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OBJECTIVE This study aimed to investigate the rates of influenza and pneumococcal vaccinations and the factors affecting vaccination rates in hemodialysis patients. METHODS The study included 360 hemodialysis patients. Patients' data were collected via a questionnaire form applied during a face-to-face interview. RESULTS Of the patients, 51.4% vaccinated at least once with influenza vaccine and 14.4% vaccinated with pneumococcal vaccine. While 31.4% of the patients had annual vaccination regularly for influenza, 20% were vaccinated irregularly. Of the patients with missing vaccination, 76.2% reported the reason for not being vaccinated as lack of knowledge about the relevant vaccine. At initial evaluation in the beginning of the study, the percentage of patients vaccinated with both influenza and pneumococcal vaccines was 10.8%. After informing the patients in the face-to-face interview, 89.7% of them reported that they planned to have both vaccines (p

The aim of this study was to determine the relationship between purified protein derivative of tuberculin (PPD) values, an indicator of BCG protection, and COVID-19 disease in patients with end-stage renal disease (ESRD) on the kidney transplant waiting list.Age, sex, dialysis type, ERSD etiologies, and PPD values of patients on the renal transplant waiting list were recorded. SARS-CoV-2 PCR data, whether the patients were previously infected with the virus, and, if infected, the severity of the disease were noted. Data were statistically compared.PCR of 87 (47.02%) of 185 patients were studied; 107 of the patients were male and 78 were female, with a mean age of 52.8 years. The test result was positive for 28 patients. Of the patients for whom PCR was studied, 41 had a negative PPD result, while 46 had a positive PPD result. There was no correlation with SARS-CoV-2 PCR positivity in patients with a PPD ≤ 5 mm and5 mm. However, patients with pneumonic infiltration who required hospitalization had a significantly higher PPD value.The PPD measurement, which is an indicator of BCG protection, might be a significant parameter for predicting the course of the disease in SARS-CoV-2 pneumonia.

Introduction: Hemodialysis (HD) patients have increased risk for short-term adverse outcomes of COVID-19. However, complications and survival at the post-COVID-19 period have not been published extensively.Methods: We conducted a national, multicenter observational study that included adult maintenance HD patients recovered from confirmed COVID-19. A control HD group without COVID-19 was selected from patients in the same center. We investigated the characteristics and outcomes in the follow-up of HD patients and compare them with the non-COVID-19 group.Results: A total of 1223 patients (635 patients in COVID-19 group, 588 patients in non-COVID-19 group) from 47 centers were included in the study. The patients' baseline and HD characteristics were almost similar. The 28th-day mortality and mortality between 28th day and 90th day were higher in the COVID-19 group than non-COVID-19 group (19 [3.0%] patients vs. none [0%]; 15 [2.4%] patients vs. 4 [0.7%] patients, respectively). The presence of respiratory symptoms, rehospitalization, need for home oxygen therapy, lower respiratory tract infection, and arteriovenous (AV) fistula thrombosis was significantly higher in the COVID-19 group in both the first 28 days and between 28 and 90 days. In the multivariable analysis, age (odds ratio [OR] [95% CI]: 1.029 [1.004-1.056]), group (COVID-19 group vs. non-COVID-19 group) (OR [95% CI]: 7.258 [2.538-20.751]), and vascular access type (tunneled catheter/AV fistula) (OR [95% CI]: 2.512 [1.249-5.051]) were found as independent parameters related to 90-day mortality.Conclusion: In the post-COVID-19 period, maintenance HD patients who have had COVID-19 have increased rehospitalization, respiratory problems, vascular access problems, and high mortality compared with the non-COVID-19 HD patients.

