Abstract
Background/Aims: In patients with autosomal dominant polycystic kidney disease (ADPKD), cardiovascular events are the most frequent cause of mortality and morbidity. The aim of our study is ...to investigate the association between serum fibroblast growth factor-23 (FGF-23) and arterial stiffness (AS) as determined with brachial-ankle pulse wave velocity (baPWV) and atherosclerosis development as determined with carotid artery intima-media thickness (CA- IMT). Methods: This cross-sectional study was conducted with totally 86 ADPKD patients, 50 (58.1%) female and 36 (41.9%) male, with a mean age of 49.5 ± 13.9 years. Patients were compared with healthy control group with similar distribution of age and gender. AS was assessed with baPWW, and atherosclerosis development was assessed with CA-IMT. CA-IMT > 9 mm was considered as increased atherosclerosis. Serum FGF-23 and soluble klotho (s-KL) levels were measured with enzyme-linked immunosorbent assay. Due to skewed distribution of variables, statistical calculations of FGF-23 and s-KL were performed with log10. Results: According to the CKD stages, 46 (53.5%) patients had stage 1-2, 32 (37.2%) had stage 3-4, and 8 (9.3%) had predialysis stage 5 disease. Mean log10FGF-23 was 2.43 ± 0.41 pg/mL, and mean log10s-KL was 1.28 ± 0.09 ng/mL. Mean baPWV was 7.48 ± 1.68 m/sec, and mean CA-IMT was 0.63 ± 0.14 mm. Among patients at various stages of CKD, systolic blood pressure (SBP) (p = 0.003), diastolic blood pressure (DBP) (p = 0.002), creatinine, 1.25hydroxy(OH)2VitaminD3, log10FGF-23, baPWV, CA-IMT were higher (p < 0.001)andlog10s-KL were lower (p < 0.001) in comparison to healthy individuals. FGF-23 was positively correlated with creatinine, 1.25(OH)2VitD3 (p < 0.001), baPWV (p = 0.002) and CA-IMT (p = 0.005), and negatively correlated with eGFR (p < 0.001). Conclusion: In patients with ADPKD, as the disease stage advanced, serum FGF-23 levels increased while s-KL decreased. In ADPKD patients, AS and atherosclerosis development increased as compared to healthy subjects, and as CKD advanced. In ADPKD patients, the effect of serum FGF-23 on the development of AS and atherosclerosis in peripheral vessels is independent of s-KL.
Background: The aim of this study was to determine the prevalence and factors associated with gallbladder stone in patients with predialysis chronic kidney disease. Methods: This cross-sectional ...study retrospectively examined follow-up data of patients with chronic kidney disease between January 2015 and December 2020 at the Health Sciences University Antalya Training and Research Hospital who had undergone abdominal ultrasonography for any reason. Patients with gallbladder stone on abdominal ultrasonography and history of cholecystectomy due to gallbladder stone were identified as the gallstone group. The prevalence of gallbladder stone was determined according to disease stage. Patients with and without gallbladder stone were compared in terms of demographic and clinical characteristics and laboratory parameters that may be associated with the development of gallbladder stone. Results: A total of 511 patients had chronic kidney disease (stages 3, 4, and 5 in 303 59.3%, 176 34.4%, and 32 6.3%, respectively). The gallstone prevalence rates were 25.1%, 30.1%, and 46.9% in stage 3, 4, and 5 chronic kidney disease, respectively, and that in all the patients was 28.2% (95% CI: 24.3-32.3, P = .026). Logistic regression analysis revealed that increased age (odds ratio: 1.045; 95% CI: 1.027-1.063, P < .001) and decreased estimated glomerular filtration rate (odds ratio: 0.974; 95% CI: 0.956-0.991, P = .004) were associated with gallbladder stone. Conclusion: The prevalence of gallbladder stone was high in the predialysis patients with chronic kidney disease and increased with increasing disease stage. High age and low estimated glomerular filtration rate were associated with gallbladder stone formation. Keywords: Chronic kidney disease, gallbladder stone, predialysis, associated factor
Introduction: Hyperuricemia has been associated with the development of hypertension, cardiovascular, and renal disease. Objectives: We conducted a prospective study to investigate the benefits of ...allopurinol treatment in hyperuricemic patients with chronic kidney disease (CKD) stage 3. Patients and Methods: Our study includes a total of 132 patients (41 females and 91 males) with CKD grade 3 who are followed up by the pre-dialysis polyclinic. Around 67 of these patients administered allopurinol while 65 patients were not administered. The therapy protocol for the patients was allopurinol 150 mg/d and the duration of the follow-up was 12 months. Clinical records of the patients were screened, to start with 3, 6, 9 and 12 months, eGFR (estimated glomerular filtration rate) values were calculated. Results: The patients’ eGFR with allopurinol treatment was increased compared with baseline values. 12th month increased by 1.02 ± 8.89 mL/min/1.73 m2 from baseline in eGFR, but it was not statistically significant (P = 0.352). In the control group 12th month showed a decrease in baseline GFR value of 2.59 ± 7.9 mL/min/1.73 m2 (P = 0.012). The 3, 6, 9, 12th months compared with baseline in the allopurinol treatment group showed a significant decrease in uric acid value (P < 0.05). Conclusion: Decreased renal progression was observed by reduction of serum uric acid levels at stage 3 hyperuricemic CKD with allopurinol. The annual decline in GFR in hyperuricemic patients, is more than normouricemic patients.
