Background/Aims: Diabetic kidney disease (DKD) is one of the most frequent microvascular complications of diabetes and is the leading cause of end-stage kidney disease worldwide. In patients with ...diabetes, non-diabetic kidney disease (NDKD) can also occur. NDKD can be either alone or superimposed with the DKD. In this study, we aimed to investigate the utility of kidney biopsy in patients with type 2 diabetes mellitus (T2DM) and the predictability of diagnosing DKD versus NDKD from clinical and laboratory data. We also evaluated the prevalence and etiology of NDKD in patients with T2DM. Methods: We retrospectively reviewed type 2 diabetic patients who had kidney biopsy in the last 10 years for diagnosing possible NDKD in our center. In all patients kidney biopsies were performed because of atypical clinical features and biopsy samples were examined by light and immunofluorescence microscopy. Clinical parameters, laboratory workup and office blood pressures were recorded for each patient at the time of biopsy. Results: Eight patients were excluded due to missing data. A total of 48 patients (female/male: 26/22 and mean age: 59±8 years) were included in the study. According to the biopsy findings, 24 (50%) patients had NDKD alone, 20 (41.7%) had DKD alone and 4 (8.3%) had coexisting DKD and NDKD. The most common NDKD diagnoses were membranous nephropathy (29.2%), tubulointerstitial nephritis (20.8%) and IgA nephropathy (12.5%). There were no significant differences in three groups with respect to the duration of diabetes, proteinuria, hematuria and glycated hemoglobin A1c levels. Diabetic retinopathy (DR) was the most significant finding, which was associated with DKD. Positive and negative predictive values of DR for DKD were 88 and 81%, respectively. Conclusion: This study demonstrated a high prevalence of NDKD in patients with T2DM. The absence of DR strongly predicted NDKD. Clinical decision alone can lead to wrong diagnosis and delay in appropriate therapy. Clinicians should consider the kidney biopsy more liberally when there is uncertainty on the exact etiology of the kidney disease. However, prospective multicenter studies are needed to clarify the prognosis and outcomes of patients with diabetics.
Abstract
Background and Aims
The role of complement in focal segmental glomerulosclerosis (FSGS) is an area of interest and C4d staining could indicate complement related renal damage. We ...investigated detailed C4d staining properties in native kidney biopsies and possible relation to clinical features.
Method
We retrospectively evaluated the renal biopsies of 114 patients diagnosed with FSGS within last 15 years. C4d expressions examined in glomeruli (mesangial and/or capillary wall, vascular pole, sclerotic areas), tubular region (basement membrane, adsorbtion droplet) and vascular areas (arteriols and arteries) via immunohistochemistry. A novel glomerular C4d score (G-C4d-S) was achieved on the basis of the localization, pattern, extent and intensity of the C4d expression (min-max, 0-13).
Results
Of the patients (56 females, mean age 43±14 years) with a median follow-up time of 35±3 months, mean proteinuria, eGFR, and albumin level were 4984 mg/day, 72.2 ml/min/1.73m2, 3.56 g/dL, respectively. Median G-C4d-S was 6 (IQR, 4-7) and it was negatively correlated with serum creatinine at diagnosis (r=-0.21, p=0.02). Glomerular staining (both focal and diffuse, higher than moderate in intensity) was positive in 78 (68.4%) of the patients. C4d on glomerular sclerotic area was positive in 43 (37%) patients and it was associated with lower eGFR at diagnosis.
Forty five patients achieved remission during the follow-up. Among the pathological features only glomerular C4d staining was associated to remission (p=0.02). There were 20 (18.7%) patients who need renal replacement theraphy (RRT) and 7 deaths (6.1%) at the end of the cohort. Lower rate of C4d staining on tubular adsorption droplets and arteriols/arteries were found to be associated need for RRT (p=0.013, p=0.012, respectively). There were no significant relationship between mortality and C4d staining features.
Conclusion
In conclusion, we noted that significant number of patients had positivie C4d on glomeruli, arteiroles and tubular area. We indicated that C4d staining at diagnosis could help to distinguish active glomerulonephritis. Additionally, it seems to be essential to examine non-glomerular area of native kidney biopsies, as well.
