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Aim Lupus nephritis (LN) is an important complication of systemic lupus erythematosus (SLE). The aim is to use indication and protocol biopsies to determine clinicopathological findings and outcomes of patients with LN undergoing kidney transplantation (KTx). Methods Patients who underwent KTx due to LN were retrospectively analyzed. Recurrent LN (RLN) was diagnosed by transplant kidney biopsy. Results Among 955 KTx patients, 12 patients with LN as the cause of end-stage renal disease were enrolled. Five patients were male. Mean follow-up time was 63 ± 34 months. At the last follow-up visit, mean levels of serum creatinine and proteinuria were 137.0 ± 69.0 µmol/L and 0.26 ± 0.26 g/day, respectively. Eighteen indication and 22 protocol biopsies were performed; 27 biopsies were additionally evaluated by immunofluorescence. In two recipients, subclinical RLN was confirmed by protocol biopsies. Clinical recurrence occurred in four patients. Among patients with RLN, time from diagnosis of LN to KTx was significantly shorter and use of ATG as induction treatment was significantly lower. Graft loss occurred in two recipients who had clinical RLN. Five-year overall graft survival was 85.7%. Conclusion Kidney transplantation is a reasonable option for patients with ESRD secondary to SLE. However, recurrence of LN is common if protocol biopsies are included in post-transplantation surveillance.

Autosomal dominant polycystic kidney disease (ADPKD) is the most frequently occurring hereditary kidney disease, and axial spondyloarthritis (SpA) is one of the most frequently occurring rheumatic diseases. Treatment-related decisions for axial SpA may pose a challenge in case of renal involvement. The authors describe two siblings with cooccurrence of these two diseases. The association of these two diseases is not well known. Practitioners should monitor renal function in SpA patients and take treatment-related decisions regarding renal involvement. Antitumor necrosis factor-alpha (anti-TNF-α) agents may be used in case nonsteroidal anti-inflammatory drugs (NSAIDs) cannot be utilized.

Persistent hypercalcemia after kidney transplantation (KTx) may cause nephrocalcinosis and graft dysfunction. The aim of this study was to evaluate patients with hypercalcemia and assess its effect on tubulointerstitial calcification. A total of 247 recipients were enrolled. Transient and persistent hypercalcemia was defined as hypercalcemia (corrected serum calcium >10.2 mg/dL) persisting for 6 and 12 months after KTx, respectively. The severity of calcification in the 0-h, 6- and 12-month protocol biopsies of patients with transient (n = 8) and persistent hypercalcemia (n = 20) was compared with a matched control group (n = 28). Twenty-eight patients were hypercalcemic at 6 months posttransplantation. Serum calcium levels were normalized in eight of them at the end of the first year. Dialysis duration was a positive predictor of persistent hypercalcemia. Tubulointerstitial calcification was detected in 70.6 and 90 % of patients with persistent hypercalcemia at 6 and 12 months posttransplantation, respectively. In 20 % of patients with transient hypercalcemia, severity of calcification regressed at 12 months posttransplantation along with normalization of serum calcium levels. Graft functions and histopathological findings (ci, ct, ci + ct, cv, ah, percentage of sclerotic glomeruli) were not different at 6 and 12 months posttransplantation. Hypercalcemia and persistent hyperparathyroidism are not rare after KTx. Tubulointerstitial calcification is more common and progressive among patients with persistent hypercalcemia. Normalization of calcium levels may contribute to regression of calcification in some patients.

The systemic absorption of the flush liquid, including sorbitol, glycine or mannitol, can lead to complications, such as hyponatremia, volume overload and pulmonary or cerebral edema. Acute hyponatremia is defined as a reduction in the plasma sodium level in less than 48 h. Acute symptomatic hyponatremia should be corrected aggressively because it may cause irreversible neurological damage and death. Rapid correction of hyponatremia causes severe neurologic deficits, such as central pontine myelinolysis; thus, the optimal therapeutic approach has been debated. This article examined acute symptomatic hyponatremia in a patient undergoing transcervical myomectomy for a submucosal myoma. A thirty-seven-year-old patient was evaluated in obstetrics and gynecology clinic because of altered mental status and agitation. There was no history of chronic illness or drug use. It was discovered that during the operation, 12 L of the flush fluid, which contained 5 % mannitol, had been infused, but only 7 L of the flush fluid had been collected. On physical examination, the patient's general condition was moderate, her cooperation was limited, she was agitated, and her blood pressure was 120/70 mmHg. The sodium level was 99 mEq/L. Furosemid and 3 % NaCl solution were given. Her serum sodium returned to normal by increasing 39 mEq/L within 14 h. Her recovery was uneventful, and she was discharged 24 h after her serum sodium returned to normal. In conclusion, if there is a difference between the infused and collected volumes of the mannitol irrigant, severe hyponatremia may develop due to the flush fluid used during transcervical hysteroscopy and myomectomy. In these patients, acute symptomatic hyponatremia may be corrected as rapidly as the sodium level dropped.

