Publications (15)28.12 Total impact
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Article: Evaluation of early atherosclerosis markers in patients with nonalcoholic fatty liver disease.
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ABSTRACT: OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) is characterized by the excessive accumulation of fat in the liver cells. It is strongly associated with cardiovascular risk factors for atherosclerosis. Flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) are noninvasive methods for the evaluation of endothelium. They are considered early markers of atherogenesis. The aim of this study was to evaluate early atherosclerosis markers in patients with NAFLD. METHODS: We examined 161 patients. All the patients underwent hepatic ultrasonography, transthoracic echocardiography, and brachial artery and carotid artery imaging. Fasting blood samples were drawn from all patients for the determination of lipids, insulin, C-peptide, and fasting blood glucose. HOMA-IR was calculated. RESULTS: Among the 161 patients, 44 had normal hepatic ultrasonography, 42 had stage 1 hepatosteatosis, 53 had stage 2 hepatosteatosis and 22 had stage 3 hepatosteatosis. FMD was reduced in patients with NAFLD as compared with the healthy controls (5.9±3.1 vs. 9.6±2.7%, P<0.001). There was a significant negative moderate correlation between ultrasonographic hepatosteatosis grade and FMD (r=-0.556, P<0.001). The mean CIMT was significantly increased in patients with NAFLD as compared with the controls (0.40±0.19 vs. 0.27±0.18, P<0.001). There was a significant positive weak correlation between ultrasonographic hepatosteatosis grade and mean CIMT (r=0.376, P<0.001). CONCLUSION: This study showed that NAFLD is associated with impaired CIMT and FMD, which are early markers of atherosclerosis. These findings may play a crucial role in understanding the pathophysiology of the atherosclerotic process in patients with NAFLD.European journal of gastroenterology & hepatology 10/2012; · 1.66 Impact Factor -
Article: Serum 25-hydroxyvitamin D levels are correlated with mitral valve calcification score in patients with rheumatic mitral stenosis.
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ABSTRACT: Rheumatic mitral stenosis (RMS) is a chronic disease related to autoimmune heart valve damage after streptococcal infection. Epidemiological evidence supports an association between vitamin D and the susceptibility and severity of autoimmune disorders. The study aim was to assess the serum levels of 25-hydroxyvitamin D and their correlation with Wilkins calcification score in patients with RMS. Thirty-four patients with RMS and 29 healthy age- and gender-matched controls were enrolled in the study. All subjects underwent transthoracic echocardiography after a complete medical evaluation and laboratory examination. The planimetric mitral valve area and Wilkins score were evaluated for all patients, and biochemical parameters and serum levels of 25-hydroxyvitamin D and calcitriol were determined. The mean patient age was similar in the RMS and control groups (50 +/- 10 versus 52 +/- 10 years; p = NS). The serum level of 25-hydroxyvitamin D was significantly lower in RMS patients than in controls (8.6 ng/ml; range: 4.9-26.3 ng/ml versus 12.3 ng/ml; range: 4-158 ng/ml; p = 0.031). A significantly moderate inverse correlation was identified between the serum 25-hydroxyvitamin D level and the Wilkins score (r = -0.567, p < 0.001), but no correlation was identified between 25-hydroxyvitamin D levels and other echocardiographic parameters of mitral stenosis. The serum level of calcitriol was also significantly lower in RMS patients than in controls (19.8 pg/ml; range: 16.0-54.6 pg/ml versus 26.1 pg/ml; range: 13.2-47.0 pg/ml; p = 0.013). The study results showed that serum levels of 25-hydroxyvitamin D were significantly lower in RMS patients than in controls, and also correlated with the Wilkins calcification score. Thus, a link may exist between 25-hydroxyvitamin D and the calcification process in RMS.The Journal of heart valve disease 09/2012; 21(5):570-5. · 0.81 Impact Factor -
Article: Increased Levels of 25 Hydroxyvitamin D and 1,25-Dihydroxyvitamin D After Rosuvastatin Treatment: A Novel Pleiotropic Effect of Statins?
