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Author(s): Zeynep Kemer Aktas [sup.1] , Gülsah Kaya Aksoy [sup.2] , Havva Serap Toru [sup.3] , Mustafa Koyun [sup.2] , Elif Çomak [sup.2] , Elif Güler [sup.4] , Mehmet Emin [...]

Author(s): Gülsah Kaya Aksoy [sup.1] , Mustafa Koyun [sup.1] , Elif Çomak [sup.1] , Sema Akman [sup.1] Author Affiliations: (1) grid.29906.34, Department of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, [...]

Author(s): Zeynep Kemer Aktas [sup.1] , Gülsah Kaya Aksoy [sup.2] , Havva Serap Toru [sup.3] , Mustafa Koyun [sup.2] , Elif Çomak [sup.2] , Elif Güler [sup.4] , Mehmet Emin [...]

Author(s): Gülsah Kaya Aksoy [sup.1] , Mustafa Koyun [sup.1] , Elif Çomak [sup.1] , Adil Boz [sup.2] , Sema Akman [sup.1] Author Affiliations: (1) grid.29906.34, Department of Pediatric Nehrology, Faculty [...]

Background: Identification of factors that affect graft survival in kidney transplantation can increase graft survival and reduce mortality. Artificial intelligence modelling enables impartial evaluation of clinician bias. This study aimed to examine factors that affect the survival of grafts in paediatric kidney transplantation through the use of machine learning. Methods: A retrospective review was conducted on records of paediatric patients who underwent kidney transplantation between 1994 and 2021 and had post-transplant follow-up > 12 months. The nearest neighbour method was used to impute missing fields from a total of 48 variables in the dataset. Models including Naive Bayes, logistic regression, support vector machine (SVM), multi-layer perceptron, and XGBoost were trained to predict graft survival. The study used 80% of the patients for training and the remaining 20% for testing. Modelling success was evaluated based on accuracy and F1 score metrics. Results: The study analysed 465 kidney transplant recipients. Of these, 56.7% were male. The mean age at transplantation was 12.08 ± 5.01 years. Of the kidney transplants, 73.1% (n = 339) were from living donors, 34.5% (n = 160) were pre-emptive transplants, and 2.2% (n = 10) were second-time transplants. The machine learning model identified several features associated with graft survival, including antibody-mediated rejection (+ 0.7), acute cellular rejection (+ 0.66), eGFR at 3 years (+ 0.43), eGFR at 5 years (+ 0.34), pre-transplant peritoneal dialysis (+ 0.2), and cadaveric donor (+ 0.2). The successes of the logistic regression and SVM models were similar. The F1 score was 91.9%, and accuracy was 96.5%. Conclusion: Machine learning can be used to identify factors that affect graft survival in kidney transplant recipients. By expanding similar studies, risk maps can be created prior to transplantation. [ABSTRACT FROM AUTHOR]

Background C3 glomerulopathy (C3G) is characterized by heterogeneous clinical presentation, outcome, and predominant C3 accumulation in glomeruli without significant IgG. There is scarce outcome data regarding childhood C3G. We describe clinical and pathological features, treatment and outcomes, and risk factors for progression to chronic kidney disease stage 5 (CKD5) in the largest pediatric series with biopsy-proven C3G. Methods Sixty pediatric patients with C3G from 21 referral centers in Turkey were included in this retrospective study. Patients were categorized according to CKD stage at last visit as CKD5 or non-CKD5. Demographic data, clinicopathologic findings, treatment, and outcome data were compared and possible risk factors for CKD5 progression determined using Cox proportional hazards model. Results Mean age at diagnosis was 10.6 ± 3.0 years and follow-up time 48.3 ± 36.3 months. Almost half the patients had gross hematuria and hypertension at diagnosis. Nephritic-nephrotic syndrome was the commonest presenting feature (41.6%) and 1/5 of patients presented with nephrotic syndrome. Membranoproliferative glomerulonephritis was the leading injury pattern, while 40 patients had only C3 staining. Patients with DDD had significantly lower baseline serum albumin compared with C3GN. Eighteen patients received eculizumab. Clinical remission was achieved in 68.3%. At last follow-up, 10 patients (16.6%) developed CKD5: they had lower baseline eGFR and albumin and higher frequency of nephrotic syndrome and dialysis requirement than non-CKD5 patients. Lower serum albumin and eGFR at diagnosis were independent predictors for CKD5 development. Conclusions Children with C3G who have impaired kidney function and hypoalbuminemia at diagnosis should be carefully monitored for risk of progression to CKD5. Graphical abstract, Author(s): Ayse Seda Pinarbasi [sup.1] , Ismail Dursun [sup.1] , Ibrahim Gokce [sup.2] , Elif Çomak [sup.3] , Seha Saygili [sup.4] , Meral Torun Bayram [sup.5] , Osman Donmez [sup.6] [...]

