IS THERE A RELATIONSHIP BETWEEN PARATHYROID HORMONE AND NEUTROPHIL LYMPHOCYTE RATIO OR PLATELET LYMPHOCYTE RATIO?

CONTEXT: Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are recent prognostic markers associated with inflammation in many diseases such as chronic kidney disease (CKD), malignancies, myocardial infarction. OBJECTIVE: In this study, we investigated the relationship between NLR-PLR and parathyroid hormone (PTH) and vitamin D in patients with high PTH levels. DESIGN: The patients with high PTH levels in Nephrology and Endocrinolgy Outpatient clinics were evaluated retrospectively. SUBJECTS AND METHODS: The medical records of the patients were examined and clinical data, including demographic details, clinical and laboratory findings, treatment and follow-up data were obtained. NLR and PLR were calculated. Serum creatinine, calcium, phosphorus, magnesium, lipid levels, calcium phosphorus product, PTH and vitamin D values were investigated. The relationship between NLR-PLR and laboratory parameters, GFR (MDRD-GFR), PTH and vitamin D were investigated. RESULTS: 48 male and 253 female patients were enrolled in this study. The mean age was 57.57±13.28. NLR correlated negatively with albumin, hemoglobin, vitamin D, calcium and cholesterol and it positively correlated with creatinine and PTH. Multiple regression analysis showed that main determinants of NLR were PTH, albumin, LDL-cholesterol, hemoglobin and gender. CONCLUSIONS: In this study NLR and PLR correlated negatively with hemoglobin and cholesterol. Positive correlation between NLR and creatinine could be explained by increased degrees of inflammation associated with more pronounced degrees of renal dysfunction. The impact of PTH on NLR was independent of GFR. In multiple regression model this suggests that PTH could be a pro-inflammatory parameter independent of the degree of renal dysfunction.

Correlation of the Volume Control Parameters With Health Related Quality of Life in Renal Transplant Patients.

INTRODUCTION: Transplantation is the most effective treatment strategy for end-stage renal failure. We aimed to investigate the correlation of volume control parameters with health-related quality of life (HRQoL) in renal transplantation patients during the pre- and post-transplantation periods. MATERIAL AND METHODS: Seventy-seven patients who underwent renal transplantation from deceased donors between January 2011 and January 2013 were included in the study. The biochemical markers, complete blood count, and creatinine levels were measured during pretransplantation and at post-transplantation month 6. The Turkish version of the Short Form 36 (SF-36) health survey questionnaire was used for the assessment of HRQoL. Blood pressure (BP) and echocardiographic measurements were used to evaluate the volume status. RESULTS: Significant improvements were achieved in all echocardiographic measurements, biochemical parameters except Ca(++), and SF-36 questionnaire domain scores (DSs) except vitality in the post-transplantation period. Systolic BP (SBP), the left atrium index, vena cava inferior collapsibility index (VCCI), and diastolic BP were associated with vitality (P = .02, .03, .05, and .04, respectively); SBP was associated with social functioning (P < .01) and role emotional (P < .01); and left ventricular mass index was associated with mental health (P = .05) DSs during the pretransplantation period. In the post-transplantation period, VCCI, left ventricular mass index, and SBP were associated with general health (P = .02, .05, and .05, respectively); VCCI and SBP were also associated with mental health (P = .05 and .01, respectively); and left atrium index was associated with role emotional (P = .05) DSs. CONCLUSION: Concomitant improvement in the volemic status may contribute to improvements in HRQoL after renal transplantation.

Pulmonary hypertension in patients with chronic renal failure.

BACKGROUND: Many etiologies causing pulmonary hypertension (PH) have been reported, and one of the background disease seen with patients with PH is chronic renal failure (CRF); however, the pathogenesis of PH in this group of patients is not explained satisfactorily. OBJECTIVES: The aims of this study were to evaluate the incidence of unexplained PH among patients with CRF and to suggest possible etiologic factors. METHODS: Two hundred and eleven patients with CRF were evaluated and the ones who have comorbid conditions that cause PH were excluded. Pulmonary arterial pressure (PAP) and cardiac functions were evaluated by Doppler echocardiography. Arteriovenous fistula (AVF) flow was measured by Doppler sonography. The patients were followed for at least 6 months. RESULTS: Forty-eight CRF patients (20 males, 28 females) were included: 23 were predialysis patients, and 25 patients received hemodialysis via AVF. Patients were followed for 7.5 +/- 1.01 months. Systolic PAP >35 mm Hg was found in 56% (14/25) of patients receiving hemodialysis (36.8 +/- 10.7 mm Hg) and in 39.1% (9/23) of predialysis patients (29.5 +/- 9.5 mm Hg). The parathyroid hormone level, cardiac output values and CRF duration were found to be increased in patients with elevated systolic PAP (p < 0.05). AVF flow and AVF duration were positively correlated with systolic PAP in patients receiving hemodialysis (p < 0.05). There was a negative correlation between systolic PAP and residual urine volume (p < 0.05). AVF compression in hemodialysis patients decreased systolic PAP from 36.8 +/- 10.7 to 32.8 +/- 10.5 mm Hg. Systolic PAP values were increased at the end of the study in the predialysis group, whereas they were decreased at the end of the follow-up in the hemodialysis group (36.9 +/- 10.5 and 32.04 +/- 10.5 mm Hg, respectively). CONCLUSIONS: This study demonstrates a high incidence of PH among patients with CRF. CRF duration, AVF flow, parathyroid hormone level and cardiac output may be involved in the pathogenesis of PH. The effective hemodialysis and dry weight reduction decreased systolic PAP values.