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ABSTRACT: ObjectivesLow levels of 25-hydroxyvitamin D are associated with higher risk of cardiovascular morbidity and mortality. Large trials demonstrated that statins significantly decrease cardiovascular morbidity and mortality. 7-dehydrocholesterol is the precursor of both cholesterol and vitamin D. The aim of this study was to investigate the possible effect of rosuvastatin on vitamin D metabolism. MethodsThe study was performed in a prospective cohort design. The study group consisted of 91 hyperlipidemic patients who had not been treated with lipid lowering medications. Lipid parameters, 25 hydroxyvitamin-D, 1,25-dihydroxyvitamin D, and bone alkaline phosphatase were obtained at baseline and after 8weeks of rosuvastatin treatment. ResultsNone of the subjects withdrew from the study because of the adverse effects. The mean age was 59.9 ± 12.5years. The majority of the patients were male (55, 60%). Seventeen patients were diabetic, and 43 patients had systemic hypertension. There was a significant increase in 25-hydroxyvitamin D, from mean 14.0 (range 3.7– 67) to mean 36.3 (range 3.8 –117) ng/ml (p < 0.001), and also an increase of 1,25-dihydroxyvitamin D from mean 22.9 ± 11.2 to 26.6 ± 9.3pg/dl (p = 0.023). Bone alkaline phosphatase decreased after 8weeks of rosuvastatin treatment, mean 17.7 (range 2.6–214) to mean 9.5 (range 2.3–19.1) u/l (p < 0.001) rosuvastatin treatment. ConclusionThis study has shown an effect of rosuvastatin on vitamin D metabolism, with an increase in both 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D. This may be an important pleiotropic effect whereby rosuvastatin reduces mortality in patients with coronary artery disease. Further studies are needed to clarify the relationship between statins and vitamin D metabolism.Cardiovascular Drugs and Therapy 04/2012; 23(4):295-299. · 3.13 Impact Factor -
Article: Elevation of B-type natriuretic peptide level in asymptomatic hepatitis B virus-positive patients is not associated with abnormalities of cardiac function.
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ABSTRACT: To compare B-type natriuretic peptide (BNP) and echocardiographic parameters in patients with hepatitis B virus (HBV) and healthy control subjects. 52 consecutive patients with HBV and 47 healthy controls were examined. All subjects underwent transthoracic echocardiography after a complete medical history and laboratory examination including BNP, C-reactive protein (CRP) and high-sensitivity CRP (hsCRP). Demographic characteristics were similar in patients with HBV and the control group. No significant difference was found in conventional Doppler and tissue Doppler parameters between the two groups. BNP levels were significantly higher in patients with HBV [6.5 ng/l (range 0.5-85.2)] than controls [4.3 ng/l (range 0.5-18.3)], p = 0.039. hsCRP [3.25 mg/l (0.02-40.2) vs. 0.5 mg/l (0.02-8.0)] levels were significantly higher in patients with HBV than control subjects (p < 0.001). Patients with HBV had higher BNP, CRP, and hsCRP levels than controls. Echocardiographic findings were similar in both groups. This slight BNP elevation in HBV patients may be related to chronic inflammation due to HBV.Medical Principles and Practice 01/2012; 21(2):150-5. · 0.89 Impact Factor -
Article: The metabolic syndrome is associated with complicated gallstone disease.
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ABSTRACT: Gallstone disease (GD) is a common condition worldwide. Several studies demonstrated that the presence of gallstones is strongly associated with cardiovascular disease. The metabolic syndrome is a highly prevalent cardiovascular condition. To examine the relationship between complicated GD (CGD) and the metabolic syndrome or its components. Two hundred seventeen patients with gallstones were examined. All patients underwent biliary ultrasonography after a complete medical history and laboratory examination. Data collection for the diagnosis of metabolic syndrome included measurements of waist circumference, blood pressure and lipids, and biochemical tests. Of the 217 patients examined, 115 patients (53%) had CGD and 102 patients (47%) had uncomplicated GD (UCGD). There was a significant difference between the number of patients with large gallstones in the CGD and UCGD groups (n=14 [12%] versus n=2 [2%], respectively; P=0.004). Metabolic syndrome, diabetes mellitus and large waist circumference were more prevalent in the CGD group than in the UCGD group. Homeostatic model assessment of insulin resistance scores were higher in the CGD group than in UCGD group (2.51 [95% CI 0.57 to 23.90] versus 2.20 [95% CI 0.09 to 8.87], respectively; P=0.032). Logistic regression analysis revealed that the presence of metabolic syndrome (OR 1.434; 95% CI 1.222 to 1.846, P=0.014), diabetes mellitus (OR 1.493; 95% CI 1.255 to 1.953; P=0.035) and large gallstones (OR 1.153; 95% CI 1.033 to 1.714; P=0.017) were independent predictors of CGD. Results of the present study demonstrated that metabolic syndrome, diabetes and gallstone size were associated with CGD. Further prospective studies are needed to understand the clinical importance of this association.Canadian journal of gastroenterology = Journal canadien de gastroenterologie 05/2011; 25(5):274-6. · 1.21 Impact Factor -
Article: Elevation of QT dispersion after obesity drug sibutramine.
