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Background: The most common infections among renal transplant patients are urinary tract infections (UTI). Our main objective in this study is to determine the incidence of UTIs in patients who have undergone renal transplantation in our hospital, to identify the causative microbiological agents, risk factors and determine the effects of UTI on short-term graft survival. Methods: Urinary tract infections, which developed within the first year of renal transplantation, were investigated. Patients were compared regarding demographic, clinical, laboratory characteristics and graft survival. Results: 102 patients were included in our study. Fifty-three patients (53%) were male and 49 (48%) were female. Sixty-seven urinary tract infection attacks in 21 patients (20.5%) were recorded. Age (p = 0.004; 95% Confidence Interval [CI]: 1.032–1.184), longer indwelling urinary catheter stay time (p = 0.039; 95% Confidence Interval [CI]: 1.013–1.661) and urologic complications (p = 0.006; 95% Confidence Interval [CI]: 0.001–0.320) were found as risk factors for UTI development in the first year of transplantation. Escherichia coli and Klebsiella pneumoniae were the most frequently isolated microorganisms. Of these bacteria, 63.2% were found to be extended spectrum beta lactamase (ESBL) positive. Multidrug resistant microorganisms (MDROs) were more frequent in male patients (32 episodes in males vs. 14 episodes in females, p = <0.001). UTI had no negative impact on short-term graft survival. Conclusion: Our study results represent the high incidence of UTI with MDROs in KT recipients. Infection control methods should be applied even more vigorously especially in male transplant patients since a higher incidence of UTI caused by resistant microorganisms was reported in male patients. [ABSTRACT FROM AUTHOR]

Objective: We aim to evaluate the effects of low-dose dopamine (LDD) infusion (0.5 -- 2.5 g/kg/min) on hemodynamic status and short-term graft function in kidney transplant recipients. Materials and Methods: Patients who underwent kidney transplantation surgery between January 2007 and December 2016 were included in the study. Demographic and laboratory data, presence of delayed graft function, and the rates of rejection, graft loss, and mortality were recorded. The data were compared between patients with and without LDD treatment. Results: A total of 126 patients were included in the study (M/F:50.8%/49.2%; mean age, 38.94 ± 11.8 years). Ninety-four patients (74.6%) received living-donor transplants. Fifty-seven patients underwent LDD infusion in the postoperative period (LDD group), while 69 patients did not receive LDD infusion. Demographic and laboratory data of the patients did not significantly differ between groups. Nineteen patients in the LDD group experienced delayed graft function (p=0.039). However, these patients tended to be older, have a longer dialysis period prior to transplantation, deceased and hypertensive donors. There was no significant difference in renal function at 6 months after transplantation between groups. Conclusion: Although, LDD infusion increases kidney blood flow, we observed no significant effects on short-term graft function or patient survival between the LDD and non-LDD groups. [ABSTRACT FROM AUTHOR]

Background: Kidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients. Patients-method: Patients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD. Results: One hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,5±11,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024–1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015–0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (≥20% risk of fracture), and 23.5% had high hip fracture probability (≥3% risk of hip fracture) according to FRAX. Conclusion: Exploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population. [ABSTRACT FROM AUTHOR]

There were also transplant-specific factors such as concomitant tacrolimus use, pre-existing graft dysfunction, and inadequate hydration status. Human papilloma virus (HPV) is mostly associated with genital warts, such as condyloma and verruca vulgaris. It has previously been suggested that mTOR inhibitors can suppress viral replications and also regulate cell growth and survival; the pathways of which are often dysregulated in various types of malignancies.[8] Therefore, avoiding MMF and changing to everolimus-based treatment can be considered in cases with HPV-related conditions. [Extracted from the article]