A case of rhabdomyolysis induced acute renal failure secondary to statin-fibrate-derivative combination and occult hypothyroidism.

Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle contents into the systemic circulation. We hereby report a patient proved to be a case of unrecognized hypothyroidism presenting with rhabdomyolytic acute renal failure precipitated by the combined use of statin and fenofibrate. A 63-year-old woman was referred to our department because of fatigue, diffuse muscle pain and oliguria. On the basis of pathogenesis, clinical and laboratory examination the diagnoses of acute renal failure secondary to the statin-fibrate-derivative combination induced rhabdomyolysis and auto-immune thyroiditis induced hypothyroidism were made. Although saline, furosemide and sodium bicarbonate infusions enabled diuresis and have led to a rapid recovery of renal function and normalization of blood pressure in five days (creatinine level decreased from 4.5 mg/dl to 1.2 mg/dl), only thyroid replacement therapy (0,1 mg thyroxine) that begun after the exclusion of adrenal insufficiency resulted in complete resolution of rhabdomyolysis. This prompted the diagnosis of background, clinically silent rhabdomyolysis aggrevated by the statin-fibrate-derivative combination. To our knowledge this case illustrates the first example of rhabdomyolytic acute renal failure induced by a statin-fibrate-derivative combination with underlying hypothyroidism which was responsible for the basal clinically unobservable rhabdomyolysis.

Hand function assessment in patients receiving haemodialysis.

OBJECTIVE: To assess the usefulness of Duruöz's Hand Index (DHI) in patients undergoing haemodialysis. METHODS: Patients receiving haemodialysis for more than 2 months were recruited randomly. Demographic, clinical and functional characteristics of patients were evaluated. Functional assessment was performed with DHI, Hand Functional Index (HFI), Health Assessment Questionnaire (HAQ), Purdue Pegboard, grip strength and 3 kinds of pinch strengths. DHI was correlated (Spearman's) with the other functional parameters in assessing the convergent validity and with non-functional parameters in assessing the divergent validity. RESULTS: Sixty patients with a mean age of 50.05 were recruited. The average duration of haemodialysis was 55.02 months. DHI is significantly correlated with HAQ, HFI, Purdue Pegboard scores, grip strength and 3 types of pinch strengths while no significant correlation was found with non-functional parameters. CONCLUSIONS: DHI is a practical scale which is efficient in assessing accurately the functional disability of the hand in patients receiving haemodialysis.

Effect of ultrafiltration on blood pressure variability in hemodialysis patients.

AIM: Increased blood pressure variability (BPV) in end-stage renal disease (ESRD) patients is proved to be a risk factor for cardiovascular disease [Tozawa et al. 1999]. The effect of ultrafiltration (UF) on BPV in hemodialysis (HD) patients has not been reported in the literature. This study was undertaken to define the effect of a single UF on BPV in HD patients. METHODS: Prior and after HD with UF, 24-hour ambulatory BP monitoring (ABPM) was applied to each patient and then diurnal and nocturnal BP and BPV parameters (both before and after UF) were compared and correlated with UF values. RESULTS: Increase in BPV after single UF in all groups was statistically significant (p < 0.05). Only the daytime systolic (DS) BPV increase (median 42.4%) was in positive correlation with delta body weight (body wt) (median 3.07%) or UF amount (r = 0.649, p < 0.01). CONCLUSIONS: Large volume depletions and sympathetic hyperreactivity could explain the increase in BPV. Increased interdialytic weight gain requires more UF and subsequently BPV, morbidity and mortality also increase. Thus, considerable efforts must be made to prevent great interdialytic weight gain in HD patients.

Increased incidence of tuberculosis in chronic hemodialysis patients.

We encountered 9 cases of tuberculosis out of our 157 chronic HD patients in 36 months. Four pulmonary, 4 lymph nodal and one isolated dermal involvement were detected. Therapy was commenced without waiting for absolute cultural or pathologic diagnosis because of the high index of clinical suspicion. All cases except one recovered completely. Among associated conditions, peptic ulcer disease, anti-HCV positivity, and diabetes mellitus were noted, though the last two did not reach statistical significance. Prompt institution of the specific therapy and close supervision of the cases during treatment enabled us to obtain a cure in all cases except one and to discern adverse drug effects immediately and to make appropriate changes in the therapy. Thus, no morbidity due to the disease itself or drugs was observed.