Background: Therapeutic apheresis (TA) is already used to treat various diseases in the field of nephrology. The aim of this study was to evaluate the frequency and types of complications that occur during TA in children with kidney disease. Methods: Records of children (≤ 18 years) who underwent TA between 2007 and 2022 were retrospectively reviewed. Children with missing data and those with a diagnosis of nonnephrological disease were excluded. Results: A total of 1214 TA sessions, including 1147 therapeutic plasma exchange (TPE) sessions and 67 immunoadsorption (IA) sessions, were performed on the 108 patients enrolled in the study. Forty-seven percent of the patients were male, and the mean age was 12.22 ± 4.47 years. Posttransplant antibody-mediated rejection (64.8%) and hemolytic uremic syndrome (14.8%) were the most common diagnoses indicating TA. Overall, 17 different complications occurred in 58 sessions (4.8%), and 53 sessions (4.6%) were not completed because of these complications. The distribution of complications among the patients was as follows: 41.4% had technical complications, 25.9% had allergic complications, and 32.7% had others. The most common technical complication was insufficient flow (37.5%). The incidence of complications was greater in patients aged 3–6 years than in patients in the other age groups (p = 0.031). The primary disease, type of vascular access, and rate of fresh frozen plasma/albumin use were similar between patients with and without complications (p values of 0.359 and 0.125 and 0.118, respectively). Conclusions: Our study showed that complications occurred in only 4.8% of TA sessions. The most common complication was technical problems. [ABSTRACT FROM AUTHOR]

Author(s): Gülsah Kaya Aksoy [sup.1] , Mustafa Koyun [sup.1] , Elif Çomak [sup.1] , Sema Akman [sup.1] Author Affiliations: (1) grid.29906.34, Department of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, [...]

Author(s): Mustafa Koyun [sup.1] , Mustafa Gökhan Ertosun [sup.2] , Gülsah Kaya Aksoy [sup.1] , Elif Çomak [sup.1] , Sema Akman [sup.1] Author Affiliations: (1) grid.29906.34, Faculty of Medicine, Department [...]

Author(s): Mustafa Koyun [sup.1] , Mustafa Gökhan Ertosun [sup.2] , Gülsah Kaya Aksoy [sup.1] , Elif Çomak [sup.1] , Sema Akman [sup.1] Author Affiliations: (1) grid.29906.34, Faculty of Medicine, Department [...]

Background Although orthostatic proteinuria (OP) is the most common cause of childhood proteinuria, excluding transient proteinuria, data regarding prevalence and long-term prognosis are limited. We aimed to determine prevalence of OP in healthy schoolchildren evaluating relationships with age, gender and body mass index, and determine follow-up. Methods A total of 1701 healthy children aged 6-15 years were selected using a population-based, stratified, cluster-sampling method; and random urine samples were taken. For proteinuria [greater than or equal to] 1+ in first urine samples, second and third random samples were taken at least 2 weeks apart to exclude transient proteinuria. For continuing proteinuria after third samples, first morning urine samples were collected. Cases where proteinuria was not detected in first morning urine samples were diagnosed as OP. Results Sixty-four of 1701 children (3.7%) had proteinuria on first random urine samples. After second and third urine samples, proteinuria persisted in only 16 (0.94%). OP was detected in 11 (0.65%). Prevalence of OP tended to decrease with increasing BMI, though not statistically significant. All 7 cases with OP who were re-evaluated later, had no proteinuria 3 years after diagnosis. Conclusions Prevalence of OP in our study was lower than the literature. At least three random urine samples should be taken to exclude transient proteinuria in an asymptomatic child/adolescent before making a diagnosis of OP using first morning urine samples. OP is a benign condition and resolves spontaneously in most cases. Underweight children had a tendency for OP compared with overweight and obese children; however, further studies with larger number of patients are needed., Author(s): Zümrüt Arslan [sup.1] , Mustafa Koyun [sup.2] , Hakan Erengin [sup.3] , Halide Akbas [sup.4] , Gülsah Kaya Aksoy [sup.2] , Elif Çomak [sup.2] , Sema Akman [sup.2] Author [...]