Background: Encapsulating peritoneal sclerosis (EPS) is characterized by neovascularization, increased inflammation, and interstitial fibrosis of the peritoneum. We investigated the effects of imatinib on the peritoneal membrane in an experimental EPS model. Methods: We separated 24 non-uremic Wistar rats into four groups: the control group which was injected with 2 mL isotonic saline intraperitoneally (IP) daily for 3 weeks, the CG group which was injected with chlorhexidine gluconate (CG) IP daily for 3 weeks, the resting group which was injected with CG IP between weeks 0-3 followed by a peritoneal rest period between weeks 3-6, and the CG + Imatinib mesylate group (CG + IMA) which received CG through weeks 0-3 followed by 50 mg/kg imatinib mesylate through weeks 3-6. At the end of the study, we performed a 1-h-peritoneal equilibration test and examined the peritoneal function and transforming growth factor- β1 (TGF- β1) in dialysate. Morphologic changes were evaluated by microscopy and immunohistochemistry. Results: An increased ultrafiltration, dialysate/plasma-creatinine-ratio, end-to-initial-dialysate-glucose-ratio, decreased active mesothelial cell ratio and inflammation, and a slightly decreased TGF- β1 of dialysate were found in the CG + IMA group compared to CG alone. Furthermore, the CG + IMA group had a lower concentration of active mesothelial cells than did the resting group. Ultrafiltration was improved in CG + IMA group compared to resting group, however, significant decrease in peritoneal thickness and inflammation were not found compared to those in resting group. Furthermore, there was no significant difference in fibrosis or TGF- β1-positivity on immunohistochemistry between the groups. Conclusions: Tyrosine kinase inhibition with imatinib may lead to a decrease in mesothelial cell activity and an increase in ultrafiltration. However, peritoneal fibrosis was unchanged by imatinib in EPS model. [ABSTRACT FROM AUTHOR]

Background: The psychological distress and sleep problems caused by current Covid-19 outbreak is not well known in kidney transplant recipients. In this study, we aimed to investigate the association between perceived stress with sleep quality, insomnia, anxiety, depression and kidney function in kidney transplant recipients during the Covid-19 pandemic. Material and methods: A hundred-six kidney transplant recipients were enrolled. Questionnaire of "Socio-demographics", "Perceived Stress Scale (PSS)", "Pittsburgh Sleep Quality Index (PSQI)", "Insomnia Severity Index (ISI)" and "Hospital Anxiety Depression Scale (HADS)" are performed. The laboratory data is recorded. The perceived stress related to Covid-19 pandemic and its associations were investigated. Results: The mean age of patients was 44.2±13.3 years, and 65 of the patients (61.3%) were men. Forty-nine (46.2%) of the patients had high-perceived stress; 51 (48.1%) of the patients had poor sleep quality, 40 (37.7%) of the patients had insomnia, 25 (23.6%) of the patients had anxiety and 47 (44.3%) of the patients had depression. The patients having a history of Covid-19 infection in own or closed relatives (9.09±4.17 vs 6.49±4.16, p:0.014) and the patients who have a rejection episode any of time (8.24±5.16 vs 6.37±3.57, p:0.033) have had significantly higher anxiety scores, when they compared to others. The high PSS were positively correlated with PSQI, ISI, HAD-A and HAD-D. Regression analyses revealed that high-perceived stress is an independent predictor of anxiety and depression. There was not significant difference between kidney function with PSS, PSQI, ISI, HAD-A and HAD-D. Conclusions: High PSS is positively correlated with poor sleep quality and insomnia and also an independent predictor of anxiety and depression in kidney transplant recipients during the outbreak of Covid-19. As the pandemic is still spreading worldwide quickly early identification and intervention of sleep disturbances and psychiatric disorders are essential to protect graft function with high compliance to treatment in transplantation patients. [ABSTRACT FROM AUTHOR]

