Search

The new Coronavirus SARS-CoV-2 (COVID-19) epidemic continues to affect the world. It is emphasized that COVID-19 is more severe in patients with solid organ transplantation, and the risk of mortality may be higher than in the normal population. Herein, with the first time, we described a COVID-19 pneumoniae kidney recipient case treated with sirolimus. A 49-year-old male patient had kidney transplantation 13 years ago. He was used prednisolone and sirolimus. His main complaints were fever (38.3°C) and weakness. Atypical pneumoniae was diagnosed with thorax computed tomography. The respiratory specimen of the patient was positive with COVID-19 by PCR test. Sirolimus was stopped due to the immunosuppressive effect, and the treatment switched to low dose everolimus. Also, hydroxychloroquine, oseltamivir and azithromycin triple therapy was started for five days. The patient was discharged with healing on the seventh day.

What is known and objectives In November 2019, several patients were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China. So far, there are no specific treatments with proven high efficacy in patients with SARS-CoV-2. Presently, several drugs, such as hydroxychloroquine, ribavirin, favipiravir (FVP), lopinavir/ritonavir (LPV/r), remdesivir and oseltamivir, have been suggested as effective treatments for SARS-CoV-2. The aim of this study was to describe the clinical experience with FPV and LPV/r in critically ill patients with COVID-19 at Sakarya University Education and Research Hospital. Methods The study included 107 consecutive patients who had a laboratory confirmation of COVID-19 and were admitted to the intensive care unit (ICU) between 19 March and 19 May 2020. Follow-up continued through 30 May 2020 when the last observed patients were discharged. Results and discussion Of the 107 patients, 65 received FPV (Group FPV) and 42 received LPV/r (Group LPV/r). The two groups were similar in terms of demographic data and clinical findings. 43 (66.2%) of the 65 patients in the FPV group and 23 (54.8%) of the 42 patients in the LPV/r group died (p = 0.237). The median ICU stay was 6.6 (IQR, 3-10) days in the FPV group and 9 (IQR, 6-16) days in the LPV/r group, which was a statistically significant difference (p = 0.010). What is new and conclusion The length of hospital stay was significantly lower in the FVP group compared to the LPV/r group among patients who were discharged from the ICU. Although the analysis was done with a limited number of patients and the observed difference in mortality rate is of some concern, FVP treatment may be more beneficial than LPV/r in terms of effective use in the ICU.

Objective: We aimed to determine the main demographic features of COVID-19, reveal the clinical differences to patients in other countries, evaluate severe adverse effects in terms of number and types of comorbidities, and provide information about prognosis possibilities.Materials and Methods: Patients’ records, followed at Sakarya University Hospital between late March 2020 and late April 2020 with a diagnosis of COVID-19, were evaluated for this study. Demographic features were noted retrospectively with records, and data were recorded in the MS Excel program for analysis with SPSS. Statistical significance was set at p < 0.05.Results: The records of 1443 cases, 704 (48.8%) women and 739 (51.2%) men, a mean age of 44.98 ± 18.72, were examined retrospectively. Among them, 9.9% were medical staff, 1.8% had a history of travel abroad, and 1.1% were pregnant. Radiological findings of 59.4% of our polymerase chain reaction (PCR) positive patients were compatible with COVID. The mean length of hospital stay was 4.5 days. Frequent comorbidities were hypertension, diabetes (DM), and ischemic heart disease. Eighty (5.5%) patients treated in intensive care (ICU) died.Conclusion: Based on the data of 1443 patients, the mean length of hospitalization of COVID-19 patients was 4.5 days, or followed up in intensive care, having DM and a long period of hospitalization, which increased mortality risk. None of the outpatients died., Amaç: COVID-19 için başlıca demografik özelliklerin belirlenmesini, diğer ülkelerdeki hastalara göre klinik farkları ortaya koymayı, ciddi yan etki riskinin komorbidite sayısı ve tipine göre değerlendirilmeyi ve olası prognozla ilgili bilgileri ortaya çıkarmayı amaçladık.Gereç ve Yöntemler: Bu araştırma Sakarya Üniversitesi hastanesinde 27 Mart 2020- 27 Nisan 2020 tarihleri arasında COVID-19 enfeksiyonu tanısıyla izlenen hastaların kayıtlarından elde edilmiştir. Hastalara ait demografik özellikler hasta kayıtlarından retrospektif olarak elde edilmiş, elde edilen veriler MS Excell programına kayıt edilmiştir. Elde edilen veriler SPSS programıyla analiz edilerek karşılaştırılmış ve p

