Nurol Arık

Serum Tumour Markers in Renal Failure

In order to assess the clinical value of six tumour markers in pre-dialysis patients with chronic renal failure as well as in patients on regular haemodialysis, we studied these markers in 35 predialysis patients, 35 patients on chronic haemodialysis and 35 healthy controls. Serum squamous cell antigen (SCC), CA 19.9, and CA 125 levels were found to be elevated in the uraemic groups as compared to the normal controls. Carcinoembryonic antigen (CEA), alpha foetoprotein (AFP), and prostate-specific antigen (PSA) levels were within normal limits in all groups.

Angiotensin converting enzyme gene polymorphism and activity in turkish patients with essential hypertension

Studies in various ethnic groups have shown contradictory evidence on the association of the angiotensin converting enzyme (ACE) insertion/ deletion (I/D) polymorphism with essential hypertension. We conducted a case-control study in Samsun, Turkey, to examine the association between ACE genotype, ACE serum activity, and blood pressure. Serum ACE activity was measured and ACE I/D polymorphism performed in 165 hypertensive and 143 normotensive subjects. Genomic DNA was extracted from blood samples and amplified by polymerase chain reaction (PCR). PCR primers were flanking the polymorphic region in intron 16 of the ACE gene. The distribution of the DD, ID, and II ACE genotypes was 65, 77, and 23 in hypertensive patients and 42, 82, and 19 in normotensive subjects (P > .05). The estimated frequency of the insertion allele was 0.37 in hypertensive and 0.42 in normotensive subjects. Nevertheless, sensitivity analysis, based on positive family history and severity of hypertension, suggested that significant associations existed between more homogeneous groups of hypertensives and normotensives (P < .05). ACE genotype influenced ACE activity and the highest level was in DD genotype, being the lowest in II genotype. ACE serum levels were significantly higher in hypertensives as compared with normotensives (P < .01). A modest correlation was observed between blood pressure and ACE among hypertensive persons (r = 0.25, P < .05) and this did persist in multivariate analysis (P < .05 for systolic blood pressure and P < .005 for diastolic blood pressure). These data suggest that ACE DD genotype may have predisposing effects on severe hypertensives and cases with positive family history, and that ACE may be one of the independent factors on hypertension.

Metronidazole-Induced Encephalopathy in a Uremic Patient: A Case Report

A variety of neurologic disorders may develop in patients with chronic renal failure. Drug toxicity must be thought of in the differential diagnosis of these disorders. We report a case with renal failure developing serious neurotoxicity after metronidazole use.

Prevalence of serum HGV-RNA among hemodialysis patients in Turkey

SummaryA possible agent for human non-A-E hepatitis has been identified and named hepatitis G virus (HGV). The aim of this study is to evaluate the prevalence of serum HGV-RNA among hemodialysis patients in our country and the possible correlations of serum HGV-RNA with antibody to hepatitis C virus (anti-HCV), chronic liver dysfunction, number of blood transfusions, serum hepatitis B surface antigen (HBs Ag), duration of hemodialysis therapy, history of renal transplantation and patients age and sex. Seventy-eight hemodialysis patients and 59 healthy controls were included in the study. Twenty-seven of 78 hemodialysis patients (34.6%) and two of the 59 healthy controls were serum HGV-RNA positive (p<0.01, x2=17.8). There was no significant difference between the HGV-RNA positive and HGV-RNA negative groups regarding mean duration of dialysis therapy, anti-HCV, chronic liver dysfunction, number of blood transfusions, serum HBs Ag, duration of hemodialysis therapy, history of renal transplantation and patients age and sex. In conclusion, hemodialysis patients carry the risk for HGV infection and transmission routes and clinical significance of HGV infection in these patients remain to be defined.

