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Nail Changes in End-Stage Renal Failure Patients on Hemodialysis  [cached]
Jamal Arshad,Subramanian P,Hussain K
Saudi Journal of Kidney Diseases and Transplantation , 2000,
Abstract: To evaluate the fingernail changes in patients with end-stage renal failure (ESRF) on regular hemodialysis (HD), we reviewed 69 patients (male 25, female 44; age 40 ± 14.8 years) who have been on HD at Samtah General Hospital, Gizan, Kingdom of Saudi Arabia for a mean of 4.3 ± 3.06 years. They were free from congenital, systemic or primary skin disorders contributing to nail changes. The patients were also free from ornamental dyes like henna, traumatic injuries or infections in the fingernails. They were also clinically free from features suggestive of the carpal tunnel syndrome or vascular steal syndrome secondary to arteriovenous fistula (AVF) created for vascular access. Their nails were examined under bright day light by the authors independently. The findings consistent among all three observers were taken for analysis. Hemoglobin and serum albumin levels were also estimated. We compared these changes according to age, sex, and duration on chronic hemodialysis, AVF, and the levels of serum albumin and hemoglobin. One or more nail changes were observed in 44/69 (64%) patients. The commonest abnormality was the so-called "Half-and-half nail changes", which was observed in the finger nails of 18/69 (26%) of the study patients (males to female ratio was 2:1). Typically, the half-and-half nails are nails where the distal portion of the nail bed is red, pink or brown, occupies 20-60% of the total nail length and is always sharply demarcated with the proximal portion. The latter has a dull whitish ground glass appearance and when pressure is applied, the distal discoloration does not fade completely. Non-specific nail changes were observed 26/69 (38%) patients. The hemoglobin and serum albumin levels were not significantly different of those with ′half-and-half′ nail, non-specific nail changes or no nail changes. We conclude that various fingernail changes are observed in ESRF patients on HD. These nail changes are independent of the age of the patient, duration on HD, AVF or hemoglobin or albumin levels. However, a gender dependent trend was noticed and the half-and-half nail seems to be characteristic of uremia.
Spontaneous Hemocholecyst in an End-Stage Renal Failure Patient on Low Molecular Weight Heparin Hemodialysis  [PDF]
Konstantinos Blouhos,Konstantinos A. Boulas,Dimitrios G. Tselios,Anestis Hatzigeorgiadis
Case Reports in Surgery , 2012, DOI: 10.1155/2012/363924
Abstract: The present paper describes a case of spontaneous hemocholecyst in a patient with end-stage renal failure on low molecular weight heparin hemodialysis. The patient presented with acute right upper quadrant pain. An initial ultrasound scan demonstrated a distended gallbladder containing echogenic bile without stones. During hospitalization the patient became febrile, and jaundiced, developed leukocytosis, and had an elevation in serum bilirubin, transaminases, and alkaline phosphatase. A new ultrasound demonstrated a thick-walled gallbladder containing echogenic bile and pericholecystic fluid. MRI depicted a distended gallbladder containing material of mixed signal intensity and a normal biliary tract. Open cholecystectomy revealed a gallbladder filled with blood and clots, and transcystic common bile duct exploration flushed blood clots out of the bile duct. To our knowledge this is the second case of spontaneous hemocholecyst reported in the literature as a consequence of uremic bleeding and LMWH hemodialysis in the absence of other pathology. 