International Journal of Urology and Nephrology

International Journal of Urology and Nephrology ISSN: 2091-1252 Vol. 3 (1), pp. 069-073, January, 2015. © International Scholars Journals

Full Length Research Paper

Comparison of Anemia and Bone Metabolism in Hemodialysis and Peritoneal Dialysis Patients

Hatice AKAY,MD¹, Nilgül Akalin,MD², Özlem HARMANKAYA, MD², Doç. , Mehmet KÖROĞLU, MD¹, Baki KUMBASAR, MD³, Doç.

¹Bakirkoy Dr.Sadi Konuk Training and Research Hospital, İnternal Medicine, Turkey.

²Bakirkoy Dr.Sadi Konuk Training and Research Hospital, Nephrology Unıt, Turkey.

³Istanbul University Medical School İnstitutes of Health Sciences, İnternal Medicine, Turkey.

E-mail:hakay24- [email protected]

Accepted 30 September, 2014

Abstract 

In this study, we compared anemia and bone metabolism in patients undergone hemodialysis and peritoneal dialysis replacement therapy. We  aimed to demonstrate superiority of the replacement therapies in terms of anemia and bone metabolism. The levels of  serum iron, iron binding capacity, ferritin, hemogram, calcium, phosphorus and parathormone were measured in the patients. In all patients were recorded ıron, erythropoiesis stimulation therapy, phosphorus lowering medications containing calcium and active vitamin D therapy and  the mean therapy doses were calculated. No differences were found in the distribution of mean age  and gender and mean duration of dialysis between the groups. Mean hemoglobine  and mean hematocrit  values of the dialysis groups were found to be similar. Hemodialysis patient group was observed to receive erythropoiesis stimulation therapy in higher doses than the peritoneal dialysis patient group. There was not significant difference between both the groups in terms of  phosphorus binding therapy  and active vitamin D therapy. No significant difference was observed between the dialysis groups in terms of anemia and bone metabolism.

Key words: Anemia, bone metabolism, hemodialysis, peritoneal dialysis, superiority of dialysis treatments.

International Journal of Urology and Nephrology ISSN: 2091-1252 Vol. 2 (4), pp. 063-068, December, 2014. © International Scholars Journals

Full Length Research Paper

Repeated education improves diet compliance in maintenance Hemodialysis Patients

HyangJin Ryu¹, Hyun Ju Jeon¹, Hui-Kyoung Sun², Kum Hyun Han², Chun Gyung Whang³, and Sang Youb Han²

¹Artificial Kidney Unit, Inje University, Ilsan-Paik Hospital, GoYang, Korea.

²Division of Nephrology,Department of Medicine, Inje University, Ilsan-Paik Hospital, GoYang, Korea.

³Division of Nutrition, Inje University, Ilsan-Paik Hospital, GoYang, Korea.

*Corresponding author. E-mail: [email protected]

Accepted 25 November, 2014

Abstract

Dietary education is important for improving the status of hemodialysis (HD) patients; however, general dietary instructions are not sufficient to reach dietary goals. To determine the effectiveness of repeated education in maintenance HD patients, we prospectively compared pre- and post-education data on the level of diet-related knowledge, role behavior, and laboratory results. Thirty HD patients were matched with a specific nurse and offered repeated individualized dietary information on sodium, potassium, phosphorus, protein, and water consumption every week for 3 months. Educational compliance was evaluated by questionnaires. The diet knowledge score increased from 4.26±0.84 to 4.72±1.43 out of 10 (p<0.001). The actual practice score, which showed the patients’ knowledge application, also improved from 17.1±4.18 to 19.1±3.49 out of 25 (p<0.001). The number of sessions with greater than 5% interdialytic weight gain (IDWG) fell significantly from 22.5±0.17% to 7.46±0.09% after intensive education (P<0.001). The rate of hyperkalemia (>5.5 mEq/L) significantly decreased from 26.7±0.31% to 13.9±0.20% on a similar dosage of potassium-lowering medicine (p=0.035). There were no significant changes in the rates of hyperphosphatemia (>5.5 mg/dL) and Ca*P product (>55 mg2/dL2) although requirement for phosphate binders decreased. Repeated education is effective in terms of improving hemodialysis patients’ dietary compliance and their physiological results.

