Ayla San

OUTCOME OF PREGNANCIES WITH HELLP SYNDROME COMPLICATED BY ACUTE RENAL FAILURE (1989–1999)

HELLP syndrome, a syndrome of hemolysis, elevated liver enzymes and low platelets may occur in pregnancy with pre-eclampsia/eclampsia, and its a significant complication is acute renal failure (ARF). The aim of study was to determine frequency and outcome of HELLP syndrome complicated by ARF. Thirty-nine patients with pregnancy-related ARF were treated between Jan 1, 1989 and Jan 1, 1999. In these patients, the most frequent causes were HELLP syndrome (n = 14; 36%), postpartum hemorrhage (n = 10; 26%), pre-eclampsia/eclampsia (n = 6;15%) and abruptio placenta (n = 4;10%). Seven of the patients with HELLP syndrome had impairment of consciousness during hospitalization. Of these patients, coma in 5, stupor in 1, confusion in 1 were diagnosed. Twelve of the patients with HELLP syndrome and 14 of the other patients were treated by dialysis. Mann-Whitney U test and X2 test(corrected by Yates and Fisher exact) were used for statistical analysis. Although serious clinical findings, with supportive treatment, 12 patients with HELLP syndrome and 21 other patients were fully recovered. One patient both with and without HELLP syndrome could not recovered due to diffus cortical necrosis. Moreover, one patient with HELLP syndrome and 3 other patients were died. Mortality rate of the patients with HELLP syndrome was not found different from those of the other patients (p = 0.544). The causes of death were cerebral hemorrhage in patient with HELLP syndrome and disseminated intravascular coagulation (n = 1), cerebral emboli (n = 1), adult respiratory distress syndrome (n = 1). Fetal death occured in 4 patients with HELLP syndrome (28.5%) and 7 other patients (28%), and rates were similar(p > 0.5). Finally, HELLP syndrome was the most frequent cause leading to ARF in pregnancy and their prognosis was not different from those of the other patients.

THE IMPORTANCE OF SERUM TRANSFERRIN RECEPTOR LEVEL IN THE DIAGNOSIS OF FUNCTIONAL IRON DEFICIENCY DUE TO RECOMBINANT HUMAN ERYTHROPOIETIN TREATMENT IN HAEMODIALYSIS PATIENTS

In haemodialysis (HD) patients, functional iron deficiency frequently appears due to recombinant human erythropoietin (r-HuEPO) treatment. However, the diagnosis of iron deficiency is not always easy in such patients. Recent studies have shown that the serum transferrin receptor (s-TfR) level is a sensitive, quantitative measure of tissue iron deficiency. In this study, we examined the changes in s-TfR levels in patients with iron deficiency anaemia due to r-HuEPO treatment.We compared s-TfR levels of 24 patients with i.v. administered r-HuEPO 50–70 U/kg/dose) at the end of each dialysis session (three times a week) and diagnosed as having iron deficiency anaemia by routine laboratory methods (ferritin<50 μg/l and transferrin saturation<16%) with s-TfR levels of 32 patients not receiving r-HuEPO and without iron deficiency anaemia. Also, 40 healthy volunteer subjects were included in the study as a control group. Serum ferritin and transferrin receptor levels were measured with ELISAs using monoclonal reagents. There were no differences between the two groups with and without iron deficiency anaemia with respect to mean age, body weight, haemodialysis duration, haemoglobin and serum creatinine levels (p>0.05). For s-TfR levels, while no difference was present between the control and the non-iron deficiency groups (p>0.05), the iron deficiency group had higher s-TfR values than those of both the control and non-iron deficiency groups (p<0.001). Besides, there was an inverse correlation between haemoglobin and s-TfR levels in patients with iron deficiency anaemia (r=−0.85, p<0.0001).We conclude that the measurement of s-TfR levels may be useful in the diagnosis of functional iron deficiency in haemodialysis patients receiving r-HuEPO.

