AİBÜ İzzet Baysal tıp fakültesi dergisi, Dec 29, 2023
Objective: Solid organ transplantation may cause a predisposition to coronavirus disease-2019 (CO... more Objective: Solid organ transplantation may cause a predisposition to coronavirus disease-2019 (COVID-19) infections. In the present study, it was aimed to investigate the outcomes of kidney transplant recipients diagnosed with COVID-19. Materials and Methods: In this retrospective cohort study, files of 1034 kidney transplant recipients from one center were reviewed. 95 of these patients had contracted COVID-19 between March 1, 2020, and March 31, 2021. In this context, patients were divided as survivors and non survivors. Statistical analysis was performed with a student-t test and p<0.05 was accepted as the threshold of significance. Results: Related 95 patients with COVID-19, were males (58 (61%)). The mean age of all patients was 48.6 ± 11.2 years, and 31 of these patients had received cadaveric transplants (32.6%). Most symptoms were seen in similar frequency in the two groups, with fever in 31%, cough in 39%, myalgias in 59%, and diarrhea in 20%. On the other hand, while only 24% of the survivor group experienced dyspnea, all of the non-survivor group had dyspnea (p<0.05). Mortality was 12.6% (12 patients). Non-survivors were older (55.89 ± 6.99 vs 47.56±11.33 years; p<0.05), in terms of a higher body mass index (28.8 ± 5.5 vs 25.5 ± 5.0 kg/m2; p< 0.05), more frequently having diabetes (50% vs. 30%; p< 0.05), with longer hospitalization durations (8.5 ± 10.6 vs 3.05 ± 5.93 days; p<0.01) than survivors. Besides, leukocytosis (15.24 ± 8.80 vs 7.13 ± 3.39 /mm3), increased liver function tests (ALT and AST (632 ± 1041 and 2722 ± 4662 vs 22.8 ± 16.8 and 23.3 ± 12.6 (U/L) p<0.001), increased ferritin (2301.3 ± 1349.1 ng/ml vs 898.4 ± 1007.6 ng/ml, p< 0.05), increased lactate dehydrogenase (554±305 vs 252±130 mg/dl, p<0.001), increased procalcitonin (1.310±1.285 vs 0.108±0.105 ng/ml, p<0.001) were more frequent in non-survivors. Estimated glomerular filtration rate levels were lower (11.12 ± 1.89 vs 50.75 ± 21.99 ml/min, p<0.05). Hemodialysis was required for all non-survivors and 2% of survivors. Survival was significantly lower in patients with cadaveric transplants (Kaplan Meier analysis; p<0.05). Conclusion: Renal transplant recipients with COVID-19 experienced had an increase in terms of acute kidney injury and mortality in the present study. Furthermore, mortality was higher in cadaveric patients.
Introduction: Nephrotic syndrome (NS) is one of the reasons of end-stage kidney disease, and eluc... more Introduction: Nephrotic syndrome (NS) is one of the reasons of end-stage kidney disease, and elucidating the pathogenesis and offer new treatment options is important. Oxidative stress might trigger pathogenesis systemically or isolated in the kidneys. Octreotide (OCT) has beneficial antioxidant effects. We aimed to investigate the source of oxidative stress and the effect of OCT on experimental NS model. Methods: Twenty-four non-uremic Wistar albino rats were divided into 3 groups. Control group, 2 mL saline intramuscular (im); NS group, adriamycin 5 mg/kg intravenous (iv); NS treatment group, adriamycin 5 mg/kg (iv) and OCT 200 mcg/kg (im) were administered at baseline (Day 0). At the end of 21 days, creatinine and protein levels were measured in 24-hour urine samples. Erythrocyte and renal catalase (CAT) and thiobarbituric acid reactive substance (TBARS) were measured. Renal histology was also evaluated. Results: There was no significant difference among the 3 groups in terms of ...
Resumo Introdução: Síndrome nefrótica (SN) é uma das causas de doença renal em estágio terminal. ... more Resumo Introdução: Síndrome nefrótica (SN) é uma das causas de doença renal em estágio terminal. É importante elucidar a patogênese e oferecer novas opções de tratamento. Estresse oxidativo pode desencadear a patogênese sistemicamente ou isoladamente nos rins. O octreotide (OCT) tem efeitos antioxidantes benéficos. Nosso objetivo foi investigar a fonte de estresse oxidativo e efeito do OCT no modelo experimental de SN. Métodos: Dividimos 24 ratos albinos Wistar não urêmicos em 3 grupos. Grupo controle, 2 mL de solução salina intramuscular (im); grupo SN, adriamicina 5 mg/kg intravenosa (iv); grupo tratamento SN, adriamicina 5 mg/kg (iv) e OCT 200 mcg/kg (im) foram administrados no início do estudo (Dia 0). Aos 21 dias, mediram-se os níveis de creatinina e proteína em amostras de urina de 24 horas. Mediu-se a catalase (CAT) eritrocitária e renal e a substância reativa ao ácido tiobarbitúrico (TBARS). Avaliou-se também histologia renal. Resultados: Não houve diferença significativa en...
