Sultan Ozkurt

Acute Renal Failure under Dasatinib Therapy

Dasatinib is a second-generation tyrosine kinase inhibitor that is approved for the treatment of imatinib-resistant or imatinib-intolerant chronic myeloid leukemia. It has a 325 times stronger in vitro activity against to native BCR-ABL when comparing with imatinib. Little is known about the effects of dasatinib on renal function. A literature review revealed only one case with imatinib-resistant chronic myeloid leukemia that developed renal failure after being placed on dasatinib therapy. Here we report a patient with imatinib-resistant chronic myeloid leukemia who developed gastroenteritis and acute renal failure after a short time from the initiation of dasatinib therapy. After dasatinib interruption, these side effects resolved completely in days. In summary, dasatinib is a potent drug in the treatment of chronic myeloid leukemia, but close clinical monitoring and the timely interruption of the therapy in patients who developed acute renal failure are warranted.

Immune response after a single vaccination against 2009 influenza A H1N1 in hemodialysis patients

Background: Influenza infection is a significant cause of morbidity and mortality in general population. Hemodialysis patients are considered at high risk of influenza infection given their altered immune status. Pandemic influenza virus is new for human beings, so it is hard to predict the response to infection or vaccination. We aimed to evaluate the response to pandemic H1N1 vaccination in hemodialysis patients. Methods: A total of 70 patients on chronic hemodialysis and 20 controls who had been vaccinated against the pandemic influenza virus 5 weeks before the time of blood sampling were included into this study. The anti-H1N1 immunoglobulin G (IgG) antibodies of the patients were studied with enzyme immune assay (EIA) method. Our cut-off optical density (OD) value was 1.503. If the patients OD value was equal or higher than this value, it was considered as positive. If it was lower, it was considered as negative. Results: The mean OD value was 2.22 ± 0.42 in the patient group and 1.99 ± 0.34 in the control group (p < 0.05). Two of 70 patients and 1 of the controls had negative OD values and they were considered as nonresponsive to vaccination. There was also a negative correlation between the age and OD values in the patient group (r = −0.277, p < 0.05). Conclusion: H1N1 vaccine can be performed safely and cost effectively with a single dose to the risk groups especially to the hemodialysis patients. Evaluation of H1N1 IgG antibody with enzyme-linked immunosorbent assay (ELISA) may be a safe, easy, and cost-effective assay.

Renal hemosiderosis and rapidly progressive glomerulonephritis associated with primary hemochromatosis

Abstract Hereditary hemochromatosis leads to the accumulation of iron in many organs including the liver, spleen and heart and results in injury and dysfunction of these organs. On the other hand, iron accumulation and functional impairment in kidney is extremely rare. We report a 61-year-old male patient with hereditary hemochromatosis, in whom the renal function was deteriorated rapidly. Renal biopsy revealed crescentic glomeruli and hemosiderin accumulation in tubular epithelial cells.

Acute and subacute effects of EV iron sucrose on endothelial functions in hemodialysis patients.

Background: Iron support is an important component of treatment of anemia in hemodialysis (HD) patients. However, there are concerns about endovenous (EV) iron therapy that may cause endothelial dysfunction (ED) by increasing oxidative stress (OS) and lead to cardiovascular events. In this study, we aimed to evaluate the effects of high and repeated doses of EV iron sucrose on endothelial functions in acute and subacute phases. Methods: We included 15 HD patients to our study. There were 16 patients with iron deficiency but normal kidney functions in control group. We also evaluated endothelium-dependent vasodilatation (EDV) and nitroglycerin-induced vasodilatation (NIV) from the brachial artery by ultrasonography at the beginning of the study, and then 200 mg EV iron sucrose was given initially to both groups for 1 h in 250 cc 0.9% saline and 4 h after the end of the infusion (acute phase) sonographic vasodilatation parameters were measured from brachial artery. These measurements and laboratory tests were repeated 1 week after the end of a total 1000 mg EV iron sucrose replacement (200 mg/week). Results: There was a statistically significant increase in hemoglobin and ferritin levels after the EV iron sucrose therapy in both control and patient groups. EDV values in the HD group were significantly lower than that in the control group before therapy (6.25% vs. 10.53%, p < 0.05). EV iron sucrose therapy did not alter EDV and NIV values at the 4th hour and 6th week in both control and patient groups. Conclusion: According to our study, compared with the control group with normal kidney functions, HD patients had impaired endothelial functions. However, in HD patients, high and repeated doses of EV iron sucrose do not have deleterious effects on endothelial functions at acute and subacute phases and can be used safely in that patient group.

