Search

The patient is a 56-year-old male admitted to the hospital for generalized weakness and fever. He was treated in hospital for 10 days due to COVID-19. He did not receive any immunosuppressive therapy during admission. One day after his discharge he experienced back pain and received analgesic therapy for 10 days. About one month later he experienced severe back pain and gross hematuria. He was admitted to hospital with acute kidney injury and new-onset lower extremity muscle weakness. His renal biopsy revealed IgA nephropathy and thoracic/cervical/lumbar-spine imaging showed an epidural abscess. This is a unique case report of a patient developing an epidural abscess and acute kidney injury together as a serious complication of COVID-19 infection.

Introduction: There is insufficient data on the role of the medium cutoff (MCO) membranes in the clearance of pro-inflammatory cytokines and oxidant radicals in patients with sepsis requiring hemodialysis. Methods: The study consisted of 38 septic patients who developed acute kidney injury (AKI) and who were scheduled to undergo 2 sessions of hemodialysis. Nineteen patients underwent their first dialysis session with the MCO membrane and 19 patients with the high-flux (HF) membrane. In the second session, the membranes were switched. Pro-inflammatory cytokine and oxidative marker levels were measured in blood samples obtained before and after both dialysis sessions. Reduction ratios were compared for the 2 types of hemodialysis membranes. Results: After the first session, there was a greater reduction in tumor necrosis factor (TNF)-α with the MCO membrane (28.2 ± 21.1 vs. 8.0 ± 6.6, p = 0.001). After the second session, there was a greater reduction in interleukin (IL)-6 (27.8 ± 26.5 vs. 5.9 ± 13.3, p = 0.003) and IL-1β (20.5 ± 21.1 vs. 4.0 ± 6.5, p = 0.004) with the MCO membrane. When the first and second sessions of all 38 patients were compared, the reductions in TNF-α, IL-6, and IL-1β were consistently greater for MCO than HF (p = 0.001, p = 0.006, p < 0.001, respectively). The reductions in total antioxidant status, total oxidant status, and myeloperoxidase were not statistically different for the 2 types of dialysis membranes. Conclusions: MCO membrane was superior to HF membrane in the removal of cytokines in septic patients with AKI. However, a similar effect was not observed for oxidative stress markers.

Background/aim: Neutrophil gelatinase-associated lipocalin (NGAL) is used previously to estimate the etiology, severity, and clinical outcomes of acute kidney injury (AKI). However, the role of urinary NGAL (uNGAL) in the postrenal setting is not clear. In our study, we aimed to discover the cut-off value of uNGAL that can be used in the differential diagnosis of underlying AKI etiologies. Materials and methods: In this prospective cross-sectional study, we examined 82 subjects in four groups: patients that had (1) postrenal AKI; (2) AKI other than postrenal etiologies; (3) stable chronic kidney disease; and (4) healthy subjects. A renal function assessment was carried out by measuring serum creatininc (sCr) and uNGAL at the time of diagnosis [0th min (T0)]. We followed the study group for three months. Results: At the time of diagnosis, sCr (T0) was highest in the postrenal AKI and AKI groups in contrast to stable chronic kidney disease patients and healthy subjects (P < 0.001), as expected. T0 median uNGAL was highest in the postrenal group (P < 0.001). Area under curve (AUC) of uNGAL to estimate postrenal AKI presence was 0.957 (95% CI, 0.897-1.000; P < 0.001). The cut-off point of uNGAL was 42.625 ng/mL for this estimation. Conclusion: Patients with AKI must be classified according to the underlying etiologies as soon as possible. uNGAL may be useful to estimate the etiologies, and whether the problem is acute or chronic in the course. In postrenal kidney problems, to plan the urgency of the urologic procedures, it is crucial. WOS:000582190800010 2-s2.0-85093663120 PubMed: 32927927

Objective Blood collection tubes (BCTs) related interferences in test results can adversely influence on patient outcomes. We compared test results of samples in BD (Becton-Dickinson, Franklin Lakes, NJ, USA) Vacutainer Serum Separator Tubes (SST), BD Vacutainer® Barricor™ Plasma BCTs (Barricor™) and BD Vacutainer® Rapid Serum Tube (RST). Materials and methods Thirty-two samples were obtained from patients after the hemodialysis were included in this study. Eight routine clinical chemistry parameters (AST, creatinin, urea, PTH, glucose, LDH, K, calcium) were measured on Roche Cobas Analyzer (Roche Diagnostics, North America). The results of samples obtained from RST and Barricor™ were compared with SST as reference tubes. Results Results of Glucose, K, Urea, PTH from the SST and Barricor™ were statistically significantly different (p = 0.017, p Conclusion Working with Barricor™ may provide not just a fast, clean, high-quality plasma samples, safety results, but also time and cost-effectivity. Therefore, these types of tubes, which are less costly than other BCTs, may be preferred to obtain plasma.

Aim: It was aimed to evaluate the awareness levels of patients about hypertension, treatment and control rates. Methods: The descriptive study included 203 patients between ages of 35–80 with a previous diagnosis of hypertension to the primary care outpatient clinic of Ankara Numune Training and Research Hospital in September 2011-January 2012. A 42-item questionnaire was used and 19 questions were used to determine the level of awareness among them. Nine measurements were in the office by the researcher and 12 measurements at home by the patient. Results: 25.6% of the patients were males and 74.4% were females. The median age was 59 years (IQR=13). The section for scoring the awareness levels revealed following: 27.1% of patients were non-aware, 58.6% had a low level of awareness and 14.3% had a high level of awareness. 72.9% of the patients were aware, 93.1% were taking antihypertensive treatment, while 42.4% measured blood pressures both at home and at office are under control. Awareness level is related to diet, exercise, education, salt usage, blood pressure measurement frequency, doctor referral frequency, education and knowledge level about hypertension, blood pressure monitoring branch, antihypertensive treatment status, hypertension duration, number of antihypertensive drugs and regular usage rates; but hypertension control was only associated with salt use, antihypertensive treatment and number of antihypertensive drugs. Conclusion: Hypertension is a common problem in our country and as we have seen in our studies, awareness rates are insufficient. Although the treatment rates are high, the control rates are not sufficient. This suggests that patients' compliance with treatment is not at the desired level. The most important thing to do in this regard is to raise awareness by increasing public awareness about hypertension. In this respect, primary care physicians have a great responsibility.

Background: Although several renal biopsy registry reports have been published worldwide, there are no data on primary glomerular disease trends in Turkey. Methods: Three thousand eight-hundred fifty-eight native kidney biopsy records were assessed in the Turkish Society of Nephrology Primary Glomerulopathy Working Group (TSN-GOLD) Registry. Secondary disease and transplant biopsies were not recorded in the registry. These records were divided into four periods, before 2009, 2009 to 2013, 2013–2017, and 2017–current. Results: A total of 3858 patients (43.6% female, 6.8% elderly) were examined. Nephrotic syndrome was the most common biopsy indication in all periods (58.6%, 53%, 44.1%, 51.6%, respectively). In the whole cohort, IgA nephropathy (IgAN) (25.7%) was the most common PGN with male predominance (62.7%), and IgAN frequency steadily increased through the periods (× 2 = 198, p < 0.001). MGN was the most common nephropathy in the elderly (> 65 years), and there was no trend in this age group. An increasing trend was seen in the frequency of overweight patients (× 2 = 37, p < 0.0001). Although the biopsy rate performed with interventional radiology gradually increased, the mean glomeruli count in the samples did not change over the periods. Conclusions: In Turkey, IgAN is the most common primary glomerulonephritis, and the frequency of this is increasing. © 2022, The Author(s), under exclusive licence to Springer Nature B.V.