AMAÇ: Kolistin gram negatif basillerde etkili, polipeptid yapıda bir polimiksin antibiyotiğidir. ... more AMAÇ: Kolistin gram negatif basillerde etkili, polipeptid yapıda bir polimiksin antibiyotiğidir. Geçmişte yan etkileri nedeniyle kullanımı azalmasına karşın son yıllarda özellikle çoklu ilaç direnci olan Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter ve Enterobacteriaceae’da etkinliği olduğundan kullanımı giderek artmaktadır. Bu çalışmada, merkezimizde kolistin kullanılan hastalar nefrotoksisite yönünden retrospektif olarak değerlendirilmiştir. GEREÇ ve YÖNTEMLER: Çalışmaya Ocak 2012– Ağustos 2013 yıllarında 2. basamak yoğun bakım ünitemizde yatarak kolistin tedavisi alan hastalar alındı. Demografik veriler; bazal, yatış sırasında günlük alınan ve taburculuk sonrası bakılan biyokimyasal tetkikler; ve kolistin başlangıç, idame ve toplamda verilen dozları değerlendirildi. BULGULAR: Yaş ortalaması 62±13 (31-86) yıl olan 17 (%63) erkek, toplam 27 hasta ortalama 63±89 gün izlenmiştir. Tüm izlem süresince hastaların 18’inde (%66,7) akut böbrek yetmezliği (ABY) gelişmiş, 17 (%63) hasta exitus olmuştur. Mortaliteler ABY grubunda 12 (%66,7), ABY olmayan grupta 5’tir (%55) (p> 0,05). Toplam kolistin dozu ve lökosit sayısı istatistiki olarak anlamlılığa ulaşmasa da ABY grubunda 3,75±2,34 g ve 12,04±5,05/mm3 olup ABY olmayan gruptaki 3,32±.1,86 g ve 7,60±3,7/ mm3 değerlerinden daha yüksektir. SONUÇ: Yoğun bakım hastalarında ABY mortaliteyi arttırmaktadır. Kolistin, dirençli enfeksiyonlarda kullanılan etkin bir tedavi ajanı olduğu halde ABY yan etkisi göz önüne alındığında bu ilacın yüksek dozlarda kullanımından mümkün olduğunca kaçınılması doğru bir yaklaşım olacaktır.OBJECTIVE: Colistin is a polymyxin antibiotic with a polypeptide structure and is effective against gram-negative bacilli. Although its use had decreased due to its side effects, it has increased again in recent years, especially for multi-drug resistant Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter and Enterobacteriaceae. In the present study, patients that received colistin at one center were retrospectively analysed in terms of nephrotoxicity. MATERIAL and METHODS: Patients hospitalized and treated with colistin in the intensive care unit between January 2012 and August 2013 were analyzed. Demographic data; biochemical tests at baseline, daily during hospitalization and after discharge; and the initial, maintenance and total doses of colistin were evaluated. RESULTS: The mean age was 62&plusmn;13 (31-86) years for the 27 patients with 17 (63%) males that were followed-up for an average duration of 63&plusmn;89 days. During follow-up, 18 patients (66.7%) developed acute renal failure (ARF) and 17 (63%) of died. There were 12 (66.7%) mortalities in the ARF group and 5 (55%) in the group without ARF ( p&gt; 0.05). The total colistin dose and leukocyte count were higher in the ARF group with 3.75&plusmn;2.34 g and 12.04&plusmn;5.05/mm3 than the non-ARF group at 3.32&plusmn;1.86 g and 7.60&plusmn;3.7/mm3 but did not reach statistical significance. CONCLUSION: ARF increases the mortality in ICU patients. Although colistin is an effective therapeutic agent used for resistant infections, we have to avoid higher doses due to its potential side effect of ARF
The need of maintaining serum uric acid (SUA) lowering agents in hemodialysis (HD) patients is an... more The need of maintaining serum uric acid (SUA) lowering agents in hemodialysis (HD) patients is an understudied area that requires a
Objective. Sulphur, similar to phosphorus, is easily attached to organic compounds. The inadequat... more Objective. Sulphur, similar to phosphorus, is easily attached to organic compounds. The inadequate elimination of sulphate may cause high sulphate concentrations in hemodialysis (HD) patients because sulphate is low in free form in plasma. Although we are well aware of the accumulation of phosphorus in chronic dialysis patients, we do not have an adequate knowledge database about the sulphur compounds. This study was designed to determine the level of sulphate in hemodialysis patients.Materials and Methods. Ninety-four prevalent HD patients and 33 patients without renal failure were included in the study. The serum inorganic sulphate levels were measured by turbidimetric technique. Moreover, the serum level of urea, creatinine, albumin, calcium, phosphorus, and parathyroid hormone concentrations was simultaneously recorded.Results. Mean levels of plasma sulphate were significantly higher (0.56 ± 0.17 mM vs 0.31 ± 0.13 mM,p<0.001) in HD patients. Serum sulphate level correlated wi...
worldwide. Genetic studies revealed causal mutations in UMOD, REN, MUC1 and SEC61A1 encoding urom... more worldwide. Genetic studies revealed causal mutations in UMOD, REN, MUC1 and SEC61A1 encoding uromodulin, renin, mucin-1 and translocon subunit SEC61A, respectively. Uromodulin, renin and mucin-1 are glycoproteins that are prominently expressed in kidney. Uromodulin and mucin-1 are targeted to tubular cell membrane and released into urine, whereas renin is actively secreted into circulation. Biosynthesis of these three proteins is dependent on proper function of the translocon. METHODS: To asses pathogenic effect of mutations in investigated proteins associated with ADTKD we performed in silico analysis, we characterized qualitative and quantitative parameters as well as cellular localization of biosynthesized mutated and WT proteins either on cellular level or in patientskidney tissue. RESULTS: We found that disease-causing mutation of uromodulin, renin, mucin-1 and SEC61A1 affect biogenesis and trafficking of the corresponding proteins. This lead to intracellular accummulation of mutated proteins along the secretory pathway and to various forms of cellular responses such organelle stress or unfolded protein response in affected nephron structures. CONCLUSIONS: In a long term the sustained cellular responses, initiate processes that lead to deterioration of kidney function and development of ADTKD.
