Ercan Turkmen

Hip fractures in a developing country: osteoporosis frequency, predisposing factors and treatment costs.

Hip fractures are a burden to both society and the individual. The aim of this study was to describe the frequency of osteoporosis and the in-hospital treatment costs of patients with hip fractures admitted to Hacettepe University Faculty of Medicine Hospital. Patients with a hip fracture who were admitted to the Orthopedics and Traumatology wards between April 2003 and December 2006 were interviewed and 50 of them were enrolled prospectively in the study protocol. Patient characteristics, predisposing factors for fractures and hospital costs were recorded as well as laboratory test results and bone mineral density measurements. The mean age was 74.2 years and 72% of the patients were women. Sixty-four percent of them presented with an intertrochanteric fracture. The patient population was significantly debilitated with a high prevalence of vitamin D insufficiency and secondary hyperparathyroidism. No association was shown with T scores and dietary habits and lifestyle characteristics of patients. In 34% of patients in whom measurements were available, no osteoporosis could be documented. The mean hospital expenditure was

Could remembering the prozone phenomenon shorten our diagnostic journey in brucellosis? A case of Brucella spondylodiscitis

5983. Factors affecting the total cost were age and functional status of the patient and the duration of hospital stay, independent of the type of fracture and surgical procedure used.

Elevated urinary angiotensinogen a marker of intrarenal renin angiotensin system in hypertensive renal transplant recipients: does it play a role in development of proteinuria in hypertensive renal transplant patients?

We reviewed a case of Brucella spondylodiscitis admitted to a referral, university hospital, in Ankara, Turkey. A 75-year-old female was referred to our hospital with low back pain. Previous magnetic resonance imaging yielded cortical destruction of T9–10 and T12–L2 vertebral bodies, focal infectious foci at discs within this range, significant microabscesses at paravertebral areas, which lead to the diagnosis of spondylodiscitis. History of consumption of unpasteurized dairy products led us to first suspect brucellosis yet, the serum agglutination test and blood culture were negative and did mislead us to several other, sometimes invasive, diagnostic tests. The final diagnosis was reached by culturing the specimen obtained through fine-needle aspiration from the paravertebral microabscesses. The exhausting diagnostic journey that started with the suspicion of tuberculosis or malignancy ended with a diagnosis of brucellosis. Brucellosis should be considered in all patients with osteoarthritic complaints in endemic regions, and the “prozone phenomenon” should be kept in mind, before proceeding to high-tech lab tests, imaging, or invasive procedures.

Blood pressure measurements, blood pressure variability and endothelial function in renal transplant recipients.

The aim of this study was to evaluate the relationship of local intrarenal renin angiotensin system (RAS) with hypertension and proteinuria in renal transplant recipients. Sixty‐nine nondiabetic renal transplant recipients (39 male, mean age: 36.3 ± 11.5 years) were included in this study. All patients were in stable condition with GFR greater than 30 ml/min/1.73 m2; (MDRD). Hypertension was defined to be present if there was a recorded diagnosis of hypertension, systolic blood pressure >130 mmHg and/or diastolic blood pressure >80 mmHg according to ambulatory blood pressure monitoring. None of the hypertensive patients were receiving RAS blockers. Spot urine samples were obtained to measure urinary angiotensinogen (AGT) using human AGT‐ELISA, urinary creatinine and protein levels. The demographic properties and laboratory findings were similar between hypertensive and normotensive transplant recipients. Urinary AGT–creatinine ratio (UAGT/UCre) was significantly higher in hypertensive patients compared with the normotensives (8.98 ± 6.89 μg/g vs. 5.48 ± 3.33 μg/g; P = 0.037). Importantly, a significantly positive correlation was found between UAGT/Ucre levels and proteinuria in hypertensive patients (P = 0.01, r = 0.405). Local intrarenal RAS probably plays an important role in the development of hypertension and proteinuria in renal transplant recipients.

The relation between urinary angiotensinogen and proteinuria in renal AA amyloidosis patients.

