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ÖzetWolfram sendromu, diyabetes mellitus, optik atrofi, diyabetes insipitus, işitme kaybı ile karakterize otozomal resesif geçiş gösteren genetik bir hastalıktır. Hastalarda nörolojik rahatsızlıklar, üriner sistem hastalıkları ve psikolojik rahatsızlıklarda izlenir. Vakaların büyük kısmında Wolframin proteinini kodlayanWolfram sendrom gen-1 deki mutasyonlar sorumludur. Şüpheli vakalarda genetik tanı ile erken tanı konularak, gerekli hormonal tedavinin başlanması ve yaşam kalitesinin artması mümkündür. Bu yazıda, tip 1 diyabetes mellitus tanısı ile takip edilirken bilateral hidronefroz ve poliüri nedeni ile tetkik edilen veWolfram sendromu tanısı alan 28 yaşında kadın vakayı sunduk., Wolfram syndrome is autosomal recessive dysmorphogenetical disease and it is characterized with the association of diabetes insipidus, diabetes mellitus, optic atrophy and deafness. Patients demonstrate neurological abnormalities, psychological disorders and urinary tract abnormalities. The mutations of theWolfram syndrome 1 gene, which encodes Wolframin are responsible for the majority of cases of Wolfram syndrome. With genetic analysis of patient with suspected features, the early diagnosis becomes an achievable reality. Early diagnosis and adequate hormonal supplementation can improve their quality oflife. We report here, a 28-year-old woman with a medical history of tip 1 diabetes mellitus and bilateral hydronephrosis and poliuria and diagnosed Wolfram syndrome.

The aim of the study is to develop a noble biomaterial that can accelerate the healing process without the risk of infection by loading tetracycline hydrochloride and collagen hemostatic agent into the chitosan tissue scaffold. After the trials, a good tissue scaffold was obtained from chitosan and PVA by electro spinning. To increase the hemostatic features of this biomaterial, 10% (by weight) collagen hemostatic agent was added to the PVA chitosan blend. After the amount of collagen hemostatic agent in the chitosan tissue scaffold was set, various amounts of tetracycline were added and 5 different biomaterials were developed to augment the antibacterial and wound healing properties. Antibiotic concentration in the biomaterial was IV 10% in the first, 15% in the second, 20% in the third, 25% in the fourth and 30% in the fifth sample. Finally, the effects of the obtained biomaterials on the nosocomial bacteria (gram positive: Staphylococcus Aureus, gram negative: Pseudomonas Aeruginosa) were analyzed with in-vitro tests at Kahramanmaras Sutcu Imam University, School of Medicine Department of Microbiology laboratories. As a result of the examination, it was examined how much the biomaterial should be and how effective it was against bacterial growth on the first, third and fifth days. It is thought that biomaterial will be very effective in emergencies and surgical procedures.

Background: Polyomavirus BK virus infection is a significant complication of renal transplantation and is an important cause of allograft loss. Today, despite the innovations in the pharmaceutical industry, a curative treatment against the BK virus has not been developed. The management is not standardized and is generally based on reported experience from transplantation centers. However, the literature on the subject with large samples is limited. Therefore, we designed a study to present our countrywide experience with BK virus nephropathy (BKVN) in renal transplant recipients. Methods: Our study was conducted with thirty kidney transplant centers from all provinces of Turkey. Only cases with BKVN proven by allograft biopsy were included in our study. Demographic characteristics and laboratory values of the patients were obtained from the archives and electronic databases of the centers. Results: A total of 13.857 patients from 30 transplantation centers were screened. 207 BKVN cases proven by allograft biopsy were identified and included in the study. The mean age was 46.4±13.1, and 146 (70.5%) patients were male. Twenty-six patients did not receive any induction therapy, 144 patients received anti-T lymphocyte globulin (ATLG), and 37 patients received basiliximab after transplantation. 23.6% of the patients had acute rejection history in the first six months of renal transplantation. all were treated with pulse steroids, and 46 were also treated with ATLG. The mean time to diagnosis of BKVN was 15.8±22.2 months after transplantation. At the time of diagnosis, the patients’ mean creatinine level was 1.8±0.7 mg/dl, and the mean estimated glomerular filtration rate was 45.8±19.6 ml/min. While BKVN was solely reported in 181 cases, there were cellular rejection findings in 21 biopsy specimens and humoral rejection in 4 biopsy specimens. In addition of dose reduction or discontinuation of immunosuppressive drugs, eighteen patients were treated with cidofovir, 11 patients with leflunomide, 17 patients with quinolones, 15 patients with intravenous immunoglobulin (IVIG), five patients with cidofovir+IVIG, and 12 patients with leflunomide+IVIG. None of the patients who received leflunomide and leflunomide+IVIG had allograft loss. Allograft loss was observed in 12 (15%) of 78 patients treated with antivirals or immunomodulators. Allograft loss occurred in 32 patients (15%) during follow-up out of 207 patients with BKVN. Five patients were retransplanted, and none developed BKVN during the follow-up. Conclusions: BKVN is still a significant cause of allograft loss in kidney transplantation, which has not been fully elucidated. Leflunomide appears to be an effective treatment in these patients.

