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.
Abstract
Background
Chronic kidney disease (CKD) and immunosuppression, such as in renal transplantation (RT), stand as one of the established potential risk factors for severe coronavirus disease ...2019 (COVID-19). Case morbidity and mortality rates for any type of infection have always been much higher in CKD, haemodialysis (HD) and RT patients than in the general population. A large study comparing COVID-19 outcome in moderate to advanced CKD (Stages 3–5), HD and RT patients with a control group of patients is still lacking.
Methods
We conducted a multicentre, retrospective, observational study, involving hospitalized adult patients with COVID-19 from 47 centres in Turkey. Patients with CKD Stages 3–5, chronic HD and RT were compared with patients who had COVID-19 but no kidney disease. Demographics, comorbidities, medications, laboratory tests, COVID-19 treatments and outcome in-hospital mortality and combined in-hospital outcome mortality or admission to the intensive care unit (ICU) were compared.
Results
A total of 1210 patients were included median age, 61 (quartile 1–quartile 3 48–71) years, female 551 (45.5%) composed of four groups: control (n = 450), HD (n = 390), RT (n = 81) and CKD (n = 289). The ICU admission rate was 266/1210 (22.0%). A total of 172/1210 (14.2%) patients died. The ICU admission and in-hospital mortality rates in the CKD group 114/289 (39.4%); 95% confidence interval (CI) 33.9–45.2; and 82/289 (28.4%); 95% CI 23.9–34.5) were significantly higher than the other groups: HD = 99/390 (25.4%; 95% CI 21.3–29.9; P < 0.001) and 63/390 (16.2%; 95% CI 13.0–20.4; P < 0.001); RT = 17/81 (21.0%; 95% CI 13.2–30.8; P = 0.002) and 9/81 (11.1%; 95% CI 5.7–19.5; P = 0.001); and control = 36/450 (8.0%; 95% CI 5.8–10.8; P < 0.001) and 18/450 (4%; 95% CI 2.5–6.2; P < 0.001). Adjusted mortality and adjusted combined outcomes in CKD group and HD groups were significantly higher than the control group hazard ratio (HR) (95% CI) CKD: 2.88 (1.52–5.44); P = 0.001; 2.44 (1.35–4.40); P = 0.003; HD: 2.32 (1.21–4.46); P = 0.011; 2.25 (1.23–4.12); P = 0.008), respectively, but these were not significantly different in the RT from in the control group HR (95% CI) 1.89 (0.76–4.72); P = 0.169; 1.87 (0.81–4.28); P = 0.138, respectively.
Conclusions
Hospitalized COVID-19 patients with CKDs, including Stages 3–5 CKD, HD and RT, have significantly higher mortality than patients without kidney disease. Stages 3–5 CKD patients have an in-hospital mortality rate as much as HD patients, which may be in part because of similar age and comorbidity burden. We were unable to assess if RT patients were or were not at increased risk for in-hospital mortality because of the relatively small sample size of the RT patients in this study.
Abstract
Background and Aims
We aimed to investigate the characteristics and survival data of biopsy-proven primary focal segmental glomerulosclerosis (FSGS) in adult patients across Turkey.
Method
...Patients with primary FSGS were included by retrospectively scanning the database of the Turkish Society of Nephrology Glomerular Diseases Study Group (TSN-GOLD). Demographic and laboratory data of the patients at baseline, sixth month, first year, and third year were recorded. Patients with secondary FSGS, missing data were excluded.