The aim of this study was to assess the clinical and laboratory correlations of bone mineral density (BMD) measurements among a large population of patients on chronic peritoneal dialysis (PD). This ...cross-sectional, multicenter study was carried out in 292 PD patients with a mean age of 56 +/- 16 years and mean duration of PD 3.1 +/- 2.1 years. Altogether, 129 female and 163 male patients from 24 centers in Canada, Greece, and Turkey were included in the study. BMD findings, obtained by dual-energy X-ray absorptiometry (DEXA) and some other major clinical and laboratory indices of bone mineral deposition as well as uremic osteodystrophy were investigated. In the 292 patients included in the study, the mean lumbar spine T-score was -1.04 +/- 1.68, the lumbar spine Z-score was -0.31 +/- 1.68, the femoral neck T-score was -1.38 +/- 1.39, and the femoral neck Z score was -0.66 +/- 1.23. According to the WHO criteria based on lumbar spine T-scores, 19.2% of 292 patients were osteoporotic, 36.3% had osteopenia, and 44.4% had lumbar spine T-scores within the normal range. In the femoral neck area, the prevalence of osteoporosis was slightly higher (26%). The prevalence of osteoporosis was 23.3% in female patients and 16.6% in male patients with no statistically significant difference between the sexes. Agreements of lumbar spine and femoral neck T-scores for the diagnosis of osteoporosis were 66.7% and 27.3% and 83.3% for osteopenia and normal BMD values, respectively. Among the clinical and laboratory parameters we investigated in this study, the body mass index (BMI) (P < 0.001), daily urine output, and urea clearance time x dialysis time/volume (Kt/V) (P < 0.05) were statistically significantly positive and Ca x PO(4) had a negative correlation (P < 0.05) with the lumbar spine T scores. Femoral neck T scores were also positively correlated with BMI, daily urine output, and KT/V; and they were negatively correlated with age. Intact parathyroid hormone levels did not correlate with any of the BMD parameters. Femoral neck Z scores were correlated with BMI (P < 0.001), and ionized calcium (P < 0.05) positively and negatively with age, total alkaline phosphatase (P < 0.05), and Ca x P (P < 0.01). The overall prevalence of fractures since the initiation of PD was 10%. Our results indicated that, considering their DEXA-based BMD values, 55% of chronic PD patients have subnormal bone mass-19% within the osteoporotic range and 36% within the osteopenic range. Our findings also indicate that low body weight is the most important risk factor for osteoporosis in chronic PD patients. An insufficient dialysis dose (expressed as KT/V) and older age may also be important risk factors for osteoporosis of PD patients.
Background/Aims: Refugee dialysis is a worldwide growing dilemma with limited experience. This report presents the largest hemodialysis (HD) patient registry data of Syrian refugees in Turkey. ...Methods: Demographic, clinical, laboratory, and dialysis practice data of 345 Syrian HD patients during one year were collected and analyzed. Results: There were 345 prevalent Syrian HD patients at the end of 2016. Majority of the patients were placed in the Southeast Anatolian Region. The majority of the patients (74.8%) are in the age range of 20-64 years. Dialysis vintage in Turkey is less than 12 months in 20.8% and less than one month in 29.3% of patients. The vascular access was arteriovenous fistula in the majority of patients (72.5%). Kt/V is over 1.7 in 57%, serum albumin is above 35 g/L in 65.8% and hemoglobin level is more than 100 g/L in %65.2 of the patients. The ratio of patients with serum phosphorus level of 1.13-1.77 mmol/L was 56.2%. Twenty Syrian HD patients (14 male, 6 female) died within the year 2016 and annual mortality rate was 5.7%. Conclusion: This study with the largest number of Syrian refugees undergoing maintenance hemodialysis showed good dialysis practices, acceptable values for dialysis adequacy and biochemical parameters along with lower mortality compared to native HD population of Turkey. Longer follow up will enrich the knowledge related to care of refugee population in all over the world.
Abstract
Background and Aims
Cytomegalovirus (CMV) infection is an important complication in immunocompomised patients. Although approach to CMV infection is well-defined in stem cell and solid organ ...transplant recipients, less is known about the frequency and risk factors of CMV disease in patients with glomerulonephritis (GN). As few studies have shown that cyclophosphamide (CYC) treatment is a risk factor for CMV infection in GN patients, we aimed to describe the frequency and risk factors of CMV infection in GN patients treated with CYC.
