Comparison of bone mineral density and biochemical factors in hemodialysis and peritoneal dialysis patients.

AIM: The aim of the study is to assess and compare the level of bone mineral density (BMD) in the patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) and to identify risk factors related to low BMD. MATERIALS AND METHODS: Dual-energy X-ray absorptiometry (DEXA) scans were performed in 34 HD patients and 47 PD patients. Serum levels of albumin, calcium, phosphorus, alkaline phosphatase (ALP), intact parathyroid hormone (I-PTH), and 25-hydroxy (OH) vitamin D were recorded for the prediction of BMD loss. RESULTS: Among the biochemical parameters compared, only calcium levels differed between the group in such that HD patients had lower calcium compared with patients on PD (p = 0.001). The overall prevalence of osteoporosis (OP) among all participants was 27%. There was a negative correlation between femur neck BMD and age (r = -554, p = 0.007), and BMI (r = -555, p = 0.007). Diabetic nephropathy was the only etiology associated with decreased BMD at the femoral site (p = 0.027). There was a positive correlation between the serum albumin and BMD of lumbar spine (LS) (r = 585, p = 0.004). Bone mass of any site did not correlate with the dialysis type, duration of dialysis, and other biochemical markers like serum calcium, phosphorus, I-PTH, ALP, and 25 (OH) vitamin D. CONCLUSION: Prevalence of OP and osteopenia are high in dialysis patients, with no difference between patients on regular HD and PD. Bone mass loss is related to older age, higher BMI, and lower serum albumin level. DEXA measurement is necessary to monitor bone loss and timely treatment of OP in dialysis patients.

Daily variability of acid-base status and determinants of serum bicarbonate in hemodialysis patients.

AIM: We aimed to evaluate daily variability of bicarbonate in hemodialysis (HD) patients and identify the factors which affect that issue. MATERIALS AND METHODS: Blood samples of 41 patients for bicarbonate (total carbon dioxide (CO2)) and blood gas analysis (pH, bicarbonate (HCO3-)) were obtained, pre-dialysis and post-dialysis, on the first, second, and third session of the week. Those with pre-dialysis HCO3- < 22 mmol/L in all sessions were classified as acidotic. Demographic and laboratory data of acidotic and non-acidotic groups were compared, and the factors related to HCO3- level were identified. RESULTS: pH, tCO2, HCO3- of the first HD session were significantly lower than those of short inter-dialytic intervals (p < 0.001, respectively). Using Blant Altman analysis, pre- and post-dialysis tCO2 did not show good agreement with HCO3-. Acidotic patients had higher levels of serum albumin and phosphorus (p < 0.01 and p = 0.02, respectively) and were more likely to use sevelamer (p = 0.04). Also, the value of HCO3- was inversely correlated with dialysis vintage (r = -0.432, p = 0.005) and serum albumin (r = -0.427, p = 0.005). CONCLUSION: Since tCO2 did not show good agreement with HCO3-, relying solely on the pre-dialysis tCO2 values to define metabolic acidosis may increase misclassification rate. More work is needed for optimal assessment of acid-base status. Also, understanding the determinants of HCO3- may guide physicians for individualized HCO3- prescription.

Spectrum of biopsy-based renal disease in an elderly Turkish population.

AIM: The prevalence of kidney disease and the number of renal biopsies performed in the elderly are increasing with aging of the population. We aimed to analyze the clinicopathological findings of kidney diseases in the elderly (≥ 65 years), in comparison with their younger counterparts (aged 16 - 64 years). MATERIALS AND METHODS: The data at the time of renal biopsy were obtained by reviewing medical records and the biopsy reports of the patients retrospectively. The data at the time of renal biopsy were obtained by reviewing medical records and the biopsy reports of the patients who underwent renal biopsy at Bakirkoy Dr. Sadi Konuk Education and Research Hospital. Demographic characteristics, clinical syndrome at presentation, and histopathological diagnosis of all patients were recorded. RESULTS: Among the 750 renal biopsies, 93 were performed in elderly patients, which constitutes 12.4% of the biopsies. The mean age of the patients was 71.7 ± 5.4 years, and 62.4% were male. The most common indication for renal biopsy was nephrotic syndrome (NS) in elderly and younger age groups (45.2% vs. 40%). The most frequent histopathological diagnosis was membranous glomerulonephritis (MGN). According to the clinical presentation, MGN (42.8%) was the leading cause of NS, and almost 1/3 of the patients with acute or rapidly progressive renal failure were found to have pauci-immune glomerulonephritis (GN). In comparison with renal biopsy results of younger patients, MGN and pauci-immune GN were more prevalent, but IgA nephropathy, lupus nephritis, and acute tubular necrosis were less common in elderly patients. CONCLUSION: Clinical presentation and the frequency of certain renal pathologies differ with age. The relatively high prevalence of potentially curative kidney diseases in the elderly indicates the importance of renal biopsy in these patients.

Leptospirosis With Acute Renal Failure and Vasculitis: A Case Report.

Leptospirosis is a zoonotic disease that occurs worldwide. Various clinical manifestations of leptospirosis can be seen. In this article, we present a case with acute renal failure, severe vasculitis and hyperbilirubinemia occurring simultaneously with leptospirosis. A 45-year-old male patient presented with fever, myalgia, jaundice and reddish skin lesions and anuria. Physical examination findings were icteric sclera, large tender hepatomegaly, and lower extremities' cutaneous necrosis due to vasculitis. Hemodialysis was started. Kidney biopsy revealed degenerative changes of proximal tubules, some of them containing bile casts. Microscopic agglutination test was positive and consistent with leptospirosis. Intravenous ampicillin and oral tetracycline were started. Methylprednisolone 60 mg per day was given for skin vasculitis. Hemodialysis therapy was discontinued. All clinical findings gradually regressed.