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P0404 PREVALENCE OF CARDIOVASCULAR RISK FACTORS IN PATIENTS WITH URIC RENAL STONES
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
Nephrology P0402 GOUTY ARTHRITIS IN A 15YEAR OLD GIRL WITH BARTTER’S SYNDROME
Nima Derakhshan. Shiraz Nephro-Urology Research Center A 15 year old girl known case of bartter’s syndrome (BS) for 7 years developed severe pain in her right knee and right and left ankle. Her older sister had BS and developed end stage renal disease (ESRD) at her 14. Regarding her previous lab data with a serial serum uric acid concentration of 7.5 mg/dl at presentation and 12.6mg/dl 6 months ago and 15.4mg/dl in her recent lab data and her noncompliance with her allopurinol use and the fact that clearance of uric acid is decreased with metabolic alkalosis, diagnosis of gouty arthritis was made. Hyperuricemia and gouty arthritis is commonly seen in adults with BS but to our knowledge there is no report of gouty arthritis in pediatric literature. Keywords: gouty arthritis, Bartter’s syndrome, Children
S137
All patients were hypertensive and under therapy. Hypertension was defined as systolic blood pressure (SBP) > 140mmHg and diastolic blood pressure (DBP) > 90mmHg. Patients with uric acid stones were 20 versus 15 patients with no stones. The presence of uric stones was determined by ultrasound examination, by the radio-opacity, high levels of uricemia and urinary Ph level. All patients presenting stones underwent pyelography. Results: The prevalence of arterial hypertension was similar in two groups, with no difference on sex. The patients, presenting renal stones, presented also a higher level of mean systolic, 151±14 mmHg versus 147±9 mmHg, (p<0,05) and diastolic blood pressure, 102±0,8mmHg versus 100±0,2mmHg (p<00,5), compared with patients without stone. Patients presenting renal stones were older 45±13 versus 38,±5 years (p<0,001), presented higher obesity, BMI 27±0,4 versus 24,7±0,6 (p>0,01), had higher levels of total cholesterol 217±5mg/dl versus 201±4 (p<0,02) and triglycerides 158±9mg/dL versus 124±5mg/dL (p<0,03), compared with no stone population. Conclusions: Uric stone formers population presented higher levels of blood pressure, were older and the blood levels of total cholesterol and triglycerides were higher compared with no stone population. This study demonstrates clearly that patients presenting hypertension and uric renal stones had higher prevalence of cardio-vascular risk factors, such as age, obesity, lipid anomalies and higher levels of hypertensions compared with the hypertensive population with no renal stones.
P0403 HBV VACCINATION PRIOR TO INITIATING PERITONEAL DIALYSIS YIELDS SIGNIFICANTLY BETTER SEROCONVERSION RATES
Shaukat Bilal, Arif Mutwali, George Mellotte, Catherine Wall. Department of Nephrology,the Adelaide and Meath Hospital, Dublin. Ireland Introduction: Seroconversion rates for HBV vaccination have been reported variably for HBV patients on Peritoneal Dialysis (PD). Objectives: To determine post vaccination HBV seroconversion rates among patients on PD. Materials & methods: All patients attending our dialysis centre for PD from 2002 to 2006 were included for analysis. Patients characteristics were recorded. All HBV negative patients received HBV vaccination either before or during CAPD. HBsAg +ve patients were excluded from analysis. Impact of age, gender, time of initiating vaccination and role of immunosuppression on seroconversion rates were determined. All p values <0.05 were regarded as statistically significant. Results: A total of 72 patients (male 48) were eligible for inclusion. Median age was 52.5 years, range 19-79 years. In 13 and 54 patients vaccination was started prior to and during PD, respectively. Seroconversion rates for patients younger thean 60 years were 32% as compared with 25% for those > 60 years (p= 