham, taurine, I/R, and I/R+taurine. Taurine 7.5 mg/kg was given intra-peritoneally to rats in the groups taurine and I/R+taurine. Renal I/R was achieved by occluding the renal arteries bilaterally for 40 min, followed by 6 h of reperfusion. Immediately thereafter, blood was drawn and tissue samples were harvested to measure 1) serum levels of BUN and creatinine; 2) serum and/or tissue levels of malondialdehyde (MDA), glutathione (GSH), glucose 6-phosphate dehydrogenase (G-6PD), 6-phosphogluconate dehydrogenase (6-PGD) and glutathione reductase (GSH-red); 3) renal morphology; and 4) immunohistochemical staining for P-selectin. Taurine administration reduced I/R-induced increases in serum BUN and creatinine, and serum and tissue MDA levels (p<0.05). Additionally, taurine lessened the reductions in serum and tissue glutathione levels secondary to I/R (p<0.05). Taurine also attenuated histopathologic evidence of renal injury, and reduced I/R-induced P-selectin immunoreactivity (p<0.05). Overall, then, taurine administration appears to reduce the injurious effects of I/R on kidney.

Atherosclerosis risk is higher in continuous ambulatory peritoneal dialysis patients than in hemodialysis patients.

While it has been reported that myocardial infarction and cerebrovascular disease are more common in continuous ambulatory peritoneal dialysis (CAPD) patients than in hemodialysis patients, some studies have not supported these results. The aim of this study was to compare CAPD and hemodialysis patients with regard to atherosclerotic changes and to assess which factors might be responsible for atherosclerosis in dialysis patients. Group 1 consisted of 65 CAPD patients, and Group 2 consisted of 109 hemodialysis patients who were age-, gender-, and duration-of-dialysis-matched with CAPD patients. We used ultrasonographic measurement of carotid artery intima media thickness to identify atherosclerosis. Known risk factors for atherosclerosis including hypertension, smoking, serum levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, lipoprotein (a) [Lp(a)], albumin, intact parathormone, fibrinogen, and C-reactive protein were determined in all patients. More atherosclerotic changes were seen in CAPD than in hemodialysis patients. Of all the atherosclerosis risk factors, only serum total cholesterol, LDL-C, and Lp(a) levels were significantly higher in patients on CAPD.

Is hepatitis C virus infection a risk factor for panel-reactive antibody positivity?

Patients with high levels of panel-reactive antibody (PRA) represent an increasingly large group in the waiting lists for cadaveric renal transplantation. Hepatitis C virus (HCV) infection has been found to be associated with a high prevalence of positivity of autoimmune serological tests. We planned this study to evaluate the effect of HCV positivity on the PRA levels in our hemodialysis (HD) patients. We included 38 HCV-infected (group I: 20 male, 18 female patients, mean duration of HD 73.6 +/- 50.6 months) and 43 hepatitis marker-negative (group II: 23 male, 20 female patients, mean duration of HD 22.2 +/- 22.4 months) HD patients. The PRA positivity ratio and number of transfusions were not significantly higher in group I than in group II (PRA ABC; 28.9%, 19.4, P > 0.05, PRA DR; 21.8%, 20.9, P > 0.05, respectively, and blood transfusions 7.0 +/- 5.7, 6.6 +/- 5.2, respectively, P = 0.06). HD duration correlated significantly with PRA positivity in our patients (PRA-positive patients: 56.1 +/- 57.9 months, PRA-negative patients: 43.3 +/- 41.9 months, P = 0.021). In conclusion, HD duration was found to be the main factor affecting PRA sensitivity independently of HCV positivity and blood transfusion.

What happens after conversion of treatment to continuous ambulatory peritoneal dialysis from hemodialysis?

A prospective study was planned to follow the clinical and laboratory data of hemodialysis (HD) patients after change of treatment to continuous ambulatory peritoneal dialysis (CAPD). Patients who had been on the HD program for more than 6 months were selected and followed for at least 6 months under CAPD treatment. Measured parameters included hemoglobin, ferritin, C-reactive protein (CRP), calcium, phosphorus, and intact parathyroid hormone (iPTH) levels; lipid profile; total protein and albumin; body mass index and triceps skin fold thickness; echocardiographic findings; and medications administered. We followed 34 patients (12 males, 22 females; mean age: 43.5 +/- 14.5 years; mean HD duration: 36.6 +/- 24.76 months) for a mean period of 19.8 +/- 11.9 months after change of treatment to CAPD. We saw a significant increase in mean hemoglobin, cholesterol, triglyceride, high-density lipoprotein (HDL), lipoprotein (a) [Lp(a)], phosphorus, and iPTH levels. We observed a decrease in erythropoietin dose, mean ferritin levels, systolic blood pressure (139.4 +/- 22.8 mmHg vs 114.4 +/- 21.0 mmHg, p = 0.001), diastolic blood pressure (85.7 +/- 12.6 mmHg vs 73.5 +/- 17.6 mmHg, p = 0.002), percentage of left ventricular hypertrophy, systolic and diastolic dysfunction, and the number of hypertensive drugs received. A significant improvement in the nutritional status of the patients (total protein, body mass index and triceps skin fold thickness) was also seen. In conclusion, CAPD treatment has a short-term outcome superior to that of HD in terms of better nutritional status and better control of hypertension and anemia.

High frequency of amyloid lymphadenopathy in uremic patients.

