Objective: The aim of the study was to evaluate the outcomes and characteristics of therapeutic plasma exchange (TPE) and double filtration plasmapheresis (DFPP) in one center.
Method: The data of ...cases treated with therapeutic plasmapheresis at the university hospital between 2007 and 2012 were retrospectively analyzed. 445 TPE and 391 DFPP sessions were done totally.
Results: In the 5.5 years, in 116 cases 445 TPE and 391 DFPP sessions were done. The mean age was 46.61±16.83 years. There were 49 female and 67 male patients. Guillain-Barre syndrome ( 8.6%) was the commonly encountered indication for neurological diseases, glomerulonephritis ( 25%) was the leading indication for the renal-related diseases. Skin involvement due to diabetes mellitus (13.8%) and Pemphigus Vulgaris (5.2%) were the dermatological diseases. Complication rates were similar between DFPP and TPE sessions (p= 0.411).
Conclusion: TPE and DFPP are safe and vital membrane separation techniques used as a treatment for a wide spectrum of diseases. These treatments can be safely done in hemodialysis units intensive care units and DFPP should be considered for the therapy refractory neurological diseases.
Background and objectives
As the stage progresses in chronic kidney disease (CKD), the risk of contrast-induced nephropathy (CIN) also increases. Serum albumin level is the strongest predictor of CIN ...development in patients with CKD. It is widely known that females of age 75 are at risk for the development of CIN. Our study aims to investigate the impact of age, gender, serum creatinine, and albumin levels on the development of CIN in patients who were admitted to the emergency department and have had contrast-enhanced computerized tomography (CECT) for diagnosis.
Materials and methods
The study was planned retrospectively. Patients who applied to the emergency department between January 1, 2018, and January 1, 2020, and had CECT were included in the study. A 25% or 0.5 mg/dL increase in serum basal creatinine level within 72 hours following the implementation of contrast agent was accepted as CIN. The patients were divided into two groups: CIN (+) and CIN (-).
Results
One-hundred twenty-two patients (53 female and 69 male), whose average age was 72.27± 12, were included in the study. Forty-five of the patients were found to be CIN (+) and 77 CIN (-). There was no significant difference between the groups (p> 0.05) in terms of age. It was found that the serum creatinine level during admission to the emergency department was the determinant for the development of CIN (p = 0.024). In addition, it was observed that serum albumin levels during the admission had no impact on the development of CIN (p = 0.326). When the serum albumin values of female and male patients diagnosed with CIN measured at the first admission to the emergency service were compared, the mean values were found to be lower in male patients (p = 0.027).
Conclusion
Serum creatinine and albumin levels, age, and gender parameters should be considered in terms of the risk of CIN development in patients who are admitted to the emergency department and given contrast agents.
Uremic encephalopathy is the most important complication of renal failure and urgent dialysis treatment is required. Parathormone (PTH) contributes to the etiopathogenesis of uremic encephalopathy. ...PTH is a hormone that acts in the calcium balance in the organism. The aim of our study was to investigate the effect of serum adjusted and ionized calcium on the development of uremic encephalopathy in patients with acute renal injury (acute kidney injury network (AKIN) stage 3).
Our study was supported by Canakkale Onsekiz Mart University Scientific Research Projects Unit (ID:1278). Three groups were formed for the study. The first group was acute renal failure AKIN stage 3 (N: 23), the second group was AKIN stage 3, and the patients who had emergency hemodialysis (N: 17) and the third group (N: 9) had AKIN stage 3 hemodialysis due to uremic encephalopathy. In these patient groups, 25-hydroxy vitamin D, PTH, calcium, albumin, urea, creatinine, and blood-gas-ionized calcium were observed in their serum during the first application. Calcium, albumin, urea, creatinine, and ionized calcium in blood gas were also examined in serum at 24th and 72th hours. Data were analyzed using SPSS version 19.0. Kruskal-Wallis test and Mann-Whitney U test were applied for the variables that did not comply with normal distribution.
< 0.005 was accepted statistically.
A statistically significant difference was found between the measurement creatinine values at the 24th and 72th hours of admission in AKIN stage 3 patients who applied to the emergency department (
= 0.008). A statistically significant difference was found in the measured calcium values (
= 0.013). A statistically significant difference was found in the measured ionized calcium values (
= 0.035).
In our study, the effect of ionized calcium level on uremic encephalopathy in serum creatinine, calcium, and blood gas in patients presenting with acute renal injury, AKIN stage 3, was significant, but studies with new and large groups are needed.