Objective Older adults with co‐morbidities have been reported to be at higher risk for adverse outcomes of coronavirus disease 2019 (COVID‐19). The characteristics of COVID‐19 in older patients and its clinical outcomes in different kidney disease groups are not well known. Methods Data were retrieved from a national multicentric database supported by Turkish Society of Nephrology, which consists of retrospectively collected data between 17 April 2020 and 31 December 2020. Hospitalised patients aged 18 years or older with confirmed COVID‐19 diagnosis suffering from stage 3‐5 chronic kidney disease (CKD) or on maintenance haemodialysis (HD) treatment were included in the database. Non‐uraemic hospitalised patients with COVID‐19 were also included as the control group. Results We included 879 patients [388 (44.1%) female, median age: 63 (IQR: 50‐73) years]. The percentage of older patients in the CKD group was 68.8% (n = 188/273), in the HD group was 49.0% (n = 150/306) and in the control group was 30.4% (n = 70/300). Co‐morbidities were higher in the CKD and HD groups. The rate of presentation with severe‐critical disease was higher in the older CKD and HD groups (43.6%, 55.3% and 16.1%, respectively). Among older patients, the intensive care unit (ICU) admission rate was significantly higher in the CKD and HD groups than in the control group (38.8%, 37.3% and 15.7%, respectively). In‐hospital mortality or death and/or ICU admission rates in the older group were significantly higher in the CKD (29.3% and 39.4%) and HD groups (26.7% and 30.1%) compared with the control group (8.6% and 17.1%). In the multivariate analysis, in‐hospital mortality rates in CKD and HD groups were higher than control group [hazard ratio (HR): 4.33 (95% confidence interval [CI]: 1.53‐12.26) and HR: 3.09 (95% CI: 1.04‐9.17), respectively]. Conclusion Among older COVID‐19 patients, in‐hospital mortality is significantly higher in those with stage 3‐5 CKD and on maintenance HD than older patients without CKD regardless of demographic characteristics, co‐morbidities, clinical and laboratory data on admission.

BackgroundAcute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and theseverity of AKI is linked to adverse outcomes. In this study, we investigated the factors asso-ciated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI.MethodsIn this multicenter retrospective observational study, we evaluated the characteristics andin-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI.Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI defini-tion and staging were based on the Kidney Disease Improving Global Outcomes criteria.Patients with end-stage kidney disease or with a kidney transplant were excluded. Renaloutcomes were identified only in discharged patients.ResultsThe median age of the patients was 69 years, and 60.9% were males. The most frequentcomorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kid-ney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%,and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit.Renal improvement was complete in 81.7% and partial in 17.2% of the patients who weredischarged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. Theoverall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was notdifferent in patients with preexisting non-dialysis CKD compared to patients without CKD(34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio[HR] [95% confidence interval (95%CI)]: 1.01 [1.0–1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04–2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06–2.17], p =0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08–3.07], p = 0.023), serum lac-tate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05–2.30], p =0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25–3.14], p = 0.003) and stage 3 (HR [95%CI]:2.25 [1.44–3.51], p = 0.0001) were independent predictors of in-hospital mortality.ConclusionsAdvanced-stage AKI is associated with extremely high mortality among hospitalizedCOVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality inpatients with COVID-19 in the general population, are also related to in-hospital mortality inpatients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mor-tality rate among AKI patients. Renal problems continue in a significant portion of thepatients who were discharged.&nbsp

Background/aim: Hospital-acquired acute kidney injury (HA-AKI) may commonly develop in Covid-19 patients and is expected to have higher mortality. There is little comparative data investigating the effect of HA-AKI on mortality of chronic kidney disease (CKD) patients and a control group of general population suffering from Covid-19. Materials and methods: HA-AKI development was assessed in a group of stage 3-5 CKD patients and control group without CKD among adult patients hospitalized for Covid-19. The role of AKI development on the outcome (in-hospital mortality and admission to the intensive care unit [ICU]) of patients with and without CKD was compared. Results: Among 621 hospitalized patients (age 60 [IQR: 47-73]), women: 44.1%), AKI developed in 32.5% of the patients, as stage 1 in 84.2%, stage 2 in 8.4%, and stage 3 in 7.4%. AKI developed in 48.0 % of CKD patients, whereas it developed in 17.6% of patients without CKD. CKD patients with HA-AKI had the highest mortality rate of 41.1% compared to 14.3% of patients with HA-AKI but no CKD (p < 0.001). However, patients with AKI+non-CKD had similar rates of ICU admission, mechanical ventilation, and death rate to patients with CKD without AKI. Adjusted mortality risks of the AKI+non-CKD group (HR: 9.0, 95% CI: 1.9-44.2) and AKI+CKD group (HR: 7.9, 95% CI: 1.9-33.3) were significantly higher than that of the non-AKI+non-CKD group. Conclusion: AKI frequently develops in hospitalized patients due to Covid-19 and is associated with high mortality. HA-AKI has worse outcomes whether it develops in patients with or without CKD, but the worst outcome was seen in AKI+CKD patients. Turkish Society of Nephrology for the organization We thank Turkish Society of Nephrology for the organization and funding of the study. We also would like to express our gratitude to the patients whose records were used in this study, without which this research would not be possible.

