Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common inherited kidney disease. Kidney stones develop in 20-30% of patients with ADPKD.Hydronephrosis, which is the most valuable ...radiological finding in the diagnosis of stone-related postrenal insufficiency, may be difficult to differentiate from common cysts in ADPKD patients. When kidney dysfunction develops in ADPKD patients, Glomerular Filtration Rate (GFR) loss reaches an average of 4.4 to 5.9 mL / min per year. Faster deterioration in these patients requires investigation for prerenal factors such as dehydration that triggers acute kidney damage or stone-related postrenal factors. In ADPKD, stone-related postrenal obstruction should be considered in rapid GFR losses despite negative ultrasound report for hydronephrosis as there is frequent occurrence of kidney stones and the difficulty in detecting hydronephrosis with ultrasonography (US) in these patients. Here, we present a case with ADPKD whose renal functions rapidly deteriorated while under chronic follow-up and renal function markers returned to the basal levels with the treatment of the underlying cause.
Kappa light chain myeloma: A case report SEZEN, Mehmet; AYTEKİN, Muhammed Mesut; DİLEK, Kamil ...
Turkish journal of internal medicine (Online),
03/2021, Letnik:
3, Številka:
Supplement 1
Journal Article
Recenzirano
Odprti dostop
Light chain myeloma nephropathy is the most common form of renal involvement in plasma cell dyscrasias. It usually causes tubulointerstitial renal damage. About one in five people with multiple ...myeloma produce only light chains. We report a case of lambda light chain deposition disease in a 61-year-old female who presented with acute renal failure . She is currently in partial remission following treatment with bortezomib, cyclophosphamide, and steroids.We present a case with rare kappa light chain myeloma with light chain deposition in renal tubules.
Sjogren's syndrome (SjS) is a chronic, slow-progressing, autoimmune and lymphoproliferative disease. The main symptoms of the syndrome are xerostomia and keratoconjuctivitis sicca as a result of ...chronic inflammatory infiltration of the salivary and lacrimal glands. Focal Segmental Glomerulosclerosis complicating primary Sjögren's syndrome is extremely rare. We report on a 39-year-old woman with 5 years history of sjogren syndrome who was found to have nephrotic syndrome. Histopathological findings in kidney biopsy compatible with focal segmental glomerulosclerosis. Steroid therapy was initiated (oral prednisolone at a dose of 15 mg/day) and Cyclosporine 2 * 100mg/d. FSGS, which is associated with sjögren's syndrome, was considered suitable for the presentation because of its rare occurrence
Abstract
Autoimmune hemolytic anemia (AIHA) is a rare disease with a rate of 1-3 in 100,000 in adults. AIHA are defined as primary (idiopathic) or secondary depending on the presence or absence of ...accompanying disease. Secondary causes include drugs, immunodeficiencies, infections, other autoimmune diseases, or malignancies. Here, we report an 42-year-old female presented to us with diarrhea, nausea-vomiting, fever, chills and jaundice for two days. Hematological investigations revealed hemolytic anemia. Direct Coombs test was positive. The patient was diagnosed acute tubuler necrosis with autoimmune hemolytic anemia. Methylprednisolone 40 mg/day was started considering autoimmune hemolytic anemia. She was on hemodialysis at regular intervals. After 4 weeks, the patient was symptomatically improved with remission of acute tubuler necrosis and hemolytic anemia. In our case, the association of AIHA due to acute gastroenteritis and acute tubular insufficiency was considered suitable for the presentation because of its rare occurrence.
In Turkey, there is 22953 end-stage kidney disease patient in national deceased kidney waiting list (1). According to the 2019 Registry Report of the Turkish Society of Nephrology, the number of ...patients receiving hemodialysis (HD) and peritoneal dialysis (PD) treatment is 64633 (2). However, patients registered on the national kidney waiting list consist of preemptive, PD, and HD patients. Due to the increase in the average life expectancy of the elderly population in our country, chronic kidney disease and comorbid diseases are increasing day by day.
