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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

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.

Introduction: Orthostatic hypotension (OH) affects 5–20% of the population. Our study investigates the presence of OH in diabetic nephropathy (DNP) patients and the factors affecting OH in comparison with nondiabetic chronic kidney disease (NDCKD) patients. Method: Patients presented to the nephrology clinic, and those who consented were included in the study. DNP was defined by kidney biopsy and/or clinical criteria. NDCKD patients of the same sex, age, and eGFR were matched to DNP patients. Demographic parameters and medications were obtained from the records. OH was determined by Mayo clinic criteria. The same researcher used an electronic device to measure blood pressure (BP). All samples were taken and analyzed the same day for biochemical and hematologic parameters and albuminuria. Results: 112 (51 F, 61 M, mean age: 62.56 ± 9.35 years) DNP and 94 (40 F, 54 M, mean age: 62.23 ± 10.08 years) NDCKD patients were included. There was no significant difference between DNP and NDCKD groups in terms of OH prevalence (70.5 vs. 61.7%, p = 0.181). Male patients had significantly higher OH prevalence than female patients (74.7 vs. 60.0%, p = 0.026). There was no significant difference in change in systolic BP between the groups (24.00 [10.00–32.00] mm Hg vs. 24.00 [13.75–30.25] mm Hg, p = 0.797), but the change in diastolic BP was significantly higher in the DNP group (8.00 [2.00–13.00] mm Hg vs. 6.00 [2.00–9.00] mm Hg, p = 0.025). In the DNP group, patients with OH had significantly higher uric acid levels than those without OH (7.18 ± 1.55 vs. 6.36 ± 1.65 mg/dL, p = 0.017). And, 73.7% of patients on calcium channel blockers developed OH (p = 0.015), and OH developed in 80.6% of 36 patients on alpha-blockers (p = 0.049). Conclusion: OH prevalence is very high in CKD, and etiology of CKD does not have a statistically significant effect on the frequency of OH, despite a difference that could be meaningful clinically. Therefore, patients with CKD are checked for OH, with or without concurrent diabetes mellitus. Evaluation of postural BP changes should be a part of nephrology practice.

BACKGROUND AND AIMS The risk of urinary tract stone formation in patients with autosomal dominant polycystic kidney disease (ADPKD) is 20%, twice as high as in the normal population. The most important reason for this increased tendency to stone disease is thought to be anatomic changes in the kidney. To investigate metabolic factors that predispose to urinary system stone formation in individuals with ADPKD. METHOD A total of 180 volunteers who applied to our outpatient clinic between December 2019 and May 2021 were included in the study. Four groups were formed: patients with ADPKD and urinary system stones (ADPKD + STONE) (n = 42), patients with ADPKD but no stones (ADPKD + STONE FREE) (n = 43), stone patients without ADPKD (STONE) (n = 47) and healthy controls (HEALTHY) (n = 48) groups. Spot urine pH, 24-h urine volume, calcium, uric acid, oxalate, citrate, sodium and magnesium parameters were measured. STONE group data were obtained retrospectively. Along with these parameters, serum electrolyte, parathormone (PTH), ferritin, albumin, creatinine, urea and uric acid values were also compared. A P value of RESULTS There was no statistically significant difference between the four groups in terms of age and gender (P > .05). The citrate value in 24-h urine was significantly lower in the ADPKD + STONE and ADPKD + STONE-FREE groups than the STONE and HEALTHY groups (P .05). In the ADPKD + STONE and ADPKD + STONE-FREE groups, the 24-h urinary calcium value was significantly lower than the STONE and HEALTHY groups (P .05). The uric acid level in 24-h urine was significantly lower in the ADPKD + STONE and ADPKD + STONE-FREE groups than in the HEALTHY group (P .05). The uric acid value in 24-h urine did not differ significantly between the STONE and HEALTHY groups (P > .05). Oxalate, sodium and magnesium values in 24-h urine and 24-h urine volume did not differ significantly between the groups (P > .05). Urine pH value was significantly lower in the ADPKD + STONE, ADPKD + STONE-FREE and STONE groups than in the HEALTHY group (P .05). Serum PTH values were significantly higher in the ADPKD + STONE and ADPKD + STONE-FREE groups than in the HEALTHY group (P .05). PTH values did not differ significantly between ODPBH + STONE, ADPKD + STONE-FREE and STONE groups (P > .05). There was no significant difference between the groups in terms of serum ferritin, sodium, potassium, calcium, phosphorus, magnesium and uric acid values (P > .05). CONCLUSION In our study, 24-h urine citrate level was found to be significantly lower in both ADPKD + STONE and ADPKD + STONE-FREE patients compared to the volunteers in the STONE and HEALTHY groups (P

BACKGROUND AND AIMS There is not enough data on the post-COVID-19 (coronavirus disease 2019) period for peritoneal dialysis (PD) patients affected from COVID-19. We aimed to compare the clinical and laboratory data retrospectively obtained in the follow-up of PD patients after COVID-19 with a control PD group. METHOD This study, supported by the Turkish Society of Nephrology, is a national multicenter retrospectively case–control study involving adult PD patients with confirmed COVID-19, using data collected from 21 April 2021 to 11 June 2021. A control PD group was also formed from each PD unit, from patients with similar characteristics but who did not have COVID-19. Patients in the active period of COVID-19 were not included. Data at the end of the first month and within the first 90 days, as well as other outcomes, including mortality, were investigated. RESULTS A total of 223 patients (COVID-19 group: 113, control group: 110) from 28 centers were included. The duration of PD in both groups was similar [median (IQR):3.0 (1.88–6.0) years and 3.0 (2.0–5.6)], but the patient age of the COVID-19 group was lower than the control group [50 (IQR:40–57) years and 56 (IQR:46–64) years, P CONCLUSION Mortality in the first 90 days after COVID-19 in PD patients with COVID-19 is not different from the control PD group. However, some of these patients continue to experience significant problems, especially respiratory system symptoms, malnutrition, and hypervolemia.

