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© 2022 Turkish Society of Nephrology. All rights reserved.Objectives: Geriatric syndromes are common in elderly subjects with chronic kidney disease. An age-adapted definition of chronic kidney disease has recently been proposed. This study aimed to investigate the effects of this change in the definition of chronic kidney disease (from an estimated glomerular filtration rate of

Objective: To determine the prevalence of different electrolyte imbalances in a cohort of elderly subjects aged ≥65 years, and evaluate associations between each electrolyte imbalance and functional dependence. Methods: We reviewed medical records of consecutive outpatient elderly subjects. Frequency of hyponatremia (serum sodium of 145 mmol/L), hypokalemia (serum potassium of 5.3 mEq/L), hypocalcemia (serum calcium of 10.5 g/dL), hypophosphatemia (serum phosphorus of 4.5 mg/ dL), hypomagnesemia (serum magnesium of 2.3 mg/dL) were assessed. Associations between each electrolyte disorder and Barthel and Lawton-Brody activities of daily living (BADL and IADL) were analyzed. Results: Among the 464 subjects, hyponatremia (11.2%) hypomagnesemia (9.1%) and hypermagnesemia (8.8%) were the most common disorders. Patients with one electrolyte imbalance constituted 30.2% (140 patients) of the cohort, while 44 (9.5%) had two, and 7 (1.5%) patients had ≥2 electrolyte imbalances, concurrently. Calcium, phosphorus, and magnesium disorders were more common among subjects who were 80 years of age or more, compared to those aged 65-79 years, while the frequency of potassium disorders was lower in the former group. Hyponatremiaand hypocalcemia were associated with functional dependence based on BADL and IADL scores. Patients with multiple electrolyte abnormalities had a higher risk of functional dependence. Conclusion: Hypomagnesemia was as common as hyponatremia, especially among patients with an age of 80 years or more. Hyponatremia and hypocalcemia appeared to be associated with functional dependence. The higher number of electrolyte abnormality the higher risk of functional dependence. Our results should be confirmed by studies with larger sample sizes.

Objective: Some studies have shown that keto amino acids (KA) reduce proteinuria and improve renal function as well as nutritional status in patients with diabetic nephropathy. We aimed to compare the pathologic findings of kidneys of rats that were given protein-restricted diets enriched with KA with those of rats given protein-restricted diet alone.

Nonvalvular atrial fibrillation is the most prevalent sustained arrhythmia in chronic kidney disease patients. When compared to warfarin, new oral anticoagulants are found to be non-inferior or superior in safety and efficacy outcomes in the general population. The efficacy and safety of anticoagulation in mild chronic kidney disease is similar to the general population. Studies are yielding conflicting results in moderate to advanced chronic kidney disease and end stage renal disease. Due to hemostasis dysfunction in chronic kidney disease, both bleeding and thromboembolism risk increase. Advanced chronic kidney disease and end stage renal disease patients are excluded from randomized controlled trials. Our knowledge about the efficacy, safety and dose adjustments of warfarin and new oral anticoagulants are based on observational data. According to the recent studies, apixaban and edoxaban use in moderate chronic kidney disease with a glomerular filtration rate between 30-50 mL/min may be safer than warfarin. There are no high quality evidence to recommend the use of warfarin in advanced and end stage chronic kidney disease patients. The Food and Drug Administration approved the use of apixaban in end stage renal disease. Randomized controlled trials are needed to evaluate the use of oral anticoagulants in advanced chronic kidney disease.

Objective: Chronic kidney disease has shown a gradual rise in prevalence. Kidney transplantation is the gold standard of renal replacement therapy and is associated with improved quality of life and decreased morbidity and mortality. The main goal of the present study was to understand the attitudes of patients with end-stage renal disease toward and apprehensions for renal transplantation.

WOS: 000471268100003 The clinical use of cisplatin, which is a first-line anticancer agent, is highly restricted due to its adverse effects on kidneys that lead to nephrotoxicity. Therefore, some potential reno-protective substances have been used in combination with cisplatin to cope with nephrotoxicity. Due to its high antitumor activity and oxygen-carrying capacity, we investigated the molecular effects of squalene against cisplatin-induced oxidative stress and kidney damage in mice. Single dose of cisplatin (7 mg/kg) was given to male Balb/c mice. Squalene (100 mg/kg/day) was administered orogastrically to mice for 10 days. Following sacrification, molecular alterations were investigated as analysis of the levels of oxidative stress index (OSI), inflammatory cytokines and cell survival-related proteins in addition to histopathological examinations in mice kidney tissue. The level OSI and Interferon-gamma (IFN-gamma) decreased in the cisplatin and squalene cotreated mice compared to cisplatin-treated mice. Squalene treatment also increased the activation of protein kinase B (AKT). Furthermore, cisplatin-induced inactivation of mammalian target of rapamycin (mTOR) and histopathological damages were reversed by squalene. It may be suggested that squalene ameliorated the cisplatin-induced histopathological damages in the kidney through activation of AKT/mTOR signaling pathway by regulating the balance of the redox system due to its antioxidative effect.

Objective: We aimed to study whether long-term kidney function would be affected by different chemotherapy regimens in patients with malignancy.

