Şükrü Sindel

The relationship between erythrocyte superoxide dismutase activity and plasma levels of some trace elements (Al, Cu, Zn) of dialysis patients

1. The effect of erythropoietin and some trace elements on superoxide dismutase (SOD) activity of dialysis patients have been studied. 2. SOD activity of dialysis patients was found to be decreased. 3. The effect of erythropoietin on SOD activity was not found in vitro. 4. Plasma and erythrocyte aluminum increased in dialysis patients, but no significant change in plasma copper was found. 5. Plasma zinc levels of dialysis patients were found to be decreased. 6. These results suggest that inhibition of erythrocyte SOD activity of dialysis patients may contribute to their anemia.

Nonrelated Living-Donor Kidney Transplantation: Medical and Ethical Aspects

Several patients with end-stage renal disease went to Bombay for renal transplantation from nonrelated living donors and then returned to Turkey for posttransplantation follow-up. The aims of this study are to evaluate the long-term results of renal transplantation from nonrelated living donors in Turkish patients with end-stage renal disease and to discuss the ethical and social aspects of nonrelated kidney donation. One hundred and twenty-seven patients (89 males, 38 females; mean age 38.1, range 17–63 years) were investigated retrospectively. None of the patients went to Bombay on our advice. All transplantations were performed between 1991 and 1995. The mean follow-up period after transplantation was 34.2 (range 1–68) months. Graft survival rates were 85, 83, and 57% after 3 months and 1 and 5 years, respectively. Patient survival rates were 94, 93, and 92% after 3 months and 1 and 5 years, respectively. Seven patients died within the first 3 months after the transplantation. Surgical problems, infections, acute rejection, ciclosporin nephrotoxicity, and hepatic problems were common complications. We conclude that medical and surgical complications occur frequently in paid kidney transplantation, but most of these complications can be prevented by adequate preoperative management, and precautionary measures should be taken to prevent commercialization of renal transplantation before the spread of emotionally related living kidney donation.

The Relationship among Asymmetric Dimethylarginine (ADMA) Levels, Residual Renal Function, and Left Ventricular Hypertrophy in Continuous Ambulatory Peritoneal Dialysis Patients

Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial-based nitric oxide synthase. Its level is increased by end stage renal disease. However, most studies showing an increase in ADMA in dialysis patients have focused on hemodialysis. Results with peritoneal dialysis patients have been more inconclusive. Recent studies suggest that ADMA may be a new cardiovascular risk factor. The aim of the present study was to evaluate the relationship between ADMA levels, residual renal function, and left ventricular hypertrophy in peritoneal dialysis patients. Serum ADMA measurements and echocardiographic evaluations were performed in 54 peritoneal dialysis patients and 26 healthy volunteers. Residual renal function was measured in peritoneal dialysis patients by urea clearance from a urine collection. Thirty-two of the 54 peritoneal dialysis patients had residual renal function. ADMA levels of the peritoneal dialysis group were found to be significantly higher than those of healthy individuals (p = 0.03). Within the peritoneal dialysis group, ADMA levels of patients with residual renal function were significantly lower than those without residual renal function (p = 0.01), though they were still higher than the ADMA levels of the control group (p = 0.04). Serum levels of ADMA were positively correlated with left ventricular mass index (r = 0.29, p = 0.01) and negatively correlated with early mitral inflow velocity (Em) (r = −0.28, p = 0.01), Em/Late mitral inflow velocity (Am) (r = −0,32, p = 0.00), and isovolumetric relaxation time (r = −0.30, p = 0.01). In conclusion, increased ADMA levels seem to be associated with left ventricular hypertrophy in peritoneal dialysis patients, and residual renal function may lead to a reduction of serum ADMA levels.

Dialysis Type May Predict Carotid Intima Media Thickness and Plaque Presence in End-Stage Renal Disease Patients

IntroductionCarotid intima media thickness (CIMT) and carotid plaques (CP) were shown to be independent predictors of mortality in end-stage renal disease (ESRD) patients. In this study, the authors aimed to compare the two dialysis modalities for CIMT and CP presence (CPP).MethodsESRD patients who had been on the same renal replacement therapy for at least 24 months were selected. CIMT, CPP, known risk factors, and laboratory parameters for atherosclerosis were determined for each patient.ResultsA total of 77 hemodialysis (HD) patients (68% male, 47.6 ± 17.0 years), 61 continuous ambulatory peritoneal dialysis (CAPD) patients (51% male, 45.3 ± 13.9 years), and 36 age- and sex-matched controls (61% male, 43.3 ± 10.6 years) were included. The mean CIMT (m-CIMT) were 0.99 ± 0.24, 0.86 ± 0.22, and 0.60 ± 0.13 mm in the HD, CAPD, and control groups, respectively (HD vs. CAPD, P = 0.001; HD vs. control, P < 0.001; and CAPD vs. control, P < 0.001). The CPP occurred more frequently in the HD group compared to the CAPD group (64% vs. 39%, respectively, P = 0.004). The backward linear and logistic regression analysis of potential confounders revealed that both m-CIMT and CPP was independently associated with dialysis type (beta = 0.249, P = 0.008; and odds ratio [OR] = 4.11, 95% CI, 1.72 to 6.73, P = 0.015, respectively).ConclusionThe authors have shown that dialysis type may be an independent predictor of m-CIMT and CPP in long-term ESRD patients.

