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Background: Vascular calcifications (VCs), recognized risk factor for increased mortality, are highly prevalent in hemodialysis (HD) patients. We aimed to investigate the relation between VC and warfarin use with plain radiography., Methods: VCs were assessed using Adragao (radial and digital) and Kauppila (aortic) scores in 76 HD patients from six centers. Out of a total 711 HD patients, there were 32 (4.5%) who had been treated with warfarin for at least 1 year, and we included 44 control patients., Results: Of the patients, 47% were females, the mean age was 66 ± 9 years, 23% were diabetics, the mean dialysis vintage was 68 ± 38 months. In warfarin group, median Kauppila score was higher than in control group [11 vs 6.5, (25%-75% percentile, 5 vs. 15), p = 0.032] and the percentage of the patients with a Kauppila score of >6 was higher, as well (76.6% vs. 50%; p = 0.029). Median Adragao score was not significantly different between the two groups [7 vs. 6, (%25,%75 percentile 6 vs. 8), p = 0.17]. Logistic regression analysis revealed that warfarin treatment was independently associated with Kauppila scores of >6 (OR 3.60, 95% CI 1.18-10.9, p = 0.024)., Discussion: In this study, we found that warfarin is associated to vascular calcifications, especially in aorta of HD patients.

Background/aim: The aim of this study is to determine the ME diterranean F e V er ( MEFV ) gene mutation carrier rate in patients with glomerulonephritis and to investigate the association between disease features and MEFV variants., Materials and Methods: Medical records regarding clinical, laboratory, histopathological, and prognostic features of 200 adult patients with biopsy-proven glomerulonephritis were evaluated retrospectively. Exons 2 and 10 of the MEFV gene of each patient were sequenced by next-generation sequencing. Variants were detected and compared with disease features., Results: MEFV mutation carrier rate was 25%, similar among disease subgroups, and higher than the previously reported rates for normal populations. Demographic, clinical, and laboratory features at diagnosis did not differ in patients with and without mutations. Refractory disease rates were 73% and 40% in carriers and noncarriers of E148Q (P = 0.051). Percentage of global sclerotic glomeruli was higher in M694V carriers than noncarriers (medians 24% vs. 0%, P = 0.047). Tubulointerstitial fibrosis was also more severe in M694V carriers. The carrier rate of M694V was 14.3% in patients eventually needing chronic renal replacement therapy (RRT) (n = 21), whereas it was 2.8% in the group without RRT (OR = 5.8 [1.28–26.3], P = 0.040)., Conclusion: MEFV mutation carrier rate was higher than expected in our sample of Turkish patients with glomerulonephritis. The E148Q mutation may be associated with refractory disease. The M694V mutation was more frequent in patients who needed chronic R RT., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

The association between pediatric celiac disease (CD) and atherosclerosis is unknown. Our aim was to investigate whether pediatric CD patients have an increased risk of atherosclerosis. We evaluated the premature atherosclerosis by pulse wave velocity (PWV) and carotid intima-media thickness (cIMT). A total of 37 CD patients (20 girls, mean age 13±3.3 years) and 36 healthy age and sex matched controls were enrolled. Mean duration of CD was 47.1±32.3 months and 40.5% of patients had positive tissue transglutaminase antibody (tTg) IgA. Total cholesterol level was lower in CD (p=0.026) and cIMT was lower in tTg IgA antibody negative CD (p=0.030). cIMT was significantly correlated with tTg IgA antibody positivity (r=0.336; p=0.042). Adherence to strict gluten-free diet is associated with decreased cIMT, suggesting that gluten withdrawal seems to have a beneficial effect on premature atherosclerosis.

Objective: To determine the distribution of blood pressure (BP) and prevalence, awareness, treatment and control of hypertension in Turkey (PatenT)., Design: A population-based cross-sectional epidemiology survey was carried out in 2003., Setting: Twenty-six cities from seven geographical provinces of Turkey, with proportional representation of urban and rural populations., Participants: A two-stage stratified sampling method was used to select a sample of the adult population over 18 years of age. The total number of participants was 4910., Interventions: Data collection and BP measurements were conducted by specifically trained physicians in the households of the participants., Main Outcome Measures: The mean systolic and diastolic BP levels, distribution of blood pressure, prevalence of hypertension (mean systolic BP>or=140 mmHg or mean diastolic BP>or=90 mmHg, or previously diagnosed and/or taking antihypertensive drugs), awareness, treatment and control of hypertension were assessed., Results: The overall age-adjusted and sex-adjusted prevalence of hypertension in Turkey was 31.8%, and it was higher in women than in men (36.1 versus 27.5%, P<0.001). In the whole group, 32.2% had never had their BP measured. Overall, 40.7% of those with hypertension were aware of their diagnosis, only 31.1% were receiving pharmacologic treatment and only 8.1% had their BP under control. The subjects who were aware and treated had a control ratio of 20.7%., Conclusions: PatenT data indicate that hypertension is a highly prevalent but inadequately managed health problem in Turkey. There is an urgent need for population-based strategies to improve the prevention, early detection and control of hypertension.