Pregnancy‐associated atypical haemolytic uraemic syndrome is a rare and potentially lethal complement-mediated disorder. It can mimic preeclampsia, gestational hypertension, thrombotic ...thrombocytopenic purpura and hemolysis, elevated liver enzymes and low platelets syndrome. Thus, it can be hard to distinguish pregnancy‐associated atypical haemolytic uraemic syndrome from other causes in peri/post-partum women presenting with features of microangiopathic haemolytic anemia, thrombocytopenia and acute kidney injury. We present a case of a 35-year-old woman in her third pregnancy at 32 weeks’ gestation who underwent caesarean section due to fetal distress. She developed severe renal impairment, thrombocytopenia and neurologic symptoms within 24 hours after delivery. A diagnosis of pregnancy‐associated atypical haemolytic uraemic syndrome was provided, and treatment with plasma therapy followed by eculizumab was initiated. A rapid improvement of both clinical and laboratory parameters was observed. This case demonstrates the significance of early initiation of anti-complement therapy to prevent irreversible renal damage and possible death in women with pregnancy‐associated atypical haemolytic uraemic syndrome.
Introduction: Erythropoietin (Epo) is a hormone that is synthesized in the kidneys and that stimulates the erythropoiesis in the bone marrow. Epo has effects apart from the erythropoiesis. In chronic ...renal failure (CRF) patients, hemorrhagic diathesis is observed, and Epo production is decreased. Erythropoiesis-stimulating agents (ESAs) are widely used in the treatment of renal anemia in these patients. Our study aimed to investigate the effect of ESAs use on platelet aggregation in peritoneal dialysis (PD) patients due to CRF. Methods: Forty-three PD patients were included in the study. Seventeen patients had been using ESAs for anemia for at least three months (ESAs user group). Twenty-six patients were not using ESAs since they did not have indications (non-ESAs user group). Platelet aggregation measurement from the whole blood was carried out in each patient by a multiplate device. The calculated values area under the curve (AUC), aggregation, and velocity were recorded. The results were evaluated statistically, and p<0.05 was accepted as statistically significant. Results: In the non-ESAs user group, the mean hemoglobin level was found higher when compared to the other group, and this difference was statistically significant (p<0.001). The percentage of transferrin saturation was found higher in the ESAs user group (p=0.021). It was observed that AUC, aggregation, and velocity values were lower in the ESAs user group, and the result was not statistically significant (p values were 0.202, 0.329, 0.290, respectively). Conclusion: ESAs use in PD patients did not have any effect on platelet aggregation. Further prospective studies involving platelet aggregation tests before and after ESA treatment in dialysis patients are needed.
Introduction: We aimed to study the characteristics of peritoneal dialysis (PD) patients with coronavirus disease-19 (COVID-19), determine the short-term mortality and other medical complications, ...and delineate the factors associated with COVID-19 outcome. Methods: In this multicenter national study, we included PD patients with confirmed COVID-19 from 27 centers. The baseline demographic, clinical, laboratory, and radiological data and outcomes at the end of the first month were recorded. Results: We enrolled 142 COVID-19 patients (median age: 52 years). 58.2% of patients had mild disease at diagnosis. Lung involvement was detected in 60.8% of patients. Eighty-three (58.4%) patients were hospitalized, 31 (21.8%) patients were admitted to intensive care unit and 24 needed mechanical ventilation. Fifteen (10.5%) patients were switched to hemodialysis and hemodiafiltration was performed for four (2.8%) patients. Persisting pulmonary symptoms (n = 27), lower respiratory system infection (n = 12), rehospitalization for any reason (n = 24), malnutrition (n = 6), hypervolemia (n = 13), peritonitis (n = 7), ultrafiltration failure (n = 7), and in PD modality change (n = 8) were reported in survivors. Twenty-six patients (18.31%) died in the first month of diagnosis. The non-survivor group was older, comorbidities were more prevalent. Fever, dyspnea, cough, serious-vital disease at presentation, bilateral pulmonary involvement, and pleural effusion were more frequent among non-survivors. Age (OR: 1.102; 95% CI: 1.032–1.117; p: 0.004), moderate-severe clinical disease at presentation (OR: 26.825; 95% CI: 4.578–157.172; p < 0.001), and baseline CRP (OR: 1.008; 95% CI; 1,000–1.016; p: 0.040) were associated with first-month mortality in multivariate analysis. Discussion/Conclusions: Early mortality rate and medical complications are quite high in PD patients with COVID-19. Age, clinical severity of COVID-19, and baseline CRP level are the independent parameters associated with mortality.
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