Kidney interstitial fibrosis is an important risk factor for the progression of chronic kidney disease. Kidney elastography is a noninvasive imaging modality that might be used to assess tissue ...fibrosis. In this study, we aimed to investigate the relationship between tissue stiffness detected in kidney elastography and interstitial fibrosis observed in kidney biopsy.
Patients who were hospitalized in a tertiary care university hospital with a kidney biopsy indication were included in this study. In all patients, the transverse and sagittal elastography measurements were made using a sonoelastography device before the biopsy. The total histological score was calculated.
Fifty-seven native kidney patients with proteinuria were included in the study. Patients were divided into two groups according to the presence (n = 6) and absence of fibrosis (n = 51) as detected by kidney biopsy. A significant correlation was found between the presence of fibrosis detected by biopsy and elastography outcomes (p = .046, r = .192). A significant correlation was found between the urea and creatinine levels and transverse elastography measurements (p = .036, r = .240). No correlation was observed between the transverse elastography measurements and total histological score consisting of glomerular, vascular, and tubular scores (r = .006, p = .967)
The findings of our study suggest a significant relationship between the elastography measurements and interstitial fibrosis. Because of the high negative predictive value (91%), we suggest that elastography should mainly be used as an exclusion test for the presence of fibrosis. We also believe that elastography may be useful to evaluate the fibrosis status in kidney diseases.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Introduction: There is increasing awareness of non-adherence to renin-angiotensin- aldosterone system inhibitors (RAASi) in chronic kidney disease (CKD). This study aimed to evaluate the incidence of ...hyperkalemic adult CKD patients who were prescribed RAASi and to determine variations in pharmacological interventions to uncover reasons for non-adherence to RAASi treatment. Methods: The incidence of hyperkalemia and non-adherence to RAASi angiotensin-converting enzyme inhibitor (ACEi)/angiotensin II receptor blockers (ARBs) in CKD patients was examined among 471 patients over the age of 18 years who had estimated-glomerular filtration rate (e-GFR) measurements and were diagnosed with CKD between stages 1 and 5. Hyperkalemia was defined as serum potassium (K+) ≥5 mmol/L. The number of hyperkalemic patients not reaching the target dose, hyperkalemia as a reason for not reaching the target dose, patients receiving sodium polystyrene sulfonate patients discontinuing ACEi/ARBs, having a decreased dose of ACEi/ARBs, or treated with the addition or increasing dose of diuretics were compared between the hyperkalemia groups. Results: Hyperkalemia was detected in 29.1% of the patients (n=137), being mild in 21.7%, moderate in 6.2%, and severe in 1.3%. The main finding was that the frequency of patients not reaching the target dose of ACEi/ARBs treatment due to hyperkalemia, hypotension, or e-GFR increase higher than 30% was dramatically higher among patients having moderate/severe hyperkalemia (p<0.0001). In 12.41% of hyperkalemic patients, hyperkalemia was cited as the cause for not achieving the target dosage of ACEi/ARB therapy. 25.71% of these patients discontinued ACEi/ARBS treatment, 14.29% had decreased dose of this treatment, and 11.43% had increased dose of diuretics or newly prescribed diuretics. However, none of the patients with mild hyperkalemia experienced these events during treatment. Conclusion: These findings suggest that serum K+ concentration may be related to major adverse clinical outcomes and affect the type of pharmacological intervention in CKD, resulting in ACEi-ARB discontinuation and halting to reach the target dose.
Recent data have suggested the presence of a reciprocal relationship between COVID-19 and kidney function. To date, most studies have focused on the effect of COVID-19 on kidney function, whereas ...data regarding kidney function on the COVID-19 prognosis is scarce. Therefore, in this study, we aimed to investigate the association between eGFR on admission and the mortality rate of COVID-19.
We recruited 336 adult consecutive patients (male: 57.1%, mean age: 55.0±16.0 years) that were hospitalized with the diagnosis of COVID-19 in a tertiary care university hospital. Data were collected from the electronic health records of the hospital. On admission, eGFR was calculated using the CKD-EPI formula. Acute kidney injury was defined according to the KDIGO criteria. Binary logistic regression and Cox regression analyses were used to assess the relationship between eGFR on admission and in-hospital mortality of COVID-19.
Baseline eGFR was under 60 mL/min/1.73m2 in 61 patients (18.2%). Acute kidney injury occurred in 29.2% of the patients. In-hospital mortality rate was calculated as 12.8%. Age-adjusted and multivariate logistic regression analysis (p: 0.005, odds ratio: 0.974, CI: 0.956-0.992) showed that baseline eGFR was independently associated with mortality. Additionally, age-adjusted Cox regression analysis revealed a higher mortality rate in patients with an eGFR under 60 mL/min/1.73m2.
