Purpose
The recent outbreak of COVID-19 rapidly spread worldwide. Comorbid diseases are determinants of the severity of COVID-19 infection and mortality. The aim of this study was to explore the ...potential association between chronic kidney disease (CKD) and the severity of COVID-19 infection.
Methods
The study included 609 consecutive adult patients (male: 54.52%, mean age: 59.23 ± 15.55 years) hospitalized with the diagnosis of COVID-19 in a tertiary level hospital. Data were collected from the electronic health records of the hospital. The patients were separated into two groups: Group I included COVID-19-positive patients with CKD stage 1–2, and Group II included COVID-19-positive with CKD stage 3–5. The relationships were examined between CKD stage, laboratory parameters and mortality.
Results
Significant differences were determined between the groups in respect of the inflammation parameters and the parameters used in prognosis. In Group II, statistically significantly higher rates were determined of comorbid diseases hypertension (
p
< 0.001) and diabetes mellitus (
p
< 0.001), acute kidney injury (AKI), which was found to be associated with mortality (
p
< 0.001), and mortality (
p
< 0.001). In multivariate regression analysis, CKD stage 3–5, AKI, male gender, hypertension, DM and malignancy were found to be significant independent variables increasing mortality.
Conclusion
The prevelance of CKD stage 3–5 on admission is associated with a high risk of in-hospital mortality in patients with COVID-19. Close follow-up can be recommended for patients with a reduced glomerular filtration rate (GFR).
We aimed to evaluate the features of primary membranous nephropathy (MNP) in Turkish people.
This is a retrospective analysis of patients with biopsy-proven primary MNP. We obtained the data ...collected between 2009 and 2019 in the primary glomerulonephritis registry of the Turkish Society of Nephrology Glomerular Diseases Study Group (TSN-GOLD). Patients with a secondary cause for MNP were excluded. Clinical, demographic, laboratory, and histopathological findings were analyzed.
A total of 995 patients with primary MNP were included in the analyses. Males constituted the majority (58.8%). The mean age was 48.4 ± 13.9 years. The most common presentation was the presence of nephrotic syndrome (81.7%) and sub nephrotic proteinuria (10.3%). Microscopic hematuria was detected in one-third of patients. The median estimated glomerular filtration rate (eGFR) was 100.6 mL/min/1.73 m
2
(IQR, 75.4-116.3), and median proteinuria was 6000 mg/d (IQR, 3656-9457). Serum C3 and C4 complement levels were decreased in 3.7 and 1.7% of patients, respectively. Twenty-four (2.4%) patients had glomerular crescents in their kidney biopsy samples. Basal membrane thickening was detected in 93.8% of cases under light microscopy. Mesangial proliferation and interstitial inflammation were evident in 32.8 and 55.9% of the patients, respectively. The most commonly detected depositions were IgG (93%), C3 complement (68.8%), and kappa and lambda immunoglobulin light chains (70%). Although renal functions were normal at presentation, vascular, interstitial, and glomerular findings were more prominent on biopsy in hypertensive patients. No significant effect of BMI on biopsy findings was observed.
Despite some atypical findings, the main features of primary MNP in Turkey were similar to the published literature. This is the largest MNP study to date conducted in Turkish people.
Purpose
Hematuria is one of the most common laboratory findings in nephrology practice. To date, there is no enough data regarding the clinical and histopathologic characteristics of primary ...glomerular disease (PGD) patients with hematuria in our country.
Methods
Data were obtained from national multicenter (47 centers) data entered into the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database between May 2009 and June 2019. The data of all PGD patients over the age of 16 years who were diagnosed with renal biopsy and had hematuria data were included in the study. Demographic characteristics, laboratory and biopsy findings were also recorded.
Results
Data of 3394 PGD patients were included in the study. While 1699 (50.1%) patients had hematuria, 1695 (49.9%) patients did not have hematuria. Patients with hematuria had statistically higher systolic blood pressure, serum blood urea nitrogen, creatinine, albumin, levels and urine pyuria. However, these patients had statistically lower age, body mass index, presence of hypertension and diabetes, eGFR, 24-h proteinuria, serum total, HDL and LDL cholesterol, and C3 levels when compared with patients without hematuria. Hematuria was present 609 of 1733 patients (35.8%) among the patients presenting with nephrotic syndrome, while it was presented in 1090 of 1661 (64.2%) patients in non-nephrotics (
p
< 0.001).