BackgroundAcute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI.MethodsIn this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients.ResultsThe median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0–1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04–2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06–2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08–3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05–2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25–3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44–3.51], p = 0.0001) were independent predictors of in-hospital mortality.ConclusionsAdvanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.

Background Maintenance hemodialysis (MHD) patients are at increased risk for coronavirus disease 2019 (COVID-19). The aim of this study was to describe clinical, laboratory, and radiologic characteristics and determinants of mortality in a large group of MHD patients hospitalized for COVID-19. Methods This multicenter, retrospective, observational study collected data from 47 nephrology clinics in Turkey. Baseline clinical, laboratory and radiological characteristics, and COVID-19 treatments during hospitalization, need for intensive care and mechanical ventilation were recorded. The main study outcome was in-hospital mortality and the determinants were analyzed by Cox regression survival analysis. Results Of 567 MHD patients, 93 (16.3%) patients died, 134 (23.6%) patients admitted to intensive care unit (ICU) and 91 of the ones in ICU (67.9%) needed mechanical ventilation. Patients who died were older (median age, 66 [57–74] vs. 63 [52–71] years, p = 0.019), had more congestive heart failure (34.9% versus 20.7%, p = 0.004) and chronic obstructive pulmonary disease (23.6% versus 12.7%, p = 0.008) compared to the discharged patients. Most patients (89.6%) had radiological manifestations compatible with COVID-19 pulmonary involvement. Median platelet (166 × 103 per mm3 versus 192 × 103 per mm3, p = 0.011) and lymphocyte (800 per mm3 versus 1000 per mm3, p p = 0.001) on admission were lower in patients who died. Age (HR: 1.022 [95% CI, 1.003–1.041], p = 0.025), severe-critical disease clinical presentation at the time of diagnosis (HR: 6.223 [95% CI, 2.168–17.863], p p = 0.009), ferritin levels on admission (HR; 1.057 [95% CI, 1.006–1.111], p = 0.028), elevation of aspartate aminotransferase (AST) (HR; 3.909 [95% CI, 2.143–7.132], p 3 per mm3) during hospitalization (HR; 1.864 [95% CI, 1.025–3.390], p = 0.041) were risk factors for mortality. Conclusion Hospitalized MHD patients with COVID-19 had a high mortality rate. Older age, presence of heart failure, clinical severity of the disease at presentation, ferritin level on admission, decrease in platelet count and increase in AST level during hospitalization may be used to predict the mortality risk of these patients.

WOS: 000392937800028 PubMed ID: 28006774 Background/Aims: Fabry disease is a treatable cause of chronic kidney disease (CKD) characterized by a genetic deficiency of a-galactosidase A. European Renal Best Practice (ERBP) recommends screening for Fabry disease in CKD patients. However, this is based on expert opinion and there are no reports of the prevalence of Fabry disease in stage 1-5 CKD. Hence, we investigated the prevalence of Fabry disease in CKD patients not receiving renal replacement therapy. Methods: This prospective study assessed a-galactosidase activity in dried blood spots in 313 stage 1-5 CKD patients, 167 males, between ages of 18-70 years whose etiology of CKD was unknown and were not receiving renal replacement therapy. The diagnosis was confirmed by GLA gene mutation analysis. Results: Three (all males) of 313 CKD patients (0.95%) were diagnosed of Fabry disease, for a prevalence in males of 1.80%. Family screening identified 8 aditional Fabry patients with CKD. Of a total of 11 Fabry patients, 7 were male and started enzyme replacement therapy and 4 were female. The most frequent manifestations in male patients were fatigue (100%), tinnitus, vertigo, acroparesthesia, hypohidrosis, cornea verticillata and angiokeratoma (all 85%), heat intolerance (71%), and abdominal pain (57%). The most frequent manifestations in female patients were fatigue and cornea verticillata (50%), and tinnitus, vertigo and angiokeratoma (25%). Three patients had severe episodic abdominal pain attacks and proteinuria, and were misdiagnosed as familial Mediterranean fever. Conclusions: The prevalence of Fa bry disease in selected CKD patients is in the range found among renal replacement therapy patients, but the disease is diagnosed at an earlier, treatable stage. These data support the ERBP recommendation to screen for Fabry disease in patients with CKD of unknown origin. (C) 2016 The Author(s) Published by S. Karger AG, Basel Sanofi Genzyme Corporation; Intensificacion ISCIII and REDINREN [RD012/0021] We are indebted to our patients and their families for volunteering to contribute their medical information to the physicians who are dedicated to their care. This work was supported by grants from Sanofi Genzyme Corporation. The lead investigator had full access to all data in the study. All investigators take responsibility for the accuracy of the individual data that they entered in the system provided by FMF Arthritis Vasculitis and Orphan disease Research (FAVOR). AO was supported by Intensificacion ISCIII and REDINREN RD012/0021.

