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Climate change problems like air pollution and global warming are assumed to be related to human activity. Global warming and air pollution are related issues. The state of health is assumed to be negatively impacted by these climatic changes, particularly in terms of the incidence and progression of chronic kidney disease. The aim of this review is to update physicians on how air pollution and global warming affect kidney disease. [ABSTRACT FROM AUTHOR]

Introduction: Immunoglobulin A nephropathy (IgAN) is the most common form of glomerulonephritis worldwide with a strong autoimmune component. 40% of diagnosed cases end up with end-stage kidney disease within 20 years of diagnosis. IgAN also affects tissues that can produce mucosal secretions, such as the nasopharynx, and causes mucosal infections in patients with IgAN. Metabolomics analysis allows us to analyze the differentiation in metabolite levels in biofluids such as urine and serum. Our aim was to evaluate the disease from a different perspective, including saliva, and assess the metabolomic differences between healthy people and IgAN patients and evaluate the correlation between urinary and salivary metabolomics in IgAN patients. Method: This study was based on two groups: healthy control and IgAN patients groups. Stimulated salivary and spot urine samples were collected from both groups. Collected samples were subjected to full metabolome analysis in a liquid chromatography-mass spectrometry (LC-MS/MS) device. In addition, general demographic information of subjects, serum urea, serum creatinine, urine creatinine, urine proteinuria, and estimated glomerular filtration rate (eGFR) levels of subjects were gathered for statistical analysis. Results: Sixteen IgAN patients participated in the study. Four of 16 patients were male, and the mean age of the IgAN group was 45.31±6.65 years. Ten healthy controls participated in the study. Four of 10 controls were male, and the mean age of the healthy control group was 41.36±6.57 years. The IgAN patients had meaningfully increased serum creatinine and urine proteinuria levels compared with the healthy controls (p=0.009 and p=0.006). GFR levels were found to be significantly decreased in IgAN patients (p=0.006). However, there were no significant differences in serum urea and urine creatinine levels (p=0.610 and p=0.111). Conclusion: These are the results of our preparatory work. Further analysis will be conducted. [ABSTRACT FROM AUTHOR]

Introduction: In Turkey, one out of every 7 people has kidney disease, and the number of patients receiving kidney replacement therapy (KRT) is increasing. The thoughts of kidney healthcare providers (KHPs) play a significant role in the decision-making process in the patient's choice of dialysis modality. In this study, we evaluated the thoughts and attitudes of KHPs in Turkey regarding the dialysis modality. Method: An online survey was conducted to investigate the demographic characteristics of KHPs and the variables influencing modality recommendations. The prepared survey was distributed to KHPs in every region of Turkey between March 15 and June 15, 2023. The distribution of the data was analyzed using the Shapiro-Wilk and Pearson chi-square tests. Results: A total of 102 physicians and 42 nurses completed the survey (F: 82, M: 62, mean age 45+/- 8.6 years). The current patients of the respondents are predominantly treated with in-center hemodialysis (90.3%) and to a lower percentage (9.7%) with peritoneal dialysis. According to the participants, the major role in the decision of the dialysis modality belongs to the nephrologist (54.9%). The preference for referring patients to in-center hemodialysis was no caregiver (76.4%), low socio-economic status (69%), more than one chronic disease (57.6%), and low education level (56.3%). In the question "If you needed a dialysis modality, which method would you prefer?", the participants answered "Home hemodialysis" (45.8%), "Peritoneal dialysis" (43.8%) and "In-center hemodialysis" (10.4%). 66.8% of the respondents believed that they had insufficient knowledge about home hemodialysis. Conclusion: The results indicate that KHPs prefer home hemodialysis, although most of their patients are treated with in-center hemodialysis. Most KHPs consider themselves incompetent in home hemodialysis. Education, training, and new regulations regarding dialysis modalities are needed. [ABSTRACT FROM AUTHOR]

