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Garayeva N, Demir E, Dirim AB, Safak S, Artan AS, Ozluk Y, Kílícaslan I, Turkmen A. Expression of JC virus in a kidney transplant recipient with renal cell carcinoma. Nefrologia 2024; 44:288-289. [PMID: 36494283 DOI: 10.1016/j.nefroe.2022.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/30/2021] [Indexed: 06/17/2023] Open
Affiliation(s)
- Nurana Garayeva
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seda Safak
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Kílícaslan
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Artan AS, Dirim AB, Yavuzkilic H, Demir E, Oto OA, Guller N, Safak S, Yazici H, Turkmen A. Thromboembolic complications after COVID-19 in kidney transplant recipients. Nephrology (Carlton) 2024; 29:39-47. [PMID: 37731224 DOI: 10.1111/nep.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/20/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023]
Abstract
AIM Increased venous thrombosis and arterial embolism rates are observed in the general population during or after COVID-19. Data regarding the kidney transplant population are scarce. In this study, we aim to investigate the thrombotic complications and risk factors associated with thrombotic complications in kidney transplant patients. METHODS This retrospective observational study included adult kidney transplant recipients diagnosed with COVID-19 between March 2020 and June 2022. The endpoint was the occurrence of thromboembolic events. RESULTS Four hundred and sixty-nine patients were followed for a median of 10.8 months after COVID-19. Forty patients (8.5%) died. Thromboembolic complications developed in 51 (11.9%) of the surviving patients. Twenty-four patients with thromboembolic events were receiving prophylactic anticoagulation before the event. The patients with mild, moderate, and severe COVID-19 were 292, 129, and 48, respectively. Patients with moderate COVID-19 had a significantly higher percentage of thromboembolic complications than patients with mild COVID-19. Older age, prior heart disease, and moderate COVID-19 were significantly associated with thromboembolic events. The incidence of thromboembolic events after COVID-19 is 10.9 per 100 patient-year. CONCLUSION Thromboembolic complications were observed at increased rates in kidney transplant recipients after COVID-19. Therefore, prospective and cohort studies for post-COVID-19 complications regarding the treatment modalities are urgently needed.
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Affiliation(s)
- Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | - Halil Yavuzkilic
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Erol Demir
- Koç University Transplant Immunology Research Center of Excellence, Koç University Hospital, Koç University, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Nurana Guller
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Seda Safak
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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Yazici H, Dirim AB, Garayeva N, Safak S, Ozluk Y, Hurdogan O, Oto OA, Artan AS, Turkmen A. Diagnostic yield and safety of percutaneous native kidney biopsy in pregnancy: 20-years of single-center experience. J Nephrol 2023; 36:2507-2517. [PMID: 37665527 DOI: 10.1007/s40620-023-01753-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Percutaneous kidney biopsy is a fundamental procedure in nephrology. Although pregnancy is not a contraindication, a careful risk-benefit assessment is mandatory in pregnancy. We aimed to evaluate safety and diagnostic accuracy of percutaneous kidney biopsy in pregnancy in a single-center retrospective study. METHODS Percutaneous kidney biopsy was performed in 19 pregnant patients. Demographics, estimated glomerular filtration rates, serum albumin levels, and proteinuria levels at the time of biopsy were evaluated. Biopsy-related complications, diagnoses, and treatments during the follow-up were analyzed. In addition, delivery success, preeclampsia, early delivery, low birth weight rates, and long-term outcomes of the patients were retrieved and analyzed. RESULTS Mean patient age was 27 (range 16-41) years. Median gestational week at kidney biopsy was 20th. All but one biopsies were diagnostic. Median gestational week of delivery was 35 (range 23-39) gestational weeks. Preterm delivery (< 37 gestational weeks) and low birth weight (< 2500 mg) occurred in 73.7% and 52.6% of cases, respectively. Median weight at birth was 2500 mg. The incidence of preeclampsia was 57.9%. Overall 89.5% of the children survived. Median post-biopsy follow-up was 64 months. Maternal mortality was not observed during the follow-up period. End stage kidney disease developed in one patient. The results of percutaneous kidney biopsy led to therapeutic decisions in 73.7% of cases. CONCLUSIONS Although percutaneous kidney biopsy is not frequently performed during pregnancy, it is relatively safe and usually diagnostic, and may guide further follow-up.
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Affiliation(s)
- Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, 34134, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, 34134, Istanbul, Turkey.
| | - Nurana Garayeva
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, 34134, Istanbul, Turkey
| | - Seda Safak
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, 34134, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozge Hurdogan
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, 34134, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, 34134, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, 34134, Istanbul, Turkey
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Dirim AB, Demir E, Safak S, Garayeva N, Artan AS, Oto OA, Ozluk Y, Ozturk S, Yazici H, Besisik SK, Turkmen A. An atypical case of refractory passenger lymphocyte syndrome after renal transplantation. Nefrologia 2023; 43:783-788. [PMID: 36517356 DOI: 10.1016/j.nefroe.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/02/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Passenger lymphocyte syndrome (PLS) causes immune-mediated hemolysis in solid and bone marrow transplant recipients. Donor-derived antibodies against the recipient erythrocyte drive the pathogenesis. It is a rare entity in kidney transplantation, and most of the cases are self-limited. CASE PRESENTATION A 36-year-old woman presented with fatigue 13 days after living donor renal transplantation. The operation was uneventful, and she was discharged with normal graft functions on the 11th day of transplantation Findings were consistent with cold agglutinin disease at her admission. However, the cold agglutinin test was negative. Eventually, she was diagnosed with PLS. Refractory intravascular hemolysis and frank hemoglobinuria were also present in the patient. Hemolysis was resistant to steroids, intravenous immunoglobulin (IVIG), and Rituximab. Because of life-threatening anemia related to refractory PLS, mycophenolate and tacrolimus were interrupted. However, hemolysis persisted. Following that, immunoadsorption (IA) treatment was obtained. Unfortunately, graft loss occurred due to rejection despite the resolution of PLS after IA. CONCLUSION PLS is a rare and usually self-limited entity. Our case was an atypical refractory PLS that resembled cold agglutinin disease. Also, frank hemoglobinuria was observed related to severe intravascular hemolysis. These features have not been described before in PLS, to the best of our knowledge. Additionally, IA treatment had never been reported in the literature for PLS, as far as we know. Treatment and management could be a challenge in refractory PLS. Rituximab, IVIG, and extracorporeal treatments could be beneficial. It should be borne in mind that refractory PLS can cause graft and patient loss.
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Affiliation(s)
- Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seda Safak
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurana Garayeva
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Savas Ozturk
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevgi Kalayoglu Besisik
- Division of Hematology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Artan AS, Fleetwood V, Guller N, Oto OA, Mirioglu S, Yazici H, Turkmen A, Caliskan Y, Lentine KL. Pregnancy in Living Kidney Donors: An Evidence-Based Review. Curr Transplant Rep 2023; 10:110-116. [PMID: 37743976 PMCID: PMC10512453 DOI: 10.1007/s40472-023-00402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 09/26/2023]
Abstract
Purpose of review To review the current studies and guidelines on the risk of adverse pregnancy outcomes in female kidney donors. Recent findings Living kidney donors include a significant amount of young women of child-bearing age. Safety and possible risks of pregnancy after donation are a concern for female kidney donor candidates. Many current studies indicate a higher risk of preeclampsia in women after kidney donation. Considering the increasing number of living kidney donors, the maternal outcomes of living kidney donation is an active area of research. Summary Guidelines and consensus statements on the risk of pregnancy in living kidney donors recommend close monitoring of blood pressure, weight gain, and proteinuria during pregnancy. Current studies indicate an increased risk of hypertensive disorders of pregnancy in living kidney donors. Counseling and informing donor candidates about the possible risks is important.
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Affiliation(s)
- Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Vidyaratna Fleetwood
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Nurane Guller
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Safak Mirioglu
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yasar Caliskan
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Krista L. Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
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Dirim AB, Safak S, Balci MC, Ozyavuz P, Garayeva N, Tiryaki TO, Oto OA, Ozluk Y, Kilicaslan I, Solakoglu S, Artan AS, Yazici H, Turkmen A, Ozturk S. Concurrent Cobalamin C and Plasminogen Deficiencies in a Patient with Chronic Thrombotic Microangiopathy. Nephron Clin Pract 2023; 148:54-62. [PMID: 37611544 DOI: 10.1159/000533417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/07/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Although most patients with atypical hemolytic uremic syndrome (aHUS) have variants in genes participating in alternative complement pathways, rare variants in non-complement pathway-related genes, including DGKE, INF2, MMACHC, PLG, and THBD, have also been described. CASE PRESENTATION We report an 18-year-old male patient with renal biopsy-proven chronic thrombotic microangiopathy that raised suspicion of aHUS. Whole-exome sequencing revealed a novel pathogenic homozygous MMACHC c.484G>T (p.Gly162Trp) variant. Subsequently, clinical and laboratory findings confirmed cobalamin C (Cbl C) deficiency. Also, homozygous missense c.1112C>T PLG (p.Thr371Ile) variant was detected (it had been reported as a variant of unknown significance). However, the low serum plasminogen (PLG) activity proved the pathogenicity of c.1112C>T. Hence, the patient was diagnosed with concurrent Cbl C and PLG deficiencies. Segregation analysis revealed that the mother and father had the same heterozygous PLG and MMACHC variants. PLG variants have generally been described in aHUS patients concomitant with complement gene variants in the literature; therefore, the association between aHUS and PLG variants is controversial. The possible contribution of PLG deficiency to thrombotic microangiopathy was also discussed in this case. CONCLUSION Non-complement-mediated aHUS is an exceptional disorder. A limited number of genes are involved in this entity. To our knowledge, this is the first aHUS patient diagnosed with both Cbl C and PLG deficiencies in the literature.
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Affiliation(s)
- Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Genetics, Istanbul University Aziz Sancar Institute of Experimental Medicine, Graduate School of Health Sciences, Istanbul University, Istanbul, Turkey
| | - Seda Safak
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Cihan Balci
- Division of Pediatric Metabolic Disorders, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pelin Ozyavuz
- Department of Genetics, Haseki Teaching and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nurane Garayeva
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tarik Onur Tiryaki
- Division of Hematology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Kilicaslan
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seyhun Solakoglu
- Department of Histology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Savas Ozturk
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Safak S, Dirim AB, Solakoglu S, Garayeva N, Demir E, Artan AS, Oto OA, Ozluk Y, Ozturk S, Yazici H, Kilicaslan I, Turkmen A. Nephrotic syndrome and acute tubular injury after bee stings in a beekeeper: expanding the electron microscopic findings of bee venom-induced renal injury. Int Urol Nephrol 2023; 55:2131-2132. [PMID: 36847974 DOI: 10.1007/s11255-023-03537-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/20/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Seda Safak
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey.
| | - Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| | - Seyhun Solakoglu
- Department of Histology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurane Garayeva
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Savas Ozturk
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| | - Isin Kilicaslan
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
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Hurdogan O, Karakus F, Dirim AB, Aksu B, Saygili S, Turkmen A, Yilmaz A, Canpolat N, Solakoglu S, Kilicaslan I, Ozluk Y. Spatial Distribution of Macrophage Subtypes Among Rejection Subtypes in Renal Transplant Biopsies by Dual Immunohistochemistry. Appl Immunohistochem Mol Morphol 2023; 31:224-231. [PMID: 36812388 DOI: 10.1097/pai.0000000000001109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/19/2023] [Indexed: 02/24/2023]
Abstract
We performed dual immunohistochemistry for CD163/CD34 and CD68/CD34 in 108 renal transplant indication biopsies to investigate the presence and distribution of macrophages in various renal compartments. All Banff scores and diagnoses were revised according to the Banff 2019 classification. CD163 and CD68 positive cell counts (CD163pos and CD68pos) were evaluated in the interstitium, glomerular mesangium, and, within glomerular and peritubular capillaries. The diagnosis was antibody-mediated rejection (ABMR) in 38 (35.2%), T-cell mediated rejection (TCMR) in 24 (22.2%), mixed rejection in 30 (27.8%), and no rejection in 16 (14.8%). Banff lesion scores t , i , and ti were correlated with both CD163 and CD68 interstitial inflammation scores ( r > 0.30; P < 0.05). Glomerular total CD163pos was correlated to Banff lesion scores g and cg ( r > 0.30; P < 0.05). Glomerular total, mesangial, and intracapillary CD68pos were correlated with g ( r > 0.30; P < 0.05). Both glomerular total and peritubular capillary CD68pos were correlated with peritubular capillaritis ( r > 0.30; P < 0.05). Glomerular CD163pos were significantly higher in ABMR compared with no rejection, in mixed rejection compared with no rejection and TCMR. CD163pos in peritubular capillaries was significantly higher in mixed rejection compared with no rejection. Glomerular CD68pos was significantly higher in ABMR compared with no rejection. CD68pos per peritubular capillary was higher in mixed rejection, ABMR, and TCMR compared with no rejection. In conclusion, compared with CD68 positive macrophages, localization of CD163 positive macrophages in various renal compartments seems to be different among rejection subtypes and their glomerular infiltration seems to be more specific for the presence of ABMR component.