Amyloid lymphadenopathy has only been reported in case report form, or in small groups of patient groups within large series. We believe that amyloid lymphadenopathy is common in uremic patients, and thus designed this study to determine the frequency of this condition in hemodialysis patients, and to assess its types and patterns. We reevaluated 46 uremic patients' lymph node biopsies for amyloid deposits. We also immunohistochemically identified the protein origin of these deposits using Amyloid A, kappa, lambda, beta2 microglobulin, and transthyretin antibodies. Histopathologically, we observed for vascular involvement, follicular deposition, and diffuse deposition. We detected amyloid deposits in 10 of the 46 (22%) patients' lymph nodes. The patterns of deposition were vascular involvement alone in six specimens, vascular involvement plus follicular deposition in three, and vascular involvement plus diffuse deposition in one specimen. Amyloid AA type protein was present in seven nodes, beta2 microglobulin-related amyloid in two nodes, and immunoglobulin-derived protein (AL) in one node. We assessed these 10 patients for causes of end-stage renal disease (ESRD) and other conditions that might relate to amyloidosis. The cause of ESRD in the seven patients with AA amyloid were renal amyloidosis secondary to Familial Mediterranean Fever in four, glomerulonephritis in one patient who had bronchiectasis and Castleman's disease, unknown in one patient who had bronchial asthma, and pyelonephritis in one patient who had no characteristics that could be linked with AA type amyloidosis. The causes of ESRD in the two individuals with beta2 microglobulin-related amyloidosis who had been on long-term hemodialysis were pyelonephritis and glomerulonephritis. The cause of ESRD in the patient with AL type protein was glomerulonephritis, and this patient had no systemic disease. We conclude that amyloid lymphadenopathy is, indeed, common in uremic patients. Amyloid type AA is the most prevalent form of amyloid protein in uremic patients, but amyloid type does not always correspond with underlying cause of renal failure, or with the presence of systemic disease.

Effect of apolipoprotein E polymorphism on serum lipid, lipoproteins, and atherosclerosis in hemodialysis patients.

Atherosclerosis and cardiovascular disease are the main causes of death in hemodialysis patients. Possession of the apolipoprotein E4 (ApoE4) allele has been associated with increased levels of serum lipids and with coronary and carotid artery atherosclerosis. We investigated the possible relationship between ApoE polymorphism and atherosclerosis risk factors in hemodialysis patients. Two hundred sixty-nine hemodialysis patients (115 women, 154 men) were included in our study. The mean patient age and mean hemodialysis duration were 45.8 +/- 15.3 years and 52.6 +/- 40.6 months, respectively. Testing was done on all patients to determine ApoE genotype and serum levels of total cholesterol (T-Cho), low-density lipoprotein (LDL-C), high-density cholesterol (HDL-C), triglyceride (TG), lipoprotein (a) (Lp[a]), intact parathormone (iPTH), and fibrinogen. ApoE genotype was identified with the polymerase chain reaction. Ultrasonographic measurement of carotid artery intima media thickness (IMT) was used to diagnose atherosclerosis. We also analyzed ApoE polymorphism and risk factors such as age, gender, duration of hemodialysis, smoking, and hypertension in relation to the presence of atherosclerosis. Serum T-Cho and LDL-C levels were higher in patients with the ApoE4/3 phenotype than in those with ApoE3/3 and ApoE3/2 phenotypes (P < 0.05). However, there was no statistically significant link between ApoE polymorphism and serum levels of TG, HDL-C, or Lp(a) (P > 0.05). Apart from a relationship with age and duration of hemodialysis (P < 0.05), we found no significant association between atherosclerosis and ApoE polymorphism or the other risk factors analyzed (P > 0.05). In conclusion, although ApoE polymorphism significantly affects serum levels of T-Cho and LDL-C in hemodialysis patients, this study indicates that ApoE polymorphism is not associated with the presence of atherosclerosis in these individuals. The high incidence of atherosclerosis in these patients underlines the need for further research on other possible causative factors.

Ambulatory blood pressure monitoring in potential renal transplant donors.

BACKGROUND: Hypertension is considered to be a contraindication in potential renal transplant donors. Ambulatory blood pressure monitoring (ABPM) was developed as an alternative to in-office blood pressure measurement (OBPM). The aim of this study was to determine the sensitivity of ABPM in revealing hypertension in potential renal transplant donors, and to measure the correlation between ABPM results and target organ damage. METHODS: The study included 126 potential living-related renal transplant donors. The potential donors's blood pressures were measured during three separate clinic visits and then evaluated using 24-h ABPM. Cardiac and ophthalmological examinations were also performed to investigate target organ damage in all of the donors. RESULTS: According to the OBPM, 89 potential donors were normotensive and 37 had borderline or mild hypertension. Of the normotensive group, six were diagnosed as hypertensive after 24-h ABPM, and these subjects had target organ involvement. The status of the other 83 donors remained unchanged after ABPM and investigation for target organ damage. Thirteen of the 37 subjects who had borderline or mildly elevated pressures on OBPM were classified as normotensive after ABPM. These 13 individuals exhibited no hypertension-related target organ damage. The other 24 patients who had been classified as borderline or mildly hypertensive on OBPM fulfilled the criteria for hypertension after ABPM, and hypertensive changes were found at target organ evaluation. Before donor nephrectomy, 94 subjects who were classified as normotensive prior to transplantation underwent renal angiography for routine pretransplant evaluation, and none showed hypertensive or atherosclerotic changes. CONCLUSION: In our study, ABPM was found to be more sensitive than OBPM in terms of identifying hypertension in potential renal transplant donors.