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Background: Living kidney donors (LKD) may experience some untoward consequences following donation such as development of chronic kidney disease (CKD). In this study, we aimed to investigate the rate of development of CKD and factors affecting the development of CKD in LKDs during long-term follow-up from a center in Turkey., Methods: This study was a retrospective analysis of LKDs followed between January 2000 and December 2017. Pre-transplant and post-transplant clinical data of the 338 LKDs were recorded and compared. Factors affecting the development of stage 3 and later stages of CKD were analyzed., Results: Majority of the donors were females (64.2%), and the median age of all donors was 47 (39-54) years. Stage 3 CKD developed in 50 donors during the median follow-up of 71 months. Older age at the time of transplantation and a low pre-transplant estimated glomerular filtration rate (eGFR) were determined as the factors affecting the development of stage 3 CKD (p < 0.001, p < 0.001). The receiver operating characteristic analysis showed that the cut-off age for the development of stage 3 CKD was 50.5 years. Newly diagnosed hypertension was detected in 57 patients (16.8%) after the transplantation. While hypertension was seen at a rate of 42% in those with an eGFR <60 mL/min/1.73 m2, it was detected at 19.4% in the group with an eGFR >60 mL/min/1.73 m2 (p < 0.001)., Conclusion: These results reveal that being a LKD is associated with the development of CKD and hypertension. Age and eGFR values at the time of transplantation were the determinants for the development of CKD., (© 2023 S. Karger AG, Basel.)

Introduction: There are not enough data on the post-CO-VID-19 period for peritoneal dialysis (PD) patients affected from COVID-19. We aimed to compare the clinical and laboratory data of PD patients after COVID-19 with a control PD group., Methods: This study, supported by the Turkish Society of Nephrology, is a national, multicenter retrospective case-control study involving adult PD patients with confirmed COVID-19, using data collected from April 21, 2021, to June 11, 2021. A control PD group was also formed from each PD unit, from patients with similar characteristics but without COVID-19. Patients in the active period of COVID-19 were not included. Data at the end of the first month and within the first 90 days, as well as other outcomes, including mortality, were investigated., Results: A total of 223 patients (COVID-19 group: 113, control group: 110) from 27 centers were included. The duration of PD in both groups was similar (median [IQR]: 3.0 [1.88-6.0] years and 3.0 [2.0-5.6]), but the patient age in the COVID-19 group was lower than that in the control group (50 [IQR: 40-57] years and 56 [IQR: 46-64] years, p < 0.001). PD characteristics and baseline laboratory data were similar in both groups, except serum albumin and hemoglobin levels on day 28, which were significantly lower in the COVID-19 group. In the COVID-19 group, respiratory symptoms, rehospitalization, lower respiratory tract infection, change in PD modality, UF failure, and hypervolemia were significantly higher on the 28th day. There was no significant difference in laboratory parameters at day 90. Only 1 (0.9%) patient in the COVID-19 group died within 90 days. There was no death in the control group. Respiratory symptoms, malnutrition, and hypervolemia were significantly higher at day 90 in the COVID-19 group., Conclusion: Mortality in the first 90 days after COVID-19 in PD patients with COVID-19 was not different from the control PD group. However, some patients continued to experience significant problems, especially respiratory system symptoms, malnutrition, and hypervolemia., (© 2022 S. Karger AG, Basel.)

Introduction: We aimed to study the characteristics of peritoneal dialysis (PD) patients with coronavirus disease-19 (COVID-19), determine the short-term mortality and other medical complications, and delineate the factors associated with COVID-19 outcome., Methods: In this multicenter national study, we included PD patients with confirmed COVID-19 from 27 centers. The baseline demographic, clinical, laboratory, and radiological data and outcomes at the end of the first month were recorded., Results: We enrolled 142 COVID-19 patients (median age: 52 years). 58.2% of patients had mild disease at diagnosis. Lung involvement was detected in 60.8% of patients. Eighty-three (58.4%) patients were hospitalized, 31 (21.8%) patients were admitted to intensive care unit and 24 needed mechanical ventilation. Fifteen (10.5%) patients were switched to hemodialysis and hemodiafiltration was performed for four (2.8%) patients. Persisting pulmonary symptoms (n = 27), lower respiratory system infection (n = 12), rehospitalization for any reason (n = 24), malnutrition (n = 6), hypervolemia (n = 13), peritonitis (n = 7), ultrafiltration failure (n = 7), and in PD modality change (n = 8) were reported in survivors. Twenty-six patients (18.31%) died in the first month of diagnosis. The non-survivor group was older, comorbidities were more prevalent. Fever, dyspnea, cough, serious-vital disease at presentation, bilateral pulmonary involvement, and pleural effusion were more frequent among non-survivors. Age (OR: 1.102; 95% CI: 1.032-1.117; p: 0.004), moderate-severe clinical disease at presentation (OR: 26.825; 95% CI: 4.578-157.172; p < 0.001), and baseline CRP (OR: 1.008; 95% CI; 1,000-1.016; p: 0.040) were associated with first-month mortality in multivariate analysis., Discussion/conclusions: Early mortality rate and medical complications are quite high in PD patients with COVID-19. Age, clinical severity of COVID-19, and baseline CRP level are the independent parameters associated with mortality., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

