Onur Özhan

Serum retinol binding protein 4 level is related with renal functions in Type 2 diabetes

Aim: We aimed to evaluate the metabolic parameters and diabetes complications which would probably affect the serum retinol-binding protein 4 (RBP4) levels in Type 2 diabetic individuals. In addition to serum RBP4 concentration, the levels of its ligands, serum retinol and transthyretin (TTR) were also considered in this evaluation. Subjects and methods: Serum RBP4, retinol, and TTR levels were measured in 53 Type 2 diabetic subjects and 30 body mass index (BMI)-matched controls. The molar ratios of RBP4 to retinol and RBP4 to TTR were compared. Results: While the RBP4 values were similar to those in the control group in Type 2 diabetic patients, the molar ratio of RBP4 to TTR was found to be higher than that of the control group. The serum RBP4 levels in patients who had retinopathy and macrovascular disease were similar to those in patients who did not. However, the RBP4 levels, molar ratios of RBP4 to retinol and RBP4 to TTR in micro-macroalbuminuric patients were found to be significantly higher than in normoalbuminuric subjects and controls. There was no correlation between the RBP4 levels and the patients’ age, BMI, duration of diabetes, LDL, triglyceride, serum creatinine, and glycated hemoglobin values. Micro-macroalbuminuria and estimated glomerular filtration rate were independent determinants for increased serum RBP4 levels. Conclusion: According to the data obtained from this study, diabetic retinopathy and cardiovascular complications do not affect the serum RBP4 level in Type 2 diabetes. Renal functions rather than the metabolic factors of diabetes determine the RBP4 level and its relation with its ligands.

Mean Platelet Volume and Related Factors in Patients at Different Stages of Diabetic Nephropathy A Preliminary Study

Introduction: Mean platelet volume (MPV) is an independent cardiovascular disease predictor, and characteristics of MPV in patients with diabetic nephropathy (DN) are not well known. Aim: To determine the MPV levels in patients at different stages of DN. Patients and Methods: The MPV levels were investigated in healthy participants (group 1, n = 157), patients with type 2 diabetes mellitus without complication (group 2, n = 160), diabetic patients with clinical proteinuria (group 3, n = 144), and in patients with chronic kidney disease due to DN (group 4, n = 160). Findings: The MPV level was higher in all diabetic patients than that in normal participants (P < .05). The MPV values had a positive correlation with the serum creatinine and proteinuria, and a negative correlation with the glomerular filtration rate ([GFR] P < .001 for all, r values; .72, and .82, and −.92, respectively). Conclusion: The MPV values were higher in diabetic groups than that in normal participants. Both GFR and proteinuria were the most powerful determinants of MPV.

Serum levels of cancer biomarkers in diabetic and non-diabetic proteinuric patients: a preliminary study

Abstract Background: Cancer biomarkers (CBs) can be used in early detection of several cancers as well as in detection of recurrence and following response to treatment. We aimed to investigate the levels of CBs in proteinuric patients with primary glomerular disease (PGD) and diabetes mellitus, and compare them with healthy controls. Methods: One hundred and two patients with untreated PGD, 62 proteinuric patients with diabetic nephropathy, and 84 healthy controls were enrolled. Levels of cancer antigen 125 (CA 125), cancer antigen 15–3 (CA 15–3), carcinoembriogenic antigen (CEA), α-fetoprotein (AFP), total prostate specific antigen (TPSA), free prostate specific antigen (FPSA) and carbohydrate antigen 19–9 (CA 19–9) were measured. Results: Compared to healthy controls, levels of CA 125, CA 15–3 and CA 19–9 were higher in patients with PGD and diabetic patients (all p<0.05), while levels of TPSA, FPSA, AFP and CEA were lower (all p<0.05). There was no correlation between levels of cancer biomarkers and serum fibrinogen and serum amyloid A protein levels (all p>0.05). Both urinary protein excretion rate and serum albumin levels were correlated with all CBs (all p<0.05). Conclusions: CBs levels seem to be changed in different proteinuric patients. This condition should be kept in mind when evaluating CBs levels in proteinuric patients.