Results
The study included 1668 patients with primary FSGS who met the criteria. 1386 patients were included. The mean age of the patients was 41.16±13.88 years, and 712 patients (51.4%) were male. The total follow-up period from the biopsy date was 37.63±40.45 (IQR:1-249) months. The mean blood pressure of the patients, respectively; 130.43±17.63/81.47±10.85 mmHg, serum creatinine 1.29±1.28 mg/dl, e-GFR: 86.10±42.70 ml/min/1.73 m2, serum albumin: 3.41±0.92 g/dl and proteinuria amount was 4687±4658 g/day. Microscopic hematuria was detected in 40.2% of the patients. The rate of admission with nephrotic syndrome was .45.7%. In light microscopy, the mean glomeruli count was 17.36±10.58, with 3.32±4.08 global sclerosis and 0.08±065 glomeruli had segmental sclerosis. Mesangial proliferation was found in 53.1% of the patients and interstitial inflammation was found in 69.7% of the patients. Interestingly, the most common immunoglobulin staining was IgM (19.3%) in the immunofluorescent microscope. The rate of receiving immunosuppressive therapy was 36%. A positive correlation was found in terms of serum creatinine, albumin, and proteinuria in the 3-year follow-up (p<0.001). In the univariate analysis, the group with e-GFR<60 ml/min/1.73 m2 was older, hypertensive, uremic, anemic, had more interstitial fibrosis/tubular atrophy and less interstitial inflammation and mesangial proliferation (p<0.001). In terms of quantitative proteinuria, Patients with proteinuria >3.5 g/day were more hypertensive, hyperlipidemic, hypoalbuminemic and anemic (p<0.05).
Conclusion
Our study presented important data on the status of patients with national primary FSGS. Approximately one-third of patients receive immunosuppressive therapy. The most important factors determining the prognosis of primary FSGS are the initial nephrotic proteinuria and the degree of renal function.
Abstract
Background and Aims
IgA nephropathy (IgAN) is the most common cause of primary glomerulonephritis in Turkey, as well as all over the world. Along with the frequent occurrence, deleterious ...renal outcome odds make treatment approaches important. Additionally, for high-risk individuals immunosuppressive treatment (IST) is recommended. However, studies to date revealed conflicting results regarding IST. Therefore, we aimed to investigate IST results among IgAN patients which is the leading primary glomerulonephritis in Turkiye.
Method
The data of 1656 IgAN patients in the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases Study Group (TSN-GOLD) were analyzed. A total of 506 primary IgAN patients (63.4% male, mean age 38.9±12.5 years) were included and divided into two groups according to treatment protocols as isolated corticosteroid (69.6%) and combined IST (30.4%) groups. The median follow-up duration was 24 (3-218) months.
Results
Remission (66.6% partial remission, 33.4% complete remission) was achieved in 70.6% of patients. Systolic and diastolic blood pressures, urea, creatinine, and proteinuria levels were lower, and eGFR levels were higher in responsive patients (Table 1). There was no difference between the treatment groups in terms of remission rates (p = 0.147) and remission types’ rates (p = 0.279). Remission rates were different between treatment subgroups. However, there was no difference between the treatment subgroups according to the remission types (p = 0.132) (Table 2). Complete remission was lower in the S1 and T1 categories (p = 0.003 and 0.039, respectively). The serious infection was higher in the combined IST group (17.1% vs 2.9%). The outcome data of 229 individuals was evaluated, 40 of 229 (17.5%) developed ESRD and 8 were dead. In the multivariate analysis, eGFR (OR 1.007, 95%CI 1.001-1.013, p = 0.020), proteinuria (OR 1.000, p = 0.009), MEST-C S1 (OR 1.912, 95%CI 1.216-3.005, p = 0.005), MEST-C T2 (OR 0.226, 95%CI 0.102-0.501, p = < 0.001) were found to be significant regarding remission.
Conclusion
IST provides remission in high-risk IgAN patients but was associated with serious adverse events. The fact that the remission rates were similar between the treatment groups and that the complete remission rate was low in chronic changes supports the necessity of determining the treatment choice according to patient characteristics.