Conclusion
This is the first multicenter national report regarding the demographic and histopathologic data of PGD patients with or without hematuria. Hematuria, a feature of nephritic syndrome, was found at a higher than expected in the PGDs presenting with nephrotic syndrome in our national database.
Background
Although several renal biopsy registry reports have been published worldwide, there are no data on primary glomerular disease trends in Turkey.
Methods
Three thousand eight-hundred ...fifty-eight native kidney biopsy records were assessed in the Turkish Society of Nephrology Primary Glomerulopathy Working Group (TSN-GOLD) Registry. Secondary disease and transplant biopsies were not recorded in the registry. These records were divided into four periods, before 2009, 2009 to 2013, 2013–2017, and 2017–current.
Results
A total of 3858 patients (43.6% female, 6.8% elderly) were examined. Nephrotic syndrome was the most common biopsy indication in all periods (58.6%, 53%, 44.1%, 51.6%, respectively). In the whole cohort, IgA nephropathy (IgAN) (25.7%) was the most common PGN with male predominance (62.7%), and IgAN frequency steadily increased through the periods (
×
2 = 198,
p
< 0.001). MGN was the most common nephropathy in the elderly (> 65 years), and there was no trend in this age group. An increasing trend was seen in the frequency of overweight patients (
×
2 = 37,
p
< 0.0001). Although the biopsy rate performed with interventional radiology gradually increased, the mean glomeruli count in the samples did not change over the periods.
Conclusions
In Turkey, IgAN is the most common primary glomerulonephritis, and the frequency of this is increasing.
The largest data on the epidemiology of primary glomerular diseases (PGDs) are obtained from the databases of countries or centers. Here, we present the extended results of the Primary Glomerular ...Diseases Study of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group.
Data of patients who underwent renal biopsy and received the diagnosis of PGD were recorded in the database prepared for the study. A total of 4399 patients from 47 centers were evaluated between May 2009 and May 2019. The data obtained at the time of kidney biopsy were analyzed. After the exclusion of patients without light microscopy and immunofluorescence microscopy findings, a total of 3875 patients were included in the study.
The mean age was 41.5 ± 14.9 years. 1690 patients were female (43.6%) and 2185 (56.3%) were male. Nephrotic syndrome was the most common biopsy indication (51.7%). This was followed by asymptomatic urinary abnormalities (18.3%) and nephritic syndrome (17.8%). The most common PGD was IgA nephropathy (25.7%) followed by membranous nephropathy (25.6%) and focal segmental glomerulosclerosis (21.9%). The mean total number of glomeruli per biopsy was 17 ± 10. The mean baseline systolic blood pressure was 130 ± 20 mmHg and diastolic blood pressure was 81 ± 12 mmHg. The median proteinuria, serum creatinine, estimated GFR, and mean albumin values were 3300 (IQR: 1467-6307) mg/day, 1.0 (IQR: 0.7-1.6) mg/dL, 82.9 (IQR: 47.0-113.0) mL/min and 3.2 ± 0.9 g/dL, respectively.
The distribution of PGDs in Turkey has become similar to that in other European countries. IgA nephropathy diagnosed via renal biopsy has become more prevalent compared to membranous nephropathy.
Galactose-deficient IgA1 (Gd-IgA1) has an increased tendency to form immunocomplexes with IgG in the serum, contributing to IgAN pathogenesis by accumulating in the glomerular mesangium. Several ...studies showed that glomerular IgG deposition in IgAN is an important cause of mesangial proliferation and glomerular damage. This study aims to determine the association of the positivity of IgG and the intensity of IgG staining with a poor renal prognosis.
A total of 943 IgAN patients were included in the study. Glomerular IgG staining negative and positive patients were compared using Oxford classification scores, histopathological evaluations, proteinuria, eGFR, albumin, blood pressures. IgG positive patients were classified as (+), (++), (+++) based on their staining intensity, and the association with the prognostic criteria was also evaluated.