Community-acquired hypernatremia in elderly and very elderly patients admitted to the hospital: Clinical characteristics and outcomes

Summary Background The clinical features, outcome and cost burden of community-acquired hypernatremia (CAH) in elderly and very elderly patients are not well known. Our aim was to investigate the etiologies, reasons for admission, clinical courses, outcomes, complications, and cost assessments of the elderly patients with CAH. Material/Methods We conducted a retrospective study in our tertiary hospital. Elderly and very elderly patients evaluated in the emergency department (ED) from January 1, 2010 to December 31, 2010 (n=4960) were included. Totally, 102 patients older than 65 years and diagnosed with CAH were evaluated. The patients were divided into 2 main groups according to their age: elderly (65–74 years old) (group 1) (n=38), and very elderly (>74 years) (group 2) (n=64). Results Our overall observed prevalence of CAH was 2.0% (n=102, 102/4960). In particular, the prevalences of CAH in group 1 and group 2 were 1.0% (38/3651) and 4.8% (64/1309), respectively (p<0.001). Totally, 62 patients had been treated by renin-angiotensin system (RAS) blockers (ie, ACE-inhibitors). Alzheimer’s disease had been diagnosed in 46.1% of the subjects. The mean Katz scores at the time of admission were 2.4±1.9 and 1.1±1.0 in group 1 and 2, respectively (p<0.001). The mean cost was higher in group 2 than in group 1 (2407.13±734.54 USD, and 2141.12±1387.14 USD, respectively) (p<0.01). The need for intensive care was significantly greater in group 2 as compared to group 1. Conclusions The important determinants of “CAH” in elderly subjects are accompanying Alzheimer’s disease, oral intake impairment, and concomitant treatment with RAS blockers.

Comparison of diagnostic accuracy of Doppler USG and contrast-enhanced magnetic resonance angiography and selective renal arteriography in patients with atherosclerotic renal artery stenosis

Background There are many systemic complications of conventional selective renal arteriography (SRA), such as contrast-mediated nephropathy. Contrast-enhanced magnetic resonance angiography (CE-MRA) and renal artery Doppler ultrasonography (DUSG) have been used increasingly for renal artery stenosis (RAS). The aim of this study was to evaluate the accuracy of CE-MRA and DUSG as used for diagnosis of RAS. Material/Methods We divided 130 consecutive patients investigated for resistant hypertension into 2 groups based on age: group 1 was patients <60 years old and group 2 was patients >60 year. DUSG, CE-MRA, and SRA were performed in group 1 and group 2 patients. Results Seventy-two patients (24 males [M], 48 females [F]) in group 1, and 58 patients (26 M, 32 F) in group 2 were included in the study. In the evaluation of clinically significant renal artery stenosis with DUSG, in group 1 the overall sensitivity was 83.33% and overall specificity was 81.82%, and in group 2 they were 69.23% and 0%, respectively, when compared with SRA. In the evaluation of clinically significant renal artery stenosis with CE-MRA, the overall sensitivity and specificity were 92.31% and 36.36%, respectively, in group 1 and 100.00% and 73.33%, respectively in group 2, when compared with SRA. Conclusions CE-MRA is an accurate, non-invasive method for the diagnosis of RAS in patients above 60 years of age and DUSG may be the choice of diagnostic method for RAS in patients under 60 years of age.

Lack of nephrotoxicity of gadopentetate dimeglumine-enhanced non-vascular MRI and MRI without contrast agent in patients at high-risk for acute kidney injury.