Echocardiographic epicardial adipose tissue measurements provide information about cardiovascular risk in hemodialysis patients

Epicardial adipose tissue (EAT) is a cardiovascular risk predictor in general population. However, its value has not been well validated in maintainance hemodialysis (MHD) patients. We aimed to assess associations of EAT with cardiovascular risk predictors in nondiabetic MHD patients. In this cross‐sectional study, we measured EAT thickness by transthoracic echocardiography in 50 MHD patients (45.8 ± 14.6 years of age, 37 male). Antropometric measurements, bioimpedance analysis, left ventricular (LV) mass, carotis intima media thickness, blood tests, homeostasis model assessment for insulin resistance (HOMA‐IR) and hemodialysis dose by single‐pool urea clearence index (spKt/V) were determined. The mean EAT thickness was 3.28 ± 1.04 mm. There were significant associations of EAT with body mass index (β = 0.590, P < 0.001), waist circumference (β = 0.572, P < 0.001), body fat mass (β = 0.562, P < 0.001), percentage of body fat mass (β = 0.408, P = 0.003), percentage of lean tissue mass (β = −0.421, P = 0.002), LV mass (β = 0.426, P = 0.002), carotis intima media thickness (β = 0.289, P = 0.042), triglyceride/high‐density lipoprotein cholesterol ratio (β = 0.529, P < 0.001), 1/HOMA‐IR (β = −0.386, P = 0.006), and spKt/V (β = −0.311, P = 0.028). No association was exhibited with visfatin C, high‐sensitivity C‐reactive protein, interleukin‐6, and tumor necrosis factor‐alpha (for all, P > 0.05). Body mass index, waist circumference, body fat mass, percentage of lean tissue mass, LV mass, triglyceride/high‐density lipoprotein cholesterol ratio, HOMA‐IR, and spKt/V appeared as independent predictors of EAT. EAT was significantly associated with body fat measures, cardiovascular risk predictors, and dialysis dose in MHD patients.

Prolonged fever: an atypical presentation of Behcet’s disease

To the Editor, A 19-year-old Turkish male was admitted with a 2-months history of fever and weight loss about 7–8 kg. Family history was unremarkable. At admission, he had fever of 38.5 C with no clinical evidence of infection. Auscultation of the chest and heart revealed normal findings, the peripheral lymph nodes were normal, and there was no enlargement of the liver or spleen. The fever predominated at night, with peaks of up to 39 C, whereas periods without fever occurred during the day. The patient was hospitalized for investigation of the etiology of fever and weight loss. Laboratory tests showed leukocytosis (13,100/mm), anemia (11.7 g/dl), elevated erythrocyte sedimentation rate to 92 mm/h and elevated C-reactive protein to 143 mg/dl (N: 0–5 mg/dl). Findings were negative from blood cultures and tests for the tubercle bacillus in sputum and gastric aspirates. The following laboratory investigations yielded normal results: liver and renal function tests, urinalysis, peripheral blood smear, anti-streptolysin O, rheumatoid factor, markers for hepatitis B and C, anti-HIV antibodies, VDRL, Brucella serology, Salmonella serology, cultures of urine, throat and blood, chest X-ray and serological tests for TORCH. One week after hospitalization oral and genital ulcers, tender nodules developed on the tibial surface of left leg, which were compatible with erythema nodosum. Pathergy test was negative at 72 h. Ophthalmologic examination revealed no signs of previous uveitis. Abdominal ultrasonography revealed thrombosis of inferior vena cava and bilateral common iliac veins. This finding is confirmed with CTangiography and as the patient fulfilled the criteria of the Behcet’s disease (BD), oral colchicine 1.5 mg/ day, oral methylprednisolone 60 mg/day, anticoagulant therapy and symptomatic treatment for orogenital and cutaneous lesions were started immediately. All signs vanished within 10 days and he was discharged from the hospital free of fever and mucocutaneous lesions. BD is a chronic, relapsing, multisystemic disorder characterized by recurrent oral and genital ulcers, ocular lesions, skin manifestations, arthritis and vascular, intestinal and neurological involvement [1]. The disease is geographically restricted to areas corresponding to the ancient ‘Silk Trading Routes’ and affects subjects genetically susceptible to the disease. According to International Study Group (ISG) criteria, a patient must have recurrent oral ulceration plus 2 of the following: recurrent genital

RENAL TRANSPLANTASYON VE ÜRETER NEKROZU

Ureter nekrozu siklikla uretero neoslstostomi bolgesinde cerrahi tekniklere bagli oiarak gelisen erken postoperaiif komplikasyondur. Idrar kacaginin erken tani ve cerrahi tedavisinin greft hasta morbidite ve mortalitesini dusurdugu bilinmektedir Bu yazida; erken ureieral nekroz ve idrar kacagi tespit edilen 3 renal transplantli hasta rapor edilmistir. Bu 3 olgu ile uriner kacaklarin erken tani ve tedavisinin greft fonksiyonunu koruma ve hasta mortalite ve morbiditesini onlemedeki onemi vurgulanmistir.