Renal transplantation in patients with familial Mediterranean fever

Amyloidosis is the most common and devastating complication of familial Mediterranean fever (FMF). Renal transplantation is the choice of treatment of in most end-stage renal disease (ESRD). We report our experience on the outcomes in eight patients who underwent renal transplantation for ESRD due to FMF secondary to amyloidosis, and we provide a discussion on the current evidence on this topic of study. The clinical charts of eight renal transplant patients (seven male, one female) who underwent ESRD due to FMF-related amyloidosis were investigated. Five patients underwent living-donor renal transplantation and three patients underwent deceased-donor renal transplant. The mean follow-up period was 35xa0months (range 3–72). All patients were on triple immunosuppressive treatment and received colchicine. All allografts are currently functioning well with a mean serum creatinine level of 1.4 (range 0.7–2.6) mg/dL. Posttransplantation complications included acute rejection (nu2009=u20094), chronic rejection (nu2009=u20091), severe gastroenteritis (nu2009=u20092), and erythrocytosis (nu2009=u20095). None of the patients had proteinuria. During follow-up, we did not observe clinically severe FMF attack, septicemia, rhabdomylosis, symptoms related to vasculitis, and clinical neuropathy. The clinical outcome of the patients in this cohort was similar to that of other renal transplant patients with ESRD due to other causes. This study shows favorable prognosis of eight ESRD patients due to amyloidosis caused by FMF after renal transplantation. Renal transplantation is a safe procedure for ESRD patients having amyloidosis due to FMF. Regular use of colchicine after transplantation should be mentioned.

Recombinant human erythropoietin treatment may induce antithrombin-III depletion.

Turgay Arinsoy, MD, Hacettepe University Medical School, Nephrology Department, 06100 Ankara (Turkey) Dear Sir, One of the most frequent adverse effects of the treatment of anemia of chronic renal failure with recombinant human erythro-poietin (r-HuEPO) is thrombosis [1]. Several mechanisms including increased blood viscosity [2] and platelet counts [1] and alteration of the coagulation-fibrinolysis balance have been proposed in the pathogenesis of increased thrombotic tendency. The effect of r-HuEPO on coagulation inhibitors, namely, protein C (PC), protein S and antithrombin-III (ATIII), has been studied by many investigators; however, the results of these studies show much controversy. We, therefore, planned a study in order to clarify the short-term effect of r-HuEPO on PC and AT-III. The study group included 34 patients (23 males, 11 females), mean age 37 ± 4 years (range 1770) with end-stage renal failure on regular hemodialysis (HD) treatment carried out 2 or 3 times a week for 37 ± 7 months (range 4-144). r-HuEPO (EPREX, Cilag, Switzerland) was administered in a dose of 75 U/kg by the intravenous route just after the discontinuation of every HD session. Before and at the 6th week of treatment, blood samples were drawn before HD for complete blood count, fibrinogen, PC activity and AT-III measurements. As seen in table 1, whilst Hb, Hct, RBC, platelet count and PC activity values showed Table 1. Hematologic parameters before and 6 weeks after r-HuEPO treatment (n = 34) treatment on AT-III levels show controversy, as well. A significant decline in AT-III levels has been reported by some [5, 8] but not all groups [3, 4, 6]. In the present study, the ratio of AT-III-deficient patients showed a rise from 11 to 38%. Thus, it may be suggested that changes in AT-III levels during r-HuEPO treatment may take part in the pathogenesis of increased thrombotic tendency.