Key words: Renal dialysis, education, nutrition, weight gain, hyperkalemia.

International Journal of Urology and Nephrology Vol. 2 (4), pp. 059-062, December, 2014.  © International Scholars Journals

Case Report

Lornoxicam-induced  acute  interstitial  nephritis

Sibel Koçak Yucel MD¹, Özlem Harmankaya  Kaptanoğulları  M.D¹, Mürvet Yılmaz M.D¹,  Nilgün Akalın M.D¹andAyşegül Kudu M.D .¹

¹Division of Nephrology, Department of Medicine, Bakırköy Dr. Sadi Konuk Teaching Hospital,Istanbul, Turkey.

Accepted 13 August, 2014.

E-mail: [email protected]

Abstract

Drug-induced acute interstitial nephritis (DI-AIN) is an important cause of reversible acute kidney injury.While antimicrobials and non-steroidal anti-inflammatory drugs are typically associated with drug-induced AIN,few reports have been made on the involvement of other analgesics.Side effects of nonsteroidal anti-inflammatory drugs (NSAIDs) most commonly affect the gastrointestinal tract and the kidney.This case report describes the first case of biopsy proven interstitial nephritis associated with acute renal failure  in a patient treated withlornoxicamthe non‐selective inhibitior of cyclo‐oxygenase‐1 and ‐2. She presented with clinical findings of acute renal failure that required dialysis.The renal biopsy showed acute interstitial nephritis with a prominent eosinophilic infiltrate in the interstitium.She recovered normal renal function three weeks after cessation of lornoxicam and use of a corticosteroid (1 mg/kg/day).A course of oral prednisolone (1 mg/kg/day) was commenced andrapidly tapered to zero within three weeks.The renal function improved, and the patient was discharged with a creatinine of 0,75mg/dl (67 μmol/L).In general, the prognosis for drug-induced AIN is good and at least partial recovery of kidney function is normally observed. Early recognition is crucial because patients can ultimately develop chronic kidney disease.

Keywords:Acute  interstitial  nephritis, lornoxicam, corticosteroids, hemodialysis, acute renal failure.

International Journal of Urology and Nephrology Vol. 2 (3), pp. 055-058, November, 2014. © International Scholars Journals

Case Report

A rare cause of renal infarct: Paradoxical embolism through the patent foramen ovale

İskender Ekinci¹, Shute Ailia Dae¹, Emin Asoğlu², Musa Atay³, Gauhar Rakhymzhan⁴, Rumeyza Kazancıoğlu⁴ and Reha Erkoç⁴

¹Bezmialem Vakif University, Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey.

²Bezmialem Vakif University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.

³Bezmialem Vakif University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey.

⁴Bezmialem Vakif University, Faculty of Medicine, Department of Nephrology, Istanbul, Turkey.

*Corresponding author. E-mail: [email protected]. Tel: 0539 556 25 72

Accepted 1 August, 2014

Abstract 

Renal infarction is a rare clinical problem and the diagnosis is frequently missed or delayed because of its nonspecific symptoms. The two major causes of renal infarction are thromboembolism and in-situ thrombosis. Paradoxical embolism is defined as a systemic arterial embolism requiring the passage of a venous thrombus into the arterial circulatory system through a right-to-left shunt. Renal infarction secondary to paradoxical embolism has rarely been described. Here we present a case of renal infarction due to paradoxical embolism through the patent foramen ovale. A 26-year-old woman presented to the emergency room with a four-day history of left flank pain. The level of lactate dehydrogenase was detected five times higher than the upper limit of normal with no rise in serum aminotransferases. A contrast-enhanced computed tomography scan revealed renal infarction and perinephric mild fluid in the left kidney.  An electrocardiogram showed sinus rhythm and the thrombosis panel was negative. A transesophageal echocardiography showed a patent foramen ovale with a right-to-left shunt. Although we have not found the source of embolism, paradoxical embolism through to PFO was strongly suspected. The patient was treated by anticoagulant therapy at a curative dose and the outcome was favorable.