In this study, the patients’ characteristics on the deceased kidney waiting list from our kidney transplant center were evaluated retrospectively. Our center's patient data were obtained from Transplantation Dialysis Monitoring System records. Turkey’s general patient data were obtained from the Turkish Statistical Institute and the 2019 Registry Report of the Turkish Society of Nephrology. In our center, the number of patients on the deceased donor kidney waiting list was 420 (HD: 301, PD: 24, preemptive 95). The number of female patients was 162 (38.6%), and the number of male patients was 258 (61.4%). The age distribution of the patients 0-9: 1.1%, 10-19: 3%, 20-29: 4.4%, 30-39: 11.6%, 40-49: 20%, 50-59: 24.4%, 60-69: 26.8%, 70-79: 7.8% and 80-89: 0.2%. The blood group distribution of patients was consistent with Turkey's general data. 0 Rh (+): 26.7%, 0 Rh (-): 3.1%, A Rh (+) 43.3%, A Rh (-) 5.7%, B Rh (+) 11%, B Rh (-) 1.7%, AB Rh (+) 8.1% and AB Rh (-) 0.5%. The number of male patients was higher than female patients in other age groups except the 40-49 and 80-89 age range (Figure 1). Our patients' distribution by gender and kidney replacement therapies was in line with the 2019 Registry Report of the Turkish Society of Nephrology. An increase in comorbid diseases and kidney failure in advanced age also increases health expenditures. The Republic of Turkey Ministry of Health aims to increase the awareness of kidney disease and the rate of early diagnosis with the "Turkey Kidney Diseases Prevention and Control Program" (3). In our center, the highest number of patients on the deceased kidney waiting list was observed in the age range of 60-69, 50-59, and 40-49, respectively. Physical quality of life worsens as the dialysis period prolongs and the patient ages. Therefore, elderly HD patients need more social and mental support (4). The donor's age is 60 years and above is one of the extended donor criteria (EDC). Using kidneys with advanced age and EDC criteria in candidates of similar age may increase patient and graft survival and physical quality of life. For this reason, policies should be developed to ensure the transplantation of EDC grafts to patients who will benefit most.
Evaluation of Death Patients on the Cadaveric Kidney Waiting List of Bursa Uludağ University Medical Faculty According to Years by Gender, Age, Blood Type, Dialysis Type
In Turkey, there is 22953 ...end-stage kidney disease patient in national deceased kidney waiting list (1). According to the 2019 Registry Report of the Turkish Society of Nephrology, the number of patients receiving dialysis is 64633. The number of patients receiving hemodialysis (HD) and peritoneal dialysis (PD) are 61341 and 3292, respectively (2). However, patients registered on the national kidney waiting list consist of preemptive, PD, and HD patients. Due to the increase in the average life expectancy of the elderly population in our country, chronic kidney disease and comorbid diseases are increasing day by day.
In this study, the characteristics of the patients who died on the deceased kidney waiting list of our kidney transplant center were evaluated retrospectively. Our center's patient data were obtained from Transplantation Dialysis Monitoring System records. Turkey’s general patient data were obtained from the Turkish Statistical Institute and the 2019 Registry Report of Turkish Society of Nephrology.
In our center, the number of patients who died on the kidney waiting list from deceased donors was 350 (HD: 273, PD: 73, preemptive: 4). The number of female patients was 134 (38.2%) and the number of male patients was 216 (61.4%). The age distribution of the patients 0-9: 5%, 1.4, 10-19: 5 1.4%, 20-29: 14 4%, 30-39: 36 10.2%, 40-49: 62 17%, 7, 50-59: 100 28.5%, 60-69: 96 27.4%, 70-79: 31 8.8%, and 80-89: 1 0.2%. The distribution of blood groups of patients was consistent with the data in Turkey. A Rh (+): 41.4%, A Rh (-): 3.7%, 0 Rh (+): 29.1%, 0 Rh (-): 6%, B Rh (+): 10.6%, B Rh (-): 0.6%, AB Rh (+): 7.1% and AB Rh (-): 1.4%. The distribution of our patients by gender and kidney replacement therapies was in line with the 2019 Registry Report of Turkish Society of Nephrology. The number of patients who died by years is shown in figure 1.
In our study, deaths between the age range of 50-59 and 60-69 registered in our center and died constitute 56% of the total deaths. Patients with chronic kidney failure have a high risk of death between the ages of 50 and 69. In one study, the course of Covid-19 disease caused by the SARS-CoV-2 virus is terrifying in elderly, co-morbid diseases, and male patients (3). Also, COVID-19 is severe and fatal in chronic kidney disease. With the COVID-19 disease being a pandemic in the world in 2020, according to the data of the current World Health Organization (WHO) dated 07.02.2021, 105,394,301 cases were detected in the world 2,302,302 deaths occurred (4). When we look at the distribution of cases by years, the death rate in 2020 is the highest. Although this suggests that this situation is related to the COVID-19 disease, the relationship with COVID-19 could not be determined since the causes of the deaths of these cases could not be reached from the death notification system of Ministry of Health.