Purpose: BK virus nephropathy (BKVN) is a latent infection and it is closely associated with immunsuppressive therapy. We aimed in this study to evaluate biopsy-proven BKVN and investigate frequency, risk factors and treatment management. Materials and Methods: In this study, 422 kidney transplant recipients were analysed retrospectively between April 2014 and April 2020 for biopsy-proven BK virus nephropathy. Group I included 16 kidney transplant patients with biopsy-proven BK nephropathy and group II included 36 kidney transplant patients with negative BK virus nephropathy. We aimed demographic, clinical features of kidney transplant recipients with BKVN (group I, n: 16 ) and non-BKVN (group II, n:36) were compared and the factors affecting of BKVN. Results: The mean age of grup I and group II were were 41±14.8 years and 39±15.2 respectively. The patients mean follow-up period of 43±11.2 months. Serum creatinine and proteinuria degree were significantly higher in the group with BKVN. In order to reduce the dose of immunosuppression in patients with BKVN, tacrolimus treatment was discontinued in 8 patients, and they were switched to everolimus + MMF + prednisone treatment, leflunamide + MMF + prednisone treatment in 4 patients, and sirolimus + MMF + prednisone treatment in 4 patients. The mean serum creatinine level of the patients who were followed up were observed as 1.78±0.98 mg/dl in group I.Conclusion: In our center, the prevalance of BKVN was found 3.92% during the study period. Reduction of dose immunosuppressive therapy is the most effective treatment. It is thought that there was no differences between Leflunamide and other approaches for treatment. Early diagnosis and screening (frequently intervals) seems to be most effective way for BKVN., Amaç: BK virüs nefropatisi (BKVN) böbrek nakli sonrasında immunsupresif tedavi dozu ile yakından ilişkili, latent enfeksiyonun reaktivasyonudur. Bu çalışmada kliniğimizde takipli hastalarda BKVN sıklığını ve olası risk faktörlerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Nisan 2014- Nisan 2020 tarihleri arasında kliniğimizden takipli olan 422 böbrek nakil hastası BK virus nefropati açısından geriye dönük oalrak analiz edildi. Gruo I’e biyopsi ile kanıtlanmış BK virus nefroatili 16 hasta, grup II’ye ise BK virus negatif olan 36 hasta dahil edildi. BKVN saptanan 16 hastanın (grup I) ve BKVN negatif olan 36 hastanın (grup II) demografik, klinik ve laboratuar özellikleri özellikleri ile BKVN ilişkili faktörler karşılaştırıldı. Bulgular: Grup I’deki hastaların yaş ortalaması 41±14.8 yıl, grup II’deki hastaların yaş ortalaması ise 39±15.2 yıl olarak saptandı. Hastaların böbrek nakli sonrasında ortalama takip süreleri 43±11.2 ay idi. BKVN olan grupta serum kreatinin ve proteinüri düzeyinin istatistiksel anlamlı olarak daha yüksek olduğu saptandı. BKVN saptanan hastalarda immunsupresyon dozunu azaltmak amacı ile 8 hastada kullanmakta oldukları takrolimus tedavisi kesilerek everolimus +MMF+ prednisone tedavisine, 4 hastada leflunamid+ MMF+ prednisone tedavisine, 4 hastada ise sirolimus +MMF+ prednisone tedavisine geçiş yapıldı. BKVN tanısı sonrasında hastaların ortalama 58.9±34.2 ay takip edildiği, 1 hastada NODAT geliştiği, 2 hastanın kardiyovasküler nedenlerle kaybedildiği, 2 hastanın ise greft kaybı nedeni ile hemodiyaliz tedavisine döndüğü gözlendi. Takibe devam eden hastaların ortalama serum kreatinin değerlerinin 1.78±0.98 mg/dl olarak gözlendi. Sonuç: Kliniğimizde çalışmanın yapıldığı dönemde BKVN sıklığı %4.86 olarak gözlendi. İmmunsupresif tedavi dozunun azaltılması hala en etkin tedavi yöntemidir. Leflunamid tedavisi ile diğer tedavi yaklaşımları arasında fark olmadığı saptandı. Sık aralıklarla tarama ve erken tanının BKVN takibinde daha etkili olduğu gözlenmiştir.