Background: Relevance of serum CRP for morbidity and mortality in pre-dialysis patients has not been assessed extensively. The aim of this study was to determine the incidence of elevated serum CRP in pre-dialysis patients and to identify the factors that associate with serum CRP. We were also evaluated the effects of serum CRP on cardiovascular disease, anemia, and nutritional markers., Methods: One hundred and eight pre-dialysis patients with a mean creatinine clearance (CrCl) of 30.1 ml/min were included in the study. Data collected from each patient included demographics, co-morbidity, medications, blood pressures, blood biochemistry including serum CRP, renal function, and echocardiography., Results: Serum CRP was elevated (>5 mg/l) in 43 patients (39.8%). There was a negative correlation between serum CRP and CrCl (r = -0.370, p < 0.001). CrCl was the unique independent factor affecting serum CRP. Serum CRP was an independent factor affecting left ventricular mass index, fractional shortening, serum albumin and hematocrit in multivariate analyses., Conclusions: Prevalence of elevated serum CRP in pre-dialysis patients is high. Reduced renal clearance of CRP and/or cytokines may contribute to the inflammatory status. Elevated serum CRP is an important cause of morbidity in pre-dialysis patients., (Copyright 2005 S. Karger AG, Basel.)

Nephrotic syndrome has been rarely reported after hematopoietic stem cell transplantation. We report a patient who developed nephrotic syndrome after allogeneic peripheral blood stem cell transplantation for acute myelogenous leukemia. Renal biopsy was performed and immunofluorescence and light microscopy were compatible with minimal change disease. The patient was treated with cyclophosphamide and prednisolone. Complete remission was achieved after three months. Previous reported cases are discussed.

Unlabelled: Effect of fluid and sodium removal on mortality in peritoneal dialysis patients., Background: Adequacy of peritoneal dialysis (PD) traditionally is assessed using Kt/V(urea) and total creatinine clearance (TCC). However, this approach underestimates the importance of fluid and sodium removal. The aim of this study was to determine the effect of fluid and sodium removal on morbidity and mortality in PD patients., Methods: One hundred twenty-five PD patients were monitored for three years from the beginning of the treatment. The effects of demographic features, comorbidity, peritonitis rate, blood pressure, medications, blood biochemistry, peritoneal membrane transport characteristics, residual renal function (RRF), Kt/V(urea), TCC, normalized protein nitrogen appearance (nPNA), and removal of sodium and fluid on mortality were evaluated. Total and cardiovascular hospitalization rates were also recorded. A Cox proportional hazards model was used to determine factors predicting mortality., Results: In the Cox model, comorbidity, total sodium and fluid removals, hypertensive status, serum creatinine, and RRF were independent factors affecting survival. In contrast, Kt/V(urea) or TCC did not affect the adjusted survivals. Total sodium and fluid removal and hypertensive status also significantly influenced the hospitalization rate. Systolic and diastolic blood pressures were negatively correlated with total fluid (P < 0.001) and sodium removal (P < 0.001)., Conclusions: Together, these findings suggest that removal of sodium and fluid is a predictor of mortality in PD patients, whereas Kt/V(urea) and TCC are not factors. Adequate fluid and sodium balance is crucial for the management of patients on PD.

Renal complications of Castleman's disease are uncommon. Among the various renal disorders, including mesangial proliferative glomerulonephritis, membranous glomerulonephritis, and minimal change disease, nephrotic syndrome attributable to renal amyloidosis is very rarely reported. We report a case of mixed type of localized Castleman's disease complicated with nephrotic syndrome. Renal biopsy was performed. The deposition of AA amyloidosis was shown. After the removal of two mesenteric lymphoid masses, the proteinuria was gradually decreased and disappeared. Renal biopsy was repeated after 14 months, and, despite complete remission of nephrotic syndrome, no regression in amyloid deposition was found.

Background: Carotid artery intima-media thickness (CIMT) has been used as a marker of atherosclerosis. An insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with various cardiovascular diseases. This study is aimed at evaluating early atherosclerotic involvement of carotid vessels and the relation to known risk factors and ACE gene I/D in hemodialysis (HD) patients., Methods: We measured CIMT using high-resolution B-mode ultrasonography in 51 non-diabetic HD patients and in 70 age- and sex-matched healthy controls, and evaluated the factors influencing CIMT. An I/D polymorphism in intron 16 of the gene coding for ACE was analysed by polymerase chain reaction., Results: The mean CIMT was significantly higher in HD patients than in healthy subjects (p<0.0001). In multiple regression analysis, independent risk factors for increased CIMT in HD patients were predialysis systolic blood pressure (p<0.001) and ACE D allele (p<0.01)., Conclusions: The present data suggest that CIMT is enlarged in HD patients. The ACE gene seems to be a candidate for influencing the CIMT and might therefore be involved in an HD patient's predisposition to the development of atherosclerosis.