Objective: Permanent catheters are used for vascular access in some patients undergoing hemodialy... more Objective: Permanent catheters are used for vascular access in some patients undergoing hemodialysis (HD). Our aim in this study was to evaluate the risk factors of permanent catheter thrombosis and the necessity of anti-coagulant and anti-aggregation drugs. Materials and Methods: In this retrospective study, 34 patients undergoing HD, with removed internal jugulary permanent catheters due to either thrombosis or maturation of operated arteriovenous fistulas, were included. Patients were divided into thrombotic and non-thrombotic, according to the catheter thrombosis status. Results: The mean age was 66.3±15.4 years, and the follow-up period was 10.9±8.5 (1-29) months. Catheter thrombosis was found in 12 patients. Albumin and total protein levels were lower in the baseline thrombotic group (3.53±0.46 g/dL and 6.64±0.92g/dL, respectively)than in the non-thrombotic group (3.95±0.41 and 7.37±0.46g/dL, respectively).In the non-thrombotic group, hemoglobin, hematocrit higher, and platelet count were lower at the catheter removal time compared to the catheter insertion time (hemoglobin 11.45±1.25, hematocrit 35.61±4.51, and platelet count 193.82±66.32 versus hemoglobin 10.33±1.37g/dL, hematocrit 31.38±3.79% and platelet count 231.77±71.7x103/uL, respectively), but in the thrombotic group, the ferritin levels significantly increased from 541.3±574.8ng/mL at the catheter insertion time to 745.1±406.5ng/mL at the catheter removal time. Conclusion: Anti-coagulant and anti-aggregation drugs and renal failure etiology did nothave any effect on permanent catheter thrombosis, but the albumin and total protein levels were related to it. Increased levels of ferritin and C-reactive protein seem to emerge as the acute phase reactants associated with thrombosis.
Background: Hyponatremia is classified according to volume status with the help of physical exami... more Background: Hyponatremia is classified according to volume status with the help of physical examination, biochemical measures, urine and serum osmolalities, and echocardiography. Bioimpedance spectroscopy (BIS) has been getting popularity for revealing tissue compositions of various patient groups. The aim of this observational study was to investigate the role of BIS for the differential diagnosis of hyponatremia (ClinicalTrials.gov Identifier: NCT01838759). Patients and methods: Personal characteristics of age, sex, weight, height, and blood pressure were recorded. Body composition monitor (BCM) was used for hydration status for each individual. Primary outcome was investigated by the accuracy of volume status measured by BIS. Statistics: Kappa statistic (K) is a measure of agreement between two sources, which is measured on a binary scale (i.e., condition present/absent). K statistic can take values between 0
The exact effect of analgesics on normal kidneys is not known yet. We aimed to evaluate the impre... more The exact effect of analgesics on normal kidneys is not known yet. We aimed to evaluate the impression of non steroidal antiinflammatory drugs (NSAID) used post-operatively on kidneys, in rat (tracheotomy) model. Twenty-five non-uremic male wistar albino rats were included. For 18 rats, tracheotomy was performed and divided into two groups. First group, NSAID (diclofenac 10 mg/kg/day intramuscular (im)) (NSAID, n=8); second group isotonic (im)(Control, n=10) were administered for a week. For third group (Histological control,n=7) in order to evaluate normal histology neither surgery nor medication were applied. At the end (7th day), 24 hours urine collected then, blood samples were taken by intracardiac punction and were sacrified. One of the kidneys fixed for histological evaluation, the other was preserved for the measurements of tissue enzyme levels. Lipid peroxidation products and antioxidant enzyme levels were measured both from plasma and renal tissues. Histologically inflamma...
Trimethylaminuria (fish malodour syndrome) is a rare genetic metabolic disorder presented with a ... more Trimethylaminuria (fish malodour syndrome) is a rare genetic metabolic disorder presented with a body odour which smells like a decaying fish. This odour is highly objectionable, that can be destructive for the social, and work life of the patient. Trimethylamine is derived from the intestinal bacterial degradation of foods that are rich of choline and carnitine. Trimethylamine is normally oxidised by the liver to odourless trimethylamine N-oxide which is excreted in the urine, so, uremia may worsen the condition. Uremia itself may cause more or less unpleasant odour. Poor uremic control may worsen the odour. We reported this case because Trimethylaminuria is not usually considered in the differential diagnosis of malodour in chronic renal failure and it is the first case that shown the association with Trimethylaminuria and chronic renal failure in the literature.
Although some studies revealed a positive relationship between vitamin D3deficiency and inflammat... more Although some studies revealed a positive relationship between vitamin D3deficiency and inflammatory markers, there have been also many studies that failed to find this relationship. The aim of this large scaled study is to determine the association between the level of plasma 25 hydroxy vitamin D3[25-(OH) D3] and inflammatory markers in the general population without chronic kidney disease (CKD) and in patients with CKD. Participants with simultaneously measured inflammatory markers and 25-(OH) D3levels were retrospectively analyzed (n=1897). The incidence of all-cause inflammation infection, hospitalization, chronic renal failure, and vitamin B12 deficiency was evaluated. The medians of serum creatinine levels in subjects without renal failure were lower in 25-(OH) D3deficient group. Patients with CKD were more likely to have vitamin D3deficiency compared with normal GFR. 25-(OH) D3levels were associated with a greater incidence of all-cause hospitalization, hypoalbuminemia, and v...
Paraoxanase 1 (PON 1) has been shown to protect against atherosclerosis by modifying lipoproteins... more Paraoxanase 1 (PON 1) has been shown to protect against atherosclerosis by modifying lipoproteins. Its activity decreases in dialysis patients but is restored after transplantation. Whether it affects arterial stiffness is unclear. In this study we aimed to investigate the effects of PON 1 on arterial stiffness in renal transplant patients. Methods: Seventy renal transplant recipients were enrolled. Arterial stiffness was measured using a Syphmocor device. PON-1 activity was assessed from the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol. Results: Mean age was 39.0 9.6 years and 5.7% of the patients were diabetic. Post-transplant follow-up time was 46.7 37.9 months. Eighty-five percent received anti-hypertensive and 12.9% antihyperlipidemic medication. Mean PON1 activity was 75.9 52.4 U/L. PON1 activity was negatively correlated with systolic and diastolic blood pressure, mean arterial pressure, LDL-cholesterol and carotid-femoral pulse wave velocity (cf-PWV). Mean c-f PWV was 8.10 1.39 m/s. Cf-PWV was positively correlated with age, systolic and diastolic blood pressure, mean arterial pressure, proteinuria and negatively correlated with PON1, PON1/HDL ratio and creatinine clearance. In linear regression analysis, PON1 was a predictor of cf-PWV in a model that included age, gender, diabetes, mean arterial pressure, urine protein level, creatinine clearance and PON 1. Conclusions: Reduced PON1 activity is significantly associated with increased arterial stiffness. The results of this study show the possible role of PON1 for arterial stiffening in renal transplant recipients.