BACKGROUND AND AIMS Haemodialysis (HD) patients are at increased risk for adverse short-term consequences of COVID-19. In this study, we investigated the characteristics of chronic HD patients in the post-COVID-19 period and compared them with the control group. METHOD We conducted a national multicentre observational study involving adult chronic HD patients recovering from COVID-19. The control HD group was selected from patients with similar characteristics who did not have COVID-19 in the same center. SARS-CoV-2 RT-PCR negative patients and patients in the active period of COVID-19 were not included. RESULTS A total of 1223 patients (635 COVID-19 groups, 588 control groups) were included in the study from the data collected from 47 centres between 21 April 2021 and 11 June 2021. The patients' baseline demographics, comorbidities, medications, HD characteristics and basic laboratory tests were quite similar between the groups (Table 1). 28th-day mortality and between 28th day and 90th day mortality were higher in the COVID-19 group than in the control group [19 (3.0%) patients and 0 (0%) patients; 15 (2.4%) patients and 4 (0.7%) patients, respectively]. Presence of respiratory symptoms, rehospitalization, need for home oxygen therapy, lower respiratory tract infection and A-V fistula thrombosis were significantly higher in the COVID-19 group in the first 28 days of illness and between 28 and 90 days. Mortality was significantly associated with preexisting COVID-19, age, current smoking, use of tunneled HD catheter, persistence of respiratory symptoms, rehospitalization, need for home oxygen support, presence of lower respiratory tract infection within 28 days and persistence of respiratory symptoms. CONCLUSION In the post-COVID-19 period, mortality, rehospitalization, respiratory problems and vascular access problems are higher in maintenance HD patients who have had COVID-19 compared to control HD patients. Table 2. Comparative presentation of patients data on the 28th day and between 28 and 90 day COVID-19 groupN = 635 Control groupN = 588 28th-day results, n(%) Death* 19(3.0) 0(0) Any respiratory symptoms* 152(23.9) 11(1.9) Rehospitalization for any reason* 52(8.2) 24(4.1) Need for home oxygen support * 26(4.1) 2(0.3) Lower respiratory tract infection* 65(10.2) 8(1.4) AV fistula thrombosis* 13(2.0) 2(0.3) Other thromboembolic events * 15(2.4) 4(0.7) Need for HD catheter placement* 21(3.3) 9(1.5) 28th day-90. day resultsa n(%) N:616 N:588 Death* 15(2.4) 4(0.7) Any respiratory symptoms* 45(7.3) 10(1.7) Rehospitalization for any reason* 44(7.1) 18(3.1) Need for home oxygen support* 12(1.9) 2(0.3) AV fistula thrombosis* 9(1.5) 1(0.2) Other thromboembolic events* 9(1.5) 2(0.3) Need for HD catheter placement 13(2.1) 10(1.7) HD: haemodialysis, AV: arteriovenous. *P