Due to the high mortality rates in the range of 50 to 69 years of age of patients in kidney transplant waiting lists, especially for patients with advanced age with chronic kidney disease "Turkey Kidney Diseases Prevention and Control Program" (5) to be controlled although work on the policy for new infectious diseases needs to be improved.
Contrast induced nephropathy (CIN) has been proven to be a clinical condition related to adverse cardiovascular outcomes. In recent studies, the monocyte to high density lipoprotein ratio (MHR) has ...been postulated as a novel parameter associated with adverse renal and cardiovascular outcomes. In this study we investigated the association of MHR with CIN in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI).
Consecutive STEMI patients treated with primary PCI were prospectively recruited. Subjects were categorized into two groups; as patients who developed CIN (CIN+) and patients who did not develop CIN (CIN-) during hospitalization. CIN was defined as either a 25% increase in serum creatinine from baseline or 44.20 µmol/L increase in absolute value, within 72 h of intravenous contrast administration.
A total number of 209 patients were included in the study. Thirty-two patients developed CIN (15.3%). In the CIN (+) patients, monocytes were higher 1.02 (0.83-1.39) vs. 0.69 (0.53-0.90) 109/L, p<0.01 and HDL cholesterol levels were lower 0.88 (0.78-1.01) vs. 0.98 (0.88-1.14) mmol/L, p<0.01. In addition, MHR was significantly higher in the CIN (+) group 1.16 (0.89-2.16) vs. 0.72 (0.53-0.95) 109/mmol, p<0.01. In multivariate logistic regression analysis, MHR, Mehran score, AGEF score and CV/eGFR were independently correlated with CIN.
Higher MHR levels may predict CIN development after primary PCI in STEMI patients.
Transplantation affects the patient's psychological state and daily life activities. Although there are various studies regarding the quality of life of patients, there are limited studies on the ...daily life activities and learning needs of patients after renal transplant. Here, we investigated the daily life activities and learning needs of patients after renal transplant.
This descriptive and cross-sectional study was conducted on 120 renal transplant recipients. Data were collected using the "Patient Information Form," the "Nottingham Extended Activities of Daily Living Scale," and the "The Patient Learning Needs Scale." Data were evaluated with t test, analysis of variance, and Pearson correlation analyses.
In our patient group, the mean general health score was 6.8 ± 2.34, and the fatigue score was 4.53 ± 2.88. Although 66.7% of our patients reported that they had information about the drugs that they used, 58.3% could not answer questions regarding the most important adverse effects of their drugs. We found that 20% of the patients had a respiratory problem, 34.2% had sexual problems, and 26.7% had sleep problems. The average Nottingham Extended Activities of Daily Living Scale levels were lower in patients with only primary school education, patients who did not work, and patients with other illnesses. Learning needs of patients were as follows in order: quality of life, feelings related to the conditions, treatment, and complications.
Our study patients reported that their overall daily life activities and quality of life, given the holistic approach to treatment and care, were good. However, when we examined each activity separately, our findings showed that patients lacked information regarding how to cope with stress, emotions, and the effects of renal transplant on their life.
Sarcopenia, defined as decrease in muscle function and mass, is common in patients with moderate to advanced chronic kidney disease (CKD) and is associated with poor clinical outcomes. Muscle ...mitochondrial dysfunction is proposed as one of the mechanisms underlying sarcopenia. Patients with moderate to advanced CKD have decreased muscle mitochondrial content and oxidative capacity along with suppressed activity of various mitochondrial enzymes such as mitochondrial electron transport chain complexes and pyruvate dehydrogenase, leading to impaired energy production. Other mitochondrial abnormalities found in this population include defective beta-oxidation of fatty acids and mitochondrial DNA mutations. These changes are noticeable from the early stages of CKD and correlate with severity of the disease. Damage induced by uremic toxins, oxidative stress, and systemic inflammation has been implicated in the development of mitochondrial dysfunction in CKD patients. Given that mitochondrial function is an important determinant of physical activity and performance, its modulation is a potential therapeutic target for sarcopenia in patients with kidney disease. Coenzyme Q, nicotinamide, and cardiolipin-targeted peptides have been tested as therapeutic interventions in early studies. Aerobic exercise, a well-established strategy to improve muscle function and mass in healthy adults, is not as effective in patients with advanced kidney disease. This might be due to reduced expression or impaired activation of peroxisome proliferator-activated receptor-gamma coactivator 1 α , the master regulator of mitochondrial biogenesis. Further studies are needed to broaden our understanding of the pathogenesis of mitochondrial dysfunction and to develop mitochondrial-targeted therapies for prevention and treatment of sarcopenia in patients with CKD.
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