81% (n = 764) of the patients were detected as IgG negative, while 19% (n = 179) were positive. Age, gender, body mass index, blood pressure, proteinuria, eGFR, uric acid values were similar in IgG positive and negative patients who underwent biopsy (p > 0.05). Intensity of glomerular IgG positivity was not found to be associated with diastolic and systolic blood pressure, urea, uric acid, age, eGFR, albumin, proteinuria (p > 0.05 for all, r = - 0.084, r = - 0.102, r = - 0.006, r = 0.062, r = 0.014, r = - 0.044, r = - 0.061, r = - 0.066, r = 0.150, respectively). There was no difference for histopathological findings between IgG (+), IgG (++), IgG (+++) groups (for all, p > 0.05).
Glomerular IgG negativity and positivity detected by routine IFM in IgAN patients is not associated with poor renal prognostic risk factors.
BACKGROUND Sensitization is one of the most important barriers against transplantation. Our aim was to evaluate the sensitization status of our patients awaiting cadaveric transplantation and to ...identify factors causing sensitization. MATERIAL AND METHODS A total of 140 patients on the cadaveric waiting list during January 2014 were included in this retrospective cross-sectional study. The parametric t-test and the non-parametric chi-square test were used to detect differences between PRA-positive and -negative patients. Multivariate analysis was used to identify factors associated with PRA positivity. One-way analysis of variance was used to compare PRA-negative and -positive results. RESULTS Anti-HCV positivity (p=0.040), history of transfusion (p=0.041), and mean number of blood product transfused (p=0.047) were significantly related to class 1 PRA positivity. History of transfusion (p=0.038) and mean number of blood product transfused (p=0.044) were related to class 2 PRA positivity. The multivariate analysis indicated that transfusion and more than 5 units of blood product transfused were related to either class 1 or class 2 PRA positivity. No associations were found between PRA positivity and pregnancy, transplantation, age, sex, infection, abortion, cardiovascular disease, diabetes mellitus, hepatitis B, or time spent on dialysis and being on the transplantation waiting list. CONCLUSIONS Anti-HCV positivity and transfusion are risk factors for sensitization. Particular emphasis should be given to sensitization and its prevention to reduce waiting time for transplantation.
Objective: To examine the causes of hypercalcemia developing after kidney transplantation and investigate its effects on graft functions. Methods: The results of 104 patients were explored ...retrospectively. Patients assigned according to calcium levels at 12th month after transplantation as hypercalcemia group (Ca.sup.2+ >10.2) and normocalcemia (Ca.sup.2+ less than or equal to10.2) group. Glomerular filtration rates were calculated using the Chronic Kidney Disease Epidemiology Collaboration equation for each follow-up period. Results: A total of 104 patients, 30 (29%) females and 74 (71%) males, were included in our study. Patients were divided into two groups as hypercalcemic (Ca.sup.2+ >10.2) (n=30, 29%) and normocalcemic (Ca.sup.2+ less than or equal to10.2) (n=74, 71%) according to their 12-month follow-up results. While there was no significant difference in alkaline phosphatase levels (ALP) (p=0.720) at the time of transplantation, a significant difference was found in ALP in the 12th-month measurements (p<0.001). Both parathormone levels at the transplantation time (p=0.006) and 12th-month follow-up results (p<0.001) were significantly higher in the hypercalcemia group. When we evaluated the graft functions of the patients, no significant difference was found between e-GFR levels in the 1st, 3rd, and 12th months. Conclusion: There is no association between posttransplant hypercalcemia and changes in graft function in kidney transplantation patients. Keywords: Graft function; hypercalcemia; kidney transplantation. Amac: Bobrek nakli sonrasi gelisen hiperkalseminin nedenlerini incelemek ve greft fonksiyonlari uzerine etkilerini arastirmak. Gerec ve Yontem: Toplam 104 hastanin sonucu geriye donuk olarak incelendi. Hastalar nakil sonrasi 12. ayda kalsiyum duzeylerine gore hiperkalsemi grubu (Ca.sup.2+ >10.2 mg/dl) ve normokalsemi (Ca.sup.2+ less than or equal to 10.2 mg/dl) grubu olarak belirlendi. Glomeruler filtrasyon hizlari, her takip donemi icin Chronic Kidney Disease Epidemiology Collaboration formulu ile hesaplandi. Bulgular: Calismamiza 30'u (%29) kadin, 74'u (%71) erkek olmak uzere toplam 104 hasta dahil edildi. Hastalar 12 aylik takip sonuclarina gore hiperkalsemik (n=30, %29) ve normokalsemik (n=74, %71) olarak iki gruba ayrildi. Transplantasyon sirasinda alkalin fosfataz duzeylerinde (p=0.720) anlamli bir farklilik yokken, 12. ay olcumlerinde alkalen fosfataz duzeylerinde anlamli farklilik bulundu (p<0.001). Hem transplantasyon anindaki parathormon duzeyleri (p=0.006) hem de 12. ay takip sonuclari (<0.001) hiperkalsemi grubunda anlamli olarak yuksekti. Hastalarin greft islevlerini degerlendirdigimizde I., 3. ve 12. aylarda e-GFR duzeyleri arasinda anlamli bir fark bulunmadi. Sonuc: Bobrek nakli hastalarinda nakil sonrasi hiperkalsemi ile greft fonksiyonundaki degisiklikler arasinda bir iliski yoktur. Anahtar Sozcukler: Bobrek nakli; greft fonksiyonlari; hiperkalsemi.