End stage kidney disease is an important health issue worldwide. Some risk factors such as hypertension, diabetes mellitus and the presence of glomerulonephritis can lead to progression towards end stage disease. There are many nutritional and medical therapies suggested to slow down the disease progression. Adequate water intake can decrease the risk of developing a spectrum of disorders from colorectal cancer to cardiovascular diseases with its protective effect shown by several studies. In this review, we aimed to discuss the data published about the protective and therapeutic effects of adequate water intake on the kidney and kidney diseases. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Focal segmental glomerulosclerosis (FSGS) as a primary glomerular disease are refractory to therapy and progress to End stage renal disease. (ESRD). After transplantation, the major problems are recurrence of the disease and its treatment. In this study, We investigated FSGS recurrence. MATERIAL and METHODS: The graft and patient's survivals, complications, recurrence rates, and therapeutic approach were documented. Twenty patients with FSGS and 20 patients as controls were included in the study. RESULTS: The recurrence rate was significantly higher in FSGS group than controls (55 % vs 0 %, p<0.0001). We found that living and cadaveric donor transplantation have similar survival rate in FSGS. One of the most effecting factors on graft survival was genetic similarities between recipient and donor. Pre transplant plasmapheresis was found as effective treatment way for the prevention of FSGS recurrence. While proteinuria recurrence was 38% in the preemptive plasmapheresis group, it was 85% in the other patients with FSGS (p<0.05). CONCLUSION: The importance of genetic similarities, similar results for graft survival in both living and cadaveric donor transplantation, and plasmapheresis as an effective approach for recurrent disease were the most important findings in this study. It also seems that the most effective therapeutic approach for the prevention of recurrence is pretransplant preemptive plasmapheresis [ABSTRACT FROM AUTHOR]

Introduction: Factor H acts as an inhibitory molecule in the complement activation pathways. Certain cancers express Factor H to escape the harmful features of the immune system. Here, we carried out high-throughput docking to determine a candidate inhibitor for Factor H-C3d binding. Hypothetically, the candidate inhibitor may serve as a possible additional therapeutic for certain cancers including glioblastoma multiforme (GBM). Method: Two approaches to computer-aided drug discovery were used. "Heuristic method" employed Factor H's binding pocket to construct counterpart molecules. "Comprehensive strategy" screened existing libraries for a potential inhibitor. Possible inhibitor molecules (target leads) were obtained from the Zinc20 database for the in silico, virtual screening purpose. Molecules that pass the Kd threshold were further analyzed by Molecular Dynamics simulations. Results: Three molecules were identified to be a suitable fit to inhibit Factor H in silico settings after a detailed investigation using both Heuristic and Comprehensive approaches. The molecule AQKQ had the smallest overall Root-mean-square deviation value. Molecule ARRE provided the best total energy (62,675 kJ/mol) for the system environment among the MD simulations performed. AQKQ-Factor H binding had the lowest energy with 24,852 kJ/mol. Wander will binding was shown to be higher for this molecule (23,724 kJ/mol). Following AQKQ, ARRE and THRS also displayed good binding energies (62,675 kJ/mol and 29,415 kJ/mol respectively). Conclusion: The findings of this study point to the possibility of using three compounds as a cancer therapeutic. Although the compounds demonstrated excellent binding abilities, their effectivity on cell level is still unclear. [ABSTRACT FROM AUTHOR]