Background Hypertension is an early finding of autosomal dominant polycystic kidney disease (ADPKD) and is related to different mechanisms. Cyst expansion related renin secretion or early endothelial dysfunctions are some of these hypotheses. Different course of hypertension in ADPKD preoccupies that relatives of ADPKD patients may also be under risk for this underlying mechanisms. In this study, we aimed to find blood pressure response problems to exercise as an initial vascular problem in unaffected relatives of hypertensive ADPKD patients. Methods The cross-sectional study included 24 unaffected relatives (siblings and children) of ADPKD patients and 30 healthy controls that performed a cycle ergometer test. Additionally, as a marker for endothelial function, nitric oxide (NO) and asymmetric dimethylarginine (ADMA) levels at baseline and post exercise were measured. Results Systolic blood pressure (SBP) and diastolic blood pressure (DBP) increases were similar in both groups during the 1st, 3rd, and 6th min of exercise. During the exercise recovery phase SBP decreased in both groups; however, in the relatives of ADPKD patients DBP remained high at the end of the 6th min, suggesting impaired capacity for exercise-induced vasodilatation. Baseline NO and ADMA, and 1-min NO and ADMA were similar in both groups. Conclusion Abnormal blood pressure response to exercise stress was observed in unaffected normotensive relatives. The observed abnormal DBP response pattern to exercise suggests that arterial vascular responses might be already altered in unaffected relatives of hypertensive ADPKD patients; however, long-term clinical trials are needed to clarify the significance of these findings.

Systemic amyloidosis may affect many organs, and may cause endocrinologic problems which may result in adrenal insufficiency. However, assessment of adrenocortical reserve is challenging in amyloidosis patients with renal involvement. We aimed to evaluate adrenocortical reserve with various methods of cortisol measurement to determine any occult clinical condition.Patients with renal amyloidosis and healthy subjects were evaluated in this cross-sectional study. Basal cortisol, corticosteroid-binding globulin (CBG), and albumin levels were measured. Serum free cortisol (cFC) level was calculated. Cortisol response tests performed after ACTH stimulation test (250 μg, intravenously) were evaluated, and free cortisol index (FCI) was calculated.Twenty renal amyloidosis patients, and 25 healthy control subjects were included in the study. Patients and control subjects had similar median serum baseline cortisol levels [258 (126-423) vs 350 (314-391) nmol/L, p=0.169)] whereas patients' stimulated cortisol levels at the 60ACTH stimulation test and cortisol measurements should be considered in renal amyloidosis patients with severe proteinuria to avoid false positive results if only ACTH stimulation test is used. It will be appropriate to evaluate this group of patients together with estimated measurements as FCI.Sistemik amiloidoz birçok organı etkileyebilir ve adrenal yetmezlikle sonuçlanabilecek endokrinolojik problemlere sebep olabilir. Renal tutulumlu amiloidoz hastalarında ise adrenokortikal rezervi değerlendirmek zordur. Biz bu çalışmada farklı kortizol ölçüm yöntemleri ile renal tutulumlu amiloidoz hastalarında gizli adrenal problemlerini tespit etmeyi planladık.Bu kesitsel çalışmada renal tutulumu olan amilodoz hastalarını ve sağlıklı kontrol grubunu adrenal yetmezlik testleri açısından değerlendirdik. Bazal kortizol ve kortizol bağlayıcı globulin (KBG) ölçüldü. Serum serbest kortizol düzeyi hesaplandı. 250 mcg ACTH stimulasyon testi sonrası kortizol yanıt testleri değerlendirildi ve serbest kortizol indeksi (SKI) hesaplandı.Çalışmaya 20 amilodoz hastası ve 25 sağlıklı kontrol grubu dahil edildi. Bazal serum kortizol düzeyleri hasta ve kontrol grubunda benzerdi [258 (126-423) vs 350 (314-391) nmol/L, p=0.169)]. Ancak amiloidoz grubunda ACTH stimulasyon testi sonrası 60. dk. kortizol yanıtı daha düşüktü [624 (497-685) vs 743 (674-781) nmol/L, p=0.011)]. 20 hastanın 8’inde (40%) bu değer500 nmol/L olarak bulundu. Ancak sadece bu sekiz hastanın üçünde (15%) SKI12 nmol/mg olarak bulundu. Bu üç hasta klinik olarak da adrenal yetmezlikle uyumlu olabilecek bulgular taşıyordu.Ağır proteinürisi olan renal tutulumlu amiloidoz hastalarında, adrenal yetmezlik araştırılırken sadece ACTH stimulasyon testinin kullanılması yanlış pozitifliklere sebep olabilir. Bu grup hastaları SKI gibi hesaplanmış ölçümlerle birlikte değerlendirmek daha uygun olacaktır.

Background and Aims Several glomerular disease registries in Europe, and they shared their data; however, there was a lack of current data on trends of primary glomerulopathy in Turkey. Glomerular disease patterns can change geographical areas and populations decade by decade. Our aim is to present Turkey's primary glomerular disease pattern from 2009 to 2017. Method 3878 native kidney biopsy records were assessed in the Turkish Society of Nephrology Glomerulopathy (TSN-GOLD) Working Group Registry. Secondary disease (lupus, etc.) and transplant biopsies do not enroll in the registry. These records divided into four periods, before 2009, 2009 to 2013, 2013 to 2017, and 2017 to current. Results A total of 3858 patients (M = 2173, K = 1685) were examined. There was no difference in the distribution of number of patients according to periods (Q1 = 968, Q2 = 960, Q3 = 968, Q4 = 962). Nephrotic syndrome was the most common biopsy indication in all quarters (58.6%, 53%, 44.1%, 51.6%, respectively). Glomerulopathy types; Membranous GN (29.9%, n = 290) was the first in Q1 and IgA nephropathy (17.7%, n = 172) was the second. IgA nephropathy (28.5%, n = 274) was the most common glomerulopathy in Q2, while Membranous GN (25.5%, n = 245) was the second most common. IgA nephropathy (29.9%, n = 285) was the most common glomerulopathy in Q3, followed by FSGS (22.9%, n = 222) and Membranous GN. In Q4, FSGS (26.8, n = 258) was the most common glomerulopathy, followed by IgA nephropathy (26.7%, n = 257) and Membranous GN (24.5%, n = 236) (Figure 1). Conclusion While biopsy indications did not change over the years, the incidence of FSGS and IgA nephropathy gradually increased.

Background and Aims Hematuria is one of the most common laboratory findings in nephrology practice. In different regions of the world, the etiologic causes differ. To date, there is no enough data regarding the clinical and histopathologic characteristics of primary glomerular diseases (PGD) patients with hematuria in our country. Method Data were obtained from national multicenter (47 centers) data entered into the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database between May 2009 and June 2019. The data of all PGD patients over the age of 16 years who were diagnosed with renal biopsy and had hematuria data were included in the study. The biopsy samples were processed using a light microscopy and immunofluorescence examination. Demographic characteristics such as age, sex, indications for biopsy, primary glomerular diseases, comorbidities, laboratory and biopsy findings of all patients were also recorded. Hematuria was defined as the presence of at least 5 red blood cells/hpf. Results Data of 3394 patients were included to the study after the exclusion of patients with secondary glomerulonephritis and patients with missing biopsy findings. While 1699 (50.1%) patients had hematuria, 1695 (49.9%) patients did not have hematuria. Demographic, laboratory, and histopathological characteristics of patients with and without hematuria are given in Table. Patients with hematuria had statistically higher systolic blood pressure (SBP), serum blood urea nitrogen, creatinine, albumin, levels and urine pyuria, however, these patients had statistically lower age, body mass index, presence of hypertension and diabetes, eGFR, 24-hour proteinuria, serum total, HDL and LDL-cholesterol and C3 levels when compared with patients without hematuria. Figure depicted the etiologic causes of patients with and without hematuria. According to histopathological findings, number of global sclerotic glomeruli, cellular and fibrocellular crescents, the levels of mesangial proliferation, endocapillary proliferation, exudative changes in glomeruli, severe tubular atrophy, interstitial inflammation, subendothelial deposition, moderate and severe IgA and C3 deposition were found to be significantly higher and the levels of basal membrane thickening, interstitial fibrosis, subepithelial deposition, severe IgG staining were found to be significantly lower in patients with hematuria. Conclusion This is the first multicenter national report regarding the demographic and histopathologic data of PGD patients with or without hematuria. Hematuria, a feature of nephritic syndrome, was found at a higher than expected in the PGDs presenting with nephrotic syndrome in our national database.