Introduction. Acute kidney injury (AKI) pathogenesis is complex. Findings of gentamicin nephrotox... more Introduction. Acute kidney injury (AKI) pathogenesis is complex. Findings of gentamicin nephrotoxicity are seen in 30% of the AKI patients. Vitamin D has proven to be effective on renin expression, inflammatory response, oxidative stress, apoptosis, and atherosclerosis. We aimed to investigate the effect of vitamin D in an experimental rat model of gentamicin-induced AKI.Methods. Thirty nonuremic Wistar albino rats were divided into 3 groups: Control group, 1 mL saline intramuscular (im) daily; Genta group, gentamicin 100 mg/kg/day (im); Genta + vitamin D, gentamicin 100 mg/kg/day (im) in addition to 1α, 25 (OH)2D30.4 mcg/kg/day subcutaneously for 8 days. Blood pressures and 24-hour urine were measured. Blood urea and creatinine levels and urine tubular injury markers were measured. Renal histology was semiquantitatively assessed.Results. Urea, creatinine and urine neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 were all increased in Genta group indicating A...
OBJECTIVE: Body composition analysis is useful technique for assessing hydration, nutritional sta... more OBJECTIVE: Body composition analysis is useful technique for assessing hydration, nutritional status and predicting clinical outcomes. Bioimpedance analysis (BIA) is a cheap and noninvasive tool for monitoring body composition but needs some improvements regarding measurement methods. We aimed to fi nd out if body position has an effect on the BIA results. MATERIAL and METHODS: Personal characteristics including age, gender, height, weight and blood pressure were recorded. Hydration and nutritional status measured by body composition monitor in supine and standing positions consequently for each individual. RESULTS: Two hundred and one populations from various region in Turkey, 61% (n: 123) male, mean age was 46.3±12 years (18-76) of age, participated in this crossectional study. From supine to standing positions overhydration and extracellular water (ECW) were increased from 0.04±1.08 and 17.69±2.92 to 0.46±1.05 L and 17.84±2.90 L while intracellular water (ICW) decreased from 22.55±4.35 to 22.04±4.28 L signifi cantly. Systolic and diastolic blood pressures were 131.3±18.1 and 75.1±12 decreased to 127.0±16.0 and 72.2±9.0 mmHg in supine to standing positions (p> 0.05). CONCLUSION: Supine and standing positions could affect the volume parameters of BIA due to shift of ECW and ICW by gravity but nutritional parameters also changes signifi cantly. Protocols should be re evaluated in order to get more accurate results in bioimpedance measurements.
OBJECTIVE: Cardiorenal syndrome (CRS) describes a dysregulation of the heart and kidneys affectin... more OBJECTIVE: Cardiorenal syndrome (CRS) describes a dysregulation of the heart and kidneys affecting each other. Recently hemodialysis treatments were used more frequently. Aim was to analyze the effects of conventional diuretic and UF treatments. MATERIAL and METHODS: Thirty-four Type 4 CRS diagnosed patients were included. Baseline characteristics were recorded. Echocardiography measured at the admission and at the end of the treatment. RESULTS: The mean age 67.4±9.3 (51-93) years and follow-up period were 15.9±11.5 months. The patients were grouped as diuretic group, n=12 and UF group, n=22. At the beginning mitral valve A wave, blood urea nitrogen and creatinine values were higher in the UF group while creatinine values were higher in the UF group compared to diuretic group at the end of the study. Although basal ejection fraction (EF) values were not different, it was higher in the UF group at the end of the study (42.38±12.70 % and 29±3.67 %, p <0.05). During follow-up mortality rates were not different in both groups (diuretic group, 6 patients (17.6 %), the UF group 1 patient (2.9 %), (p> 0.05). CONCLUSION: In Type 4 CRS, mortality and hospital admissions were not reduced by UF treatment but cardiac function assessed by EF was signifi cantly improved suggesting this therapy to be benefi cial in appropriate patients.
OBJEctIVE: Colistin is a polymyxin antibiotic with a polypeptide structure and is effective again... more OBJEctIVE: Colistin is a polymyxin antibiotic with a polypeptide structure and is effective against gram-negative bacilli. Although its use had decreased due to its side effects, it has increased again in recent years, especially for multi-drug resistant Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter and Enterobacteriaceae. In the present study, patients that received colistin at one center were retrospectively analysed in terms of nephrotoxicity. mAtErIAl and mEtHODS: Patients hospitalized and treated with colistin in the intensive care unit between January 2012 and August 2013 were analyzed. Demographic data; biochemical tests at baseline, daily during hospitalization and after discharge; and the initial, maintenance and total doses of colistin were evaluated. rESultS: The mean age was 62±13 (31-86) years for the 27 patients with 17 (63%) males that were followed-up for an average duration of 63±89 days. During follow-up, 18 patients (66.7%) developed acute renal failure (ARF) and 17 (63%) of died. There were 12 (66.7%) mortalities in the ARF group and 5 (55%) in the group without ARF (p> 0.05). The total colistin dose and leukocyte count were higher in the ARF group with 3.75±2.34 g and 12.04±5.05/mm3 than the non-ARF group at 3.32±1.86 g and 7.60±3.7/mm3 but did not reach statistical significance. cOncluSIOn: ARF increases the mortality in ICU patients. Although colistin is an effective therapeutic agent used for resistant infections, we have to avoid higher doses due to its potential side effect of ARF.
