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Objective: Transplant renal artery stenosis (TRAS) and post-transplant arterial hypertension is a treatable cause of allograft dysfunction and graft loss. The risk factors for the development of TRAS include: donor age, prolonged and delayed graft function, cold ischemia time,concomitantCMV infection and surgical technique. Percutaneous transluminal angioplasty (PTA) has proven successful in treating TRAS in 60-90% of cases by providing renal reperfusion. In this study,we evaluated six TRAS cases in our clinic. Material and Methods: We evaluated patients retrospectively from medical records who underwent transplantation in 2017. We recorded the age, gender, creatinine, other findings during transplantation, and the demographic features of transplant patients with TRAS. Results: TRAS was reported in 6 of 26 cases. The presence of iliac artery stenosis associated with renal artery stenosis was seen in two patients with CMV PCR (+). Patients underwent PTA and stent implantation. The need for antihypertensive treatment of the patients lessened during follow-up. Conclusion: TRAS is one of the reasons for allograft dysfunction after kidney transplantation. For this reason it should be kept in mind when determining the cause of the allograft disfunction. In addition to other risk factors, surgical technique plays an important role in the development of TRAS. Graft function can be preserved with early intervention., Amaç: Transplant renal arter stenozu (TRAS) ve posttransplant arterial hipertansiyon allograft disfonksiyon ve greft kaybının tedavi edilebilir bir nedenidir. TRAS gelişiminde risk faktörleri arasında donor yaşı, uzun sureli gecikmiş greft fonksiyonu, soğuk iskemi süresi, eşzamanlı CMV enfeksiyonu varlığı ve cerrahi teknik vardır. Perkütan Translüminal Anjioplasti (PTA) %60-90 vakada renal perfüzyonu sağlar. Bu çalışmamızda, kliniğimizdeki 6 TRAS vakasının özelliklerini inceledik. Gereç ve Yöntem: Kliniğimizde, 2017 yılında böbrek nakli yapılan hastalar tıbbi kayıtlardan inceledik. TRAS gelişen hastaların yaş, cinsiyet, nakil sırasındaki diğer bulguları ve demografik özellikleri kaydedildi. Bulgular: Yirmi altı vakanın altısında TRAS saptandı. İliak arter darlık varlığı ile birlikte renal arter stenozu olan 2 hastada CMV PCR pozitifliği saptandı. Hastalara PTA ve stent implantasyonu uygulandı. Takiplerde antihipertansif tedavi ihtiyacı azaldı. Sonuç: TRAS, böbrek nakli sonrasında allograft disfonksiyonun nedenlerinden biridir. Sonuç olarak allograft disfonksiyonda akılda tutulmalıdır. Diğer risk fatörlerine ek olarak, cerrahi teknik de TRAS gelişiminde önemli bir rol oynar. Greft fonksiyonu erken girişimle korunabilir.

Cerrahpaşa Tıp Fakültesi İç Hastalıkları Anabilim Dalı Nefroloji Bilim Dalı Hemodiyaliz Ünitesinde Ocak 2000-Aralık 2010 tarihleri arasında acil diyaliz uygulanan hastaların acil diyaliz endikasyonları, klinik ve laboratuvar bulguları, sağkalım-ölüm oranları ve bunları etkileyen faktörler retrospektif araştırıldı.Yediyüzkırkdokuz (469 erkek, 280 kadın) hastaya acil diyaliz (745 hemodiyaliz (HD), 4 periton diyalizi) uygulandığı, acil HD'in 7 hastada zehirlenme, 738 hastada böbrek yetmezliği nedeniyle uygulandığı görüldü. Yediyüzotuzsekiz (463 erkek/275 kadın, ortalama yaş 57.6 ± 16.8) hasta incelendiğinde acil HD endikasyonları % 30 hipervolemi,% 29 üremi, % 24 hiperkalemiydi. HD endikasyonu, % 28 akut böbrek yetmezliği, % 44 kronik böbrek yetmezliği ve % 28 KBY üzerine ABY olarak saptandı.Hastaların %32'sinde hipertansiyon, % 25'inde malignite, % 23'ünde diabetes mellitus saptandı. En sık görülen semptomlar: bulantı-kusma (% 80), iştahsızlık (% 48), dispne (% 43) idi. Oligüri %70, nonoligüri %30 hastada saptandı.Laboratuvar bulgularında, üre 224.4 ± 66.5 mg/dl, kreatinin 7.8 ± 3.3 mg/dl, potasyum 4.9 ± 1.2 mEq/L saptandı.En sık gelişen komplikasyonlar: hipotansiyon (% 13), bulantı-kusma (% 4.2), hipoglisemi (% 3.7) idi. Hastaların % 34'ünün öldüğü saptandı. Ölüm nedenleri, altta yatan hastalık (% 47.8), infeksiyonlar (% 