Background and Aims In IgA nephropathy (IgAN), which is characterized by mesangial IgA accumulation, there is the formation of circulating autoantibodies against galactose deficient IgA1s (Gd-IgA1). IgG / Gd-IgA1 immunocomplexes accumulate in the glomerular mesangium and play a role in the pathogenesis of IgAN. Recent studies have suggested a relationship between glomerular IgG deposition and the severity of glomerular inflammation. However, detection of the presence and severity of IgG in routine immunofluorescence microscopy (IFM) may fail. This study aims to investigate whether IgG positivity detected by IFM is associated with poor renal prognostic indicators and whether renal prognosis can be predicted according to IgG positivity. Method 4399 patients who were enrolled between May 2009-June 2019 in database of Turkish Society of Nephrology, Glomerular Diseases Working Group (TSN-GOLD) including 44 centers were evaluated. After exclusion criteria, 994 primary IgAN patients were included in the study. Glomerular IgG negative and positive patients were compared by means of Oxford classification scores, histopathological evaluations, proteinuria, creatinine, albumin, blood pressures. IgG positive patients were divided into subgroups according to the grade of the IFM positivity. The relationship between IgG positivity and poor prognosis criteria were evaluated. Results Demographic and biochemical findings of glomerular IgG positive and negative patients at the time of biopsy are shown in Table 1. No difference was found between the groups. There was no difference in the demographic and biochemical findings at the time of biopsy in IgG subgroup analyses (Table 2). There was no difference between the histopathological and Oxford MEST scores of the subgroups. Glomerular IgG positivity was not associated with diastolic blood pressure, systolic blood pressure, urea, uric acid, age, eGFR, albumin, proteinuria (p> 0.05 for all, r= -0.084, r= -0.102, r= -0.006, r=0.062, r= 0.014, r= -0.044, r= -0.061, r= -0.066, r= 0.150, respectively). Conclusion Glomerular IgG positivity detected by routine IFM in IgAN is not associated with poor renal prognostic indicators. It is difficult to predict renal prognosis by looking at the severity of IgG positivity at the baseline evaluation.

Background and Aims According to the data of the Turkish Society of Nephrology-Glomerular Diseases Working Group (TSN-GOLD Working Group), IgA nephropathy is the most common primary glomerular disease in Turkey. The purpose of this study was to investigate the epidemiological and clinical data of IgA nephropathy patients in Turkey. Method 4399 patients with primary glomerular diseases from 47 centers who were followed up between May 2009 and May 2019 were included in the study conducted by TSN-GOLD Working Group. 524 patients were excluded due to lack of pathological data. Among the remaining patients, demographic, clinical and laboratory data of 994 patients with IgA nephropathy were analyzed. Results The median age of the patients was 37 (28-47) years, and 37.3% of them were female. The laboratory and clinical data at the time of diagnosis is presented in Figure-1, and biopsy indications are described in Figure-2. The median number of glomeruli was 16 (IQR: 3.5-4.3), sclerotic glomeruli was 2 (IQR: 1-5), and segmental sclerotic glomeruli was 1 (IQR: 1-2). Exudative changes, subendothelial and subepithelial deposition were present in 566 patients (56.9%), 46 patients (4.6%) and in 38 patients (3.8%), respectively. 662 (66.1%) and 611 of the patients (61.4%) had tubular atrophy and interstitial fibrosis in varying degrees, respectively. 672 (%67.6) and 416 patients (%41.9) had interstitial inflammation and vascular changes, respectively. In immunofluorescence staining, 18%, 30.1%, 4.4%, 68% of the patients had IgG, IgM, C1q and C3 positivity, respectively. Crescentic glomeruli were detected in 227 patients (3.3 ± 3.1 glomeruli). Patients with crescentic glomeruli had significantly higher proteinuria and lower eGFR than the patients without [2203 mg/day (15-26078) vs 1807 mg/day (15-29112); p=0.001; 55.3 ml/min/1.73 m2 (3.72-141.9) vs 72 ml/min/1.73 m2 (3.84-150.81); p Conclusion In this study we found that, the most common presentation of IgA nephropathy patients in our country was asymptomatic urinary abnormalities followed by nephritic and nephrotic syndrome. Higher proteinuria and lower eGFR values in patients with crescentic glomeruli, support the adoption of crescentic lesions in the new Oxford classification (MEST-C) to predict more precise outcome of IgA nephropathy patients. The high number of patients to whom the Oxford classification was applied provided us with the opportunity to examine the clinical reflections of pathological features. Evaluation of the follow-up data of the patients will give us the possibility to reveal the effect of initial clinical and pathological features on clinical findings and renal outcome.

Background and Aims Rapidly progressive glomerulonephritis (RPGN) is a clinical condition that develops due to different etiologic causes, characterized by a rapid and progressive decrease in renal function and progresses to end-stage renal failure in weeks to months if not treated. In our study, diagnostic and demographic characteristics of patients diagnosed with RPGN by biopsy, clinical and laboratory findings in our country were investigated. Method Data were obtained from national multicenter (47 centers) data entered into the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group database between May 2009 and June 2019. Demographic characteristics such as age, sex, indications for biopsy, diagnosis of the glomerular diseases, comorbidities, laboratory and biopsy findings of all patients were recorded. The data presented is cross-sectional and includes application data for the biopsy period. According to their types, RPGN patients were classified as type 1 (anti-GBM related), type 2 (immunocomplex related) and type 3 (immune-negative; “pauci-immune”). Results After exclusion of 46 patients with missing data, 200 patients (mean age 47.9 ± 16.7 years, 44% female) were included in the study which constitutes 5.2% of the total glomerulonephritis database (total number of patients: 3875). Hypertension was present in 62 patients (31.0%) and diabetes was present in 18 patients (9.0%). Renal biopsy was performed in 147 (73.5%) patients due to nephritic syndrome (RPGN included). 80.2% of the patients' biopsies were performed in nephrology clinics and 19.8% of them were performed in radiology clinics. ANCA positivity was found in 121 (60.5%) patients (proteinase 3-ANCA was positive in 55 and myeloperoxidase-ANCA positive in 66 patients). Type 1 RPGN was detected in 11 (5.5%), type 2 RPGN in 42 (21%) and type 3 RPGN in 147 (73.5%) patients. In 21 patients (10.5%), biopsy revealed RPGN with advanced chronic changes (fibrous global sclerotic glomeruli, advanced interstitial fibrosis and tubular atrophy). Mean serum creatinine was 4.2 ± 3.4 mg/dl, median glomerular filtration rate was 18 (10-37) ml/min and proteinuria 2100 (1229-3526) mg/day according to CKD-EPI formula. The mean number of glomeruli in the biopsies was 18.8 ± 10.6 and the number of crescentic glomeruli was 9.9 ± 7.7 (ratio: 52.7%) (Figure). The patients were divided into 3 groups according to their crescentic glomeruli ratios. The proportion of crescentic glomeruli is 10-50% in group 1, 50-80% in group 2, and >80% in group 3. The demographic, laboratory and histopathological characteristics of the groups are given in Figure. It was observed that urea and creatinine increased and calcium and hemoglobin decreased with increasing crescentic glomerular ratio. Conclusion Our study provides valuable demographic, clinical, laboratory and histopathological data about RPGN in our country. Our data are generally compatible with the literature. In our study, advanced chronic histopathological findings were prominent in the biopsy of 21 patients. Early biopsy should be performed to confirm the diagnosis of RPGN and to avoid unnecessary intensive immunosuppressive therapy. In addition to the treatments applied, detailed data, including patient and renal survival are needed.

