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Amlodipine/valsartan therapy plus hydration did not reduce the risk of CIN in chronic kidney disease (CKD) Stage 2 patients who underwent elective CAG using a low-osmolar nonionic contrast medium. This is because there was a decrease in the glomerular filtration rate (GFR) using the Levey Modification of Diet in Renal Disease (MDRD) formula in the amlodipine/valsartan group and CIN occurred at a higher frequency in this group; ARBs and CCBs may be withheld before CAG in high-risk patients.

Aim: We aimed to investigate the prevalence, type, and possible risk factors of renal tubular acidosis (RTA) in Turkish patients with renal transplantation. Patients and method: The study included 66 adult renal transplantation recipients. We recorded the parameters of venous blood gas analysis including serum pH value, serum bicarbonate (HCO 3 ) concentration, presence of metabolic acidosis, which was defined as low HCO 3 (<22 mEq/L), and serum pH value (<7.35) together, and base excess and urine pH at the last follow-up. Creatinine clearance was determined from 24-hour collected urine samples. RTA was defined to be metabolic acidosis with normal serum anion gap and positive urine anion gap. Results: Mean age of 66 patients was 37.0 ± 10.4 years; 48 of 66 patients were male. RTA was found in 14 (21.2%) patients. Considering for differential diagnosis of RTA, 4 patients had type 2 RTA and 10 had type 1 RTA. On the contrary, type 4 RTA was observed in no patients. Creatinine clearance was meaningfully lower in acidosis group than in those of the nonacidosis group (55.16 ± 23.27 vs. 71.06 ± 28.14 mL/min; p = 0.028). HCO 3 was correlated with hemoglobin level (r = 0.423, p = 0.001) and creatinine clearance (r = 0.262, p = 0.034). It was inversely correlated with cyclosporine A (CsA) level (r = −0.499, p = 0.035). Conclusion: RTA is a common complication after kidney transplantation. It is related with low creatinine clearance, low hemoglobin level, and high CsA level. Particularly, the value of creatinine clearance is lower and the possibility of RTA is higher.

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Peritonitis is the most frequent complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Bacterial peritonitis accounts for most CAPD-related peritonitis episodes, and the most common etiological agents are Gram-positive bacteria. 1 Brucellosis is a zoonosis transmitted to humans from infected animals. 2 Peritonitis caused by Brucella species is extremely rare, and CAPD-related peritonitis caused by Brucella species has been reported in only three patients. [3][4][5] We report two cases with CAPD-related peritonitis due to Brucella species. Both patients were effectively treated with antibiotics, consisting of rifampicin and doxycycline, without removal of the CAPD catheter. Case 1A 38-year-old male patient with end-stage renal disease of unknown cause underwent CAPD for 2 months and presented with abdominal pain, nausea, vomiting, and cloudy dialysate for 2 days. He had no history of peritonitis. On admission, physical examination revealed a body temperature of 37.3˚C, blood pressure 135/85 mmHg, heart rate 88 beats/min, and diffuse abdominal mild tenderness. His other systems and the tunnel and exit site of the CAPD catheter were found to be normal. He was a farmer and had a history of unpasteurized cheese consumption.Laboratory tests showed a white blood cell count (WBC) of 4,080/mm 3 , hemoglobin 11.5 g/dL, and platelet count 165,000/mm 3 . The erythrocyte sedimentation rate (ESR) was 30 mm/h. Blood urea nitrogen (BUN) was 70 mg/dL, creatinine 7.4 mg/dL, albumin 2.4 g/dL, sodium 138 mmol/L, potassium 3.8 mmol/L, calcium 8.0 mg/dL, phosphorus 4.4 mg/dL, aspartate aminotransferase (AST) 20 IU/ L, and alanine aminotransferase (ALT) 22 IU/L. The WBC in peritoneal fl uid was 1,600/mm 3 with a neutrophil predominance. Gram stain of peritoneal fl uid did not reveal any microorganisms. The patient was diagnosed with CAPD-related peritonitis.After microbiological evaluation, he was started on empirical antibiotic treatment consisting of vancomycin and amikacin intraperitoneally. His clinical status did not improve, and his peritoneal fl uid WBC continued above 100/mm 3 with a lymphocyte predominance. On the fi fth day, Brucella melitensis organisms had increased in his peritoneal fl uid sample. He was started on combined therapy consisting of oral rifampicin 600 mg once a day and doxycycline 100 mg twice daily. A dialysate Brucella agglutination test was negative. However, Brucella serum agglutination titer was positive, at 1:640, and Brucella melitensis organisms also grew in blood culture. After a week of the combined therapy, the peritoneal fl uid WBC had decreased to 100/mm 3 . The combined treatment was continued for 6 weeks without removal of the Tenkhoff catheter. After 4 weeks, the peritoneal effl uent WBC was 100/mm 3 . The Brucella serum agglutination titer had decreased to 1:160, and no microorganisms grew in either dialysate or blood cultures. The patient has since undergone peritoneal dialysis without any problems. Case 2A 52-year-old male patient was admitted with complaint...

Aim: The aim of this study is to investigate whether there is a relationship between inflammation and volume status in patients underwent peritoneal dialysis (PD). Patients and method: This cross-sectional study included 159 PD patients. The median duration of PD was 17 (range, 1-151) months. All patients were examined using bioelectrical impedance analysis to estimate the ratio of extracellular water to total body water (ECW/TBW), which was used to assess their volume status. The patients were categorized as having one of the following three volume statuses: hypervolemic (above +2 SD from the mean, which was obtained from healthy controls), normovolemic (between +2 SD and À2 SD), or hypovolemic (below À2 SD from the mean). Five patients with hypovolemia were excluded from the study. Fifty-six patients were hypervolemic whereas 98 patients were euvolemic. High-sensitive C-reactive protein (hs-CRP) levels were measured to evaluate inflammation in all patients. Results: hs-CRP value levels were significantly higher in hypervolemic patients compared with euvolemic patients [7.1 (3.1-44.0) mg/L vs. 4.3 (3.1-39.6), p: 0.015, respectively]. Left ventricular hypertrophy was more frequent in hypervolemic patients compared with euvolemic patients (53.6% vs. 30.6%, p: 0.004, respectively). ECW/TBW ratio positively correlated with hs-CRP (r: 0.166, p: 0.039). Gender, hs-CRP, and residual Kt/V urea were found to be independent risk factors for hypervolemia in multivariate analysis. Conclusion: Inflammation is associated with hypervolemia in PD patients. Residual renal functions play an important role to maintain euvolemia in PD patients.