Aim:We aimed to evaluate the prevalence and clinicopathological features of acute interstitial nephritis in patients undergoing renal biopsy.Materials and Methods:A total of 1048 native kidney ...biopsies performed between 2010 and 2018 in the Nephrology Clinic of Katip Celebi University Atatürk Training and Research Hospital were reviewed retrospectively. The records of 42 patients with histopathological diagnosis of acute interstitial nephritis were screened. Medical history, clinical, laboratory and pathological findings, all treatments and results of all patients with acute interstitial nephritis were recorded.Results:The prevalence of acute interstitial nephritis in all renal biopsies was found 4%. We found that the most common cause of acute interstitial nephritis was non-steroid anti-inflammatory drugs (40.5% in 17 patients). Thirty patients (71.4%) received steroid treatment, among them renal function improved in 17 patients (56%). There was no significant difference between the groups receiving end not receiving steroid therapy in terms of complete recovery of renal function (p>0.05). During admission, 12 patients (28.6%) required acute hemodialysis and all of these patients received steroid treatment. A total of eight patients (19.0%) remained in the chronic hemodialysis program. Overall eight patients (19%) died due to acute interstitial nephritis during the follow-up.Conclusion:The prevalence and the most common etiologic factors of acute interstitial nephritis were found similar to literature. In particular, non-steroidal anti-inflammatory drugs took the first place. Therefore, the history of the drug should be questioned well in all patients. Firstly, the underlying etiologic cause of acute interstitial nephritis should be corrected.
To examine the activity of the mammalian target of rapamycin (mTOR) pathway and its regulators, transforming growth factor (TGF)-β1 and phosphatase and tensin homolog (PTEN), in minor salivary gland ...biopsies of Sjogren's syndrome (SS) and systemic sclerosis (SSc) patients.
We retrospectively evaluated SS, SSc, and SS-SSc overlap patients admitted to our outpatient rheumatology clinic between January 2007 and December 2015 who underwent a minor salivary gland biopsy. Patient demographics and some clinical features were obtained from hospital records. Immunohistochemistry was used to analyze total mTOR, total PTEN, and TGF-β1 expression in the biopsied tissues. The biopsy specimens were also examined for the presence and degree of fibrosis.
Minor salivary gland biopsies of 58 SS, 14 SSc, and 23 SS-SSc overlap patients were included in the study. There was no significant difference in mTOR expression between these groups (P = 0.622). PTEN protein was expressed in 87.2% of patients with SS, 57.9% with overlap syndrome, and 100% of the SSC patients, and these differences were statistically different (P = 0.023). Although ductal epithelial TGF-β1 expression was similar between the groups (P = 0.345), acinar cell expression was found to be more frequent in the SSc (72.7%) and overlap patients (85.7%) in comparison with the SS cases (58.2%; P = 0.004).
mTOR may be one of the common pathways in the pathology of both SS and SSc. Hence, there may be a role for mTOR inhibitors in the treatment of both diseases. Additionally, PTEN and TGF-β1 expression may be a distinctive feature of SSc.
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.
Splenic involvement is rarely reported in patients with ANCA-associated vasculitides (AAVs), particularly in those with granulomatosis with polyangiitis (GPA) and is in fact considered to be ...underestimated. We aimed to investigate the frequency of splenic lesions—mainly infarction—and related factors in patients with AAVs. Patients with AAV whose abdominal or thoracic computed tomographies (CTs) were performed at or after diagnosis were included in the study. CT images were examined for splenic lesions. Overall, 69 patients (median age at diagnosis 54 IQR 24 years; 55% with GPA, 29% with microscopic polyangiitis, and 16% with renal-limited disease) were included in the analysis. Splenic pathologies were detected in 19 (28%) patients; 12/19 (63%) splenomegaly and 7/19 (37%) splenic infarction. All patients with splenic infarction exhibited GPA with PR3-ANCA-positive serology. Three of these seven patients had autosplenectomy. Patients with splenic infarction were younger at diagnosis (
p
= 0.018) with also significantly higher ear-nose-throat (ENT) (%100 vs 37;
p
= 0.002) and eye involvement (%50 vs %12;
p
= 0.044) than patients without splenic infarction. Splenic pathologies are not rare in AAVs. Furthermore, infarction can help separate GPA from MPA. In young patients with GPA, particularly those with ENT and eye involvements, physicians should consider splenic infarction.