Outcome of Renal Transplantation from Foreign Unrelated Living Donors in Turkey

Dr. Nurol Arik, Ondokuz Mayis Universitesi, Tip Fakültesi, Hemodiyaliz ve Nefroloji Bölümü, TR-55139 Samsun (Turkey) Dear Sir, Transplantation is the optimal treatment for patients with end-stage renal disease (ESRD). In Turkey, renal transplants (RTs) are mainly obtained from living donors. Unfortunately, due to the insufficient availability of cadaveric grafts and compatible living donors, RTs have to be obtained from abroad. Some units in South-East Asia have run RT commercial programmes for many years [1-4]. Several patients with ESRD have gone to Bombay for RT from unrelated living donors and have returned to Turkey for posttransplantation follow-up. The purpose of this report is to evaluate the results of RT from unrelated living donors in Turkish patients with ESRD and to discuss the ethical and social aspects of organ transplantation. Sixty-three patients (38 males, 25 females, mean age 38.4 years, range 17-63) from 4 Transplantation units were investigated retrospectively. All transplantations were performed in 1992 and 1993. Mean duration of dialytic therapy before transplantation was 26.1 months (range 0-96). Sixty patients have received primary and 3 patients have received secondary grafts. Mean follow-up time after transplantation was 12.1 months (range 1-25 months). Patient data were collected from the hospital file during transplantation in Bombay and regular follow-up in Turkey. All the donors were males with a mean age of 25.4 years (range 23-30). Mean preoperative period for patient preparation was 5-7 days in most of the patients and mean hospitalization time after operation was 10-12 days. Most of the transplanted patients had been admitted to transplantation units in Turkey at 10-15 days after transplantation. The immunosuppres-sive protocol was as follows at the time of admission: cyclosporine 7-10 mg/kg, aza-thioprine 1-2 mg/kg and prednisolone 1 mg/ kg. Dipyridamole, salicylic acid, polyvita-min tablets, iron supplements, 7⁄8 receptor blockers and antacids were other medications in most of the patients and 1 patient was

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.

Evaluation of the patients with renovascular hypertension after percutaneous revascularization by Doppler ultrasonography

OBJECTIVEnEvaluation of the effectiveness of percutaneous revascularization is based primarily on clinical criteria, and laboratory findings rather than direct investigation of luminal width. The purpose of this study was to evaluate the success of endovascular revascularization with serial Doppler ultrasound (US) examinations.nnnMETHODS AND MATERIALn19 patients (14 were atherosclerotic, five were with fibromuscular dysplasia) with suspected renovascular hypertension treated by percutaneous revascularization were included in a prospective study. Patients had 23 renal artery stenoses reducing the diameter by more than 50%. Doppler US examinations were performed before intervention, and 1 day, 3 and 6 months after intervention.nnnRESULTSnInitial revascularization was technically successful in 21 of 23 stenoses (91.3%) (18 PTRA, three stent placement). Hypertension was cured in five atherosclerotic and in five fibromuscular dysplasia (FMD) patients, and improved in four atherosclerotic patients. Residual stenosis was determined in six patients and the others were evaluated as normal by initial postprocedure Doppler US. As based on Doppler US, restenosis (>60%-narrowing) was depicted in four of six (66.6%) renal arteries with residual stenosis, and one of 15 (6.6%) normal renal arteries at 1 year. This difference in restenosis rates (residual stenosis vs. normal) was significant (P<0.05).nnnCONCLUSIONnPositive predictor for recurrence was a residual renal artery stenosis documented by Doppler US 1 day after percutaneous revascularization in atherosclerotic cases.

Do Erythrocyte Sedimentation Rate and C-Reactive Protein Levels Have Diagnostic Usefulness in Patients with Renal Failure?

Accessible online at: www.karger.com/journals/nef Dear Sir, Patients with chronic renal failure have a tendency to develop infectious and inflammatory disorders. On the other hand, there is no reliable serum marker for the diagnosis of infectious complications in these patients. Because of the conflicting reports, the validity of the two well-known acute-phase reactants, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), has not been determined clearly yet [1–4]. In order to evaluate the possible role of the acute-phase reactants in diagnosing and monitoring of inflammatory states, we studied ESR and CRP levels in uremic patients. The hemodialysis group consisted of 63 men and 52 women with a mean age of 44.6 B 1.3 (range 12–73) years. The mean duration of dialysis prior to entry into the study was 64.7 B 4.28 (range 3–175) months. The predialysis group included 19 men and 23 women. The mean age was 55.0 B 2.3 (range 25–86) years. There were 33 men and 42 women in the control group. The mean age was 43.8 B 1.7 (range 18–78) years. All the participitants were free from inflammatory signs within 1 month prior to study. As indicated in table 1, the basal ESR and CRP levels have been found to be higher in uremic patients without evidence of inflammation than the ones in controls. It seems that these parameters cannot be useful Table 1. Mean ESR and CRP levels in the study groups