0.008). Seroconversion rates for males amd females were 26% and 33% respectively (p= 0.005). Patients who received vaccination during (n= 54) and prior (n= 13) to initiating PD had seroconversion rates of 28% and 46% repectively (p= 0.01). Discussion & conclusion: Age, gender and time of initiation of HBV vaccination significantly influence seroconversion rates in patients on PD. HBV vaccination should be initiated prior to initiating PD to achieve higher rates of seroconversion. Patient who receive HBV vaccination prior to initiation of dialysis have significantly higher rate of seroconversion. Keywords: Peritoneal Dialysis (PD), HBV, vaccination
P0404
P0405 L-CARNITINE IN THE MANAGEMENT OF EPOETIN -RESISTANT ANEMIA IN PREDYALISIS PATIENTS
Margarita Nelaj, Ergita Nelaj, Ledio Collaku, Edite Sadiku, Mihal Tase. UHC "Mother Teresa", Dept. of Internal Medicine Background: L-carnitine has been extensively studied for patients in renal failure. It has been known that carnitine levels are altered in chronic renal failure and in haemodialysis (HD) patients. Supplementation, either orally or intravenously, mitigates some of the disorders associated with dialysis, including renal anemia, cardiac dysfunction, left ventricular ejection fraction, insulin resistance, lipid abnormalities, and oxidative stress.Anaemia is frequently a problem in chronic renal failure patients on HD. Recombinant human erythropoietin (rHuEPO) is often used to treat these patients. Several factors can affect the dose of rHuEPO required, including blood loss, inflammation, iron deficiency. Many patients receiving rHuEPO have low carnitine levels, and this has been shown to affect the amount of rHuEPO needed. The aim of the study was to demonstrate whether L-carnitine treatment could further improve the anemia in predialysis patients under recombinant human erythropoietin (r-HuEPO) therapy, leading to a reduction in r-HuEPO requirements. Materials and methods: The study is trans-sectional. 17 patients presented 5th stage of CKD (GFR <15ml/min). Creatinine clearance was calculated by using the Cockroft and Gault equation. The mean age was 42±16,3. L-carnitine (2 g/day) was administered for 3 months to a group of 14 patients; the results were compared with data from a placebo control group (N = 13). L-Carnitine treatment promoted a reduction in r-HuEPO requirements in the active group from 5444±1149, 03 UI/kg/month in 5000±1044, 47 UI/kg/month. (p< 0,03) Conclusion: L-carnitine deficiency might promote EPO resistance in predialysis patients, which is corrected by L-carnitine supplementation, ultimately reducing rHuEPO requirements.
PREVALENCE OF CARDIOVASCULAR RISK FACTORS IN PATIENTS WITH URIC RENAL STONES
Margarita Gjata, Ergita Nelaj, Ledio Collaku, Edite Sadiku, Mihal Tase. UHC Introduction: The metabolic syndrome is associated with alterations in renal function. Overly acidic urine has been described as a renal manifestation of the metabolic syndrome in patients with kidney stone disease. Furthermore, among patients affected with nephrolithiasis, the incidence of hypertension was found to be higher than that of the general population, and a higher mean pressure level was reported in stone formers as opposed to controls The pathogenic link between hypertension and stone disease is not fully understood. The aim of the study was to evaluate the prevalence of hypertension in patients with uric acid stones and compare it with the hypertensive population without renal stones. We also aim to study the correlations between renal stone disease with age, lipid abnormalities and obesity. Material and patients. The study is cross-sectional. In this study were examined 35 patients (20 men, 15 female), admitted during 2007, near the Service of Internal Medicine and Hypertension of the University Hospital Center "Mother Teresa" of Tirana, Albania. Patient’s age varied from 22-68 years old.