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ABSTRACT: QT dispersion (QTd) is an arrhythmia parameter that can be used to assess homogeneity of cardiac repolarization. An antiobesity drug sibutramine is linked with several cardiovascular adverse events, including arrhythmias. Previous studies showed that sibutramine may prolong the QT interval and may be associated with cardiac arrest. The aim of this study was to evaluate the effect of sibutramine on QTd. The study group consisted of 65 consecutive patients with obesity. All patients were to receive 15 mg of sibutramine once a day in addition to standard care for lifestyle change. Twelve-lead ECG was performed before the onset of the medication and after 16 weeks of treatment. QTd was calculated. Three individuals were withdrawn from the study because of the adverse effects of sibutramine. Sixty-two patients with obesity were recruited into the study. All patients were women (62, 100%). Body weight (106.3 ± 15.0 kg vs. 101.6 ± 16.9 kg, P < 0.001) and low-density lipoprotein cholesterol (128.4 ± 29.7 mg/dl vs. 111.6 ± 24.6 mg/dl, P < 0.001) levels were significantly decreased whereas QTd (46.1 ± 22.6 ms vs. 53.7 ± 16.7 ms, P = 0.026) was significantly increased after 16 weeks of sibutramine treatment. The increase in QTd was not correlated with the decrease in body weight. There was no correlation between QTd and any conditions such as diabetes or hypertension. This study has shown an elevation in QTd, which may lead to cardiac arrhythmias, after sibutramine treatment. Molecular mechanisms may play role in increasing QTd. Further randomized studies are needed to clarify cardiac adverse events of the sibutramine.Journal of Cardiovascular Medicine 11/2010; 11(11):832-5. · 1.51 Impact Factor -
Article: A novel echocardiographic marker in hypertensive patients: is diastolic dysfunction associated with atrial electromechanical abnormalities in hypertension?
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ABSTRACT: Atrial arrhythmias are common problems in hypertensive patients. Atrial electromechanical delay (AEMD) can be used to evaluate development of atrial arrhythmias. The authors aimed to assess inter- and intra-AEMD in hypertensive patients. The study population consisted of 200 medically treated hypertensive patients and 151 normotensive controls. Inter-AEMD and intra-left AEMD were measured from parameters of Doppler tissue imaging. There were 72 (36%) hypertensive patients with diastolic dysfunction, 128 (64%) patients without diastolic dysfunction, and 151 healthy controls. Inter-AEMD (59 ms [36-104 ms] vs 42 ms [36-68 ms] vs 46 ms [30-82 ms]) was significantly higher in hypertensive patients with diastolic dysfunction compared with patients without diastolic dysfunction and controls. Our data demonstrated that inter-AEMD is longer in hypertensive patients with diastolic dysfunction. It may be suggested that diastolic dysfunction is associated with atrial electromechanical abnormalities, which can be associated with atrial fibrillation in hypertension.Journal of Clinical Hypertension 09/2010; 12(9):687-92. · 1.83 Impact Factor -
Article: Is psoriasis a pre-atherosclerotic disease? Increased insulin resistance and impaired endothelial function in patients with psoriasis.
