Peritoneal dialysis (PD) has been a successful modality for chronic renal replacement therapy for more than 30 years. Icodextrin has been a major addition to the management of ultrafiltration in peritoneal dialysis (PD). Currently, it is widely used in PD because of several long-term complications of solutions containing high glucose. Although the efficacy and safety of Icodextrin is well known, it may cause allergic reactions and aseptic peritonitis. We report an interesting PD patient with findings that do not correspond to the complications previously reported due to Icodextrin.

Amac: Bu calismanin amaci kronik bobrek yetmezlikli (KBY) hastalarin mizac ve kisilik ozelliklerini ve yasam kalitesi arastirmaktir . Yontem: Calisma grubu Eskisehir Yunus Emre Devlet Hastanesi ve Eskisehir Devlet Hastanesinde 2012 - 2013 tarihleri arasinda hemodiyalize giren KBY tanili 50 hasta ve 50 saglikli kontrol grubundan olusturulmustur. Tum katilimcilardan mizac ve karakter envanteri (MKE) ve yasam kalitesi olceg i (SF- 36) ‘ni doldurmasi istendi. Bulgular: MKE’ nin alt olcekleri olan zarardan kacinma, kendini yonetme, isbirligi yapma toplam puanlari hasta ve saglikli kontroller arasinda anlamli olarak farkli bulundu (p=0.02, p<0.01, p<0.01, sirasiyla). SF - 36 olceginin tum alt olceklerinde de iki grup arasinda anlamli farkliliklar vardi. Sonuc: KBY’ li hastalarin daha az heyecan duyan, cabuk yorulan, sorumluluk almayan kisilik yapisinda oldugu bulunmustur.

Hiponatremi , serum sodyum duzeyinin 136 mmol/L nin altinda olmasi olarak tanimlanir. Hastanede yatan hastalarda en sik gorulen elektrolit bozuklugudur. Ilaclar hiponatremi nedenlerinden biridir. Sefaperazon-sulbaktam, klinik pratikte sik kullanilan bir antibiyotiktir. Cesitli yanetkileri bilinmekle beraber, hiponatremi cok nadir olarak gorulur. Klinigimizde takip ettigimiz, Sefaperazon-Sulbaktam kullanimina bagli gelisen hiponatremi olgusuyla, ilac iliskili hiponatremiye dikkat cekmeyi amacladik. Aciklanamayan hiponatremi gelisen hastalarda, nadir de olsa, antibiyotik iliskili hiponatremi akilda tutulmalidir.

Sirotik asit tedavisinde kullanilan parasentez, yuksek volumle yapildiginda dolasim disfonksiyonu ve buna sekonder bobrek fonksiyon bozukluklarina neden olabilir. Klinigimizde, masif asit ve hepatorenal sendrom nedeniyle takip ettigimiz hastamizda spontan perforasyon gelismesi takibinde, kreatinin degerlerinde dramatik bir dusme ve normal degerlerine gerileme gozlendi. Sonuc olarak; parasentez ile kreatinin degerlerinde yukselme olmadan da fazla miktarda asit mayisi direne edilebilecegi, hastalarin hemodinamik durumu da goz onune alinarak, tedavi planlanirken akilda bulundurulmalidir.

OBJECTIVE:Acute kidney injury (AKI) is a serious condition that can be induced by liver transplantation, major hepatic resection or prolonged portal vein occlusion. AKI can increase the frequency of postoperative complications. In the current study, we aimed to investigate whether interleukin-18 binding protein (IL-18BP) pretreatment has a protective effect against possible kidney injury following liver ischemia-reperfusion (IR) achieved by Pringle maneuver in an experimental rat model.MATERIALS AND METHODS:A total of 24 male Wistar albino rats were included in this study. Animals were equally and randomly separated into 3 groups as follows: I, Sham group, II, IR group (1-hour ischemia and 4-hour reperfusion) and III, IR + IL-18BP group (50μg/kg IL-18BP was intraperitoneally administered 30 minutes before surgery). Blood, liver and kidney samples were collected for histopathological and biochemical (hepatic and renal function, nitric oxide, malondialdehyde and glutathione levels) analysis. In addition, proinflammatory cytokines including tumor necrosis factor α, IL-1β and IL-6 levels were measured in kidney tissues.RESULTS:IL-18BP has improved kidney functions in acute kidney damage, restored structural changes, exhibited anti-inflammatory effects by decreasing proinflammatory cytokines and regulated the oxidative stress parameters by antioxidant effect.CONCLUSIONS:Current study would be the first to evaluate the protective, antioxidant and anti-inflammatory effects of IL-18BP on renal damage induced by liver ischemia (1 hour) and reperfusion (4 hours). As a result, we have demonstrated that AKI may develop after hepatic IR with Pringle maneuver and IL-18BP pretreatment can attenuate this damage. By this way, complications related to liver IR could be minimized and also postoperative hospitalization durations, treatment costs and healing periods could be decreased.