Abstract Background/Aims: Hypertension is an important cardiovascular risk factor in renal transplant recipients. Elevated blood pressure variability (BPV) during 24-h ambulatory blood pressure monitoring (ABPM) is associated with increased risk of target organ damage and cardiovascular events, independent of mean blood pressure levels. We aimed to evaluate the relationship between endothelial function, blood pressure levels obtained by various measurement methods, and BPV in renal transplant recipients. Methods: In total, 73 hypertensive renal transplant recipients were included in the study. Office blood pressure measurements, central blood pressure measurements, home blood pressure measurements and 24-h ABPM were obtained from the subjects. BPV was calculated using the average real variability index. All patients underwent brachial flow-mediated vasodilatation tests. Predictive values of blood pressures obtained by different measurement techniques and BPV on endothelial functions were investigated. Results: Endothelial dysfunction was present in 68.5% of the patients. No difference was found between the group with and without endothelial dysfunction with regard to office systolic or diastolic blood pressure, central blood pressure or home systolic blood pressure. In the group with endothelial dysfunction, 24-h ambulatory systolic blood pressure and night-time ambulatory systolic blood pressure were higher. In patients with endothelial dysfunction, the 24-h systolic, diastolic and mean BPV were all higher. There was also a negative correlation between the percentage of flow-mediated vasodilatation with 24-h mean and systolic BPV. Conclusion: Patients with endothelial dysfunction had significantly higher ambulatory blood pressure values and higher BPV. There was a significant negative correlation between endothelial function and BPV.

HFE gene mutation is a risk factor for tissue iron accumulation in hemodialysis patients

Objective: The aim of this study was to evaluate the relationship of local intrarenal renin angiotensin system (RAS) with proteinuria in patients with renal AA amyloidosis. Methods: Thirty-two patients with renal AA amyloidosis (19 male, mean age: 45 ± 13 years) and sixteen healthy controls (5 male, mean age: 32 ± 5 years) were included in this study. Spot urine samples were obtained to measure urinary angiotensinogen (AGT) using human AGT-ELISA, urinary creatinine and protein levels. Logarithmic transformations of urinary AGT-creatinine ratio log(UAGT/Ucre) and urinary protein-to-creatinine ratio (UPCR) were done to obtain the normal distributions of these parameters. Results: Log(UAGT/UCre) was significantly higher in patients compared with the controls (1.88 ± 0.92 µg/g vs. 1.25 ± 0.70 µg/g; p = 0.023). Importantly a significantly positive correlation was found between log(UAGT/Ucre) and logUPCR in patients (r = 0.595, p = 0.006). Conclusions: Urinary AGT levels are higher in renal AA amyloidosis patients than in controls. Also, there is a significant positive correlation between urinary AGT and proteinuria in renal AA amyloidosis.

Endothelial Dysfunction in Renal Transplant Recipients: Role of Vitamin D and Fibroblast Growth Factor-23

Introduction: HFE gene mutations are responsible from iron overload in general population. Studies in hemodialysis patients investigated the effect of presence of HFE gene mutations on serum ferritin and transferrin saturation (TSAT) with conflicting results. However effect of HFE mutations on iron overload in hemodialysis patients was not previously extensively studied.

Relationship between hemorheology and endothelial dysfunction in renal transplant patients receiving calcineurin inhibitors.