Background/aims: Refugee dialysis is a worldwide growing dilemma with limited experience. This report presents the largest hemodialysis (HD) patient registry data of Syrian refugees in Turkey., Methods: Demographic, clinical, laboratory, and dialysis practice data of 345 Syrian HD patients during one year were collected and analyzed., Results: There were 345 prevalent Syrian HD patients at the end of 2016. Majority of the patients were placed in the Southeast Anatolian Region. The majority of the patients (74.8%) are in the age range of 20-64 years. Dialysis vintage in Turkey is less than 12 months in 20.8% and less than one month in 29.3% of patients. The vascular access was arteriovenous fistula in the majority of patients (72.5%). Kt/V is over 1.7 in 57%, serum albumin is above 35 g/L in 65.8% and hemoglobin level is more than 100 g/L in %65.2 of the patients. The ratio of patients with serum phosphorus level of 1.13-1.77 mmol/L was 56.2%. Twenty Syrian HD patients (14 male, 6 female) died within the year 2016 and annual mortality rate was 5.7%., Conclusion: This study with the largest number of Syrian refugees undergoing maintenance hemodialysis showed good dialysis practices, acceptable values for dialysis adequacy and biochemical parameters along with lower mortality compared to native HD population of Turkey. Longer follow up will enrich the knowledge related to care of refugee population in all over the world., (© 2019 The Author(s). Published by S. Karger AG, Basel.)

Takayasu arteritis is a disease that results in the granulomatous inflammation of large vessel walls. Takayasu arteritis is generally observed in young females during the second or third decades of life. This disease is treated by the revascularization of the affected organs either by surgery or by endovascular interventions. In this study, we present a case where renal autotransplantation was performed on a lady with an autologous saphenous vein graft subsequent to numerous previous endovascular interventions for her solitary kidney due to Takayasu arteritis-induced renal artery stenosis. The patient was prevented from becoming dialysis dependent through this surgical intervention. Renal autotransplantation is the choice of treatment, especially for those in whom endovascular interventions have failed. Patient management must include the partnership of an experienced vascular surgeon, transplant urologist, rheumatologist, nephrologist and radiologist., (© 2017 S. Karger AG, Basel.)

Objective: We aimed to investigate the prevalence and etiology of potassium abnormalities (hypokalemia and hyperkalemia) and management approaches for hospitalized patients., Subjects and Methods: Over a 4-month period, all hospitalized patients at Hacettepe University Medical Faculty Hospitals who underwent at least one measurement of serum potassium during hospitalization were included. Data on serum levels of electrolytes, demographic characteristics, cause(s) of hospitalization, medications, etiology of potassium abnormality and treatment approaches were obtained from the hospital records., Results: Of the 9,045 hospitalized patients, 1,265 (14.0%) had a serum potassium abnormality; 604 (6.7%) patients had hypokalemia and 661 (7.30%) had hyperkalemia. In the hypokalemic patients, the most important reasons were gastrointestinal losses in 555 (91.8%) patients and renal losses in 252 (41.7%) patients. The most frequent treatment strategies were correcting the underlying cause and replacing the potassium deficit. Of the 604 hypokalemic patients, 319 (52.8%) were normokalemic at hospital discharge. The most common reason for hyperkalemia was treatment with renin-angiotensin-aldosterone system blockers in 228 (34.4%) patients, followed by renal failure in 191 (28.8%). Two hundred and ninety-eight (45.0%) patients were followed without any specific treatment. Of the 661 hyperkalemic patients, 324 (49.0%) were normokalemic at hospital discharge., Conclusion: This study showed a high prevalence of potassium imbalance among hospitalized patients. Although most of the potassium abnormalities were mild/moderate, approximately half of the patients treated for hypokalemia or hyperkalemia were discharged from the hospital with ongoing dyskalemia.