Diabetes Where Continents Meet: Turkey Buyukbese, Mehmet Akif; Bakar, Betul
European journal of general medicine,
01/2012, Letnik:
9, Številka:
3
Journal Article
The two main modalities used for congenital aortic valvular stenosis (AVS) treatment are balloon aortic valve dilatation (BAD) and surgical aortic valvuloplasty (SAV). This study evaluates residual ...and recurrent stenosis, aortic regurgitation (AR) development/progression, reintervention rates, and the risk factors associated with this end point in patients with non-critical congenital AVS who underwent BAD or SAV after up to 18 years of follow-up. From 1990 to 2017, 70 consecutive interventions were performed in patients with AVS, and 61 were included in this study (33 BADs and 28 SAVs). There were no significant differences in age, sex distribution, PSIG, and AR frequency between the BAD and SAV groups. Bicuspid valve morphology was more common in the BAD group than the SAV group. There was no statistically significant difference between PSIGs and AR development or progression after intervention at the immediate postoperative echocardiography of patients who underwent BAD or SAV (
p
= 0.82 vs.
p
= 0.29). Patients were followed 6.9 ± 5.1 years after intervention. The follow-up period in the SAV group was longer than that of the BAD group (9.5 ± 5.4 vs. 5.5 ± 4.4 years,
p
= 0.003). There was no statistically significant difference in the last echocardiographic PSIG between patients who underwent SAV or BAD (51.1 ± 33.5 vs. 57.3 ± 35.1,
p
= 0.659). Freedom from reintervention was 81.3% at 5 years and 57.5% at 10 years in the BAD group and 95.5% at 5 years and 81.8% at 10 years in the SAV group, respectively (
p
= 0.044). There was no difference in postprocedural immediate PSIG and last PSIG at follow-up and the development/progression of AR between patients who were treated with BAD versus SAV. However, long-term results of SAV were superior to those of BAD, with a somewhat prolonged reintervention interval.
We evaluated the natural course of congenital aortic valvular stenosis (AVS) and factors affecting AVS progression during long-term follow-up with echocardiography. Medical records of 388 patients ...with AVS were reviewed; patients with concomitant lesions other than aortic regurgitation (AR) were excluded. Trivial AVS was defined as a transvalvular Doppler peak systolic instantaneous gradient of < 25 mmHg; mild stenosis, 25–49 mmHg; moderate stenosis, 50–75 mmHg; and severe stenosis, > 75 mmHg. Median age of the patients was 3 years (range 0 day to 21 years), and 287 (74%) were male. A total of 355 patients were followed with medical treatment alone for a median of 4.6 years (range 1 month to 20.6 years), and the degree of AVS increased in 75 (21%) patients. The risk of AVS progression was higher when AVS was diagnosed in neonates (OR 4.29, CI 1.81–10.18,
p
= 0.001) and infants (OR 3.79, CI 2.21–6.49,
p
= 0.001). After the infancy period, bicuspid valve morphology increased AVS progression risk (OR 2.4, CI 1.2–4.6,
p
= 0.034). Patients with moderate AVS were more likely to have AVS progression (OR 2.59, CI 1.3–5.1,
p
= 0.006). Bicuspid valve morphology increased risk of AR development/progression (OR 1.77, CI 1.1–2.7,
p
= 0.017). The patients with mild and moderate AVS were more likely to have AR development/progression (
p
= 0.001). The risk of AR development/progression was higher in patients with AVS progression (OR 2.25, CI 1.33–3.81,
p
= 0.002). Newborn babies and infants should be followed more frequently than older patients according to disease severity. Bicuspid aortic valve morphology and moderate stenosis are risk factors for the progression of AVS and AR.
Behcet's disease (BD) is a chronic, relapsing, systemic vasculitis of unknown etiology.
To measure serum ghrelin levels in BD patients and healthy controls and to investigate its association with ...metabolic syndrome (MetS).
Thirty BD patients and 30 healthy individuals were enrolled in the study. Ghrelin levels were measured in blood samples using ELISA.
The mean serum ghrelin level in BD patients (28.57 ±14.04) was significantly lower compared to healthy controls (40.72 ±23.21) (
= 0.01). The mean serum ghrelin level in BD patients who had MetS (24.18 ±12.73) was lower compared to BD patients who did not have MetS (30.77 ±14.45), but this difference was not significant (
> 0.05).
Ghrelin levels were lower in BD patients compared to healthy controls. There was no association between reduced ghrelin levels and MetS; however, there was a negative correlation between ghrelin levels and disease activity.
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