AİBÜ İzzet Baysal tıp fakültesi dergisi, Dec 29, 2023
Objective: Solid organ transplantation may cause a predisposition to coronavirus disease-2019 (CO... more Objective: Solid organ transplantation may cause a predisposition to coronavirus disease-2019 (COVID-19) infections. In the present study, it was aimed to investigate the outcomes of kidney transplant recipients diagnosed with COVID-19. Materials and Methods: In this retrospective cohort study, files of 1034 kidney transplant recipients from one center were reviewed. 95 of these patients had contracted COVID-19 between March 1, 2020, and March 31, 2021. In this context, patients were divided as survivors and non survivors. Statistical analysis was performed with a student-t test and p<0.05 was accepted as the threshold of significance. Results: Related 95 patients with COVID-19, were males (58 (61%)). The mean age of all patients was 48.6 ± 11.2 years, and 31 of these patients had received cadaveric transplants (32.6%). Most symptoms were seen in similar frequency in the two groups, with fever in 31%, cough in 39%, myalgias in 59%, and diarrhea in 20%. On the other hand, while only 24% of the survivor group experienced dyspnea, all of the non-survivor group had dyspnea (p<0.05). Mortality was 12.6% (12 patients). Non-survivors were older (55.89 ± 6.99 vs 47.56±11.33 years; p<0.05), in terms of a higher body mass index (28.8 ± 5.5 vs 25.5 ± 5.0 kg/m2; p< 0.05), more frequently having diabetes (50% vs. 30%; p< 0.05), with longer hospitalization durations (8.5 ± 10.6 vs 3.05 ± 5.93 days; p<0.01) than survivors. Besides, leukocytosis (15.24 ± 8.80 vs 7.13 ± 3.39 /mm3), increased liver function tests (ALT and AST (632 ± 1041 and 2722 ± 4662 vs 22.8 ± 16.8 and 23.3 ± 12.6 (U/L) p<0.001), increased ferritin (2301.3 ± 1349.1 ng/ml vs 898.4 ± 1007.6 ng/ml, p< 0.05), increased lactate dehydrogenase (554±305 vs 252±130 mg/dl, p<0.001), increased procalcitonin (1.310±1.285 vs 0.108±0.105 ng/ml, p<0.001) were more frequent in non-survivors. Estimated glomerular filtration rate levels were lower (11.12 ± 1.89 vs 50.75 ± 21.99 ml/min, p<0.05). Hemodialysis was required for all non-survivors and 2% of survivors. Survival was significantly lower in patients with cadaveric transplants (Kaplan Meier analysis; p<0.05). Conclusion: Renal transplant recipients with COVID-19 experienced had an increase in terms of acute kidney injury and mortality in the present study. Furthermore, mortality was higher in cadaveric patients.
Introduction: Nephrotic syndrome (NS) is one of the reasons of end-stage kidney disease, and eluc... more Introduction: Nephrotic syndrome (NS) is one of the reasons of end-stage kidney disease, and elucidating the pathogenesis and offer new treatment options is important. Oxidative stress might trigger pathogenesis systemically or isolated in the kidneys. Octreotide (OCT) has beneficial antioxidant effects. We aimed to investigate the source of oxidative stress and the effect of OCT on experimental NS model. Methods: Twenty-four non-uremic Wistar albino rats were divided into 3 groups. Control group, 2 mL saline intramuscular (im); NS group, adriamycin 5 mg/kg intravenous (iv); NS treatment group, adriamycin 5 mg/kg (iv) and OCT 200 mcg/kg (im) were administered at baseline (Day 0). At the end of 21 days, creatinine and protein levels were measured in 24-hour urine samples. Erythrocyte and renal catalase (CAT) and thiobarbituric acid reactive substance (TBARS) were measured. Renal histology was also evaluated. Results: There was no significant difference among the 3 groups in terms of ...
Resumo Introdução: Síndrome nefrótica (SN) é uma das causas de doença renal em estágio terminal. ... more Resumo Introdução: Síndrome nefrótica (SN) é uma das causas de doença renal em estágio terminal. É importante elucidar a patogênese e oferecer novas opções de tratamento. Estresse oxidativo pode desencadear a patogênese sistemicamente ou isoladamente nos rins. O octreotide (OCT) tem efeitos antioxidantes benéficos. Nosso objetivo foi investigar a fonte de estresse oxidativo e efeito do OCT no modelo experimental de SN. Métodos: Dividimos 24 ratos albinos Wistar não urêmicos em 3 grupos. Grupo controle, 2 mL de solução salina intramuscular (im); grupo SN, adriamicina 5 mg/kg intravenosa (iv); grupo tratamento SN, adriamicina 5 mg/kg (iv) e OCT 200 mcg/kg (im) foram administrados no início do estudo (Dia 0). Aos 21 dias, mediram-se os níveis de creatinina e proteína em amostras de urina de 24 horas. Mediu-se a catalase (CAT) eritrocitária e renal e a substância reativa ao ácido tiobarbitúrico (TBARS). Avaliou-se também histologia renal. Resultados: Não houve diferença significativa en...
