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Introduction: Alterations in the peritoneal membrane can cause trouble for adequate dialysis. We proposed to evaluate a possible relationship between peritoneal permeability and Grem1 protein in peritoneal dialysis (PD) patients. Methods: Adult PD patients who undergoing dialysis for at least one year were included. Grem1 level was measured in plasma. The peritoneal equalization test (PET) was used to define peritoneal transporting properties. Dialysate to plasma ratio for creatinine (DPRC) value was used as the parameter of the permeability. The first and last DPRC values were compared to determine membrane alteration status. Results: A total of 60 patients were enrolled. The mean age was 52.9±14.3 years. The average PD duration was 60.3 (24-86.5) months. The average Grem1 level was 164.9 (81.6-164.9) ng/mL. An overall 5.8% increase was determined in DPRC value. There was no statistically significant difference in Grem1 levels between increasing DPRC and non-increasing DPRC groups (p=0.783). According to PET classification: class elevation was observed in 31.7% (19) patients. The plasma Grem1 levels of these groups are as follows: 204.2 ng/mL in stable patients, 168.2 ng/mL in ascending patients, and 196.2 ng/mL in descending patients. There was no statistically significant difference between the groups in terms of Grem1 levels in One-Way ANOVA (p=0.709). Conclusion: We did not identify any correlation between changes in peritoneal permeability and plasma Grem1 levels. However, we have emphasized the importance of novel biomarkers that could predict the changes in peritoneal permeability.

ABSTRACT Background: Severe acute problems, which are related to different systems, could be reasons for applying to the emergency department in patients with peritoneal dialysis. In this study, the aim was to evaluate the reasons and treatment of applications to the emergency department in these patients after office hours. Methods: This study included followed up CAPD patients, who applied to the Emergency Department between January 2017 and May 2020 at our University. Demographical, biochemical, and clinical data, such as, renal, peritoneal, and weekly Kt/V, normalized protein catabolic rate (nPCR), peritoneal UF, and GFR were recorded from the outpatient’s department data. In addition, reasons for application to emergency services and hospitalization were evaluated. Results: 38 peritoneal dialysis patients applied 88 times to the emergency department and were hospitalized between 2017 and 2020. Patients, who applied after office hours were included in the study. Around 130 patients were regularly followed-up in our CAPD outpatient clinic during this period. While the most important peritoneal reasons for admission were exit site infection and catheter dysfunction, extra peritoneal complications were various. Patients were hospitalized in the Cardiology and General Surgery departments with a high rate of acute cardiovascular events and acute abdominal pathologies. Conclusion: Although the first approach to these patients in the emergency department is usually performed by a consulted nephrologist, effective and priority treatment could only be given by an emergency doctor, who has knowledge about the special problems of dialysis patients.

Introduction: Mucociliary clearance (MC) is a critical defense mechanism for the protection of the entire respiratory system. Nasal colonization of some pathogens and chronical nasal infections are important risk factors for peritonitis. Any disturbance in the MC causes stasis of secretions and secondary infections. Objective: The aim of the study was to evaluate the patients with chronic kidney disease (CKD) receiving continuous ambulatory peritoneal dialysis (CAPD) in terms of nasal MC. More specifically, the goal is to investigate the possible correlation between the nasal MC and peritonitis. Methods: Forty CAPD patients and 39 healthy volunteers were involved in the study. The nasal MC was evaluated with the saccharin test, in which a 1 mm diameter saccharin particle was carefully placed on the antero-medial surface of inferior nasal concha. The time taken by the subjects from the placement of particle to the perception of the sweet taste was taken as mucociliary clearance time (MCT). The groups were compared in terms of MCT. The patient group was evaluated in terms of a peritonitis history, and the correlations with MC were analyzed. Results: Patient group with CKD consisted of 16 females and 24 males with a mean age of 32.4 years; healthy individuals in the control group consisted of 17 women and 22 men with a mean age of 33.3 years. There was not a significant difference in terms of mean MC time in patients with CKD when compared with the individuals in the control group. The comparison between the mean MCT in the patients who had a history of peritonitis and patients without peritonitis was statistically significant (p