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Affiliation(s)
| | | | | | - Bagdagul Aksu
- Department of Pediatrics, Subdivision of Pediatric Nephrology, Istanbul University
| | - Seha Saygili
- Department of Pediatrics, Subdivision of Pediatric Nephrology, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Aydin Turkmen
- Department of Internal Medicine, Subdivision of Nephrology
| | - Alev Yilmaz
- Department of Pediatrics, Subdivision of Pediatric Nephrology, Istanbul University
| | - Nur Canpolat
- Department of Pediatrics, Subdivision of Pediatric Nephrology, Istanbul University Cerrahpasa, Istanbul, Turkey
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Caliskan Y, Safak S, Oto OA, Velioglu A, Yelken B, Mirioglu S, Dirim AB, Yildiz A, Guller N, Yazici H, Ersoy A, Turkmen A, Lentine KL. Propensity score-matched analysis of long-term outcomes for living kidney donation in alternative complement pathway diseases: a pilot study. J Nephrol 2023; 36:979-986. [PMID: 36808609 DOI: 10.1007/s40620-023-01588-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/15/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Atypical hemolytic syndrome (aHUS) and C3 glomerulopathy (C3G) are complement-mediated rare diseases with excessive activation of the alternative pathway. Data to guide the evaluation of living-donor candidates for aHUS and C3G are very limited. The outcomes of living donors to recipients with aHUS and C3G (Complement disease-living donor group) were compared with a control group to improve our understanding of the clinical course and outcomes of living donation in this context. METHODS Complement disease-living donor group [n = 28; aHUS(53.6%), C3G(46.4%)] and propensity score-matched control-living donor group (n = 28) were retrospectively identified from 4 centers (2003-2021) and followed for major cardiac events (MACE), de novo hypertension, thrombotic microangiopathy (TMA), cancer, death, estimated glomerular filtration rate (eGFR) and proteinuria after donation. RESULTS None of the donors for recipients with complement-related kidney diseases experienced MACE or TMA whereas two donors in the control group developed MACE (7.1%) after 8 (IQR, 2.6-12.8) years (p = 0.15). New-onset hypertension was similar between complement disease and control donor groups (21.4% vs 25%, respectively, p = 0.75). There were no differences between study groups regarding last eGFR and proteinuria levels (p = 0.11 and p = 0.70, respectively). One related donor for a recipient with complement-related kidney disease developed gastric cancer and another related donor developed a brain tumor and died in the 4th year after donation (2, 7.1% vs none, p = 0.15). No recipient had donor-specific human leukocyte antigen antibodies at the time of transplantation. Median follow-up period of transplant recipients was 5 years (IQR, 3-7). Eleven (39.3%) recipients [aHUS (n = 3) and C3G (n = 8)] lost their allografts during the follow-up period. Causes of allograft loss were chronic antibody-mediated rejection in 6 recipients and recurrence of C3G in 5. Last serum creatinine and last eGFR of the remaining patients on follow up were 1.03 ± 038 mg/dL and 73.2 ± 19.9 m/min/1.73 m2 for aHUS patients and 1.30 ± 0.23 mg/dL and 56.4 ± 5.5 m/min/1.73 m2 for C3G patients. CONCLUSION The present study highlights the importance and complexity of living related-donor kidney transplant for patients with complement-related kidney disorders and motivates the need for further research to determine the optimal risk-assessment for living donor candidates to recipients with aHUS and C3G.
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Affiliation(s)
- Yasar Caliskan
- Saint Louis University Transplant Center, SSM-Saint Louis University Hospital, 1201 S. Grand Blvd., St. Louis, MO, 63104, USA. .,Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey.
| | - Seda Safak
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Arzu Velioglu
- Division of Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Berna Yelken
- Organ Transplantation Center, Koc University Hospital, Istanbul, Turkey
| | - Safak Mirioglu
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey.,Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Abdulmecit Yildiz
- Division of Nephrology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Nurana Guller
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Alparslan Ersoy
- Division of Nephrology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Krista L Lentine
- Saint Louis University Transplant Center, SSM-Saint Louis University Hospital, 1201 S. Grand Blvd., St. Louis, MO, 63104, USA
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Mirioglu S, Dirim AB, Bektas M, Demir E, Tor YB, Ozluk Y, Kilicaslan I, Oto OA, Yalcinkaya Y, Caliskan Y, Artim-Esen B, Yazici H, Inanc M, Turkmen A, Gul A, Sever MS. Efficacy and safety of interleukin-1 blockers in kidney transplant recipients with familial Mediterranean fever: a propensity score-matched cohort study. Nephrol Dial Transplant 2022; 38:1327-1336. [PMID: 36542475 DOI: 10.1093/ndt/gfac335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Data on use of IL-1 blockers in kidney transplant recipients (KTRs) with familial Mediterranean fever (FMF) are very limited. We aimed to evaluate the efficacy and safety of anakinra and canakinumab in the transplantation setting.
Methods
In this retrospective cohort study, we included KTRs suffered from AA amyloidosis caused by FMF and treated with anakinra or canakinumab (study group, n = 36). Using propensity score matching, we selected 36 patients without FMF or amyloidosis from our database of 696 KTRs as the control group. Primary outcomes were patient and graft survival. Biopsy-confirmed graft rejection, changes in eGFR, hsCRP, erythrocyte sedimentation rate (ESR), proteinuria, and number of monthly attacks were secondary outcomes.
Results
All KTRs with FMF began IL-1 blocker therapy with anakinra and nine (25%) were switched to canakinumab. Overall death was more frequent in study group (19.4% vs 0%) (p = 0.005); however, overall graft loss was comparable between study (27.8%) and control groups (36.1%) (p = 0.448). Five- and 10-year graft survival rates were significantly higher in study group (94.4% and 83.3%, respectively) than control group (77.8% and 63.9%, respectively) (p = 0.014 and p<0.001, respectively). Rejections were numerically lower in study group (8.3% vs 25%), but it did not reach to statistical significance (p = 0.058). When compared to pre-treatment period, with IL-1 blockers, number of attacks per month (p<0.001), eGFR (p = 0.004), hsCRP (p<0.001) and ESR (p = 0.026) levels were lower throughout the follow-up; whereas proteinuria levels were not.
Conclusions
Anakinra and canakinumab are effective in KTRs suffering from FMF; however, mortality rate may be of concern.
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Affiliation(s)
- Safak Mirioglu
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine , Istanbul , Turkey
| | - Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Murat Bektas
- Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Yavuz Burak Tor
- Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Isin Kilicaslan
- Department of Pathology, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Yasemin Yalcinkaya
- Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Yasar Caliskan
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
- Center for Abdominal Transplantation, Saint Louis University School of Medicine , Saint Louis , MO, USA
| | - Bahar Artim-Esen
- Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Ahmet Gul
- Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Mehmet Sukru Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
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11
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Noordzij M, Meijers B, Gansevoort RT, Covic A, Duivenvoorden R, Hilbrands LB, Hemmelder MH, Jager KJ, Mjoen G, Nistor I, Parshina E, Pessolano G, Tuglular S, Vart P, Zanoli L, Franssen CFM, van der Net JB, Essig M, du Buf-Vereijken PWG, van Ginneken B, Maas N, van Jaarsveld BC, Bemelman FJ, Klingenberg-Salahova F, Vervloet MG, Nurmohamed A, Vogt L, Abramowicz D, Verhofstede S, Maoujoud O, Malfait T, Fialova J, Lips J, Hengst M, Konings C, Rydzewski A, Oliveira J, Zakharova EV, Lepeytre F, Rabaté C, Rostoker G, Marques S, Azasevac T, Majstorovic GS, Fricke L, Slebe JJP, ElHafeez SA, El-Wakil HS, Verhoeven M, Logan I, Panagoutsos S, Mallamaci F, Postorino A, Cambareri F, Matceac I, Groeneveld JHM, Jousma J, van Buren M, Pereira TA, Arias-Cabrales C, Crespo M, Llinàs-Mallol L, Buxeda A, Tàrrega CB, Redondo-Pachon D, Jimenez MDA, Mendoza-Valderrey A, Martins AC, Mateus C, Alvila G, Laranjinha I, Arroyo D, Castellano S, Rodríguez-Ferrero ML, Lemahieu W, Dirim AB, Demir E, Sever MS, Turkmen A, Şafak S, Hollander DAMJ, Büttner S, Sridharan S, van der Sande FM, Christiaans MHL, Luca MD, Beerenhout C, Adema AY, Stepanov VA, Zulkarnaev AB, Turkmen K, Fliedner A, Åsberg A, Pini S, de Biase C, Kerckhoffs A, van de Logt AE, Maas R, Lebedeva O, Reichert LJM, Verhave J, Marcantoni C, van Gils-Verrij LEA, Battaglia Y, Lentini P, Cabezas-Reina CJ, Roca AM, Nauta F, Goffin E, Kanaan N, Labriola L, Devresse A, Coca A, Naesens M, Kuypers D, Desschans B, Dedinska I, Malik S, Berger SP, Sanders JSF, Özyilmaz A, Ponikvar JB, Pernat AM, Kovac D, Arnol M, Abrahams AC, Molenaar FM, van Zuilen AD, Meijvis SCA, Dolmans H, Esposito P, Krzesinski JM, Barahira JD, Gallieni M, Guglielmetti G, Guzzo G, Luik AJ, van Kuijk WHM, Stikkelbroeck LWH, Hermans MMH, Rimsevicius L, Righetti M, Islam M, Heitink-ter Braak N. Strategies to prevent SARS-CoV-2 transmission in hemodialysis centres across Europe - Lessons for the future. Clin Kidney J 2022; 16:662-675. [PMID: 37007687 PMCID: PMC10061429 DOI: 10.1093/ckj/sfac253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Indexed: 12/04/2022] Open
Abstract
Abstract
Background
Early reports on the pandemic nature of COVID-19 directed the nephrology community to develop infection prevention and control guidance. We aimed to make an inventory of strategies that dialysis centres followed to prevent infection with COVID-19 in the first pandemic wave.
Methods
We analyzed IPC measures taken by hemodialysis centres treating patients presenting with COVID-19 between March 1, 2020 and July 31, 2020 and that completed the European Renal Association COVID-19 Database centre questionnaire. Additionally, we made an inventory of guidelines published in European countries to prevent spread of SARS-CoV-2 in dialysis centres.
Results
Data from 73 dialysis units located in and bordering Europe were analyzed. All participating centres implemented IPC measures to mitigate the impact of SARS-CoV-2 during the first pandemic wave. Measures mentioned most often included triage with questions before entering the dialysis ward, measuring body temperature, hand disinfection, masking for all patients and staff, and personal protective equipment for staff members. These measures were also recommended in most of the 14 guidelines that were identified in the inventory of national guidelines and were also scored as being among the most important measures by the authors of this paper. Heterogeneity existed between centres and national guidelines regarding the minimal distance between dialysis chairs and recommendations regarding isolation and cohorting.
Conclusions
Although variation existed, measures to prevent transmission of SARS-CoV-2 were relatively similar across centres and national guidelines. Further research is needed to assess causal relationships between measures taken and spread of SARS-CoV-2.
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Affiliation(s)
- Marlies Noordzij
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Björn Meijers
- Department of Nephrology , UZ Leuven, Leuven , , Immunology and Transplantation, KU Leuven, Leuven , Belgium
- Belgium and Department of Microbiology , UZ Leuven, Leuven , , Immunology and Transplantation, KU Leuven, Leuven , Belgium
| | - Ron T Gansevoort
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Adrian Covic
- Grigore T Popa University of Medicine and Pharmacy , Iasi , , Iasi , Romania
- Romania / Dr Ci Parhon Hospital , Iasi , , Iasi , Romania
| | - Raphaël Duivenvoorden
- Department of Nephrology, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Marc H Hemmelder
- Dept. of Internal Medicine, Div. of Nephrology, Maastricht University Medical Center / CARIM school for cardiovascular disease, University of Maastricht , Maastricht , The Netherlands
| | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam , Medical Informatics, Amsterdam , The Netherlands
- Amsterdam Public Health Research Institute , Quality of Care, Amsterdam , The Netherlands
| | - Geir Mjoen
- Department of Transplantation, Oslo University Hospital , Norway
| | - Ionut Nistor
- Grigore T Popa University of Medicine and Pharmacy , Iasi , , Iasi , Romania
- Romania / Dr Ci Parhon Hospital , Iasi , , Iasi , Romania
| | - Ekaterina Parshina
- Nephrology and Dialysis Department, Saint Petersburg State University Hospital , Saint-Petersburg, Russia
| | - Giuseppina Pessolano
- Division of Nephrology , Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | - Serhan Tuglular
- Medical Faculty, Department of Internal Medicine, Marmara University , Istanbul , Turkey
| | - Priya Vart
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen , The Netherlands
| | - Luca Zanoli
- Nephrology and dialysis, San Marco Hospital, University of Catania , Catania , Italy
| | - Casper F M Franssen
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
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12
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Oto OA, Safak S, Mirioglu S, Yelken B, Velioglu A, Dirim AB, Guller N, Yildiz A, Ersoy A, Turkmen A, Yazici H, Lentine KL, Caliskan Y. Long-Term Outcomes of Living-Related Kidney Donation for Alport Syndrome Spectrum: A Propensity Score-Matched Analysis. Am J Nephrol 2022; 53:628-635. [PMID: 36349757 DOI: 10.1159/000527180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Data to guide the evaluation of living-related donor candidates for kidney transplant recipients with Alport syndrome (AS) spectrum are limited. We aimed to examine a cohort of living-related donors to recipients with AS and compare their outcomes with a control group to improve understanding of the clinical course and outcomes of living donation in this context. METHODS Living donors (LDs) of AS recipients and propensity score-matched control LDs without any family history of AS (control group) were followed for major cardiac events, death, post-donation estimated glomerular filtration rate (eGFR), and proteinuria. RESULTS There were 31 LDs (48.4% male), in whom relationship to AS recipient included mother (45.2%), father (32.3%), sibling (16.1%), grandparent (3.2%), and uncle (3.2%). Long-term outcomes over 10.0 (IQR, 3.0-15.0) years were evaluated in 25 and 25 LDs from study and control groups, respectively. During follow-up, 5 LDs (20.0%) in study group developed major cardiac event (acute coronary ischemia [n = 4] and severe congestive heart failure [n = 1]) after 5.5 (IQR, 4.5-10.3) years, whereas only 2 (8.0%) LDs in control group developed major cardiac events (p = 0.221). New-onset hypertension was higher in study group (56.0%) compared to the control group (16.0%) (p = 0.003). Three donors in study and 2 donors in control group who developed new-onset hypertension died during follow-up (p = 0.297). Major cardiac event rate was significantly higher in donors who developed hypertension after donation (0 vs. 28.0%, p < 0.001). There were no differences between study groups regarding last eGFR and proteinuria levels (p = 0.558 and p = 0.120, respectively). DISCUSSION/CONCLUSION Although the risk of kidney disease can be minimized by careful donor evaluation, our findings suggest that hypertension risk after the donation is higher than expected in related donors of recipients with AS.
