Bülent Huddam

A Randomized Study of Allopurinol on Endothelial Function and Estimated Glomular Filtration Rate in Asymptomatic Hyperuricemic Subjects with Normal Renal Function

BACKGROUND AND OBJECTIVES Endothelial dysfunction is an early manifestation of vascular injury and contributes to the development of atherosclerotic cardiovascular disease. Recent studies have implicated hyperuricemia as a risk factor for cardiovascular disease. We hypothesized that lowering uric acid in subjects with asymptomatic hyperuricemia with allopurinol might improve endothelial dysfunction, BP, estimated GFR (eGFR), and inflammatory markers. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Subjects with asymptomatic hyperuricemia and no history of gout and 30 normouricemic control subjects were enrolled in this 4-month randomized prospective study. Thirty hyperuricemic patients received 300 mg/d allopurinol and were compared with 37 hyperuricemic patients and 30 normouricemic subjects in matched control groups. Flow-mediated dilation (FMD), eGFR, ambulatory BP monitoring, spot urine protein-creatine ratio, and highly sensitive C-reactive protein were measured at baseline and at 4 months. RESULTS Age, gender, lipid profile, eGFR, hemoglobin, glucose, and level of proteinuria were similar in hyperuricemic subjects and controls at baseline. As expected, hyperuricemic patients had higher levels of highly sensitive C-reactive protein and lower FMD compared with normouricemic patients. Allopurinol treatment resulted in a decrease in serum uric acid, a decrease in systolic BP, an increase in FMD, and an increase in eGFR compared with baseline. No significant difference was observed in the control hyperuricemic and normouricemic groups. In a multiple regression analysis, FMD levels were independently related to uric acid both before (beta = -0.55) and after (beta = -0.40) treatment. CONCLUSIONS Treatment of hyperuricemia with allopurinol improves endothelial dysfunction and eGFR in subjects with asymptomatic hyperuricemia.

Additive Effectiveness of Everolimus Plus Tamoxifen Therapy in Treatment of Encapsulating Peritoneal Sclerosis

Peritoneal dialysis (PD) is one of the commonly used choices of continuous renal replacement therapies. Peritoneal membrane is damaged by using solutions with lower biocompatibility, peritonitis episodes, and vintage of PD therapy. Encapsulating peritoneal sclerosis (EPS) is a rare complication of PD and is presented by progressive fibrosis of the peritoneum. Fibrous tissue entrapment of the intestine, leading to complete intestinal obstruction, is referred to as EPS, the most severe form of sclerosing peritonitis. EPS is irreversible fibrosis of the peritoneal membrane usually associated with high rates of morbidity and mortality. Preventive strategies are the best choice of treatment. Also there is no proven effective therapy for EPS; there are only small-sized trials. Herein we present a case of EPS who improved with everolimus plus tamoxifen therapy.

Is Conventional Hemodialysis Enough to Manage Carbamazepine Intoxication

Hemodialysis (HD) is a technique that helps in the management of drug intoxications/overdoses – the most important point being the protein-binding rate of the molecules which have to be cleared. In cases where the drug is not bound to the proteins, conventional HD may be effective enough, but if the drug is highly bound to proteins then HD may be insufficient to be effective. Hemoperfusion and albumin dialysis are therefore appropriate alternatives. Herein we report a case of carbamazepine intoxication where conventional HD treatment was performed.

The Relationship Between Serum Fetuin-A, Cystatin-C Levels, and Microalbuminuria in Patients With Metabolic Syndrome

The metabolic syndrome, syndrome X, is a group of metabolic disorders in which insulin resistance plays a pivotal role. The MS is an important risk factor for subsequent development of type 2 diabetes and cardiovascular disease. Fetuin‐A is a liver derived blood protein that acts as effective inhibitor of soft tissue calcification. Cystatin C is a useful marker in measuring glomerular filtration rate. Moreover, recently it has been suggested that cystatin C may be a potential biomarker for detecting microalbuminuria. Microalbuminuria (MA) is a strong indicator of morbidity related to cardiovascular disorders, and is currently considered a novel diagnostic criterion for MS. It has been also demonstrated that the increased serum fetuin‐A levels is associated with several parameters of MS. In this study, we attempted to investigate the relationship between serum fetuin‐A, cystatin‐C levels and microalbuminuria in patients with MS.

Coexistent findings of renal glomerular disease with Hashimoto’s thyroiditis

Aim and Background  Hashimoto’s thyroiditis (HT) is a common autoimmune thyroid disease with a female preponderance. Renal involvement in HT is not uncommon. In the present study, we aimed to define the frequency and characteristics of the glomerular diseases associated with HT and further the understanding of any common pathogenesis between HT and glomerular disease.

MCP-1 and soluble TWEAK levels are independently associated with coronary artery disease severity in patients with chronic kidney disease

Abstract Purpose: Patients diagnosed with chronic kidney disease (CKD) have a greater rate of cardiovascular mortality when compared with the general population. The soluble form of TNF-like weak inducer of apoptosis (TWEAK) and monocyte chemoattractan protein 1 (MCP-1) play important roles in cellular proliferation, migration and apoptosis. The current study aimed to analyze whether soluble TWEAK (sTWEAK) and MCP-1 levels are associated with the severity of coronary arterial disease (CAD) in CKD patients. Methods: Ninety-seven patients diagnosed with CKD stages 2–3 according to their estimated glomerular filtration rate and the presence of kidney injury were included in the study. Plasma sTWEAK and MCP-1 concentrations were determined using commercially available ELISA kits. Coronary angiographies were performed through femoral artery access using the Judkins technique. Results: Correlation analysis of sTWEAK and Gensini scores showed significant association (p < 0.01, r2 = 0.287). Also significant correlation has been found in MCP-1 levels and Gensini scores (p < 0.01, r2 = 0.414). When patients were divided into two groups with a limit of 17 according to their Gensini score, sTWEAK levels indicated a statistically significant difference (p < 0.01). Conclusions: Our findings support a relationship between sTWEAK and MCP-1 levels and CAD in CKD stages 2–3 patients.