Background: C3 glomerulopathy (C3G) is a complement-mediated disease. Although genetic studies are not required for diagnosis, they are valuable for treatment planning and prognosis prediction. The aim of this study is to investigate the clinical phenotypes, kidney survival, and response to mycophenolate mofetil (MMF) treatment in pediatric C3G patients with and without mutations in complement-related genes. Methods: Sixty pediatric C3G patients were included, divided into two groups based on complement-related gene mutations. Demographic and clinical-pathological findings, treatment modalities, and outcome data were compared, and Kaplan–Meier analysis was performed for kidney survival. Results: Out of the 60 patients, 17 had mutations. The most common mutation was in the CFH gene (47%). The mean age at diagnosis was higher in the group with mutation (12.9 ± 3.6 vs. 11.2 ± 4.1 years, p = 0.039). While the patients without mutation most frequently presented with nephritic syndrome (44.2%), the mutation group was most likely to have asymptomatic urinary abnormalities (47.1%, p = 0.043). Serum parameters and histopathological characteristics were similar, but hypoalbuminemia was more common in patients without mutation. During 45-month follow-up,10 patients progressed to chronic kidney disease stage 5 (CKD5), with 4 having genetic mutation. The time to develop CKD5 was longer in the mutation group but not significant. MMF treatment had no effect on progression in either group. Conclusions: This study is the largest pediatric C3G study examining the relationship between genotype and phenotype. We showed that the mutation group often presented with asymptomatic urinary abnormalities, was diagnosed relatively late but was not different from the without mutation group in terms of MMF treatment response and kidney survival. [ABSTRACT FROM AUTHOR]

Author(s): Gülsah Kaya Aksoy [sup.1] , Mustafa Koyun [sup.1] , Elif Çomak [sup.1] , Adil Boz [sup.2] , Sema Akman [sup.1] Author Affiliations: (1) grid.29906.34, Department of Pediatric Nehrology, Faculty [...]

Author(s): Gulsah Kaya Aksoy [sup.1] , Mustafa Koyun [sup.1] , Kimiyoshi Ichida [sup.2] , Elif Comak [sup.1] , Sema Akman [sup.1] Author Affiliations: (Aff1) 0000 0001 0428 6825, grid.29906.34, Department [...]

Author(s): Mustafa Koyun [sup.1] , Gülsah Kaya Aksoy [sup.1] , Elif Çomak [sup.1] , Sema Akman [sup.1] Author Affiliations: (1) grid.29906.34, Department of Pediatrics, Division of Pediatric Nephrology, School of [...]

Author(s): Gülsah Kaya Aksoy [sup.1] , Elif Çomak [sup.1] , Bahar Akkaya [sup.2] , Mustafa Koyun [sup.1] , Sema Akman [sup.1] Author Affiliations: (Aff1) 0000 0001 0428 6825, grid.29906.34, Department [...]

Author(s): Gulsah Kaya Aksoy[sup.1] [sup.4] , Mustafa Koyun[sup.1] , Adnan Kabaalioglu[sup.2] , Oguz Dursun[sup.3] , Sema Akman[sup.1] Author Affiliations: (1) Department of Pediatric Nephrology, School of Medicine, Akdeniz University, AntalyaTurkey [...]

Author(s): Mustafa Koyun [sup.1] , Muhammet Sancaktar [sup.1] , Gülsah Kaya Aksoy [sup.1] , Elif Çomak [sup.1] , Ayla Kaçar [sup.1] , Mehtap Adar [sup.1] , Afig Berdeli [sup.2] , [...]

Background An increase in the number of circulating endothelial cells (CEC) indicates endothelial damage and the risk of cardiovascular disease. The aim of our study was to investigate the association of CEC with various clinical parameters in pediatric renal transplant recipients. Methods CEC, defined as [CD45.sup.-] [CD146.sup.+], were enumerated by flow cytometry from the peripheral blood of 50 pediatric renal transplant recipients and 20 healthy controls. Clinical parameters, including renal function tests, fasting blood glucose, serum cholesterol and triglyceride, cyclosporine A (CsA) (trough and 2nd-hour) and tacrolimus (tac) trough blood levels and their association with CEC numbers were analyzed. Results CEC numbers of patients were higher than those of controls (respectively, 128±89 cells/ml (42-468 cells/ml), 82±33 cells/ml (32-137 cells/ml), p = 0.024). There was a statistically significant negative correlation between CEC numbers and glomerular filtration rate (GFR) (r = -0.300, p = 0.012). There was also a statistically positive association between CEC numbers and transplant duration as well as cyclosporine trough level (respectively, r = 0.397, p = 0.004, r=0.714,p =0.004). CEC numbers in patients on tac and CsA were similar (p =0.716). Conclusions Our results demonstrate that renal transplant recipients with high CsA trough blood level, longer transplant duration, and lower GFR, are at greater risk of developing endothelial damage. Keywords CD146 * Chronic kidney disease (CKD) * Cardiovascular disease (CVD) * Pediatric kidney transplantation * Endothelial damage * Cyclosporine, Introduction Life expectancy of renal transplant recipients is shorter than the general population due to cardiovascular diseases (CVD) [1]. The risk factors for CVD in patients with chronic kidney disease [...]