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Affiliation(s)
- Ozgur Akin Oto
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey,
| | - Seda Safak
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Safak Mirioglu
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey.,Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Berna Yelken
- Organ Transplantation Center, Koc University Hospital, Istanbul, Turkey
| | - Arzu Velioglu
- Division of Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Nurana Guller
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Abdulmecit Yildiz
- Division of Nephrology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Alparslan Ersoy
- Division of Nephrology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University, St. Louis, Missouri, USA
| | - Yasar Caliskan
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey.,Center for Abdominal Transplantation, Saint Louis University, St. Louis, Missouri, USA
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13
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Caliskan Y, Mirioglu S, Dirim AB, Ozluk Y, Yegit O, Aksoy E, Safak S, Guller N, Demir E, Artan AS, Oto OA, Besisik S, Yazici H, Turkmen A, Lentine KL. A comparison of methods of plasmapheresis for the treatment of late antibody mediated rejection in kidney transplant recipients. Ther Apher Dial 2022; 27:428-434. [PMID: 36201223 DOI: 10.1111/1744-9987.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We compared the outcomes associated with plasma exchange (PE), double filtration plasmapheresis (DFPP) or immunoadsorption (IA) in the treatment of late antibody mediated rejection (AMR). METHODS Sixty-nine kidney transplant (KTx) recipients with late AMR were retrospectively categorized according to management with PE (n=30), DFPP(n=22) or IA(n=17). Allograft loss was compared across treatment groups by Kaplan-Meier analysis and Cox regression. RESULTS Study groups were similar regarding age, sex, donor type, kidney function, donor specific antibodies and post-KTx follow-up time. Five-year graft survival trended higher with IA(70.6%) compared to PE(36.7%) and DFPP(27.3%) (p=0.06). In multivariate Cox regression, baseline eGFR (HR per ml/min/1.73m2 [95%CI]; 0.96 [0.94 to 0.99]), rituximab use (HR [95%CI]; 0.42[0.21 to 0.84]), interstitial inflammation(i) (HR [95%CI]; 2.05[1.13 to 3.69]) and transplant glomerulopathy(cg) (HR [95%CI]; 1.46[1.13 to 1.87]) were associated with graft loss. CONCLUSION These results motivate the need for continued assessment of rituximab and plasmapheresis in larger studies. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yasar Caliskan
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA.,Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Safak Mirioglu
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.,Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozan Yegit
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Elif Aksoy
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Seda Safak
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurana Guller
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Demir
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevgi Besisik
- Division of Hematology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
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14
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Demir E, Ucar ZA, Dheir H, Danis R, Yelken B, Uyar M, Parmaksiz E, Artan AS, Sinangil A, Merhametsiz O, Yadigar S, Dirim AB, Akin B, Garayeva N, Safak S, Turkmen A. COVID-19 in Kidney Transplant Recipients: A Multicenter Experience from the First Two Waves of Pandemic. BMC Nephrol 2022; 23:183. [PMID: 35550025 PMCID: PMC9097147 DOI: 10.1186/s12882-022-02784-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 04/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Kidney transplant recipients have an increased risk of complications from COVID-19. However, data on the risk of allograft damage or death in kidney transplant recipients recovering from COVID-19 is limited. In addition, the first and second waves of the pandemic occurred at different times all over the world. In Turkey, the Health Minister confirmed the first case in March 2020; after that, the first wave occurred between March and August 2020; afterward, the second wave began in September 2020. This study aims to demonstrate the clinical presentations of kidney transplant recipients in the first two waves of the pandemic in Turkey and explore the impact of COVID-19 on clinical outcomes after the initial episode. METHODS Patients with COVID-19 from seven centers were included in this retrospective cohort study. Initially, four hundred and eighty-eight kidney transplant recipients diagnosed with COVID-19 between 1 March 2020 to 28 February 2021 were enrolled. The endpoints were the occurrence of all-cause mortality, acute kidney injury, cytokine storm, and acute respiratory distress syndrome. In addition, longer-term outcomes such as mortality, need for dialysis, and allograft function of the surviving patients was analyzed. RESULTS Four hundred seventy-five patients were followed up for a median of 132 days after COVID-19. Forty-seven patients (9.9%) died after a median length of hospitalization of 15 days. Although the mortality rate (10.1% vs. 9.8%) and intensive care unit admission (14.5% vs. 14.5%) were similar in the first two waves, hospitalization (68.8% vs. 29.7%; p < 0.001), acute kidney injury (44.2% vs. 31.8%; p = 0.009), acute respiratory distress syndrome (18.8% vs. 16%; p = 0.456), and cytokine storm rate (15.9% vs. 10.1%; p = 0.072) were higher in first wave compared to the second wave. These 47 patients died within the first month of COVID-19. Six (1.4%) of the surviving patients lost allografts during treatment. There was no difference in the median serum creatinine clearance of the surviving patients at baseline (52 mL/min [IQR, 47-66]), first- (56 mL/min [IQR, 51-68]), third- (51 mL/min [IQR,48-67]) and sixth-months (52 mL/min [IQR, 48-81]). Development of cytokine storm and posttransplant diabetes mellitus were independent predictors for mortality. CONCLUSIONS Mortality remains a problem in COVID-19. All the deaths occur in the first month of COVID-19. Also, acute kidney injury is common in hospitalized patients, and some of the patients suffer from graft loss after the initial episode.
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Affiliation(s)
- Erol Demir
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zuhal Atan Ucar
- Department of Internal Medicine, Division of Nephrology, Florence Nightingale Hospital, Bilim University, Istanbul, Turkey
| | - Hamad Dheir
- Department of Internal Medicine, Division of Nephrology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Ramazan Danis
- Department of Internal Medicine, Division of Nephrology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Berna Yelken
- Department of Internal Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Murathan Uyar
- Department of Internal Medicine, Division of Nephrology, T.C. Istanbul Yeni Yuzyil University, Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Ergun Parmaksiz
- Department of Internal Medicine, Division of Nephrology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ayse Serra Artan
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Sinangil
- Department of Internal Medicine, Division of Nephrology, Florence Nightingale Hospital, Bilim University, Istanbul, Turkey
| | - Ozgur Merhametsiz
- Department of Internal Medicine, Division of Nephrology, T.C. Istanbul Yeni Yuzyil University, Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Serap Yadigar
- Department of Internal Medicine, Division of Nephrology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baris Akin
- Department of Internal Medicine, Division of Nephrology, Florence Nightingale Hospital, Bilim University, Istanbul, Turkey
| | - Nurana Garayeva
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seda Safak
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Internal Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
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15
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Dirim AB, Demir E, Guller N, Safak S, Artan AS, Oto OA, Ozluk Y, Ozturk S, Yazici H, Kalayoglu-Besisik S, Turkmen A. Efficacy of intravenous combined immunosuppression with plasmapheresis in adult patients with refractory primary focal segmental glomerulosclerosis. J Clin Apher 2022; 37:376-387. [PMID: 35535432 DOI: 10.1002/jca.21985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Primary focal segmental glomerulosclerosis (FSGS) treatment is based on immunosuppressive therapies. Since refractory disease is common, alternative methods are emerging. One of these methods is plasmapheresis with intravenous cyclosporine and corticosteroids, and it could be an option in post-transplant recurrent FSGS. We retrospectively investigated the efficacy of this combined treatment in adult patients with refractory primary FSGS. METHODS Seven refractory primary FSGS patients were included. Demographics, estimated glomerular filtration rates, serum albumin levels, urine protein/creatinine ratios, and previous treatments were evaluated. Also, complications and remission rates were assessed. RESULTS Median patient age was 23 years. Median duration of diagnosis was 2 years. Median number of plasmapheresis sessions was 14. Five of seven patients (71.4%, one complete, four partial remissions) were responders after the protocol. Changes in serum albumin levels and proteinuria after protocol were statistically significant (P = 0.018 and P = 0.018, respectively). eGFR levels did not change statistically (P = 0.753). Median follow-up duration after the treatment was 17 months. However, two patients experienced disease relapse (28.5%). End-stage kidney disease was developed in two patients. Sustained remission rate was 42.8% during follow-up (One complete and two partial remissions). Also, 42.8% of patients experienced catheter infections. Catheter-associated thrombosis that required surgery was observed in a patient. CONCLUSIONS Plasmapheresis combined with intravenous cyclosporine and corticosteroids could be an option in refractory primary FSGS. High response rates after this protocol were encouraging. However, the relapsing disease was observed after the cessation of apheresis. Also, complications of the protocol could limit the applicability.
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Affiliation(s)
- Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurane Guller
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seda Safak
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Savas Ozturk
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevgi Kalayoglu-Besisik
- Division of Hematology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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16
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Demir E, Tamer Dincer M, Karaca C, Erel C, Karahan L, Pekmezci A, Trabulus S, Seyahi N, Turkmen A. MO988: Malignancy After Kidney Transplantation: A Two-Center Experience. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac087.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Kidney transplantation (KT) is the preferred treatment option for patients with end-stage renal disease (ESRD) as it provides better patient survival and quality of life. While longer graft survival is maintained with potent immunosuppressive drugs used to prevent allograft rejection, de novo malignancy development after transplantation has become a substantial issue. In this study, we aimed to investigate the incidence and risk factors of post-transplant malignancy in kidney transplant recipients, including its demographic, clinical and laboratory features.
METHOD
A retrospective cohort study was conducted at two tertiary care kidney transplant centers in the same province. We recruited adult (>18 years of age) kidney transplant recipients who underwent kidney transplantation between 1986 and 2020. We excluded KT recipients who lost to follow-up in the early post-transplant period and/or with incomplete records. Malignancies that occurred after graft failure were also excluded. Kidney transplant recipients with malignancy were matched to KT recipients without malignancy using a 1:1 ratio.
RESULTS
In this study, 2750 eligible patients were reviewed for the development of malignancy after kidney transplantation. A total of 278 KT recipients (10.1%) had biopsy confirmed malignancies during the follow-up period. The median post-transplant follow-up time was 217 months (IQR: 148–290 months). The most common malignancies were nonmelanoma skin cancer (28.8%), urinary tract cancer (16.5%), Kaposi's sarcoma (9.7%), gastrointestinal tract cancer (6.5%) and post-transplant lymphoproliferative disease (6.5%). The median time from kidney transplantation to the diagnosis of malignancy was 127 months (IQR: 62–198 months).
In comparison to the control group, patients with malignancy were older (P ≤ 0.001), had a higher family history of malignancy (P ≤ 0.001), had a greater history of smoking (P = 0.005), and usage of erythropoietin in the pre-transplant period was higher (P ≤ 0.001). There was no significant difference between the two groups in terms of gender and the type of induction therapy. Overall mortality was higher in patients with malignancy (OR: 2.491 [CI: 1.586–3.912], P < 0.001).
CONCLUSION
The most common malignancy in kidney transplant recipients was found to be non-melanoma skin cancer. Elderly recipients, patients with a family history of malignancy and patients using erythropoietin in the pre-transplant period should be closely monitored for the development of malignancy.
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Affiliation(s)
- Erol Demir
- İstanbul Faculty of Medicine, İstanbul University, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Cebrail Karaca
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Cansu Erel
- İstanbul Faculty of Medicine, İstanbul University, Department of Internal Medicine, Istanbul, Turkey
| | - Latif Karahan
- İstanbul Faculty of Medicine, İstanbul University, Department of Internal Medicine, Istanbul, Turkey
| | - Aslihan Pekmezci
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Sinan Trabulus
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Nurhan Seyahi
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Aydin Turkmen
- İstanbul Faculty of Medicine, İstanbul University, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
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17
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Atasu B, Acarlı ANO, Bilgic B, Baykan B, Demir E, Ozluk Y, Turkmen A, Hauser AK, Guven G, Hanagasi H, Gurvit H, Emre M, Gasser T, Lohmann E. Genotype-Phenotype correlations of SCARB2 associated clinical presentation: a case report and in-depth literature review. BMC Neurol 2022; 22:122. [PMID: 35346091 PMCID: PMC8962058 DOI: 10.1186/s12883-022-02628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Biallelic pathogenic variants in the SCARB2 gene have been associated with action myoclonus-renal failure (AMRF) syndrome. Even though SCARB2 associated phenotype has been reported to include typical neurological characteristics, depending on the localization and the feature of the pathogenic variants, clinical course and the presentations have been shown to differ. CASE PRESENTATION Whole exome sequencing (WES) analysis revealed a homozygous truncating variant (p.N45MfsX88) in SCARB2 gene in the index case, and subsequent sanger sequencing analysis validated the variant in all affected family members from a Turkish family with the clinical characteristics associated with AMRF and related disorders. Intrafamilial clinical heterogeneity with common features including dysarthria, tremor and proteinuria, and distinct features such as peripheral neuropathy (PNP), myoclonus and seizures between the affected cases, was observed in the family. In-depth literature review enabled the detailed investigation of the reported variants associated with AMRF and suggested that while the type of the variant did not have a major impact on the course of the clinical characteristics, only the C terminal localization of the pathogenic variant significantly affected the clinical presentation, particularly the age at onset (AO) of the disease. CONCLUSIONS In this study we showed that biallelic SCARB2 pathogenic variants might cause a spectrum of common and distinct features associated with AMRF. Of those features while the common features include myoclonus (100%), ataxia (96%), tonic clonic seizures (82%), dysarthria (68%), tremor (65%), and renal impairment (62%), the uncommon features involve PNP (17%), hearing loss (6.8%), and cognitive impairment (13.7%). AO has been found to be significantly higher in the carriers of the p.G462DfsX34 pathogenic variant. SCARB2 pathogenic variants have not been only implicated in AMRF but also in the pathogenesis of Parkinson's disease (PD) and Gaucher disease (GD), suggesting the importance of genetic and functional studies in the clinical and the diagnostic settings. Given the proven role of SCARB2 gene in the pathogenesis of AMRF, PD and GD with a wide spectrum of clinical symptoms, investigation of the possible modifiers, such as progranulin and HSP7, has a great importance.