Frequency and outcome of patients with acute renal failure have more causes than one in etiology

In literature, there was little data about frequency and outcomeof ARF with two or more causes in etiology. Therefore, the aim of this studywas to search this issue. This series included 339 patients with ARF from Jan 1,1987 to Jan 1,1999.Fourty-six (30 males) of all patients (13.5%) had two or more causes in etiologyof ARF. Of these patients, causes were prerenal and renal in 26 (56%), prerenal,renal and postrenal in 12 (26%), renal and postrenal in 4 (9%), and prerenaland postrenal in 4 (9%). The most frequent cause is diarrhea and vomitingin prerenal, gentamycin usage in renal and prostat hypertrophy in postrenal.Of these patients, there was oliguria in 32 (70%), anuria in 8 (17%) and non-oliguriain 6 (13%). Treatment modalities of patients was only medical in 19 (41%),dialysis in addition to medical therapy in 27 (59%). In spite of treatment,5 (10.8) of patients with two or more causes in etiology died. Causes of deathwere uremic coma in 2, cardiac disorders in 2 and septic shock in 1. Three(11.2%) of other patients with one cause died. Mortality rates were not different(χ2: 0.0298, p> 0.5). Cortical necrosis was diagnosed in one patient with multiplee etiologyand 2 of other patients. Finally, frequency of ARF with two or more etiologic causes was 13.5%,and most frequent causes were hypovolemia and nephrotoxic drugs. Outcome ofthese patients was similar to other patients with one cause.

Serum Transferrin Receptor Level in the Diagnosis of Iron Deficiency due to Erythropoietin Treatment

Accessible online at: http://BioMedNet.com/karger Dear Sir, In hemodialysis patients iron deficiency frequently occurs due to recombinant human erythropoietin (r-HuEPO) treatment [1]. However, the diagnosis of iron deficiency is not always easy in such patients [2]. It has been suggested [3] that the serum transferrin receptor (s-TfR) is a sensitive quantitative measure of tissue iron deficiency. We examined the changes in s-TfR levels of 24 patients (12 males, 12 females) who received r-HuEPO (50–70 U/kg/dose i.v.) at the end of each dialysis session (three times a week) diagnosed as having iron deficiency anemia by routine laboratory methods (ferritin !50 Ìg/l, transferrin saturation !16%). These s-TfR levels were compared with those of 32 hemodialysis patients (18 females, 14 males) not receiving r-HuEPO and having no iron deficiency anemia (ferritin 1 100 Ìg/l, transferrin saturation 120%). Also, 40 healthy volunteers (24 females, 16 males) were included in the study as a control group. Patients with a history of blood transfusions within the last 3 months or with any hemolysis finding were excluded from the study. Serum ferritin and s-TfR levels were measured with enzyme-linked immunosorbent assays using monoclonal reagents. As shown in table 1, there were no differences between the groups with and without iron deficiency anemia with respect to mean age, body weight, time on hemodialysis, and hemoglobin and serum creatinine levels (p 1 0.05). For s-TfR levels, while no difference Table 1. Demographic data and biochemical characteristics of patients and controls

Effects of a Normalized Protein Catabolism Rate on Platelet Functions in Non-Dialyzed Uraemic Patients

NPCR (p < 0.001, p < 0.001), lower platelet adhesion rates (p < 0.001, p < 0.001) and a more prolonged bleeding time (p < 0.05, p < 0.01) than the other groups. The patients in the high-BMI group had a lower NPCR than the normal-BMI group (p < 0.01), and their ADP-, epi-nephrine, ristocetin- and collagen-stimulated mean percent platelet aggregation values were higher than those of the low-BMI group (p < 0.01, p < 0.0001, p < 0.01, p < 0.01, respectively) and than those of the normal-BMI group for only epinephrine, ristocetin and collagen (p < 0.001, p < 0.05, p < 0.05, respectively). In low-BMI patients, ADPand epinephrine-stimulated percent aggregation values were lower than those of the nor-mal