Background and Aims The largest data on the epidemiology of primary glomerular diseases (PGD) are obtained from the databases of countries or centers. Here, we presented the extended results of the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD)Working Group. Method The data of patients who underwent renal biopsy and diagnosed as primary glomerular disease were recorded in the database prepared for the study. Between May 2009 and May 2019, a total of 4399 patients from 47 centers were evaluated. Basal data of 3875 patients were analyzed after exclusion of those lacking light microscopy and immunofluorescence findings. Results The mean age was 41.5 ± 14.9 years. Of the patients, 1690 were female (43.6%) and 2180 (56.3%) were male. Nephrotic syndrome was the most common biopsy indication (51.7%). This was followed by asymptomatic urinary abnormalities (18.3%) and nephritic syndrome (17.8%). The most common PGH was IgA nephropathy (25.7%), followed by membranous nephropathy (25.6%) and FSGS (21.9%). The mean total number of glomeruli per biopsy was 17 ± 10. Mean baseline systolic blood pressure was 130 ± 20 mmHg and diastolic blood pressure was 81 ± 12 mmHg. Median proteinuria was 3300 (IQR: 1467-6307) mg / day, mean serum creatinine, estimated GFR and albumin values were 1.4 ± 1.5 mg / dl, 80.7 ± 39.1 ml / min and 3.2 ± 0.9 g / dl, respectively. Conclusion In Turkey, the incidence of IgA nephropathy patients have become more common than membranous nephropathy among PGD patients diagnosed with renal biopsy.

10th International Congress on Psychopharmacology & 6th International Symposium on Child and Adolescent Psychopharmacology[Abstract:0110] [Addiction]Cessation of cigarette smoking in adolescents: s...

Amac: Bu calismada kronik bobrek hastaligi olan hastalarda dinamik tiyol/disulfid dengesinin arastirilmasi amaclandi. Gerec ve Yontem: Calismaya evre 1-5 (non diyaliz) 150 ( 57 erkek, 93 kadin) kronik bobrek hastasi ve (76 ( 30 erkek, 46 kadin ) saglikli kontrol grubu alindi. Kan tiyol/disulfid dengesi yeni gelistirilen otomatik ve kalorimetrik bir yontemle olculdu. Bulgular: Tum populasyonun serum thiol duzeyi ortalamasi 320.8±57.8 µmol/L , total thiol duzeyi ortalamasi 352.0±61.5 µmol/L , ortalama disulfid duzeyi 15.6±5.3 µmol/L idi. Kronik bobrek hastalarinda ortalama serum thiol ( p

Israiliyat, Islam kaynaklarina ve bilhassa tefsir kulliyatina girmis olan Yahudi, Hiristiyan ve diger dinlere ait kulturel kalintilarla, dinin lehine veya aleyhine uydurulup Hz. Peygamber (s.a.v.)’e, sahabeye ve sonraki nesillere izafe edilen her turlu haber israiliyat diye nitelendirilmektedir. Buyuk olcude sozlu olarak nakledilen israiliyatin ozellikle rivayete dayali klasik tefsirlerde onemli bir yeri vardir. Israiliyatla ilgili nakiller tefsir ilminin onemli konularindan biridir. saglam ve zayifi tefrik edilmeksizin nakledilen israiliyat dinimize girerek tehlikeli yaralar acmistir. Modern donem Kur’an ve tefsir arastirmalarindaki genel yaklasima gore israiliyat, bilhassa rivayet agirlikli tefsir edebiyatindaki temel sorunlardan olup zayiflik sebebi sayilabilecek ciddi bir tefsir problemi olarak gorulur. Biz bu calismamizda Ibâzi mezhebi mensuplarinca Kutbu’l-Eimme diye tavsif edilen ve telif ettigi uc tefsir ile Ibâzi tefsir tarihinin en dikkat cekici mufessiri olan Muhammed bin Yusuf Itfiyyis’in Tefsir’e dair yazdigi son eser olan Teysiru’t-Tefsir baglaminda israiliyat konusuna yaklasimini ve bunun eserine yansimalarini ele almaya calistik.

Various anatomical and physiological changes occur in the kidneys on aging. Systemic hemodynamics in kidney functioning, which is quite important in aging-induced adaptation to these changes, undermines the ability of the kidneys. Acute kidney injury and fluid balance in the head, including the development of the deterioration of many older patients with kidney disease, are much more frequently observed. There is an increase in the frequency of comorbid diseases and related drug use in this age group. Many causes of renal pathology have emerged.

The kidney is a structurally and functionally complex organ that plays an important role in control and regulation of homeostasis with various reabsorptive, secretory, metabolic and endocrine functions. High levels of lead exposure is indicated as a cause of chronic renal injury. Chronic occupational exposure to lead, or consumption of illicit alcohol adulterated with lead, has also been linked to a high incidence of renal dysfunction, which is characterized by glomerular and tubulointerstitial changes resulting in chronic kidney disease, hypertension, hyperuricemia and gout. Here, we aimed to report a patient who has hipertension and high uric asit level and was 6.5 years working for the battery factory with high creatinin levels, and result of renal biopsy intranuclear electron dense deposits were found in some of the round tubular epithelial nuclei., Böbrek, çeşitli reabsorpsiyon, sekresyon, metabolik ve endokrin fonksiyonların düzenlenmesinde ve kontrolünde önemli bir rol oynayan, yapısal ve işlevsel olarak kompleks bir organdır. Yüksek düzeyde kurşun maruziyeti kronik böbrek hastalığının bir nedeni olarak gösterilir. Mesleki nedenlerle kronik kurşun maruziyeti veya içine kurşun karıştırılmış yasadışı alkol tüketimi, kronik böbrek hastalığı ile sonuçlanan glomerüler ve tübülointerstisyel değişiklikler, hipertansiyon, hiperürisemi ve gut ile karakterize böbrek fonksiyon bozukluğu ile yüksek oranda ilişkilidir. Biz burada 6,5 yıldır pil fabrikasında çalışan, hipertansiyonu ve ürik asit yüksekliği olan, kreatinin yüksekliği ile başvuran ve renal biyopsisinde yuvarlak tübül epitelyal nükleusların etrafında intranükleer elektron dense depositler olan etiyolojik açıdan başka bir neden tespit edilememiş bir hastayı tartışmayı amaçladık.

Background The largest data on the epidemiology of primary glomerular diseases (PGDs) are obtained from the databases of countries or centers. Here, we present the extended results of the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group. Methods Data of patients who underwent renal biopsy and received the diagnosis of PGD were recorded in the database prepared for the study. A total of 4399 patients from 47 centers were evaluated between May 2009 and May 2019. The data obtained at the time of kidney biopsy were analyzed. After the exclusion of patients without light microscopy and immunofluorescence microscopy findings, a total of 3875 patients were included in the study. Results The mean age was 41.5 ± 14.9 years. 1690 patients were female (43.6%) and 2185 (56.3%) were male. Nephrotic syndrome was the most common biopsy indication (51.7%). This was followed by asymptomatic urinary abnormalities (18.3%) and nephritic syndrome (17.8%). The most common PGD was IgA nephropathy (25.7%) followed by membranous nephropathy (25.6%) and focal segmental glomerulosclerosis (21.9%). The mean total number of glomeruli per biopsy was 17 ± 10. The mean baseline systolic blood pressure was 130 ± 20 mmHg and diastolic blood pressure was 81 ± 12 mmHg. The median proteinuria, serum creatinine, estimated GFR, and mean albumin values were 3300 (IQR: 1467–6307) mg/day, 1.0 (IQR: 0.7–1.6) mg/dL, 82.9 (IQR: 47.0–113.0) mL/min and 3.2 ± 0.9 g/dL, respectively. Conclusions The distribution of PGDs in Turkey has become similar to that in other European countries. IgA nephropathy diagnosed via renal biopsy has become more prevalent compared to membranous nephropathy.