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Affiliation(s)
- Burcu Atasu
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
- German Center for Neurodegenerative Diseases (DZNE)-Tübingen, Tübingen, Germany.
| | - Ayse Nur Ozdag Acarlı
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Basar Bilgic
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Division of Nephrology, Department of Internal Medicine, Koc School of Medicine, Koc University, Istanbul, Turkey
| | - Ann-Kathrin Hauser
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE)-Tübingen, Tübingen, Germany
| | - Gamze Guven
- Institute for Experimental Medicine, Genetics Department, Istanbul University, Istanbul, Turkey
| | - Hasmet Hanagasi
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hakan Gurvit
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Emre
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Thomas Gasser
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE)-Tübingen, Tübingen, Germany
| | - Ebba Lohmann
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE)-Tübingen, Tübingen, Germany
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18
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Akcasu E, Safak S, Turkmen A. Fever, Dysuria, and AKI in a Kidney Transplant Patient. Kidney360 2022; 3:403-404. [PMID: 35373140 PMCID: PMC8967648 DOI: 10.34067/kid.0003422021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/14/2021] [Indexed: 01/10/2023]
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19
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Dirim AB, Demir E, Safak S, Garayeva N, Artan AS, Oto OA, Ozluk Y, Ozturk S, Yazici H, Besisik SK, Turkmen A. An atypical case of refractory passenger lymphocyte syndrome after renal transplantation. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Garayeva N, Demir E, Dirim AB, Safak S, Artan AS, Ozluk Y, Kílícaslan I, Turkmen A. Expression of JC virus in a kidney transplant recipient with renal cell carcinoma. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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21
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Caliskan Y, Demir E, Karatay E, Ozluk Y, Mirioglu S, Dirim AB, Artan AS, Usta Akgul S, Oto OA, Savran Oguz F, Turkmen A, Lentine KL, Yazici H. Oxidative stress and macrophage infiltration in IgA nephropathy. J Nephrol 2021; 35:1101-1111. [PMID: 34787798 DOI: 10.1007/s40620-021-01196-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/27/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the interactions among serum levels of galactose-deficient IgA1 (Gd-IgA1), oxidative stress and macrophage infiltration and their clinical correlates in patients with IgA Nephropathy (IgAN). METHODS A total of 47 patients with biopsy-proven primary IgAN, aged between 16 and 79 years, with a follow-up period ≥ 1 year or who showed progression to end stage kidney disease (ESKD) regardless the duration of follow-up were included. Study endpoint was the progression to ESKD. Serum Gd-IgA1 and advanced oxidation protein product (AOPP) levels were measured using ELISA assays. Kidney biopsies were evaluated according to the Oxford MEST-C scoring, with C4d and CD68 staining. RESULTS Seventeen patients (36%) experienced ESKD during a median follow-up time of 6 years (IQR 3.7-7.5). Serum AOPP levels were correlated with the intensity of glomerular C3 deposition (r = 0.325, p = 0.026), glomerular (r = 0.423, p = 0.003) and interstitial CD68 + cell count (r = 0.298, p = 0.042) and Gd-IgA1 levels (r = 0.289, p = 0.049). Serum Gd-IgA1 levels were correlated with the intensity of C3 deposition (r = 0.447, p = 0.002). eGFR at biopsy (adjusted HR (aHR) 0.979 p = 0.011), and E score (aHR, 8.305, p = 0.001) were associated with progression to ESKD in multivariate analysis. 5-year ESKD-free survival rate was significantly lower in patients with higher E score compared to patients with E score 0 [p = 0.021]. CONCLUSIONS An increased number of macrophages in the glomerular and tubulointerstitial area may play a role in oxidative stress and complement system activation. Endocapillary hypercellularity is a predictive factor for poor prognosis in IgAN.
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Affiliation(s)
- Yasar Caliskan
- Division of Nephrology, Saint Louis University School of Medicine, 3660 Vista Ave, Saint Louis, MO, USA. .,Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Erol Demir
- Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ecem Karatay
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Safak Mirioglu
- Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sebahat Usta Akgul
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatma Savran Oguz
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Krista L Lentine
- Division of Nephrology, Saint Louis University School of Medicine, 3660 Vista Ave, Saint Louis, MO, USA
| | - Halil Yazici
- Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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22
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Incir S, Tasdemir M, Kocak B, Yelken B, Arpali E, Akyollu B, Palaoglu KE, Baygul A, Bilge I, Turkmen A. Improving the urine spot protein/creatinine ratio by the estimated creatinine excretion to predict proteinuria in pediatric kidney transplant recipients. Pediatr Transplant 2021; 25:e14142. [PMID: 34523202 DOI: 10.1111/petr.14142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/18/2021] [Accepted: 09/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Since the daily creatinine excretion rate (CER) is directly affected by muscle mass, which varies with age, gender, and body weight, using the spot protein/creatinine ratio (Spot P/Cr) follow-up of proteinuria may not always be accurate. Estimated creatinine excretion rate (eCER) can be calculated from spot urine samples with formulas derived from anthropometric factors. Multiplying Spot P/Cr by eCER gives the estimated protein excretion rate (ePER). We aimed to determine the most applicable equation for predicting daily CER and examine whether ePER values acquired from different equations can anticipate measured 24 h urine protein (m24 h UP) better than Spot P/Cr in pediatric kidney transplant recipients. METHODS This study enrolled 23 children with kidney transplantation. To estimate m24 h UP, we calculated eCER and ePER values with three formulas adapted to children (Cockcroft-Gault, Ghazali-Barratt, and Hellerstein). To evaluate the accuracy of the methods, Passing-Bablok and Bland-Altman analysis were used. RESULTS A statistically significant correlation was found between m24 h UP and Spot P/Cr (p < .001, r = 0.850), and the correlation was enhanced by multiplying the Spot P/Cr by the eCER equations. The average bias of the ePER formulas adjusted by the Cockcroft-Gault, Ghazali-Barratt, and Hellerstein equations were -0.067, 0.031, and 0.064 g/day, respectively, whereas the average bias of Spot P/Cr was -0.270 g/day obtained by the Bland-Altman graphics. CONCLUSION Using equations to estimate eCER may improve the accuracy and reduce the spot urine samples' bias in pediatric kidney transplantation recipients. Further studies in larger populations are needed for ePER reporting to be ready for clinical practice.
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Affiliation(s)
- Said Incir
- Department of Clinical Laboratory, Koç University Hospital, Istanbul, Turkey
| | - Mehmet Tasdemir
- Department of Pediatrics, Division of Pediatric Nephrology, Koç University Hospital Istanbul, Turkey.,Department of Pediatrics, Division of Pediatric Nephrology, İstinye University School of Medicine, Istanbul, Turkey
| | - Burak Kocak
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
| | - Berna Yelken
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
| | - Emre Arpali
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
| | - Basak Akyollu
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
| | | | - Arzu Baygul
- Koç University School of Medicine, Istanbul, Turkey
| | - Ilmay Bilge
- Department of Pediatrics, Division of Pediatric Nephrology, Koç University School of Medicine, Istanbul, Turkey
| | - Aydin Turkmen
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
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23
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Amikishiyev S, Demir E, Aghamuradov S, Garayeva N, Artan AS, Gul A, Turkmen A. Reinfection with SARS-CoV-2 in a kidney transplant recipient. Transpl Infect Dis 2021; 23:e13695. [PMID: 34291543 PMCID: PMC8420343 DOI: 10.1111/tid.13695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Shirkhan Amikishiyev
- Department of Internal Medicine, Division of Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Demir
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sarvan Aghamuradov
- Department of Internal Medicine, Division of Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurana Garayeva
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Serra Artan
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Gul
- Department of Internal Medicine, Division of Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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24
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Demir E, Turkmen A, Sever MS. Risk factors, pathogenesis, presentation and management of BK virus infection in kidney transplantation. Nephrol Dial Transplant 2021; 36:985-987. [PMID: 34047340 DOI: 10.1093/ndt/gfz214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 09/11/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Erol Demir
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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25
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Caliskan Y, Karahan G, Akgul SU, Mirioglu S, Ozluk Y, Yazici H, Demir E, Dirim AB, Turkmen A, Edwards J, Savran FO, Sever MS, Kiryluk K, Gharavi A, Lentine KL. LIMS1 Risk Genotype and T-Cell Mediated Rejection in Kidney Transplant Recipients. Nephrol Dial Transplant 2021; 36:2120-2129. [PMID: 33909908 DOI: 10.1093/ndt/gfab168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This study aims to examine the association of LIM Zinc Finger Domain Containing 1 (LIMS1) genotype with allograft rejection in an independent kidney transplant cohort. METHODS We genotyped 841 kidney transplant recipients for LIMS1 rs893403 variant by Sanger sequencing followed by PCR confirmation of the deletion. Recipients who were homozygous for LIMS1 rs893403 genotype GG were compared to AA/AG genotypes. The primary outcome was T-cell mediated (TCMR) or antibody mediated rejection (ABMR) and secondary outcome was allograft loss. RESULTS After a median follow-up of 11.4 years, the rate of TCMR was higher in recipients with the GG (n = 200) compared to AA/AG (n = 641) genotypes [25 (12.5%) vs 35 (5.5%); p = 0.001] while ABMR did not differ by genotype [18 (9.0%) vs 62 (9.7%)]. Recipients with GG genotype had 2.4-times higher risk of TCMR than those who did not have this genotype (adjusted hazard ratio (aHR), 1.442.434.12, p = 0.001). A total of 189 (22.5%) recipients lost their allografts during follow up. Kaplan-Meier estimates of 5-year (94.3% vs. 94.4%, p = 0.99) and 10-year graft survival rates (86.9% vs. 83.4%, p = 0.31) did not differ significantly in those with GG compared to AA/AG groups. CONCLUSIONS Our study demonstrates that recipient LIMS1 risk genotype is associated with increased risk of TCMR after kidney transplantation, confirming the role of LIMS1 locus in allograft rejection. These findings may have clinical implications for the prediction and clinical management of kidney transplant rejection by pretransplant genetic testing of recipients and donors for LIMS1 risk genotype.
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Affiliation(s)
- Yasar Caliskan
- Division of Nephrology, Saint Louis University, Saint Louis, MO, USA.,Division of Nephrology, Istanbul University School of Medicine, Turkey
| | - Gonca Karahan
- Department of Medical Biology, Istanbul University School of Medicine, Turkey.,Leiden University Medical Center, Leiden, The Netherlands
| | - Sebahat Usta Akgul
- Department of Medical Biology, Istanbul University School of Medicine, Turkey
| | - Safak Mirioglu
- Division of Nephrology, Istanbul University School of Medicine, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul University School of Medicine, Turkey
| | - Halil Yazici
- Division of Nephrology, Istanbul University School of Medicine, Turkey
| | - Erol Demir
- Division of Nephrology, Istanbul University School of Medicine, Turkey
| | - Ahmet B Dirim
- Division of Nephrology, Istanbul University School of Medicine, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Istanbul University School of Medicine, Turkey
| | - John Edwards
- Division of Nephrology, Saint Louis University, Saint Louis, MO, USA
| | - Fatma Oguz Savran
- Department of Medical Biology, Istanbul University School of Medicine, Turkey
| | - Mehmet S Sever
- Division of Nephrology, Istanbul University School of Medicine, Turkey
| | | | - Ali Gharavi
- Division of Nephrology, Columbia University Medical Center, NY, USA
| | - Krista L Lentine
- Division of Nephrology, Saint Louis University, Saint Louis, MO, USA
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26
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Arpali E, Sunnetcioglu E, Demir E, Saglam A, Ozluk Y, Velioglu A, Yelken B, Baydar DE, Turkmen A, Oguz FS. Significance of caveolin-1 immunohistochemical staining differences in biopsy samples from kidney recipients with BK virus viremia. Transpl Infect Dis 2021; 23:e13605. [PMID: 33749103 DOI: 10.1111/tid.13605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/08/2021] [Accepted: 03/14/2021] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Emre Arpali
- Department of Medical Biology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ecem Sunnetcioglu
- Department of Pathology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Arzu Saglam
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Arzu Velioglu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Berna Yelken
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
| | - Dilek E Baydar
- Department of Pathology, School of Medicine, Koç University, İstanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatma S Oguz
- Department of Medical Biology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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27
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Dirim AB, Demir E, Yadigar S, Garayeva N, Parmaksiz E, Safak S, Bahat KA, Ucar AR, Oruc M, Oto OA, Medetalibeyoglu A, Basaran S, Orhun G, Yazici H, Turkmen A. COVID-19 in chronic kidney disease: a retrospective, propensity score-matched cohort study. Int Urol Nephrol 2021; 53:2117-2125. [PMID: 33548044 PMCID: PMC7864795 DOI: 10.1007/s11255-021-02783-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/19/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND The prognostic factors for COVID-19 in patients with chronic kidney disease (CKD) are uncertain. We conducted a study to compare clinical and prognostic features between hospitalized COVID-19 patients with and without CKD. METHODS Fifty-six patients with stage 3-5 CKD and propensity score-matched fifty-six patients without CKD were included in the study. Patients were followed-up at least fifteen days or until death after COVID-19 diagnosis. The endpoints were death from all causes, development of acute kidney injury (AKI) or cytokine release syndrome or respiratory failure, or admission to the intensive care unit (ICU). RESULTS All patients were reviewed retrospectively over a median follow-up of 44 days (IQR, 36-52) after diagnosis of COVID-19. Patients with CKD had higher intensive care unit admission and mortality rates than the patients without CKD, but these results did not reach statistical significance (16 vs. 19; p = 0.54 and 11 vs. 16, p = 0.269, respectively). The frequency of AKI development was significantly higher in predialysis patients with CKD compared to the other group (8 vs. 5; p < 0.001), but there was no significant difference between the groups in terms of cytokine release syndrome (13 vs. 8; p = 0.226), follow-up in the ICU (19 vs. 16; p = 0.541), and respiratory failure (25 vs. 22, p = 0.566). Multivariate logistic regression analysis revealed that respiratory failure and AKI were independent risk factors for mortality. CONCLUSION The mortality rates of COVID-19 patients with CKD had higher than COVID-19 patients without CKD. Also, AKI and respiratory failure were independently related to mortality.