Background: Bleeding is the most frequent complication of kidney biopsy. Although bleeding risk in patients with AA amyloidosis after kidney biopsy has not been studied in a large population, AA amyloidosis has long been perceived as a risk factor for bleeding. The aim of the present study was to evaluate post-biopsy bleeding risk in patients with AA amyloidosis., Methods: We retrospectively analyzed bleeding complications in 88 patients with AA amyloidosis and 202 controls after percutaneous kidney biopsy. All the kidney biopsies were performed under the guidance of real-time ultrasound with the use of an automated core biopsy system after a standard pre-biopsy screening protocol. Bleeding events were classified as major when transfusion of blood products or surgical or radiological intervention was required, or if the bleeding caused hypovolemic shock or death. Bleeding events that did not meet these criteria were accepted as minor., Results: The incidence of post-biopsy bleeding was comparable between AA amyloidosis and control groups (5.7 vs. 5.0%, p = 0.796). Major bleeding events were observed in 3 patients from each group (p = 0.372). Selective renal angiography and embolization were applied to 2 patients from the AA amyloidosis group. One of these patients underwent colectomy and died because of infectious complications. Bleeding events were minor in 2.3% of the patients with AA amyloidosis and 3.5% of the controls (p = 0.728)., Conclusions: AA amyloidosis was not associated with increased post-biopsy bleeding risk. Kidney biopsy is safe in AA amyloidosis when standard pre-biopsy screening is applied. Further data are needed to confirm these findings., (© 2015 S. Karger AG, Basel.)

A definite criteria for starting chronic hemodialysis treatment is still lacking even after 50 years of regular hemodialysis treatment. Although none of the current guidelines have designated a certain glomerular filtration rate (GFR) level to start hemodialysis, most favor an 'earlier' start after GFR falls below 15 ml/min. Hence, since mid-1990s, more patients have initiated dialysis on higher GFR levels. Most of the observational data and one randomized trial, however, failed to find any benefit, but even harm, from an earlier start in various patient populations including the healthiest groups. This paper has reviewed the available evidence and criticized the use of only 'GFR level' in the absence of a validated method in end-stage kidney disease patients. A new patient scoring system mimicking traffic lights was proposed in which patients were placed into green, yellow or red zones for deciding the ideal time to start hemodialysis. This scoring system should include not only validated GFR criteria but also a wide set of demographic and clinical parameters., (Copyright © 2011 S. Karger AG, Basel.)

Hypertension is a worldwide epidemic and its control is costly, but still inadequate. The mechanisms underlying the development of primary hypertension remain elusive. Several observations point to the kidney as a primary actor and sodium as the main culprit for development of hypertension. Over the last few decades, experimental, observational and clinical data have continuously indicated that excess salt intake is positively associated with elevated blood pressure and that blood pressure can be significantly reduced with substantial reductions in dietary sodium. This review highlights the pathophysiological mechanisms linking sodium to elevated blood pressure, synthesizes available evidence for the effect of reducing salt intake in controlling blood pressure. It specifically analyzes 6 recent meta-analyses and dietary approaches to stop hypertension., (Copyright 2006 S. Karger AG, Basel.)

Background: Iron supplementation is the cornerstone of anaemia management in haemodialysis (HD) patients. However, efficacy and safety of intravenous (IV) iron therapy in hepatitis C virus (HCV)-positive HD patients is yet to be elucidated., Methods: Sixty-six maintenance HD patients with suboptimal response to recombinant human erythropoietin (rh-EPO) were administered IV iron. Each patient received 100 mg/session IV iron sucrose for ten consecutive HD sessions and then the dose was decreased to 50-100 mg weekly or biweekly. Patients were followed for haemoglobin (Hb), ferritin, rh-EPO dose requirements, transaminase levels, and adverse drug reactions., Results: Baseline demographic and clinical characteristics, as well as Hb, ferritin, transaminase levels, rh-EPO and iron doses were similar between HCV-positive (n = 32) and HCV-negative patients (n = 29). After 5 months of follow-up, a significant increase in ferritin and Hb levels and decrease in rh-EPO doses were observed in both groups. The incidence of adverse drug reactions was not associated with HCV serology. Significant elevation in both alanine and aspartate aminotransferase levels were detected in HCV-positive patients., Conclusion: This study has shown that IV iron administration reverses suboptimal response to rh-EPO administration in HD patients regardless of HCV serology. There is however subtle increase of transaminase levels in HCV-positive patients. Further studies are warranted to reveal the impact of variation in serum transaminase levels during IV iron administration in HCV-positive HD patients.

