In the current study, we evaluated the balance of ESRD patients before and after a routine session of hemodialysis treatment. This is the first study to investigate the effect of hemodialysis on balance, using an electronic posturographic balance system. We found the Fall Index score to be significantly higher after hemodialysis, indicating a negative effect of hemodialysis on postural stability. As expected, our data showed an increased Fall Index score correlated with the increase in age both in ESRD patients and in healthy controls. However, the correlation with age was not observed for the patient group at the post-dialysis balance measurement. We might conceive that young patients with ESRD are also prone to fall risk after a session of hemodialysis. Methods that provide quantitative assessment for fall risk could be rather beneficial for high-risk populations such as patients on maintenance hemodialysis.

The aim of our study was to evaluate the frequency of fibromyalgia syndrome (FMS) in hemodialysis (HD) patients and to assess whether this syndrome is associated with gender, age, duration of HD, or various laboratory parameters. This study was composed of 221 chronic HD patients (99 females and 122 males), and we recorded each participant's age, gender, causes of kidney failure, HD duration, education level, and symptoms related to FMS, which was diagnosed according to the 2010 American College of Rheumatology criteria. We documented the laboratory parameters for all patients. In addition, patients with FMS filled out the Fibromyalgia Impact Questionnaire. Twenty-two patients met the diagnostic criteria for FMS (9%), and there were no statistically significant differences related to age, gender, or HD duration between FMS and non-FMS groups (P > 0.05). In addition, the education levels were lower in patients diagnosed with FMS (P < 0.05), and there were statistically significant differences related to sleep disturbance, fatigue, and cognitive symptoms between the two groups (P < 0.05) as well. However, their laboratory parameters were similar (P > 0.05). There was a higher prevalence of FMS in HD patients than in the general population. Sleep disturbances, fatigue, education level, and cognitive symptoms were associated with FMS, but there was no correlation between the laboratory parameters and this condition.

SUMMARYThe aim of this study was to evaluate the effect of obesity on renal functions and the possible relationship between TGF-β1 and obesity in hypertensive patients. Seventy newly diagnosed, hypertensive patients (male/female 36/34, aged 45.0 ± 8.0 years) and 30 (male/female 17/13, aged 41.8 ± 7.7 years) normotensive controls were included. Patients in both groups were analyzed for serum levels of glucose, creatinine, uric acid, lipids, and TGF-β1. A 24-hour urine sample was also obtained; creatinine clearance rate and urinary albumin excretion (UEA) were investigated. TGF-β1 levels were significantly higher (40.7 ± 13.6 versus 34.2 ± 12.1 pg/mL, P = 0.02), and creatinine clearance was significantly lower in patients compared with controls (98.9 ± 25.5 versus 124.5 ± 23.1 mL/min. per. 1.73 m 2 , P = 0.001). Serum TGF-β1 levels (45.2 ± 14 versis 38.0 ± 12.8 pg/mL, P = 0.03), creatinine clearance rates (109.8 29.9 versus 93.0 ± 20.8 mL/min. per. 1.73 m 2 , P = 0.001), and urinary albumin excretion (55.7 ± 62.0 versus 12.7 ± 12.6 mg/24 h, P = 0.002) were higher in obese hypertensive patients than in nonobese patients. In hypertensive patients, TGF-β1 levels correlated with body mass index (r = 0.296, P = 0.01) and creatinine clearance (r = 0.238, P = 0.04). The results suggest that increased body mass index is associated with increased creatinine clearance, urinary albumin excretion, and TGF-β1 levels in essential hypertension. In addition, TGF-β1 is positively correlated with body mass index and creatinine clearance in patients with essential hypertension. (Int Heart J 2007; 48: 733-741)

Visceral leishmaniasis is a rare opportunistic infection in renal transplantation patients and its presentation may be associated with or masked by many other factors in immunosuppressed patients. So, if it is not searched for in particular, diagnosis may be easily overlooked or delayed in renal transplant patients. A 32-year-old renal transplant recipient devoleped splenomegaly, pyrexia and pancytopenia. Six months after the first bone marrow examination, the delayed diagnosis was made possible by a second bone marrow aspiration. Liposomal amphotericin B was effective in his treatment although he had a recurrence. Early diagnosis of visceral leishmaniasis is crucial for the renal transplant recipient's therapy; and even in treated patients, the mortality rate may be high. In our case, although the time up to diagnosis was as long as six months after the onset of symptoms, response to treatment was satisfactory with higher doses of liposomal amphotericin B in the second cycle. Also, in the short term, the rate of recurrence was comparable to other reported patients who were diagnosed and treated in a month.

