Immunoglobulin A (IgA) nephropathy (IgAN) treatment consists of maximal supportive care and, for high-risk individuals, immunosuppressive treatment (IST). There are conflicting results regarding IST. ...Therefore, we aimed to investigate IST results among IgAN patients in Turkiye.
The data of 1656 IgAN patients in the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases Study Group were analyzed. A total of 408 primary IgAN patients treated with IST (65.4% male, mean age 38.4 ± 12.5 years, follow-up 30 (3-218) months) were included and divided into two groups according to treatment protocols (isolated corticosteroid CS 70.6% and combined IST 29.4%). Treatment responses, associated factors were analyzed.
Remission (66.7% partial, 33.7% complete) was achieved in 74.7% of patients. Baseline systolic blood pressure, mean arterial pressure, and proteinuria levels were lower in responsives. Remission was achieved at significantly higher rates in the CS group (78%
66.7%,
= 0.016). Partial remission was the prominent remission type. The remission rate was significantly higher among patients with segmental sclerosis compared to those without (60.4%
49%,
= 0.047). In the multivariate analysis, MEST-C S1 (HR 1.43, 95% CI 1.08-1.89,
= 0.013), MEST-C T1 (HR 0.68, 95% CI 0.51-0.91,
= 0.008) and combined IST (HR 0.66, 95% CI 0.49-0.91,
= 0.009) were found to be significant regarding remission.
CS can significantly improve remission in high-risk Turkish IgAN patients, despite the reliance on non-quantitative endpoints for favorable renal outcomes. Key predictors of remission include baseline proteinuria and specific histological markers. It is crucial to carefully weigh the risks and benefits of immunosuppressive therapy for these patients.
Renal biopsy is the gold standard diagnostic method in adults with the renal parenchymal disease. Retroperitoneal hemorrhage is one of the rare and most severe complications of percutaneous renal ...biopsy. The incidence of hemorrhagic complications due to interventional procedures in patients with enoxaparin use is 1.9-6.5%. Patients undergoing percutaneous renal biopsy under anti-coagulant therapy should be carefully monitored for this potentially fatal complication after a biopsy. In this case report, we presented a 45-year-old female patient who was admitted to our nephrology department for renal biopsy for unexplained proteinuria and hematuria. Because of mitral valve replacement history, a percutaneous renal biopsy was performed under low molecular weight heparin treatment. The follow-up and treatment process of retroperitoneal hemorrhage after the procedure were described.
Recently, the role of hepcidin as a cardiovascular marker in the chronic kidney disease (CKD) population has gained interest. The aim of this study was to investigate the relationship between serum ...hepcidin-25, inflammation, iron parameters, and carotid intima-media thickness (CIMT) in peritoneal dialysis (PD) patients.
A total of 58 patients (30 male, 51.3%; mean age: 46.8±13.6 years; mean dialysis duration: 69.2±39.1 months) were included in this cross-sectional study. Clinical and routine laboratory data were recorded and the CIMT and hepcidin values were determined. The study population was divided into 2 groups according to the median hepcidin value of 60 ng/mL. Correlation analysis and logistic regression analysis were performed to determine the relationship between the hepcidin level and other parameters.
Age (p=0.003), systolic blood pressure (p=0.039), body mass index (p=0.031), glucose (p=0.028) level, C-reactive protein (CRP) level (p<0.001), and CIMT (p=0.011) were found to be statistically significantly higher in the high hepcidin group. In correlation analysis, hepcidin was positively correlated with age (p<0.001), dialysis duration (p=0.041), glucose (p=0.015), ferritin (p=0.005), CRP (p<0.001), and CIMT (p=0.035). In multivariate linear regression analysis, age (p<0.001) and CRP (p=0.005) were found to be related to CIMT.
Hepcidin-25 was strongly associated with both age and CRP in patients undergoing PD treatment. The results suggest that hepcidin may be involved in the pathophysiology of atherosclerosis. Prospective studies should be carried out in this patient population to determine whether hepcidin has an effect on atherosclerosis.