Malignant disorders are one of the major causes of morbidity and mortality in transplant patients. We present herein a renal transplant recipient with malignant lymphoma which preceded by pure red cell aplasia (PRCA). Acquired PRCA is a rare hematologic disorder in renal transplant recipients. It has been associated with a variety of disorders of immunologic dysfunction and neoplasms, exposure to drugs and toxins, infectious diseases, pregnancy and severe nutritional deficiency. This is the first case with PRCA preceding the malign lymphoma in a renal transplant patient. Treatment of lymphoma and lymphoma-related humoral and cellular changes or other undefined effects that may be related to therapy may be responsible of the resolving of PRCA in this patient. In this regard, renal transplant patients with acquired PRCA, must be closely followed for an underlying neoplastic disorder., (Copyright 2002 S. Karger AG, Basel)

Purpose: We evaluated the effect of oral single-dose (20 mg) ketanserin on intraocular pressure (IOP) in normotensive and hypertensive eyes., Methods: This study included 15 healthy volunteers and 16 patients with ocular hypertension. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, IOP and pupil diameter were recorded at baseline and at 1-hour intervals for 6 h, in addition, tonographic outflow facility was studied at the third hour after the administration of placebo or an oral single dose of 20 mg ketanserin given in a randomized double-blind crossover fashion. The alternative treatment was applied a week later., Results: In both groups, oral single-dose (20 mg) ketanserin significantly lowered IOP and SBP (p < 0.01). No variation was observed in DBP, heart rate and pupil diameter (p >0.01). Moreover, after drug administration, the total outflow facility measured by conventional tonography increased in a statistically significant way (p < 0.01). Placebo did not induce any significant reduction in IOP and SBP in either group., Conclusion: The results showed that systemic ketanserin can be used in the treatment of glaucoma patients to reduce IOP., (Copyright 2001 S. Karger AG, Basel)

Purpose: To evaluate intraocular pressure (IOP) control after extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation in patients with capsular glaucoma (CG) and coexisting cataract., Methods: This prospective study included 20 patients (20 eyes) having CG and cataract whose IOPs were under 22 mm Hg and controlled with antiglaucoma medication. All patients had ECCE with PCIOL implantation and the follow-up period was at least 18 months. IOP was measured postoperatively at 3, 6, 9, 12 and 18 months and compared with preoperative IOP., Results: Following the cataract extraction, PCIOL implantation produced a statistically significant reduction in IOP at all time points compared with the preoperative IOP during the study period (p < 0. 001). The mean preoperative IOP was 18.25 +/- 1.83 mm Hg; postoperatively at 1 month, it was 13.45 +/- 2.06 mm Hg; at 3 months 14.80 +/- 2.50 mm Hg; at 6 months 15.35 +/- 1.27 mm Hg, at 12 months 14.85 +/- 1.87 mm Hg and at 18 months 15.15 +/- 1.42 mm Hg (p < 0. 0008). The mean reduction in IOP was 16.98% from baseline at 18 months postoperatively. The mean number of antiglaucoma medication was reduced from 1.35/eye preoperatively to 0.60/eye postoperatively at 18 months (p < 0.0007)., Conclusion: The result of our study revealed that ECCE with PCIOL implantation may be a reliable choice in controlling IOP in patients with CG., (Copyright 2000 S. Karger AG, Basel.)

Purpose: To evaluate the conjunctival structure and inflammatory cell counts and to determine the predictive value of these histological parameters for postoperative intraocular pressure (IOP) levels after trabeculectomy., Methods: A clinical and histological study was performed on consecutive patients. Postoperative (mean 32. 8 +/- 18.4 months; range 6-60 months) conjunctival biopsies of 36 eyes of 28 primary open-angle glaucoma patients who had trabeculectomy between 1992 and 1995 were included in the study. According to postoperative pressure control, patients with < or = 16 mm Hg and those with >16 mm Hg were taken as groups 1 and 2, respectively. The control group (group 3) consisted of 15 age-matched patients without glaucoma, who had received no topical therapy. We compared the conjunctival structure and cell counts within these groups. Goblet cells, acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness, vascular density, mucopolysaccharides and collagen compositions were determined in groups 1, 2 and 3., Results: The number of goblet cells was significantly higher in group 1 (6.74 +/- 7.23) than group 2 (3. 09 +/- 2.77; p = 0.017). No statistical difference was observed in the number of acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness, vascular density, mucopolysaccharide or collagen compositions between groups 1 and 2 (p > 0.05). In addition, when groups 1 and 2 were compared with the control group, there was a significant decrease in goblet cells (p < 0.001), an increase in acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness and vascular density (p < 0.001), but there was no significant difference in mucopolysaccharide and collagen compositions (p > 0.05)., Conclusions: This study suggests that at the time of surgery a high number of goblet cells may be a predictor of lowered IOP (< or = 16 mm Hg) following trabeculectomy without antimetabolite., (Copyright 1999 S. Karger AG, Basel)