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ABSTRACT: Several studies have shown an association between psoriasis and atherosclerotic risk factors. In this study, we aimed to evaluate endothelial function by flow-mediated dilation (FMD) and insulin resistance by Homeostasis model assessment-insulin resistance (HOMA-IR). We examined 75 consecutive psoriasis patients and 50 healthy controls. All subjects underwent transthoracic echocardiography and brachial artery imaging for detecting FMD. Fasting blood samples were drawn from all subjects for measuring insulin, C-peptide, fasting blood glucose. HOMA-IR was calculated. Baseline characteristics of both groups were similar. Twenty-four psoriatic patients had arthritis. Insulin [9.3 (4.0-208.1) vs. 8.2 (2.3-16.5) mcIU/ml, P = 0.016] and C-peptide [2.5 (0.9-20.0) vs. 2.0 (0.9-3.7) ng/ml, P = 0.009] levels were significantly higher in patients with psoriasis than in controls. HOMA-IR [2.1 (0.8-68.9) vs. 1.8 (0.6-8.6), P = 0.036] was significantly higher in patients with psoriasis than in controls. FMD was reduced in patients with psoriasis compared with healthy controls (5.6 +/- 1.9% vs. 10.9 +/- 1.9%, P < 0.001). This study demonstrated a significant impairment in endothelial function and increased insulin resistance in patients with psoriasis. This is a comprehensive study for identifying atherosclerotic risk factors in psoriasis. We suggest that psoriatic patients should be paid attention for atherosclerosis and its risk factors.International journal of dermatology 06/2010; 49(6):642-6. · 1.18 Impact Factor -
Article: Aspirin resistance is associated with glycemic control, the dose of aspirin, and obesity in type 2 diabetes mellitus.
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ABSTRACT: Aspirin resistance (AR) is increased in diabetic patients. It is not known whether glycemic control has effect on AR. To test the hypothesis that glycemic control might have influence on aspirin resistance, we measured aspirin resistance and glycated hemoglobin (HbA1c) in diabetic patients. We also measured aspirin resistance in nondiabetic subjects and compared the results with the diabetic group. We examined AR in 108 diabetic patients and 67 nondiabetic subjects with impedance platelet aggregometry. Glycemic control was evaluated according to both fasting blood glucose (FBG) and HbA1c levels. According to the analyses, diabetic patients had significantly higher AR (P < 0.01), alanine aminotransferase (P < 0.005), and body mass index (P < 0.05) and significantly lower high-density lipoprotein cholesterol (P < 0.005) levels compared with nondiabetic controls. A correlation analysis revealed that AR was positively correlated with body mass index (r = 0.190, P < 0.01), fasting blood glucose (r = 0.224, P < 0.001), and HbA1c levels (r = 0.297, P < .0001). Using low-dose aspirin (100 mg/d) was a risk factor for aspirin-resistant status in both diabetic patients (odds ratio 1.26, 95% confidence interval 1.01-1.58, P < 0.05) and overall study group (odds ratio 1.3, 95% confidence interval 1.08-1.56, P < 0.01). These data suggest that glycemic control, obesity, and the dose of aspirin have influence on AR in diabetic subjects. Further studies with larger groups are needed to clarify the role of glycemic control on AR.The Journal of clinical endocrinology and metabolism 04/2010; 95(6):2897-901. · 6.50 Impact Factor -
Article: STATIN-D Study: Comparison of the Influences of Rosuvastatin and Fluvastatin Treatment on the Levels of 25 Hydroxyvitamin D.