Effects of renin-angiotensin-aldosterone system blockade on chlorhexidine gluconate-induced sclerosing encapsulated peritonitis in rats.

Sclerosing encapsulated peritonitis (SEP) is a rare complication of long term peritoneal dialysis. Renin‐angiotensin‐aldosterone system (RAAS) may play a role in the development of peritoneal fibrosis in CAPD patients. We aimed to evaluate the effect of aliskiren, valsartan, and aliskiren + valsartan therapy on SEP. The study included 30 Wistar albino rats which were divided into five groups: I (Control) SF solution i.p.; II (CG group) chlorhexidine gluconate i.p.; III aliskiren oral plus CG i.p.; IV valsartan oral plus CG i.p.; and V aliskiren oral, valsartan oral and CG i.p. On the twenty‐first day, all of the rats were sacrificed. All of the groups were analyzed in terms of peritoneal thickness, degree of inflammation, vasculopathy, neovascularization and fibrosis. Also, the parietal peritoneal tissue samples were evaluated for matrix metalloproteinase 2 (MMP‐2) using the ELISA method. Peritoneal thickness and fibrosis scores were lower in the valsartan group compared to the CG group (P < 0.05). Peritoneal fibrosis scores were lower in the aliskiren group compared to CG group (P < 0.05) but no difference was observed between the peritoneal thickness scores of the two groups (P > 0.05). Tissue MMP‐2 levels were significantly higher in the CG group compared other groups (P < 0.05). There were no statistically significant differences between the aliskiren, valsartan and aliskiren + valsartan groups according to the tissue MMP‐2 levels. Due to the antifibrotic properties of valsartan, it is thought to be a possible choice to prevent SEP development. We found no positive impact of aliskiren or aliskiren + valsartan combination compared to valsartan alone.

Contribution of high flux membranes to the therapy of uremia-associated dyslipidemia.

Cardiovascular diseases are the leading causes of mortality in hemodialysis patients. Uremia induced hypertriglyceridemia; increased levels of lipoprotein remnants and low high‐density lipoprotein are the main features of cardiovascular risk factors. Also, elevated oxidative stress and inflammation are the main contributors of endothelial dysfunction. Even statin based interventional trials failed to improve mortality in dialysis patients, and different treatment options have been proved to be useful. We aimed to evaluate the effect of dialyzer type on uremia‐associated dyslipidemia and endothelial dysfunction. In total 312 patients were enrolled. The initial and 6th month blood samples were obtained from the non‐arteriovenous fistula arm on the day before the first hemodialysis session of the week. Flow mediated dilatation of the patients was measured from the same arm before obtaining the blood samples. Patients were on hemodialysis therapy for 76.43 ± 52.7 months. According to their dialyzer type, there has been a statistically significant improvement noted in terms of total cholesterol, low‐density lipoprotein‐cholesterol, high‐density lipoprotein‐cholesterol and triglyceride levels. The flow mediated dilatation of the patients are measured as 4.3 ± 0.5 and 4.4 ± 0.4 in baseline measurements of the low flux and high flux groups, respectively. Sixth month values of the patients were measured as 4.34 ± 0.4 and 4.62 ± 0.6. The improvement in low flux groups was not statistically significant but in the high flux group the endothelial dysfunction was significantly improved. Our results show that high‐flux dialyzers improved dyslipidemia and endothelial dysfunction in hemodialysis patients. These findings provide a new insight on the selection of high efflux in hemodialysis.

Antibody response after single H1N1 influenza vaccine in chronic dialysis patients.

The first influenza pandemic of this century happened through a rapid spread of a novel swine‐derived H1N1 influenza virus. Vaccines are produced in order to avoid the infection. Children and other high risk groups are highly recommended for vaccination due to the high probability of contracting the virus. Chronic kidney disease patients were also accepted as a risk group and vaccination of all patients undergoing hemodialysis or peritoneal dialysis was recommended. The results of H1N1 influenza virus vaccine on patients receiving hemodialysis and peritoneal dialysis are analyzed. Antibody titers of both hemodialysis and peritoneal dialysis patients were elevated after vaccination. Peritoneal dialysis patients responded better.

Acinetobacter lwoffii Peritonitis in a Patient Receiving Continuous Ambulatory Peritoneal Dialysis

Dear Editor, Peritonitis is one of the major complications of peritoneal dialysis (PD) and still a cause of high rates of mortality and morbidity. While Gram-positive cocci are isolated in the majority of peritonitis cases, Gram-negative bacteria are isolated in at least 15–25% of cases of PD related peritonitis (1). However, it has been reported that the rate of peritonitis attributable to Gram-negative organisms has increased (1). Acinetobacter lwoffii (A. lwoffii) is a nonfermentative aerobic Gram-negative bacillus that is present in the normal flora of the oropharynx and skin (2). Among the Gram-negative bacteria, Acinetobacter species (spp.) have been reported in several series of PD related peritonitis, herein we present a case of peritonitis caused by A. lwoffii.