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Affiliation(s)
- Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serap Yadigar
- Division of Nephrology, Department of Internal Medicine, Dr. Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey
| | - Nurana Garayeva
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ergun Parmaksiz
- Division of Nephrology, Department of Internal Medicine, Dr. Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey
| | - Seda Safak
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kubra Aydin Bahat
- Division of Nephrology, Department of Internal Medicine, Dr. Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey
| | - Ali Riza Ucar
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Meric Oruc
- Division of Nephrology, Department of Internal Medicine, Dr. Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alpay Medetalibeyoglu
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seniha Basaran
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gunseli Orhun
- Department of Anesthesiology and Intensive Care, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Safak S, Aksoy E, Dirim AB, Demir E, Garayeva N, Oto OA, Artan AS, Yazici H, Besisik S, Turkmen A. Successful treatment of a COVID-19 patient with thrombotic microangiopathy. Clin Kidney J 2021; 14:1287-1288. [PMID: 34094522 PMCID: PMC7929034 DOI: 10.1093/ckj/sfab024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/11/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Seda Safak
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Elif Aksoy
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurana Garayeva
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevgi Besisik
- Division of Hematology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Sumnu A, Turkmen K, Cebeci E, Turkmen A, Eren N, Seyahi N, Oruc A, Dede F, Derici Ü, Basturk T, Şahin G, Sipahioglu M, Sahin GM, Tatar E, Dursun B, Sipahi S, Yılmaz M, Suleymanlar G, Ulu S, Gungor O, Kutlay S, Bahçebaşı ZB, Sahin İ, Kurultak I, Sevinc C, Yilmaz Z, Kazancioglu RT, Cavdar C, Candan F, Aydin Z, Oygar D, Gul B, Altun B, Paydas S, Uzun S, Istemihan Z, Ergul M, Dincer MT, Gullulu M, Piskinpasa S, Akcay OF, Unsal A, Koyuncu S, Gok M, Ozturk S. Characteristics of primary glomerular diseases patients with hematuria in Turkey: the data from TSN-GOLD Working Group. Int Urol Nephrol 2020; 53:945-954. [PMID: 33155086 DOI: 10.1007/s11255-020-02690-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Hematuria is one of the most common laboratory findings in nephrology practice. To date, there is no enough data regarding the clinical and histopathologic characteristics of primary glomerular disease (PGD) patients with hematuria in our country. METHODS Data were obtained from national multicenter (47 centers) data entered into the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database between May 2009 and June 2019. The data of all PGD patients over the age of 16 years who were diagnosed with renal biopsy and had hematuria data were included in the study. Demographic characteristics, laboratory and biopsy findings were also recorded. RESULTS Data of 3394 PGD patients were included in the study. While 1699 (50.1%) patients had hematuria, 1695 (49.9%) patients did not have hematuria. Patients with hematuria had statistically higher systolic blood pressure, serum blood urea nitrogen, creatinine, albumin, levels and urine pyuria. However, these patients had statistically lower age, body mass index, presence of hypertension and diabetes, eGFR, 24-h proteinuria, serum total, HDL and LDL cholesterol, and C3 levels when compared with patients without hematuria. Hematuria was present 609 of 1733 patients (35.8%) among the patients presenting with nephrotic syndrome, while it was presented in 1090 of 1661 (64.2%) patients in non-nephrotics (p < 0.001). CONCLUSION This is the first multicenter national report regarding the demographic and histopathologic data of PGD patients with or without hematuria. Hematuria, a feature of nephritic syndrome, was found at a higher than expected in the PGDs presenting with nephrotic syndrome in our national database.
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Affiliation(s)
- Abdullah Sumnu
- Department of Nephrology, Medical Faculty, Medipol Mega Hastanesi, Medipol University, Göztepe Mahallesi Metin Sk. No: 4, Bağcılar, Istanbul, Turkey.
| | - Kultigin Turkmen
- Nephrology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Egemen Cebeci
- Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Aydin Turkmen
- Nephrology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Necmi Eren
- Nephrology Medical Faculty, Kocaeli University, İzmit, Kocaeli, Turkey
| | - Nurhan Seyahi
- Nephrology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Aysegul Oruc
- Nephrology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Fatih Dede
- Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ülver Derici
- Nephrology, Medical Faculty, Gazi University, Ankara, Turkey
| | - Taner Basturk
- Nephrology, Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Garip Şahin
- Nephrology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Murat Sipahioglu
- Nephrology, Medical Faculty, Erciyes University, Kayseri, Turkey
| | - Gulizar Manga Sahin
- Nephrology, Sultan Abdulhamit Han Research and Training Hospital, Istanbul, Turkey
| | - Erhan Tatar
- Nephrology, Bozyaka Training and Research Hospital, Izmır, Turkey
| | - Belda Dursun
- Nephrology, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Savas Sipahi
- Nephrology, Medical Faculty, Sakarya University, Sakarya, Turkey
| | - Mürvet Yılmaz
- Nephrology, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Sena Ulu
- Nephrology, Medical Faculty, Afyon University, Afyon, Turkey
| | - Ozkan Gungor
- Nephrology, Medical Faculty, Sutcu İmam University, Kahramanmaras, Turkey
| | - Sim Kutlay
- Nephrology, İbni Sina Hospital, Medical Faculty, Ankara University, Ankara, Turkey
| | | | - İdris Sahin
- Nephrology, Medical Faculty, Inonu University, Malatya, Turkey
| | - Ilhan Kurultak
- Nephrology, Medical Faculty, Trakya University, Edirne, Turkey
| | - Can Sevinc
- Nephrology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | | | | | - Caner Cavdar
- Nephrology, Medical Faculty, Dokuz Eylul University, Izmir, Turkey
| | - Ferhan Candan
- Nephrology, Medical Faculty, Cumhuriyet University, Sivas, Turkey
| | - Zeki Aydin
- Nephrology, Darica Farabi Training and Research Hospital, Darıca, Kocaeli, Turkey
| | - Deren Oygar
- Nephrology, Burhan Nalbantoglu State Hospital, Lefkosa, Cyprus
| | - Bulent Gul
- Nephrology, Bursa Yuksek Ihtisas Training and Research Hospital, Nilüfer, Bursa, Turkey
| | - Bulent Altun
- Nephrology, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Saime Paydas
- Nephrology, Medical Faculty, Cukurova University, Adana, Turkey
| | - Sami Uzun
- Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Zulal Istemihan
- Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Metin Ergul
- Nephrology Medical Faculty, Kocaeli University, İzmit, Kocaeli, Turkey
| | - Mevlut Tamer Dincer
- Nephrology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mustafa Gullulu
- Nephrology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Serhan Piskinpasa
- Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | | | - Abdulkadir Unsal
- Nephrology, Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sumeyra Koyuncu
- Nephrology, Medical Faculty, Erciyes University, Kayseri, Turkey
| | - Mahmut Gok
- Nephrology, Sultan Abdulhamit Han Research and Training Hospital, Istanbul, Turkey
| | - Savas Ozturk
- Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey
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Dirim AB, Demir E, Ucar AR, Garayeva N, Safak S, Oto OA, Yazici H, Alibeyoglu AM, Orhun G, Cagatay AA, Turkmen A. Fatal SARS-CoV-2 infection in a renal transplant recipient. CEN Case Rep 2020; 9:409-412. [PMID: 32564306 PMCID: PMC7305930 DOI: 10.1007/s13730-020-00496-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) caused a pandemic that first discovered in Wuhan, China. While 10% of the patients have asymptomatic infection, 15-20% have lung involvement, 5-10% have multiple organ failure, and macrophage activation syndrome. Chronic respiratory diseases, diabetes mellitus, hypertension, and cancer are risk factors for mortality. Prognosis or optimal treatment strategy for renal transplant recipients in SARS-CoV-2 infection is still unknown. Besides fatal cases, there were also milder case reports. In addition, COVID-19 treatment and the maintenance immunosuppression strategy is still under debate. Antiviral therapies and drug interactions are special topics for these patients. To the best of our knowledge, favipiravir and anti-cytokine treatments have not been previously reported in a kidney transplant recipient with SARS-CoV-2 infection before. We report a case of SARS-CoV-2 infection in a kidney transplant recipient with fatal outcomes.
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Affiliation(s)
- Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Riza Ucar
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurana Garayeva
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seda Safak
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alpay Medet Alibeyoglu
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gunseli Orhun
- Department of Anesthesiology and Intensive Care, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Arif Atahan Cagatay
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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31
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Oto OA, Yazici H, Caliskan Y, Artan AS, Sever MS, Cebeci E, Ozturk S, Turkmen A. Presence of M-type Phospholipase A2 Receptor Antibody in Membranous Nephropathy. Turk J Nephrol 2020. [DOI: 10.5152/turkjnephrol.2020.3733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Demir E, Uyar M, Parmaksiz E, Sinangil A, Yelken B, Dirim AB, Merhametsiz O, Yadigar S, Atan Ucar Z, Ucar AR, Demir ME, Mese M, Akin EB, Garayeva N, Safak S, Oto OA, Yazici H, Turkmen A. COVID-19 in kidney transplant recipients: A multicenter experience in Istanbul. Transpl Infect Dis 2020; 22:e13371. [PMID: 32657540 PMCID: PMC7404438 DOI: 10.1111/tid.13371] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/04/2020] [Accepted: 06/14/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Management of COVID-19 in kidney transplant recipients should include treatment of the infection, regulation of immunosuppression, and supportive therapy. However, there is no consensus on this issue yet. This study aimed to our experiences with kidney transplant recipients diagnosed with COVID-19. MATERIAL AND METHODS Kidney transplant recipients diagnosed with COVID-19 from five major transplant centers in Istanbul, Turkey, were included in this retrospective cohort study. Patients were classified as having moderate or severe pneumonia for the analysis. The primary endpoint was all-cause mortality. The secondary endpoints were acute kidney injury, the average length of hospital stay, admission to intensive care, and mechanical ventilation. RESULTS Forty patients were reviewed retrospectively over a follow-up period of 32 days after being diagnosed with COVID-19. Cough, fever, and dyspnea were the most frequent symptoms in all patients. The frequency of previous induction and rejection therapy was significantly higher in the group with severe pneumonia compared to the moderate pneumonia group. None of the patients using cyclosporine A developed severe pneumonia. Five patients died during follow-up in the intensive care unit. None of the patients developed graft loss during follow-up. DISCUSSION COVID-19 has been seen to more commonly cause moderate or severe pneumonia in kidney transplant recipients. Immunosuppression should be carefully reduced in these patients. Induction therapy with lymphocyte-depleting agents should be carefully avoided in kidney transplant recipients during the pandemic period.
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Affiliation(s)
- Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murathan Uyar
- Division of Nephrology, Department of Internal Medicine, Gaziosmanpasa Hospital, Yeniyuzyil University, Istanbul, Turkey
| | - Ergun Parmaksiz
- Division of Nephrology, Department of Internal Medicine, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ayse Sinangil
- Division of Nephrology, Department of Internal Medicine, Florence Nightingale Hospital, Demiroglu Bilim University, Istanbul, Turkey
| | - Berna Yelken
- Division of Nephrology, Department of Internal Medicine, Koc School of Medicine, Koc University, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozgur Merhametsiz
- Division of Nephrology, Department of Internal Medicine, Gaziosmanpasa Hospital, Yeniyuzyil University, Istanbul, Turkey
| | - Serap Yadigar
- Division of Nephrology, Department of Internal Medicine, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Zuhal Atan Ucar
- Division of Nephrology, Department of Internal Medicine, Florence Nightingale Hospital, Demiroglu Bilim University, Istanbul, Turkey
| | - Ali Riza Ucar
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Emin Demir
- Division of Nephrology, Department of Internal Medicine, Gaziosmanpasa Hospital, Yeniyuzyil University, Istanbul, Turkey
| | - Meral Mese
- Division of Nephrology, Department of Internal Medicine, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Emin Baris Akin
- Division of Nephrology, Department of Internal Medicine, Florence Nightingale Hospital, Demiroglu Bilim University, Istanbul, Turkey.,Unit of Renal Transplantation, Department of General Surgery, Florence Nightingale Hospital, Demiroglu Bilim University, Istanbul, Turkey
| | - Nurana Garayeva
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seda Safak
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Division of Nephrology, Department of Internal Medicine, Koc School of Medicine, Koc University, Istanbul, Turkey
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Dirim AB, Demir E, Safak S, Garayeva N, Ucar AR, Oto OA, Yazici H, Medetalibeyoglu A, Kose M, Esen F, Simsek Yavuz S, Turkmen A. Hydroxychloroquine-Associated Hypoglycemia in Hemodialysis Patients With COVID-19. Kidney Int Rep 2020; 5:1811-1814. [PMID: 32838079 PMCID: PMC7354765 DOI: 10.1016/j.ekir.2020.06.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 01/30/2023] Open
Affiliation(s)
- Ahmet Burak Dirim
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Demir
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seda Safak
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurana Garayeva
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Riza Ucar
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozgur Akin Oto
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alpay Medetalibeyoglu
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Kose
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Figen Esen
- Department of Anesthesiology and Intensive Care, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serap Simsek Yavuz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Turgutalp K, Cebeci E, Turkmen A, Derici Ü, Seyahi N, Eren N, Dede F, Gullulu M, Basturk T, Manga Sahin G, Yılmaz M, Sipahi S, SAHIN G, Ulu MS, Tatar E, Gundogdu A, Turan Kazancioglu R, Sevinc C, Gungor O, Sahin İ, Kutlay S, Kurultak I, Aydin Z, Altun B, Dursun B, Yilmaz Z, Uzun O, Suleymanlar G, Candan F, Sezer S, Tanburoglu DB, Bicik Bahçebaşı Z, Guven Taymez D, Oygar D, Akcali E, Istemihan Z, Akcay OF, Dincer MT, Ergul M, Yenigun E, Turkmen K, Ozturk S. P0490IS THE SEVERITY OF GLOMERULAR IGG STAINING IN PATIENT WITH IGA NEPHROPATHY USEFUL FOR PREDICTING POOR RENAL PROGNOSIS? THE DATA FROM TSN-GOLD WORKING GROUP. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
In IgA nephropathy (IgAN), which is characterized by mesangial IgA accumulation, there is the formation of circulating autoantibodies against galactose deficient IgA1s (Gd-IgA1). IgG / Gd-IgA1 immunocomplexes accumulate in the glomerular mesangium and play a role in the pathogenesis of IgAN. Recent studies have suggested a relationship between glomerular IgG deposition and the severity of glomerular inflammation. However, detection of the presence and severity of IgG in routine immunofluorescence microscopy (IFM) may fail. This study aims to investigate whether IgG positivity detected by IFM is associated with poor renal prognostic indicators and whether renal prognosis can be predicted according to IgG positivity.