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ABSTRACT: Several studies have shown that low 25-hydroxyvitamin D levels are associated with higher risk of cardiovascular disease and an increase in 25-hydroxyvitamin D levels protects against cardiovascular disease. In this study, we aimed to compare the effects of rosuvastatin and fluvastatin on vitamin D metabolism. The study population consisted of 134 hyperlipidemic patients who had not previously been treated with lipid lowering medications. Patients were randomized in a 1:1 ratio to rosuvastatin 10 mg or fluvastatin 80 mg XL during the study. Lipid parameters, 25 hydroxyvitamin-D, and bone alkaline phosphatase (BALP) were obtained at baseline and after 8 weeks of rosuvastatin and fluvastatin treatment. Sixty-nine patients were administered rosuvastatin, and 65 patients fluvastatin. Total Cholesterol and LDL cholesterol decreased after 8 weeks of both rosuvastatin and fluvastatin treatments. Rosuvastatin was significantly more effective than fluvastatin on lowering total (P < 0.001) and LDL cholesterol (P < 0.001). There was a significant increase in 25-hydroxyvitamin D with rosuvastatin treatment (P < 0.001), whereas no significant change in 25-hydroxyvitamin D was observed with fluvastatin treatment. Mean BALP fell from 18.5 to 9.6 u/I (P < 0.001) with rosuvastatin and from 17.0 to 12.8 with fluvastatin (P= 0.004). There was no significant difference in BALP levels between rosuvastatin and fluvastatin treatment (P= 0.368). The present study demonstrated that 25-hydroxyvitamin D levels increased with rosuvastatin treatment; whereas fluvastatin treatment had no effect on 25-hydroxyvitamin D. This disparity could be related to the potency or the bioavailability of these two statins. Further studies are needed to clarify the relationship between statins and the vitamin D physiology.Cardiovascular Therapeutics 03/2010; · 2.35 Impact Factor -
Article: Decreasing brain natriuretic peptide levels after treatment for hyperthyroidism.
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ABSTRACT: BNP are produced in ventricular cardiomyocytes, and secreted in response to volume expansion or pressure overload. The purpose of this study was to assess BNP levels in patients with hyperthyroidism before specific treatment for hyperthyroidism and after euthyroidism was achieved. The study was performed in a prospective design. The study population consisted of 48 consecutive newly diagnosed untreated overt hyper-thyroid patients who had not been treated any anti-thyroid medications before. All subjects underwent transt-horacic echocardiography. Levels of fT3, fT4, TSH and BNP were measured before the onset of the treatment and after euthyroidism was achieved. A significant decrease in BNP (102.5 (6.7-1769) ng/L vs. 5.0 (0.1-87.0) ng/L p< 0.001) levels were observed, after euthyroidism was achieved. The decrease in BNP levels was posi-tively correlated with the decrease in fT3 (r=0.298; p=0.049) and fT4 (r=0.313; p=0.030). There was no cor-relation between BNP levels and TSH levels (p=NS). We conclude that hyperthyroidism may cause high BNP measurements which can lead to misdiagnosis of congestive heart failure. We suggest that thyroid hormones should be checked in patients with high levels of BNP.Endocrine Journal 09/2009; 56(9):1043-8. · 2.03 Impact Factor -
Article: Increased mean platelet volume in rheumatic mitral stenosis: a possible factor for thromboembolic events.
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ABSTRACT: Systemic embolism is an important complication in patients with rheumatic mitral stenosis (RMS). The mean platelet volume (MPV) is considered a marker and determinant of platelet function since larger platelets are hemostatically more reactive than platelets of normal size, increasing the propensity to thrombosis. The aim of this study was to investigate MPV in patients with RMS and healthy control subjects. We selected 30 consecutive patients with RMS and 31 consecutive healthy age- and sex-matched control subjects. All subjects were in sinus rhythm. We measured MPV in a blood sample collected in EDTA. Demographic data of the RMS (mean age: 39.5+/-9.9 years, 22 [71%] female) and control groups (mean age: 39.2+/-9.3 years, 20 [67%] female) were similar. The MPV was significantly higher in patients with RMS 8.8 (8.2-11.3) fl than control subjects 8.1 (7.1-9.3) (P<0.001). Elevated MPV might be considered as a marker of increased thromboembolic risk in patients with RMS. We suggest that patients with high MPV values might benefit from antiplatelet therapy.Journal of Cardiology 05/2009; 53(2):204-7. · 1.28 Impact Factor -
Article: The relationship between updated Sydney System score and LDL cholesterol levels in patients infected with Helicobacter pylori.