Paracentesis which is used for cirrhotic acid treatment may cause renal dysfunction secondary to circulatory dysfunction when performed with high volume. In our clinic, spontaneous ascites perforation has developed in a patient hospitalized due to massive ascites and hepatorenal syndrome. In the follow-up period, dramatical decline was observed in creatinine values. In conclusion; it should be kept in mind that, a large amount of ascites drainage may be performed without increase in creatinine values during paracentesis taking into account the hemodynamic status of the patient.

Cystatin C is a small molecular weight protein with a constant production rate and plasma levels that remain unchanged with age or gender. Cystatin C is filtered freely from the glomeruli and is not secreted; it is reabsorbable from the tubular epithelial cells and metabolized from the kidney rapidly. It is seen as a new marker for calculating the glomerular filtration rate. The number of studies in which cystatin C was used in recent years and the percentage that has been published by nephrology professionals is an important matter to consider. Our aim was to investigate the number of scientific studies using cystatin C from Turkey and the world, and the issues and publication details of the journals they appeared in by year, and to evaluate the use of cystatin C by nephrology experts in our country.

BACKGROUND:The aims of this study were to investigate the utility of neutrophil-to-lymphocyte ratio (NLR) as a simple and readily available predictor for clinical disease activity in inflammatory bowel disease (IBD).METHODS:Sixty-six patients (22 CD, 44 UC) and 41 healthy controls were enrolled in the study. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels and complete blood count (CBC) were measured. The neutrophil and lymphocyte counts were recorded and NLR was calculated. The patients with active or inactive UC and CD were classified according to the severity of the disease.RESULT:The serum NLR values of active CD patients were significantly higher than those of inactive ones and controls (p = 0.000, p = 0.000, respectively). NLR values of active UC patients were significantly higher than those of inactive ones and controls (p = 0.000, p = 0.000, respectively. The optimum NLR cut-off point for active CD and UC was 3.2 and 3.1.CONCLUSION:This study demonstrates that NLR in subjects with IBD is strongly associated with active disease and correlated with clinical and laboratory indices (Tab. 5, Fig. 2, Ref. 31).

This study aims to investigate whether preoperative L-carnitine supplementation affects the neutrophil-to-lymphocyte ratio (NLR) in patients undergoing coronary artery bypass grafting surgery. The neutrophil-to-lymphocyte ratio is an inflammatory marker that has proven usefulness for predicting postoperative complications in coronary artery bypass surgery. A lot of studies concerning the role of L-carnitine in the immune system have been performed, contradictory results have been reported on its effects on absolute numbers of WBC subtypes. This randomized, double-blinded, placebo-controlled study was conducted among patients scheduled for coronary artery bypass grafting surgery between June 2012 and December 2013 in our cardiovascular surgery clinic. A total of 60 consecutive patients were randomized and divided into 2 groups. The first group received 2 g of L-carnitine in 1000 mL of 0.9% saline solution infused over 24 hours for each of the 3 preoperative days (L-carnitine group, n = 30), or only 1000 mL of 0.9% saline solution for the same time period (placebo group, n = 30). The basal values of leukocyte, neutrophil, lymphocyte counts, and neutrophil to lymphocyte ratio were similar in the 2 groups. After L-carnitine supplementation (just before surgery), leukocyte and neutrophil counts of the L-carnitine group were significantly lower than those of the placebo group (7.7 ± 1.5 versus 9.7 ± 2.6, P < 0.001 and 4.6 ± 1.3 versus 6.5 ± 2.2, P < 0.001). On postoperative day 1, lymphocyte counts were significantly higher in the L-carnitine group (1.1 ± 0.6 versus 0.8 ± 0.9, P < 0.001). Moreover, the increase in NLR was significantly lower in the L-carnitine group at postoperative day 1 (20.7 ± 13.8 versus 10.8 ± 4.1, P < 0.001). Preoperative L-carnitine supplementation may reduce neutrophil-lymphocyte ratio during the early postoperative period of coronary artery bypass grafting surgery.

MPV (mean platelet volume) is one of the determinants of the platelet function which is situated in the routine complete blood count tests and was shown to be inversely correlated with inflammation. We aimed to evaluate MPV values in patients with peritoneal dialysis and in acute peritonitis attacks. 37 patients with PD and 42 healthy subjects were included in the study. 42 peritonitis attacks of the patients were recorded. C reactive protein (CRP) levels and complete blood count tests were analyzed. Mean MPV values were significantly higher in patients with PD in the stable period compared with the control group (p <0.001). Mean MPV values were significantly lower and CRP values were significantly higher in peritonitis attack periods, compared with the stable period of the same PD patients, both (p <0.001). In the correlation analysis, MPV levels in the peritonitis attack were negatively correlated with CRP levels, hospitalization day, peritoneal fluid and plasma leukocyte count (r= -0.751, p<0.001); (r= -0.355, p=0.002, ; ( r= -0.851, p<0.001) ; (r= - 0.579, p<0.001) respectively. In conclusion, our results suggest that assessment of MPV in acute peritonitis in PD patients may indicate systemic inflammation. MPV may be used as an hepler marker to predict the severity of acute peritonitis.

