Progression of Metabolic Syndrome in Renal Transplant Recipients

Background

Metabolic syndrome, which is closely related to insulin resistance, is highly prevalent in renal transplant recipients.

Purpose

We aimed to investigate prevalence, risk factors, and progression of metabolic syndrome in renal transplant recipients.

Methods

One hundred fifty-eight renal transplant recipients who had been on transplantation for more than 1 year and 79 age-sex matched healthy controls were included in the cross-sectional phase of the study. We measured baseline characteristics, blood pressure, fasting blood glucose, and lipid profiles and we defined metabolic syndrome using the National Cholesterol Education Program Adult Treatment Panel III criteria. One hundred twenty-four renal transplant recipients were eligible for the second evaluation after 22.9 ± 3.8 months. Metabolic syndrome prevalence and homeostasis model assessment insulin resistance levels were evaluated during the follow-up period.

Results

Overall, metabolic syndrome was present in 34.2% of the patients and 12.7% of the controls at the cross-sectional phase of the study (P = .000). Only the hypertension component of metabolic syndrome was significantly increased in patients compared to controls (P = .000). Pretransplantation weight and body mass index were significantly higher in patients who had metabolic syndrome (P = .000). During the follow-up period, prevalence of metabolic syndrome did not change (P = .510); however, body mass index and blood pressure increased and the high density lipoprotein cholesterol component of metabolic syndrome decreased (P = .001). We did not find any significant difference in glomerular filtration rate change among patients with and without metabolic syndrome (−2.2 ± 11.36 vs −6.14 ± 13.19; P = .091). Glucose metabolism parameters including hemoglobin A1c, insulin, and homeostasis model assessment insulin resistance were disturbed in patients with metabolic syndrome (P = .000, P = .001, P = .002, respectively).

Conclusion

Metabolic syndrome is highly prevalent in renal transplant recipients and closely associated with insulin resistance. The prominent criterion of metabolic syndrome in patients seems to be hypertension, especially high systolic blood pressure. The identification of metabolic syndrome as a risk factor may yield new treatment modalities to prevent it.     

Ultrasonographic Maturation of Native Arteriovenous Fistulae: A Follow-Up Study

Background/aims. Ideal time needed for arteriovenous fistula (AVF) maturation is still controversial. In this study, we aimed to investigate the natural course of AVF maturation and also investigated the factors affecting AVF maturation. Methods. We studied 31 (21M/10F, mean age 55.8 ± 16.2) chronic renal failure patients. We evaluated the patients with color Doppler ultrasound examination before the fistula operation, at the first day, and at the first, second, third, and sixth months. Radial artery (RA) diameter, flow velocity, flow, resistance index, fistula vein diameter, flow velocity, and flow were measured. Results. Patency rates at the first post-operative day and the sixth month were 87.1% and 67.1%, respectively. Cephalic vein flow was 451.2 ± 248.6 mL/min at the first month and 528.6 ± 316.5 mL/min at the sixth month. Baseline RA diameter was lower in failing fistulas than that of patent fistulas. Failing fistulas were more common in women. Conclusion. Blood flow was enough for hemodialysis at the end of the first month. However, fistula maturation had continued until the end of the study; women and patients with low RA diameter are particularly prone to fistula failure. Therefore, especially in these patients, AVF must be created at least three or four months before the predicted hemodialysis initiation time.     

Antinutritional factors and in vitro protein digestibility of improved haricot bean (Phaseolus vulgaris L.) varieties grown in Ethiopia