Background: In our study, diagnostic and demographic characteristics of patients diagnosed with RPGN by biopsy, clinical and laboratory findings in our country were investigated. Methods: Data were obtained from the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group database. Demographic characteristics, indications for biopsy, diagnosis of the glomerular diseases, comorbidities, laboratory and biopsy findings of all patients were recorded. According to their types, RPGN patients were classified as type 1 (anti-GBM related), type 2 (immuncomplex related) and type 3 (pauci-immune). Results: Of 3875 patients, 200 patients with RPGN (mean age 47.9 ± 16.7 years) were included in the study which constitutes 5.2% of the total glomerulonephritis database. Renal biopsy was performed in 147 (73.5%) patients due to nephritic syndrome. ANCA positivity was found in 121 (60.5%) patients. Type 1 RPGN was detected in 11 (5.5%), type 2 RPGN in 42 (21%) and type 3 RPGN in 147 (73.5%) patients. Median serum creatinine was 3.4 (1.9–5.7) mg/dl, glomerular filtration rate was 18 (10–37) ml/min/1.73m2 and proteinuria 2100 (1229–3526) mg/day. The number of crescentic glomeruli ratio was ratio 52.7%. It was observed that urea and creatinine increased and calcium and hemoglobin decreased with increasing crescentic glomerular ratio. Conclusions: Our data are generally compatible with the literature. Advanced chronic histopathological findings were prominent in the biopsy of 21 patients. Early biopsy should be performed to confirm the diagnosis of RPGN and to avoid unnecessary intensive immunosuppressive therapy. In addition to the treatments applied, detailed data, including patient and renal survival, are needed. © 2020, Japanese Society of Nephrology.

Calcium channel blockers (CCBs) are commonly used agents in the treatment of hypertension as part of monotherapy or combination therapy. Peripheral edema is the most common side effect that requires discontinuation or replacement of treatment. Some studies in the literature have shown that long-acting dihydropyridine type CCBs lead chylous ascites in peritoneal dialysis patients. However, amlodipine-associated serous ascites cases are not available in the literature.In this case report, we describe a rare case of amlodipine induced massive ascites in a 30-year-old male with renal transplantation.We aimed to create awareness that pharmacologic causes should be considered in cases of ascites of unknown aetiology.

High dietary salt intake was reported to increase blood pressure by numerous studies, but no study has investigated the effect of dietary salt intake on blood pressure variability (BPV). This study aimed to determine if daily salt intake is related to ambulatory BPV. The study included 136 primary hypertensive patients (92 male, 44 female) with a mean age of 50.7 +/- 11.1 years. All the patients underwent 24-h ambulatory blood pressure monitoring to determine both the 24-h systolic and 24-h diastolic BPV. 24-h urine sodium was measured. The correlation between BPV and 24-h urinary sodium was investigated. Logarithmic transformation of 24-h urinary sodium [log(24-h urinary sodium)] was positively correlated with the mean 24-h systolic ARV, and nighttime systolic ARV (r=0.371 and p=0.001, r=0.329 and p=0.028, respectively). Similarly, log(24-h urinary sodium) was positively correlated with mean 24-h diastolic ARV and nighttime diastolic ARV (r=0.381 and p=0.001, r = 0.320 and p=0.020 respectively). Log(24-h urinary sodium) was an independent predictor of BPV based on multivariate regression analysis. Dietary salt intake might play a role in the pathogenesis of ambulatory BPV. (C) 2016 Sociedad Espanola de Nefrologia. Published by Elsevier Espana, S.L.U.

In this study, our aim was to determine total oxidative stress and asymmetric dimethylarginine (ADMA) levels in patients with masked hypertension (MHT) and to examine their association with blood pressure.Fifty patients diagnosed with MHT and 48 healthy volunteers without any known chronic diseases have been included in this study.When compared to the control group, patients with MHT had higher levels of mean ADMA (p0.001), total oxidant status (TOS) (p0.001), and oxidative stress index (OSI) (p0.001), and a lower mean total antioxidant status (TAS) (p0.001) level. While a positive correlation was determined between the systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels with ADMA, TOS, and OSI levels, a negative correlation was determined with the TAS level. During the stepwise multivariable logistic regression analysis, age (OR = 1.221; p = 0.003), body mass index (OR = 1.512; p = 0.005), low density lipoprotein (OR = 0.925; p = 0.016), ADMA (OR = 1.200; p = 0.002), and OSI (OR = 3.750; p = 0.002) levels were determined to be the predictors of MHT. During the linear regression analysis, it was determined that the independent risk factors of SBP and DBP are ADMA and OSI, and the independent risk factor of TOS, OSI, and ADMA is SBP. Our study found out that oxidative stress and ADMA levels of patients with MHT are higher than those of the control group. ADMA and OSI were determined to be predictors of MHT.Based on these results, it could be said that oxidative stress, and therefore the ADMA level, could have an effect on the etiopathogenesis of MHT.

Aim: Contrast-induced acute kidney injury (AKI) may be seen after contrast agent exposure which is known as nephrotoxic. It is fact that, patients with AKI have an increased risk after contrast exposure compared to patients with normal renal function values. However, the incidence of contrast nephropathy after contrast exposure with AKI is not clear. In this study, we planned to investigate the incidence of contrast nephropathy in patients undergoing coronary angiography with AKI and whether there is an increased risk compared to the control group. Materials and Methods: The study was planned as a retrospective study and we investigated the clinical outcome of patients who underwent isoosmolar contrast angiography in the arterial phase with acute kidney injury between January 2014 and December 2017. Results: The number of AKI patients included in the study was 280 and the control group consisted of 478 participants. There was no statistically significant difference between two groups. (3.2% (n: 9) of patients with AKI contrast nephropathy vs 6.5% (n: 31) of patients with normal kidney function and contrast nephropathy) (p> 0.05). On the other hand, there was statistically significant difference between two groups according to diabetes mellitus (patients with contrast nephropathy 26 (65%) had diabetes vs 14 (35%) participants had no diabetes). This difference was statistically significant (p

Background: Fabry disease (FD) is an X-linked lysosomal storage disorder resulting from lack of alpha-galactosidase A (AGALA) activity in lysosomes. Objective: In this multicenter study, we aimed to evaluate the prevalence of FD in renal transplant (Tx) recipients in Turkey. We also screened dialysis patients as a control group. Methods: All Tx and dialysis patients were screened regardless of the presence of a primary disease. We measured the AGALA activity in all male patients as initial analysis. Mutation analysis was performed in male patients with decreased AGALA activity and in female patients as the initial diagnostic assay. Results: We screened 5,657 patients. A total of 17 mutations were identified. No significant difference was observed between the groups regarding the prevalence of patients with mutation. We found FD even in patients with presumed primary kidney diseases. Seventy-one relatives were analyzed and mutation was detected in 43 of them. We detected a patient with a new, unknown mutation (p.Cys223) in the GLA gene. Conclusions: There are important implications of the screening. First, detection of the undiagnosed patients leads to starting appropriate therapies for these patients. Second, the transmission of the disease to future generations may be prevented by prenatal screening after appropriate genetic counseling. In conclusion, we suggest screening of kidney Tx candidates for FD, regardless of etiologies of chronic kidney disease. (C) 2019 S. Karger AG, Basel C1 [Yalin, Serkan Feyyaz; Senates, Banu Erkalma; Oruc, Meric; Altiparmak, Mehmet Riza; Seyahi, Nurhan] Istanbul Univ Cerrahpasa, Cerrahpasa Med Fac, Dept Nephrol, Istanbul, Turkey. [Eren, Necmi] Kocaeli Univ, Dept Nephrol, Med Fac, Kocaeli, Turkey. [Sinangil, Ayse; Ecder, Tevfik] Bilim Univ, Dept Nephrol, Med Fac Med, Istanbul, Turkey. [Yilmaz, Vural Taner; Kocak, Huseyin] Akdeniz Univ, Div Nephrol, Med Fac, Antalya, Turkey. [Tatar, Erhan; Uslu, Adam] Bozyaka Training & Res Hosp, Dept Nephrol, Izmir, Turkey. [Ucarf, Ali Riza; Demir, Erol; Caliskan, Yasar; Turkmen, Aydin] Istanbul Univ, Fac Med, Div Nephrol, Istanbul, Turkey. [Sevinc, Mustafa; Basturk, Taner] Sisli Hamidiye Etfal Training & Res Hosp, Dept Nephrol, Istanbul, Turkey. [Can, Ozgur; Ogutmen, Melike Betul] Haydarpasa Training & Res Hosp, Dept Nephrol, Istanbul, Turkey. [Gurkan, Alp; Kinalp, Can] Medicana, Dept Nephrol, Istanbul, Turkey. [Arik, Nurol] Ondokuz Mayis Univ, Dept Nephrol, Med Fac, Samsun, Turkey. [Ecder, Sabahat Alisir] Medeniyet Univ, Div Nephrol, Goztepe Training & Res Hosp, Istanbul, Turkey. [Uyar, Murathan] Gaziosmanpasa Hosp, Dept Nephrol, Istanbul, Turkey. [Yasar, Murat; Dursun, Belda] Pamukkale Univ, Dept Nephrol, Med Fac, Denizli, Turkey. [Gulcicek, Sibel] Istanbul Training & Res Hosp, Dept Nephrol, Istanbul, Turkey. [Mese, Meral; Bahcebasi, Zerrin Bicik] Dr Lufti Kirdar Kartal Training & Res Hosp, Dept Nephrol, Istanbul, Turkey. [Dheir, Hamad; Sipahi, Savas; Genc, Ahmed] Sakarya Univ, Dept Nephrol, Tip Med Fac, Sakarya, Turkey. [Cakir, Ulkem] Acibadem Univ, Dept Nephrol, Med Fac, Istanbul, Turkey. [Cevher, Simal Koksal; Dede, Fatih] Ankara Numune Training & Res Hosp, Dept Nephrol, Ankara, Turkey. [Turkmen, Kultigin] Necmettin Erbakan Univ, Div Nephrol, Meram Med Fac, Konya, Turkey. [Guven, Bahtisen] Bahcesehir Univ, Dept Nephrol, Med Fac, Istanbul, Turkey. [Taymez, Dilek Guven] Kocaeli State Hosp, Dept Nephrol, Kocaeli, Turkey. [Yelken, Berna] Mem Hosp, Dept Nephrol, Istanbul, Turkey.