Amac: Akut bobrek yetmezligi, bobrek fonksiyonlarinda hizli bir azalmayla karakterize ve yuksek mortalite oranina sahip onemli bir klinik sendromdur. Akut bobrek yetmezliginde mortalite, son yillardaki yogun bakim ve renal replasman tedavilerindeki gelismeye ragmen yuksek kalmaya devam etmektedir. Bu calismada klinigimizde ABY tanisiyla yatan hastalari degerlendirdik.Gerec ve Yontem: Ocak 2011 ve Aralik 2012 arasinda hastanemize Akut bobrek yetmezligi tanisiyla basvuran 145 hastayi retrospektif olarak inceledik. Hastalarin kayitlarindan yasi, Akut bobrek yetmezligi tipi, basvuru sekli, basvurudaki temel bulgulari, etyolojisi, zeminde eslik eden hastaliklar, uygulanan tedavi ve laboratuvar degerleri kaydedildi.Bulgular: Olgularin etiyolojisi incelendiginde en sik nedenler prerenal azotemi (%38,6) ve nefrotoksik ajan kullanimiydi (%30,3). Hastalarin %72,6’si nonoligurik %27,4’u oligurik idi. Olgularin %65,5’ine medikal tedavi uygulanirken %34,5’ine medikal tedaviye ek olarak hemodiyaliz tedavisi uygulandi. Hastalarin %86,9’u tedavi sonucu iyilesirken, %13,1’i kaybedildi. Olen hastalarin %63,2’si medikal tedaviye ek olarak hemodiyaliz tedavisi alirken %36,8’i sadece medikal tedavi almisti. Oligurik hastalarin %67,5’i medikal tedavi ve hemodiyaliz, %32,5’i sadece medikal tedavi alirken nonoligurik hastalarin %21,9’u medikal tedavi ve hemodiyaliz, %78,1’i sadece medikal tedavi aldi.Sonuc: Akut bobrek yetmezligi etiyolojisinde 40 yil oncesine gore medikal nedenler on plana cikmaktadir. Ayrica oligoa

Amac: Insulin direnci, hiperhomosisteinemi ve obezite kardiyovaskuler hastaliklar icin onemli bir risk faktorudur. Buna ragmen insulin direnci, homosistein duzeyi ve obezite arasindaki iliski ile ilgili tartismalar devam etmektedir. Biz calismamamizda bu parametreler ve sendromun iliskisini incelemeyi amacladik. Gerec ve yontem: Hastanemize basvurmus ve tetkikleri yapilmis olan 80 hastanin insulin direnci, homosistein duzeyi, bel kalca orani (BKO), beden kitle indeksi (BKI), yag yuzdesi, rutin biyokimyasal parametreleri kaydedildi. Bulgular: Insulin direnci olan hastalarin homosistein duzeyleri, BKI ve yag yuzdeleri insulin direnci olmayanlara gore yuksekti. BKO, aclik kan sekeri, tokluk kan sekeri ve lipid degerleri acisindan ise fark yoktu. Sonuc: Insulin direnci olanlarda kardiyovaskuler risk artmis oldugundan, bir baska risk faktoru olarak hiperhomosisteineminin de bulunmasi bu hastalarin daha yakindan izlenmesi gerektirdigini dusundurmektedir

Patients on continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis have accelerated atherosclerosis associated with an increase in cardiovascular morbidity and mortality. Atherosclerosis is associated with increased arterial stiffness (AS), endothelial dysfunction and elevated oxidative stress (OS) and inflammation. We aimed to investigate the relationship between oxidative stress status, arterial stiffness, hepcidin and fibroblast growth factor-21 (FGF-21) levels in CAPD patients.

We investigated whether there was a significant increase in thyroid autoimmunity, and disorders in patients with rheumatic diseases (RDs). We enrolled 201 patients with RDs (41 with ankylosing spondylitis, 15 with systemic lupus erythematosus, 80 with rheumatoid arthritis [RA], 65 with familial Mediterranean fever), and 122 healthy controls. Serum levels of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), C-reactive protein, and thyroid autoantibodies (anti-thyroglobulin and anti-thyroid peroxidase) were measured in all participants. There were no significant differences between the ages of the patients and controls. The mean TSH values of the patients with RDs and the controls were 3.1 ± 2.68 mIU/L and 1.9 ± 0.83 mIU/L, respectively (P = 0.004). The mean fT4 value of the patients with RDs was 1.43 ± 0.67 ng/dL whereas that of the controls was 1.58 ± 0.68 ng/dL (P <0.001). Subclinical hypothyroidism was detected in 24 patients with RDs. Thyroid antibodies were detected in 16 of 201 (8%) patients with RDs. Three of these patients had subclinical hypothyroidism, while the others were euthyroid. Thyroid autoantibodies were significantly higher in patients with RDs (P <0.001). Additionally, thyroid disorders were observed more frequently in patients with RDs than in the healthy controls. Based on our findings, we recommend that thyroid function tests should better be included in the clinical evaluation of patients with RDs.