Key Points
•
Splenic infarction is more common than previously thought in ANCA-associated vasculitides, particularly in granulomatosis with polyangiitis.
•
Detecting splenic infarction can help differentiate granulomatosis with polyangiitis from other subgroups.
Resumo Fundamento O padrão pressórico não-dipper é definido por uma redução inferior a 10% na pressão arterial noturna e está associado a doenças cardiovasculares. Acredita-se que a inflamação ...desempenhe um papel na patogênese da doença pulmonar obstrutiva crônica (DPOC) e no padrão pressórico não-dipper e ambas as doenças estão associadas a uma qualidade de vida mais baixa. Objetivo O objetivo deste estudo foi o de investigar os efeitos do padrão pressórico não-dipper em pacientes com DPOC. Métodos Foi realizado um estudo transversal incluindo 142 pacientes com DPOC. O Questionário Respiratório de Saint George e a Escala de Qualidade de Vida Euro foram utilizados para a coleta de dados. Para entender a rigidez arterial, o índice de aumento e a velocidade da onda de pulso foram medidos; subsequentemente, foi realizada a monitorização ambulatorial da pressão arterial de 24 horas. Foi aplicado um modelo de regressão logística multivariável para entender a relação entre as diferentes variáveis independentes e o padrão pressórico. Foram considerados estatisticamente significativos valores de p inferiores a 0,05. Resultados Como resultado, 76,1% (n = 108) dos pacientes apresentaram o padrão pressórico não-dipper. Os pacientes com padrão não-dipper apresentaram valores mais altos de proteína C reativa (OR: 1,123; IC 95%: 1,016;1,242), índice de aumento (OR: 1,057; IC 95%: 1,011;1,105) e pontuação total no Questionário Respiratório de Saint George (OR: 1,021; IC 95%: 1,001;1,042), em comparação com os pacientes com padrão dipper. Adicionalmente, com o aumento do número de pessoas que habitavam o domicílio, verificou-se que o padrão pressórico não-dipper era mais frequente (OR: 1,339; IC 95%:1,009;1,777). Conclusão O padrão pressórico não-dipper pode aumentar o risco cardiovascular ao desencadear a inflamação e pode afetar adversamente o prognóstico da DPOC diminuindo a qualidade de vida relacionada à doença. (Arq Bras Cardiol. 2020; online.ahead print, PP.0-0)
Background
Although anthropometric measurements are related with clinical outcomes; these relationships are not universal and differ in some disease states such as in chronic kidney disease (CKD). ...The current study was aimed to analyze the relationship between height, weight and BMI with hemodynamic and arterial stiffness parameters both in normal and CKD patients separately.
Methods
This cross-sectional study included 381 patients with (
N
226) and without CKD (
N
155) with hypertension. Routine laboratory and 24-h urine collection were performed. Augmentation index (Aix) which is the ratio of augmentation pressure to pulse pressure was calculated from the blood pressure waveform after adjusted heart rate at 75 Aix@75 (%). Pulse wave velocity (PWV) is a simple measure of the time taken by the pressure wave to travel over a specific distance. Both Aix@75 (%) and PWV which are measures of arterial stiffness were measured by validated oscillometric methods using mobil-O-Graph device.
Results
In patients without CKD, height is inversely correlated with Aix@75 (%). Additionally, weight and BMI were positively associated with PWV in multivariate analysis. However, in patients with CKD, weight and BMI were inversely and independently related with PWV. In CKD patients, as weight and BMI increased stiffness parameters such as Aix@75 (%) and PWV decreased. While BMI and weight are positively associated with arterial stiffness in normal patients, this association is negative in patients with CKD.
Conclusion
In conclusion, height, weight and BMI relationship with hemodynamic and arterial stiffness parameters differs in patients with and without CKD.
Background: The characteristic lesion of pauci-immune glomerulonephritis is focal necrotizing and crescentic glomerulonephritis. The underlying mechanisms in the formation or progression of crescent ...formation need further investigations. Therefore, we aimed to evaluate the role of mammalian target of rapamycin (mTOR), which might be a potential therapeutic target, in kidney biopsies of patients with pauci-immune glomerulonephritis.