Purpose
The increasing frequency of coexistence of focal segmental glomerulosclerosis (FSGS) and obesity-associated glomerulopathy and the relationship between metabolic syndrome components and ...chronic kidney disease have been demonstrated in studies. Based on this information, in this study, we aimed to compare FSGS and other primary glomerulonephritis diagnoses in terms of parameters of metabolic syndrome and hepatic steatosis.
Materials and methods
In our study, the data of 44 patients who were diagnosed FSGS through kidney biopsy and 38 patients with any other primary glomerulonephritis diagnoses in our nephrology clinic were retrospectively analyzed. Patients were divided into two groups: FSGS and other primary glomerulonephritis diagnoses, and they were examined in terms of their demographic data, laboratory parameters, body composition measurements, and the presence of hepatic steatosis, as shown using liver ultrasonography.
Results
In the comparative analysis of patients with FSGS and other primary glomerulonephritis diagnoses, with the increase in age increased the risk of FSGS by 1.12 times, the increase in BMI increased the risk of FSGS by 1.67 times, while with the decrease in waist circumference decreased the risk of FSGS by 0.88 times, the decrease in HbA1c decreased the risk of FSGS by 0.12 times, and the presence of hepatic steatosis increased the risk of FSGS by 20.24 times.
Conclusion
The presence of hepatic steatosis, an increase in waist circumference and BMI values, which are body components favoring obesity, and an increase in HbA1c, which is a marker for hyperglycemia and insulin resistance, are greater risk factors for the development of FSGS compared with other primary glomerulonephritis diagnoses.
Insulin resistance is commonly observed in uremic patients. Glucose-based peritoneal dialysis solutions have long-term metabolic complications like hyperinsulinemia, hyperlipidemia, and obesity. The ...purpose of this study was to examine the insulin resistance in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) with standard glucose and icodextrin containing solutions. The entire non diabetic CAPD patients of our center were studied: forty-four patients in all who were on CAPD treatment for 36.2 ± 23.7 months. Twenty-seven of them (11 male and 16 female) with a mean age of 46 ± 16 years were treated with standard glucose solutions (glucose group). The other 17 patients (10 male and 7 female) with a mean age of 49 ± 16 years were treated with standard glucose solutions during the day and icodextrin dwell during the night, for a median of 12 ± 6.3 months (icodextrin group). Morning fasting serum insulin levels were 20.59 ± 17.86 in the glucose group and 10.15 ± 6.87 in the icodextrin group (p = 0.0001).
Homeostasis Model Assessment Method scores of the glucose group were significantly higher (4.8±4.1 vs 2.3± 1.7; p = 0.025) than the icodextrin group. A significant positive correlation of HOMA score with insulin, fasting plasma glucose, and triglyceride levels were found in HOMA (IR+) patients. Twenty patients of the icodextrin group (74%) and 15 patients of the glucose group (88%) were hypertensive, but there was no statistically significant difference between the two groups (p = 0.13). The groups showed no significant differences for body mass index and serum levels of glucose, total cholesterol, LDL cholesterol, VLDL cholesterol, HDL cholesterol, triglyceride, intact parathyroid hormone (iPTH), and fibrinogen. In conclusion, the use of icodextrin in the long nighttime dwell can reduce serum insulin levels and increase insulin sensitivity in CAPD patients.
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