Functional bowel disorders (FBDs) impair the quality of life in patients with end-stage renal disease (ESRD). The aim of our study was to determine the prevalence and distribution of the subtypes of ...FBDs in hemodialysis (HD) patients.
This prospective, cross-sectional study included 80 patients who received HD for more than 3 months (patient group) and 80 healthy controls (control group). FBDs were diagnosed according to the Rome II diagnostic criteria by excluding organic pathologies.
Forty-six (57.5%) patients were males, and their average age was 62.13±12.92 (23-90) years. The mean duration of dialysis was 57.48±59.23 (3-312) months, and the mean Kt/V (K: dialyzer clearance of urea, t: dialysis time, V: volume of distrubition of urea) value was 1.53±0.31. The rate of FBDs was significantly higher in the patient group than in the control group (p=0.01). In total, 7.5% of the patients had irritable bowel syndrome, 3.8% had functional bloating, and 16.3% had functional constipation. FBDs were significantly higher in women (p=0.004). While there was no statistically significant difference between patients with and those without FBDs in terms of the presence of additional diseases, smoking, alcohol use, educational level, marital status, and resi- dential areas (p>0.05), serum phosphorus (P) levels were significantly higher in the patients with FBDs (p=0.03).
FBDs and their functional constipation subtype are more common in HD patients than in the healthy population in Turkey. FBDs are most frequently observed in females and housewives with high serum P levels.
Purpose
Autosomal dominant polycystic kidney disease (ADPKD) is a common congenital chronic kidney disease (CKD). We report here the relationship of serum angiopoietin-1 (Ang-1), Ang-2, and vascular ...endothelial growth factor (VEGF) with total kidney volume (TKV), total cyst volume (TCV), and renal failure in adult ADPKD patients at various stages of CKD.
Methods
This cross-sectional study was conducted with 50 patients diagnosed with ADPKD and a control group of 45 age-matched healthy volunteers. In patient group, TKV and TCV were determined with upper abdominal magnetic resonance imaging, whereas in controls, TKV was determined with ultrasonography according to ellipsoid formula. Renal function was assessed with serum creatinine, estimated glomerular filtration rate (eGFR), and spot urinary protein/creatinine ratio (UPCR). Ang-1, Ang-2, and VEGF were measured using enzyme-linked immunosorbent assay.
Results
Patients with ADPKD had significantly higher TKV (
p
< 0.001) and UPCR (
p
< 0.001), and lower eGFR (
p
≤ 0.001) compared to the controls. Log
10
Ang-2 was found to be higher in ADPKD patients at all CKD stages. Multiple linear regression analysis showed that there was no association between log
10
Ang-1, log
10
Ang-2, or log
10
VEGF and creatinine, eGFR, UPCR, log
10
TKV (
p
> 0.05).
Conclusion
There was no association of serum angiogenic growth factors with TKV or renal failure in ADPKD patients. Increased serum Ang-2 observed in stages 1–2 CKD suggests that angiogenesis plays a role in the progression of early stage ADPKD, but not at later stages of the disease. This may be explained by possible cessation of angiogenesis in advanced stages of CKD due to the increased number of sclerotic glomeruli.
Nephrologists may encounter many systemic problems in their patients, including involvement of the neurological system and the development of seizures. Seizures are defined as abnormal neurological ...functions that cause overstimulation of neurons in the cerebral cortex or limbic system. Seizures may be focal or generalized depending on their origin and may have tonic, clonic, tonic-clonic or myoclonic character depending on the level of involvement of the motor movements. Patients with kidney disease may develop seizures due to etiologies seen in the general population (such as intracranial bleeding, cerebrovascular events, tumors, infections and intoxications) or due to kidney-related etiologies (such as uremic encephalopathy, dialysis disequilibrium syndrome and hyponatremia). Management of seizures in kidney patients is challenging for proper determination of the type and dosage of antiepileptic drugs due to varying renal clearances. This review covers the major causes of new-onset seizures in patients with acute kidney injury, electrolyte imbalances, chronic kidney disease, dialysis, renal transplantation or hypertension, and the available management approaches.
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