Key words: Renal infarction, paradoxical embolism, patent foramen ovale, flank pain, transesophageal echocardiography.

International Journal of Urology and Nephrology Vol. 2 (2), pp. 052-054, August, 2014. © International Scholars Journals

Case report

Acute phosphate nephropathy due to use of phosphorous enema: Case report

Jamshid Hamdard¹, Rumeyza Kazancıoğlu¹, Işın Kılıçaslan², Yasemin Özlük², Murat Alay¹, Ruhper Çekin¹ and Reha Erkoç¹

¹Bezmialem Vakif University Faculty of Medicine, Department of Nephrology, Istanbul, Turkey.

²Istanbul University Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey.

*Corresponding author. E-mail: [email protected]

Accepted 11 June, 2014

Abstract

Acute phosphate nephropathy is a rare but serious type of kidney injury that commonly occurs after the use of bowel purgatives that contain oral sodium phosphate. Bowel purgatives are widely used to prepare patients for colonoscopy, but their use can cause acute or chronic kidney disease. Acute phosphate nephropathy is a type of crystal nephropathy characterized by tubular and interstitial deposition of calcium phosphate. Here we presented a case of acute kidney injury following the use of a sodium phosphate-containing enema who required a renal biopsy for diagnosis.

Key words: acute phosphate nephropathy, acute kidney injury, oral sodium phosphate, crystal nephropathy, colon cleansing. 

International Journal of Urology and Nephrology Vol. 2 (2), pp. 048-051, August, 2014. © International Scholars Journals

Full Length Research Paper

Laparoscopic nephrectomy for atrophic kidney due to serious infection: A review of 15 cases

Hitoshi Yanaihara¹, Fuminari Hanashima¹, Koichiro Ogihara¹, Hirofumi Kaguyama¹, Hirofumi Sakamoto¹, Kayo Aonuma¹, Kaori Matsuda², Yoko Nakahira¹ and Hirotaka Asakura¹

¹Department of Urology, Saitama Medical University, Saitama, Japan.

²Department of Urology, Kanetsu Hospital, Saitama, Japan.

*Corresponding author. E-mail: [email protected]

Tel: +81-49-276-1243; Fax: +81-49-295-8004

Accepted 5, March 2014

Abstract

Review cases in which laparoscopic nephrectomy was performed for atrophic kidney due to serious infection with an emphasis on procedural details and complications. Data from 15 patients who underwent laparoscopic nephrectomy for atrophic kidney due to serious infection between November 2007 and March 2013 were reviewed. All procedures were performed by a single surgeon at our institution. Atransperitoneal approach was used in 14 patients and drainage tubes were placed in the renal fossa following nephrectomy in 10 patients. The tubes were removed on the first postoperative day in 9 patients. Postoperative antibiotic therapy was required in 1 patient, but all procedures were completed without requiring a blood transfusion. No conversions to an open surgical procedure were required, and there were no serious complications in any of the patients. The pneumoperitoneum time and blood loss of the patients were 126.5±58.8 min (range, 61–261 min) and 37.7±81.2 mL (range, 0–300 mL), respectively. Contrary to reports from previous studies, threat of blood transfusion and conversion to open surgery in patients undergoing laparoscopic nephrectomy for atrophic kidney due to serious infection was low in our study. With technological advances, the benefits of laparoscopic management increasingly outweigh the difficulties of this procedure. Laparoscopic nephrectomy for infectious conditions is an acceptable alternative to open nephrectomy when selected with appropriate preparation and forethought.

Key words: Laparoscope, nephrectomy, atrophic kidney, infection, complication.