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ABSTRACT: Helicobacter pylori (H. pylori) chronically infects the human stomach and may cause extra-gastrointestinal diseases. The role of H. pylori in the pathogenesis of atherosclerosis and its effect on lipids remains controversial. The aim of this study was to examine lipid levels in patients with and without H. pylori infection. A total of 244 consecutive patients who underwent esophagogastroduodenoscopy were included in this study. Patients receiving statin and fibrate therapy and diabetic patients were excluded. Biopsies from each individual were taken and analyzed for H. pylori detection using ultrastructural methods. Patients were divided into two groups: H. pylori (+) (group 1) and H. pylori (-) (group 2). Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride levels were measured in all subjects. A total of 163 patients were included in group 1 and 81 patients were included in group 2. Frequency of H. pylori was 67% in the study population. Total cholesterol (204 +/- 39 mg/dl versus 189 +/- 42 mg/dl, respectively; P = 0.007) and LDL-C (128 +/- 30 mg/dl versus 116 +/- 32 mg/dl, respectively; P = 0.003) were significantly higher in group 1 than in group 2. Updated Sydney classification score showed a positive correlation with LDL-C (r = 0.333, P < 0.001) and TC (r = 0.288, P < 0.001) levels. Increased levels of TC and LDL-C were found in patients infected with H. pylori, and updated Sydney System score showed a positive correlation with LDL-C and TC levels. These findings may explain why H. pylori infection is associated with increased risk of atherosclerosis.Digestive Diseases and Sciences 03/2009; 54(3):604-7. · 2.12 Impact Factor -
Article: Hashimoto's thyroiditis is a frequent occurrence in patients with rheumatic mitral stenosis.
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ABSTRACT: Rheumatic mitral stenosis (RMS), an autoimmune sequel of streptococcal infection, causes significant morbidity and mortality. As Hashimoto's thyroiditis (HT) is recognized as the major form of chronic autoimmune thyroiditis, it was hypothesized that the coexistence of HT and RMS might have an autoimmune origin. The study aim was to examine this possible relationship. A total of 55 consecutive patients with RMS was examined and compared to 54 healthy controls with normal echocardiographic findings. All subjects underwent transthoracic echocardiography and thyroid ultrasonography after a complete medical history and laboratory examination. The demographic data of the RMS group (38 females, 17 males; mean age 39.9 +/- 9.3 years) and control group (39 females, 15 males; mean age 39.6 +/- 10.5 years) were similar. HT was found to occur significantly more frequently in RMS patients (n = 16; 29%) than in controls (n = 6; 11%) (p = 0.019) The higher frequency of HT in patients with RMS than controls may have genetic associations. Hence, further genetic-based studies should be conducted to provide a better understanding of this suggested relationship.The Journal of heart valve disease 12/2008; 17(6):635-8. · 0.81 Impact Factor -
Article: Relation of thyroid disfunction, thyroid autoantibodies, and renal function.
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ABSTRACT: Fifty-eight patients with thyroid dysfunction were included, comparing 27 healthy subjects to evaluate the relationship between thyroid autoimmunity, thyroid functional status, and renal function. Regardless of clinical status, hypothyroidism was defined as T3-T4 upper limit of normal, and hyperthyroidism was defined as T3-T4>normal limits and TSH <0.1 mcU/mL. In all participants, serum antithyroperoxidase level, serum antithyroglobulin level, creatinine clearance (CC), and urinary albumin excretion rate (UAER) in 24-h urine collections were measured. Of 85 persons, 41 patients ages 20 to 71 years (median; 44) had hypothyroidism, 17 patients ages 22 to 56 years (median; 32) had hyperthyroidism, and 27 subjects ages 20 to 67 years (median; 50) were normal. Regarding thyroid autoantibody positiveness, the positive group had a higher UAER than the negative group (30.2 mg/day, 20.8 mg/day, respectively; p=0.05). In hypothyroid patients, UAER was significantly higher than in hyperthyroid patients and control subjects (30.1 mg/day, 11.8 mg/day, 10.5 mg/day, respectively; p<0.001). In the hypothyroid population, with regard to UAER and CC, we could not find a significant difference between the thyroid autoantibody positive and negative groups. In view of CC, hypothyroid patients had significantly lower CC than the hyperthyroid group (79.0 mL/ min, 86.5 mL/min, respectively; p<0.01). A careful control of the renal function in thyroid diseases should be evaluated. Renal dysfunction seems to be secondary to hypothyroidism rather than thyroid autoimmunity.Renal Failure 01/2005; 27(6):739-42. · 0.82 Impact Factor
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2009–2011
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Tepecik Teaching and Research Hospital
İzmir, Izmir, Turkey
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