Background Recent studies have shown that neutrophil lymphocyte ratio (NLR) is a strong indicator in determining inflammation in cardiac and non-cardiac diseases. We aimed to evaluate the relationship between proteinuria and NLR in chronic kidney disease (CKD) patients without diabetes mellitus (DM). Methods Between 2011 and 2012 files of a total of 1000 CKD patients attending outpatient clinic were retrospectively scanned. Patients with DM, chronic disease, malignancy or stage 5 CKD were excluded. After these patients were excluded, a total of 69 patients with stage 3 and 4 CKD were evaluated. Results The study comprised 27 patients with CKD without proteinuria (Group 1), 42 patients with CKD and proteinuria (Group 2) and 30 healthy volunteers (Group 3). NLR was highest in Group 2 and this was statistically significant compared with the control group (p = 0.012). The platelet lymphocyte ratio (PLR) in Group 2 was higher than the control group at a significant level (p = 0.004). There was a moderate positive correlation found between proteinuria and NLR (p = 0.013, r = 0.3). There was a positive correlation found between proteinuria and PLR (p = 0.002, r = 0.306). Conclusion In conclusion, NLR, a parameter easily found in routine blood counts of CKD patients, is a marker with prognostic value for the presence and degree of proteinuria.

Sjögren’s syndrome is mainly affects the exocrine glands. Patients usually complain of persistent dryness of the mouth and eyes. However, nonexocrine organs such as the kidneys are often affected in these patients. Distal renal tubular acidosis (dRTA) and interstitiel nephritis are common in Sjögren’s syndrome. Nonetheless, severe hypokalemia and paralysis secondary to dRTA are unusual initial manifestation of Sjögren’s syndrome. Here, we describe a case of a 48 year old women admitted to the emergency setting with severe hypokalemic paralysis and diagnosed Sjögren’s syndrome.

To assess changes in choroidal thickness (CT) in diabetes patients with and without diabetic nephropathy using enhanced depth imaging spectral domain optical coherence tomography (EDI-OCT). Thirty-five type 2 diabetes patients with a diagnosis of diabetic nephropathy (DNP) in nephrology department and 35 type 2 diabetes patients without nephropathy (non-DNP) were included in our prospective study consecutively. The control group comprised 34 healthy individuals. CT measurements were recorded under the fovea and at 1500 µm from the foveal center in the nasal and temporal sides. The study parameters also included age, refractive error, axial length, intraocular pressure, HbA1c, glomerular filtration rate and proteinuria amount. The subfoveal, temporal and nasal choroidal thickness was noted to be thinner in patients with DNP compared with non-DNP and normal subjects (p

OBJECTIVE To investigate the relationship of blood pH and bicarbonate levels with sleep disorders in patients with end-stage renal disease. METHODS The cross-sectional study was conducted at Kocaeli Derince Health Practice and Research Center, Kocaeli, Turkey, in July 2015, and comprised stable haemodialysis patients aged over 18 years who had undergone at least 3 months of treatment. The Pittsburgh sleep quality index was used to assess sleep quality, and the Epworth sleepiness scale was used to assess sleepiness. Blood urea nitrogen levels were measured to determine dialysis success. SPSS 17 was used for data analysis. RESULTS Of the 62 patients, 22(35.4%) were good sleepers, while 40(65.6%) were bad sleepers, and 11(17.7%) had excessive daytime sleepiness. There was no significant difference between poor and good sleepers with respect to venous pH (p=0.197) and bicarbonate (p=0.305) levels. Also, the two levels did not differ significantly between patients with routine or excessive daytime sleepiness (p>0.05). Patients with excessive daytime sleepiness had significantly lower calcium (p=0.046) and higher creatinine (p-0.014) levels and were older (p=0.01). Age was the only independent predictor of both the index and the scale scores (p

Patients receiving dialysis therapy are known to be at increased risk of tuberculosis (TB). The aim of this study was to evaluate the frequency, clinical characteristics and course of TB disease in dialysis patients treated at our institution. Medical records of 330 regular haemodialysis (n=219) and continuous ambulatory peritoneal dialysis (n=111) patients (172 male, 158 female; mean age 55+/-16 y) who were cared for at our tertiary university hospital between December 2002 and January 2006 were retrospectively evaluated. Nine cases of TB (2.7%) occurred, in the following locations: vertebra (n=3), miliary (n=3), lymph nodes (n=1), peritoneum (n=2; one as peritionitis, 1 as an abscess). Four of these 9 patients died during the follow-up (mean time from diagnosis to death, 7 months); none of the deaths appeared to be caused by the disease itself. The incidence of TB disease in patients receiving renal replacement therapy is high, and occurs primarily in extrapulmonary sites.