Outcome of living unrelated (commercial) renal transplantation. Background. Due to inadequate cadaveric and living related organ supply, many end-stage renal disease patients go to Third World countries for commercial transplantation, although the high risk of complications is well established and ethical arguments debate this practice. Methods. The midterm outcome of 115 patients who had been commercially transplanted in various countries and admitted to our center for post-transplant care and follow-up between 1992 and 1999 was retrospectively analyzed. Data considering the transplantation practice and post-transplant course were collected from the patient files. Outcome of these patients was compared with those with a living related transplant performed at our center. Results. The patients (91 male and 24 female; mean age of 42 ± 12 years) were transplanted in India (N = 106), Iraq (N = 7), and Iran (N = 2). The mean follow-up period was 64.5 ± 23.9 months. Post-transplant course was complicated by numerous surgical and/or medical complications, and many of the latter were unconventional infections caused by malaria, invasive fungal infections, and pneumonia due to various opportunistic pathogens. Overall, 52 patients still have functioning allografts, while 22 lost their grafts, 20 died, and 21 were lost to follow-up. Graft survival rates at two, five, and seven years were 84, 66, and 53%, respectively, for the study group, while it was 86, 78, and 73% for living related transplantations performed at our center (P = 0.036). Patient survival rates for the same periods were 90, 80, and 74% for the study group and 90, 85, and 80% for the living related transplantations (P = 0.53). Conclusions. Besides the ongoing ethical debate, commercial transplantation carries a high risk of unconventional complications, and despite that the patient survival rate is comparable, graft survival is worse than conventional living related transplantations at the midterm. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of different electrolyte imbalances in a cohort of elderly subjects aged =65 years, and evaluate associations between each electrolyte imbalance and functional dependence. Methods: We reviewed medical records of consecutive outpatient elderly subjects. Frequency of hyponatremia (serum sodium of <136 mmol/L), hypernatremia (serum sodium of >145 mmol/L), hypokalemia (serum potassium of <3.5 mEq/L), hyperkalemia (serum potassium of >5.3 mEq/L), hypocalcemia (serum calcium of <8.5 mg/dL), hypercalcemia (serum calcium of >10.5 g/dL), hypophosphatemia (serum phosphorus of <2.5 mg/dL), hyperphosphatemia (serum phosphorus of >4.5 mg/dL), hypomagnesemia (serum magnesium of <1.6 mg/dL), and hypermagnesemia (serum magnesium of >2.3 mg/dL) were assessed. Associations between each electrolyte disorder and Barthel and Lawton-Brody activities of daily living (BADL and IADL) were analyzed. Results: Among the 464 subjects, hyponatremia (11.2%) hypomagnesemia (9.1%) and hypermagnesemia (8.8%) were the most common disorders. Patients with one electrolyte imbalance constituted 30.2% (140 patients) of the cohort, while 44 (9.5%) had two, and 7 (1.5%) patients had ≥2 electrolyte imbalances, concurrently. Calcium, phosphorus, and magnesium disorders were more common among subjects who were 80 years of age or more, compared to those aged 65-79 years, while the frequency of potassium disorders was lower in the former group. Hyponatremia and hypocalcemia were associated with functional dependence based on BADL and IADL scores. Patients with multiple electrolyte abnormalities had a higher risk of functional dependence. Conclusion: Hypomagnesemia was as common as hyponatremia, especially among patients with an age of 80 years or more. Hyponatremia and hypocalcemia appeared to be associated with functional dependence. The higher number of electrolyte abnormality the higher risk of functional dependence. Our results should be confirmed by studies with larger sample sizes. [ABSTRACT FROM AUTHOR]

Objective: This study investigates correlations between different methods for diagnosis of protein energy malnutrition (PEM) in peritoneal dialysis patients. Methods: Twenty four patients were included. Patients with amputations, infections, peritonitis, malignancies and PD duration less than three months were excluded. Physical examination findings, laboratory results and anthropometric measurements were recorded. Body composition analysis was performed with multi-frequency bioimpedance analyzer. Dialysis malnutrition score (DMS) was calculated. The correlations of different parameters were searched. Results: Eleven patients were female and 13 patients were male. Mean age was 58.9±12.6 years. Median dialysis duration was 25 (interquartile range: 14) months. Protein percentage was negatively correlated with fat percentage (r=-0.785; p<0.001), triceps skinfold thickness (SFT) (r=-0.641; p<0.001), biceps SFT (r=-0.685; p<0.001), body mass index (BMI) (r=-0.867; p<0.001), mid-arm circumference (r=-0.680; p=0.001). Fat percentage was positively correlated with BMI (r=0.780; p<0.001), biceps SFT (r=0.817; p<0.001), triceps SFT (r=0.901; p<0.001) and mid-arm circumference (r=0.558; p=0.005) Albumin was negatively correlated with DMS (r= -0.439; p=0.032). DMS and albumin were not correlated with bioimpedance and anthropometry. Conclusion: Albumin is a marker of PEM in PD patients. Malnutrition scores may be used as adjunct methods. Increase in fat mass and percentage may influence the interpretation of anthropometric measurements. [ABSTRACT FROM AUTHOR]

Objective: This study investigates correlations between different methods for diagnosis of protein energy malnutrition (PEM) in peritoneal dialysis patients. Methods: Twenty four patients were included. Patients with amputations, infections, peritonitis, malignancies and PD duration less than three months were excluded. Physical examination findings, laboratory results and anthropometric measurements were recorded. Body composition analysis was performed with multi-frequency bioimpedance analyzer. Dialysis malnutrition score (DMS) was calculated. The correlations of different parameters were searched. Results: Eleven patients were female and 13 patients were male. Mean age was 58.9±12.6 years. Median dialysis duration was 25 (interquartile range: 14) months. Protein percentage was negatively correlated with fat percentage (r=-0.785; p<0.001), triceps skinfold thickness (SFT) (r=-0.641; p<0.001), biceps SFT (r=0.685; p<0.001), body mass index (BMI) (r=-0.867; p<0.001), mid-arm circumference (r=-0.680; p=0.001). Fat percentage was positively correlated with BMI (r=0.780; p<0.001), biceps SFT (r=0.817; p<0.001), triceps SFT (r=0.901; p<0.001) and mid-arm circumference (r=0.558; p=0.005) Albumin was negatively correlated with DMS (r= -0.439; p=0.032). DMS and albumin were not correlated with bioimpedance and anthropometry. Conclusion: Albumin is a marker of PEM in PD patients. Malnutrition scores may be used as adjunct methods. Increase in fat mass and percentage may influence the interpretation of anthropometric measurements. [ABSTRACT FROM AUTHOR]

There is no standard practice for the sustainability of medical education in epidemics such as Covid-19 and disasters affecting society. Synchronous or asynchronous trainings have been carried out in some of universities and colleges that have distance education technical infrastructure, during the Covid-19 pandemic. If every student has access to information technologies and the skills of the instructors who will prepare and deliver the training increase their ability to use information technologies, there is no problem in the implementation and maintenance of theoretical lessons. During the Covid-19 pandemic, we had to go to distance education, which we had not yet implemented at Bezmialem Vakıf University Faculty of Medicine. During this period, we applied asynchronous and synchronous education models (mixed model) for theoretical lessons. However, the fact that practical and internship applications were carried out by distance education - although videos about skills and practices were shot and uploaded to the system - it was not possible to replace the formal education. Distance education is inevitable for the continuity of education in epidemic and disaster situations. However, after the epidemic and disaster situations have passed, practical and internship practices should be carried out as much as possible in addition to distance education in medical education. In normal times, distance education can only be used to support formal education in medical education. As a result of all these evaluations and experiences we gained in the Covid 19 pandemic, we think that synchronous/synchronous distance education applications will improve over time and contribute to medical education. [ABSTRACT FROM AUTHOR]

The clinical use of cisplatin, which is a first-line anticancer agent, is highly restricted due to its adverse effects on kidneys that lead to nephrotoxicity. Therefore, some potential reno-protective substances have been used in combination with cisplatin to cope with nephrotoxicity. Due to its high antitumor activity and oxygen-carrying capacity, we investigated the molecular effects of squalene against cisplatin-induced oxidative stress and kidney damage in mice. Single dose of cisplatin (7 mg/kg) was given to male Balb/c mice. Squalene (100 mg/kg/day) was administered orogastrically to mice for 10 days. Following sacrification, molecular alterations were investigated as analysis of the levels of oxidative stress index (OSI), inflammatory cytokines and cell survival-related proteins in addition to histopathological examinations in mice kidney tissue. The level OSI and Interferon-gamma (IFN-γ) decreased in the cisplatin and squalene cotreated mice compared to cisplatin-treated mice. Squalene treatment also increased the activation of protein kinase B (AKT). Furthermore, cisplatin-induced inactivation of mammalian target of rapamycin (mTOR) and histopathological damages were reversed by squalene. It may be suggested that squalene ameliorated the cisplatin-induced histopathological damages in the kidney through activation of AKT/mTOR signaling pathway by regulating the balance of the redox system due to its antioxidative effect. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We studied the effect of initial peritoneal equilibration test (PET) results on mortality in peritoneal dialysis (PD) patients besides classical mortality markers. MATERIAL and METHODS: Seventy-eight patients were enrolled. Initial PET and biochemical and clinical findings were recorded after the beginning of PD. Survival analysis model included comorbidities, PD modality, peritoneal modality change during follow-up, history of peritonitis, calcium X phosphorus, dialysate volume, presence of anuria, ultrafiltration volume, albumin, Kt/V, normalized protein equivalent of nitrogen appearance (nPNA), and peritoneal permeability. RESULTS: The mean age was 55.2±13.8 (52.6%, female) years and PD duration was 49.7±26.1 months. When current conditions of the patients were evaluated, 42.3% of the 78 patients received PD treatment, 24.4% switched to hemodialysis, 6.4% had kidney transplantation and 26.9% died. The most significant factors determining patient survival were age, albumin and weekly total Kt/V according to the Cox regression analysis using the backward elimination method. When Cox regression analysis was repeated by the forward selection method, albumin was detected as the most significant factor determining patient survival. CONCLUSION: Albumin was found to be the most important factor predicting patient survival among peritoneal permeability, nPNA, PD modality, weekly total Kt/V, dialysate volume, ultrafiltration volume on the initial PET. [ABSTRACT FROM AUTHOR]

Background/aim: This study aimed to compare washed red blood cell (WRBC) transfusion versus nonwashed RBC (NWRBC) transfusion in terms of posttransfusion potassium levels in dialysis patients on a day when the patient did not receive dialysis. Materials and methods: The patients were randomly assigned into two groups, i.e. those receiving WRBCs (n = 21) and those receiving NWRBCs (n = 17). Both groups received one unit of RBCs. Serum potassium and sodium levels were measured before and at the 1st, 2nd, 3rd, 4th, and 6th hours after transfusion. Results: In the WRBC group, the changes in the serum potassium levels at the 3rd, 4th, and 6th hours after transfusion were significant compared with pretransfusion levels. In the serum potassium levels mean decreases by 0.38 ± 0.57 mEq/L at the 3rd hour (P = 0.006), by 0.32 ± 0.47 mEq/L at the 4th hour (P = 0.005), and by 0.32 ± 0.51 mEq/L at the 6th hour (P = 0.009) after transfusion were significant compared with the pretransfusion levels. Conclusion: Although nonwashed RBC transfusion does not change serum potassium levels, washed RBC transfusion significantly reduces serum potassium levels. Washed RBC transfusion is considered to be safer in hemodialysis patients with hyperkalemia and anemia. [ABSTRACT FROM AUTHOR]

Hyperkalemia is commonly seen in hemodialysis patients and is a potentially life-threatening condition. Serum potassium concentration greater than 10 mEq/L is defined as extreme hyperkalemia. Emergent treatment of hyperkalemia is made with intravenous calcium, insulin-dextrose solutions, diuretics, gastrointestinal cation-exchange resin and dialysis. We present here a 52-year-old chronic hemodialysis patient with extreme hyperkalemia and cardiac arrhythmia. She was treated with emergent hemodialysis. Her abnormal laboratory findings and electrocardiography recovered. Further examinations suggested insufficient hemodialysis treatment as the possible cause of hyperkalemia. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus is a disease that affects millions of people worldwide. Extensive randomized clinical studies are ongoing on SGLT-2 inhibitors, Empagliflozin and Dapagliflozin, in patients with heart failure and chronic renal failure. The aim of this study is to investigate the equivalence and superiority of different SGLT2 inhibitors by comparing the metabolic and renal effects. Method: Six week old 44 male Sprague-Dawley male rats were divided into four groups treatment, placebo and control. Throughout the trial, rats had unrestricted access to food and water (ad libitum) and were kept at a standard temperature, humidity and light level. Streptozotocin was given intraperitoneally after a two-week high-fat diet, and groups were randomly divided based on mean glucose levels. Dapagliflozin and Empagliflozin were administered daily at 13:00, for 1 month. Blood samples and glucose levels were measured at certain intervals. For all groups, urine samples were collected before the treatment and after 1 month of treatment with metabolic cages. Urine samples were analysed with nuclear magnetic resonance. Results: The Empagliflozin-treated group had considerably decreased blood glucose levels as compared to the Dapagliflozin-treated group (p<0.001). In comparison to the placebo group, blood urea nitrogen showed a significant decrease in the Dapagliflozin (p=0.001) and Empagliflozin treatment groups (p<0.001). Levels of urinary protein and microalbumin increased in the Placebo and Dapa-treated groups (p=0.002 and p=0.006), but not in the Empa-treated group. Conclusion: According to the first-ever head-to-head animal model to assess distinct molecules in the same class of SGLT-2 inhibitors, Empagliflozin outperforms Dapagliflozin in terms of blood and urine parameters. [ABSTRACT FROM AUTHOR]