Author(s): Mustafa Koyun [sup.1] , Muhammet Sancaktar [sup.1] , Gülsah Kaya Aksoy [sup.1] , Elif Çomak [sup.1] , Ayla Kaçar [sup.1] , Mehtap Adar [sup.1] , Afig Berdeli [sup.2] , [...]

In infants with ureteropelvic junction obstruction (UPJO), the risk of urinary tract infection (UTI) is unknown, and there is a lack of prospective studies showing definitive evidence regarding the benefits and necessity of antibiotic prophylaxis. The aim of this study was to assess the risk of UTI in infants with UPJO and to determine whether the risk varies according to the degree of hydronephrosis. Infants with hydronephrosis detected prenatally or within the postnatal 28th day and who had no previous history of UTI were followed prospectively without antibacterial prophylaxis. Imaging studies were performed according to our Pediatric Uro-Nephrology Study Group protocol. Dimercaptosuccinate (DMSA) scintigraphy was performed in all infants at the end of 1 year of follow-up. Eighty-four infants (56 boys, 28 girls) were included in the study. The distribution of patients in each hydronephrosis grading group was incidentally similar. Within a median follow-up period of 18 (12-24) months, none of the patients had UTI. Furthermore, no pyelonephritic scar was found on DMSA scans in any patient. We conclude that prophylactic antibiotic usage is not indicated in infants with UPJO, regardless of the severity of hydronephrosis, as the risk of UTI is minimal in this population. Keywords Ureteropelvic junction obstruction * Prenatal hydronephrosis * Prophylaxis * Urinary tract infection * DMSA, Introduction The wide usage of obstetric ultrasonography (US) since the 1980s has led to prenatal recognition of many congenital malformations. Urinary tract abnormalities constitute 20-30% of these and are mainly [...]

Author(s): Gulsah Kaya Aksoy [sup.1] , Mustafa Koyun [sup.1] , Kimiyoshi Ichida [sup.2] , Elif Comak [sup.1] , Sema Akman [sup.1] Author Affiliations: (Aff1) 0000 0001 0428 6825, grid.29906.34, Department [...]

Author(s): Mustafa Koyun [sup.1] , Elif Çomak [sup.1] , Sema Akman [sup.1] Author Affiliations: (Aff1) 0000 0001 0428 6825, grid.29906.34, School of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, [...]

Data on urolithiasis (UL) in infancy are limited. The objective of this study was to increase awareness of infant UL and to investigate the influence of possible risk factors in this very specific age group. Nonfasting, second-voiding urine samples were obtained to test for urinary excretions of calcium, oxalate, citrate, magnesium, uric acid, and creatinine. Blood analysis included calcium, phosphate, magnesium, uric acid, creatinine, sodium, potassium, chloride, and alkaline phosphatase. Patients received follow-up testing every 1-2 months; serial ultrasonography was used to track UL status. Fifty infants with a median age of 5 months were enrolled in the study. Hypercalciuria was detected in 9/47, hyperoxaluria in 5/39, hypocitraturia in 4/31, and cystinuria in 2/50 infants. We identified at least one metabolic abnormality in 46% of our patients; no metabolic abnormality was identified in 27 infants. Within a mean follow-up period of 14 months, 17 infants became stone free, stones increased in number in ten patients and decreased in number in 16, and recurrence was detected in seven. This study showed that UL could be detected in very early life, even in the newborn period, and could be the source of late childhood/adulthood UL. Infants with nonspecific symptoms such as restlessness may have UL and should undergo ultrasonographic examination. Metabolic evaluation of UL in this specific age group carries some diagnostic challenges, e.g. unsatisfactory data regarding normal ranges of urinary mineral excretion, and collection of 24-h urine samples., Author(s): Ayfer Gür Güven [sup.1] , Mustafa Koyun [sup.1] [sup.4] , Yunus Emre Baysal [sup.1] , Sema Akman [sup.1] , Emel Alimoglu [sup.2] , Halide Akbas [sup.3] , Adnan Kabaalioglu [...]