1. Introduction Uremic bleeding is a well-recognized complication in patients with renal failure. The clinical importance of bleeding associated with chronic renal failure (CRF) itself is, however, difficult to assess, especially as various dialysis techniques, comorbidities, and medications are known to affect platelet aggregation and/or the coagulation cascade [1]. Although renal dialysis patients are at an increased risk for developing acute gastrointestinal bleeding, bleeding confined to the gallbladder (GB) is extremely rare. This study presents a case of hemocholecyst in a patient with end-stage renal failure on low molecular weight heparin (LMWH) hemodialysis, which is an exceptionally rare event, especially when there is no concurrent pathology as in our patient case. 2. Case Presentation A 70-year-old male with end-stage renal failure was referred to our surgical department owing to abdominal pain localized in the right upper quadrant, 2 hours after hemodialysis. The patient suffered from CRF secondary to mesangioproliferative glomerulonephritis and commenced short dialysis sessions using routinely enoxaparin (40?mg) via the arterial port 3 to 4 minutes prior dialysis, as anticoagulation. Direct questioning revealed no other past medical history and no use of oral anticoagulants or antiplatelet medications. Physical examination revealed localized tenderness and palpable mass in the right upper quadrant. The patient was hemodynamically stable. Axillary temperature was 36.6°C. Initial laboratory and
Impact of Parathormone Hormone on Platelet Count and Mean Volume in End-stage Renal Failure Patients on Regular Hemodialysis  [PDF]
Azar Baradaran,Hamid Nasri
Journal of Medical Sciences , 2005,
Abstract: The increased bleeding tendency of end-stage renal failure patients under hemodialysis (HD) has been attributed to platelet dysfunction. We sought to conduct a study to consider the effect of parathormone on mean platelet volume and count in chronic hemodialysis patients. Complete blood count containing platelet count and Mean Platelet Volume (MPV) and levels of serum calcium, phosphorus, alkaline phosphatase and Intact serum PTH (iPTH) were measured. Total patients were 36 (F = 14, m = 22), consisting of 26 non-diabetic HD patients and 10 diabetic HD patients. Findings were a near significant difference of PLT count between diabetic and non-diabetic HD patients with more values in diabetic population, a significant inverse correlation PLT count and MPV and a near significant positive correlation of MPV with serum iPTH. A significant inverse correlation of PLT count with serum iPTH was seen too. The inverse correlation of serum parathormone with platelet count and the positive correlation of serum parathormone with MPV shows the role of secondary hyperparathyroidism in PLT dysfunction regarding the bleeding tendency of uremic patients, which implies to better control of PTH over secretion in these patients.
The effect of hemodialysis on right ventricular functions in patients with end-stage renal failure  [cached]
Mehmet Akkaya,Ercan Erdo?an,Saim Sa?,Hasan Ar?
Anadolu Kardiyoloji Dergisi , 2012,
Abstract: Objective: The aim of this study was to evaluate the effects of hemodialysis (HD) on right ventricular echocardiographic parameters in patients with end-stage renal failure (ESRF). Methods: Forty-three uremic patients who underwent echocardiography before and 30 minutes after dialysis included in this prospective observational study. Right ventricular systolic function was evaluated using tricuspid annular plane systolic excursion (TAPSE) by M-mode echocardiography and tricuspid lateral annular systolic velocity (Sa) by tissue Doppler echocardiography whereas diastolic function was evaluated using tricuspid early (E) and late (A) diastolic flow velocities by conventional and tricuspid lateral annular early (Ea) and late (Aa) diastolic velocities by tissue Doppler echocardiography. Myocardial performance index was taken as an indicator of global functions. Paired t test or Wilcoxon test were used for statistical analysis where appropriate.Results: E decreased significantly (68±13 cm/s and 56±12 cm/s before and after HD, respectively; p<0.0001) but A did not (p=0.797).TAPSE was 1.84±0.34 cm before HD and showed a significant increase to 2.03±0.20 cm after HD (p=0.006). Right ventricular MPI, Sa and Aa did not change significantly by dialysis (p=0.504; p=0.118 and p=0.150 respectively) whereas Ea decreased to 8.8±2.5 cm/s from 11.3±3.4 cm/s (p<0.001). Ea/Aa ratio also decreased significantly to 0.69±0.35 from 0.84±0.44 with HD (p=0.007).Conclusion: The results of this study indicates that parameters of right ventricular systolic function such as Sa and MPI are independent of preload whereas the conventional and tissue Doppler parameters of right ventricular diastolic function are preload dependent in patients with end-stage renal failure who undergo regular hemodialysis.