Aims: This study aimed to screen for Fabry disease in adult kidney transplant patients at a nephrology clinic in Turkiye. Methods: This cross-sectional, single-center study prospectively enrolled ...kidney transplant recipients regardless of the etiology of renal failure. a-galactosidase A (a-GLA) enzyme activity and a-GLA gene analysis were used to screen for Fabry disease. The screening was initiated by measuring enzyme activity in males, and those with <2.5 nmol/mL/hour activity underwent gene analysis. Females were screened directly by gene analysis, independent of the enzyme activity. Results: We screened 125 patients (age: 48.9 + or - 10.1, male: 70.4%). Gene analysis was performed on a 68-year-old male patient with enzyme activity at the lower end of the reference range. No mutations associated with Fabry disease were detected. The enzyme activity test was considered false positive. A heterozygous c.937G>T (p. D313Y) mutation was detected in the gene analysis of a 29-year-old female patient. However, systemic evaluation did not reveal any clinical findings consistent with Fabry disease. Screening tests were within normal limits in other patients. Although there were abnormal screening findings in 2 patients, none was diagnosed with Fabry disease. Conclusions: Screening studies for Fabry disease in kidney transplant patients may contribute to the determination of the true prevalence. Keywords: Kidney transplant patients, Fabry disease, screening
Amaç: Böbrek yetmezliğinde artmış inflamasyon söz konusudur. Serum ferritini bir akut faz reaktanıdır. Sistemik immün inflamasyon indeksi, kardiyovaskuler hastalıklarda ve kanserlerde prognostic ...önemi olduğu gösterilen, nötrofil, lenfosit ve trombosit sayılarından hesaplanan yeni bir belirteçtir. Bu çalışma, sistemik immün inflamasyon indeksinin diyaliz hastalarının mortalite riskini belirlemede kullanılabilirliğini ve mortalite ile ferritin düzeyleri arasındaki ilişkiyi belirlemeyi amaçlamaktadır.
Gereç ve Yöntemler: Çalışmaya 84 hemodiyaliz ve periton diyaliz hastası alındı. Hastaların bazal demografik, klinik ve laboratuvar verileri, tıbbi kayıtlardan elde edildi. Mutlak nötrofil lenfosit oranının, mutlak platelet ile çarpımı ile sistemik immün inflamasyon indeksi elde edildi.
Sonuç: Hastaların ortalama yaşı 51.3 ± 20.1olup, ortalama takip süreleri 60 (6 ~ 85) aydı. Takip süresince hastaların 45(%53) ü öldü. Hastalar medyan ferritin düzeyine göre analiz edildi. Kaplan-Meier analizine göre ferritinin yüksek olduğu grupta mortalitenin daha yüksek olduğu saptandı (log-rank test, P = 0.029).
Yine hastalar medyan sistemik immün inflamasyon indeksine göre analiz edildi. Kaplan-Meier analizine göre sitemik immün inflamasyon indeksinin yüksek olduğu grupta daha yüksek mortalite oranları saptandı (log-rank test, P = 0.029).
Çok değişkenli regresyon analizinde yaş (HR 1.060, P=0.00), Kt/V (HR 0.161, P=0.014), CRP (HR1.001, P=0.0429) ve Sistemik immün inflamasyon indeksi (HR 1.001, P=0.00) ve ferritin (HR) 1.001, P=0.013) tüm nedenlere bağlı ölümlerin en önemli belirleyicileriydi.
Tartışma: Yeni bir inflamatuar belirteç olan Sistemik immün inflamasyon indeks ve ferritin, diyaliz hastalarında tüm nedenlere bağlı ölümlerle ilişkilidir. Diyaliz hastalarında inflamasyonun Sistemik immün inflamasyon indeks ve ferritin düzeyleri ile takip edilebileceğini düşünüyoruz.
Renal failure patients have increased inflammation. Serum ferritin is an acute phase reactant. Systemic immune inflammation index is a new marker calculated using lymphocyte, neutrophil, and platelet counts and have been shown to be a prognostic marker for cardiovascular disease and cancers.
This study aims to determine the availability of Systemic immune inflammation index in determining the mortality risk of dialysis patients and the relationship between mortality and ferritin levels.
Material and Methods: This retrospective, multicenter study enrolled 84 patients on peritoneal dialysis and hemodialysis. Baseline demographic, clinical and laboratory data, were obtained from medical records. Inflammatory indices were defined as NLR: absolute neutrophil count divided by absolute lymphocyte count and SII: absolute platelet count multiplied by NLR.
Results: Mean age was 51.3 ± 20.1 years and the mean follow-up time was 60 (6 ~ 85) months. During the follow-up period, 45 (53%) patients died.
Study population was analyzed according to median ferritin level. Kaplan-Meier curves showed higher mortality in patients in the high ferritin group (log-rank test, P = 0.029)
Study population was analyzed according to median SII values. Kaplan-Meier survival analysis showed higher mortality in the group with the higher SII (log-rank test, P = 0.029)
In multivariate regression analysis age (HR 1.060, P=0.00), Kt/V(HR 0.161,P=0.014), CRP(HR1.001,P=0.0429 and SII(HR 1.001, P=0.00), and ferritin (HR 1.001, P=0.013) were the most important determinants of all-cause mortality.
Conclusion: SII, a novel inflammatory marker, and ferritin are related to all-cause mortality in dialysis patients. We believe that inflammation can be followed with SII and ferritin levels.
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