Objective: There is a relationship between inflammation and cardiovascular disease (CVD) in patients with chronic kidney disease. Visfatin is an adipocytokine, which has been shown to be associated with inflammation, endothelial dysfunction, and CVD. Our study aimed to examine the relationship of visfatin with metabolic and echocardiographic parameters in patients on peritoneal dialysis (PD).

Aim:There is no enough data on pulmonary involvement in autosomal dominant polycystic kidney disease (ADPKD). The aim of this study is to examine pulmonary function test in patients with ADPKD with varying stages of renal function and to compare them with those in healthy controls.Methods:Forty-six patients with ADPKD and 43 healthy control subjects were included in the study. Pulmonary function test was performed for each patient after routine physical examination and biochemical analysis.Results:Age, gender, weight, height and smoking rate were similar in both groups. Seven patients (15.2%) had restrictive pattern and one (2.1%) had obstructive pattern in ADPKD group while one patient (2.3%) had obstructive pattern and two (4.6%) had restrictive pattern in the control group. The frequency of restrictive pattern was not significantly higher (p=0.15), but forced vital capacity volume was significantly lower in the patient group (p=0.04).Conclusion:Restrictive spirometric pattern was more prevalent in the patient group, but there was no statistically significant difference. It is thought that the difference may be statistically significant when the study is performed with kidney volume analysis and larger patient population.

While COVID-19 pandemic continues to affect our country and most countries in the world, we have to make some changes both in our social life and our approach to healthcare. We have to struggle with the pandemic on one hand and also try to follow up and treat our patients with chronic diseases in the most appropriate way. In this period, one of our group of patients who are challenging us for follow-up and treatment are those who should start or continue to use immunosuppressive therapy. In order to contribute to the accumulation of knowledge in this area, we wanted to report a patient who was followed up with the diagnosis of COVID-19 and had been administered rituximab very recently due to a nephrotic syndrome caused by membranous nephropathy.

Aim:The aim of this study was to determine the relationship between left ventricular hypertrophy (LVH) and inflammatory markers in patients with type 2 Diabetes Mellitus (T2DM) with diabetic nephropathy at different stages.Methods:Our study was a cross-sectional study involving patients with various stage of T2DM. Patients with LVH were identified by 2D echocardiography. Plasma human tumor necrosis factor alpha (TNF-α), interleukin (IL)-1, IL-6, vaspin, vispatin and midkine were measured.Results:A total of 59 T2DM patients (56% women) with a mean age of 56.1±8.8 years were included in the study. The mean left ventricular mass index was 129±30. LVH was detected in 62.7% of the patients. Patients with an estimated glomerular filtration rate (eGFR) of

Objective: Some studies have shown that keto amino acids (KA) reduce proteinuria and improve renal function as well as nutritional status in patients with diabetic nephropathy. We aimed to compare the pathologic findings of kidneys of rats that were given protein-restricted diets enriched with KA with those of rats given protein-restricted diet alone.

© 2020, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.To investigate the visfatin levels at the stages of diabetic nephropathy(DNP), changes in visfatin levels according to stages of DNP, and the association of visfatin levels with other anti-inflammatory parameters including high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumor necrosis factor alpha(TNFα). Patients were divided into 4 groups based on the glomerular filtration rate (GFR) and albuminuria as follows; Group I: Albuminuria60ml/min, Group II:albuminuria 30 to 300 mg per day and GFR>60ml/min, Group III:albuminuria>300mg per day and GFR>60ml/min, and Group IV: Albuminuria>300 mg per day and GFR

Introduction: There are not enough data on the post-CO-VID-19 period for peritoneal dialysis (PD) patients affected from COVID-19. We aimed to compare the clinical and laboratory data of PD patients after COVID-19 with a control PD group. Methods: This study, supported by the Turkish Society of Nephrology, is a national, multicenter retrospective case-control study involving adult PD patients with confirmed COVID-19, using data collected from April 21, 2021, to June 11, 2021. A control PD group was also formed from each PD unit, from patients with similar characteristics but without COVID-19. Patients in the active period of COVID-19 were not included. Data at the end of the first month and within the first 90 days, as well as other outcomes, including mortality, were investigated. Results: A total of 223 patients (COVID-19 group: 113, control group: 110) from 27 centers were included. The duration of PD in both groups was similar (median [IQR]: 3.0 [1.88-6.0] years and 3.0 [2.0-5.6]), but the patient age in the COVID-19 group was lower than that in the control group (50 [IQR: 40-57] years and 56 [IQR: 46-64] years, p < 0.001). PD characteristics and baseline laboratory data were similar in both groups, except serum albumin and hemoglobin levels on day 28, which were significantly lower in the COVID-19 group. In the COVID-19 group, respiratory symptoms, rehospitalization, lower respiratory tract infection, change in PD modality, UF failure, and hypervolemia were significantly higher on the 28th day. There was no significant difference in laboratory parameters at day 90. Only 1 (0.9%) patient in the COVID-19 group died within 90 days. There was no death in the control group. Respiratory symptoms, malnutrition, and hypervolemia were significantly higher at day 90 in the COVID-19 group. Conclusion: Mortality in the first 90 days after COVID-19 in PD patients with COVID-19 was not different from the control PD group. However, some patients continued to experience significant problems, especially respiratory system symptoms, malnutrition, and hypervolemia. © 2022 S. Karger AG, Basel. Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.