Objective: Patients with chronic kidney disease (CKD) may experience psychiatric problems while having to cope with the various characteristics of the disease. Identifying the level of hope, coping strategies, and perceived social support may provide valuable information to improve treatment plans and the response to treatment. This study aimed to evaluate the association between hope, anxiety, depression, coping strategies, and perceived social support in patients with CKD. Method: A total of 65 grade 3 or 4 CKD patients and a healthy control group (51 volunteers) with matched baseline sociodemographic characteristics were included. The participants were evaluated using a sociodemographic data form, the Herth Hope Scale (HHS), Hospital Anxiety Depression Scale (HADS), COPE Inventory, and the Multidimensional Scale of Perceived Social Support (MSPSS). Results: The level of hope was lower, depression scores were higher and non-functional coping strategies were observed more often in patients with CKD compared to the healthy control group. In multiple linear regression analysis, anxiety and depression levels were found to have a negative effect and perceived social support by the family a positive effect on the level of hope in patients with CKD. Conclusion: Anxiety, depression, and perceived social support by the family predict the hope level of patients with CKD. A multidisciplinary approach including psychiatric consultation should be adopted in the treatment of patients with CKD as hope plays an important role in treatment compliance. © 2019 Yerkure Tanitim ve Yayincilik Hizmetleri A.S. All Rights Reserved.

BACKGROUND Blood from patients who are receiving anticoagulant therapy may take longer to clot. Anticoagulation is an important component of the dialysis prescription. We compared BD Vacutainer® Barricor™ Plasma Blood Collection Tubes (BD BarrricorTM), BD Vacutainer® PST™ Lithium Heparin Tubes (BD PST™), and BD (Becton-Dickinson, Franklin Lakes, NJ, USA) Vacutainer Serum Separator Tubes (BD SST), as reference tube in dialysis patients to examine whether they had an effect on routine biochemical tests. MATERIALS AND METHODS A total of 29 chronic hemodialysis patients were included in this study. Samples were collected into BD BarrricorTM, BD PST™, and BD SST tubes after the dialysis. All the tubes were centrifuged by NF 1200R rotor (1,300 g for 10 minutes at 22°C, 1,200 g for 10 minutes at 4°C, 2,400 g for 10 minutes at 22°C, respectively) after the incubation period. Eleven routine clinical chemistry parameters (Creatinine, Urea, Na, K, Cl, AST, ALT, Total Bilirubin, Direct Bilirubin, Calcium, Cholesterol) were analyzed on a Beckman Coulter AU 5800. RESULTS Results of creatinine, K and cholesterol were statistically significantly different between the SST and LiH (p = 0.014, p = 0.009, and p < 0.001, respectively). In terms of other biochemical parameters we tested for all three tubes there was no clinically significance inspite of the statistically significance. CONCLUSIONS BD Barricor™ tubes provide fast, clean, high-quality plasma samples, safe results, and may lower times and costs.

Introduction: We aimed to investigatethe effects of social and artistic activity support on quality of life, painperception, and anxiety status in hemodialysis (HD) patients and the relationbetween occupational therapy and frequent complications of HD.Methods: Volunteer instructors trained 22patients participated in this study for wood painting for 4 hours/day, 2-3 daysa week for six months. The State-Trait Anxiety Inventory (STAI I and STAI II)and Visual Analog Scale were applied before the social activity and at the 6thmonth. The quality of life evaluated with Short Form-36.Results: The patients who participated in the socialactivity more than 25 hours formed the study group (n=9), and thoseparticipated less than 25 hours made control group (n=13). There weresignificant differences in initial and 6th month values in both STAI I and STAIII scores of the study group, and only in STAI II score in the control group(p=0.008, p=0.015, p=0.003, respectively). In the study group, while STAI I andII mean was 49.9 and 52.8 in the first month, respectively, it decreased to30.0 and 38.8 in 6th month, respectively. In the control group, in the firstmonth mean of STAI II score was 56.9 and it decreased to 45.3 in the sixthmonth. The mean of physical function capacity from SF-36 parameters increasedfrom 73.9 to 84.4 (p=0.026) in the study group and from 47.7 to 75.8 (p=0.002)in the control group. The difference between study and control group wasstatistically significant (p = 0.029).Conclusions: Our results support that social and artisticactivities during HD have positive effects on chronic HD patients in terms ofphysical functioning level., Giriş: Sosyal ve sanatsal etkinlik desteğininhemodiyaliz (HD) hastalarında yaşam kalitesi, ağrı algısı ve anksiyete durumuüzerindeki etkilerini ve mesleki tedavinin HD sırasında sık görülenkomplikasyonlarla ilişkisini araştırmayı amaçladık.Yöntem: Gönüllü eğitmenler, bu çalışma için 22katılımcıyı 6 ay boyunca, haftada 2-3 gün, günde 4 saat ahşap boyama aktivitesiçalıştırdılar. Sosyal aktivite öncesi ve 6. ayda Durumluluk ve Sürekli KaygıÖlçekleri (STAI I ve STAI II) ve Vizuel Analog Skala uyguladı. Yaşam kalitesiKısa Form-36 ile değerlendirildi.Bulgular: Sosyalaktiviteye 25 saatten fazla katılan hastalar çalışma grubunu (n=9)oluştururken, kontrol grubu (n=13) aktiviteye 25 saatten daha az katılanlardanoluşuyordu. Çalışma grubunun hem STAI I ve hem de STAI II skorlarında, kontrolgrubunda ise sadece STAI II skorlarında ilk ve 6. ay değerleri arasında anlamlıfarklılıklar vardı (sırasıyla p=0,008, p=0,015, p=0,003). Çalışma grubundasırasıyla STAI I ve II ortalamaları ilk ay 49,9 ve 52,8 iken, 6. Ayda sırasıyla30,0 ve 38,8’e düştü. Kontrol grubunda ilk ay STAI II skoru ortalaması 56,9olup, 6. Ayda 45,3’e düştü. SF-36 parametrelerinden fiziksel fonksiyonkapasitesinin ortalaması çalışma grubunda 73,9’dan 84,4’e (p=0,026), kontrolgrubunda 47,7’den 75,8’e (p=0,002) yükseldi. Çalışma ve kontrol grubuarasındaki değişim istatistiksel olarak anlamlı bulundu (p = 0,029).Sonuç: Sonuçlarımız, HD sırasındasosyal ve sanatsal aktivitelerin fiziksel işlev düzeyi açısından kronik HDhastaları üzerinde olumlu etkileri olduğunu desteklemektedir.