AMAÇ: Kolistin gram negatif basillerde etkili, polipeptid yapıda bir polimiksin antibiyotiğidir. ... more AMAÇ: Kolistin gram negatif basillerde etkili, polipeptid yapıda bir polimiksin antibiyotiğidir. Geçmişte yan etkileri nedeniyle kullanımı azalmasına karşın son yıllarda özellikle çoklu ilaç direnci olan Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter ve Enterobacteriaceae’da etkinliği olduğundan kullanımı giderek artmaktadır. Bu çalışmada, merkezimizde kolistin kullanılan hastalar nefrotoksisite yönünden retrospektif olarak değerlendirilmiştir. GEREÇ ve YÖNTEMLER: Çalışmaya Ocak 2012– Ağustos 2013 yıllarında 2. basamak yoğun bakım ünitemizde yatarak kolistin tedavisi alan hastalar alındı. Demografik veriler; bazal, yatış sırasında günlük alınan ve taburculuk sonrası bakılan biyokimyasal tetkikler; ve kolistin başlangıç, idame ve toplamda verilen dozları değerlendirildi. BULGULAR: Yaş ortalaması 62±13 (31-86) yıl olan 17 (%63) erkek, toplam 27 hasta ortalama 63±89 gün izlenmiştir. Tüm izlem süresince hastaların 18’inde (%66,7) akut böbrek yetmezliği (ABY) gelişmiş, 17 (%63) hasta exitus olmuştur. Mortaliteler ABY grubunda 12 (%66,7), ABY olmayan grupta 5’tir (%55) (p> 0,05). Toplam kolistin dozu ve lökosit sayısı istatistiki olarak anlamlılığa ulaşmasa da ABY grubunda 3,75±2,34 g ve 12,04±5,05/mm3 olup ABY olmayan gruptaki 3,32±.1,86 g ve 7,60±3,7/ mm3 değerlerinden daha yüksektir. SONUÇ: Yoğun bakım hastalarında ABY mortaliteyi arttırmaktadır. Kolistin, dirençli enfeksiyonlarda kullanılan etkin bir tedavi ajanı olduğu halde ABY yan etkisi göz önüne alındığında bu ilacın yüksek dozlarda kullanımından mümkün olduğunca kaçınılması doğru bir yaklaşım olacaktır.OBJECTIVE: Colistin is a polymyxin antibiotic with a polypeptide structure and is effective against gram-negative bacilli. Although its use had decreased due to its side effects, it has increased again in recent years, especially for multi-drug resistant Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter and Enterobacteriaceae. In the present study, patients that received colistin at one center were retrospectively analysed in terms of nephrotoxicity. MATERIAL and METHODS: Patients hospitalized and treated with colistin in the intensive care unit between January 2012 and August 2013 were analyzed. Demographic data; biochemical tests at baseline, daily during hospitalization and after discharge; and the initial, maintenance and total doses of colistin were evaluated. RESULTS: The mean age was 62&plusmn;13 (31-86) years for the 27 patients with 17 (63%) males that were followed-up for an average duration of 63&plusmn;89 days. During follow-up, 18 patients (66.7%) developed acute renal failure (ARF) and 17 (63%) of died. There were 12 (66.7%) mortalities in the ARF group and 5 (55%) in the group without ARF ( p&gt; 0.05). The total colistin dose and leukocyte count were higher in the ARF group with 3.75&plusmn;2.34 g and 12.04&plusmn;5.05/mm3 than the non-ARF group at 3.32&plusmn;1.86 g and 7.60&plusmn;3.7/mm3 but did not reach statistical significance. CONCLUSION: ARF increases the mortality in ICU patients. Although colistin is an effective therapeutic agent used for resistant infections, we have to avoid higher doses due to its potential side effect of ARF
The need of maintaining serum uric acid (SUA) lowering agents in hemodialysis (HD) patients is an... more The need of maintaining serum uric acid (SUA) lowering agents in hemodialysis (HD) patients is an understudied area that requires a
Objective. Sulphur, similar to phosphorus, is easily attached to organic compounds. The inadequat... more Objective. Sulphur, similar to phosphorus, is easily attached to organic compounds. The inadequate elimination of sulphate may cause high sulphate concentrations in hemodialysis (HD) patients because sulphate is low in free form in plasma. Although we are well aware of the accumulation of phosphorus in chronic dialysis patients, we do not have an adequate knowledge database about the sulphur compounds. This study was designed to determine the level of sulphate in hemodialysis patients.Materials and Methods. Ninety-four prevalent HD patients and 33 patients without renal failure were included in the study. The serum inorganic sulphate levels were measured by turbidimetric technique. Moreover, the serum level of urea, creatinine, albumin, calcium, phosphorus, and parathyroid hormone concentrations was simultaneously recorded.Results. Mean levels of plasma sulphate were significantly higher (0.56 ± 0.17 mM vs 0.31 ± 0.13 mM,p<0.001) in HD patients. Serum sulphate level correlated wi...
worldwide. Genetic studies revealed causal mutations in UMOD, REN, MUC1 and SEC61A1 encoding urom... more worldwide. Genetic studies revealed causal mutations in UMOD, REN, MUC1 and SEC61A1 encoding uromodulin, renin, mucin-1 and translocon subunit SEC61A, respectively. Uromodulin, renin and mucin-1 are glycoproteins that are prominently expressed in kidney. Uromodulin and mucin-1 are targeted to tubular cell membrane and released into urine, whereas renin is actively secreted into circulation. Biosynthesis of these three proteins is dependent on proper function of the translocon. METHODS: To asses pathogenic effect of mutations in investigated proteins associated with ADTKD we performed in silico analysis, we characterized qualitative and quantitative parameters as well as cellular localization of biosynthesized mutated and WT proteins either on cellular level or in patientskidney tissue. RESULTS: We found that disease-causing mutation of uromodulin, renin, mucin-1 and SEC61A1 affect biogenesis and trafficking of the corresponding proteins. This lead to intracellular accummulation of mutated proteins along the secretory pathway and to various forms of cellular responses such organelle stress or unfolded protein response in affected nephron structures. CONCLUSIONS: In a long term the sustained cellular responses, initiate processes that lead to deterioration of kidney function and development of ADTKD.
