Simge Bardak

Community-acquired hyperkalemia in elderly patients: risk factors and clinical outcomes

Abstract Background: Although the risk and related factors of hyperkalemia developed in the hospital are known in elderly, risk and related factors of community-acquired hyperkalemia (CAH) in this population are not well known. This study was performed to investigate the risk of CAH in elderly and evaluate the related factors and clinical outcomes. Study design, setting and participants, intervention: Patients (aged ≥65 years) with hyperkalemia were screened. Group 1 (young-old); 65–74 years/old, Group 2 (middle-old); 75–84 years/old, Group 3 (oldest-old); ≥85 years/old, and Group 4 (control group); ≥65 years/old (normal serum potassium levels). The relation between CAH and hospital expenses (HE), the number of comorbid diseases (NCD), and all-cause of mortality rates (MR) were evaluated. We also investigated whether drugs, sex, and NCD are risk factors for the development of CAH. Results: There was a positive correlation between serum potassium levels and length of hospital stay, MR, HE, and NCD (p < 0.001). Risk factors for CAH were the use of non-steroidal-anti inflammatory drugs (NSAIDs) (Odds Ratio [OR]: 2.679), spironolactone (OR: 2.530), and angiotensin converting enzyme inhibitors (ACEI) (OR: 2.242), angiotensin receptor blockers (ARB) (OR: 2.679), ≥2 comorbid diseases (OR: 2.221), female gender (OR: 2.112), and renal injury (OR: 5.55). CAH risk was found to be increased 30.03 times when any of ACEI, ARB, NSAIDs, or spironolactone is given to a patient with a renal injury. Conclusion: Use of NSAIDs, ACEI, ARB, spironolactone and increased NCD are all independent risk factors for CAH in the elderly, especially in patients with kidney diseases.

Recurrent Acute Kidney Injury in Renal Transplant Patients: A Single-Center Study

OBJECTIVE Renal transplant patients may have recurrent episodes of acute kidney injury (AKI) during the posttransplant period. Determination and management of risk factors may help to prevent recurrence of AKI and allograft loss. In this study, we investigated the clinical features of renal transplant patients with recurrent AKI and evaluated etiologies and risk factors. MATERIALS AND METHODS A total of 19 patients with 79 AKI episodes were examined retrospectively. AKI classes, etiologies, and risk factors were investigated. Their features were compared with 38 renal transplant patients without AKI. RESULTS Distribution of AKI episodes according to the type of injury was as follows: 15 prerenal, 43 renal, 6 postrenal, and 15 mixed. Renal transplant patients with recurrent AKI had a greater duration of dialysis before transplantation (P < .05). Logistic regression analysis revealed no predictor for recurrent AKI after renal transplantation. Infections participated in the development of 45 AKI episodes. Chronic kidney disease developed in 16 patients. CONCLUSION Infections are the leading condition associated with recurrent AKI in renal transplant patients. Recurrent AKI may contribute to the development and progression of chronic kidney injury.

Is the red cell distribution width strong predictor for treatment response in primary glomerulonephritides

Abstract Background: Novel biomarkers are needed to predict the response to treatment in patients with nephrotic syndrome (NS) due to primary glomerulonephritides (PGN). We aimed to test the predictive value of red blood cell distribution width (RDW) for estimation of response to therapy in adult patients with NS. Study design, setting & participants, and intervention: We performed a prospective study including 176 patients with NS due to PGN. Patients were divided into three groups according to their response to the treatment. Group 1 was composed of patients with complete remission whereas group 2 was composed of patients with partial remission and group 3 was composed of patients who were resistant to the treatment. Results: The highest baseline mean RDW value was found in group 3 patients (17.8 ± 1.8) whereas the lowest in group 1 (13.4 ± 0.7) before treatment (p < 0.05). We found a significant decrease in RDW value after an effective treatment in groups 1 and group 2 (p < 0.05). However, there was no significant change in RDW values after treatment in group 3 (p > 0.05). Most of the patient with complete remission had base-line RDW level ≤ 14% (n = 45, 90%) (p < 0.001, Kendal Tau: −0.86), and most of the patients who were resistant to the treatment had base-line RDW level p > 15% (n = 68, 86.1%) (p < 0.001, Kendal Tau: −0.87). Conclusion: Our results suggest that pre-treatment RDW value is a promising novel biomarker for predicting response to the treatment in adult patients with NS due to PGN.

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.

Acute Thrombotic Thrombocytopenic Purpura Following Orthopedic Surgery: Case Report and Review of the Literature

Thrombotic thrombocytopenic purpura (TTP) is an uncommon cause of hematological and renal abnormalities in the postoperative period. An association between TTP and orthopedic surgery, a rare entity, has been reported in the literature. It has the strong possibility of being fatal and therefore should be treated immediately, mostly by plasmapheresis. We report a 15-year-old girl of TTP following a high tibial valgus osteotomy (HTO).

How do we measure blood pressure at home

Abstract Background. Home blood pressure monitoring (HBPM) is one of the measures that increases compliance with antihypertensive therapy. HBPM requires a proper measurement technique as well as an accurate sphygmomanometer. The aim of this study was to assess the characteristics of home sphygmomanometers (HS) in a big city in Turkey. Subjects and method. We assessed the HS of hypertensive patients (n = 452; male: 253, female: 199) who were examined for the first time in our outpatient center. General evaluation of HS included trademark, model, devices age, cuff size, validation and calibration status. Results. We interviewed 452 patients and 452 HS were identified. The most common factors affecting the patients’ choice for the type and model of the HS were its simplicity and ease of use (28.2%), followed by advertisements (44%), physicians advice (19.3%) and the belief in accurate measurement (< 1%). All patients were unaware of validation and calibration of their devices. Conclusion. Awareness of both patients and physicians about the validation status of HS is not enough. Some complaints from patients may be associated with using non-validated HS. There is a need for a policy or standard criteria for HS.

Red Blood Cell Distribution Width Level: A Predictive Marker for Early Detection and Monitoring of Diabetic Nephropathy Progression

Chronic inflammation may be one of the factors that contribute to the development of diabetic nephropathy (DN). However, erythropoiesis, erythrocyte circulatory half-life and erythrocyte deformability may be influenced by inflammation. Thus, red blood cell distribution width (RDW) levels increase in inflammatory conditions. We investigated the RDW values and related factors in patients with uncomplicated type 2 diabetes mellitus (DM) and diabetic patients with DN. We carried out a retrospective study on patients with type 2 DM admitted to our hospital. Subjects were divided into three groups. Group 1 consisted of healthy subjects. Group 2 consisted of patients with uncomplicated type 2 DM. Patients with various stages of DN were included in Group 3. The RDW values in group 1 subjects were significantly lower than those in group 2 and 3 patients (p<0.05). The RDW values of group 3 patients were higher than those in the other two groups (p<0.05). While the RDW values had positive correlation with blood pressure, serum creatinine, HbA1c, body mass index, proteinuria, platelet (PLT), triglyceride, low density lipoprotein (LDL), total cholesterol (TC), and fasting blood glucose (r values: 0.95, 0.72, 0.56, 0.86, 0.82, 0.76, 0.88, 0.84, 0.88, 0.86, respectively) (p<0.05 for all), there was negative correlation between estimated glomerular filtration rate (eGFR), albumin, high density lipoprotein (HDL) and RDW levels (r values: −0.92, −0. 88, −0.78, respectively) (p value < 0.05 for all).