Method
4399 patients who were enrolled between May 2009-June 2019 in database of Turkish Society of Nephrology, Glomerular Diseases Working Group (TSN-GOLD) including 44 centers were evaluated. After exclusion criteria, 994 primary IgAN patients were included in the study. Glomerular IgG negative and positive patients were compared by means of Oxford classification scores, histopathological evaluations, proteinuria, creatinine, albumin, blood pressures. IgG positive patients were divided into subgroups according to the grade of the IFM positivity. The relationship between IgG positivity and poor prognosis criteria were evaluated.
Results
Demographic and biochemical findings of glomerular IgG positive and negative patients at the time of biopsy are shown in Table 1. No difference was found between the groups. There was no difference in the demographic and biochemical findings at the time of biopsy in IgG subgroup analyses (Table 2). There was no difference between the histopathological and Oxford MEST scores of the subgroups. Glomerular IgG positivity was not associated with diastolic blood pressure, systolic blood pressure, urea, uric acid, age, eGFR, albumin, proteinuria (p> 0.05 for all, r= -0.084, r= -0.102, r= -0.006, r=0.062, r= 0.014, r= -0.044, r= -0.061, r= -0.066, r= 0.150, respectively).
Conclusion
Glomerular IgG positivity detected by routine IFM in IgAN is not associated with poor renal prognostic indicators. It is difficult to predict renal prognosis by looking at the severity of IgG positivity at the baseline evaluation.
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Affiliation(s)
| | - Egemen Cebeci
- Haseki Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul University, Department of Nephrology, Istanbul, Turkey
| | - Ülver Derici
- Gazi University Faculty of Medicine, Department of Nephrology, Ankara, Turkey
| | - Nurhan Seyahi
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Necmi Eren
- Kocaeli University, Department of Nephrology, Kocaeli, Turkey
| | - Fatih Dede
- Health Sciences University, Ankara Numune Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Mustafa Gullulu
- Uludag University Faculty of Medicine, Department of Medicine, Bursa, Turkey
| | - Taner Basturk
- Health Sciences University, Sıslı Hamidiye Etfal Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Gulizar Manga Sahin
- Istanbul Abdulhamid Han Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Mürvet Yılmaz
- Health Sciences University, Bakirkoy Sadi Konuk Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Savas Sipahi
- Sakarya University Medical Faculty Education and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Garip SAHIN
- Eskisehir Osmangazi University, Department of Nephrology, Istanbul, Turkey
| | - Memnune Sena Ulu
- Afyon Health Sciences University, Department of Nephrology, Afyon, Turkey
| | - Erhan Tatar
- Health Sciences University, Izmir Bozyaka Training and Research Hospital, Department of Nephrology, Izmir, Turkey
| | - Ali Gundogdu
- Erciyes University, Department of Nephrology, Kayseri, Turkey
| | | | - Can Sevinc
- Atatürk University, Department of Nephrology, Erzurum, Turkey
| | - Ozkan Gungor
- Kahramanmaras Sutcu Imam University, Department of Nephrology, Kahramanmaraş, Turkey
| | - İdris Sahin
- Inonu University Faculty of Medicine, Department of Nephrology, Malatya, Turkey
| | - Sim Kutlay
- Ankara University, School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Ilhan Kurultak
- Trakya University, Department of Nephrology, Edirne, Turkey
| | - Zeki Aydin
- Darica Farabi Training and Research Hospital, Department of Nephrology, Kocaeli, Turkey
| | - Bulent Altun
- Hacettepe University, Department of Nephrology, Ankara, Turkey
| | - Belda Dursun
- Pamukkale University, Department of Nephrology, Denizli, Turkey
| | - Zulfikar Yilmaz
- Dicle University, Department of Nephrology, Diyarbakır, Turkey
| | - Ozcan Uzun
- Dokuz Eylül University, Department of Nephrology, İzmir, Turkey
| | | | - Ferhan Candan
- Cumhuriyet University, Department of Nephrology, Sivas, Turkey
| | - Siren Sezer
- Atilim University Medicana International Hospital, Department of Nephrology, Ankara, Turkey
| | | | - Zerrin Bicik Bahçebaşı
- Kartal Lutfi Kirdar Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | | | - Deren Oygar
- Lefkosa BND Training and Research Hospital, Department of Nephrology, Lefkosa, Cyprus
| | - Esra Akcali
- Mersin University, Department of Nephrology, Mersin, Turkey
| | - Zulal Istemihan
- Istanbul University, Department of Nephrology, Istanbul, Turkey
| | - Omer Faruk Akcay
- Gazi University Faculty of Medicine, Department of Nephrology, Ankara, Turkey
| | - Mevlut Tamer Dincer
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Metin Ergul
- Kocaeli University, Department of Nephrology, Kocaeli, Turkey
| | - Ezgi Yenigun
- Health Sciences University, Ankara Numune Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Kultigin Turkmen
- Necmettin Erbakan University, Meram School of Medicine, Department of Internal Medicine, Division of Nephrology, Konya, Turkey
| | - Savas Ozturk
- Haseki Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
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Demir E, Kayaş K, Erel C, Caparali B, Ozler TE, Dirim AB, Catikkas NM, Guller N, Safak S, Ucar AR, Oto OA, Yazici H, Caliskan YK, Akgul SU, Temurhan S, Ozluk Y, Kilicaslan I, Yildiz A, Turkmen A, Sever MS. P1743IMPORTANCE OF KIDNEY ALLOGRAFT REJECTİON IN BK VIRUS NEPHROPATHY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Allograft rejection following BK virus nephropathy (BKVN) is an important cause of allograft loss in kidney transplant recipients. However, the effect of rejection type on allograft survival in patients with BKVN has not been described previously. This study aimed to investigate the relationship between allograft rejection type and graft survival in patients with BKVN.
Method
We retrospectively analyzed the data of 159 kidney transplant recipients diagnosed BKVN and followed-up in our center between January 2009 and December 2019. BKVN was diagnosed by persistent viremia of more than 10000 copies/mL for four weeks or allograft biopsy. Vascular, obstructive or other non-parenchymal etiologies for allograft dysfunction were excluded. All patients were investigated for the presence of anti-HLA antibody at 6 and 12 months after BKVN diagnosis. Luminex solid-phase assay was used to investigate Class I and Class II PRA and MFI values greater than 1000 were accepted as positive. Allograft biopsy was performed in patients with progressive graft dysfunction or the presence of donor-specific antibodies (DSA) and analyzed according to the Banff Classification. The primary outcomes were defined as allograft loss or the allograft dysfunction which defined as was doubling serum creatinine levels.
Results
Patients were followed-up median 70 (IQR 13-198) months after kidney transplantation. Demographic data and clinical characteristics are provided in the table. 28 kidney transplant recipients suffered from allograft rejection after BKVN. Median rejection time to rejection after BKVN was 9 (IQR 5-164) months. 3 patients (18,8%) in the AMR group and 1 patient (8,3%) in the TCMR group experienced graft loss during follow-up. The mean serum creatinine levels at the last clinical visit were significantly higher in the AMR group compared to the TCMR group (1,9±0,8 vs 1,3±1,2 mg/dl; p=0,002). In multivariate analysis, AMR was an independent risk factor for allograft dysfunction (HR, 1,735; 95% CI 1,060 to 2,839; p=0,028).
Conclusion
The occurrence of AMR after BKVN is an important indicator of allograft dysfunction compared to TCMR. DSA screening should be routinely used in this group for early diagnosis and treatment of AMR.
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Affiliation(s)
- Erol Demir
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Kamil Kayaş
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Cansu Erel
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Bilge Caparali
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Tuba Elif Ozler
- Haseki Education Research Hospital, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Nezahat Muge Catikkas
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Nurana Guller
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Seda Safak
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Ali Riza Ucar
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Ozgur Akin Oto
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Halil Yazici
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Yasar Kerem Caliskan
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Sebahat Usta Akgul
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Biology, Istanbul, Turkey
| | - Sonay Temurhan
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Biology, Istanbul, Turkey
| | - Yasemin Ozluk
- Istanbul University, Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Isin Kilicaslan
- Istanbul University, Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Alaattin Yildiz
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
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36
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Turkmen A, Sumnu A, Cebeci E, Yazici H, Eren N, Seyahi N, Dilek K, Dede F, Derici Ü, Unsal A, SAHIN G, Sipahioglu M, Gok M, Tatar E, Dursun B, Sipahi S, Yılmaz M, Suleymanlar G, Ulu MS, Gungor O, Kutlay S, Bicik Bahçebaşı Z, Sahin İ, Kurultak I, Turkmen K, Yilmaz Z, Turan Kazancioglu R, Cavdar C, Candan F, Aydin Z, Oygar D, Gul CB, Arici M, Paydas S, Guven Taymez D, Kucuk M, Trablus S, Turgutalp K, Koc L, Sezer S, Duranay M, Bardak S, Altintepe L, Arikan IH, Azak A, Odabas AR, Manga Sahin G, Ozturk S. P0501THE EPIDEMIOLOGICAL FEATURES OF PIRMARY GLOMERULAR DISEASES IN TURKEY: THE MULTICENTER STUDY OF TURKISH SOCIETY OF NEPHROLOGY GLOMERULAR DISEASES (TSN-GOLD) WORKING GROUP. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
The largest data on the epidemiology of primary glomerular diseases (PGD) are obtained from the databases of countries or centers. Here, we presented the extended results of the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD)Working Group.
Method
The data of patients who underwent renal biopsy and diagnosed as primary glomerular disease were recorded in the database prepared for the study. Between May 2009 and May 2019, a total of 4399 patients from 47 centers were evaluated. Basal data of 3875 patients were analyzed after exclusion of those lacking light microscopy and immunofluorescence findings.
Results
The mean age was 41.5 ± 14.9 years. Of the patients, 1690 were female (43.6%) and 2180 (56.3%) were male. Nephrotic syndrome was the most common biopsy indication (51.7%). This was followed by asymptomatic urinary abnormalities (18.3%) and nephritic syndrome (17.8%). The most common PGH was IgA nephropathy (25.7%), followed by membranous nephropathy (25.6%) and FSGS (21.9%). The mean total number of glomeruli per biopsy was 17 ± 10. Mean baseline systolic blood pressure was 130 ± 20 mmHg and diastolic blood pressure was 81 ± 12 mmHg. Median proteinuria was 3300 (IQR: 1467-6307) mg / day, mean serum creatinine, estimated GFR and albumin values were 1.4 ± 1.5 mg / dl, 80.7 ± 39.1 ml / min and 3.2 ± 0.9 g / dl, respectively.
Conclusion
In Turkey, the incidence of IgA nephropathy patients have become more common than membranous nephropathy among PGD patients diagnosed with renal biopsy.