Living donation challenges the ethical principle of non-maleficence in that it exposes healthy persons to risks for the benefit of someone else. This makes safety, informed consent (IC) and education a priority. Living kidney donation has multiple benefits for the potential donor, but there are also several known short- and long-term risks. Although complete standardization of IC is likely to be unattainable, studies have emphasized the need for a standardized IC process to enable equitable educational and decision-making prospects for the prevention of inequities across transplant centers. Based on the Three-Talk Model of shared decision-making by Elwyn et al. we propose a model, named 3-Step (S) Model, where each step coincides with the three ideal timings of the process leading the living donor to the decision to pursue living donation: prior to the need for kidney replacement therapy (team talk); at the local nephrology unit or transplant center, with transplant clinicians and surgeons prior to evaluations start (option talk); and throughout evaluation, after having learned about the different aspects of donation, especially if there are second thoughts or doubts (decision talk). Based on the 3-S Model, to deliver conceptual and practical guidance to nephrologists and transplant clinicians, we provide recommendations for standardization of the timing, content, modalities for communicating risks and assessment of understanding prior to donation. The 3-S Model successfully allows an integration between standardization and individualization of IC, enabling a person-centered approach to potential donors. Studies will assess the effectiveness of the 3-S Model in kidney transplant clinical practice. [ABSTRACT FROM AUTHOR]

Background: Calprotectin is an important molecule in the initiation and progression of the inflammatory process. Systemic and local intraperitoneal inflammation are distinct processes and consequences in peritoneal dialysis (PD). We aimed to evaluate dialysate calprotectin levels and its associations with peritonitis and dialysis adequacy in PD patients. Methods: Forty‐four PD patients were included in this prospective study. Calprotectin concentration was evaluated in 24‐h peritoneal drainage fluid. Patients were followed‐up for 1 year, and peritonitis episodes were recorded. Dialysate calprotectin levels were compared to dialysis adequacy parameters and peritonitis frequency. Results: The mean age of patients was 54.9±12.7 years. Median PD duration was 54 (23–76) months. Seventeen patients (38.6%) had previous peritonitis episodes. During follow‐up, 15 of 44 patients (34.1%) had peritonitis. The median calprotectin concentration was 79.5 (75.2–86.3) ng/ml. The patients were divided into low and high calprotectin groups according to median value. In the high calprotectin group, BMI was found higher (p = 0.04). There was no significant relationship between calprotectin concentration and peritonitis during follow‐up (p = 0.29). However, the patients that have had previous peritonitis had higher calprotectin concentrations (p = 0.02). The patients who had higher erythrocyte sedimentation rate (ESR) levels also had higher calprotectin concentrations (p = 0.01). Conclusion: Peritoneal calprotectin concentrations were correlated with higher BMI and ESR, and it was higher in patients with previous peritonitis episodes. To our knowledge, this is the first study to examine the peritoneal calprotectin levels in PD patients. Further studies are needed to determine the use of peritoneal calprotectin as an inflammatory marker in PD. [ABSTRACT FROM AUTHOR]

Purpose: Kidney transplant recipients are prone to metabolic bone diseases and consequent fractures. This study aimed to evaluate the incidence of incipient vertebral fractures, osteopenia, osteoporosis, and the clinical factors associated with incipient vertebral fractures in a group of kidney transplant patients. Methods: Two hundred sixty-four patients (F/M 124/140, 45.3 ± 13 years) who had undergone kidney transplantation in tertiary care centers were included. Vertebral fractures were assessed semiquantitatively using conventional thoracolumbar lateral radiography in 202 of the patients. Results: Vertebral fractures were observed in 56.4% (n = 114) of the study group. The frequency of osteoporosis was 20.0% (53 of 264 patients), and osteopenia was 35.6% (94 of 264 patients). Bone mineral density (BMD) levels were in the normal range in 40.3% (n = 46) of the subjects with vertebral fractures. It was in the osteoporotic range in 20.1% (n = 23) and the osteopenic range in 40.3% (n = 46). Vertebral fractures were associated with age, duration of hemodialysis, BMI, and femoral neck Z score (R2 37.8%, p = 0.027). Conclusion: As incipient vertebral fractures can be observed in patients with normal BMD levels in kidney transplant recipients, conventional X-ray screening for vertebral fractures may be beneficial for a proper therapy decision of metabolic bone disease in kidney transplant recipients. [ABSTRACT FROM AUTHOR]