Amac : Urik asit, purin metabolizmasinin son urunu ve gut icin iyi bilinen bir risk faktorudur. Bununla birlikte, yuksek serum urik asit duzeyleri insulin rezistansi, obezite , hipertansiyon, renal disfonksiyon, hipotiroidi gibi bircok hastalikla iliskili bulunmustur. Ote yandan, urik asidin kardiyovaskuler morbiditede nedensel bir rol oynayip oynamadigi tartisilmaktadir. Calismamizda serum urik asit (UA) ve kalp yetmezligi prognostik belirteci olan N terminal pro B - tipi Natriuretik P eptit ( NT-proBNP ) duzeyleri ile sol ventrikul f onksiyon bozuklugu arasinda iliski olup olmadigini arastirmayi amacladik. Materyal ve Metot : Calisma retrospektif olarak planlandi. Mart 2016 ile Subat 2017 tarihleri arasinda Ankara Numune Egitim ve Arastirma Hastanesi Kardiyoloji Servisi ve Koroner Yogun Bakimda yatan 326 hasta calismaya dahil edildi. Bu hastalarin serum UA, NT-proBNP duzeyleri ile ejeksiyon fraksiyonu (EF) bulgulari hastane enformasyon sisteminden alindi. Hastalar serum UA duzeylerine gore 4 gruba ayrildi (1. grup UA; 2 , 7-4 , 9 mg/dL, 2. g rup UA; 5-6 mg/dL, 3. grup UA; 6 , 1-7 , 4 mg/dL, 4. grup UA; 7 , 5-15 , 6 mg/dL). Gruplar arasinda parametreler ANOVA testi kullanilarak karsilastirildi. Ayrica, sol ventrikul disfonksiyon bulgularinda urat duzeylerine gore degisimler incelenirken, cinsiyet, yas ve eGFR ‘nin bu parametreler uzerindeki etkileri degerlendirildi. Degiskenler arasinda iliski icin Pearson korelasyon testi kullanildi. Bulgular: 4. grup; yas, NT-proBNP, eGFR diger gruplardan anlamli duzeyde farkliydi (p

Amaç: Ürik asit, pürin metabolizmasının son ürünü ve gut için iyi bilinen birrisk faktörüdür. Bununla birlikte, yüksek serum ürik asit düzeyleri insülinrezistansı, obezite,hipertansiyon, renal disfonksiyon, hipotiroidi gibi birçok hastalıkla ilişkilibulunmuştur. Öte yandan, ürik asidin kardiyovaskülermorbiditede nedensel bir rol oynayıp oynamadığı tartışılmaktadır. Çalışmamızda serum ürik asit(ÜA) ve kalp yetmezliği prognostik belirteci olan Nterminal pro B-tipi Natriüretik Peptit (NT-proBNP) düzeyleri ile sol ventrikül fonksiyonbozukluğu arasında ilişki olup olmadığını araştırmayı amaçladık.Materyal ve Metot: Çalışma retrospektifolarak planlandı. Mart 2016 ile Şubat 2017 tarihleri arasında Ankara NumuneEğitim ve Araştırma Hastanesi Kardiyoloji Servisi ve Koroner Yoğun Bakımda yatan 326 hasta çalışmaya dahil edildi. Bu hastaların serum ÜA,NT-proBNP düzeyleri ile ejeksiyon fraksiyonu (EF) bulguları hastane enformasyonsisteminden alındı. Hastalar serum ÜA düzeylerine göre 4 gruba ayrıldı (1. grupÜA; 2,7-4,9 mg/dL, 2. grup ÜA; 5-6 mg/dL, 3. grup ÜA; 6,1-7,4mg/dL, 4. grup ÜA; 7,5-15,6 mg/dL). Gruplar arasında parametreler ANOVA testikullanılarak karşılaştırıldı. Ayrıca, sol ventrikül disfonksiyon bulgularındaürat düzeylerine göre değişimler incelenirken, cinsiyet, yaş ve eGFR ‘nin bu parametreler üzerindeki etkilerideğerlendirildi. Değişkenler arasında ilişki için Pearson korelasyon testikullanıldı.Bulgular: 4. grup; yaş,NT-proBNP, eGFR diğer gruplardan anlamlı düzeyde farklıydı (p, Objectives: Uric acid (UA) is the end-product of purine metabolism and is a well-known risk factor for gout disease. In addition to that, elevated serum UA levels have been associated with many disorders including insulin resistance, obesity, hypertension, renal dysfunction and hypothyroidism. On the other hand, whether uric acid has any causal relationship with cardiovascular morbidity is a debated issue. Materials and Methods: This retrospective study included totally 326 patients who were inpatients at the Cardiology Ward or Coronary Intensive Care Unit of Ankara Numune Training and Research Hospital between March 2016 and February 2017. Data regarding serum UA and N-terminal pro B-type Natriuretic Peptide (NT-proBNP) levels and left ventricular ejection fraction %) LVEF) were retrieved from the hospital information system. Patients were categorized into four groups based on their UA levels (Group 1 UA: 2.7-4.9 mg/dL, Group 2 UA: 5-6 mg/dL, Group 3 UA: 6.1-7.4 mg/dL, Group 4 UA: 7.5-15.6 mg/dL). Other parameters were compared between the groups using ANOVA test. Additionally, the effects of gender, age and eGFR were also examined when evaluating the changes in left ventricular function according to UA levels. Correlation between the variables was analyzed with Pearson’s correlation test.Results: Group 4 was significantly different than the rest of the groups in terms of age, NT-proBNP and eGFR (p

BackgroundThere is a strong association between chronic kidney disease (CKD) and cardiovascular events. Increased arrhythmia risk in kidney disease is one of the main predominant factors in increased mortality and sudden cardiac death. To estimate this risk, noninvasive measurement of repolarization abnormalities including QT interval and its heart rate-corrected value (QTc) with surface ECG, are commonly used parameters in clinical practice. The aim of this study is to examine the effect of CKD-related problems – mainly acidosis – on QT intervals.Methods30 patients with stage 3–5 CKD whose serum bicarbonate concentrations below 20 mmol/L were included in the study. Alkali therapy with oral sodium bicarbonate was used to maintain the serum bicarbonate concentration in the normal range. At the beginning all patients had sinus rhythm on surface ECG records. Kidney function tests including serum urea, serum creatinine, uric acid, blood gas analysis, and electrolytes were analyzed at the beginning and at the end of alkali treatment. All patients underwent 12 lead-ECGs, recorded simultaneously. One cardiologist examined the ECGs manually in terms of QT intervals, corrected for heart rate (QTc), QT dispersion (QTd) and corrected QT dispersion (QTcd).ResultsThere were statistically significant differences in QT intervals, QTc, QTd and QTcd before and after sodium bicarbonate treatment. The correlation analyses revealed that there were significant negative correlations in pretreatment ECGs of patients between QTd and QTcd with blood pH level. Multivariate analyses between biochemical parameters and QTd-QTcd intervals have revealed that pH was related to QTd and QTc.ConclusionsThis study demonstrated that QT intervals on surface ECG are decreased after treatment of acidosis in CKD. Further studies are needed to show whether increased QT intervals cause ventricular arrhythmias in CKD.

Background/aim: We aimed to investigate the relation between carotid intima-media thickness (CIMT) and serum cathepsin D level in hypertensive patients. Materials and methods: This was a cross-sectional study of 74 hypertensive patients (22 males and 52 females, with a mean age of 51.86 ± 11.75 years). Serum levels of cathepsin D were measured with an enzyme-linked immunosorbent assay. CIMT measurements were taken from 3 different points: right and left common carotid arteries, bifurcation, and the first 2 cm of the internal carotid artery. Mean CIMT was calculated by averaging the measurements taken 3 times from each carotid artery. Results: Mean CIMT value was 0.76 ± 0.15 mm, and median cathepsin D level was 190.3 (12.8-2681.3) ng/mL. A marked positive correlation was found between cathepsin D levels and CIMT (r = 0.331, P = 0.04). In multivariate linear regression analysis, cathepsin D, albumin levels, and the duration of hypertension were significant predictors of CIMT (P = 0.017, P = 0.008, and P = 0.043, respectively). Conclusions: Increased serum cathepsin D level was found to be associated with CIMT in nondiabetic hypertensive patients.

