Purpose
Living with end-stage renal disease may be burdensome, not only for patients, but also for caregivers. In this study, we aim to compare caregiver burden, psychological symptoms in caregivers ...of peritoneal dialysis (PD), hemodialysis (HD), and transplantation (TX), and find out associated factors.
Methods
A total of 43 PD, 42 HD, 42 TX patients and a total of 127 caregivers that were actively involved with the care of their patients’ dialysis were enrolled. Patients had been on renal replacement therapy at least for 6 months and caregivers had given care at least for 6 months. The World Health Organization Quality of Life short version and hospital anxiety and depression scale (HAD) were applied to the patients. Symptom Checklist-90-Revised and Zarit caregiver burden scale were applied to the caregivers.
Results
Zarit caregiver burden score was found highest in HD group, which was significantly higher than PD and TX. All three groups had similar HAD anxiety scores, whereas the HAD depression score was highest in HD group, lower in PD, and lowest in TX. Quality of life was lowest in HD group. Zarit caregiver burden score was found higher in caregivers with symptoms like somatization, anxiety, obsessive–compulsive, depression, interpersonal sensitivity, psychoticism, paranoid ideation, hostility, and additional psychological symptoms than the ones who did not have these symptoms. Psychological symptoms were similar in PD, HD, and TX groups.
Conclusion
Caregiver burden was found highest in HD group. Educational, social, and psychological support interventions may be considered for caregivers.
Prediction of prognosis in Immunoglobulin A Nephropathy (IgAN) and taking appropriate precautions may reduce annual incidence of chronic kidney disease. This may be possible by close follow-up for ...the development and progression of interstitial fibrosis (IF) or interstitial fibrosis/tubular atrophy (IFTA) in IgAN patients.
To investigate whether Young's elastic modulus (YM) which measured shear wave elastography (SWE) might be used for follow-up of IF or IFTA in IgAN patients.
Prospective study was approved by Human Research Ethics Committee. Group 1 consisted of patients with IgAN. Group 2 consisted of healthy control participants. Young's elastic modulus which is a value of stiffness along with longitudinal stiffness was used to evaluate tissue elasticity. Specificity, sensitivity, positive predictive value (PPV) of YM for the presence of IF and IFTA were evaluated.
Group 1 consisted of 30 participants, and group 2 consisted of 32 participants. Sensitivity and specificity of SWE to diagnose presence of IF for YM > 15 kPa were 89% and 90%, respectively. PPV among the ones whom IF was diagnosed by YM >15 kPa was 91%. Sensitivity and specificity of SWE to diagnose presence of IFTA for YM > 15 were 65% and 51%, respectively. PPV among the ones whom IFTA was diagnosed by YM >15 kPa was 78.1%.
YM which measured SWE is highly specific and sensitive in the diagnosis of IF, but not for IFTA in IgAN patients. Therefore, progression for IF in IgAN may be followed by SWE.
As in many countries, there is neither a surveillance system nor a study to reveal the hemodialysis (HD) related infection rates in Turkey. We aimed to investigate the infection rate among HD ...outpatients and implement CDC's surveillance system. A multicenter prospective surveillance study is performed to investigate the infection rate among HD patients. CDC National Healthcare Safety Network (NHSN) dialysis event (DE) protocol is adopted for definitions and reporting. During April 2016-April 2018, 9 centers reported data. A total of 199 DEs reported in 10,035 patient-months, and the overall DE rate was 1.98 per 100 patient-months. Risk of blood culture positivity is found to be 17.6 times higher when hemodialysis was through a tunneled catheter than through an arteriovenous fistula. DE rate was significantly lower in patients educated about the care of their vascular access site. Staphylococcus aureus was the most causative microorganism among mortal patients. Outcomes of DEs were hospitalization (73%), loss of vascular access (18.2%), and death (7.7%). This first surveillance study revealed the baseline status of HD related infections in Turkey and showed that CDC National Healthcare Safety Network (NHSN) DE surveillance system can be easily implemented even in a high workload dialysis unit and be adopted as a nationwide DE surveillance program.
Purpose: Accurate blood pressure measurement (BPM) is the main point for the proper diagnosis and management of hypertension. In this paper, we aim to assess the approaches taken by family physicians ...(FPs) about BPM and blood pressure measurement devices’ (BPMDs) standards.
Materials and Methods: A survey was prepared in accordance with the current hypertension guidelines to assess the knowledge and awareness of FPs about BPM methods and BPMDs’ standards. Questionnaires were filled out face-to-face with family physicians.
Results: In total, 300 of 412 local FPs were included in this study. Office BPMs were preferred by 41.7% of physicians, whereas 42.7% expressed their preference for HBPMs for hypertension diagnosis and treatment. Aneroid devices were chosen by 61.3% of FPs who believed that their knowledge and skills about BPM were excellent. The rate of FPs who preferred devices not compatible with one of the recommended devices in the guidelines was 79.7%. A total of 53% of FPs recommended upper arm automatic BPMDs to their patients and only 25% of FPs recommended BPMDs proved by clinical studies. Conclusion: We concluded that the awareness, knowledge, and routine daily practice of FPs in Mersin regarding BPM and BPMDs are poor and need to be improved. The results of this study may help us to question the approaches of FPs to hypertensive patients and may improve HT management.