BACKGROUND Endothelial dysfunction can be detected at early stages of chronic kidney disease. Although endothelial functions improve after successful renal transplantation, renal transplant recipients have still worse endothelial functions compared to healthy subjects. Vitamin D deficiency and high fibroblast growth factor-23 (FGF-23) levels may have a role on endothelial dysfunction in chronic kidney disease patients. The aim of this study is to investigate the association between endothelial functions, vitamin D, and FGF-23 levels in renal transplant recipients. METHODS One hundred nine renal transplant recipients (71 male, 38 female) underwent brachial flow-mediated dilatation (FMD), serum 25-OH vitamin D, and FGF-23 level measurements. Vitamin D and FGF-23 levels were compared between patients with normal and abnormal endothelial functions. Correlations between FMD, vitamin D, and FGF-23 were also investigated. RESULTS Endothelial functions were abnormal in 72.5% of the patients. Prevalence of vitamin D deficiency was 80.7%. Vitamin D levels were significantly lower in patients with endothelial dysfunction compared to patients with normal endothelial functions (12.6 ± 6.6 μg/L vs 17.3 ± 10.0 μg/L respectively, P = .02). FGF-23 levels were not different between the two groups. 25-OH vitamin D levels had a significant positive correlation with amount of FMD (r = 0.218 and P = .02) and were an independent predictor of FMD after adjusting for potential confounding factors including age, transplantation duration, body mass index, mean blood pressure, glomerular filtration rate, proteinuria, hemoglobin, and FGF-23 in multivariate regression analysis (beta = 0.194, P = .04). FGF-23 levels were not predictive of FMD in this model (beta: -0.125, P = .197) CONCLUSION: Vitamin D deficiency is associated with endothelial dysfunction in renal transplant recipients. Further clinical and experimental studies are necessary to define a causal relationship between the parameters, discover the potential mechanisms, and observe the effect of vitamin D replacement on endothelial functions in renal transplant recipients.

Kidney transplantation for end-stage renal disease secondary to familial Mediterranean fever

BACKGROUND Calcineurin inhibitors, mainly cyclosporin A (CsA), are associated with endothelial dysfunction in renal transplant recipients (RTRs). Hemorheological disturbances including decreased erythrocyte deformability (ED), increased plasma viscosity and erythrocyte aggregation (EA) have also been reported in CsA-treated RTRs. The aim of this study was to investigate the relationship between hemorheological factors and endothelial dysfunction in CsA- and tacrolimus (Tc)-treated RTRs. METHODS Thirty-one RTRs and 16 healthy subjects were recruited. The RTR group received either CsA (n = 16) or Tc (n = 15). Endothelial function was evaluated by flow-mediated dilation (FMD) of the brachial artery. ED and EA were measured with laser-assisted optical rotational cell analyzer, and plasma viscosity by a cone-plate viscometer. RESULTS FMD of the CsA group was significantly lower than that of controls (6.3% ± 5.1% vs. 11.9% ± 5.6%, p = 0.024), whereas, there was no significant difference between the Tc group (8.8% ± 5.4%) and controls. At shear stresses ranging between 0.95 and 30 Pa, EDs of the CsA group were significantly lower compared with controls. In the Tc group, the decrease in ED was significant at shear stresses ranging between 0.53 and 5.33 Pa. ED indices did not correlate with FMD in any of the groups. CONCLUSIONS The degree of endothelial dysfunction and reduction in ED were more remarkable in patients on CsA therapy. Hemorheological factors were not likely to be associated with endothelial dysfunction in RTRs.

Tip lesion variant of primary focal and segmental glomerulosclerosis: clinicopathological analysis of 20 cases.

Although kidney transplantation (KT) is widely used for treating renal amyloidosis secondary to familial Mediterranean fever (FMF), data concerning transplant outcome are limited and inconsistent. The aim of this study was to determine the long‐term outcome of KT in patients with amyloidosis secondary to FMF. Kidney transplantation outcome in 24 patients with FMF was compared to that in 72 controls matched for age, gender of recipient, and type of the donor that underwent KT due to end‐stage renal disease (ESRD) not caused by FMF. Mean follow‐up time was 80.3 ± 55.1 months in the FMF group, vs. 86.5 ± 47.6 months in the control group. Death‐censored graft survival at five and 10 yr in the FMF group was 95.8% and 78.4%, respectively, and was comparable to that in the control group. In the FMF group, five‐ and 10‐yr patient survival (87.5 and 65.6%) was shorter than in the control group, but the difference was not statistically significant. The findings show that long‐term outcome of KT in the patients with amyloidosis secondary to FMF was comparable to that in patients with ESRD not caused by FMF. Recurrence of amyloidosis in the allograft, gastrointestinal intolerance, and fatal infections remain as major complications during the post‐transplant period.