Method
268 patients diagnosed GN between January 2017 and November 2019 in Ankara University İbni Sina Hospital, Nephrology Department. We recruited 43 GN patients who were treated with CYC and screened all patients for viral DNA monthly. CMV infection defined by CMV DNA detected >500 copies/µl. Patients developed CMV and no-CMV infection were compared for age, sex, glomerular pathology, renal function and clinical status before and after treatment.
Results
CMV infection was detected in 10 (23,3%) patients at 2±1 (min:1 max:3) months of CYC treatment (Table-1). 7 patients were treated for CMV infection with parenteral ganciclovir, while the other 3 patients with low CMV DNA level (509, 538 and 540 copies/ml) and no disease symptoms were monitored without antiviral treatment. Patients with CMV infection had higher serum creatinine (4,2±3,2 vs. 1,9±1,8 mg/dl, p=0,006), lower estimated glomerular filtration rate (29±11 vs. 65±8 (ml/min/1.73 m2, p=0.016), lower low-density lipoprotein (144±71 vs. 221±83 mg/dl, p=0,012) at diagnosis compared with no-CMV infection patients (Table-2). Also more patients were diagnosed with rapidly proggressive GN (80,0% vs. 27.3%, p=0,007), and secondary GN was the most common GN diagnosis (80,0% vs. 27.3%, p=0.007) in CMV infection group.
Conclusion
CMV infection is a common complication in GN patients treated with CYC. Routine monitoring and prophylaxis should be considered for the patients who have risk factors for CMV infection.
Table-2.
Demographic and Clinical Data of Glomerulonephritis Patients, According to CMV Status
CMV Infection
(n:10, 23,3%)
No CMV Infection (n:33, 76,7%)
P-value
All patiens (n:43)
Age (years) (mean±SD)
57±19
49±14
0,183
51±15
Female gender n,(%)
4, (40,0)
11, (33,3)
0,719
15, (34,9)
Laboratory values at GN diagnosis
Serum creatinine (mg/dl)
4,2±3,2
1,9±1,8
0,006
2,5±2,4
(mean±SD)
29±11
65±8
0,016
57±6
eGFR (CKD-EPI) (ml/min/1.73 m2)
(mean±SE)
2,8±0,6
2,7±0,7
0,684
2,7±0,7
Serum albumin (g/dl) (mean±SD)
144±71
221±83
0,012
202±86
Serum LDL (mg/dl) (mean±SD)24-h proteinuria (mg/d) (mean±SD)
6934±6799
8889±7461
0,464
8434±7282
Clinical presentation on GN diagnosis
Nephrotic syndrome n,(%)
3, (30,0)
21, (63,6)
0,079
24, (55,8)
RPGN n,(%)
8, (80,0)
9, (27,3)
0,007
17, (39,5)
Dialysis treatment n,(%)
3, (30,0)
2, (6,1)
0,073
5, (11,6)
Crescents on biopsy n,(%) (n=39)
5, (71,4)
9, (28,1)
0,075
14, (35,9)
Type of glomerular disease
0,007
Primary GN n,(%)
2, (20,0)
24, (72,7)
26, (60,5)
Secondary GN n,(%)
8, (80,0)
9, (27,3)
17, (39,5)
Total CYC dose (g) (mean±SE)
4,5±1,7
6,7±1,0
0,291
6,2±0,9
Remission n,(%)
6, (60,0)
22, (66,7)
0,719
28, (65,1)
Maintenance treatment n,(%) (n=38)
7, (70,0)
22, (78,6)
0,673
29, (76,3)
Table-1.
ClinicalCharacteristicsandOutcomes in Patientswith CMV Infection
CMV Infection (n:10, 23,3%)
Diagnosis time after CYC onset, months (mean±SD)
2±1 (min:1 max:3)
CMV DNAemia (PCR, copies/µl) (mean±SE)
7849±3785 (min:509 max:34601)
CMV disease n,(%)
5, (50,0)
Laboratory values on CMV diagnosisSerum creatinine (mg/dl) (mean±SD)eGFR (CKD-EPI) ) (ml/min/1.73 m2) (mean±SE)Serum albumin (g/dl) (mean±SD)Serum CRP(mg/dl) (mean±SD)24-h proteinuria (mg/d) (mean±SD)
2,9±1,945±182,4±0,42,9±1,93451±1770
CMV treatment n,(%)
7, (70,0)
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