ORIGINAL PAPER: The association of 25-hydroxyvitamin D levels with secondary hyperparathyroidism in end-stage renal failure patients undergoing regular hemodialysis
Hamid Nasri,Azar Baradaran
Archives of Medical Science , 2005,
Abstract: Introduction: To investigate the role of 25-OHD as a marker of nutrition and its association with mineral metabolism and serum parathormone secretion in end-stage renal failure patients undergoing regular hemodialysis (HD), a cross sectional study was carried out on a group of maintenance hemodialysis patients. Material and methods: Serum 25-hydroxy (25-OH vitamin D) levels, Intact serum PTH (iPTH) and also serum C-reactive protein(CRP), calcium, phosphorus and alkaline phosphatase (ALP) were measured. Results: In the study, significant differences of serum 25-OH vitamin D between diabetic and non-diabetics of male dialysis patients with more values in nondiabetic HD patients and a significant positive correlation of serum 25-OH vitamin D with BMI and also a near significant inverse correlation of serum 25-OH vitamin D with serum phosphorus were found, also a significant inverse correlation of serum 25-OH VitD with serum calcium was seen, too. Moreover, a weakly significant inverse correlation of serum 25-OH vitamin D with serum iPTH was seen, too. In this study no significant association between serum 25-OH vitamin D with serum albumin, CRP, ALP, dialysis adequacy and ages of the patients, duration and sessions of dialysis were found. Conclusions: In hemodialysis patients, low serum 25-OHD levels could be a risk factor for secondary hyperparathyroidism. Serum 25-OHD could show the nutritional status of HD patients. In dialysis patients, we suggest that the plasma levels of 25-OHD are maintained around the upper limit of the reference range of sunny countries.
Helicobacter Pylori IgG Antibodies in Association with Secondary Hyperparathyroidism in End-stage Renal Failure Patients Undergoing Regular Hemodialysis  [PDF]
Hamid Nasri,Azar Baradaran
Pakistan Journal of Biological Sciences , 2006,
Abstract: The aim of present study was the assessment of relationships between PTH abnormalities and the parameter of Helicobacter pylori (H. pylori) infection as expressed by concentration of IgG antibodies against H. pylori. The study was carried out on 44 (F = 17, M = 27) stable hemodialysis (HD) patients with upper gastrointestinal symptoms. A significant positive correlations of H. pylori IgG antibody titers with serum iPTH and phosphorus also a significant inverse correlation of H. pylori IgG antibody titers with serum alkalin phosphatase was found. It is known that hyperparathyroidism is connected with stimulation of gastrin synthesis as well with increased acidity of gastric juice. Hypergastrinaemia induced stimulation of gastrin synthesis and resultant increased acidity of gastric juice could intensify the H. pylori infection in hemodialysis patients. We strongly propose to more study on the association of secondary hyperparathyroidism with H. pylori infection, because both dyspeptic symptoms and secondary hyperparathyroidism are quite common in chronic hemodialysis patients and in the meantime needs more attention toward control of high levels of parathormone in HD patients.
Color Doppler Indices of Orbital Arterial Flow in End-Stage Renal Disease Patients; Are the Changes Related to Chronic Hemodialysis or Chronic Renal Failure?  [cached]
Hadi Rokni Yazdi,Safoura Faraji,Farokhlegha Ahmadi,Reza Shahmirzae
Iranian Journal of Radiology , 2012,
Abstract: Background: Endothelial injury is a well-known complication in chronic kidney disease (CKD) and hemodialysis. One of the sites in which early vascular changes may be detected is the retina. Of course, these flow changes may not be detected in ophthalmologic exams, but it seems that color Doppler sonography of retinal arteries may be helpful in these cases.Objectives: In previous studies on CKD patients who underwent chronic hemodialysis, hemodynamic changes were noted in retinal arteries, but no study has been performed to determine which of the two processes (CKD or chronic hemodialysis) can produce these changes. In this study, we tried to answer this question.Patients and Methods: Doppler ultrasonography of the orbital vasculature including the ophthalmic artery and the central retinal artery was carried out in 17 patients (34 eyes) with chronic renal failure (CRF) who underwent hemodialysis, 17 patients (34 eyes) with CRF without a history of hemodialysis and 17 normal patients (34 eyes). The peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index were measured excluding hypertensive, diabetic patients and patients with cardiovascular disease.Results: The mean PSV and EDV were lower only in the ophthalmic artery of CRF patients irrespective of the history of hemodialysis (PSV was 35.2 in hemodialysis, 38.8 in CRF and 51.6 in normal patients, P value = 0.001 and EDV was 7.4, 9.4, 11.8, respectively, P value = 0.001) with no significant difference in the resistance index of the ophthalmic artery and other parameters [EDV, PSV, Resistance Index (RI)] in the central retinal artery.Conclusions: The mean PSV and DSV in the ophthalmic artery were lower only in the ophthalmic artery of CRF patients regardless of the history of hemodialysis. No significant difference in the resistance index of the ophthalmic artery and other parameters (EDV, PSV) of the central retinal artery were noted between different groups.These findings suggest that microvascular disease and endothelial cell dysfunction of the orbital vasculature are related to CRF and not to chronic hemodialysis.