A 4-month-old male baby was admitted because his father and uncles had chronic kidney disease. His father was diagnosed with membranoproliferative glomerulonephritis at the age of 5, underwent a kidney transplant at the age of 22, and lost the graft due to recurrence of the disease. In contrast, the young uncle was diagnosed with C3 glomerulopathy and mycophenolate mofetil and eculizumab were initiated early. It was remarkable that our patient had normal kidney function and urine analyses but low serum C3 level (0.56 g/L; N, 0.9–1.8 g/L). In the disease-associated clinical exome analysis, a heterozygous change in the CFH gene was found. The same mutation was found homozygous in the uncle. In genetically inherited diseases, findings may occur sequentially; early screening of at-risk individuals contributes to kidney survival. [ABSTRACT FROM AUTHOR]

Abstract Although it has been reported that high-dose immunoglobulin has beneficial effects in chronic glomerulonephritis, it is not known whether it is effective in the treatment of idiopathic nephrotic syndrome. [...]

Author(s): Gülsah Kaya Aksoy [sup.1] , Mustafa Koyun [sup.1] , Elif Çomak [sup.1] , Cansu Mutlu [sup.2] , Sema Akman [sup.1] Author Affiliations: (Aff1) 0000 0001 0428 6825, grid.29906.34, Department [...]

Author(s): Gülsah Kaya Aksoy [sup.1] , Mustafa Koyun [sup.1] , Elif Çomak [sup.1] , Cansu Mutlu [sup.2] , Sema Akman [sup.1] Author Affiliations: (Aff1) 0000 0001 0428 6825, grid.29906.34, Department [...]

Author(s): Gulsah Kaya Aksoy [sup.1] , Atilla Gemici [sup.1] , Mustafa Koyun [sup.1] , Elif Çomak [sup.1] , Sema Akman [sup.1] Author Affiliations: (Aff1) 0000 0001 0428 6825, grid.29906.34, Department [...]

Author(s): Gülsah Kaya Aksoy [sup.1] , Atilla Gemici [sup.1] , Mustafa Koyun [sup.1] , Elif Çomak [sup.1] , Sema Akman [sup.1] Author Affiliations: (Aff1) 0000 0001 0428 6825, grid.29906.34, Department [...]

Author(s): Gülsah Kaya Aksoy [sup.1] , Elif Çomak [sup.1] , Bahar Akkaya [sup.2] , Mustafa Koyun [sup.1] , Sema Akman [sup.1] Author Affiliations: (Aff1) 0000 0001 0428 6825, grid.29906.34, Department [...]

Background: C3 glomerulopathy (C3G) is characterized by heterogeneous clinical presentation, outcome, and predominant C3 accumulation in glomeruli without significant IgG. There is scarce outcome data regarding childhood C3G. We describe clinical and pathological features, treatment and outcomes, and risk factors for progression to chronic kidney disease stage 5 (CKD5) in the largest pediatric series with biopsy-proven C3G. Methods: Sixty pediatric patients with C3G from 21 referral centers in Turkey were included in this retrospective study. Patients were categorized according to CKD stage at last visit as CKD5 or non-CKD5. Demographic data, clinicopathologic findings, treatment, and outcome data were compared and possible risk factors for CKD5 progression determined using Cox proportional hazards model. Results: Mean age at diagnosis was 10.6 ± 3.0 years and follow-up time 48.3 ± 36.3 months. Almost half the patients had gross hematuria and hypertension at diagnosis. Nephritic-nephrotic syndrome was the commonest presenting feature (41.6%) and 1/5 of patients presented with nephrotic syndrome. Membranoproliferative glomerulonephritis was the leading injury pattern, while 40 patients had only C3 staining. Patients with DDD had significantly lower baseline serum albumin compared with C3GN. Eighteen patients received eculizumab. Clinical remission was achieved in 68.3%. At last follow-up, 10 patients (16.6%) developed CKD5: they had lower baseline eGFR and albumin and higher frequency of nephrotic syndrome and dialysis requirement than non-CKD5 patients. Lower serum albumin and eGFR at diagnosis were independent predictors for CKD5 development. Conclusions: Children with C3G who have impaired kidney function and hypoalbuminemia at diagnosis should be carefully monitored for risk of progression to CKD5. Graphical abstract [ABSTRACT FROM AUTHOR]

Author(s): Gülsah Kaya Aksoy[sup.1] , Mustafa Koyun[sup.1] , Adnan Kabaalioglu[sup.2] , Oguz Dursun[sup.3] , Sema Akman[sup.1] Author Affiliations: (1) Department of Pediatric Nephrology, School of Medicine Akdeniz University, 07070, AntalyaTurkey [...]