Melda Dilek

Renal Behçet's Disease: An Update

OBJECTIVE The aims of this study are (1) to report 33 patients with Behçets disease (BD) having various renal manifestations, and (2) to update current data using our patients and published papers about BD and renal manifestations. METHODS The PubMed database was searched using the terms BD or Behçets syndrome. We found reports of 94 patients (including ours) with BD and specific renal diseases (amyloidosis, 39; glomerulonephritis [GN], 37; renal vascular disease, 19; interstitial nephritis, 1). RESULTS The presentation of renal disease was edema/nephrotic syndrome in 12 patients (36%). Renal disease was incidentally diagnosed by routine urine analysis and measurement of serum creatinine level in 20 patients (61%). Renal failure was present in 23 patients (70%) and 5 of them have had cyclosporine treatment. The frequency of renal disease among BD patients has been reported to vary from less than 1 to 29%. CONCLUSIONS The clinical spectrum of renal BD shows a wide variation. Amyloidosis (AA type), GN, and macroscopic/microscopic vascular disease are the main causes of renal BD. Patients with vascular involvement have a high risk of amyloidosis and amyloidosis is the most common cause of renal failure in BD. Several types of glomerular lesions are seen in BD. Current treatment options for renal BD are not evidence based. Radiological vascular intervention combined with immunosuppressive drugs can be useful in selected cases. Routine urine analysis and measurement of serum creatinine level are needed for early diagnosis of renal BD.

Evidence of Left Ventricular Systolic and Diastolic Dysfunction by Color Tissue Doppler Imaging Despite Normal Ejection Fraction in Patients on Chronic Hemodialysis Program

Background: Cardiovascular diseases are responsible for about half of deaths and are the major cause of mortality in hemodialysis patients. The aim of this study is to assess left ventricular (LV) longitudinal myocardial functions by color tissue Doppler imaging (TDI) in patients with chronic renal failure on a regular hemodialysis program. Methods: Thirty‐one patients on a regular hemodialysis program (mean age 47 ± 12 years; 17 males, 14 females) were included into the study. Twenty‐three healthy subjects (mean age 44 ± 8 years; 15 males, 8 females) were studied as a control group. The patients had been on maintenance hemodialysis for at least 1 month and hemodialysis sessions were three times per week. For color TDI, apical two‐ and four‐chamber views of left ventricle were used. Sample volumes were placed on the mid‐left ventricle in the inner half of the myocardium at the septum, lateral, inferior, and anterior walls. Peak LV strain, peak systolic strain rate, peak early diastolic strain rate, peak late diastolic strain rate, peak systolic tissue velocity, peak early diastolic tissue velocity, and peak late diastolic tissue velocity values were measured. Results: Mean peak LV strain, mean peak systolic strain rate, and mean peak systolic tissue velocity values were all lower in the hemodialysis group. Although mean peak late diastolic strain rate and mean peak late diastolic tissue velocity values were similar between the groups, mean peak early diastolic strain rate and mean peak early diastolic tissue velocity values were lower in the hemodialysis group. Conclusion: Patients with chronic renal failure on regular hemodialysis program show significant alterations at LV longitudinal myocardial function parameters assessed by color TDI.

SAA1 α/α alleles in Behçet’s disease related amyloidosis

Behçet’s disease (BD) related amyloidosis is relatively rare. Serum amyloid A protein (SAA) protein gene polymorphism is one of the factors implicated in the pathogenesis of AA type amyloidosis. The aim of this study is to investigate SAA1 gene polymorphism in different patient groups: (1) BD related amyloidosis, (2) BD without amyloidosis, and (3) healthy controls. One hundred eleven patients from three main groups were included in the study: (1) BD related amyloidosis (n = 9), (2) BD without amyloidosis (n = 39), and (3) healthy controls (n = 63). Homozygous α/α is present in 78% of patients with BD and amyloidosis. The SAA1 α/α genotype is significantly more common among patients with BD and amyloidosis. This study demonstrated increased frequency of α/α genotype in BD related amyloidosis. To our knowledge, the relationship between α/α genotype and BD related amyloidosis was not studied previously. In conclusion, the SAA1 α/α genotype is a risk factor for amyloidosis in BD.

