• ÖZ

A 70-year-old woman is hospitalized after a fall that resulted in a right femoral neck fracture. Her medical history includes obesity, type 2 diabetes mellitus, hypertension, and chronic kidney disease (CKD). She has smoked a pack of cigarettes daily for 40 years. Results of the patient’s initial workup in the emergency department demonstrated the right femoral neck fracture, serum creatinine of 1.8 mg/dL, and a negative noncontrast head CT. She was admitted to the hospital and the following day underwent surgical repair. The procedure was uncomplicated. However, on postoperative day 4 the patient is developed sudden onset chest pain and shortness of breath. The acute coronary syndrome work-up is negative. Current medications include prophylactic subcutaneous heparin, insulin glargine, omeprazole, and paracetamol. Temperature is 37.8°C, blood pressure is 110/65 mm Hg, pulse is 116/min, and respirations are 30/min. Pulse oximetry is 88% on room air. Lung auscultation revealed decreased breath sounds at the bilateral bases. Cardiac rhythm is regular with normal S1 and S2. The surgical incision shows no surrounding erythema or purulent drainage. The patient follows commands and moves all extremities except the left leg. Laboratory results are as follows: Complete blood count: Leukocytes 12,000/mm3 , Hemoglobin 11 g/dL, Platelets 250,000/mm3 , Serum biochemical tests: Sodium 135 mEq/L, pH: 7.48, pCO2: 30,mmHg, pO2: 85 mmHg, Bicarbonate 24 mEq/L, serum creatinine: 1.8 mg/ dL, Glucose 170 mg/dL, Troponin T is undetectable. Chest x-ray shows slight bibasilar atelectasis without focal consolidation, pleural effusion, or pulmonary edema. ECG shows sinus tachycardia but is otherwise unremarkable.

• ÖZ

Objective: The aim of the present study was to determine the quality of sleep and depression scores of hemodialysis patients and to search their relationship. Materials and Methods: This cross-sectional study was performed on 150 patients at the Erciyes University Health Application and Research Center and a private dialysis center between July 2017 and November 2017. A questionnaire form including the demographic sociocultural properties of the patients and Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI) was used as data collection tools. Results: The patients’ mean PSQI point was 11.82±2.81, and the BDI mean point was 15.1±9.65. The BDI mean point was significantly higher in patients with chronic disease other than chronic renal failure than in patients without other chronic diseases (p<0.05). The PSQI and BDI mean points were both significantly high in patients reporting change in life due to the disease (p<0.05). The BDI mean points were significantly high in patients feeling extremely tired after dialysis (p<0.05). There was a weak positive correlation between the PSQI and the BDI points (p<0.01). Conclusion: The depression points of patients with chronic disease other than chronic renal insufficiency were higher. Quality of sleep was low in patients with high depression points.

• ÖZ

Smoking is the leading preventable cause of death worldwide. Smoking affects all systems of the organism. Smoking stimulates the sympathetic nervous system, increases blood pressure and albuminuria, and decreases renal function. Smoking increases renal functional loss in patients with chronic kidney disease. Moreover, smoking accelerates the course of atherosclerosis, causing cardiovascular complications and premature death. Smoking decreases graft survival in kidney transplant patients. As a result, all physicians and health care providers should acknowledge all patients who smoke about the deleterious effects of smoking and continuously motivate them to stop smoking.

• ÖZ

Goodpasture’s syndrome is a rare autoimmune disease in which anti-glomerular basement membrane antibodies damage the glomerular and alveolar basement membrane. Its relapse is very rare, compared to other pulmonary-renal syndromes. Herein, we present an unusual case of Goodpasture’s syndrome, which recurred despite immunosuppressive treatment. After the initial treatment with corticosteroid and cyclophosphamide pulses, plasmapheresis, alveolar hemorrhage ended, and the anti-glomerular basement membrane antibody finding became negative, but hemodialysis had to be continued. After 8 months of hemodialysis, anti-glomerular basement membrane antibodies were re-detected, and hemoptysis occurred a month later. Then, plasmapheresis, intravenous immunoglobulin, and methylprednisone were given in addition to azathioprine treatment; however, the serum anti-glomerular basement membrane antibody positivity persisted. Relapse of this syndrome is rare, and if observed, it generally strikes years following disappearance of anti-glomerular basement membrane antibodies; however, in our case, relapse was observed within a few months. It should be kept in mind that, in patients who achieve remission following immunosuppressive therapy, clinical and serological relapses are rare, and the anti-glomerular basement membrane antibody positivity may persist despite the application of immunosuppressive agents in subjects who relapsed.

• ÖZ

Gitelman syndrome (GS) is a genetically transmitted tubulopathy. It is caused by mutation in the thiazide-sensitive Na-Cl cotransporter–coding gene, SLC12A3. In this case study, we have discussed a patient diagnosed with GS and referred with muscular weakness and cramping complaints due to discontinuing potassium replacement in the follow-up. The patient was diagnosed with rhabdomyolysis and acute kidney injury secondary to hypokalemia upon determination of 2.14 mEq/L potassium, 27.610 U/L creatine kinase, and 3.09 mg/dL creatinine in further examination. Therefore, NaCl 100 cc/h isotonic was administered to the patient in addition to oral and intravenous potassium replacement. The dose of given acetazolamide was 2×250 due to the presence of severe metabolic alkalosis. Clinical and laboratory findings were fully restored to normal levels one week following the initiation of treatment.