Objective: Permanent catheters are used for vascular access in some patients undergoing hemodialy... more Objective: Permanent catheters are used for vascular access in some patients undergoing hemodialysis (HD). Our aim in this study was to evaluate the risk factors of permanent catheter thrombosis and the necessity of anti-coagulant and anti-aggregation drugs. Materials and Methods: In this retrospective study, 34 patients undergoing HD, with removed internal jugulary permanent catheters due to either thrombosis or maturation of operated arteriovenous fistulas, were included. Patients were divided into thrombotic and non-thrombotic, according to the catheter thrombosis status. Results: The mean age was 66.3±15.4 years, and the follow-up period was 10.9±8.5 (1-29) months. Catheter thrombosis was found in 12 patients. Albumin and total protein levels were lower in the baseline thrombotic group (3.53±0.46 g/dL and 6.64±0.92g/dL, respectively)than in the non-thrombotic group (3.95±0.41 and 7.37±0.46g/dL, respectively).In the non-thrombotic group, hemoglobin, hematocrit higher, and platelet count were lower at the catheter removal time compared to the catheter insertion time (hemoglobin 11.45±1.25, hematocrit 35.61±4.51, and platelet count 193.82±66.32 versus hemoglobin 10.33±1.37g/dL, hematocrit 31.38±3.79% and platelet count 231.77±71.7x103/uL, respectively), but in the thrombotic group, the ferritin levels significantly increased from 541.3±574.8ng/mL at the catheter insertion time to 745.1±406.5ng/mL at the catheter removal time. Conclusion: Anti-coagulant and anti-aggregation drugs and renal failure etiology did nothave any effect on permanent catheter thrombosis, but the albumin and total protein levels were related to it. Increased levels of ferritin and C-reactive protein seem to emerge as the acute phase reactants associated with thrombosis.
Background: Hyponatremia is classified according to volume status with the help of physical exami... more Background: Hyponatremia is classified according to volume status with the help of physical examination, biochemical measures, urine and serum osmolalities, and echocardiography. Bioimpedance spectroscopy (BIS) has been getting popularity for revealing tissue compositions of various patient groups. The aim of this observational study was to investigate the role of BIS for the differential diagnosis of hyponatremia (ClinicalTrials.gov Identifier: NCT01838759). Patients and methods: Personal characteristics of age, sex, weight, height, and blood pressure were recorded. Body composition monitor (BCM) was used for hydration status for each individual. Primary outcome was investigated by the accuracy of volume status measured by BIS. Statistics: Kappa statistic (K) is a measure of agreement between two sources, which is measured on a binary scale (i.e., condition present/absent). K statistic can take values between 0
The exact effect of analgesics on normal kidneys is not known yet. We aimed to evaluate the impre... more The exact effect of analgesics on normal kidneys is not known yet. We aimed to evaluate the impression of non steroidal antiinflammatory drugs (NSAID) used post-operatively on kidneys, in rat (tracheotomy) model. Twenty-five non-uremic male wistar albino rats were included. For 18 rats, tracheotomy was performed and divided into two groups. First group, NSAID (diclofenac 10 mg/kg/day intramuscular (im)) (NSAID, n=8); second group isotonic (im)(Control, n=10) were administered for a week. For third group (Histological control,n=7) in order to evaluate normal histology neither surgery nor medication were applied. At the end (7th day), 24 hours urine collected then, blood samples were taken by intracardiac punction and were sacrified. One of the kidneys fixed for histological evaluation, the other was preserved for the measurements of tissue enzyme levels. Lipid peroxidation products and antioxidant enzyme levels were measured both from plasma and renal tissues. Histologically inflamma...
Trimethylaminuria (fish malodour syndrome) is a rare genetic metabolic disorder presented with a ... more Trimethylaminuria (fish malodour syndrome) is a rare genetic metabolic disorder presented with a body odour which smells like a decaying fish. This odour is highly objectionable, that can be destructive for the social, and work life of the patient. Trimethylamine is derived from the intestinal bacterial degradation of foods that are rich of choline and carnitine. Trimethylamine is normally oxidised by the liver to odourless trimethylamine N-oxide which is excreted in the urine, so, uremia may worsen the condition. Uremia itself may cause more or less unpleasant odour. Poor uremic control may worsen the odour. We reported this case because Trimethylaminuria is not usually considered in the differential diagnosis of malodour in chronic renal failure and it is the first case that shown the association with Trimethylaminuria and chronic renal failure in the literature.
Although some studies revealed a positive relationship between vitamin D3deficiency and inflammat... more Although some studies revealed a positive relationship between vitamin D3deficiency and inflammatory markers, there have been also many studies that failed to find this relationship. The aim of this large scaled study is to determine the association between the level of plasma 25 hydroxy vitamin D3[25-(OH) D3] and inflammatory markers in the general population without chronic kidney disease (CKD) and in patients with CKD. Participants with simultaneously measured inflammatory markers and 25-(OH) D3levels were retrospectively analyzed (n=1897). The incidence of all-cause inflammation infection, hospitalization, chronic renal failure, and vitamin B12 deficiency was evaluated. The medians of serum creatinine levels in subjects without renal failure were lower in 25-(OH) D3deficient group. Patients with CKD were more likely to have vitamin D3deficiency compared with normal GFR. 25-(OH) D3levels were associated with a greater incidence of all-cause hospitalization, hypoalbuminemia, and v...
Paraoxanase 1 (PON 1) has been shown to protect against atherosclerosis by modifying lipoproteins... more Paraoxanase 1 (PON 1) has been shown to protect against atherosclerosis by modifying lipoproteins. Its activity decreases in dialysis patients but is restored after transplantation. Whether it affects arterial stiffness is unclear. In this study we aimed to investigate the effects of PON 1 on arterial stiffness in renal transplant patients. Methods: Seventy renal transplant recipients were enrolled. Arterial stiffness was measured using a Syphmocor device. PON-1 activity was assessed from the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol. Results: Mean age was 39.0 9.6 years and 5.7% of the patients were diabetic. Post-transplant follow-up time was 46.7 37.9 months. Eighty-five percent received anti-hypertensive and 12.9% antihyperlipidemic medication. Mean PON1 activity was 75.9 52.4 U/L. PON1 activity was negatively correlated with systolic and diastolic blood pressure, mean arterial pressure, LDL-cholesterol and carotid-femoral pulse wave velocity (cf-PWV). Mean c-f PWV was 8.10 1.39 m/s. Cf-PWV was positively correlated with age, systolic and diastolic blood pressure, mean arterial pressure, proteinuria and negatively correlated with PON1, PON1/HDL ratio and creatinine clearance. In linear regression analysis, PON1 was a predictor of cf-PWV in a model that included age, gender, diabetes, mean arterial pressure, urine protein level, creatinine clearance and PON 1. Conclusions: Reduced PON1 activity is significantly associated with increased arterial stiffness. The results of this study show the possible role of PON1 for arterial stiffening in renal transplant recipients.