Lemon juice as an alternative therapy in hypertension in Turkey

We aimed to learn the frequency of lemon juice usage among the hypertensive patients in a local region of northern Turkey. One hundred fifty six (72.5%) of hypertensive patients were using alternative therapy and eighty six patients (40%) were drinking lemon juice. We think that to gain success in the treatment of hypertension educating the society is important and there should be clinical studies about the effect of lemon juice on blood pressure, which is one of the most common alternative therapies in our country.

Transplantation tourism: high risk for the recipients.

Yakupoglu YK, Ozden E, Dilek M, Demirbas A, Adibelli Z, Sarikaya S, Akpolat T. Transplantation tourism: high risk for the recipients. 
Clin Transplant 2010: 24: 835–838.

Home sphygmomanometers: validation versus accuracy.

ObjectiveThe validation and accuracy of sphygmomanometers are important issues in the home sphygmomanometer market and in clinical practice. The aims of this study are to assess the frequency of validated home sphygmomanometers and to evaluate the relationship between the validation and accuracy of the devices. MethodsEight hundred and ninety-six home sphygmomanometers were brought by individuals to the University Hospital Hypertension Clinic for this study, and 870 (97%) of the devices were in adequate working condition and suitable for analysis. The relationship between accuracy and validation was investigated only in automated sphygmomanometers (n = 554). ResultsBoth the manufacturer and model were known in 500 devices (90%), and these devices were eligible for evaluation of validation. We found 74 devices listed in the dabl Educational Trust website. Twenty-two of the 74 (30%) devices were validated. Four hundred (72%) of the 554 automated sphygmomanometers were inaccurate. The frequency of accuracy was higher among validated devices compared with nonvalidated devices (68 vs. 15%) (P<0.01). ConclusionOur study showed that the frequency of accurate devices was higher among validated sphygmomanometers compared with nonvalidated sphygmomanometers. To our knowledge, our study is the first to demonstrate the relationship between accuracy and validation of home sphygmomanometers. The frequency of device-related errors can be decreased by training patients and supervising the blood pressure device market. Nonprofit organizations can help patients to overcome some of the problems in the blood pressure device market.

Self-measurement of blood pressure at home: is it reliable?

Self‐measurement of blood pressure (BP) at home is more common than 10 years ago and encouraged by current guidelines to increase patient adherence to treatment and reach the goal of target BP. The aims of this study are to evaluate the accuracy of home sphygmomanometers and to investigate behavior/knowledge of the sphygmomanometer owners. A campaign was planned to determine the accuracy of home sphygmomanometers in 2006. Seven hundred and twenty‐three home sphygmomanometers were brought by individuals to the University Hospital Hypertension Clinic within 1 year and 693 (96%) of the devices were in adequate working condition and suitable for analysis. Four hundred and thirty‐nine (63%) of the sphygmomanometers were automatic. Four hundred and eleven (59.3%) of the 693 sphygmomanometer were inaccurate. About 80% (256/320) of the wrist devices were inaccurate. Most studies evaluating the accuracy of sphygmomanometers are conducted in hospital or primary care settings; studies investigating home sphygmomanometers are rare. High frequency of inaccurate home devices is a major public health problem. In conclusion, inaccurate devices have been used in home BP measurements frequently and frequency of device‐related errors can be decreased by awareness and training of the patients. Physicians and healthcare providers should advise the patients to check the accuracy of their home sphygmomanometers regularly.