Arteriovenous fistula is a preferred approach to obtain vascular access in chronic hemodialysis patients. Arteriovenous fistula has some effects on cardiac and pulmonary systems. High output heart failure is a rare but an important complication of arteriovenous fistula. We report here a case of acute pulmonary arteriovenous fistula in a hemodialysis edema after creating, Arteriovenöz fistül, kronik hemodiyaliz hastalarında damar eriĢimi için sıklıkla tercih edilen bir yoldur. Arteriovenöz fistülün kalp ve pulmoner vasküler sistem üzerinde etkileri mevcuttur. Yüksek debili kalp yetmezliği, arteriovenöz fistülün nadir görülen önemli bir komplikasyonudur. Burada, sol akciğeri malignite nedeni ile total olarak alınan ve arteriovenöz fistül açılmasını takiben akut akciğer ödemi geliĢen bir hemodiyaliz hastası sunulmuĢtur.Anahtar Kelimeler: akciğer ödemi, arteriovenöz fistül, hemodiyaliz, kalp yetmezliği, pnömonektomi

Omentin-1 is suggested to affect inversely atherosclerosis (AS). Data about omentin-1 is limited to chronic kidney disease (CKD). Our aim was to examine omentin-1 in non-diabetic CKD patients who are not dialyzed and investigate its relationships with inflammation and carotid AS.We performed a cross-sectional study in 55 non-diabetic CKD patients and 30 healthy controls. Baseline clinical and laboratory data were obtained for all participants. Serum omentin-1 and interleukin-6 (IL-6) levels were measured according to the manufacturer's instructions. Carotic plaque and intima-media thickness (IMT) were assessed by carotid ultrasonography. The homeostasis model assessment of insulin resistance index (HOMA-IR) was used to assess IR.Omentin-1 and IL-6 levels in the patient group were found to be higher than the control group; the differences were statistically significant (p = 0.01 and p = 0.04, respectively). Carotid IMT(mean) was significantly higher in the patient group (p = 0.01). Omentin-1 did not correlate with IL-6 and IMT in the patient group (p = 0.51 and p = 0.76, respectively). In subgroup analysis, omentin-1 levels in patients with carotid plaque were lower than those without carotid plaque (179.5 ± 88.1 ng/ml and 185.9 ± 67.8 ng/ml, respectively). However, the difference was not statistically significant (p = 0.47).We conclude that omentin-1 is higher in not dialyzed non-diabetic CKD and there is no correlation between omentin-1 and IL-6 or carotid IMT(mean).

To investigate antiproteinuric effect of spironolactone in patients with chronic kidney disease (CKD) treated with angiotensin-converting enzyme (ACE) inhibitors and/or angiotensin II type 1 receptor blockers (ARBs).This study was performed in 33 CKD patients with proteinuria. 24 h urinary protein excretion and biochemical parameters were obtained before the therapy. Then, spironolactone (25 mg/d) was added to the therapy. The antiproteinuric effect of spironolactone was examined for eight weeks.At eight weeks, there was a significant decrease in proteinuria (p0.001, 47.9% decrease). Systolic and diastolic blood pressures were significantly decreased (p0.004, p0.001, respectively). However, no correlation was detected between the reductions in systolic and diastolic BP and the reduction in proteinuria (p = 0.464, p = 0.239, respectively). Serum potassium level increased significantly (p0.001).Our study suggests that spironolactone significantly reduces urinary protein excretion. This strategy may be useful to slow the progression of CKD. However, hyperkalemia is the most important side effect of treatment, and it is necessary to monitor potassium level. Further studies are needed to determine the efficacy of spironolactone on proteinuria.

Diffuse alveolar hemorrhage (DAH) is rarely seen in patients with systemic lupus erythematosus (SLE), often associated with a poor outcome. It almost affects young women and it is an unusual initial manifestation of SLE. We report a case of SLE presenting with DAH. The patient was a male. He had no history of photosensitivity, malar rash, discoid rash, arthritis, and oral ulcer. Antinuclear antibody, and anti-double stranded DNA (dsDNA) were positive with very high titers, and serum complement levels (C3, C4) were low. He also had renal dysfunction and pericardial effusion. He was diagnosed as DAH due to SLE. He had to undergo hemodialysis for several weeks. DAH and renal dysfunction were improved with intensive treatment including corticosteroid, cyclophosphamide, and mycophenolate mophetil.