Hypernatremia is a common electrolyte disorder associated with prolonged hospitalization and death. Severe hypernatremia is defined as a serum sodium (Na(+)) concentration160 mmol/L. To the best of our knowledge, there is little information on patients with severe hypernatremia, Na(+)160 mmol/L. Therefore, in this study, we aimed to determine the frequency, demographic and clinical characteristics, comorbid conditions and treatment strategies in patients presenting to the emergency department with severe hypernatremia, and also to evaluate the effects of these factors on mortality. A retrospective chart review was performed on patients presenting to the emergency department between January 2011 and June 2014. Patients with Na(+)160 mmol/L were screened retrospectively via the hospital electronic information management system and patient medical record files. During the 3.5 years of screening, 256 patients (0.04 %) with Na(+)160 mmol/L presented to the emergency department. The mean age of the patients included in the study was 74.4 ± 15.2 years, mean Na(+) level was 168.7 ± 7.4 mmol/L and, mean mortality was 49.5 % during the hospitalization. Multivariable Cox regression analysis showed that low systolic blood pressure, low pH, Na(+)166 mmol/L, increased plasma osmolarity, mean sodium reduction rate ≤-0.134 mmol/L/h, dehydration, and, pneumonia to be independently associated with mortality. This study describes the demographic and clinical characteristics of patients with Na(+)160 mmol/L in a large population along with comorbid conditions, incidence, treatment strategies and, its association with mortality.

Dynamic thiol/disulphide homeostasis plays a critical role in numerous intracellular enzymatic pathways including antioxidant defence and detoxification. In this study, we sought to investigate dynamic thiol/disulphide homeostasis in patients with masked hypertension (MHT) and its relationship with blood pressure. Forty patients (23 men, 17 women) with newly diagnosed MHT and not yet on medical therapy, and 40 healthy volunteers (21 men, 19 women) were enrolled. Blood thiol/disulphide homeostasis was measured in both groups. Serum native and total thiol levels were measured using the novel, fully automated colorimetric method developed by Erel et al. Serum disulphide level was calculated as (serum total thiol - serum native thiol)/2. Native and total thiol levels (p = 0.001) and native thiol/total thiol ratio (p = 0.023) were found to be lower in patients with MHT when compared to those of the control group. Disulphide level and ratios of disulphide/native thiol and disulphide/total thiol were higher in patients with MHT than in the control group (p = 0.001). A positive correlation of systolic blood pressure (SBP) and diastolic blood pressure (DBP) was observed with disulphide/native thiol ratio (p

To investigate the nature of dyslipidemia and its diversity in patients with systemic AA amyloidosis.The reports of the kidney biopsies performed due to nephrotic proteinuria (3.5 g/day/1.73 m(2)) with preserved renal function [glomerular filtration rate (GFR)60 mL/min/1.73 m(2)] were reviewed. Clinical and laboratory data of the patients with systemic AA amyloidosis and primary glomerulonephritis (PG) were analyzed.A total of 104 (systemic AA amyloidosis: 43, PG: 61) patients were included in the study. Proteinuria and GFR levels were similar in both the groups. Patients with systemic AA amyloidosis group had lower serum albumin (p = 0.002), lower hemoglobin levels (p = 0.001), higher platelet counts (p = 0.002) and higher C-reactive protein levels (p = 0.001) compared to patients in PG group. Although the frequency of dyslipidemia was similar in the groups (86.0 vs. 93.4%), patients with systemic amyloidosis had both lower values of LDL-C (4.56 ± 2.05 vs. 5.49 ± 2.23 mmol/L, p = 0.028) and HDL-C (1.19 ± 0.36 vs. 1.35 ± 0.39 mmol/L, p = 0.035). Serum lipid levels were correlated with serum total protein, albumin and proteinuria levels in PG group. However, in the systemic amyloidosis group, only one clear correlation between serum lipid and hemoglobin levels was estimated. A multivariate analysis demonstrated that LDL-C was independently associated with the etiology of nephrotic proteinuria, serum total protein, serum albumin (inversely) and hemoglobin levels.Although dyslipidemia is closely associated with serum total protein, albumin and proteinuria in patients with PG, there is no clear such association in patients with systemic amyloidosis. Correlation between serum lipid and hemoglobin levels in this group and other findings point out that probably complex mechanisms take place in dyslipidemia of nephrotic syndrome caused by systemic AA amyloidosis.

We aimed to evaluate the levels of oxidative stress (OS) parameters such as total antioxidant status or TAS, total oxidant status (TOS), OS index (OSI), paraoxonase 1 (PON1), arylesterase, and total thiol in hypertensive patients with and without asymptomatic organ damage (AOD), and to determine the relationship between these parameters and AOD.Sixty-six patients (21 men, 45 women) with AOD and 66 patients without AOD (21 men, 45 women) were enrolled in the study. Serum OS parameters were measured by colorimetric method.The OSI levels were found to be higher while PON1, PON1/high-density lipoprotein, and arylesterase levels were found to be lower in patients with AOD compared with those in the patients without AOD. Stepwise regression analysis showed high 24-h mean systolic blood pressure, OSI, and low arylesterase level to be independent predictors of AOD.OS level was found to be higher in hypertensive patients with AOD compared with the patients without AOD. However, it is not clear whether increased OS leads to AOD or AOD increases the level of OS. For this purpose, OS level needs to be decreased by antioxidant therapies and patients need to be followed up for a longer duration.

INTRODUCTION: Glomerulonephritis is still the primary cause among the diseases causing end stage renal disease. Helicobacter pylori (HP), also having a local proinflammatory effect on gastric mucosa, can trigger a local and systemic inflammatory response, and consequently have a role in the development of extragastrointestinal defects. MATERIAL AND METHODS: The study was composed of patients diagnosed with primary glomerulonephritis who had dyspeptic complaints throughout the diagnosis. Patients who received endoscopic biopsy upon the determination of pathologic findings in their upper gastrointestinal endoscopy were HP positive in their biopsy material. A triple eradication therapy was initiated for HP. RESULTS: The study included 14 female and 19 male patients, 33 in total, whose biopsy material was determined to be HP positive. Before the eradication for HP, we found serum albumin to be 34.0 (19.0-51.0) g/l, serum total protein 58.6 ±12.9 g/l, serum creatinine 0.9 (0.5-1.2) and proteinuria 3069 (652-12392) mg/day in 24-hour urine. After the eradication, however, serum albumin was found to be 40 (20-52) g/l, serum total protein 62.3 ±11.1 g/l, serum creatinine 1.02 (0.6-1.29) mg/dl and proteinuria was 2850 (172-15181) mg/day in 24-hour urine. A comparison of the results showed that a statistically significant difference is established between the serum albumin, total protein and creatinine values (p = 0.001, p = 0.001 and p = 0.021, respectively), but not between proteinuria values in 24-hour urine (p = 0.990). CONCLUSIONS: Patients with primary glomerulonephritis, HP eradication treatment has an effect on serum albumin levels.

Icodextrin may be used as an alternative to glucose as the osmotic agent in peritoneal dialysis with ultrafiltration failure. In general, icodextrin is known to be safe and well tolerated, but it can also cause hypersensitivity reactions such as skin rashes. Allergic rashes are generally defined as erythematous, itchy and maculopapular, visible over the trunk and the extremities. When a rash occurs, it generally develops early in therapy, is self-limited, and resolves without sequelae after the discontinuation of icodextrin. Although the safety and efficacy of icodextrin peritoneal dialysis solution is well documented, clinicians should be aware of the possibility of severe adverse cutaneous reactions to it. We report the case of a 23-year-old female who developed a skin rash following the use of icodextrin.