Maksiller posterior bölgede yapılan diş çekimleri sırasında maksiller sinüs ile ilişkili çok sayıda komplikasyon ile karşılaşılmaktadır. Diş kökenli maksiller sinüzitlerin %10’unu oluşturan sinüse kök kaçırılması dental kaynaklı nedenlerden birisidir. Literatürde dental kaynaklı sinüs enfeksiyonu oluşturabilen birçok bakteri türünden bahsedilmesine rağmen, enterik bir bakteri olan Citrobacter koseri (C. koseri) nadir görülen bir sinüs enfeksiyonu etkenidir. 34 yaşındaki, bayan hasta, kliniğimize üst çene sağ taraf büyükazı dişler bölgesinde ağrı şikayeti ile başvurdu. Yapılan radyografik inceleme sonucunda hastanın maksiller sinüsünde rezidüel kök tespit edildi. Mevcut residüel kök Caldwel Luc cerrahisi ile çıkarıldı. Hastanın şikayetleri ortadan kalktı. Yeşil renkli olan diş kökü mikrobiyoloji laboratuvarında anaerobik ve aerobik olarak kültüre edildi. 37 °C’taki 24 saatlik aerobik inkübasyonu takiben gram negatif basil morfolojisine sahip saf koloniler saptandı. Koloniler konvansiyonel yöntemlerin yanısıra VITEK2 Compact otomatik identifikasyon sistemi ile de C. koseri olarak tanımlandı.

The therapeutic use of autologous platelet-rich fibrin constitutes a relatively new biotechnology that has been a breakthrough in the stimulation and acceleration of soft-tissue and bone healing. The efficiency of this process lies in the local and continuous delivery of a wide range of growth factors and proteins, mimicking the needs of the physiological wound healing and reparative tissue processes. Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates, with simplified processing and without biochemical blood handling. This easy protocol allows the production of leukocyte and platelet-rich fibrin clots starting from autologous blood samples. PRF is used especially in clinical Periodontal and Oral and Maxillofacial Surgery applications. The significance of the PRF is gradually increasing Keywords: Platelet, Autogenous Fibrine, Growth hormone. ÖZET Trombositten zengin otojen ürünlerin tedavi amacı ile kullanılması, güncel bir yaklaşım olarak dikkati çekmektedir. Sert ve yumuşak doku iyileşmelerinde kullanılan ve çok çeşitli büyüme faktörleri ve proteinlerin kontrollü salınımlarını içeren bu preparatların doğal yara iyileşmesi için gerekli olan maddeleri yoğun olarak içerdikleri bilinmektedir. Platelet-rich fibrin (PRF), yeni jenerasyon trombositten zengin otojen ürün olarak bilinmektedir. Kolay uygulanabilir ve biyokimyasal herhangi bir işlem gerektirmeyen PRF protokolü, kişinin kendisinden alınan kan örneklerinden lökositten ve trombositten zengin bir otolog biyomateryal elde edilmesine izin vermektedir. Diş Hekimliğinde özellikle Periodontoloji ve Ağız, Diş ve Çene Cerrahisi’ndeki klinik uygulamalarda kullanılmaya başlanan PRF’nin önemi giderek artmaktadır.

Background We aimed to evaluate the features of primary membranous nephropathy (MNP) in Turkish people.Methods This is a retrospective analysis of patients with biopsy-proven primary MNP. We obtained the data collected between 2009 and 2019 in the primary glomerulonephritis registry of the Turkish Society of Nephrology Glomerular Diseases Study Group (TSN-GOLD). Patients with a secondary cause for MNP were excluded. Clinical, demographic, laboratory, and histopathological findings were analyzed.Results A total of 995 patients with primary MNP were included in the analyses. Males constituted the majority (58.8%). The mean age was 48.4 ± 13.9 years. The most common presentation was the presence of nephrotic syndrome (81.7%) and sub nephrotic proteinuria (10.3%). Microscopic hematuria was detected in one-third of patients. The median estimated glomerular filtration rate (eGFR) was 100.6 mL/min/1.73 m2 (IQR, 75.4–116.3), and median proteinuria was 6000 mg/d (IQR, 3656–9457). Serum C3 and C4 complement levels were decreased in 3.7 and 1.7% of patients, respectively. Twenty-four (2.4%) patients had glomerular crescents in their kidney biopsy samples. Basal membrane thickening was detected in 93.8% of cases under light microscopy. Mesangial proliferation and interstitial inflammation were evident in 32.8 and 55.9% of the patients, respectively. The most commonly detected depositions were IgG (93%), C3 complement (68.8%), and kappa and lambda immunoglobulin light chains (70%). Although renal functions were normal at presentation, vascular, interstitial, and glomerular findings were more prominent on biopsy in hypertensive patients. No significant effect of BMI on biopsy findings was observed.Conclusions Despite some atypical findings, the main features of primary MNP in Turkey were similar to the published literature. This is the largest MNP study to date conducted in Turkish people.

