• ÖZ

Objective: We investigated the effect of active D vitamin therapy on echocardiographic examination results in hemodialysis patients with hyperparathyroidism. Materials and Methods: This prospective study involved 20 patients who undergoing HD for a total of 12 hours per week at least 6 months. Patients with serum intact parathormone level (iPTH) ≥20.8 pmol/L, phosphorus level 3.5 - 5.5 mg/dL, calcium level <9.5 mg/dL included in this study. Before and after 6 months active vitamin D treatment, left ventricular mass index (LVMI) of all patients were investigated by echocardiography. Results: The mean age was 51.2±15.0 Ten patients were female and ten patients were male. The mean iPTH level in serum before and six months after active vitamin-D treatment were 35.97±16.41 and 24.92±13.28 pmol/L respectively (p<0.001). Before and six months after active vitamin- D treatment the mean LVMI were 294.40±103.2 gr/m2 and 250.40±101.44 gr/ m2 respectively. LVMI was statistically significant decreased after six months treatment compared to before treatment (p<0.001). Conclusion: Increased serum iPTH levels in patients undergoing HD decrease with active vitamin-D treatment and this results in significant reduction in LVMI. Our results show that treatment of hyperparathyroidism plays an important role in correcting LVH.

• ÖZ

Objective: Differential diagnosis of iron deficiency anemia (IDA) and anemia of chronic disease (ACD) is performed based on some biochemical indicators of iron metabolism. Although these traditional indicators are useful to determine iron status, they may not provide conclusive criteria for determining iron deficiency because of their high variability and low sensitivity. The aim of the present study was to evaluate the clinical significance of neutrophil gelatinase-associated lipocalin (NGAL) in the differential diagnosis of IDA and ACD and to compare it with other conventional anemia parameters. Materials and Methods: A total of 35 patients with IDA with serum hemoglobin<12 g/dL, transferrin saturation (TSAT)<20%, and serum ferritin<20 ng/mL and 31 patients with ACD with serum hemoglobin<12 g/dL, TSAT >20%, and serum ferritin >50 ng/mL were enrolled in the study. Results: The median serum NGAL values were 0.44 (0.32-0.66) ng/mL in the IDA group and 2.16 (1.39-3.22) ng/mL in the ACD group, and a statistically significant difference was observed between the two groups with respect to NGAL (p<0.001). NGAL showed a significant positive correlation with hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, serum iron, TSAT, and ferritin (p<0.001) and a significant negative correlation with transferrin and total iron-binding capacity (p<0.001). The NGAL cut-off value was obtained as 1.02 ng/mL (97.1% sensitivity and 83.9% specificity) for the differentiation of IDA from ACD by receiver operating characteristic analysis. Conclusion: Our data suggest that NGAL can be a useful parameter in the differential diagnosis of IDA and ACD. An NGAL cut-off value of 1.02 ng/mL predicts differential diagnosis.

• ÖZ

Objective: Familial Mediterranean fever (FMF) is a hereditary disease. It usually affects countries in the Mediterranean region and is common in Turks. This retrospective study was conducted to evaluate phenotype-genotype characteristics of children with FMF in Malatya district and surrounding areas in eastern Turkey. Materials and methods: A total of 427 patients who had been diagnosed with clinical FMF between 2006 and 2015 were included in the study. Results: Of the patients, 207 (48.5%) were female, and 220 (51.5%) were male. The mean age of diagnosis was 7.7±3.7 years, and the age of onset of complaints was 5.7±3.5 years. The delay of diagnosis was 1.9±1.8 years. The most common complaint was abdominal pain (95.1%). The most commonly detected mutant allele was M694V (26.9%) mutation. We detected heterozygous mutations in 203 (52%) patients, homozygous mutations in 71 (18%) patients, compound heterozygous mutations in 81 (22%) patients, and no mutation in 8% of the patients. The most common homozygous mutation was M694V (57.7%), the most common heterozygous mutation was E148Q (38.4%), and the most common compound heterozygous mutation was M694V/M680I (17.1%). Conclusion: In our study, we found that the frequency of mutations was similar to that of the whole population of Turkey, and the severity of the disease was lower.

• ÖZ

Anemia is one of the common chronic renal failure (CRF) complications. Reduced renal erythropoietin (EPO) production and a shortened life span of erythrocytes due to uremic environment and iron deficiency are the main causes of anemia in patients with CRF. Correcting of iron deficiency constitutes the basis for the treatment of anemia in patients with CRF. Iron replacement can be done orally or intravenously. The seriousness of anemia and iron deficiency, tolerance of tablet use, response to previous treatments, and the presence of a ready vascular access determine the manner in which iron treatment is done. New generation parenteral iron preparations have complex carbohydrate structures that strongly bind to iron and reduce plasma free iron release. New generation iron molecules correct iron deficiency without causing an inflammatory process. The point that should be kept in mind is that new formulations may have a side effect profile that has not yet been experienced, in addition to various advantages. When using new iron molecules, precaution measures should be taken with regard to the development of arrhythmia, unstable angina, and hypophosphatemia.

• ÖZ

Objective: An urgent hemodialysis (uHD) procedure is performed in acute kidney injury (AKI) with life-threatening complications. In this study, we aimed to investigate the clinical and laboratory findings that were associated with mortality in a regular HD unit. Materials and Methods: In total, 811 patients who underwent uHD were included in the study. The indications for uHD, demographic data, comorbidities, and pre- and post uHD laboratory results were obtained from patients’ registry files. Clinical outcomes regarding the renal status after uHD, patient survival, and causes of mortality were evaluated. Results: The most common uHD indication was hypervolemia; 276 patients died in the follow-up period, and the most common cause of death was progression of underlying disorders. The most frequent renal outcome was dialysis dependency. Oliguria and hypotension during uHD were associated with an increased likelihood of mortality based on an age-adjusted analysis. According to a multivariate analysis, malignancy, presence of crackle, and prerenal AKI were independently associated with increased mortality. Conclusion: Due to high mortality in AKI, a prompt diagnosis and appropriate management of the patients are of paramount importance. Anticipation of the clinical risk factors associated with increased mortality may help in better stratification of patients at high risk.