Acute renal failure (ARF) is a clinical situation that renal functions deteriorate suddenly within hours to days. Postrenal causes are responsible for a small part of ARF. In this article, we presented a case gone to left nephrectomy priorly, with a right ureter stone led to complete obstruction, ARF, and treated by ureterorenoscopy (URS). A seventy year old male patient was sent to Emergency Department because of anuria for 48 hours. In ultrasonographic exam; there wasn’t hydronephrosis of right kidney. A right lower ureter stone was seen in the non-contrast spiral abdominal computed tomography. The lower ureter stone was removed by URS and JJ catheter was replaced. He was discharged with normal renal function tests. In conclusion, postrenal ARF must be ruled out in patients with acute anuria, especially zero urine, even if hydronephrosis delinea. If postrenal ARF is diagnosed and treated quickly, the outcomes will be excellent.

WOS: 000386130100021, PubMed ID: 27274836, Background: There are significant differences between countries in the mortality rates of haemodialysis (HD) patients. The extent of these differences and possible contributing factors are worthy of investigation. Methods: As of March 2009, all patients undergoing HD or haemodiafiltration for >3 months (n = 4041) in the Turkish clinics of the NephroCare network were enrolled. Data were prospectively collected for 2 years through the European Clinical Dialysis Database. Mean age +/- standard deviation was 58.7 +/- 14.7 years, 45.9% were female and 22.9% were diabetic. Comparison with US data was performed by applying an indirect standardization technique, using specific mortality rates for patients on HD by age, gender, race and primary diagnosis as provided by the 2012 US Renal Data System Annual Data Report as reference. Results: The crude mortality rate in Turkey was 95.1 per 1000 patient-years. Compared with the US reference population, the annual mortality rate for Turkey was significantly lower, irrespective of gender, age and diabetes. After adjustments for age, gender and diabetes, the mortality risk in the Turkish cohort was 50% lower than US whites [95% confidence interval (CI) 0.46-0.54, P < 0.001], 44% lower than US African-Americans (95% CI 0.52-0.61, P < 0.001) and 20% lower than Asian-Americans (95% CI 0.74-0.86, P < 0.05). Conclusions: The annual mortality rate of prevalent HD patients was found to be significantly lower in the studied Turkish cohort compared with that published by the US Renal Data System Annual Data Report. Differences in practice patterns may contribute to the divergence.

Background and Aim The effect of preemptive transplantation of kidneys from living donors on patient and allograft survival is controversial. In this study, we aimed to evaluate whether preemptive kidney transplantation performed without the development of patient dialysis-related complications has a favorable effect on patient and graft survival. Patients and Method The study included 334 adult renal transplant recipients. Patients who underwent renal transplantation between January 2008 and December 2012 at a tertiary referral teaching hospital were followed, and outcomes were obtained by retrospective chart review. A total of 244 patients underwent dialysis before renal transplantation, whereas 90 patients underwent preemptive transplantation. Results There were no significant differences between the 2 groups with regard to patients and graft survival rates ( P > .05). Patient survival rates in preemptive and nonpreemptive groups were 98.9% and 96.3% in the first year, respectively ( P = .199). Graft survival rates in preemptive and nonpreemptive groups were 96.7% and 93.0% in the first year, respectively ( P = .163). Patient survival rates in preemptive and nonpreemptive groups were 98.9% and 95.7% in the third year, respectively ( P = .155). Graft survival rates in preemptive and nonpreemptive groups were 93.5% and 88.5% in the third year, respectively ( P = .138). There was a significant difference among years with regard to ratio of patients with preemptive transplantation ( P = .009). The ratio was 17.5% in 2008, whereas it rose to 43.1% in 2012. Conclusion Although preemptive kidney transplantation does not provide a significant patient and allograft survival advantage compared to nonpreemptive kidney transplantation, both therapeutic modalities provide good outcomes. Preemptive kidney transplantation has been an increasingly frequent renal replacement therapy option in recent years.