Hypothyroidism as a Cause of Resistance to Erythropoietin

Accessible online at: www.karger.com/journals/nef Dear Sir, A poor response to human recombinant erythropoietin (EPO) is seen in 5–10% of the patients with renal anemia. Several factors, such as iron deficiency, blood loss, infections, inflammatory conditions, hyperparathyroidism, aluminum toxicity, vitamin B12 or folate deficiency, red cell enzyme defects, hemoglobinopathies, and hemolysis, have been shown to inhibit a response to EPO [1]. Hypothyroidism may lead to anemia. The aim of this report is to present a hypothyroid hemodialysis patient with a diminished response to EPO. A 50-year-old female patient was admitted to the University Hospital because of a poor response to EPO. She had autosomal dominant polycystic kidney disease, hypertension, and a history of thyroidectomy. She was treated with regular hemodialysis (three times weekly during the last year, twice weekly before) for 5 years. Her hemoglobin and hematocrit values were 6.7 g/dl and 20%, respectively, after 1 year of EPO treatment (4,000 U s.c. three times weekly). Iron (parenteral and oral supplementation), folate, amlodipine, vitamin D, phosphorus binders, and levothyroxine (100 Ìg/day) were the other medications of the patient. In order to define the underlying mechanism of the EPO resistance, she underwent a hematological survey which yielded the following results: serum iron 39 Ìmol/l, serum iron binding capacity 160 Ìmol/l, serum ferritin 611 ng/ml, serum vitamin B12 240 pg/ml, and serum folate 6 ng/ml. A peripheral blood smear showed normochromic, normocytic erthyrocytes with normal leukocytes and platelets. A bone marrow aspiration biopsy revealed a normocellular marrow. There were no clinical or laboratory findings suggesting blood loss, infection, or inflammation. Thyroid function tests revealed free triiodothyronine 1.01 pmol/l, free thyroxine 0.74 pmol/l, and thyroid-stimulating hormone 48 mIU/l. The dosage of levothyroxine was increased to 150 Ìg/day, later to 200 Ìg/ day. Three months thereafter, her hemoglobin and hematocrit values rose to 11.8 g/dl and 37%, respectively, with suppression of thyroid-stimulating hormone. Three years later, the patient is now receiving EPO at a dosage of 4,000 U three times weekly, and her hemoglobin and hematocrit values are within the desired limits. These findings support that underlying hypothyroidism is the cause of resistance to EPO treatment in this patient. The requirement of an euthyroid state for the action of EPO on the bone marrow is well known, but only 1 hypothyroid hemodialysis patient with a poor response to EPO has been reported previously [2]. Hypothyroidism should be included in the differential diagnosis of a poor response to EPO in patients with renal failure.

Effect of rosiglitazone on cisplatin-induced nephrotoxicity.

Aim: Nephrotoxicity is a major side effect of cisplatin (Cis), a widely used chemotherapeutic drug. Recent studies have strongly suggested that inflammatory mechanisms may play an important role in the pathogenesis of Cis nephrotoxicity. Rosiglitazone (Ros), a peroxisome proliferator-activated receptor-gamma agonist has been recently demonstrated to regulate inflammation by modulating the production of inflammatory mediators and adhesion molecules. The aim of this study was to evaluate the effect of Ros on the prevention of Cis-induced nephrotoxicity. Methods: Eighteen male Sprague–Dawley rats weighing 150–200 g were included in the study. The rats were randomly divided into three groups: group 1: Cis-treated group; group 2: Cis–Ros-treated group; group 3: saline-treated group. Blood urea nitrogen (BUN) and serum creatinine concentrations were measured. In addition, extent of histological renal tubular injury in each animal was graded histologically. Results: Mean BUN and serum creatinine concentrations were significantly lower in group 3 than in group 1 (p < 0.05) and group 2 (p < 0.05). There were no significant differences in terms of BUN and serum creatinine concentrations between groups 1 and 2 (p > 0.05). Acute tubular injury with karyomegalic changes in corticomedullary junction was significantly higher in groups 1 and 2 than group 3 (p < 0.05). However, there were no significant differences between groups 1 and 2 (p > 0.05). Conclusion: This study indicates that post-insult administration of Ros does not seem to have a beneficial effect on prevention and severity of nephrotoxicity induced by Cis.

Red Cell Distribution Width and Mean Platelet Volume in Amyloidosis

We aimed to determine whether red cell distribution width (RDW) and mean platelet volume (MPV) values differ between patients with reactive amyloid A (AA) amyloidosis due to chronic inflammatory disease and in healthy participants. In this study, 33 patients with AA amyloidosis and 40 age- and sex-matched healthy controls were enrolled. Erythrocyte sedimentation rate (ESR), RDW, platelet count (PLT), and MPV levels were retrospectively obtained from our computerized patient database. We found RDW, ESR, and PLT levels to be significantly higher in patients with AA amyloidosis compared with the controls (P < .0001). Mean platelet volume was significantly lower in patients with amyloidosis (P < .0001). Inflammatory diseases such as AA amyloidosis may demonstrate low MPV and high RDW levels.