P0406 A RANDOMIZED TRIAL ON EFFECT OF G-CSF IN AB RESPONSE IN HEMODIALYSIS PATIENTS WHO ARE NON RESPONDERS TO HBV VACCINE
Poopak Mohaghegh. Department of Internal Medicine, Shiraz University-Fassa Medical Faculty, Shiraz, Iran Patients with end stage renal disease, on hemodialysis are at increased risk of hepatitis B infection.Unlike healthy adults, patients undergoing dialysis who are infected with hepatitis B virus (HBV) usually have mild, asymptomatic disease. However high proportion become chronic carriers of the virus and most remain highly infectious, as indicated by a high prevalence of the hepatitis B antigen. HBV infection in hemodialysis patients becomes chronic in 30-60%, compared with less than 10% in non uremic patients Only 50% to 60% of dialysis patients develop sufficient anti hepatitis B surface antibodies after hepatitis vaccination by the intramuscular route, with injection of three doses 40μg of recombinant hepatitis B vaccine
Nephrology P0402 GOUTY ARTHRITIS IN A 15YEAR OLD GIRL WITH BARTTER’S SYNDROME
Nima Derakhshan. Shiraz Nephro-Urology Research Center A 15 year old girl known case of bartter’s syndrome (BS) for 7 years developed severe pain in her right knee and right and left ankle. Her older sister had BS and developed end stage renal disease (ESRD) at her 14. Regarding her previous lab data with a serial serum uric acid concentration of 7.5 mg/dl at presentation and 12.6mg/dl 6 months ago and 15.4mg/dl in her recent lab data and her noncompliance with her allopurinol use and the fact that clearance of uric acid is decreased with metabolic alkalosis, diagnosis of gouty arthritis was made. Hyperuricemia and gouty arthritis is commonly seen in adults with BS but to our knowledge there is no report of gouty arthritis in pediatric literature. Keywords: gouty arthritis, Bartter’s syndrome, Children
S137
All patients were hypertensive and under therapy. Hypertension was defined as systolic blood pressure (SBP) > 140mmHg and diastolic blood pressure (DBP) > 90mmHg. Patients with uric acid stones were 20 versus 15 patients with no stones. The presence of uric stones was determined by ultrasound examination, by the radio-opacity, high levels of uricemia and urinary Ph level. All patients presenting stones underwent pyelography. Results: The prevalence of arterial hypertension was similar in two groups, with no difference on sex. The patients, presenting renal stones, presented also a higher level of mean systolic, 151±14 mmHg versus 147±9 mmHg, (p<0,05) and diastolic blood pressure, 102±0,8mmHg versus 100±0,2mmHg (p<00,5), compared with patients without stone. Patients presenting renal stones were older 45±13 versus 38,±5 years (p<0,001), presented higher obesity, BMI 27±0,4 versus 24,7±0,6 (p>0,01), had higher levels of total cholesterol 217±5mg/dl versus 201±4 (p<0,02) and triglycerides 158±9mg/dL versus 124±5mg/dL (p<0,03), compared with no stone population. Conclusions: Uric stone formers population presented higher levels of blood pressure, were older and the blood levels of total cholesterol and triglycerides were higher compared with no stone population. This study demonstrates clearly that patients presenting hypertension and uric renal stones had higher prevalence of cardio-vascular risk factors, such as age, obesity, lipid anomalies and higher levels of hypertensions compared with the hypertensive population with no renal stones.
P0403 HBV VACCINATION PRIOR TO INITIATING PERITONEAL DIALYSIS YIELDS SIGNIFICANTLY BETTER SEROCONVERSION RATES
Shaukat Bilal, Arif Mutwali, George Mellotte, Catherine Wall. Department of Nephrology,the Adelaide and Meath Hospital, Dublin. Ireland Introduction: Seroconversion rates for HBV vaccination have been reported variably for HBV patients on Peritoneal Dialysis (PD). Objectives: To determine post vaccination HBV seroconversion rates among patients on PD. Materials & methods: All patients attending our dialysis centre for PD from 2002 to 2006 were included for analysis. Patients characteristics were recorded. All HBV negative patients received HBV vaccination either before or during CAPD. HBsAg +ve patients were excluded from analysis. Impact of age, gender, time of initiating vaccination and role of immunosuppression on seroconversion rates were determined. All p values <0.05 were regarded as statistically significant. Results: A total of 72 patients (male 48) were eligible for inclusion. Median age was 52.5 years, range 19-79 years. In 13 and 54 patients vaccination was started prior to and during PD, respectively. Seroconversion rates for patients younger thean 60 years were 32% as compared with 25% for those > 60 years (p= 0.008). Seroconversion rates for males amd females were 26% and 33% respectively (p= 0.005). Patients who received vaccination during (n= 54) and prior (n= 13) to initiating PD had seroconversion rates of 28% and 46% repectively (p= 0.01). Discussion & conclusion: Age, gender and time of initiation of HBV vaccination significantly influence seroconversion rates in patients on PD. HBV vaccination should be initiated prior to initiating PD to achieve higher rates of seroconversion. Patient who receive HBV vaccination prior to initiation of dialysis have significantly higher rate of seroconversion. Keywords: Peritoneal Dialysis (PD), HBV, vaccination