Acute renal failure is a well-recognized complication of acute leukaemias. Howevcr, serious renal failure caused by leukaemic infiltration as a primary manifestation is unusual. Here we report two patients with acute lymphoblastic leukaemia presenting with acute renal failure due to leukaemic infiltration. The first patient died before the administration of specific therapy for leukaemia, whereas the second case recovered after chemotherapy. She was discharged without necessitating dialysis therapy.

A 49-year-old female patient on continuous ambulatory peritoneal dialysis presented with fever, abdominal pain and loss of appetite. While peritoneal fluid bacterial cultures remained negative, she had no relief after 3 weeks of broad-spectrum antibiotics for possible bacterial peritonitis. In a peritoneal fluid sample, Mycobacterium tuberculosis DNA was detected by nucleic acid amplification using real-time PCR testing. The initiation of antituberculous therapy (isoniazid, rifampicin, ethambutol and pyrazinamide) was followed by resolution of fever and abdominal pain within one week. Nucleic acid amplification tests can play an important role in the species-specific diagnosis of tuberculous peritonitis.

Hyponatremia and its rapid correction may cause osmotic demyelination syndrome (ODS) with damage to the pontine and extrapontine areas of the brain. The damage may become persistent or may regress and disappear during follow-up. We describe the case of a 35-year-old woman with chronic renal failure who was admitted to the emergency department with profound hyponatremia which was corrected rapidly after hemodialysis treatment. During follow-up, she developed quadriparesis and dysartria. Magnetic resonance imaging (MRI) demonstrated abnormalities characteristic of ODS in the pons as well as the basal ganglia with increased signal intensity on T2 and diffusion-weighted (DW) MRI and low apparent diffusion coefficient (ADC) values. After the sixth day, her clinical status improved progressively. Control MRI revealed rapid normalization of the ADC values during the first week and month parallel to the clinical improvement. However, the hyperintensities on T2-weighted images persisted. Four months later the MRI findings were completely normal. The close relationship between the ADC abnormality and the clinical status suggests that DW-MRI may be useful in predicting the prognosis of ODS.

Hyperhomocysteinemia is considered to be an independent risk factor for atherosclerotic heart disease, including coronary artery disease (CAD). It is already known that overt hypothyroidism gives rise to a slight hyperhomocysteinemia. However, the effects of subclinical hypothyroidism on the levels of homocysteine are not known. In this study, we have evaluated homocysteine levels and the effect of L-thyroxine treatment in patients with subclinical hypothyroidism. For the purpose of the study, we selected 33 women patients with the diagnosis of subclinical hypothyroidism but without clinical CAD. After a euthyroidism development period of almost four months, a further study was done on patients who had been treated with thyroid hormone. The patient group was compared with 25 healthy control female subjects who were of similar age. In the patient group, homocysteine levels prior to treatment were significantly higher than in the control group (P0.001). After L-thyroxine treatment, homocysteine levels were reduced significantly. In summary, we found that homocysteine levels were in the normal range in subclinical hypothyroidism. However, when compared with the healthy control group, the difference between them was significant. On the other hand, therapy to produce euthyroidism caused a significant reduction in homocysteine levels.

Mad honey poisoning syndrome is common in Turkey mostly in Black Sea Region. Gastrointestinal, cardiovascular and neurologic systems are mostly involved in this syndrome. Hypotension, bradycardia and visual disorders are usually encountered problems. Intravenous fluid and atropin therapy are successfully used in symptomatic patients. We report a 46 year old male with mad honey poisoning who presented with prolonged hypotension and bradycardia., Deli bal zehirlenmesi Türkiye’nin daha çok Karadeniz bölgesinde görülen, gastrointestinal, kardiyovasküler ve nörolojik sistemleri etkilyebilen bir sendromdur. Hipotansiyon, bradikardi ve görme sorunları en sık karşılaşılan problemlerdir. İntravenöz sıvı ve atropin tedavisi semptomatik hastalarda başarıyla kullanılır. Burada deli bal zehirlenmesi olan, hipotansiyonu ve bradikardisi 72 saat süren 46 yaşında erkek bir hasta sunulmuştur.