Introduction: The coronavirus disease 2019 (Covid-19) pandemic has influenced the whole world, where after the first case was diagnosed in Turkey, educational activities were suspended and partial curfews were implemented. This study was conducted to assess the concerns faced by the medical students about their professional life due to the disrupted educational activities and related psychological effects.Methods: This is a cross-sectional survey study, conducted with self-administered questionnaires on Bezmialem Vakif University medical students, during the pandemic. The questionnaire consists of queries about demographics, environmental factors, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) scales.Results: A total of 178 students participated in the study, with a female-to-male ratio of 5:2. Of the total respondents, 19.7% were experiencing severe anxiety, 17.4% moderate anxiety, and 37.1% mild anxiety, according to the GAD-7; and 13.5% of the respondents were experiencing severe depression, 21.9% moderate–severe depression, and 23% mild depression according to the PHQ-9. There was no statistically significant difference between the grades in terms of GAD-7 or PHQ-9 scores. Male participants were more likely to have suicidal thoughts (p = 0.013). According to our study, the factors with the highest influence on students were as follows: “Major changes in personal life,” “Disruption in educational activities,” and “Covid-19 related anxiety of loss of relatives and contamination or infection.” On average, women voted higher points for “Covid-19 related anxiety of loss of relatives and contamination.”Conclusions: We found that a significant portion of students regardless of their year in medical school were profoundly affected by the pandemic process as is shown by their anxiety and depression scores. The disruption in educational activities is one of the main factors of these effects, and we believe that these should not be ignored, as they could in the future lead to a series of problems for medical education and students alike.

Hyperkalemia is commonly seen in hemodialysis patients and is a potentially life-threatening condition. Serum potassium concentration greater than 10 mEq/L is defined as extreme hyperkalemia. Emergent treatment of hyperkalemia is made with intravenous calcium, insulin-dextrose solutions, diuretics, gastrointestinal cation-exchange resin and dialysis. We present here a 52-year-old chronic hemodialysis patient with extreme hyperkalemia and cardiac arrhythmia. She was treated with emergent hemodialysis. Her abnormal laboratory findings and electrocardiography recovered. Further examinations suggested insufficient hemodialysis treatment as the possible cause of hyperkalemia.

The bidirectional relationship between cancer and chronic kidney disease (CKD) is complex. Patients with cancer, particularly those with hematological malignancies such as multiple myeloma and lymphoma, are at increased risk of developing acute kidney injury and CKD. On the other hand, emerging evidence from large observational registry analyses have consistently shown that cancer risk is increased by at least 2- to 3-fold in kidney transplant recipients, and the observed increased risk occurs not only in those who have received kidney transplants but also in those on dialysis and with mild- to moderate-stage CKD. The interactions between cancer and CKD have raised major therapeutic and clinical challenges in the management of these patients. Given the magnitude of the problem and uncertainties, and current controversies within the existing evidence, Kidney Disease: Improving Global Outcomes (KDIGO) assembled a global panel of multidisciplinary clinical and scientific expertise for a controversies conference on onco-nephrology to identify key management issues in nephrology relevant to patients with malignancy. This report covers the discussed controversies in kidney disease in hematological malignancies, as well as cancer after kidney transplantation. An overview of future research priorities is also discussed. © 2020 Kidney Disease: Improving Global Outcomes (KDIGO)

The association between kidney disease and cancer is multifaceted and complex. Persons with chronic kidney disease (CKD) have an increased incidence of cancer, and both cancer and cancer treatments can cause impaired kidney function. Renal issues in the setting of malignancy can worsen patient outcomes and diminish the adequacy of anticancer treatments. In addition, the oncology treatment landscape is changing rapidly, and data on tolerability of novel therapies in patients with CKD are often lacking. Caring for oncology patients has become more specialized and interdisciplinary, currently requiring collaboration among specialists in nephrology, medical oncology, critical care, clinical pharmacology/pharmacy, and palliative care, in addition to surgeons and urologists. To identify key management issues in nephrology relevant to patients with malignancy, KDIGO (Kidney Disease: Improving Global Outcomes) assembled a global panel of multidisciplinary clinical and scientific expertise for a controversies conference on onco-nephrology in December 2018. This report covers issues related to kidney impairment and solid organ malignancies as well as management and treatment of kidney cancer. Knowledge gaps, areas of controversy, and research priorities are described. © 2020 Kidney Disease:Improving Global Outcomes (KDIGO)

Endocan is a newly identified proteoglycan released from endothelium, stimulating angiogenesis and when increased, indicates endothelial activation (inflammation). Our aim was to examine the association between serum endocan levels and urine albumin-creatinine ratio (UACR).One hundred and thirty-seven patients with type 2 diabetes mellitus and normal serum creatinine who had no co-morbidities other than hypertension, diabetic nephropathy, retinopathy, or neuropathy were divided into normoalbuminuria (G1), microalbuminuria (G2), and macroalbuminuria (G3) groups and compared cross-sectionally regarding serum endocan levels.There were 55, 47, and 35 patients in G1, G2, and G3, respectively. The groups were comparable in terms of gender, age, duration of diabetes, diabetic neuropathy/retinopathy, fasting glucose, HbA1c, serum creatinine level, and eGFR. Patients in G3 had significantly higher blood pressure but lower serum albumin and endocan levels. UACR showed a negative bivariate correlation with serum endocan levels (r = -.282, p = .001). There was bivariate positive correlation between endocan and systolic blood pressure (r=.185, p = .030). In linear regression analysis, UACR was negatively correlated with endocan while positively correlated with systolic blood pressure, duration of diabetes, and platelet distribution width.Patients with macroalbuminuria had lower endocan levels, and increasing UACR was associated with decreasing serum endocan levels. Despite the occurrence of angiogenesis and glomerular hypertrophy in the early phase of diabetic nephropathy, ensuing significant renal injury over time may reduce the expression of endocan. Serum endocan levels may represent a novel marker for nephropathy progression.