Objective: Renal tubular acidosis (RTA) is a clinical manifestation that occurs with insufficiency in restoring bicarbonate or disruption in hydrogen ion elimination as a result of a disruption in tubulus functions, causing normal anion gap-opening metabolic acidosis. In the present study, we aimed to investigate the prevalence of RTA in the largest systemic lupus erythematosus (SLE) patient population to date. Materials and Methods: SLE patients, who were followed up in 2 different healthcare centers, were included. Patients with metabolic acidosis (pH 3 Results: A total of 108 patients were included in the present study. The mean age of the patients was 41.5 ± 1.2 and 87% were female. The SLE diagnosis duration was 75 ± 5 months. The mean creatinine value ​​was 0.6 ± 0.1 mg/dL and the mean eGFR was 111 ± 2 mL/min. According to the blood gas analysis, 18 patients (16.7% of the total) had RTA. Sixteen of these patients had type 1 RTA and 2 had type 2 RTA; type 4 RTA was not determined in any of the patients. Conclusion: RTA should be considered in SLE patients even if they have normal eGFR values. This is the largest study to examine the prevalence of RTA in SLE patients in the literature.

Introduction: Hemodialysis (HD) patients have increased risk for short-term adverse outcomes of COVID-19. However, complications and survival at the post-COVID-19 period have not been published extensively.Methods: We conducted a national, multicenter observational study that included adult maintenance HD patients recovered from confirmed COVID-19. A control HD group without COVID-19 was selected from patients in the same center. We investigated the characteristics and outcomes in the follow-up of HD patients and compare them with the non-COVID-19 group.Results: A total of 1223 patients (635 patients in COVID-19 group, 588 patients in non-COVID-19 group) from 47 centers were included in the study. The patients' baseline and HD characteristics were almost similar. The 28th-day mortality and mortality between 28th day and 90th day were higher in the COVID-19 group than non-COVID-19 group (19 [3.0%] patients vs. none [0%]; 15 [2.4%] patients vs. 4 [0.7%] patients, respectively). The presence of respiratory symptoms, rehospitalization, need for home oxygen therapy, lower respiratory tract infection, and arteriovenous (AV) fistula thrombosis was significantly higher in the COVID-19 group in both the first 28 days and between 28 and 90 days. In the multivariable analysis, age (odds ratio [OR] [95% CI]: 1.029 [1.004-1.056]), group (COVID-19 group vs. non-COVID-19 group) (OR [95% CI]: 7.258 [2.538-20.751]), and vascular access type (tunneled catheter/AV fistula) (OR [95% CI]: 2.512 [1.249-5.051]) were found as independent parameters related to 90-day mortality.Conclusion: In the post-COVID-19 period, maintenance HD patients who have had COVID-19 have increased rehospitalization, respiratory problems, vascular access problems, and high mortality compared with the non-COVID-19 HD patients.

Aims The aim of this study is to determine the impact of the COVID-19 pandemic on the management and disease control of the patients with diabetes mellitus in Kocaeli. Methods This study was carried out in six leading central hospitals in five major districts of Kocaeli. The study was conducted between June 2020 and November 2020. The patients who had previous admissions to these clinics within 6 months prior to the pandemic were enrolled in the study. Results A total of 283 patients were enrolled in the study, among them 151 (53%) patients were female, 268 (95%) had type 2 DM and remaining 5% had type 1 DM. The median weight of the patients was similar between the previous and last visits (84 kg vs 83 kg, p = 0,88). Laboratory parameters of previous and current visits revealed that mean fasting plasma glucose (FPG) and HbA1c levels were not significantly changed. The number of the patients who had controlled blood pressure was significantly decreased. The number of those who had neuropathic complains and the severity of dyslipidemia significantly increased during pandemic period. Conclusion Our study demonstrated that despite decreased compliance with diet and exercise, and difficulty in accessing medication, there was no significant change in weight, FPG and HbA1c levels in diabetic patients. Since cultural differences, education level and socioeconomic opportunities differ between societies, national and international studies will be more accurate to evaluate the effects of epidemics on the course of chronic diseases.