BackgroundAcute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and theseverity of AKI is linked to adverse outcomes. In this study, we investigated the factors asso-ciated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI.MethodsIn this multicenter retrospective observational study, we evaluated the characteristics andin-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI.Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI defini-tion and staging were based on the Kidney Disease Improving Global Outcomes criteria.Patients with end-stage kidney disease or with a kidney transplant were excluded. Renaloutcomes were identified only in discharged patients.ResultsThe median age of the patients was 69 years, and 60.9% were males. The most frequentcomorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kid-ney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%,and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit.Renal improvement was complete in 81.7% and partial in 17.2% of the patients who weredischarged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. Theoverall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was notdifferent in patients with preexisting non-dialysis CKD compared to patients without CKD(34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio[HR] [95% confidence interval (95%CI)]: 1.01 [1.0–1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04–2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06–2.17], p =0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08–3.07], p = 0.023), serum lac-tate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05–2.30], p =0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25–3.14], p = 0.003) and stage 3 (HR [95%CI]:2.25 [1.44–3.51], p = 0.0001) were independent predictors of in-hospital mortality.ConclusionsAdvanced-stage AKI is associated with extremely high mortality among hospitalizedCOVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality inpatients with COVID-19 in the general population, are also related to in-hospital mortality inpatients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mor-tality rate among AKI patients. Renal problems continue in a significant portion of thepatients who were discharged.&nbsp

Objective: Due to the COVID-19 pandemic, renal transplantation operations were either stopped or restricted to be performed in selected patient groups in many centers globally. When evaluated together with the kidney transplantation process surgery and immunosuppression therapy applied in the postoperative period, it is a complex procedure, and requires close follow-up. The purpose of our study; to present the renal transplantation operations that performed during the pandemic process, the pre-operative preparation of the patients, the post-operative follow-up processes, and applied treatment approaches.Method: Renal transplantation operations which are performed in our transplant center during the pandemic were evaluated retrospectively. The demographic characteristics of the recipients and donors, graft function tests, COVID-19 PCR results, HLA matches, hot-cold ischemia times and post-transplantation complications were recorded. As induction therapy, the patients were divided into two groups as Group 1 with antithymuside globulin (ATG), and Group 2 with Basiliximab. The groups were evaluated in terms of preoperative and postoperative day 1, day 7, and 1st month serum creatinine levels, ATG cumulative level and HLA compatibility.Results: Twenty-two kidney transplantations were performed in our center between March 2020 and November 2020. Living donor kidney transplantation was performed in 21 patients. There were 7 female and 14 were male patients. The mean age of the patients was 41.95 ± 15.11 years and the body mass index was 26.37 ± 5.04 kg / m2. As induction therapy, ATG was applied to 7 patients and basiliximab to 13 patients. Induction therapy was not applied to one patient with full compliance. There was no statistically significant difference between the two groups in terms of early acute rejection or graft dysfunction for any reason (p> 0.05). COVID-19 infection developed in 3 patients within a 6-month postoperative period.Conclusion: During the pandemic period when the frequency of transmission is decreasing kidney transplantation operations can be performed at low intensity in experienced centers under close follow-up and strict isolation measures during periods, Amaç: COVID-19 pandemisi nedeniyle global düzeyde pek çok merkezde böbrek nakli operasyonları ya durdurulmuş yada seçilmiş hasta gruplarında yapılmak üzere kısıtlamaya gidilmiştir. Böbrek nakil süreci, cerrahisi ve postoperatif dönemde uygulanan immünosüpresyon tedavisi ile birlikte değerlendirildiğinde karmaşık ve yakın takip gerektiren bir uygulamadır. Çalışmamızın amacı; pandemi sürecinde yaptığımız nakil operasyonlarını, hastaların operasyon öncesi hazırlık, operasyon sonrası takip süreçlerini ve uyguladığımız tedavi yaklaşımlarını sunmaktır.Yöntem : Pandemi süresince nakil merkezimizde gerçekleştirilen böbrek transplantasyonu operasyonları retrospektif olarak değerlendirildi. Alıcı ve vericilerin demografik özellikleri, greft fonksiyo testleri, COVID-19 PCR sonuçları, HLA uyumları, sıcak-soğuk iskemi süreleri ve nakil sonrası görülen komplikasyonları kaydedildi. İndüksiyon tedavisi olarak hastalar antitimusit globülin (ATG) uygulanan Grup 1 ve Basiliksimab uygulananlar Grup 2 olmak üzere iki gruba ayrıldı. Gruplar preoperatif ve postoperatif 1. Gün 7. Gün ve 1. Ay serum kreatinin düzeyleri, ATG kümülatif düzeyi, HLA uyumları açılarından değerlendirildi.Bulgular: Merkezimizde Mart 2020 Kasım 2020 tarihleri arasında 22 böbrek nakli operasyonu gerçekleştirildi. 21 hastaya canlı vericili böbrek nakli uygulandı. Hastaların 7’si kadın 14’ü erkekti. Hastaların ortalama yaşı 41,95±15,11 yıl ve vücut kitle indeksi 26,37±5,04 kg/m2 idi. İndüksiyon tedavisi olarak hastaların 7’sine ATG, 13‘üne basiliksimab uygulandı. Tam uyum olan bir hastaya indüksiyon tedavisi uygulanmadı. Erken dönemde akut rejeksiyon veya herhangi bir nedenle greft disfonksiyonu açısından istatistiksel olarak iki grup arasında anlamlı fark yoktu (p>0.05).Sonuç: Pandemi döneminde bulaş sıklığının azaldığı dönemlerde yakın takip ve sıkı izolasyon tedbirleri altında deneyimli merkezlerde böbrek nakli operasyonları düşük yoğunlukta yapılabilir.Living Donor Kidney Transplantation During The COVID-19 Pandemic: A Single Center ExperienceAbstractObjective: Due to the COVID-19 pandemic, renal transplantation operations were either stopped or restricted to be performed in selected patient groups in many centers globally. When evaluated together with the kidney transplantation process surgery and immunosuppression therapy applied in the postoperative period, it is a complex procedure, and requires close follow-up. The purpose of our study; to present the renal transplantation operations that performed during the pandemic process, the pre-operative preparation of the patients, the post-operative follow-up processes, and applied treatment approaches.Method : Renal transplantation operations which are performed in our transplant center during the pandemic were evaluated retrospectively. The demographic characteristics of the recipients and donors, graft function tests, COVID-19 PCR results, HLA matches, hot-cold ischemia times and post-transplantation complications were recorded. As induction therapy, the patients were divided into two groups as Group 1 with antithymuside globulin (ATG), and Group 2 with Basiliximab. The groups were evaluated in terms of preoperative and postoperative day 1, day 7, and 1st month serum creatinine levels, ATG cumulative level and HLA compatibility.Results: Twenty-two kidney transplantations were performed in our center between March 2020 and November 2020. Living donor kidney transplantation was performed in 21 patients. There were 7 female and 14 were male patients. The mean age of the patients was 41.95 ± 15.11 years and the body mass index was 26.37 ± 5.04 kg / m2. As induction therapy, ATG was applied to 7 patients and basiliximab to 13 patients. Induction therapy was not applied to one patient with full compliance. There was no statistically significant difference between the two groups in terms of early acute rejection or graft dysfunction for any reason (p> 0.05).Conclusion: During the pandemic period when the frequency of transmission is decreasing kidney transplantation operations can be performed at low intensity in experienced centers under close follow-up and strict isolation measures during periods Keywords: Kidney transplantation, chronic renal disease, laparoscopic donor nephrectomy, COVID-19, induction therapy

