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.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect various body organs, especially the skin, joints, hematopoietic system, kidneys and central nervous system. The signs and symptoms occur depending on the inflammation in the affected tissues. Although many factors are responsible for its aetiology, it is known that some viruses such as Epstein Bar virus may also cause this disease by triggering autoimmunity. Recent studies have revealed that the immune system could be activated due to coronavirus infections and that some autoantibodies could be observed in the blood. A small number of SLE cases activated by COVID infection have been reported in the literature. The present study presented and discussed with the information in the literature a 20-year-old patient with COVID infection, diagnosed with SLE with renal involvement according to EULAR/ACR 2019 criteria by considering histopathological and immunofluorescence findings.

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.

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.

Hidradenitis Suppurativa: a lesser-known cause of AA amyloidosis

Background and Aims Membranous nephropathy (MN) is the most common cause of nephrotic syndrome in the adult population. The aim of our study is to determine the demographic and clinical characteristics and biopsy findings of the patients diagnosed with MN in our country. Method The study included 991 patients with renal biopsy who were followed in 47 nephrology clinics and enrolled in the database of Turkish Nephrology Primary Glomerular Diseases (TSN-GOLD) Working Group between May 1, 2009, and June 1, 2019. The demographic and clinical characteristics and biopsy findings of all patients included in the study were analyzed. Results The mean age of patients included in our study was 46±14.8 years and the gender distribution was (M / F, 582/409). 80.3% (n = 796) of the patients had nephrotic proteinuria at the time of diagnosis. Before the biopsy, the PLAR2 antibody was examined in 137 patients and positive in 71.5% (n = 98) patients. Hypertension was present in 34.6% (n = 343) of the patients. Mean estimated glomerular filtration rate was 93.9±32.8 ml/min/1.73 m2, albumin level was 2.7 ± 0.2 mg/dL, proteinuria level in urine was 7,1±6,4 gr/day and total cholesterol level was 295±3.7 mg/dL. On light microscopy, baseline membrane thickening was found in 92% (n=907) and interstitial inflammation in 53% (n=524) specimens. In immunofluorescence staining, 3 (+) IgG accumulation was highest in 578 (58.3%) of the specimen. Conclusion This multicentre study is the largest study to analyze clinical, laboratory, and biopsy specimens of MN patients at the time of biopsy in our country. The findings are consistent with the literature. Prospective follow-up results of these patients will help us to understand the renal prognosis and treatment response better.

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: 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.

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.

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.

Primary lymphedema is a rare disease caused by a disorder of lymphatic system. Clinical presentation and age at onset are variable. AA amyloidosis is usually due to chronic inflammatory diseases, malignant tumors or less frequently chronic infectious diseases. The appearance of AA amyloidosis is rare in the course of inflammatory skin diseases, and chronic leg ulcers have been rarely reported to cause AA type amyloidosis. We report here two cases of AA amyloidosis that presented with renal failure and nephrotic syndrome in patients with primary lymphedema-induced chronic leg ulcers. We aimed to reveal that there is a relation between lymphedema, chronic leg ulcers, AA amyloidosis and chronic kidney disease. KEY wORDS: Secondary renal amyloidosis, Primary lymphedema, Chronic leg ulcers, Chronic kidney disease

Kidneys and thyroid are two basic organs that interact with each other, and when one of them becomes ill, functions of the other are affected. Although electrolyte disturbances are the most common symptoms reported due to hypothyroidism, some are case reports in the literature suggested that acute kidney injury developed due to hypothyroidism. Despite this, we doubt that this information comes into mind in routine clinical practice. To report a case of reversible hypothyroidism-induced acute kidney injury, and review those two clinical conditions, which are often overlooked in the nephrology practice, in the light of the literature. We reported a 75-year-old female patient who admitted for acute kidney injury associated with deep hypothyroidism, required hemodialysis, and underwent a renal biopsy since no etiological factors were detected for acute kidney injury. We emphasized that the patient’s creatinine concentrations gradually returned to normal following hormone replacement therapy. Renal dysfunction in presence of hypothyroidism is a known, but frequently overlooked entity. Hypothyroidism should not be overlooked as the cause of reversible kidney injury since it is easy to treat, and there is almost complete response to treatment in terms of renal failure.

Post-transplant diabetes mellitus is a serious complication of organ transplantation. Post-transplant diabetes mellitus is a form of type 2 diabetes mellitus that is thought to develop in response to a relative insulin deficiency resulting from increased insulin resistance or impaired insulin production or a combination of both. The clinical presentation varies from asymptomatic hyperglycemia to hyperosmolar dehydration or diabetic ketoacidosis. The onset of diabetes is associated with reduced graft function and patient survival. Immunosuppressive drugs, such as corticosteroids and calcineurin inhibitors (cyclosporine and tacrolimus), are known to be diabetogenic. However, the association of diabetic ketoacidosis with the use of systemic corticosteroids is infrequently reported. Here, we report a 27-year-old female recipient of a live renal transplant who developed diabetic ketoacidosis associated with short-term corticosteroid treatment.

Amlodipine Induced Massive Ascites, a Rare Clinical Case