Our aim was to determine the relationship between the modality of renal replacement therapy and inflammation markers, BP control, and quality of life (QoL). Sixteen hemodialysis, 17 peritoneal dialysis patients, and 27 kidney transplant receivers (KTr) have been included in this study. Short Form-36 (SF-36) for the evaluation of QoL and ambulatory BP monitoring were performed on the same day. Erythrocyte sedimentation rate, CRP, IL-6, and IL-10 were measured. While the mean IL-10, IL-6, and CRP levels were the highest in the dialysis groups, there were no significantly differences any parameters for all groups. QoL was better in the KTr almost as in healthy controls but worse in the dialysis patients. It should be taken into account that hypertension may occur at night even if the daytime BP is normal in KTr.

To investigate the frequency and risk factors of ED in haemodialysis patients (HDps) and kidney transplantation (KTx) recipients (KTxRs). HDps and KTxRs between the ages of 18-65 were compared in terms of ED. IEFF-15 (International Index of Erectile Function) score was used to evaluation of ED. Fifty-seven male HDps and 52 male KTxRs with a mean age of 45.6 ± 10.4 years were included in our study. DM, CAD, hyperlipidaemia, smoking and beta blocker use were higher HDps (p = 0.037, p < 0.001, p = 0.001, p = 0.001 and p = 0.031 respectively). There was no ED in five (8.8%) HDps and 27(51.9%) KTxRx. Severity of ED was significantly higher in HDps (p < 0.001). In multiple logistic regression analysis, KTx was found the most relevant associated factor with ED. KTxRs had decreased risk for ED (OR = 0.09, 95% CI 0.02-0.30, p < 0.001). ED is significantly more common in HDps than KTxRs. Known risk factors for ED, HT, DM, CAD, HL, smoking, obesity and beta-blocker use were not related to ED in the HDps and KTxRs, and the KTx was positively effective for ED in patients undergoing renal replacement therapy.

BackgroundAcute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI.MethodsIn this multicenter retrospective observational study, we evaluated the characteristics and in-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 definition 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. Renal outcomes were identified only in discharged patients.ResultsThe median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney 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 were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different 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 lactate 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 hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.

INTRODUCTION This study aimed to determine whether predialysis blood gases is affected by altitude differences in hemodialysis patients with arteriovenous fistulas living in Turkey at three different altitudes. METHODS Patients' predialysis blood gases were compared by standardizing both arterial blood gases collections and working methods for patients undergoing hemodialysis using a dialysate with the same properties at altitudes of 30 m (sea level), 1020 m (moderate altitude), and 1951 m (high altitude). FINDINGS Blood gases disorders were detected in 32 (82.1%) high altitude group patients, whereas 49 (74.2%) sea level group patients had no blood gases disorders (P

Wilson disease (WD) is an autosomal recessive inherited disease caused by abnormalities of the copper-transporting protein encoding gene ATP7B. Wilson's disease can cause various types of renal involvement. We present the case of a 56-year-old male liver transplant receiver patient who had proteinuria and cellulitis. © 2018 Turkish Society of Nephrology. All rights reserved.

The systemic disorder of mineral and bone metabolism which is related to chronic kidney disease (CKD) is called mineral and bone disorder (MBD). Calcifications related to CKD-MBD may occur in ophthalmic tissue, arterial walls, subcutaneous and periarticular soft tissues and organs. The vascular calcifications are the most important causes of mortality and morbidity in CKD. Here, we present a case of systemic lupus erythematosus with early and disseminated calcifications of vascular and periarticular soft tissues related to CKD-MBD.

Background: Secondary hyperparathyroidism (SH) is major problem in chronic renal failure. There are studies to examine proliferation and apoptosis associated biomarkers expressions in parathyroid lesions to reveal specific features. In this study, we evaluated the expression of some growth factors and their receptors in parathyroid gland of patients with SH or primary hyperparathyroidism (PH). Materials and Methods: A total of 49 patients had been operated for PH and 26 for SH. Parathyroid tissue samples were evaluated histopathologically and immunohistochemically using antibodies to human p53, KI-67, anti-human p21, antitransforming growth factor (TGF) α, CPP32 (caspase 3), and epidermal growth factor receptor (EGFR). Results: Adenoma was higher in PH compared with SH as 48/49 and 3/26, respectively ( P = 0.000). Parathyroid hyperplasia was found in 23/26 patients with SH and 1/49 patient with PH. In parathyroid tissue there were no difference between PH and SH for p53, Ki-67, caspase, EGFR expressions; while there were significantly difference for TGFα ( P = 0.047) and borderline significant difference for p21 ( P = 0.06) expressions. Conclusion: Adenoma was priority present in PH patients, hyperplasia was present in SH. There were no differences between primary and SH or adenoma and hyperplasia for expressions of cycline-dependent kinase inhibitor p21, p53, EGFR, Ki67, caspase; while TGFα expression was found to be different.