28.5), kardiyovasküler nedenler (% 11.6) olarak sıralandı. Hastaların %12'sinde tam iyileşme, % 21' inde HD ihtiyacı olmayan ve % 67'sinde HD ihtiyacı olan KBY görüldü.Acil HD uygulanan hastalarda ileri yaş, sosyal güvencenin olmaması ve malignitenin mortaliteyi arttırdığı saptandı. Hiperkalemi, hipervolemi, lökositoz, CRP, ALT, AST yüksekliği ve oligüri mortalite artışıyla ilişkiliydi. Prerenal ABY'de, etyolojisi saptanamayan KBY' li hastalarda ve HD esnasında hipotansiyon gelişenlerde mortalite daha yüksekti. Patients who underwent urgent dialysis between 2000-2010 in Cerrahpasa Medical Faculty were enrolled in this study. Demographic, clinical and laboratory findings, dialysis indications, survival rates were obtained retrospectivelyA total of 749 patients (469 male/280 female) underwent urgent dialysis (745 hemodialysis (HD), 4 peritoneal dialysis). Urgent HD were performed in 7 patients for intoxication and in 738 patients for renal failure.738 patients (463 male/275 female, mean age 57.6 ± 16.8) who underwent urgent HD were investigated. İndications were as follows: hypervolemia (30%), uremic symptoms (29 %), hyperkalemia (24 %). Rates of clinical situations were as follows: acute renal failure (28 %), chronic renal failure (44 %) and ARF with pre-existent CRF (28%). Comorbid situations were: hypertension (32 %), malignity (25%), diabetes mellitus (23%). The most seen symptoms were: nausea-vomiting (80 %), anorexia (48 %), dyspnea (43 %). Seventy percent of patients were oliguric and the others were non-oliguric.Laboratory findings were: urea 224.4 ± 66.5 mg/dL, creatinine 7.8 ± 3.3 mg/dL, potassium 4.9 ± 1.2 mEq/L.Most seen complications were: hypotension (13 %), nausea-vomiting (22 %), hypoglycemia (37.2 %).Thirtyfour percent of patients were dead. Causes of deaths were: underlying disorder (47.8%), infection (28.5%), cardiovascular disease (11.6 %). Outcomes of 489 patients who survived were: recovery (% 12), CRF not requiring dialysis (21 %) and CRF requiring diaysis (67 %).Advanced age, lack of health insurance, malignancy, hyperkalemia, hypervolemia, leukocytosis, elevated CRP, ALT, AST, oliguria, prerenal ARF, CRF with unidentified etiology, hypotension during HD were all associated with increased mortality. 49

WOS: 000361339400015, PubMed ID: 26123266, We aimed to investigate the demographic, clinical, diagnostic, treatment and outcome features of patients with urinary tuberculosis (UTB). Patients with UTB admitted to seven separate centers across Turkey between 1995 and 2013 were retrospectively evaluated. The diagnosis of UTB was made by the presence of any clinical finding plus positivity of one of the following: (1) acid-fast bacilli (AFB) in urine, (2) isolation of Mycobacterium tuberculosis, (3) polymerase chain reaction (PCR) for M. tuberculosis, (4) histopathological evidence for TB. Seventy-nine patients (49.36% male, mean age 50.1 +/- 17.4 years) were included. Mean time between onset of symptoms and clinical diagnosis was 9.7 +/- 8.9 months. The most common signs and symptoms were hematuria (79.7%), sterile pyuria (67.1%), dysuria (51.9%), weakness (51.9%), fever (43%) and costovertebral tenderness (38%). Cystoscopy was performed in 59 (74.6%), bladder biopsy in 18 (22.8%), kidney biopsy in 1 (1.26%) and nephrectomy in 12 (15.2%) patients. Histopathological verification of UTB was achieved in 12 (63.1%) patients who undergone biopsy and in 100% of those undergone nephrectomy. Mycobacterium tuberculosis was isolated in the urine of 50 (63.3%) cases. Four-drug standard anti-TB treatment was the preferred regimen for 87.3% of the patients. Mean treatment duration was 10.5 +/- 2.7 months. Deterioration of renal function occurred in 15 (18.9%) patients two of whom progressed to end-stage renal disease and received hemodialysis. Only one patient died after 74-day medical treatment period. Cases with UTB may present with non-specific clinical features. All diagnostic studies including radiology, cyctoscopy and histopathology are of great importance to exclude UTB and prevent renal failure.