Background Gadolinium chelates (GCs) have been traditionally considered as non-nephrotoxic magnetic resonance imaging (MRI) contrast materials. However, it has been suggested in some recent articles that GCs may have a nephrotoxic potential, but most of these reports are retrospective. However, the evaluated contrast agents, their doses, and the tests used to determine the kidney function were not consistent across studies. We aimed to investigate the effect of magnetic field and an MRI contrast agent, gadopentetate dimeglumine (GD), on renal functions in patients at high risk for acute kidney injury (AKI). Material/Methods We designed a prospective case-control study with 2 age- and sex-matched groups of patients at high-risk for AKI (n=72 for each group). Patients in Group 1 received a fixed dose of (0.2 mmol/kg) GD-enhanced non-vascular MRI and patients in Group 2 received MRI without GD. Before the MRI and at 6, 24, 72, and 168 hours after the MRI, biochemical tests, estimated glomerular filtration rate (eGFR), albumin/creatinine ratio in spot urine, and early AKI biomarkers (cystatin C, N-Acetyl-Glucosaminidase [NAG], Neutrophil gelatinase-associated lipocalin [NGAL]) were measured. Results Serum creatinine, albumin/creatinine ratio, and eGFR were not different between Group 1 and 2 (p>0.05). There were no significant changes in renal function tests and AKI biomarkers (Δserum creatinine, Δalbumin/creatinine ratio, ΔGFR, Δcystatin C, ΔNAG, and ΔNGAL) for either groups 6, 24, 72, and 168 hours after the procedures (p>0.05). Conclusions MRI without contrast agent and non-vascular contrast-enhanced (GD, 0.2 mmol/kg) MRI are not nephrotoxic procedures for patients at high risk for AKI.

Does the MRI or MRI contrast medium gadopentetate dimeglumine change the oxidant and antioxidant status in humans

Background It has become evident that gadolinium-based contrast agents (GBCA) may have nephrotoxic potential. Oxidative stress is one of the most important pathways in the pathogenesis of iodinated contrast-induced nephropathy. Purpose To investigate the effects of static magnetic fields and gadopentetate dimeglumine (Magnevist®) on oxidant/antioxidant status via measurement of total antioxidant capacity (TAC), total oxidant status (TOS), and serum malondialdehide (MDA). Material and Methods Two age- and sex-matched groups of patients not under oxidative stress conditions that underwent magnetic resonance imaging (MRI) were recruited to this study. While contrast-enhanced (Magnevist®, 0.2 mmol/kg) MRI was performed in group 1, MRI without GBCA was performed in group 2. Fasting blood glucose, C-reactive protein, serum creatinine, liver enzymes, uric acid, and lipid parameters were examined in all patients. Peripheral venous blood samples in order to determine TAC, TOS, and MDA were collected before and 6, 24, and 72 h after the MRI procedures. The TOS:TAC ratio was used as the oxidative stress index (OSI). Patients were followed up to 72 h. Results There were no significant changes in serum TAC, TOS, and MDA levels (Δserum TAC, Δserum TOS, and ΔMDA) in either group 6, 24, or 72 h after the procedures (P > 0.05). Furthermore, OSI did not change after the procedures in either group (P > 0.05). Conclusion Magnetic field and gadopentetate dimeglumine (Magnevist®) do not change the oxidant or antioxidant status at a dose of 0.2 mmol/kg.

An unusual cause of duodenal obstruction: mesenteric fibromatosis in a patient with type I Mayer-Rokitansky-Kuster-Hauser syndrome.

Patients with mesenteric fibromatosis (MF) are clinically asymptomatic, with little or no focal symptoms until later in their course, at which time they complain of pain, abdominal discomfort, constipation, vomiting, abdominal mass, weight loss, and symptoms due to organ compression. Generally, it occurs as an abdominal mass but may also present in many different ways. In some cases, trauma, previous abdominal surgery, and hormonal stimulation (such as estrogen) may play a role in onset of this neoplasm. Patients with Mayer-Rokitansky-Kuster-Hauser syndrome present primary amenorrhea and may have some other anomalies, including hearing defects, heart defects, skeletal deformities, and genital neoplastic diseases. We diagnosed duodenal obstruction due to MF in a patient with type I Mayer-Rokitansky-Kuster-Hauser syndrome.