Abstract Background This study aimed to evaluate the etiologies, comorbidities, and outcomes of acute kidney injury (AKI) in Turkey and determine any potential differences among different geographical parts of the country. Methods This prospective observational study was conducted by the Acute Kidney Injury Working Group of the Turkish Society of Nephrology. Demographical and clinical data of patients with AKI at the time of diagnosis and at the 1st week and 1st, 3rd, and 6th months of diagnosis were evaluated to determine patient and renal survival and factors associated with patient prognosis. Results A total of 776 patients were included (54.7% male, median age: 67 years). Prerenal etiologies, including dehydration, heart failure, and sepsis, were more frequent than other etiologies. 58.9% of the patients had at least one renal etiology, with nephrotoxic agent exposure as the most common etiology. The etiologic factors were mostly similar throughout the country. 33.6% of the patients needed kidney replacement therapy. At the 6th month of diagnosis, 29.5% of the patients had complete recovery; 34.1% had partial recovery; 9.5% developed end-stage kidney disease; and 24.1% died. The mortality rate was higher in the patients from the Eastern Anatolian region; those admitted to the intensive care unit; those with prerenal, renal, and postrenal etiologies together, stage 3 AKI, sepsis, cirrhosis, heart failure, and malignancy; those who need kidney replacement therapy; and those without chronic kidney disease than in the other patients. Conclusion Physicians managing patients with AKI should be alert against dehydration, heart failure, sepsis, and nephrotoxic agent exposure. Understanding the characteristics and outcomes of patients with AKI in their countries would help prevent AKI and improve treatment strategies.

Abstract Background Tunneled catheters can be used as an alternative vascular access in patients with limited health expectancy,vascular access problems and several comorbidities. We aimed to present a patient with venous stenosis related- reversible acute Budd-Chiari syndrome after catheter malposition. Case presentation After changing of tunneled catheter insertion, 36-year old man was admitted to our hospital with sudden onset of nausea, fever, chills and worsening general condition In computed tomography (CT) imaging, a hypodense thrombus was observed in which the distal end of the catheter is at the level of drainage of the hepatic veins in the inferior vena cava and that blocked hepatic vein drainage around the catheter. The catheter was removed and a new catheter was inserted in the same session. Because patient’s general condition was good and without fever, he was discharged with advices on the 9th day of hospitalization. Conclusion Although catheter malposition and thrombosis are not a common complication, clinicians should be alert of these complications.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited cause of chronic kidney disease with Polycystin (PKD) 1 and 2 gene mutation. However, the intra-familial variability in symptoms further suggests a non-Mendelian contribution to the disease. Our goal was to find a marker to track the epigenetic changes common to rapidly progressing forms of the disease. The risk of ADPKD increases with age, and aging shortens the telomere length (TL). Telomeres are a nucleoprotein structure composed mainly of three complexes, shelterin, CST and RNA-containing telomere repeat(TERRA), which protects the ends of chromosomes from degradation and fusion, and plays a role in maintaining cellular stability and in the repair of telomeric damage. TERRAs are transcribed from telomeric regions and a part of them is engaged in a DNA/RNA hybrid (R-loop) at each chromosome end. We tracked TL and TERRA levels in blood samples of 78 patients and 20 healthy control. Our study demonstrates that TL was shortened and TERRA expression levels in the DNA-attached fraction increased in autosomal dominant polycystic kidney patients with mutations in PKD1 and PKD2 compared to the control group. Moreover, it was observed that the expression of TERRA engaged in the R-loop was higher and the length of telomeres shorter in patients with ADPKD who showed rapid disease progression. Intrafamilial variation in TL and TERRA levels with the same mutation would indicate reliable epigenetic potential biomarkers in disease monitoring.

Abstract Background Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary disorder with unclear disease mechanism. Currently, overt hypertension and increased renal volume are the best predictors of renal function. In this study, we assessed the usefulness of selected circulating microRNAs (miRs) to predict disease progress in a cohort with ADPKD. Methods Eighty ADPKD patients (44.6 ± 12.7 years, 40% female, 65% hypertensive) and 50 healthy subjects (HS; 45.4 ± 12.7, 44% female) were enrolled in the study. Serum levels of 384 miRs were determined by Biomark Real Time PCR. Groups were compared using the limma method with multiple-testing correction as proposed by Smyth (corrected p 10% loss of GFR over the following 12 months (cut-off >2.2 AU, sensitivity 83%, specificity 78%, area 0.872 [95% CI: 0.790–0.953, p