The antinutrient (raffinose oligosaccharides, tannins, phytic acid and trypsin inhibitors) composition and in vitro protein digestibility of eight improved varieties of Phaseolus vulgaris grown in Ethiopia were determined. Stachyose was the predominant alpha-galactosides in all haricot bean samples. Raffinose was also present in significant quantities but verbascose, glucose and fructose were not detected at all in the samples. The concentrations observed for the protein digestibility and antinutritional factors, varied significantly (P<0.05) between varieties investigated in this study. Mean values for protein digestibility ranged from 80.66% (in Roba variety) to 65.64% (in Beshbesh variety). Mean values for raffinose, stachyose, sucrose, trypsin inhibitors, tannins and phytic acid were 3.14 mg/g, 14.86 mg/g, 24.22 mg/g, 20.68 TUIx10(3)/g, 17.44 mg, catechin equivalents/g and 20.54 mg/g respectively. Statistical analyses of data revealed that antinutritional factors and protein digestibility were influenced by variety (genotype). Relationships between antinutritional factors and protein digestibility were also observed. The possibility of selecting varieties to be used for large-scale cultivation in Ethiopia on the basis of these data is discussed. Among the improved varieties studied, Roba, Redwolaita, Mexican and Awash were found to be the best food and export type of haricot beans in the Ethiopian context, because of their higher protein digestibility, lower antinutrtional factors and other beneficial nutritional parameters. Roba variety can be used by local food processors for the production of value-added bean-based products especially to combat the problem of protein energy malnutrition and related diseases which are very common in developing countries.     

Intracranial calcification and tumoural calcinosis during vitamin D therapy

Extraskeletal calcifications are frequently observed in patients with chronic renal failure. However, clinically, they usually remain silent. In this report, we describe two patients with massive extraskeletal calcifications that caused significant morbidity. The first patient had tumoural calcification located on the shoulder and the second patient had severe neurological symptoms caused by intracranial calcifications. High calcium phosphorus product and severe secondary hyperparathyroidism were present in both patients. Furthermore, they both received inappropriately high doses of active vitamin D, even though they failed to respond to this therapy. We suggest to monitor closely the calcium, phosphorus and parathyroid hormone levels during calcitriol therapy and to perform parathyroidectomy, without delay, in patients who were resistant to calcitriol.     

Clinical, electrophysiological and neuropsychological findings of twenty-two children with mesial temporal sclerosis

Twenty-two patients, followed with the diagnosis of epilepsy between the ages of 8.5 and 19 years who were found to have mesial temporal sclerosis (MTS) on brain magnetic resonance imaging (MRI) were evaluated according to their clinical, electrophysiological and neuropsychological characteristics, and assessed for the significance of neuropsychological tests on lateralization. In both MTS groups, a remarkable number of patients had their intial seizure before one year of age (45.5% in the right MTS group, and 36.4% in the left MTS group). Half of the patients were seizure-free for a period of two months-9.5 years (average 3.9 years). The duration between the febrile seizure and first non-febrile seizure was 6.2 years. Eleven patients had MTS on the left temporal lobe. Interictal EEG was normal in five (22.5%) patients; 10 (45.5%) had temporal spike on the corresponding side with MTS. Six (27.3%) patients had paroxysmal activity and voltage asymmetry on cortical areas other than temporal region. The Wechsler Memory Scale (WMS), Visual Reproduction Subtest and Auditory Verbal Learning Test (AVLT) Delayed Recall and Retrieval Subtest performances were poor in the right MTS group.     

Osteoporosis after renal transplantation

This study was performed to determine risk factors associated with osteoporosis that develops after renal transplantation. Sixty-five kidney graft recipients were included in this study. They were divided into four groups according to the time since transplantation: Group 1 (< 1 year; n = 26), group 2 (1-3 years; n = 16), group 3 (3-5 years; n = 12) and group 4 (> 5 years; n = 11). These groups were matched according to probable risk factors for osteoporosis, findings of serum biochemistry, biochemical markers of bone turnover and measurements of bone mineral density. One way ANOVA test and Kruskal-Wallis test were used for statistical analysis. Osteoporosis was found in 22 recipients (33.8%). There were significant differences in recipient age, cumulative steroid dose, and episodes of acute rejection between the four groups. Increasing age, cumulative steroid dose and episodes of acute rejection were found to be risk factors for osteoporosis in our study.     

Suprascapular nerve entrapment by a ganglion cyst: a case report

A twenty-two-year-old male patient presented with complaints of muscle atrophy and shoulder pain. Clinical and radiological studies showed a ganglion cyst near the spinoglenoid notch and a diagnosis of compression of the inferior branch of the suprascapular nerve was made. Following open excision of the cyst by a posterior approach, the patient's complaints subsided. A year after the operation recurrence of the lesion was detected. Arthroscopic control showed no intrarticular lesion. The patient still experiences minimal pain from time to time.