Introduction. Acute kidney injury (AKI) pathogenesis is complex. Findings of gentamicin nephrotox... more Introduction. Acute kidney injury (AKI) pathogenesis is complex. Findings of gentamicin nephrotoxicity are seen in 30% of the AKI patients. Vitamin D has proven to be effective on renin expression, inflammatory response, oxidative stress, apoptosis, and atherosclerosis. We aimed to investigate the effect of vitamin D in an experimental rat model of gentamicin-induced AKI.Methods. Thirty nonuremic Wistar albino rats were divided into 3 groups: Control group, 1 mL saline intramuscular (im) daily; Genta group, gentamicin 100 mg/kg/day (im); Genta + vitamin D, gentamicin 100 mg/kg/day (im) in addition to 1α, 25 (OH)2D30.4 mcg/kg/day subcutaneously for 8 days. Blood pressures and 24-hour urine were measured. Blood urea and creatinine levels and urine tubular injury markers were measured. Renal histology was semiquantitatively assessed.Results. Urea, creatinine and urine neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 were all increased in Genta group indicating A...
OBJECTIVE: Body composition analysis is useful technique for assessing hydration, nutritional sta... more OBJECTIVE: Body composition analysis is useful technique for assessing hydration, nutritional status and predicting clinical outcomes. Bioimpedance analysis (BIA) is a cheap and noninvasive tool for monitoring body composition but needs some improvements regarding measurement methods. We aimed to fi nd out if body position has an effect on the BIA results. MATERIAL and METHODS: Personal characteristics including age, gender, height, weight and blood pressure were recorded. Hydration and nutritional status measured by body composition monitor in supine and standing positions consequently for each individual. RESULTS: Two hundred and one populations from various region in Turkey, 61% (n: 123) male, mean age was 46.3±12 years (18-76) of age, participated in this crossectional study. From supine to standing positions overhydration and extracellular water (ECW) were increased from 0.04±1.08 and 17.69±2.92 to 0.46±1.05 L and 17.84±2.90 L while intracellular water (ICW) decreased from 22.55±4.35 to 22.04±4.28 L signifi cantly. Systolic and diastolic blood pressures were 131.3±18.1 and 75.1±12 decreased to 127.0±16.0 and 72.2±9.0 mmHg in supine to standing positions (p> 0.05). CONCLUSION: Supine and standing positions could affect the volume parameters of BIA due to shift of ECW and ICW by gravity but nutritional parameters also changes signifi cantly. Protocols should be re evaluated in order to get more accurate results in bioimpedance measurements.
OBJECTIVE: Cardiorenal syndrome (CRS) describes a dysregulation of the heart and kidneys affectin... more OBJECTIVE: Cardiorenal syndrome (CRS) describes a dysregulation of the heart and kidneys affecting each other. Recently hemodialysis treatments were used more frequently. Aim was to analyze the effects of conventional diuretic and UF treatments. MATERIAL and METHODS: Thirty-four Type 4 CRS diagnosed patients were included. Baseline characteristics were recorded. Echocardiography measured at the admission and at the end of the treatment. RESULTS: The mean age 67.4±9.3 (51-93) years and follow-up period were 15.9±11.5 months. The patients were grouped as diuretic group, n=12 and UF group, n=22. At the beginning mitral valve A wave, blood urea nitrogen and creatinine values were higher in the UF group while creatinine values were higher in the UF group compared to diuretic group at the end of the study. Although basal ejection fraction (EF) values were not different, it was higher in the UF group at the end of the study (42.38±12.70 % and 29±3.67 %, p <0.05). During follow-up mortality rates were not different in both groups (diuretic group, 6 patients (17.6 %), the UF group 1 patient (2.9 %), (p> 0.05). CONCLUSION: In Type 4 CRS, mortality and hospital admissions were not reduced by UF treatment but cardiac function assessed by EF was signifi cantly improved suggesting this therapy to be benefi cial in appropriate patients.
OBJEctIVE: Colistin is a polymyxin antibiotic with a polypeptide structure and is effective again... more OBJEctIVE: Colistin is a polymyxin antibiotic with a polypeptide structure and is effective against gram-negative bacilli. Although its use had decreased due to its side effects, it has increased again in recent years, especially for multi-drug resistant Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter and Enterobacteriaceae. In the present study, patients that received colistin at one center were retrospectively analysed in terms of nephrotoxicity. mAtErIAl and mEtHODS: Patients hospitalized and treated with colistin in the intensive care unit between January 2012 and August 2013 were analyzed. Demographic data; biochemical tests at baseline, daily during hospitalization and after discharge; and the initial, maintenance and total doses of colistin were evaluated. rESultS: The mean age was 62±13 (31-86) years for the 27 patients with 17 (63%) males that were followed-up for an average duration of 63±89 days. During follow-up, 18 patients (66.7%) developed acute renal failure (ARF) and 17 (63%) of died. There were 12 (66.7%) mortalities in the ARF group and 5 (55%) in the group without ARF (p> 0.05). The total colistin dose and leukocyte count were higher in the ARF group with 3.75±2.34 g and 12.04±5.05/mm3 than the non-ARF group at 3.32±1.86 g and 7.60±3.7/mm3 but did not reach statistical significance. cOncluSIOn: ARF increases the mortality in ICU patients. Although colistin is an effective therapeutic agent used for resistant infections, we have to avoid higher doses due to its potential side effect of ARF.
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