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
Although existing data suggest an increased mortality rate, data about the course of coronavirus disease 2019 (COVID-19) in peritoneal dialysis (PD) patients, its short- ...and long-term effects on the patient and technique survival are limited. Moreover, specific factors associated with increased risk of death have not been clearly defined yet. Therefore, we aimed to study the characteristics of PD patients with COVID-19, determine the short-term mortality and other medical complications, and delineate the factors associated with COVID-19 outcome.
METHOD
This national multicenter study included all PD patients who had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive reverse transcriptase–polymerase chain reaction testing of a nasopharyngeal swab recorded in this database from the attending 27 PD centers. The demographic data, comorbidities, medications used, PD-related data were recorded as well as clinical, laboratory and radiological findings of COVID-19 and outcomes at the end of the first month were recorded.
RESULTS
We enrolled 142 COVID-19 patients (median age: 52 years). A total of 58.2% of patients had mild disease at diagnosis, lung involvement was detected in 60.8% of patients. A total of 83 (58.4%) patients were hospitalized, 31 (21.8%) patients were admitted to intensive care unit and 24 needed mechanical ventilation. A total of 15 (10.5%) patients were switched to hemodialysis and hemodiafiltration was performed for 4 (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. During the 1 month from the diagnosis of COVID-19, 26 patients (18.31%) died. The non-survivor group was older and 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 CRP levels (OR:1.008; 95% CI; 1.000–1.016; P:0.040) were associated with increased first-month mortality in multivariate analysis.
CONCLUSION
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.
Abstract
BACKGROUND AND AIMS
There is not enough data on the post-COVID-19 (coronavirus disease 2019) period for peritoneal dialysis (PD) patients affected from COVID-19. We aimed to compare the ...clinical and laboratory data retrospectively obtained in the follow-up of PD patients after COVID-19 with a control PD group.
METHOD
This study, supported by the Turkish Society of Nephrology, is a national multicenter retrospectively case–control study involving adult PD patients with confirmed COVID-19, using data collected from 21 April 2021 to 11 June 2021. A control PD group was also formed from each PD unit, from patients with similar characteristics but who did not have COVID-19. Patients in the active period of COVID-19 were not included. Data at the end of the first month and within the first 90 days, as well as other outcomes, including mortality, were investigated.
RESULTS
A total of 223 patients (COVID-19 group: 113, control group: 110) from 28 centers were included. The duration of PD in both groups was similar median (IQR):3.0 (1.88–6.0) years and 3.0 (2.0–5.6), but the patient age of the COVID-19 group was lower than the control group 50 (IQR:40–57) years and 56 (IQR:46–64) years, P < 0.001. PD characteristics and baseline laboratory data were similar in both groups, except serum albumin and hemoglobin levels on Day 28, which were significantly lower in the COVID-19 group. In the COVID-19 group, respiratory symptoms, rehospitalization, lower respiratory tract infection, change in PD modality, UF failure and hypervolemia were significantly higher on the 28th day. There was no significant difference in laboratory parameters at Day 90. Only one (0.9%) patient in the COVID-19 group died within 90 days. There was no death in the control group. Respiratory symptoms, malnutrition and hypervolemia were significantly higher at Day 90 in the COVID-19 group.
CONCLUSION
Mortality in the first 90 days after COVID-19 in PD patients with COVID-19 is not different from the control PD group. However, some of these patients continue to experience significant problems, especially respiratory system symptoms, malnutrition, and hypervolemia.
Abstract
BACKGROUND AND AIMS
Haemodialysis (HD) patients are at increased risk for adverse short-term consequences of COVID-19. In this study, we investigated the characteristics of chronic HD ...patients in the post-COVID-19 period and compared them with the control group.
METHOD
We conducted a national multicentre observational study involving adult chronic HD patients recovering from COVID-19. The control HD group was selected from patients with similar characteristics who did not have COVID-19 in the same center. SARS-CoV-2 RT-PCR negative patients and patients in the active period of COVID-19 were not included.