© TÜBİTAK.Background/aim: This study aimed to investigate pregnancy frequency and evaluate the factors affecting live births in hemodialysis (HD) patients. Materials and methods: Female HD patients whose pregnancy was retrospectively reported between January 1, 2014, and December 31, 2019. The duration of HD, primary disease, and the information on whether the pregnancy resulted in abortion, stillbirth, or live birth, whether the HD duration was prolonged after diagnosing the pregnancy and whether it accompanied preeclampsia were recorded. Results: In this study, we reached 9038 HD female patients’ data in the study. A total of 235 pregnancies were detected in 145 patients. The mean age was 35.42 (35 ± 7.4) years. The mean age at first gestation was 30.8 ± 6.5 years. The average birth week was 32 (28 –36) weeks. A total of 53.8% (no = 78) of the patients had live birth, 51.7% (no = 70) had at least one abortion in the first 20 weeks, and 13.1% (no = 19) had at least one stillbirth after 20 weeks. The rate of patients’ increased numbers of dialysis sessions during pregnancy was 71.7%. The abortion rate was 22.4% in those with increased HD sessions, whereas 79.3% in those not increased HD sessions (p < 0.001). Live birth frequency was 67.2% in the increased HD sessions group and 3.4% in those who did not differ in HD sessions (p < 0.001). Conclusion: For the first time, we reported pregnancy outcomes in HD female patients, covering all regions of Turkey. It has been observed that; increasing the number of HD sessions in dialysis patients will decrease fetal and maternal complications and increase live birth rates.