Methods: The patients diagnosed as pauci-immune glomerulonephritis at an outpatient nephrology clinic were retrospectively reviewed and those patients who had a kidney biopsy before receiving an immunosuppressive treatment were included in the study. Kidney biopsy specimens were immunohistochemically stained with mTOR, antibodies of phosphatase and tensin homolog (PTEN) and transforming growth factor-β (TGF-β) and scored by an experienced renal pathologist.
Results: In total, 54 patients with pauci-immune glomerulonephritis (28 52% female) were included. According to the histopathologic examination, 22% of our cases were classified as focal, 33% crescentic, 22% mixed, and 22% as sclerotic. The mTOR was expressed in substantial percentages of glomeruli of patients with pauci-immune glomerulonephritis. However, we observed PTEN expression in all samples and mTOR in all tubulointerstitial areas. mTOR expression was found to be related with the presence of crescentic and sclerotic changes observed in glomeruli and the degree of fibrosis in interstitial areas. Serum creatinine level or response to treatment was not found to be associated with mTOR pathway expression.
Conclusion: Our results suggest that mTOR pathway may play role in the pathogenesis of pauci-immune glomerulonephritis, besides targeting this signaling may be an alternative option for those patients.
Objectives: Fabry's disease is an X-linked inherited, rare, progressive, lysosomal storage disorder, affecting multiple organs due to the deficient activity of α-galactosidase A (α-Gal A) enzyme. The ...prevalence has been reported to be 0.15-1% in hemodialysis patients; however, the information on the prevalence in chronic kidney disease not on dialysis is lacking. This study aimed to determine the prevalence of Fabry's disease in chronic kidney disease.
Methods: The patients older than 18 years, enclosing KDIGO 2012 chronic kidney disease definitions, not on dialysis, were enrolled. Dried blood spots on Guthrie papers were used to analyze α-Gal A enzyme and genetic analysis was performed in individuals with enzyme activity ≤1.2 μmol/L/h.
Results: A total of 1453 chronic kidney disease patients not on dialysis from seven clinics in Turkey were screened. The mean age of the study population was 59.3 ± 15.9 years. 45.6% of patients were female. The creatinine clearance of 77.3% of patients was below 60 mL/min/1.73 m
2
, 8.4% had proteinuria, and 2.5% had isolated microscopic hematuria. The mean value of patients' α-Gal A enzyme was detected as 2.93 ± 1.92 μmol/L/h. 152 patients had low levels of α-Gal A enzyme activity (≤1.2 μmol/L/h). In mutation analysis, A143T and D313Y variants were disclosed in three male patients. The prevalence of Fabry's disease in chronic kidney disease not on dialysis was found to be 0.2% (0.4% in male, 0.0% in female).
Conclusion: Fabry's disease should be considered in the differential diagnosis of chronic kidney disease with unknown etiology even in the absence of symptoms and signs suggestive of Fabry's disease.
Objectives: Chronic Obstructive Pulmonary Disease (COPD) is one of the most common diseases in the world. Non-dipper blood pressure is less than 10% reduction in blood pressure at night time. ...Besides, non-dipper blood pressure is associated with cardiovascular disease and end organ damage. Inflammation is thought to play a role in the pathogenesis of both COPD and non-dipper blood pressure patterns and both diseases are associated with lower quality of life. The aim of this study was to investigate the effects of non-dipper blood pressure pattern in COPD patients. Methods: The study design is cross-sectional. COPD patients admitted to the outpatient clinic and hospitalized in the chest diseases department were included in the study. The data collection tools of the study consisted of sociodemographic data form, Saint George Respiratory System Questionnaire (SGRQ) and Euro-QOL 5-D (EQ-5D) questionnaire; blood samples were taken from the patients. Multivariable logistic regression model was used to understand the relationship between different independent variables and blood pressure pattern. Results: It was found that non-dipper patients had statistically higher CRP, Augmentation Index (Aix) and SGRQ total score than dipper patients (p=0.024, p=0.015 and p=0.040, respectively). It was also found that the risk of non-dipper blood pressure pattern increased as the number of people living at home increased (p=0.043). Conclusion: Non-dipper blood pressure pattern may increase cardiovascular risk by triggering inflammation and may adversely affect the prognosis of COPD by lowering the disease-related quality of life.
PDF