Objective: Although liver dysfunction is not considered the main organ involvement in Systemic Lupus Erythematosus (SLE), the frequency of liver dysfunction or abnormal liver enzyme values may be observed in 50–60% of patients. The aim of this study was to assess fatty liver and liver fibrosis in SLE patients using Fibroscan as well as determine associated factors such as immunosuppressive medications. Methods: Sixty SLE patients and 30 healthy controls were included. Patients with HBV, HCV or cirrhosis, malignancy, cardiac disease, or patients on dialysis were excluded. All participants underwent Fibroscan measurements. Results: The prevalence of fatty liver disease was similar between SLE patients and healthy controls (21.7 vs 26.7%, p =.597). Liver fibrosis was also similar between the two groups (26.7 vs 10.0%, p =.069). Since the majority of SLE patients were female, we performed a subgroup analysis in female patients (n = 51) and controls (n = 25). Fatty liver disease was similar between female SLE patients and controls (23.5 vs 24.0%, p =.964). However, liver fibrosis in female patients with SLE was increased compared to female controls (29.4 vs 4.0%, p =.011) and was associated with age (Exp (B) 95% CI: 1.083 (1.006–1.166), p =.034) and low-dose cumulative glucocorticoid use (Exp (B) 95% CI: 14.116 (1.213–164.210), p =.034). Conclusion: The prevalence of fatty liver was similar between SLE patients and controls, while liver fibrosis was increased in the female patient group as compared to controls. Furthermore, liver fibrosis was associated with age and low dose cumulative glucocorticoid use. Interestingly, fatty liver did not precede liver fibrosis in the majority of cases, contrary to what is observed in the general population. Larger studies are needed to confirm our findings and determine whether immunosuppressive use has any impact on the development of liver fibrosis in SLE patients. [ABSTRACT FROM AUTHOR]

BK virus infections which usually remains asymptomatic in healthy adults may have different clinical manifestations in immunocompromised patient population. BK virus reactivation can cause BK virus nephropathy in 8% of kidney transplant patients and graft loss may be seen if not treated. Clathrin or Caveolar system is known to be required for the transport of many viruses from Polyomaviruses family including BK viruses. In this study, kidney transplant patients with BK virus viremia were divided into two groups according to the BK virus nephropathy found in kidney biopsy (Group I: Viremia+, Nephropathy+ / Group II: Viremia+, Nephropathy−). Kidney biopsies were examined with immunohistochemical staining to determine the distribution and density of the Caveolin‐1 and Clathrin molecules. Immunohistochemical staining of the 31 pathologic specimens with anti‐caveolin‐1 immunoglobulin revealed statistically significant difference between group‐I and group‐II. The number of the specimens stained with anti‐caveolin‐1 was less in group I. On the other hand, we did not find any difference between the groups regarding the anti‐clathrin immunochemical analysis. According to these findings, caveolin‐1 expression differences in kidney transplant patients may be important in disease progression. [ABSTRACT FROM AUTHOR]

Kocuria kristinae is a gram-positive coccus of Micrococcaceae family. Kocuria kristinae inhabits the skin and mucous membranes. It can cause opportunistic infections in patients with indwelling devices and severe underlying diseases. We describe here a case of acute peritonitis caused by Kocuria kristinae in a patient on continuous ambulatory peritoneal dialysis (CAPD). Additionally, a review of other reported CAPD related peritonitis by Kocuria kristinae is provided. The importance of Kocuria kristinae as a pathogen in patients with CAPD peritonitis should not be underestimated. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 45-year-old woman referred to nephrology outpatient clinic with bilateral ankle swelling. Topics discussed include Abdominal computed tomography scan reveals right-sided hydronephrosis due to obstruction of the uretero-pelvic junction (UPJ); unilateral partial UPJ obstruction could be the cause of full-blown nephrotic syndrome; and patient treated with oralmethyl prednisolone therapy.