Cerebral Sinovenous Thrombosis Associated with Factor V Leiden and Methylenetetrahydrofolate Reductase A1298C Mutation in Adult Membranous Glomerulonephritis

Abstract Thromboembolic diseases are accepted as the most important complications in adult nephrotic syndrome, particularly membranous nephropathy. As renal vein thrombosis is usually seen in patients with membranous nephropathy, cerebral venous thrombosis is a very rare condition, which has not been reported previously in adult patients with membranous nephropathy. Although acquired dysfunctions of coagulation and fibrinolytic systems are responsible for hypercoagulopathy in patients with nephrotic syndrome, the two most common causes of hereditary venous thrombosis [the mutations of factor V Leiden and methylenetetrahydrofolate reductase (MTHFR)] facilitate thrombosis in arterial and venous system in these patients. We report a 56-year-old man with sinovenous thrombosis, diagnosed as membranous nephropathy and detected to have mutations in factor V Leiden and MTHFR A1298C. Our patient is important because he had genetic risk of thrombotic conditions and was the first adult patient with membranous nephropathy.

Colonization of peritoneal catheter with a thermophilic fungus, Thermoascus crustaceus: a case report

Thermoascus crustaceus is a thermophilic fungus and the teleomorph form of Paecilomyces crustaceus. Thermoascus spp. have been rarely isolated from human mycoses as etiological fungal agents. We believe that our patient is the first case of catheter colonization with Thermoascus crustaceus. In a 50-year-old male patient undergoing chronic peritoneal dialysis, the mold was isolated from three separate, consecutive dialysate fluid specimens and peritoneal catheter tip. The patient had slight clinical findings and he was treated by early catheter removal without antifungal treatment. Therefore this case was considered as the colonization of the peritoneal catheter rather than peritonitis. Consequently, we think that the human pathogen fungal spectrum will continue to enlarge.

Echocardiographic evaluation of epicardial adipose tissue in non-diabetic, non-hypertensive hemodialysis patients.

Abstract Purpose: It has been found out that the epicardial adipose tissue (EAT) measured by echocardiography is related with various metabolic parameters. Being accepted as the new cardiovascular risk indicator, there have been few studies on EAT in relation to the patients with end-stage renal failure. In our study, we aim to evaluate EAT and carotid intima media thickness (CIMT) in non-diabetic, non-hypertensive hemodialysis (HD) patients. Methods: Our study recruited 47 non-diabetic, non-hypertensive HD patients (22 males, 25 females, median age 54 (44.3–60.8) years) and an age-gender matched control group consisting 41 healthy subjects (17 males, 24 females, median age 52 (48–56) years). In all patients, EAT was measured by echocardiography and CIMT by ultrasonography; and routine laboratory parameters were studied. Results: In our study, we obtained laboratory findings matching with the profiles of uremic patients among HD patients and CIMT values of HD patients are significantly higher than that of the control group [0.79 (0.64–0.93) vs. 0.6 (0.53–0.68) p < 0.001], and EAT values are similar [0.5 (0.33–0.6) vs. 0.4 (0.4–0.53) p > 0.05]. Conclusions: EAT is not a cardiovascular risk indicator in HD patients without diabetes mellitus and hypertension. Besides, echocardiographic measurement of EAT is easy, non-invasive, cheap and credible method.