The term cardiorenal syndrome (CRS) has been used to define interactions between acute or chronic dysfunction of the heart or kidney. When primary chronic kidney disease contribute to cardiac dysfunction, it is classified as type 4 CRS. Cardiac dilatation, valve regurgitations, and left ventricular dysfunction are observed in end-stage renal failure patients with uremic cardiomyopathy. Because of perioperative risks in these patients, they may not be considered a candidate for kidney transplantation. However, uremic cardiomyopathy can be corrected when volume control is achieved by appropriate dose and duration of ultrafiltration. By presenting two cases with occult hypervolemia in uremic cardiomyopathy whose cardiac functions improved early after kidney transplantation, attention is drawn to the importance of kidney transplantation on cardiac function in such patients primarily and the importance of strict volume control on cardiac function in dialysis patients waiting for kidney transplantation.

Hypermagnesemia is rarely seen in peritoneal dialysis (PD) patients because PD can lower the plasma magnesium (Mg) concentration effectively. In this report, a continuous ambulatory peritoneal dialysis (CAPD) patient with life-threatening hypermagnesemia treated by hemodialysis (HD) is presented. A 52-year-old male patient on PD treatment was admitted to our clinic with complaints of fatigue and muscle weakness. Decrease in deep tendon reflexes (DTR), decrease in muscle strength at bilateral upper and lower extremities, and increased level of magnesium (7.7 mg/dl) were detected. Bradycardia, prolongation of the P-R interval, and an increase in Q-T interval were found on the electrocardiography. HD was performed two times. After HD, all the signs and symptoms of the patient improved. HD is a dialysis modality that should be preferred in the treatment of symptomatic patients with hypermagnesemia, because of providing more rapid clearance of Mg. KEy woRDS: Hemodialysis, Hypermagnesemia, Peritoneal dialysis doi: 10.5262/tndt.2013.1001.17 Yazisma Adresi: Mustafa YAPRAK Ege Universitesi Tip Fakultesi, Ic Hastaliklari Anabilim Dali, Nefroloji Bilim Dali, Izmir, Turkiye Gsm : 0 505 572 56 67 E-posta : mustafayaprakdr@yahoo.com Gelis Tarihi : 27.06.2012 Kabul Tarihi : 26.09.2012 tedavisi alan bir hastada Mg hidroksit kullanimina bagli ortaya cikan, hayati tehdit eden hipermagnezemi tablosunun acil hemodiyalizle (HD) duzeltildigi bir olgu sunulmustur.

Lithium is the treatment of choice in bipolar disorders. Long-term use has important side effects such as nephrotoxicity. A 37-year-old female patient on lithium with proteinuria and renal failure was diagnosed as having chronic tubulointerstistial nephritis and secondary focal segmental glomerulosclerosis at renal biopsy. These findings were linked to lithium use. We present this case as it is a rare event. key words: Lithium, Focal segmental glomerulosclerosis, Chronic renal failure doi: 10.5262/tndt.2012.1003.23 Yazisma Adresi: Ozkan GunGOR Ege Universitesi, Tip Fakultesi, Nefroloji Bilim Dali, Izmir, Turkiye Gsm : 0 506 664 80 54 E-posta : ozkangungor@yahoo.com.tr Gelis Tarihi : 10.02.2012 Kabul Tarihi : 27.04.2012 yan etkileridir (2). Lityumun bobrek fonksiyonlari uzerine de olumsuz etkileri vardir. Nefrojenik diyabetes insipitus, tubulointerstisyel nefrit ve nefrotik sendrom nadir gorulen ancak onemli yan etkileri arasindadir (3). Biz, bipolar bozukluk nedeniyle uzun sure lityum tedavisi alan hastada proteinuri ve bobrek yetmezligi gelismesi uzerine bobrek biyopsisi yaptik; kronik tubulointerstisyel nefrit ve FSGS saptadik. Olguyu literaturde nadir olmasi nedeniyle sunuyoruz.