PubMedID: 27109634 Objective: One of the most common encountered problems in free flap surgeries is anastomotic thrombosis. The mean platelet volume (MPV) may indicate the concentration of intra-platelet proactive substances and the thrombogenic potential of the platelets. MPV is used as a clinical monitoring index in routine blood counts, it has not yet been effectively used in free flap surgery. Methods: This study evaluates the relationship between the preoperative MPV value and anastomotic thrombus formation during the postoperative 48 hours in 32 free flap operations from September 2013 to September 2014. The mean patient age was 36.75 years. The preoperative MPV value, which was obtained from the complete blood count, was recorded and correlation of MPV and postoperative thrombus formation was investigated. Results: Four anastomotic thrombus were encountered in 34 free flaps during the postoperative 48 hours. Two of them were salvaged by performing thrombectomy and/or administration of i.v. heparin. There was no statistical relationship between MPV value and postoperative thrombus formation during 48 hours follow-up (p = 0.925). Conclusion: Even though this study didn’t find a correlation between preoperative MPV value and postoperative early anastomotic thrombus, it would be helpful to validate the results using multi-centre and comprehensive studies with larger patient cohorts. © 2016 Acta Chirurgica Scandinavica Society.

PubMedID: 29970732 Chronic kidney disease (CKD) patients have a high risk for cardiac arrhythmia. This study aimed to investigate the prevalence of cardiac arrhythmia in CKD patients and to evaluate the relationship between arrhythmia and biochemical and echocardiographic parameters. CKD patients between 18 and 80 years of age were enrolled from the nephrology outpatient clinic. Physical examination, complete blood count, urinalysis biochemical analysis, electrocardiogram, echocardiogram, and 24-h Holter electrocardiogram were performed. Patients with and without cardiac arrhythmia were compared regarding their characteristics, laboratory findings, and echocardiographic parameters. Risk factors for cardiac arrhythmia were also evaluated. The carotid intima-media thickness was measured using Doppler ultrasonography. In our study involving 59 patients, 44 (74%) had atrial arrhythmia (AA) and 40 (68%) had ventricular arrhythmia (VA). Atrial and/or VA were diagnosed in 46 patients (78%), of whom six (10.2%) had AA, two (3.4%) had VA and 38 (64.4%) had AA plus VA. Atrial fibrillation (AF) was present in two patients (3.4%) in the form of paroxysmal AF. Risk factors for AA were low calcium level and posterior wall thickness, while factors associated with VA were age, triglyceride level, leukocyte count, and nonusage of angiotensin 2 receptor blockers. Risk factors for AA and/or VA included increased platelet count, age, and leukocyte count. AA and/or VA were found in as high as 78% of CKD patients. Further studies evaluating course of the disease from early stages are needed to identify risk factors.

Metformin is a biguanide group oral antidiabetic drug used for the treatment of type 2 diabetes mellitus. Nausea, vomiting, diarrhea, abdominal pain, and anorexia are the most common adverse effects encountered during treatment. Lactic acidosis is a serious side effect seen with metformin use, and while the incidence of lactic acidosis is similar to other oral antidiabetics, metformin is not recommended to patients with certain risk factors, such as cardiovascular, pulmonary, and renal and liver failure. We describe a chronic hemodialysis patient treated with metformin, presenting to the nephrology department with altered mental status.

Endometrial cancer (EC) is the most common malignancy of the female genital tract. Lymph node involvement is one of the major prognostic factors. Therefore, pelvic and paraaortic lymph nodes dissection is a part of the surgical management of these patients. Isolated peripheral lymph node metastasis has not been previously reported as a finding of recurrence in EC. We report a 67-year-old woman with recurrent EC presented with an isolated cervical lymph node metastasis (ICLM). Following the combination chemotherapy of doxorubicin, cisplatin and cyclophosphamide, her cervical lymph node was completely regressed. To our knowledge, this is the first case of recurrent EC presented with ICLM. We suggest that for women with EC who had isolated peripheral lymphadenopathies, peripheral lymph node metastasis should be considered as the finding of recurrence in patient with EC.