Background/Aims: Fabry disease is a treatable cause of chronic kidney disease (CKD) characterized by a genetic deficiency of α-galactosidase A. European Renal Best Practice (ERBP) recommends screening for Fabry disease in CKD patients. However, this is based on expert opinion and there are no reports of the prevalence of Fabry disease in stage 1-5 CKD. Hence, we investigated the prevalence of Fabry disease in CKD patients not receiving renal replacement therapy. Methods: This prospective study assessed α-galactosidase activity in dried blood spots in 313 stage 1-5 CKD patients, 167 males, between ages of 18-70 years whose etiology of CKD was unknown and were not receiving renal replacement therapy. The diagnosis was confirmed by GLA gene mutation analysis. Results: Three (all males) of 313 CKD patients (0.95%) were diagnosed of Fabry disease, for a prevalence in males of 1.80%. Family screening identified 8 aditional Fabry patients with CKD. Of a total of 11 Fabry patients, 7 were male and started enzyme replacement therapy and 4 were female. The most frequent manifestations in male patients were fatigue (100%), tinnitus, vertigo, acroparesthesia, hypohidrosis, cornea verticillata and angiokeratoma (all 85%), heat intolerance (71%), and abdominal pain (57%). The most frequent manifestations in female patients were fatigue and cornea verticillata (50%), and tinnitus, vertigo and angiokeratoma (25%). Three patients had severe episodic abdominal pain attacks and proteinuria, and were misdiagnosed as familial Mediterranean fever. Conclusions: The prevalence of Fabry disease in selected CKD patients is in the range found among renal replacement therapy patients, but the disease is diagnosed at an earlier, treatable stage. These data support the ERBP recommendation to screen for Fabry disease in patients with CKD of unknown origin.

Increased inflammation, associated with the increase in chronic kidney disease (CKD) stage, has a very important influence in vascular injury and cardiovascular diseases. In this study, we aimed to investigate the levels of IL-33 and ST2 in the different stages of CKD and to determine their effect on vascular damage and cardiovascular events (CVE).This was an observational cohort study in which serum IL-33 and ST2 were obtained from 238 CKD (stages 1-5) patients. We examined the changes in IL-33/ST2 levels in CKD patients, as well as the association with a surrogate of endothelial dysfunction. Fatal and non-fatal CVE were recorded for a mean of 24 months. We also performed a COX regression analysis to determine the association of IL-33/ST2 levels with CVE and survival.IL-33 and ST2 levels were significantly increased and estimated glomerular filtration rates (eGFR) were decreased. Flow-mediated dilatation (FMD) was significantly decreased from stage 1 to stage 5 CKD. IL-33 and ST2 levels were associated with FMD, and ST2 was a predictor. Multivariate Cox analysis showed that the presence of diabetes mellitus, smoking, and proteinuria and haemoglobin, Hs-CRP, IL-33, and ST2 were associated with the risk of CVE. Kaplan-Meier survival curves showed that patients with IL-33 and ST2 levels below the median value (IL-33 = 132.6 ng/L, ST2 = 382.9 pg/mL) had a higher cumulative survival compared with patients who had IL-33 and ST2 levels above the median value (log-rank test, p = 0.000).This is the first study that demonstrates that serum IL-33 and ST2 are associated with vascular injury, cardiovascular events, and survival in CKD patients.

Ethylene glycol (EG) may be consumed accidentally or intentionally, usually in the form of antifreeze products or as an ethanol substitute. EG is metabolized to toxic metabolites. These metabolites cause metabolic acidosis with increased anion gap, renal failure, oxaluria, damage to the central nervous system and cranial nerves, and cardiovascular instability. Early initiation of treatment can reduce the mortality and morbidity but different clinical presentations can cause delayed diagnosis and poor prognosis. Herein, we report a case with the atypical presentation of facial paralysis, hematuria, and kidney failure due to EG poisoning which progressed to end stage renal failure and permanent right peripheral facial nerve palsy.

Aim. Carpal tunnel syndrome (CTS) is one of the frequent problems of the patients who underwent hemodialysis (HD). The role of venous hypertension due to arteriovenous fistula (AVF) has not been clarified completely; therefore, we aimed to investigate the role of venous hypertension due to AVF in hemodialysis patients who had CTS. Patients and Methods. We included 12 patients who had been receiving HD treatment for less than 8 years and the newly diagnosed CTS patients with the same arm of AVF. All patients were diagnosed clinically and the results were confirmed by both nerve conduction studies and electromyography. Open carpal tunnel release surgery was performed on all of them. Venous pressure was measured in all patients before and after two weeks of surgery. Results. There were significant differences before and after the surgery with regard to pressures (). After the surgery, all carpal ligament specimens of the patients were not stained with Congo red for the presence of amyloid deposition. Conclusion. Increased venous pressure on the same arm with AVF could be responsible for CTS in hemodialysis patients. Carpal tunnel release surgery is the main treatment of this disease by reducing the compression on the nerve.