Bone and mineral metabolism disorders are common in patients with chronic kidney disease (CKD). These patients are susceptible to fractures. Bilateral femoral neck fracture secondary to renal osteodystrophy is a rare complication. We report a case of CKD with bilateral spontaneous femoral neck fracture associated with secondary hyperparathyroidism and osteoporosis.

Diabetes Mellitus is a chronic and complex disease with glycemic control at the center of its treatment and requires continuous monitoring and treatment of complications. Clinical studies such as DCCT/EDIC and UKPDS have shown that proper glycemic control is effective in preventing early and late complications of diabetes. Insulin therapy is a critical part of treatment for people with type 1 diabetes and also for many patients with type 2 diabetes.

Obesity is an important public health problem with increasing frequency, leading to different comorbidities including hypertension and can cause mortality. Possible mechanisms that increase blood pressure in overweight and obese people are renal damage, activation of the renin-angiotensin-aldosterone system, insulin resistance, hyperinsulinemia, sleep apnea syndrome, leptin-melanocortin pathway and genetic predisposition. Most of these mechanisms stimulate the sympathetic nervous system. Medical nutrition therapy, lifestyle interventions, medical and/or surgical antiobesity treatment modalities contribute to the control of blood pressure via weight loss. Besides antihypertensive medications should be chosen carefully in overweight and obese patients and drug groups preventing weight loss should not be preferred if possible.

Introduction:Although there are studies evaluating vitamin B12 levels in different patient groups, there is none encountered in Turkish adult patients with or without DM reported in the English literature.The aim of the study was to evaluate the possible additional effects of diabetes and metformin usage on serum levels of vitamin B12 in cobalamin deficient Turkish adult patients. Material and Methods:Medical records of subjects =18 years of age, having a vitamin B12 level <180 pg/mL were screened, consecutive 98 subjects were included in the study. Results:Among a total of 75 female and 23 male subjects with a mean age of 51.3±15.9 years and vitamin B12 level of 139.3±29.2 pg/mL, 34 had the diagnosis of type 2 diabetes mellitus and 64 had no diabetes diagnosis. Mean ages were 59.0±10.8 years for diabetics and 47.2±16.8 years for nondiabetics. Vitamin B12 levels were found to be insignificantly low in people with the diagnosis of diabetes compared to without diabetes (131.2±30.6 and 143.5±27.7 pg/mL, respectively, p=0.05). Vitamin B12 levels had no correlation with diabetes duration, presence of complications, metformin usage duration. Conclusions:In conclusion, our results demonstrated that people with diabetes had lower levels of vitamin B12 compared to nondiabetics but this fact could not solely be explained by the duration of disease, accompanying complications, metformin treatment duration. All patients with or without the diagnosis of diabetes should be encouraged for sufficient vitamin B12 intake and all possible factors that lead to deficiency should be eliminated.

function after kidney transplantation. Methods: Thirteen of all recipients were taking a cyclosporine-based regimen and serum creatinine levels were above 1.5 mg/dL. In 13 patients, MPA treatment was started instead of AZA. Renal functions were evaluated for 12 months after MPA treatment. Results: Serum creatinine levels increased from 2.11±0.48 mg/dL to 2.16±0.72 mg/dL at 12th months. This increase was not statistically significant. Serum creatinine levels decreased in 5 of 13 patients. Conclusion: In selected patients, conversion from AZA to MPA may slow down the rate of deterioration in graft functions.

Central venous catheterization (CVC) is frequently used in urgent intervention needed cases and in patients that require long-term vascular access. The catheter tip perforating the ventricular wall leading to a cardiac tamponade is a complication with high mortality. A 26-year-old female patient with IgA nephropathy was admitted to the emergency department with complaints of fainting at home about 2 months after taking the hemodialysis program through a jugular venous catheter. Echocardiographic evaluation revealed fibrin-rich, intense pericardial fluid located in front of the right ventricle and causing collapse in the right structures (Figure 1). The patient was evaluated as pericardial tamponade upon hypotension (70/40 mmHg) and tachycardia (140 beats/min, Figure 2) existence and pericardiocentesis was planned through the sub-xiphoid region. About 650 ml of hemorrhagic pericardial fluid was evacuated with a pigtail catheter inserted under ultrasound guidance. Patients whose hemogram levels were stabilized, blood pressure and heart rate returned to normal was discharged from the hospital. She was removed from the hemodialysis program after her urea, creatinine and urinary output evaluation and nephrology outpatient control was suggested. This rare, mostly mortal complication had a dramatic response to the appropriate treatment if it is recognized earlier. Adequate training and following procedures for catheter placement will be the most effective prevention to reduce the risk of such complications.