Late Effects of Renal Transplantation on Endothelial Functions and Cardiac Morphology

BACKGROUND Endothelial dysfunction is common in patients undergoing hemodialysis (HD), and cardiovascular morbidity and mortality are higher in these patients. In this study, we evaluated the late posttransplantation effects of cyclosporine and tacrolimus on endothelial function, inflammation, and cardiac architecture. METHODS The study included 12 patients undergoing hemodialysis (group 1); 22 renal transplant recipients, of which 13 were receiving cyclosporine therapy (group 2) and 9 were receiving tacrolimus therapy (group 3); and 12 healthy control individuals (group 4). Kidney recipients were included if the transplantation procedure had been performed at least 1 year before the study. Asymmetric dimethylarginine, C-reactive protein, carotid intima-media thickness, left ventricular posterior wall thickness, interventricular septal thickness, left ventricular muscle mass index, flow-mediated dilation, and nitroglycerine-induced dilation of the brachial artery were evaluated. RESULTS Serum asymmetric dimethylarginine, C-reactive protein, carotid intima-media thickness, left ventricular posterior wall thickness, interventricular septal thickness, and left ventricular muscle mass index values were significantly higher in patients undergoing HD than in the other 3 groups (P < .05), whereas percent change in flow-mediated dilation and nitroglycerine-induced dilation of the brachial artery was significantly lower (P < .05). CONCLUSION Patients undergoing HD demonstrate endothelial dysfunction. In the late posttransplantation period, kidney recipients seem to have similar endothelial function and cardiac architecture as in the healthy population. This result may explain the reduction in cardiovascular morbidity and mortality after transplantation in patients undergoing HD. Tacrolimus and cyclosporine have similar effects on endothelial function.

Painful and painless shoulder Magnetic Resonance Imaging comparisons in hemodialysis patients and correlation with clinical findings

BACKGROUND Shoulder pain is frequently observed in haemodialysis patients. OBJECTIVE To compare haemodialysis patients with or without shoulder pain in terms of shoulder motion ranges, β2 microglobulin levels and magnetic resonance imaging findings. METHODS Forty-three patients undergoing dialysis were enrolled, of which 23 patients had explicit shoulder pain at night, which appeared during dialysis. Range of joint motion and impingement tests were evaluated. β 2 microglobulin value was recorded. MRI was used to evaluate rotator cuff tendons for thickness, homogeneity, integrity and presence of effusion. RESULTS Ranges of motion were significantly lower in the painful shoulder group. Supraspinatus tendon thickness and the number of areas with effusion were higher in the painful group. There was a positive correlation between the β 2 microglobulin level and supraspinatus (r:0.352 p< 0.05) and subscapular (r:0.454 p< 0.05) tendon thicknesses. While effusion areas and pain (r:0.351 p< 0.05) showed positive correlation, there was a negative correlation between pain and shoulder motion ranges. CONCLUSIONS Shoulder pain in dialysis patients can be related with tendon thickness and effusion. While the β 2 microglobulin level affects tendon thickness, it has no relation to pain and movement constraint.

Pseudoexfoliation syndrome in chronic kidney disease patients.

Abstract This study was performed to determine whether chronic kidney disease (CKD) is associated with an increased risk of pseudoexfoliation (PEX) syndrome. This is an age-matched case control study evaluating frequency of PEX in patients over age 40 with the diagnosis of stage 1–4 CKD and those undergoing hemodialysis (HD). Subjects over age 40 with hypertension and/or diabetes mellitus (DM) and normal kidney functions were studied as a control group. CKD was diagnosed as decreased glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 for at least 3 months. Study groups were arranged as group 1 consisting of HD receiving CKD patients, group 2 consisting of CKD patients who do not need HD and group 3 as a control. Demographic properties and the prevalence of PEX were evaluated and compared between groups. Because of the effect of DM on PEX occurrence, it was also evaluated after exclusion of diabetic patients. A total of 101 cases in group 1, 106 cases in group 2 and 117 cases in group 3 were included in the study. Pseudoexfoliation was found in 7 (6.9%) patients in group 1, 5 (4.7%) patients in group 2 and 7 (5.9%) patients in group 3 (p > 0.05). After exclusion of diabetic patients the prevalence of PEX changed as 4 (5.6%) in group 1, 2 (4.4%) in group 2 and 1 (1.8%) in group 3 (p > 0.05). In conclusion, CKD was not associated with increased prevalence of PEX in this study.