Original paper Helicobacter pylori IgG antibodies in association with secondary hyperparathyroidism in end-stage renal failure patients undergoing regular hemodialysis
Azar Baradaran,Hamid Nasri
Archives of Medical Science , 2005,
Abstract: Helicobacter pylori (H. pylori) has been shown to play an important role in the development of gastritis and gastric ulcer. Excess parathyroid hormone (PTH) has long been considered detrimental to the health of patients with end-stage renal disease. PTH has been implicated as a multisystem uremic toxin, and hyperparathyroidism can be a debilitating complication in dialyzed patients. The aim of our study was the assessment of relationships between PTH abnormalities and concentration of IgG antibodies against H. pylori. The study included 44 (F=17, M=27) stable hemodialysis (HD) patients with upper gastrointestinal symptoms. Significant positive correlations between H. pylori IgG antibody titers with serum iPTH and phosphorus and significant inverse correlation of H. Pylori IgG antibody titers with serum alkalin phosphatase were found. Hyperparathyroidism is related with stimulation of gastrin synthesis as well with increased acidity of gastric juice. Hypergastrinaemia induced stimulation of gastrin synthesis and resultant increased acidity of gastric juice could intensify the H. pylori infection in HD patients. Further studies on the association of secondary hyperparathyroidism with helicobacter pylori infection are necessary, because both dyspeptic symptoms and secondary hyperparathyroidism are quite common in HD patients and in the meantime, more attention toward control of high levels of parathormone in HD patients is needed.
Pregnancy in End Stage Renal Disease Patients on Hemodialysis
Rohina Swaroop,Raja Zabaneh,Cindy Addison
JK Science : Journal of Medical Education & Research , 2009,
Abstract: Pregnancy in patients suffering from chronic renal failure is still rare due to numerous factors that impairfertility. Even if pregnancy does occur pregnancy outcome with a live birth has a low success rate.Moreover there is a significant risk of worsening of renal disease in the mother.The purpose of hemodialysisis not only to maintain life but also to make the quality of life as normal as possible for the patient.Propogation of life is basic to all life forms and the ability to do so can be considered as a success in apatient of chronic renal failure. As patients of End stage renal disease rarely complain about sexual orgynecological problems ,considering them trivial as compared to their more life threatening renal condition,it is the physicians role to be attentive to these aspects of the disease.We hereby report 2 cases ofsuccessful pregnancy managed on hemodialysis by Northwest Louisiana Nephrology
Correlation of Serum Leptin with Circulating Anti-Helico Bacter Pylori IgG Antibodies in End-Stage Renal Failure Patients on Regular Hemodialysis
M.D. Azar Baradaran,M.D. Hamid Nasri
Pakistan Journal of Nutrition , 2005,
Abstract: Leptin is synthesized mainly by the adipose tissue. Leptin also is detected in gastric chief cells. To consider the association of serum leptin with helicobacter pylori- IgG antibodies as parameters of nutritional status, on a group of hemodialysis patients, serum Leptin and serum helicobacter pylori specific IgG (H. Pylori-IgG) antibody titer were measured. Total patients were 36. In all patients there were a significant positive correlation of serum leptin with BMI and a near significant positive correlation of serum leptin with age. In the diabetic HD group a significant inverse correlation of helicobacter pylori IgG antibody titer and serum leptin was seen. This is the first report of the association of serum leptin with pylori-IgG antibodies in hemodialysis patients which may explain nutritional problems that is frequently seen in diabetic hemodialysis patients .More research is needed regarding the clinical consequences of this association.
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