P0404
P0405 L-CARNITINE IN THE MANAGEMENT OF EPOETIN -RESISTANT ANEMIA IN PREDYALISIS PATIENTS
Margarita Nelaj, Ergita Nelaj, Ledio Collaku, Edite Sadiku, Mihal Tase. UHC "Mother Teresa", Dept. of Internal Medicine Background: L-carnitine has been extensively studied for patients in renal failure. It has been known that carnitine levels are altered in chronic renal failure and in haemodialysis (HD) patients. Supplementation, either orally or intravenously, mitigates some of the disorders associated with dialysis, including renal anemia, cardiac dysfunction, left ventricular ejection fraction, insulin resistance, lipid abnormalities, and oxidative stress.Anaemia is frequently a problem in chronic renal failure patients on HD. Recombinant human erythropoietin (rHuEPO) is often used to treat these patients. Several factors can affect the dose of rHuEPO required, including blood loss, inflammation, iron deficiency. Many patients receiving rHuEPO have low carnitine levels, and this has been shown to affect the amount of rHuEPO needed. The aim of the study was to demonstrate whether L-carnitine treatment could further improve the anemia in predialysis patients under recombinant human erythropoietin (r-HuEPO) therapy, leading to a reduction in r-HuEPO requirements. Materials and methods: The study is trans-sectional. 17 patients presented 5th stage of CKD (GFR <15ml/min). Creatinine clearance was calculated by using the Cockroft and Gault equation. The mean age was 42±16,3. L-carnitine (2 g/day) was administered for 3 months to a group of 14 patients; the results were compared with data from a placebo control group (N = 13). L-Carnitine treatment promoted a reduction in r-HuEPO requirements in the active group from 5444±1149, 03 UI/kg/month in 5000±1044, 47 UI/kg/month. (p< 0,03) Conclusion: L-carnitine deficiency might promote EPO resistance in predialysis patients, which is corrected by L-carnitine supplementation, ultimately reducing rHuEPO requirements.
PREVALENCE OF CARDIOVASCULAR RISK FACTORS IN PATIENTS WITH URIC RENAL STONES
Margarita Gjata, Ergita Nelaj, Ledio Collaku, Edite Sadiku, Mihal Tase. UHC Introduction: The metabolic syndrome is associated with alterations in renal function. Overly acidic urine has been described as a renal manifestation of the metabolic syndrome in patients with kidney stone disease. Furthermore, among patients affected with nephrolithiasis, the incidence of hypertension was found to be higher than that of the general population, and a higher mean pressure level was reported in stone formers as opposed to controls The pathogenic link between hypertension and stone disease is not fully understood. The aim of the study was to evaluate the prevalence of hypertension in patients with uric acid stones and compare it with the hypertensive population without renal stones. We also aim to study the correlations between renal stone disease with age, lipid abnormalities and obesity. Material and patients. The study is cross-sectional. In this study were examined 35 patients (20 men, 15 female), admitted during 2007, near the Service of Internal Medicine and Hypertension of the University Hospital Center "Mother Teresa" of Tirana, Albania. Patient’s age varied from 22-68 years old.
P0406 A RANDOMIZED TRIAL ON EFFECT OF G-CSF IN AB RESPONSE IN HEMODIALYSIS PATIENTS WHO ARE NON RESPONDERS TO HBV VACCINE
Poopak Mohaghegh. Department of Internal Medicine, Shiraz University-Fassa Medical Faculty, Shiraz, Iran Patients with end stage renal disease, on hemodialysis are at increased risk of hepatitis B infection.Unlike healthy adults, patients undergoing dialysis who are infected with hepatitis B virus (HBV) usually have mild, asymptomatic disease. However high proportion become chronic carriers of the virus and most remain highly infectious, as indicated by a high prevalence of the hepatitis B antigen. HBV infection in hemodialysis patients becomes chronic in 30-60%, compared with less than 10% in non uremic patients Only 50% to 60% of dialysis patients develop sufficient anti hepatitis B surface antibodies after hepatitis vaccination by the intramuscular route, with injection of three doses 40μg of recombinant hepatitis B vaccine