Tuberous sclerosis complex (TSC) is an inherited multisystem disorder; it may involve kidney, brain, skin, lungs, and liver. We report a 37-year-old female TSC patient presenting with skin lesions (angiofibromas, molluscum pendulum). Radiologic examination revealed additional brain and renal lesions consisting of tumors, cysts, and angiomyolipomas. Treatment with rapamycin disclosed improvement in skin lesions. The number and volume of angiofibromas and molluscum pendulum reduced progressively in 6 months. During the ninth month of treatment, magnetic resonance imaging was repeated for renal and brain lesions. Imaging results showed reduction in tumor and angiomyolipoma volumes. Oral rapamycin therapy can improve renal, brain, and skin lesions in TSC disease. Therefore, it may be an alternative therapy for TSC patients.

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SummaryThe aim of this study was to evaluate the relationship between renal resistive index and inflammation in untreated hypertensive patients. Sixty-one hypertensive patients (male/female: 38/23, aged 45.8 ± 8.3 years, and mean hypertension duration 28.2 ± 35.6 months) and 40 (male/female: 23/17, aged 42.7 ± 8.5 years) healthy control subjects were included in the study. Renal resistive index was positively correlated with age (P = 0.016, r = 0.308), pulse pressure (P = 0.022, r = 0.294), C-reactive protein (P = 0.00, r = 0.757), urinary albumin excretion (P = 0.003, r = 0.371) and negatively correlated with creatinine clearance (P = 0.042, r = -0.262) in the hypertensive group. The hypertensive group was further divided in two groups according to the renal resistive index; < 0.60 and > 0.60. In the > 0.60 group, age (48.0 ± 7.3 versus 42.8 ± 8.9 years, P = 0.01) and C-reactive protein levels (7.4 ± 1.5 versus 4.0 ± 1.6 mg/L, P = 0.01) were higher, and creatinine clearance (95.5 ± 22.1 versus 109.1 ± 25.3 mL/min, P = 0.04) was lower than the < 0.60 group. Renal resistive index was higher in the nondippers than the dippers (0.61 ± 0.04 versus 0.58 ± 0.03, P = 0.003). Renal resistive index is associated with inflammation and may be a useful marker, together with albuminuria, in hypertensive patients when evaluating hypertensive renal damage. (Int Heart J 2009; 50: 753-761) Key words: Atherosclerosis, Hypertension, Inflammation, Renal resistive index HYPERTENSION is a modifiable risk factor for coronary, cerebral, renal, and peripheral vascular disease. It is known that slight elevations of blood pressure can cause structural and functional renal damage. 1) The clinical signs of hypertensive renal damage include increased urinary albumin excretion and a reduction in the glomerular filtration rate.Hypertension is one of the traditional risk factors for atherosclerosis. Atherosclerosis is an inflammatory disease, and the association of inflammation with the initiation and progression of atherosclerosis suggests that markers of inflammation, for example, acute phase reactants such as hsC-reactive protein From the

The aim of this study was to investigate the effects of cinacalcet therapy on anemia parameters, bone mineral metabolism, left ventricular mass index (LVMI) and parathyroid gland volume in hemodialysis (HD) patients with secondary hyperparathyroidism. Twenty-five HD patients (M/F: 11/14, mean age: 45.2±17.9 years, mean HD duration: 96.4±32.7 months) were included in this prospective pilot study. The indication to start calcimimetic therapy was persistent serum levels of parathyroid hormone (PTH)>1000 pg/mL, refractory to intravenous (i.v.) vitamin D and phosphate-binding therapy. The initial and one-year results of adjusted serum calcium (Ca+2), phosphate (P), Ca×P product, PTH, hemoglobin (Hb) and ferritin levels, transferrin saturation index (TSAT), median weekly erythropoietin (EPO) dose, LVMI, and parathyroid volume by parathyroid ultrasonography were determined. There were no differences between pre- and post-treatment levels of serum Ca+2 (P=0.853), P (P=0.447), Ca×P product (P=0.587), PTH (P=0.273), ferritin (P=0.153) and TSAT (P=0.104). After 1 year of calcimimetic therapy, the Hb levels were significantly higher than the initial levels (P=0.048). The weekly dose of EPO decreased with no statistical significance. The dose of cinacalcet was increased from 32.4±12.0 to 60.0±24.4 mg/day (P=0.01). There were no differences between the pre- and post-treatment results regarding weekly vitamin D dose, parenteral iron dose, LVMI and parathyroid volume. The results of our study suggest that cinacalcet therapy might have an additional benefit in the control anemia in HD patients.