Introduction Increased oxidative stress and blunted anti-oxidant mechanisms are important problems in hemodialysis (HD) patients. Reactive oxygen species (ROS) act directly on proteins, leading to the formation of oxidized amino acids. Advanced oxidation protein products (AOPP) are among these substances. Many oxidant substances increase the level of AOPP. Iron is an element with strong oxidant capacity, especially when used intravenously. It is thought that iron treatment further increases the oxidative stress in HD patients. We aimed to investigate the relationship between AOPP and inflammatory status in HD patients. Materials and Methods Patients who were on maintenance HD program without additional co-morbidities and no history of use of intravenous iron within the last two weeks were recruited in the study. The blood samples taken just before the dialysis session were analyzed for AOPP, serum iron, total iron binding capacity (TIBC), ferritin, C-reactive protein (CRP), ß2-microglobulin, fibrinogen, interleukin (IL)-1, IL-6 and tumor necrosis factor-α levels besides routine biochemical measurements and complete blood count. Results The number of patients included in the study was 102 (n: 53 female, %52.0) and the mean age was 47.6±13.9 years. The mean transferrin saturation was 25.4%. AOPP levels, iron use in patients was higher compared to patients who do not use (respectively 2.58±0.19 mmol/l and 2.50 ±0.16mmol/l, p = 0.046). We did not detect statistically significant correlation of AOPP levels with iron parameters and other inflammatory markers. Conclusion The present study showed that intravenous iron therapy does not increase oxidative stress. Although serum AOPP level was higher in patients on intravenous iron treatment, it was not correlated with iron indices and inflammatory markers. So, intravenous iron may exert its oxidant effect free from serum iron indices.

Nonvalvular atrial fibrillation is the most prevalent sustained arrhythmia in chronic kidney disease patients. When compared to warfarin, new oral anticoagulants are found to be non-inferior or superior in safety and efficacy outcomes in the general population. The efficacy and safety of anticoagulation in mild chronic kidney disease is similar to the general population. Studies are yielding conflicting results in moderate to advanced chronic kidney disease and end stage renal disease. Due to hemostasis dysfunction in chronic kidney disease, both bleeding and thromboembolism risk increase. Advanced chronic kidney disease and end stage renal disease patients are excluded from randomized controlled trials. Our knowledge about the efficacy, safety and dose adjustments of warfarin and new oral anticoagulants are based on observational data. According to the recent studies, apixaban and edoxaban use in moderate chronic kidney disease with a glomerular filtration rate between 30-50 mL/min may be safer than warfarin. There are no high quality evidence to recommend the use of warfarin in advanced and end stage chronic kidney disease patients. The Food and Drug Administration approved the use of apixaban in end stage renal disease. Randomized controlled trials are needed to evaluate the use of oral anticoagulants in advanced chronic kidney disease.

Background/Aims: Autosomal dominant polycystic kidney disease (ADPKD) is a tubulointerstitial disease. Different degrees of glomerular affection in ADPKD may affect the further course of disease in which it may hypothetically be secondary to the result of glomerular involvement causing podocyte injury. Our aim was to compare urinary excretion of podocin and podocalyxin, which are biomarkers of podocyte injury, and to assess their relationship with proteinuria and renal function in ADPKD. Methods: Fifty-six patients with ADPKD and 28 volunteers were enrolled to study. Podocin, podocalyxin protein levels, and proteinuria were measured in urine. Patients were categorized based on their estimated glomerular filtration rate (eGFR). Results: Patients with ADPKD had higher podocin and podocalyxin levels compared to the control group. The levels of podocin and podocalyxin were higher in ADPKD patients both with eGFR ≥60 mL/min/1.73 m2 and with eGFR 2 than in controls. The levels of podocin and podocalyxin were higher in ADPKD patients with eGFR 2 than in ADPKD patients with eGFR ≥60 mL/min/1.73 m2. Podocin and podocalyxin were negatively correlated with eGFR and positively correlated with urine protein to creatinine ratio in ADPKD patients. Conclusion: Urine biomarkers of podocytes injury were significantly higher in ADPKD patients even in the early stage of the disease than in the control group. It should be clarified whether these biomarkers can provide new prognostic parameters for disease surveillance.

Background/Aims: Refugee dialysis is a worldwide growing dilemma with limited experience. This report presents the largest hemodialysis (HD) patient registry data of Syrian refugees in Turkey. Methods: Demographic, clinical, laboratory, and dialysis practice data of 345 Syrian HD patients during one year were collected and analyzed. Results: There were 345 prevalent Syrian HD patients at the end of 2016. Majority of the patients were placed in the Southeast Anatolian Region. The majority of the patients (74.8%) are in the age range of 20-64 years. Dialysis vintage in Turkey is less than 12 months in 20.8% and less than one month in 29.3% of patients. The vascular access was arteriovenous fistula in the majority of patients (72.5%). Kt/V is over 1.7 in 57%, serum albumin is above 35 g/L in 65.8% and hemoglobin level is more than 100 g/L in %65.2 of the patients. The ratio of patients with serum phosphorus level of 1.13-1.77 mmol/L was 56.2%. Twenty Syrian HD patients (14 male, 6 female) died within the year 2016 and annual mortality rate was 5.7%. Conclusion: This study with the largest number of Syrian refugees undergoing maintenance hemodialysis showed good dialysis practices, acceptable values for dialysis adequacy and biochemical parameters along with lower mortality compared to native HD population of Turkey. Longer follow up will enrich the knowledge related to care of refugee population in all over the world.