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Affiliation(s)
- Aydin Turkmen
- Istanbul University, Istanbul Faculty of Medicine, Nephrology, Istanbul, Turkey
| | - Abdullah Sumnu
- Medipol University Medical Faculty, Medipol Mega Hospital, Nephrology, İstanbul, Turkey
| | - Egemen Cebeci
- Haseki Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Halil Yazici
- Istanbul University, Istanbul Faculty of Medicine, Nephrology, Istanbul
| | - Necmi Eren
- Kocaeli University Medical Faculty, Nephrology, Kocaeli, Turkey
| | - Nurhan Seyahi
- Istanbul University, Cerrahpasa Faculty of Medicine, Nephrology, Istanbul, Turkey
| | - Kamil Dilek
- Uludag University, Medical Faculty, Nephrology, Bursa, Turkey
| | - Fatih Dede
- Ankara Numune Training and Research Hospital, Nephrology, Ankara, Turkey
| | - Ülver Derici
- Gazi University Medical Faculty, Nephrology, Ankara, Turkey
| | - Abdulkadir Unsal
- Hamidiye Sisli Etfal Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Garip SAHIN
- Eskisehir Osmangazi University, Medical Faculty, Nephrology, Eskisehir, Turkey
| | - Murat Sipahioglu
- Erciyes University, Medical Faculty, Nephrology, Kayseri, Turkey
| | - Mahmut Gok
- Sultan Abdulhamit Han Research and Training Hospital, Nephrology, Istanbul, Turkey
| | - Erhan Tatar
- Bozyaka Training and Research Hospital, Nephrology, Izmır, Turkey
| | - Belda Dursun
- Pamukkale University, Medical Faculty, Nephrology, Denizli, Turkey
| | - Savaş Sipahi
- Sakarya University, Medical Faculty, Nephrology, Sakarya, Turkey
| | - Mürvet Yılmaz
- Bakirkoy Sadi Konuk Training and Research Hospital, Nephrology, Istanbul, Turkey
| | | | | | - Ozkan Gungor
- Sutcu İmam University, Medical Faculty, Nephrology, Kahramanmaras, Turkey
| | - Sim Kutlay
- Ankara University, Medical Faculty, İbni Sina Hospital, Nephrology, Ankara, Turkey
| | | | - İdris Sahin
- Inonu University, Medical Faculty, Nephrology, Malatya, Turkey
| | - Ilhan Kurultak
- Trakya University, Medical Faculty, Nephrology, Istanbul, Turkey
| | - Kultigin Turkmen
- Necmettin Erbakan University, Meram Medicine Faculty, Nephrology, Konya, Turkey
| | - Zulfikar Yilmaz
- Dicle University, Medical Faculty, Nephrology, Diyarbakir, Turkey
| | | | - Caner Cavdar
- Dokuz Eylul University, Medical Faculty, Nephrology, Izmir, Turkey
| | - Ferhan Candan
- Cumhuriyet University, Medical Faculty, Nephrology, Sivas, Turkey
| | - Zeki Aydin
- Darica Farabi Training and Research Hospital, Nephrology, Kocaeli, Turkey
| | - Deren Oygar
- Burhan Nalbantoglu State Hospital, Nephrology, Lefkosa, Cyprus
| | - Cuma Bulent Gul
- Bursa Yuksek Ihtisas Training and Research Hospital, Nephrology, Bursa, Turkey
| | - Mustafa Arici
- Hacettepe University, Medical Faculty, Nephrology, Ankara, Turkey
| | - Saime Paydas
- Cukurova University, Medical Faculty, Nephrology, Adana, Turkey
| | | | - Mehmet Kucuk
- Okmeydanı Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Sinan Trablus
- Istanbul Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Kenan Turgutalp
- Mersin University, Medical Faculty, Nephrology, Mersin, Turkey
| | - Leyla Koc
- Taksim Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Siren Sezer
- Atilim University, Medicana International Hospital, Nephrology, Ankara, Turkey
| | - Murat Duranay
- Ankara Training and Research Hospital, Nephrology, Ankara, Turkey
| | - Simge Bardak
- Batman State Hospital, Nephrology, Batman, Turkey
| | | | | | - Alper Azak
- Balikesir Training and Research Hospital, Nephrology, Balikesir, Turkey
| | - Ali Riza Odabas
- Medeniyet University Medical School, Goztepe Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Gulizar Manga Sahin
- Sultan Abdulhamit Han Research and Training Hospital, Nephrology, Istanbul, Turkey
| | - Savas Ozturk
- Haseki Training and Research Hospital, Nephrology, Istanbul, Turkey
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Mirioglu S, Gurel E, Guzel-Dirim M, Kara A, Ozluk Y, Aktar I, Dirim AB, Ciftkaya A, Oto OA, Caliskan YK, Kilicaslan I, Yazici H, Turkmen A, Sever MS. P0406ASSOCIATION OF MICROHEMATURIA WITH OUTCOMES IN ADULT PATIENTS WITH IGA NEPHROPATHY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Although hematuria is the cardinal symptom of IgA nephropathy (IgAN), its effects on the outcome have not been studied extensively. We, therefore, aimed to analyze the association between microhematuria and clinicopathological features as well as outcome parameters in adult patients with IgAN.
Method
129 adults with IgAN, diagnosed by kidney biopsy, and followed up for a median duration of 54.5 (IQR: 24.25-92.75) months, were included in this retrospective study. Urinary sediment analyses during the bouts of macrohematuria were not taken into consideration. For the purpose of this analysis, microhematuria was described as ≥5 red blood cells per high-power field (RBCs/hpf) and classified as mild (5-9 RBCs/hpf), moderate (10-19 RBCs/hpf), or severe (≥20 RBCs/hpf). Study outcome (event) was defined as at least a 50% reduction in baseline eGFR or development of stage 5 chronic kidney disease (eGFR <15 ml/min/1.73 m2). eGFRs of the patients were calculated by using CKD-EPI formula.
Results
Demographic, clinical, laboratory and histopathological features of patients at the time of diagnosis are summarized in the table. Usage of ACEi/ARBs [75/81 (92.5%) vs 45/48 (93.75%), p=0.803], fish oil [30/81 (37%) vs 19/48 (39.5%), p=0.773], azathioprine [16/81 (19.7%) vs 10/48 (20.8%), p=0.882] and mycophenolic acid derivatives [14/81 (17.2%) vs 11/48 (22.9%), p=0.434] were comparable among the patients with and without microhematuria. Corticosteroids were more frequently used in patients with microhematuria [41/81 (50.6%) vs 17/48 (35.4%)], although this difference was not statistically significant (p=0.093). Overall 30 patients (23.2%) reached the study outcome, and there were no differences between patients with (19, 23.4%) and without (11, 22.9%) microhematuria (p=0.944). Kaplan-Meier analysis revealed that event free survival rates were similar across study groups: 77.1% for patients without microhematuria; while 80% for mild, 77.3% for moderate, and 72.7% for severe microhematuria (p=0.436) (Figure). Microhematuria did not predict the study outcome when multivariable Cox regression analyses were performed [HR: 1.847 (95% CI: 0.696-4.904), p=0.218]. Throughout the follow-up, microhematuria disappeared (dropped below 5 RBCs/hpf) in 43 patients (53%), 8 of whom (18.6%) reached the study outcome as compared to 11 patients (28.9%) with persistent microhematuria (p=0.273). Disappearance of microhematuria was not a predictor of study outcome, as well [HR: 0.386 (95% CI: 0.068-2.180), p=0.281].
Conclusion
Microhematuria is not associated with renal outcomes of adult patients with IgAN.
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Affiliation(s)
- Safak Mirioglu
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Erdem Gurel
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Merve Guzel-Dirim
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Asli Kara
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Yasemin Ozluk
- Istanbul University Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Irem Aktar
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Aylin Ciftkaya
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Ozgur Akin Oto
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Yasar Kerem Caliskan
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Isin Kilicaslan
- Istanbul University Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Halil Yazici
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
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Akyildiz A, Uludag O, Mirioglu S, Ucar AR, Demir E, Caliskan YK, Ozluk Y, Turkmen A, Sever MS, Yazici H. P0353EFFECT OF RITUXIMAB IN PATIENTS WITH RELAPSED OR REFRACTORY PRIMARY MEMBRANOUS NEPHROPATHY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Membranous nephropathy (MN) is the most common cause of glomerulonephritis in non-diabetic adults. B-cell dysfunction is an important pathway involved in pathogenesis. We, therefore, investigated effects of rituximab (RTX) on the outcome of patients with relapsed or refractory primary MN.
Method
In this retrospective analysis, 48 patients with primary MN were evaluated. Patients, who had relapsed or refractory biopsy-proven disease, with a nephrotic-range proteinuria despite at least six months of prior immunosuppressive therapy using corticosteroids, calcineurin inhibitors or mycophenolic acid derivatives, which were used according to KDIGO guidelines. All patients received at least 2 doses of 375 mg/m2 of RTX. Proteinuria and serum albumin levels of the patients were recorded at baseline, and 3,6,12,18 and 24 months.
Results
Of 48 patients who participated in this study, 27(56.3%) were male. Mean age was 45.3±17.2 years. Results of serum anti-phospholipase-A2-receptor (PLA2R) were available in 31 patients, 23 of whom (74%) were positive. Proteinuria levels at 3, 6, 12, 18, and 24 months after treatment with RTX showed a significant decrease when compared to baseline (p<0.05) (Figure 1): From 7±3.5 g/24h at baseline to 2.6±2.4 g/24h at 12 months. Serum albumin levels at 3, 6, 12, 18, and 24 months after RTX significantly increased compared to baseline values (p<0.05) (Figure 2): From 2.97±0.76 g/dl at baseline to 3.88±0.67 g/dl at 12 months.
Conclusion
Treatment with RTXiseffective in patients suffering from relapsed or refractory primary MN.
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Affiliation(s)
- Arif Akyildiz
- Istanbul Faculty of Medicine, Department of Internal Medicine, Turkey
| | - Omer Uludag
- Istanbul Faculty of Medicine, Department of Internal Medicine, Turkey
| | - Safak Mirioglu
- Cerrahpasa Medical Faculty, Division of Nephrology, Department of Internal Medicine, Turkey
| | - Ali Riza Ucar
- Istanbul Faculty of Medicine, Division of Nephrology, Department of Internal Medicine, Turkey
| | - Erol Demir
- Istanbul Faculty of Medicine, Division of Nephrology, Department of Internal Medicine, Turkey
| | - Yasar Kerem Caliskan
- Istanbul Faculty of Medicine, Division of Nephrology, Department of Internal Medicine, Turkey
- Saint Louis University School of Medicine, Division of Nephrology and Hypertension, Saint Louis, United States of America
| | - Yasemin Ozluk
- Istanbul Faculty of Medicine, Department of Pathology, Turkey
| | - Aydin Turkmen
- Istanbul Faculty of Medicine, Division of Nephrology, Department of Internal Medicine, Turkey
| | - Mehmet Sukru Sever
- Istanbul Faculty of Medicine, Division of Nephrology, Department of Internal Medicine, Turkey
| | - Halil Yazici
- Istanbul Faculty of Medicine, Division of Nephrology, Department of Internal Medicine, Turkey
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39
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Eren N, Gursu M, Cebeci E, Turkmen A, Yeter HH, Seyahi N, Piskinpasa SV, Ersoy A, Basturk T, Manga Sahin G, Kocak Yucel FS, Genç AB, SAHIN G, Ulu MS, Soyhan M, Turkmen K, Ozberk S, Elcioğlu O, Altunoren O, Sahin İ, Kutlay S, Üstündağ S, Kalender B, Dede F, Altun B. P0440EPIDEMIOLOGICAL AND CLINICAL CHARACTERSTICS OF IGA NEPHROPATHY PATIENTS IN TURKEY: TSN-GOLD WORKING GROUP. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
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<0.001, respectively]. Oxford classification was applied to 544 patients. Endocapillary hypercellularity (E1), mesengial hypercellularity (M1), tubular atrophy and interstitial fibrosis (T1 and T2), segmental sclerosis (S1) were present in 126 (13%), 425 (42.8%), 306 (30.8%) and 325 patients (%32.7), respectively. Proteinuria levels were higher in patients with endocapillary hypertrophy, mesengial hypercellularity, tubular atrophy-interstitial fibrosis and segmental sclerosis. eGFR levels were lower in patients with endocapillary hypertrophy, tubular atrophy-interstitial fibrosis and segmental sclerosis (Figure-3).
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.
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Affiliation(s)
- Necmi Eren
- Kocaeli University, Faculty of Medicine, Division of Nephrology, Kocaeli, Turkey
| | - Meltem Gursu
- Bezmialem Vakif University, Faculty of Medicine, Division of Nephrology, Istanbul, Turkey
| | - Egemen Cebeci
- Haseki Training and Research Hospital, Division of Nephrology, Istanbul, Turkey
| | - Aydin Turkmen
- İstanbul University, İstanbul Medical Faculty, Division of Nephrology, Istanbul, Turkey
| | - Hasan Haci Yeter
- Gazi University, Faculty of Medicine, Division of Nephrology, Ankara, Turkey
| | - Nurhan Seyahi
- İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Division of Nephrology, Istanbul, Turkey
| | | | - Alpaslan Ersoy
- Uludağ University Faculty of Medicine, Division of Nephrology, Bursa, Turkey
| | - Taner Basturk
- Şişli Etfal Training and Research Hospital, Division of Nephrology, Istanbul, Turkey
| | - Gulizar Manga Sahin
- Sultan Abdülhamid Han, Training and Research Hospital, Division of Nephrology, Istanbul, Turkey
| | | | - Ahmed Bilal Genç
- Sakarya University, Faculty of Medicine, Division of Nephrology, Adapazari, Turkey
| | - Garip SAHIN
- Eskişehir Osmangazi University, Faculty of Medicine, Division of Nephrology, Eskisehir, Turkey
| | - Memnune Sena Ulu
- Afyon Saglik Bilimleri University, Faculty of Medicine, Division of Nephrology, Afyonkarahisar, Turkey
| | - Merve Soyhan
- Bozyaka Training and Research Hospital, Division of Nephrology, Izmir, Turkey
| | - Kultigin Turkmen
- Necmettin Erbakan Üniversity, Meram Medical Faculty, Division of Nephrology, Konya, Turkey
| | - Sumeyra Ozberk
- Erciyes University, Faculty of Medicine, Division of Nephrology, Kayseri, Turkey
| | - Omer Elcioğlu
- Bezmialem Vakif University, Faculty of Medicine, Division of Nephrology, Istanbul, Turkey
| | - Orcun Altunoren
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Division of Nephrology, Kahramanmaras, Turkey
| | - İdris Sahin
- Inonü University, Faculty of Medicine, Division of Nephrology, Malatya, Turkey
| | - Sim Kutlay
- Ankara University, Faculty of Medicine, Division of Nephrology, Ankara, Turkey
| | - Sedat Üstündağ
- Trakya University, Faculty of Medicine, Division of Nephrology, Edirne, Turkey
| | - Betul Kalender
- Kocaeli University, Faculty of Medicine, Division Of Nephrology, Kocaeli, Turkey
| | - Fatih Dede
- Ankara Numune Training and Research Hospital, Division of Nephrology , Ankara, Turkey
| | - Bulent Altun
- Hacettepe University, Faculty of Medicine, Division of Nephrology, Ankara, Turkey
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Sumnu A, Turkmen K, Cebeci E, Turkmen A, Eren N, Seyahi N, Oruc A, Dede F, Derici Ü, Basturk T, SAHIN G, Sipahioglu M, Manga Sahin G, Tatar E, Dursun B, Sipahi S, Yılmaz M, Suleymanlar G, Ulu MS, Gungor O, Kutlay S, Bicik Bahçebaşı Z, Sahin İ, Kurultak I, Sevinc C, Yilmaz Z, Turan Kazancioglu R, Cavdar C, Candan F, Aydin Z, Oygar D, Gul CB, Altun B, Paydas S, Uzun S, Istemihan Z, Ergul M, Dincer MT, Gullulu M, Piskinpasa SV, Akcay OF, Unsal A, Koyuncu S, Gok M, Ozturk S. P0448CHARACTERISTICS OF PRIMARY GLOMERULAR DISEASE PATIENTS WITH HEMATURIA IN TURKEY: THE DATA FROM TSN-GOLD WORKING GROUP. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Hematuria is one of the most common laboratory findings in nephrology practice. In different regions of the world, the etiologic causes differ. To date, there is no enough data regarding the clinical and histopathologic characteristics of primary glomerular diseases (PGD) patients with hematuria in our country.