RESULTS
A total of 1223 patients (635 COVID-19 groups, 588 control groups) were included in the study from the data collected from 47 centres between 21 April 2021 and 11 June 2021. The patients' baseline demographics, comorbidities, medications, HD characteristics and basic laboratory tests were quite similar between the groups (Table 1). 28th-day mortality and between 28th day and 90th day mortality were higher in the COVID-19 group than in the control group 19 (3.0%) patients and 0 (0%) patients; 15 (2.4%) patients and 4 (0.7%) patients, respectively. Presence of respiratory symptoms, rehospitalization, need for home oxygen therapy, lower respiratory tract infection and A-V fistula thrombosis were significantly higher in the COVID-19 group in the first 28 days of illness and between 28 and 90 days.
Mortality was significantly associated with preexisting COVID-19, age, current smoking, use of tunneled HD catheter, persistence of respiratory symptoms, rehospitalization, need for home oxygen support, presence of lower respiratory tract infection within 28 days and persistence of respiratory symptoms.
CONCLUSION
In the post-COVID-19 period, mortality, rehospitalization, respiratory problems and vascular access problems are higher in maintenance HD patients who have had COVID-19 compared to control HD patients.
Table 2. Comparative presentation of patients data on the 28th day and between 28 and 90 day COVID-19 groupN = 635 Control groupN = 588 28th-day results, n(%) Death* 19(3.0) 0(0) Any respiratory symptoms* 152(23.9) 11(1.9) Rehospitalization for any reason* 52(8.2) 24(4.1) Need for home oxygen support * 26(4.1) 2(0.3) Lower respiratory tract infection* 65(10.2) 8(1.4) AV fistula thrombosis* 13(2.0) 2(0.3) Other thromboembolic events * 15(2.4) 4(0.7) Need for HD catheter placement* 21(3.3) 9(1.5) 28th day-90. day resultsa n(%) N:616 N:588 Death* 15(2.4) 4(0.7) Any respiratory symptoms* 45(7.3) 10(1.7) Rehospitalization for any reason* 44(7.1) 18(3.1) Need for home oxygen support* 12(1.9) 2(0.3) AV fistula thrombosis* 9(1.5) 1(0.2) Other thromboembolic events* 9(1.5) 2(0.3) Need for HD catheter placement 13(2.1) 10(1.7) HD: haemodialysis, AV: arteriovenous. *P < .05. a Patients who died before 28 days were not included.
The aim of this study is to investigate whether macrophage migration inhibitory factor (MIF) predicts the prognosis of COVID-19 disease.
This descriptive and cross-sectional study was conducted on 87 ...confirmed COVID-19 patients. The patients were separated into two groups according to the admission in the ICU or in the ward. MIF was determined batchwise in plasma obtained as soon as the patients were admitted. Both groups were compared with respect to demographic characteristics, biochemical parameters and prediction of requirement to ICU admission.
Forty seven patients in ICU, and 40 patients in ward were included. With respect to MIF levels and biochemical biomarkers, there was a statistically significant difference between the ICU and ward patients (p< 0.024). In terms of ICU requirement, the cut-off value of MIF was detected as 4.705 (AUC:0.633, 95%CI:0.561-0.79, p= 0.037), D-dimer was 789 (AUC:0.779, 95%CI: 0.681-0.877, p= 0.000), troponin was 8.15 (AUC: 0.820, 95%CI:0.729-0.911, p= 0.000), ferritin was 375 (AUC: 0.774, 95%CI:0.671-0.876, p= 0.000), and lactate dehydrogenase (LDH) was 359.5 (AUC:0.843, 95%CI: 0.753-0.933, p= 0.000). According to the logistic regression analysis; when MIF level > 4.705, the patient's requirement to ICU risk was increased to 8.33 (95%CI: 1.73-44.26, p= 0.009) fold. Similarly, elevation of troponin, ferritin and, LDH was shown to predict disease prognosis (p< 0.05).
Our study showed that MIF may play a role in inflammatory responses to COVID-19 through induction of pulmonary inflammatory cytokines, suggesting that pharmacotherapeutic approaches targeting MIF may hold promise for the treatment of COVID-19 pneumonia.
Background: Many hemodialysis patients need support at various levels from their relatives while performing their daily activities. The ‘burden’ of these needs of patients on their relatives and ...their negative effects on their lives have been shown in the literature. The aim of the study was to evaluate the ‘care burden’ in terms of the patient.Methods: The patient who had received hemodialysis for at least 3 months was included in the study. A patient identification form including demographic data and medical history data was prepared. The Perceived care burden scale, Beck depression scale and WHO Quality of life questionnaire were applied to the patients.Results: A statistically significant positive correlation was found between SPBS and BDI (p<0.001, r=0.820). A statistically significant negative correlation was observed between the perceived care burden and all sub-dimensions of the quality of life scale (p<0.001). The frequency of comorbidity in the geriatric group was higher than non-geriatric group. A statistically significant positive correlation was found between comorbidity and QOL (p<0.001). The median scores of all sub-dimensions of the QOL scale were lower in geriatric group and there were significance differences except environment dimension.Conclusions: The self-perceived burden on caregivers of hemodialysis patients was positively associated with depression and negatively associated with QOL. Decrease in QOL was more pronounced in geriatric patients.
Abstract
Background and Aims
In IgA nephropathy (IgAN), which is characterized by mesangial IgA accumulation, there is the formation of circulating autoantibodies against galactose deficient IgA1s ...(Gd-IgA1). IgG / Gd-IgA1 immunocomplexes accumulate in the glomerular mesangium and play a role in the pathogenesis of IgAN. Recent studies have suggested a relationship between glomerular IgG deposition and the severity of glomerular inflammation. However, detection of the presence and severity of IgG in routine immunofluorescence microscopy (IFM) may fail. This study aims to investigate whether IgG positivity detected by IFM is associated with poor renal prognostic indicators and whether renal prognosis can be predicted according to IgG positivity.
Method
4399 patients who were enrolled between May 2009-June 2019 in database of Turkish Society of Nephrology, Glomerular Diseases Working Group (TSN-GOLD) including 44 centers were evaluated. After exclusion criteria, 994 primary IgAN patients were included in the study. Glomerular IgG negative and positive patients were compared by means of Oxford classification scores, histopathological evaluations, proteinuria, creatinine, albumin, blood pressures. IgG positive patients were divided into subgroups according to the grade of the IFM positivity. The relationship between IgG positivity and poor prognosis criteria were evaluated.
Results
Demographic and biochemical findings of glomerular IgG positive and negative patients at the time of biopsy are shown in Table 1. No difference was found between the groups. There was no difference in the demographic and biochemical findings at the time of biopsy in IgG subgroup analyses (Table 2). There was no difference between the histopathological and Oxford MEST scores of the subgroups. Glomerular IgG positivity was not associated with diastolic blood pressure, 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).
Conclusion
Glomerular IgG positivity detected by routine IFM in IgAN is not associated with poor renal prognostic indicators. It is difficult to predict renal prognosis by looking at the severity of IgG positivity at the baseline evaluation.
Table 1.
Baseline demographic and biochemical findings
IgG positive patients
(n: 179)
IgG negative patients (n: 764)
Age (years)
38.5 ± 13.1
38.4 ± 12.8
Gender (male)
63.7%
62.7%
Body mass index (kg/m2)
26.4 ± 5.1
26.7 ± 5.1
Systolic blood pressure (mmHg)
130 ± 22
130 ± 20
Diastolic blood pressure (mmHg)
82 ± 13
81 ± 12
Glucose (mg/dl)
97 ± 29
95 ± 23
BUN (mg/dl)
26 ± 22
24 ± 17
Creatinine (mg/dl)
1.51 ± 1.36
1.56 ± 1.25
eGFR (ml/min/1.73 m2)
69.7 ± 37.9
66.5 ± 36.8
Proteinuria (g/day)
3.20 ± 0.48
3.24 ± 0.45
Albumin (g/dl)
3.9 ± 0.6
3.8 ± 0.7
Uric acid (mg/dl)
6.6 ± 1.9
6.6 ± 2.0
Total protein (g/dl)
7.6 ± 0.9
7.6 ± 0.9
Total cholesterol (mg/dl)
206 ± 49
215 ± 62
LDL (mg/dl)
129 ± 41
133 ± 50
HDL (mg/dl)
46 ± 17
46 ± 16
Triglycerides (mg/dl)*
163 ± 99
187 ± 123
Hemoglobin (g/dl)
13 ± 2
13 ± 2
Pyuria (leukocyte> 5)
17.7%
20.6%
C3 low
6.6%
8.4%
C4 low
0.9%
0.9%
*statistically significant
Table 2.
Baseline demographic and biochemical analysis of the subgroups of IgG staining by IFM (differences between the parameters of the groups were not statistically significant)
IgG (+)
IgG (++)
IgG (+++)
(n: 131)
(n: 36)
(n: 12)
Age (years)
38.2 ± 12.8
40.3 ± 15.0
36.5 ± 11.2
Gender (male)
63.4%
63.9%
66.7%
Body mass index (kg/m2)
26.4 ± 5.1
26.1 ± 4.6
27.5 ± 10.4
Systolic blood pressure (mmHg)
131 ± 23
128 ± 22
119 ± 15
Diastolic blood pressure (mmHg)
83 ± 12
80 ± 14
81 ± 13
Glucose (mg/dl)
99 ± 31
93 ± 22
90 ± 21
BUN (mg/dl)
26 ± 23
26 ± 20
24 ± 12
Creatinine (mg/dl)
1.56 ± 1.53
1.39 ± 0.69
1:32 ± 0.34
eGFR (ml/min/1.73 m2)
70.4 ± 39.0
69.6 ± 38.7
61.6 ± 16.7
Proteinuria (g/day)
3.16 ± 0.50
3.27 ± 0.38
3.37 ± 0.48
Albumin (g/dl)
3.9 ± 0.5
3.9 ± 0.9
3.6 ± 0.7
Uric acid (mg/dl)
6.6 ± 2.0
7.6 ± 1.8
7.1 ± 1.5
Abstract
Background and Aims
Hematuria is one of the most common laboratory findings in nephrology practice. In different regions of the world, the etiologic causes differ. To date, there is no ...enough data regarding the clinical and histopathologic characteristics of primary glomerular diseases (PGD) patients with hematuria in our country.
Method
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. The biopsy samples were processed using a light microscopy and immunofluorescence examination. Demographic characteristics such as age, sex, indications for biopsy, primary glomerular diseases, comorbidities, laboratory and biopsy findings of all patients were also recorded. Hematuria was defined as the presence of at least 5 red blood cells/hpf.
Results
Data of 3394 patients were included to the study after the exclusion of patients with secondary glomerulonephritis and patients with missing biopsy findings. While 1699 (50.1%) patients had hematuria, 1695 (49.9%) patients did not have hematuria. Demographic, laboratory, and histopathological characteristics of patients with and without hematuria are given in Table. Patients with hematuria had statistically higher systolic blood pressure (SBP), 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-hour proteinuria, serum total, HDL and LDL-cholesterol and C3 levels when compared with patients without hematuria. Figure depicted the etiologic causes of patients with and without hematuria. According to histopathological findings, number of global sclerotic glomeruli, cellular and fibrocellular crescents, the levels of mesangial proliferation, endocapillary proliferation, exudative changes in glomeruli, severe tubular atrophy, interstitial inflammation, subendothelial deposition, moderate and severe IgA and C3 deposition were found to be significantly higher and the levels of basal membrane thickening, interstitial fibrosis, subepithelial deposition, severe IgG staining were found to be significantly lower in patients with hematuria.
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.
Table. De
mographic and laboratory characteristics of the patients with or without hematuria
Parameters
Hematuria positive
n: 1699 (50.1%)
Hematuria negative
n: 1695 (49.9%)
Age (years)*
40.7±14.8
42.5±14.8
Gender (Male, %)
56.5
57.0
Hypertension (%)*
30.7
34.6
Diabetes Mellitus (%)*
7.0
11.1
Systolic blood pressure (mmHg)*
131±21
129±19
Diastolic blood pressure (mmHg)
81±12
81±12
Blood Urea Nitrogen (mg/dL)*
26±22
21±16
Creatinine (mg/dl)*
1.73±1.78
1.25±1.21
CKD-EPI (ml/min/1.73 m2)*
72.2±46.0
86.3±48.1
Albumin (gr/dl)*
3.36±0.92
3.17±0.97
Proteinuria (mg/d) *
4247±4886
5416±5396
Uric acid (mg/dl)
6.3±1.9
6.2±1.8
Total cholesterol (mg/dL)*
243±94
273±110
LDL cholesterol (mg/dL) *
153±76
175±92
Triglyceride (mg/dL)*
193±127
225±138
Hemoglobin (gr/dl)*
13±2
13±2
Presence of pyuria (Leukocyte>5/hpf) (%)*
27.7
10.3
Low C3 level (%) *
8
4
Low C4 level (%)
3
2.3
*statistically significant
Figure. The etiologic causes of PGN patients with and without hematuria
Mes.PGN: mesangioproliferative GN; CGN: crescentic GN; Acute PGN: acute proliferative GN
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