Objective: We aimed to study whether long-term kidney function would be affected by different chemotherapy regimens in patients with malignancy.

Introduction In this study, we aimed to determine the endothelial dysfunction (ED) and atherosclerosis in patients with autosomal dominant polycystic kidney disease (ADPKD). Materials and methods This study was conducted with 83 subjects (26 male, mean age: 46±11 years) consisted of three groups including ADPKD, hypertension (HT) and healthy control groups. The groups were evaluated in terms of serum endocan and asymmetric dimethylarginine (ADMA) levels, flow-mediated dilatation (FMD), nitroglycerin-mediated dilation (NMD) and carotid intima-media thickness (CIMT). Results Serum endocan and ADMA levels and CIMT were significantly higher while NMD was significantly lower in ADPKD group than control group. FMD and NMD were lower but serum ADMA level was higher in the ADPKD group than HT group; while serum endocan level and CIMT were not significantly different in ADPKD and HT groups. In ADPKD patients, CIMT value and serum endocan and ADMA levels were higher while NMD was lower in patients with eGFR≤60 mL/min/1.73 m2 than patients with eGFR>60 mL/min/1.73 m2. Serum ADMA level was higher and NMD was lower in hypertensive ADPKD patients than non-hypertensive ones. Serum endocan level was higher in ADPKD patients with nephrolithiasis and a negative correlation was detected between serum endocan level and 24-hour urine volume. Conclusions Endothelial dysfunction and atherosclerosis are common conditions in ADPKD patients and it was further reinforced in our study. In order to clarify the relationship between serum endocan level and 24-hour urine volume, which is a remarkable finding in our study, larger studies that including the measurement of urine endocan may be useful.

Background and Aims Anemia is one of the most important complications in chronic renal disease and inadequate erythropoietin production is the most important reason for anemia. Fibrosis of renal interstitium may be associated with inadequate synthesis of erythropoietin and anemia. In our study, we investigated the relationship between the severity of interstitial fibrosis (IF) in patients with primary glomerulonephritis (PGN) and anemia parameters. Method A total of 2794 patients who were recorded to the database of the Turkish Society of Nephrology, Glomerular Diseases (TSN-GOLD) Working Group between May 2009 and June 2019 were included in our national multicenter (44 centers) study. Patients aged 16 years or more with documented biopsy were included in the study. Patients were divided into four groups according to IF severity. IF was not detected in the interstitial area, was defined as none, if fibrosis was present in less than 25% of the area, defined as mild, if fibrosis was present in 25-50%, defined as moderate and if more than 50%, defined as severe. Anemia was defined as hemoglobin Results In the study, 57% of the patients were male and their mean age was 41.0 ± 14.3 years. The mean eGFR was 82.7 ± 36.9 ml / min / 1.73 m2 and the hemoglobin level was 13.1 ± 1.9 g/dl. General characteristics of patients with and without anemia are given in Table 1. While 41.1% of patients had no IF, 41.2% had mild, 14.1% had moderate and 3.5% had severe IF. When the patients were divided into four groups according to the severity of IF, the mean hemoglobin and hematocrit levels were significantly different between the groups (Figure 1). Anemia was present in 960 patients (34.4%) (Figure 2). Anemia rate was significantly higher in the patients with IF than patients without IF (36.8% vs 30.9%, p = 0.001). Anemia rate was %25.1 in patients with eGFH≥60 ml/min/1.73m2 and 56% in patients with eGFR Conclusion Approximately one-third of PGN patients had anemia at the time of biopsy and the frequency of anemia increases in patients with IF. The presence of IF is an independent risk factor associated with the development of anemia in PGN. The elucidation of the etiopathogenesis of anemia in PGN patients may play an important role in the follow-up and treatment of patients. Studies on IF can play a critical role.

Background and Aims According to the data of the Turkish Society of Nephrology-Glomerular Diseases Working Group (TSN-GOLD Working Group), IgA nephropathy is the most common primary glomerular disease in Turkey. The purpose of this study was to investigate the epidemiological and clinical data of IgA nephropathy patients in Turkey. Method 4399 patients with primary glomerular diseases from 47 centers who were followed up between May 2009 and May 2019 were included in the study conducted by TSN-GOLD Working Group. 524 patients were excluded due to lack of pathological data. Among the remaining patients, demographic, clinical and laboratory data of 994 patients with IgA nephropathy were analyzed. Results The median age of the patients was 37 (28-47) years, and 37.3% of them were female. The laboratory and clinical data at the time of diagnosis is presented in Figure-1, and biopsy indications are described in Figure-2. The median number of glomeruli was 16 (IQR: 3.5-4.3), sclerotic glomeruli was 2 (IQR: 1-5), and segmental sclerotic glomeruli was 1 (IQR: 1-2). Exudative changes, subendothelial and subepithelial deposition were present in 566 patients (56.9%), 46 patients (4.6%) and in 38 patients (3.8%), respectively. 662 (66.1%) and 611 of the patients (61.4%) had tubular atrophy and interstitial fibrosis in varying degrees, respectively. 672 (%67.6) and 416 patients (%41.9) had interstitial inflammation and vascular changes, respectively. In immunofluorescence staining, 18%, 30.1%, 4.4%, 68% of the patients had IgG, IgM, C1q and C3 positivity, respectively. Crescentic glomeruli were detected in 227 patients (3.3 ± 3.1 glomeruli). Patients with crescentic glomeruli had significantly higher proteinuria and lower eGFR than the patients without [2203 mg/day (15-26078) vs 1807 mg/day (15-29112); p=0.001; 55.3 ml/min/1.73 m2 (3.72-141.9) vs 72 ml/min/1.73 m2 (3.84-150.81); p Conclusion In this study we found that, the most common presentation of IgA nephropathy patients in our country was asymptomatic urinary abnormalities followed by nephritic and nephrotic syndrome. Higher proteinuria and lower eGFR values in patients with crescentic glomeruli, support the adoption of crescentic lesions in the new Oxford classification (MEST-C) to predict more precise outcome of IgA nephropathy patients. The high number of patients to whom the Oxford classification was applied provided us with the opportunity to examine the clinical reflections of pathological features. Evaluation of the follow-up data of the patients will give us the possibility to reveal the effect of initial clinical and pathological features on clinical findings and renal outcome.

PubMed ID: 30251011 Purpose: Renal infarction is a clinical condition which is caused by renal artery occlusion and leads to permanent renal parenchymal damage. In the literature, there are generally case reports on this subject, and few studies that include a large group of patients. Therefore, we aimed to present the data of a large group of patients who were diagnosed with acute renal infarction in our country in this retrospective study. Methods: The data of patients who were diagnosed with acute renal infarction according to clinical and radiological findings in Turkey in the last 3 years were examined. For this purpose, we contacted with more than 40 centers in 7 regions and obtained support from clinically responsible persons. Demographic data of patients, laboratory data at the time of diagnosis, tests performed for etiologic evaluation, given medications, and patients’ clinical status during follow-up were obtained from databases and statistical analysis was performed. Results: One-hundred and twenty-one patients were included in the study. The mean age was 53 ± 1.4 (19–91) years. Seventy-one (58.7%) patients were male, 18 (14.9%) had diabetes, 53 (43.8%) had hypertension, 36 (30%) had atrial fibrillation (AF), and 6 had a history of lupus + antiphospholipid syndrome (APS). Forty-five patients had right renal infarction, 50 patients had left renal infarction, and 26 (21.5%) patients had bilateral renal infarction. The examinations for the ethiologies revealed that, 36 patients had thromboemboli due to atrial fibrillation, 10 patients had genetic anomalies leading to thrombosis, 9 patients had trauma, 6 patients had lupus + APS, 2 patients had hematologic diseases, and 1 patient had a substance abuse problem. Fifty-seven (57%) patients had unknown. The mean follow-up period was 14 ± 2 months. The mean creatinine and glomerular filtration rate (GFR) values at 3 months were found to be 1.65 ± 0.16 mg/dl and 62 ± 3 ml/min, respectively. The final mean creatinine and GFR values were found to be 1.69 ± 0.16 mg/dl and 62 ± 3 ml/min, respectively. Conclusions: Our study is the second largest series published on renal infarction in the literature. More detailed studies are needed to determine the etiological causes of acute renal infarction occurring in patients. © 2018, Springer Nature B.V.

Aim The association of increased resistin levels in chronic kidney disease with diabetic nephropathy has not yet been clarified. Our aim was to analyze the relationship between serum resistin levels and various diabetic microvascular complications in patients. Methods A total of 83 patients were enrolled in this cross-sectional study. The subjects were divided into 3 groups: 27 patients with type 2 diabetes mellitus (T2DM) having no diabetic retinopathy (DRP) or microalbuminuria and having normal renal function were included in Group-1, 28 patients with T2DM having DRP and normal renal function in Group-2, and 28 patients with T2DM with DRP and microalbuminuria and an estimated glomerular filtration rate (eGFR) of Results The mean age of the patients [46 female (55.4%)] was 54.8±9.1 years. The resistin level in Group-3 was significantly higher than in Group-1 and Group-2 (p Conclusion The main determinants of resistin level in patients with T2DM are the level of renal function and inflammation rather than presence of microvascular complications, obesity and insulin resistance.

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.

Aim: Asymmetric dimethylarginine (ADMA) is associated with increased coronary artery disease risk through endothelial dysfunction in dialysis patients. We aimed to investigate the role of flow-mediated dilatation (FMD), a non-invasive indicator of endothelial function, and ADMA in mortality in peritoneal dialysis (PD) patients. Methods: PD patients aged 18-80 years; with dialysis duration of at least three months were included. FMD measurement and ADMA levels were recorded. Outcome of the patients on the third year were analyzed with binary logistic analyses. Results: The mean age of the 55 patients was 53±15 years and the mean follow-up duration was 36 months. Mean FMD and ADMA levels were 10.6±6.4% and 81.8±48.0 mol/L, respectively. Eighteen patients died during follow-up. Age, presence of diabetes mellitus and ischemic heart disease, ultrafiltration amount and serum albumin level were related with mortality while gender, weekly Kt/V and ADMA levels were not. There was no significant relationship between ADMA level and FMD (p=0.873). FMD was negatively correlated with systolic and diastolic blood pressures (p=0.001, p

Acute kidney injury (AKI) and chronic kidney disease (CKD) have many common points regarding risk factors, etiology, clinical and laboratory factors. We aimed in this review to discuss the outcome, the risk of CKD, cardiovascular and overall mortality risk after AKI, and the mechanisms underlying the relationship between AKI and CKD.

BACKGROUND In this study, we aimed to examine the impact of fasting during the month of Ramadan on autosomal dominant polycystic kidney disease (-ADPKD) patients with normal to near-normal glomerular filtration rate (GFR). MATERIALS AND METHODS This was a prospective observational study of patients with ADPKD, the majority of whom had normal or near-normal GFR. Patients were divided into two groups: the fasting group (FG) and the nonfasting group (NFG). Assessments in the NFG were performed 1 week before and 1 month after Ramadan, while FG patients were assessed on the last day of fasting in addition to the abovementioned visits. The following parameters were checked at each visit: blood pressure (BP), weight, sodium, potassium, blood urea nitrogen (BUN), creatinine, calcium, phosphorus, glucose, lipid profile, bicarbonate, urine density, 24-hour urine volume, 24-hour urine protein, GFR, neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule-1 (KIM-1). Kidney function tests were carried out on the 7th day of fasting in the FG for the identification of early kidney damage. RESULTS Of the overall group of 54 patients, 23 were in FG (19 female) and 31 were in NFG (18 female). There were no significant differences between the two groups in terms of age, gender, ADPKD duration, and presence of hypertension. The mean estimated glomerular filtration rate (eGFR) values of FG and NFG were 86.4 ± 18.5 and 66.1 ± 36.5 mL/min/1.73m2, respectively. During the follow-up period, no significant changes occurred in BP, weight, creatinine, 24-hour urine volume, NGAL, KIM-1, or GFR in either group (p > 0.05), while 24-hour urinary protein was significantly decreased in FG (p

WOS: 000456923400005 Objective: Asymmetric dimethylarginine (ADMA) is known as a non-traditional risk factor for cardiovascular disease. Considering the increased prevalence of hypervolemia and heart failure in patients with peritoneal dialysis (PD), we aimed to investigate the relationship of ADMA with other biochemical parameters, echocardiographic findings, and results of bioimpedance analysis, which is a method for the determination of body fluid distribution in detail. Methods: The study was conducted on 21 patients with chronic PD. Bioimpedance was evaluated by Body Composition Monitor H02.201.1 (R). ADMA level was analyzed by an ELISA kit. Results: The mean ADMA level was 87.6 +/- 58.2 (18.54-247.34) mu mol/L. The mean ADMA level in patients with hypertension was significantly higher than those with normal blood pressure (95.8 +/- 58.8 mu mol/L and 41.0 +/- 27.9 mu mol/L, respectively; p=0.045). In univariate analysis, the parameters associated with serum ADMA levels were uric acid (r=0.681, p=0.001), left ventricular end-systolic diameter (LVESD) (r=0.509, p=0.019), intracellular water (ICW) (r=0.606, p=0.004), extracellular water (r=0.471, p=0.031), dialysate-to-plasma (D/P) creatinine ratio (r=0.452, p=0.04), body surface area (r=0.52, p=0.016), total body water (r=0.581, p=0.006), and lean tissue mass (r=0.528, p=0.014). In multivariate analysis, only uric acid level, ICW, LVESD, and D/P creatinine were found to be significantly associated with ADMA. Conclusion: Serum ADMA level may be a useful marker to detect cardiovascular risk in patients with PD. Serum uric acid and LVESD are important parameters related to ADMA levels in patients with PD. Bioimpedance spectroscopy findings support the association of ADMA with body fluid volume. Amaç: Kardiyovasküler hastalıklar diyaliz hastalarında mortalitenin en sık nedenidir. Asimetrik dimetilarginin (ADMA) düzeyleri ile aterogenezin ilk basamağı olan endotelyal disfonksiyon arasındaki ilişki gösterilmiş olup, ADMA kardiyovasküler hastalıklar için geleneksel olmayan bir risk faktörü olarak kabul edilmektedir. Periton diyalizi (PD) hastalarında hipervolemi ve kalp yetmezliği prevalansının yüksek olduğunu göz önüne alarak, çalışmamızda ADMA ile diğer biyokimyasal parametreler, ekokardiyografi bulguları ve vücut sıvı dağılımının belirlenmesinde geçerli bir yöntem olan biyoimpedans analizi sonuçları ile ilişkisini araştırmayı hedefledik. Yöntemler: Kronik PD tedavisi gören 21 hasta çalışmaya alındı. Biyoimpedans analizi için BCM (Body Composition Monitor H02.201.1®) cihazı kullanıldı. ADMA düzeyleri ELISA kiti ile çalışıldı. Bulgular: Yirmi bir hastanın 13’ü kadın 8’i erkek idi. PD modalitesi 12 hastada CAPD, 5 hastada APD ve 4 hastada CCPD idi. Hastaların 18’i (%85) hipertansif, 9’u ise (%42) dislipidemik idi. Son dönem böbrek yetmezliğinin etyolojisi 8 hastada (%38) diyabetik nefropati idi. 13 hastanın günlük idrar volümLeri ortalama 1402±636 mL iken, geri kalan 8 hasta ise anürik idi. Ortalama sistolik ve diyasyolik kan basınçları sırasıyla 124,5±36,8 mmHg ve 79,8±11,7 mmHg idi. Hastaların ortalama ADMA düzeyi 87,6±58,2 μmol/L (18,54-247,34 μmol/L) bulundu. Ortalama ADMA seviyesi hipertansif hastalarda normotensif olanlara göre istatistiksel açıdan anlamLı olarak daha yüksek tespit edildi (95,8±58,8 μmol/L ve 41,0±27,9 μmol/L; p=0,045). Tek değişkenli analizde ADMA düzeyi ile ilişkili bulunan parametreler, ürik asit (r=0,681, p=0,001), sol ventrikül diyastol sonu çapı (LVESD) (r=0,509, p=0,019), intrasellüler sıvı miktarı (r=0,606, p=0,004), ekstrasellüler sıvı miktarı (r=0,471, p=0,031), diyalizat/plazma kreatinin oranı (r=0,452, p=0,04), vücut yüzey alanı (r=0,52, p=0,016), total vücut suyu (r=0,581, p=0,006) ve yağsız vücut kitlesi (r=0,528, p=0,014) olarak saptandı. Çok değişkenli analizde ise sadece ürik asit düzeyi, intrasellüler su, LVESD ve diyalizat/plazma kreatinin oranı istatistiksel olarak ADMA düzeyi ile ilişkili bulundu. Sonuç: PD hastalarında kardiyovasküler riskin belirlenmesinde ADMA düzeyi yararlı bir marker olarak kullanılabilir. Serum ürik asit düzeyi ve LVESD, ADMA düzeyi ile yakından ilişkilidir. Biyoimpedans analizi sonuçları ADMA düzeyi ile total vücut sıvısı arasındaki ilişkiyi desteklemektedir.

WOS: 000374928100006 OBJECTIVE: Autosomal dominant polycystic kidney disease (ADPKD) is a systemic disease with cysts in many organs including the urogenital tract. The aim of the study was to evaluate the relationship between urogenital cysts, semen pathologies and infertility in ADPKD. MATERIAL and METHODS: Male ADPKD patients aged 18-60 with creatinine clearance years higher than 60 ml/min were included. All patients had magnetic resonance imaging of the urinary system and pelvis, scrotal Doppler ultrasonography and sperm analysis. The results were compared with those of a healthy control group. RESULTS: 27 patients and 17 volunteers were included. Seminal vesicle and prostate cysts were detected in four (15%) and six (22%) patients, respectively. Five of the 23 married patients (21%) had infertility and this rate was higher than in the control group (p=0.044). The ratio of sperms with normal morphology and progressive motility was lower, and the rate of hypospermia, oligozoospermia, azospermia, asthenozoospermia and teratozoospermia were higher in the patient group. There was no significant difference between patients with/without urogenital cysts regarding seminal pathologies. CONCLUSION: Seminal abnormalities and infertility are more frequent in patients with ADPKD. Defects in spermatogenesis and sperm motility may be related to urogenital cysts as well as ciliary pathologies. There is a need for further studies evaluating the role of urogenital cysts in semen pathologies. AMAÇ: Otozomal dominant polikistik böbrek hastalığı (ODPBH) ürogenital sistemle birlikte birçok organda kist oluşumuna neden olabilen sistemik bir hastalıktır. Çalışmada, ODPBH olan bireylerde ürogenital kistler ile semen patolojileri ve infertilite ilişkisi değerlendirilmiştir. GEREÇ ve YÖNTEMLER: Çalışmaya 18-60 yaşları arasında, kreatinin klirensi 60 ml/dakika/1.73 m2’nin üzerinde, ODPBH olan erkekler dahil edildi. Tüm hastalara üriner sistem ve pelvik manyetik rezonans(MR) inceleme, skrotal Doppler ultrasonografi ve semen analizi yapıldı. Sonuçlar sağlıklı kontrol grubu ile karşılaştırıldı. BULGULAR: Yirmiyedi hasta ve 17 gönüllü çalışmaya dahil edildi. Seminal vezikül kisti 4(%15), prostat kisti 6 (%22) hastada tespit edildi. Kontrol grubundan daha sık olarak, evli olan 23 hastanın 5’inde (%21) infertilite mevcuttu (p=0.044). Normal morfolojili sperm oranları ve ileri motilite daha düşük, hipospermi, oligozoospermi, azospermi, asthenozoospermi ve teratozoospermi oranları hasta grubunda daha yüksekti. Ürogenital kisti olan/olmayan hastalarda semen patolojileri açısından anlamlı fark yoktu. SONUÇ: Seminal anormallikler ve infertilite ODPBH olanlarda daha sıktır. Spermatogenez ve sperm motilite defektleri siliar patolojiler gibi urogenital kistlerle ilişkili olabilir. Ürogenital kistlerin semen patolojilerindeki rolünü değerlendirmek için ileri çalışmalara ihtiyaç vardır.

Aim: Degenerative valvular heart disease (DVHD) may cause serious cardiac problems and mortality. Determination of the factors related to DVHD may render possible the prevention and/or slowing down the progression of DVHD. In this study, we evaluated the relationship of DVHD with lipid profile, microalbuminuria and high sensitive C-reactive protein (hsCRP) levels. Methods: 50 patients (age=65.6±12.4 years) with DVHD were compared with the control group including 20 patients (age=57.3±13.9 years) with left ventricle hypertrophy, but no DVHD. Microalbuminuria, blood lipid parameters and hsCRP levels were measured besides routine biochemical tests. Clinical, laboratory and echocardiographic findings were compared between the groups. Results: Total cholesterol, HDL-cholesterol and LDL-cholesterol levels were significantly higher in DVHD group (215.26±48.59 mg/dL vs. 177.45±22.47 mg/dL, p=0.001; 45.04±11.03 mg/dL vs. 38.90±11.82 mg/dL, p=0.043 and 138.49±40.69 mg/dL vs. 114.26±16.07 mg/dL, p=0.001) compared with control group. hsCRP and microalbuminuria levels were relatively higher in DVHD group. Conclusion: Hyperlipidaemia is related to DHVD development, and the progress of DHVD may be related to the inflammatory process. Elevated hsCRP levels may be an indicator of pathologies active in DVHD development. Routine echocardiographic analysis in hypertensive patients with high hsCRP and LDL-cholesterol levels might be useful for screening of DVHD. (The Medical Bulletin of Haseki 2015; 53: 62-6)

OBJECTIVE : In malnourished patients, in anthropometric measurements such as a decrease in the body-mass index (BMI), the triceps skinfold (TSF) thickness and the mid-upper arm circumference (MUAC) are often determined along with weight loss. Our aim in this study was to evaluate the nutritional status of chronic hemodialysis patients by taking anthropometric measurements.

Aims: Transport characteristics of phosphorus are different from other small solutes that are evaluated in routine peritoneal equilibration test ( PET) in peritoneal dialysis (PD) patients. We aimed to evaluate peritoneal phosphorus clearance and permeability, and their relationship with peritoneal membrane transport type and creatinine clearance as well as factors affecting peritoneal phosphorus clearance. Methods: 70 adult patients on a PD program were included in our study. Phosphorus transport status was classified according to dialysate/plasma (D/P) phosphorus at the 4th hour of PET as slow transporter ( 0.67). We evaluated the relationship of peritoneal phosphorus clearance and transport type with PD regime, phosphorus level, and presence of residual renal function in addition to investigating factors that are effective on peritoneal phosphorus clearance. Results: D/P phosphorus and peritoneal phosphorus clearance were positively correlated with D/ P creatinine and peritoneal creatinine clearance, respectively. Automated PD and continuous ambulatory PD patients were similar regarding phosphorus and creatinine clearances and transport status based on D/ P phosphorus. The major determinant of peritoneal phosphorus clearance was anuria status. Anuric patients had higher dialysate volume (11.6 +/- 3.0 L vs. 8.4 +/- 2.1 L, p < 0.001) and therefore higher peritoneal phosphorus clearance (61.7 +/- 15.1 L/week/1.73 m(2) vs. 48.4 +/- 14.0 L/week/1.73 m(2), p = 0.001). Hyperphosphatemia was present in 40% and 11% of anuric patients and those with residual renal function, respectively (p = 0.005). Conclusions: Peritoneal phosphorus transport characteristics are similar to that of creatinine. Although increased dialysis dose may increase peritoneal phosphorus clearance, it may be insufficient to prevent hyperphosphatemia in anuric patients.

Soluble TNF-like weak inducer of apoptosis (sTWEAK) is a member of the TNF super family with many biological activities. There is a limited number of studies on the role of sTWEAK in chronic kidney disease. We aimed in this study to examine the relation of sTWEAK with albuminuria and inflammatory markers in patients with type 2 diabetes mellitus (DM). One hundred and eighteen diabetic patients with varying levels of albuminuria were included. Group 1 comprised patients with albuminuria less than 30 mg/day, while Group 2 and Group 3 were composed of patients with albuminuria between 30–300 mg/day or more than 300 mg/day, respectively. Groups were compared for sTWEAK levels besides demographic, clinical and biochemical data. There was no difference between groups regarding sTWEAK and TNF-α levels. IL-1 levels in Group 1 were higher than in Group 3. hsCRP levels were significantly higher in Group 3 compared to other groups. Use of a renin angiotensin system blocker did not have any effect on sTWEAK, TNF-α and hsCRP levels, while IL-1 level was significantly lower in patients using a renin angiotensin blocker. A statistically significant positive correlation was detected between sTWEAK and IL-1 levels (r=0.245; p=0.008). The groups were found to be similar regarding sTWEAK and TNF-α level. This finding may be interpreted as there being no effect of proteinuria on sTWEAK levels. But the close correlation between proteinuria and IL-1, and between IL-1 and sTWEAK may be a clue for an indirect relationship. Lack of difference between groups regarding sTWEAK levels may be due to involvement of patients with GFR more than 60 ml/minute only.

Bone mineral metabolism deteriorates gradually beginning from the early stages of chronic kidney disease (CKD). But, the KDIGO-2009 guideline could not provide high quality data regarding the biochemical tests related with bone mineral disorder in CKD. The aim of our study was to analyse the relationship between bone mineral densitometry and clinical and biochemical parameters in chronic peritoneal dialysis (PD) patients. Besides the demographic parameters, routine hematological and biochemical analysis results of PD patients followed up in our clinic were recorded. Bone mineral density (BMD) was measured at lumbar vertebrae and femur neck using DEXA machine. The mean lumbar T- and femur T-score were -1.03±1.20 (minimum:-3.73; maximum:+1.75) and -2.49±1.20 (minimum:-4.63; maximum:-0.51), respectively. Lumbar T score was significantly higher than femur T score (p, Kronik böbrek yetersizliği (KBY)'nin erken evrelerinden başlayarak kemik-mineral metabolizması giderek bozulur. Ancak KDIGO-2009 kılavuzunda KBY'de kemik mineral bozukluğu ile ilişkili verilerin çoğunluğunun kanıt düzeyi düşük olduğu ifade edilmiştir. Bu çalışmada, kronik periton diyalizi (PD) hastalarımızın kemik mineral dansitesi (KMD) ölçümleri ile klinik ve biyokimyasal parametreleri arasındaki ilişkiyi araştırdık. Hastanemizin PD ünitesinden takipli 53 hastanın demografik verileri yanında rutin hematolojik ve biyokimyasal tetkikleri kaydedildi. Hastalarda lomber vertebra ve femur boynundan DEXA cihazıyla kemik mineral dansitesi (KMD) ölçümü yapıldı. Hastaların lomber-T skoru -1.03±1.20[(-3.73)-(+1.75)] bulunur iken femur-T skoru -2.49±1.20[(-4.63)-(0.51)] olarak saptandı. Lomber T skoru, femur T skorundan anlamlı olarak daha yüksekti (p