Method
Data were obtained from national multicenter (47 centers) data entered into the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database between May 2009 and June 2019. The data of all PGD patients over the age of 16 years who were diagnosed with renal biopsy and had hematuria data were included in the study. The biopsy samples were processed using a light microscopy and immunofluorescence examination. Demographic characteristics such as age, sex, indications for biopsy, primary glomerular diseases, comorbidities, laboratory and biopsy findings of all patients were also recorded. Hematuria was defined as the presence of at least 5 red blood cells/hpf.
Results
Data of 3394 patients were included to the study after the exclusion of patients with secondary glomerulonephritis and patients with missing biopsy findings. While 1699 (50.1%) patients had hematuria, 1695 (49.9%) patients did not have hematuria. Demographic, laboratory, and histopathological characteristics of patients with and without hematuria are given in Table. Patients with hematuria had statistically higher systolic blood pressure (SBP), serum blood urea nitrogen, creatinine, albumin, levels and urine pyuria, however, these patients had statistically lower age, body mass index, presence of hypertension and diabetes, eGFR, 24-hour proteinuria, serum total, HDL and LDL-cholesterol and C3 levels when compared with patients without hematuria. Figure depicted the etiologic causes of patients with and without hematuria. According to histopathological findings, number of global sclerotic glomeruli, cellular and fibrocellular crescents, the levels of mesangial proliferation, endocapillary proliferation, exudative changes in glomeruli, severe tubular atrophy, interstitial inflammation, subendothelial deposition, moderate and severe IgA and C3 deposition were found to be significantly higher and the levels of basal membrane thickening, interstitial fibrosis, subepithelial deposition, severe IgG staining were found to be significantly lower in patients with hematuria.
Conclusion
This is the first multicenter national report regarding the demographic and histopathologic data of PGD patients with or without hematuria. Hematuria, a feature of nephritic syndrome, was found at a higher than expected in the PGDs presenting with nephrotic syndrome in our national database.
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Affiliation(s)
- Abdullah Sumnu
- Medipol University, Medical Faculty, Nephrology, Istanbul, Turkey
| | - Kultigin Turkmen
- Necmettin Erbakan University, Meram Medical Faculty, Nephrology, Konya, Turkey
| | - Egemen Cebeci
- Haseki Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul University, Istanbul Medical Faculty, Nephrology, Istanbul, Turkey
| | - Necmi Eren
- Kocaeli University, Medical Faculty, Nephrology, Kocaeli, Turkey
| | - Nurhan Seyahi
- Istanbul University, Cerrahpasa Medical Faculty, Nephrology, Istanbul, Turkey
| | - Aysegul Oruc
- Uludag University, Medical Faculty, Nephrology, Bursa, Turkey
| | - Fatih Dede
- Ankara Numune Training and Research Hospital, Nephrology, Ankara, Turkey
| | - Ülver Derici
- Gazi University, Medical Faculty, Nephrology, Ankara, Turkey
| | - Taner Basturk
- Hamidiye Sisli Etfal Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Garip SAHIN
- Eskisehir Osmangazi University, Medical Faculty, Nephrology, Eskisehir, Turkey
| | - Murat Sipahioglu
- Erciyes University, Medical Faculty, Nephrology, Kayseri, Turkey
| | - Gulizar Manga Sahin
- Sultan Abdulhamit Han Research and Training Hospital, Nephrology, Istanbul, Turkey
| | - Erhan Tatar
- Bozyaka Training and Research Hospital, Nephrology, Izmır, Turkey
| | - Belda Dursun
- Pamukkale University, Medical Faculty, Nephrology, Denizli, Turkey
| | - Savas Sipahi
- Sakarya University, Medical Faculty, Nephrology, Sakarya, Turkey
| | - Mürvet Yılmaz
- Bakirkoy Sadi Konuk Training and Research Hospital, Nephrology, Istanbul, Turkey
| | | | | | - Ozkan Gungor
- Sutcu İmam University, Medical Faculty, Nephrology, Kahramanmaras, Turkey
| | - Sim Kutlay
- Ankara University, Medical Faculty, İbni Sina Hospital, Nephrology, Ankara, Turkey
| | | | - İdris Sahin
- Inonu University, Medical Faculty, Nephrology, Malatya, Turkey
| | - Ilhan Kurultak
- Trakya University, Medical Faculty, Nephrology, Edirne, Turkey
| | - Can Sevinc
- Ataturk University, Medical Faculty, Nephrology, Erzurum, Turkey
| | - Zulfikar Yilmaz
- Dicle University, Medical Faculty, Nephrology, Diyarbakir, Turkey
| | | | - Caner Cavdar
- Dokuz Eylul University, Medical Faculty, Nephrology, Izmir, Turkey
| | - Ferhan Candan
- Cumhuriyet University, Medical Faculty, Nephrology, Sivas, Turkey
| | - Zeki Aydin
- Darica Farabi Training and Research Hospital, Nephrology, Kocaeli, Turkey
| | - Deren Oygar
- Burhan Nalbantoglu State Hospital, Nephrology, Lefkosa, Cyprus
| | - Cuma Bulent Gul
- Bursa Yuksek Ihtisas Training and Research Hospital, Nephrology, Bursa, Turkey
| | - Bulent Altun
- Hacettepe University, Medical Faculty, Nephrology, Ankara, Turkey
| | - Saime Paydas
- Cukurova University, Medical Faculty, Nephrology, Adana, Turkey
| | - Sami Uzun
- Haseki Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Zulal Istemihan
- Istanbul University, Istanbul Medical Faculty, Internal Medicine, Istanbul, Turkey
| | - Metin Ergul
- Kocaeli University, Medical Faculty, Nephrology, Kocaeli, Turkey
| | - Mevlut Tamer Dincer
- Istanbul University, Cerrahpasa Medical Faculty, Nephrology, Istanbul, Turkey
| | - Mustafa Gullulu
- Uludag University, Medical Faculty, Nephrology, Bursa, Turkey
| | | | | | - Abdulkadir Unsal
- Hamidiye Sisli Etfal Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Sumeyra Koyuncu
- Erciyes University, Medical Faculty, Nephrology, Kayseri, Turkey
| | - Mahmut Gok
- Sultan Abdulhamit Han Research and Training Hospital, Nephrology, Istanbul, Turkey
| | - Savas Ozturk
- Haseki Training and Research Hospital, Nephrology, Istanbul, Turkey
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Kocak B, Arpali E, Akyollu B, Yelken B, Tekin S, Kanbay M, Turkmen A, Kalayoglu M. Oligosymptomatic Kidney Transplant Patients With COVID-19: Do They Pose a Risk to Other Recipients? Transplant Proc 2020; 52:2663-2666. [PMID: 32419709 PMCID: PMC7225704 DOI: 10.1016/j.transproceed.2020.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The clinical course of viral infections in patients under immunosuppression can be atypical and/or fatal if not diagnosed and treated appropriately. The coronavirus disease 2019 (COVID-19) may also have an atypical presentation. Contrary to the general opinion, transplant patients may be asymptomatic or oligosymptomatic, which could be a risk factor for underdiagnosis and the dissemination of this viral disease. This study presents the clinical features of 2 oligosymptomatic kidney transplant patients diagnosed with COVID-19. We suggest that new screening algorithms for COVID-19 should be reconsidered for the transplant patient population.
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Affiliation(s)
- Burak Kocak
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
| | - Emre Arpali
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey.
| | - Basak Akyollu
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
| | - Berna Yelken
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
| | - Suda Tekin
- Department of Infectious Disease, Koc University Hospital, İstanbul, Turkey
| | - Mehmet Kanbay
- Department of Nephrology, Koc University Hospital, İstanbul, Turkey
| | - Aydin Turkmen
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
| | - Munci Kalayoglu
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
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Arpali E, Akyollu B, Yelken B, Tekin S, Turkmen A, Kocak B. Case report: A kidney transplant patient with mild COVID-19. Transpl Infect Dis 2020; 22:e13296. [PMID: 32301198 PMCID: PMC7235513 DOI: 10.1111/tid.13296] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/12/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus Disease 2019 (COVID‐19) is currently a pandemic with a mortality rate of 1%‐6% in the general population. However, the mortality rate seems to be significantly higher in elderly patients, especially those hospitalized with comorbidities, such as hypertension, diabetes, or coronary artery diseases. Because viral diseases may have atypical presentations in immunosuppressed patients, the course of the disease in the transplant patient population is unknown. Hence, the management of these patients with COVID‐19 is an area of interest, and a unique approach is warranted. Here, we report the clinical features and our treatment approach for a kidney transplant patient with a diagnosis of COVID‐19. We believe that screening protocols for SARS‐Cov‐2 should be re‐evaluated in patients with solid‐organ transplants.
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Affiliation(s)
- Emre Arpali
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
| | - Basak Akyollu
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
| | - Berna Yelken
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
| | - Suda Tekin
- Department of Infectious Disease, Koc University Hospital, İstanbul, Turkey
| | - Aydin Turkmen
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
| | - Burak Kocak
- Department of Organ Transplantation, Koç University Hospital, İstanbul, Turkey
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43
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Yelken B, Osmanbaşoğlu E, Ertoy Baydar D, Turkmen A. SUN-360 CATASTROPHIC EBV INFECTION AFTER CADAVERIC KIDNEY TRANSPLANTATION Abstract paid for submission. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Eksioglu Demiralp E, Elbasi MO, Turkmen A. New Bio-Markers: Cell-Free DNAs and MICRO-RNAs. Turk J Nephrol 2019. [DOI: 10.5152/turkjnephrol.2019.3677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mirioglu S, Caliskan Y, Ozluk Y, Dirim AB, Istemihan Z, Akyildiz A, Yazici H, Turkmen A, Kilicaslan I, Sever MS. Co-Deposition of IgM and C3 May Indicate Unfavorable Renal Outcomes in Adult Patients with Primary Focal Segmental Glomerulosclerosis. Kidney Blood Press Res 2019; 44:961-972. [PMID: 31437846 DOI: 10.1159/000501827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS We aimed to investigate the effects of glomerular IgM and C3 deposition on outcomes of adult patients with primary focal segmental glomerulosclerosis (FSGS). METHODS In this retrospective analysis, 86 consecutive adult patients with biopsy-proven primary FSGS were stratified into 3 groups according to their histopathological features: IgM- C3-, IgM+ C3-, and IgM+ C3+. Primary outcome was defined as at least a 50% reduction in baseline estimated glomerular filtration rate (eGFR) or development of kidney failure, while complete or partial remission rates were secondary outcomes. RESULTS Glomerular IgM deposits were found in 44 (51.1%) patients, 22 (25.5%) of which presented with accompanying C3 deposition. Patients in IgM+ C3+ group had higher level of proteinuria (5.6 g/24 h [3.77-8.5], p = 0.073), higher percentage of segmental glomerulosclerosis (20% [12.3-27.2], p = 0.001), and lower levels of eGFR (69 ± 37.2 mL/min/1.73 m2, p = 0.029) and serum albumin (2.71 ± 0.85 g/dL, p = 0.045) at the time of diagnosis. Despite 86.3% of patients in IgM+ C3+ group (19/22) received immunosuppressive treatment, the primary outcome was more common in patients in the IgM+ C3+ group compared with patients in IgM+ C3- and IgM- C3- groups (11 [50%] vs. 2 [9%] and 11 [26.1%] respectively [p = 0.010]). Complete or partial remission rates were lower in patients in the IgM+ C3+ group (5/22, 22.7%), as well (p = 0.043). Multivariate Cox regression analysis revealed that IgM and C3 co-deposition was an independent risk factor associated with primary outcome (hazard ratio 3.355, 95% CI 1.349-8.344, p = 0.009). CONCLUSIONS Glomerular IgM and C3 co-deposition is a predictor of unfavorable renal outcomes in adult patients with primary FSGS.
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Affiliation(s)
- Safak Mirioglu
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey,
| | - Yasar Caliskan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zulal Istemihan
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Arif Akyildiz
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Kilicaslan
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Bayraktar A, Catma Y, Akyildiz A, Demir E, Bakkaloglu H, Ucar AR, Dirim AB, Usta Akgul S, Temurhan S, Gok AFK, