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Lupus nephritis (LN) is an important complication of systemic lupus erythematosus (SLE). The aim is to use indication and protocol biopsies to determine clinicopathological findings and outcomes of patients with LN undergoing kidney transplantation (KTx).Patients who underwent KTx due to LN were retrospectively analyzed. Recurrent LN (RLN) was diagnosed by transplant kidney biopsy.Among 955 KTx patients, 12 patients with LN as the cause of end-stage renal disease were enrolled. Five patients were male. Mean follow-up time was 63 ± 34 months. At the last follow-up visit, mean levels of serum creatinine and proteinuria were 137.0 ± 69.0 µmol/L and 0.26 ± 0.26 g/day, respectively. Eighteen indication and 22 protocol biopsies were performed; 27 biopsies were additionally evaluated by immunofluorescence. In two recipients, subclinical RLN was confirmed by protocol biopsies. Clinical recurrence occurred in four patients. Among patients with RLN, time from diagnosis of LN to KTx was significantly shorter and use of ATG as induction treatment was significantly lower. Graft loss occurred in two recipients who had clinical RLN. Five-year overall graft survival was 85.7%.Kidney transplantation is a reasonable option for patients with ESRD secondary to SLE. However, recurrence of LN is common if protocol biopsies are included in post-transplantation surveillance.

Genotyping of hepatitis C virus (HCV) has become important and clinical interest has increased because of its associations with response to therapy and progless of disease. Furthermore, phylogenetic analysis is useful in epidemiological studies. The aim of this study is to evaluate the routine use of direct sequence analysis of polymerase chain reaction (PCR) products for determining HCV genotypes and phylogenetic analysis. Fifty serum samples found to be HCV RNA positive by Cobas Amplicor test (Roche Molecular Systems, Branchburg NJ) were included in the study. Genotyping was based upon regions identified as discriminative within 184 base pairs of 5’ noncoding region (NCR) of viral genome. Nucleotide sequences were determined by using Big Dye Terminator kit with ABI Prism 310 DNA sequencer (PE Applied Biosystems, Foster City, Calif.) and were aligned using Clustal W program. Phylogenetic tree was constructed by Treecon program. Genotyping could be achieved with 45 serum samples (90%) belonging to 24 chronic hepatitis C, 7 renal transplant and 14 thalasemia patients. Among 45 HCV isolates, 15 were 1a and 30 were 1b. Although nucleic acid sequencing is the gold standard for genotyping, commercial kits are more practical for routine laboratory use. However, sequencing helps to identify the genotypes of the isolates which could not be determined, precisely. 5’NCR of HCV did not seem to be appropriate in our group of samples for detailed phylogenetic analysis such as tracing viral transmission route.

Metformin biguanid sınıfından, Tip 2 diyabetiklerde, özellikle böbrek fonksiyonları normal hastalarda ilk basamakta kullanılan oral antidiyabetiktir. Metforminin en ciddi yan etkisi laktik asidozdur. Böbrek yetersizliği laktat atılım bozukluğunun en sık sebebidir. Metformin kullanan bir hastada gelişen akut böbrek yetersizliğinin alevlendirdiği laktik asidoz tablosunun sunulması amaçlanmıştır. Atmış sekiz yaşında bayan hasta metformin kullanırken iki haftadır devam eden ishal, bulantı ve kusma yakınmaları ile enfeksiyon hastalıkları servisine yatırıldı. Kan gazında artmış anyon açıklı metabolik asidoz saptandı. Laktik asit düzeyi yüksek saptanması üzerine metformin kullanımına bağlı Tip B laktik asidoz olarak değerlendirildi. Hasta akut böbrek yetmezliği nedeni ile hemodiyalize alındı. Yatışının 11. gününde tüm kan parametreleri düzelmiş olarak şifa ile taburcu edildi. Metformin böbrek yetersizliği gelişen hastalarda laktik asidoza sebep olabilmektedir, bu hastalarda erken diyaliz klinik durumun hızla düzelmesini sağlar., Metformin is a biguanide used in the treatment of type 2 diabetic patients with normal renal functionLactic acidosis is the most serious side effect of metformin. Renal failure is the most common cause of reduced lactate excretion. It is aimed to present a case of metformin-induced lactic acidosis exacerbated by acute renal failure. A 68-year-old female patient used metformin was admitted to the infectious disease department due to diarrhea, nausea and vomiting. Type B lactic acidosis due to metformin was diagnosed after the detection of high anion gap metabolic acidosis and high lactate level on blood gas analysis. Hemodialysis was performed because of acute renal failure. The patient was discharged on the 11th day of the hospitalization with normal serum parameters. Metformin may cause lactic acidosis among patients with acute renal failure; early hemodialysis provides rapid clinical improvement.

Peritonit, periton diyalizi hastalarında sık karşılaşılan önemli bir problemdir. Olguların çoğunluğunda etken Gram pozitif mikroorganizmalardan Stafi lokoklardır. Streptococcus agalactiae peritoniti nadir görülen ancak fatal seyreden bir enfeksiyondur. Biz burada 39 yaşındaki kadın periton diyalizi hastasında Streptococcus agalactiae'ya bağlı gelişen peritoniti intraperitoneal Sefazolin ve Vankomisin tedavisiyle başarılı bir şekilde tedavi ettik. Hastanın izlemindeki 6 aylık süre içerisinde peritonit atağı gözlenmedi., Peritonitis is a common clinical problem in patients treated by peritoneal dialysis. The most common organisms causing peritonitis are Gram-positive (especially staphylococcus species). Peritonitis with Streptococcus agalactiae causes rare but often fatal infections in peritoneal dialysis patients. We present the case of a 39-year-old female peritoneal dialysis patient who had peritonitis due to Streptococcus agalactiae and the infection was successfully treated with intraperitoneal Cefazolin and Vancomycin. There were no further episodes of peritonitis during the six-month follow-up.