Abstract
BACKGROUND AND AIMS
Recently, prognostic importance of antibodies in primary membranous nephropathy is well defined. However, knowledge about antibodies related to disease activity in ...membranous lupus nephritis (MLN) is limited. Exostosin1 and exostosin2 (EXT1/2) are novel antibodies detected in MLN, and further studies are needed for the prognostic significance of them as a marker.
The aim of this study is to determine whether renal prognostic markers differ between EXT1/2 positive and negative MLN patients.
METHOD
This is a single-center, retrospective and observational study. Class 5 MLN patients aged 18 or older were included in the study. Clinical characteristics, results of biochemical analysis and histopathological examination were recorded from 6 to 18 months. The end-point of the study was determined as complete remission, partial remission, need for renal replacement therapy (RRT) and exitus. Group 1: EXT1/2 positive patients. Group 2: EXT1/2 negative patients. Light, immunofluorescent and electron microscopy findings and laboratory parameters were evaluated in EXT1/2 positive and negative patients.
RESULTS
Group 1: n = 11 patients. Group 2: n = 7 patients. The main demographic, biochemical and histopathological characteristics of the groups were shown in Table 1. EXT1/2 negative patients, a higher number of sclerotic glomeruli, interstitial fibrosis and a higher amount of proteinuria were present than positive patients (P < 0.05). EXT1/EXT2 negative patients had significantly lower C3 and C4 levels than positive patients (P < 0.05). EXT1/EXT2 negative patients had a higher RRT or exitus rate within 18 months than positive patients (P < 0.05). In contrast, EXT1/EXT2 positive patients had a higher rate of achieving complete or partial remission within 18 months than negative patients (P < 0.05). The effect of immunosuppressive drug use other than steroids and glomerulosclerosis remission was statistically significant (P = 0.04 and P = 0.011).
CONCLUSION
EXT1/2 negative class 5 LMN patients have more poor renal prognostic indicators than positive patients. RRT or exitus rate is higher in EXT1/EXT2 negative patients than positive patients. However, more randomized controlled studies are needed.
Abstract
BACKGROUND AND AIMS
Focal Segmental Glomerulosclerosis (FSGS) and Minimal Change Disease (MCD) are most common seen glomerulonephritis. Differential diagnosis between FSGS and MCD by light ...microscopy (LM) cannot be made in some times. In this situation, electron microscopy (EM) is needed for differential diagnosis. Rarely, EM may not be sufficient for differential diagnosis. There are needed new markers for differential diagnose between FSGS and MCD. The aim of this study is to determine which of the glomerular C4d, nephrine staining is specific and sensitive for FSGS and MCD.
C4d, Recent experimental data show that complement activation plays a pathogenic role in the development of FSGS. Therefore, C4d staining in the sclerotic focus of the glomeruli in FSGS patients may have an important differential diagnosis.
Nephrine is the main component of the slit diaphragm that connects the foot protrusions of the podocytes. Epithelial cell and podocyte dysfunction occurs as a result of defects in the genes encoding these key proteins expressed in GBM.
Wilms’ tumour suppressor gene (WT1) is a transcription factor that plays very important role in the embryonal development of the genital organs and kidney. WT-1 is expressed in podocytes and is an important transcription factor for podocyte function.
METHOD
This is a retrospective study, comprised of patients diagnosed as FSGS, MCD and the ones who diagnosed as having FSGS or MCD couldnot be differentiated. The patients were divided into three groups. Group 1: FSGS patients, Group 2: patients with indefinite diagnosis; either FSGS or MCD and Group 3: MCD patients. All biopsy materials were stained with C4d, WT1 and nephrine. The specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of C4d, WT1 and nephrine were evaluated for the diagnosis of both FSGS and MCD.
RESULTS
C4d staining in group 1 was significantly higher compared with group 2 and group 3 (P < .05). Nephrine was shown significantly more staining in group 3 patients than group 1 (P < .05). C4d was found to be associated with the presence of global or segmental sclerosis in the glomeruli, adhesion to the Bowman's capsule (P < .05). The specificity and sensitivity of C4d in FSGS patients were 85%, 73.9%, while it was 26.1% and 15.4% in MCD. Specificity and sensitivity of nephrine were 87%, 69% in MCD patients compared with 30.8% and 13% in FSGS (Fig. 1). PPV and NPV values of C4d and nephrine in FSGS and MCD were shown in Figure 2.
CONCLUSION
C4d and nephrine have predictive diagnostic value for FSGS and MCD respectively. C4d and nephrine are more specific and sensitive to FSGS and MCD, respectively. However, there is a need for randomized studies with larger study groups
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