PubMedID: 25758891 [No abstract available]

PubMedID: 26354572 Secondary hyperparathyroidism (SHPT) is a common problem in patients with end-stage renal disease. In cases with severe and resistant SHPT, surgical parathyroidectomy (PTX) is recommended. Hungry bone syndrome (HBS) following surgical PTX is most often associated with hypocalcemia and hypophosphatemia. The mechanisms for the HBS are not clear, and a method for its prevention has not been established. We present three hemodialysis patients with persistant hypophosphatemia after PTX. In our parathyroidectomized patients, hypocalcemia could be corrected with calcium and vitamin D treatment, but hypophosphatemia continued for eight months in one patient and in two other patients until the last visit (10 and 2 months, respectively). Predisposing factors such as old age, diabetes mellitus and parathyroid adenoma were not found in our patients. All three patients were younger (

Kolesterol embolizasyon sendromu (KES), aorta ve major dallarının aterosklerotik plaklarından kaynaklanan kolesterol kristallerinin küçük arteriolleri tıkaması ile meydana gelen sistemik bir bozukluk olup, lokal iskemi ve organ hasarı ile sonuçlanır. Tanı çoğu zaman özellikle diyaliz hastalarında atlanmakta olup kesin bir tedavisi yoktur ve mortalitesi oldukça yüksektir. Burada koroner anjiyografi sonrası ayak parmaklarında morarma ve nekrotik ülsere yaraları gelişen ve cilt biyopsisi ile tanısı doğrulanan kolesterol embolizasyon sendromu olan hemodiyaliz hastası literatür bilgileri ile tartışılmıştır. Cholesterol Embolization Syndrome (CES) is a systemic disorder due to cholesterol crystal embolization from atherosclerotic plaques of the aorta and its major branches to the small arterioles, resulting in local ischemia and organ damage. The diagnosis is mostly missed, especially in dialysis patients. There is no definite treatment available and the mortality is relatively high. We present a hemodialysis patient with cholesterol embolization syndrome who developed discoloration of the toes and necrotic ulcers after coronary angiography and whose diagnosis was confirmed with skin biopsy, and discuss the case with literature information.

Metformin is a biguanide group oral antidiabetic drug used for the treatment of type 2 diabetes mellitus. Nausea, vomiting, diarrhea, abdominal pain, and anorexia are the most common adverse effects encountered during treatment. Lactic acidosis is a serious side effect seen with metformin use, and while the incidence of lactic acidosis is similar to other oral antidiabetics, metformin is not recommended to patients with certain risk factors, such as cardiovascular, pulmonary, and renal and liver failure. We describe a chronic hemodialysis patient treated with metformin, presenting to the nephrology department with altered mental status.

The milk-alkali syndrome (MAS) was a common cause of hypercalcemia, metabolic alkalosis, and renal failure in the early 20 th century. This syndrome was first recognized secondary to treatment of peptic ulcer disease with milk and absorbable alkali. Its incidence fell after the introduction of H2-blocker and proton pump inhibitor. Persistent ingestion of calcium carbonate and vitamin D caused MAS. We report a patient presenting with a triad of hypercalcemia, metabolic alkalosis and renal failure secondary to treatment of idiopathic hypoparathyroidism.

Familial Mediterranean Fever (FMF) causing AA amyloidosis and chronic renal failure is also called recurrent polyserositis. Diagnosis of FMF is established by clinical signs and sometimes by genetic analysis for MEFV mutations. We present four cases of kidney transplantation recipients (KTrs). Interestingly, FMF was diagnosed following episodes of acute renal failure, abdominal pain, and/or fever in these KTrs. When colchicine was added to their standard therapy, these events did not develop. Therefore, in cases with unknown etiologies of fever, abdominal pain, and even acute renal failure in KTrs, FMF should also be considered, particularly in certain geographic areas and ethnic groups.