On admission eGFR seems to be a prognostic marker for mortality in patients with COVID-19. We recommend that eGFR be measured in all patients on admission and used as an additional tool for risk stratification. Close follow-up should be warranted in patients with a reduced eGFR.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction: Renal artery stenosis (RAS) is a clinical picture that is evaluated as a renovascular disorder and includes many diseases in its etiology. The primary purpose of the present study was ...to reveal the etiology of cases followed up in the nephrology outpatient clinic due to RAS; to describe their demographic, clinical, and radiological features; and investigate their treatment and prognosis. The second aim of the study was to investigate the relationship between isolated RAS cases that cannot be attributed to any etiological cause and Takayasu’s arteritis. Methods: Patients were included in retrospectively examining all patient files that were registered between January 1996 and 2018. Demographic data of the patients, date of diagnosis, initial physical examination findings, comorbid diseases, imaging findings, interventional and medical treatments, need for kidney replacement therapy, and time to hemodialysis/transplantation were recorded. Results: Out of the 17427 (8800 M/8627 F) patients, a total of 134 (70 M/64 F) patients aged over 18 years with RAS were included in the study; 60 (55%) patients had atherosclerotic RAS, whereas 23 (21.1%) patients were diagnosed with vasculitis. In total, 16 patients (13.5%) died with a mean of 6±3.4 years after admission. It was found that advanced age, low GFR at diagnosis, and small kidneys are significant and poor prognostic factors. Conclusion: A more systematic approach model can be developed in terms of applying “maximal medical treatment”, which is our approach that we can currently describe as incomplete in cases of RAS with an early atherosclerotic process.
COVID-19 is a global threat with an increasing number of infections. Research on IgG seroprevalence among health care workers (HCWs) is needed to re-evaluate health policies. This study was performed ...in three pandemic hospitals in Istanbul and Kocaeli. Different clusters of HCWs were screened for SARS-CoV-2 infection. Seropositivity rate among participants was evaluated by chemiluminescent microparticle immunoassay. We recruited 813 non-infected and 119 PCR-confirmed infected HCWs. Of the previously undiagnosed HCWs, 22 (2.7%) were seropositive. Seropositivity rates were highest for cleaning staff (6%), physicians (4%), nurses (2.2%) and radiology technicians (1%). Non-pandemic clinic (6.4%) and ICU (4.3%) had the highest prevalence. HCWs in "high risk" group had similar seropositivity rate with "no risk" group (2.9 vs 3.5 p = 0.7). These findings might lead to the re-evaluation of infection control and transmission dynamics in hospitals.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Anemia is highly prevalent in chronic kidney disease patients; however, its identification and management have been reported to be suboptimal. In this study we aimed to describe the prevalence, ...severity, risk factors, and treatment of anemia in different nephrology centers, among chronic kidney disease patients who were not given renal replacement therapy.
We performed a multicenter cross-sectional study in three different nephrology clinics. Adult (>18 years of age) chronic kidney disease patients with an estimated glomerular filtration rate (eGFR) below 60 ml/min, and who were not started dialysis were recruited. Demographic, clinical and laboratory data regarding anemia and its management were collected using a standard data form. Anemia was defined as a hemoglobin level below 12g/dL and severe anemia as a hemoglobin level below 10g/dl.
A total of 1066 patients were enrolled in the study. Anemia and severe anemia were present in 55.9% and 14.9% of the patients, respectively. The mean hemoglobin level for the whole cohort was 11.8±1.8 g/dL. Univariate analyses revealed that the mean hemoglobin level was significantly different among the centers. Moreover, the frequency of the presence of anemia stratified by severity was also significantly different among the centers. According to binary logistic regression analysis, gender, levels of eGFR and iron, ferritin ≥ 100 ng/mL, and the nephrology center were independent determinants of severe anemia.
We found a high prevalence of anemia among chronic kidney disease patients who were not on renal replacement therapy. Each center should determine the treatment strategy according to the patient's characteristics. According to our results, the center-specific management of anemia seems to be important.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with ...in-hospital outcomes among hospitalized patients with COVID-19 and AKI. Methods In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients. Results The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio HR 95% confidence interval (95%CI): 1.01 1.0-1.03, p = 0.035, male gender (HR 95%CI: 1.47 1.04-2.09, p = 0.029), diabetes mellitus (HR 95%CI: 1.51 1.06-2.17, p = 0.022) and cerebrovascular disease (HR 95%CI: 1.82 1.08-3.07, p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR 95%CI: 1.55 1.05-2.30, p = 0.027) and AKI stage 2 (HR 95%CI: 1.98 1.25-3.14, p = 0.003) and stage 3 (HR 95%CI: 2.25 1.44-3.51, p = 0.0001) were independent predictors of in-hospital mortality. Conclusions Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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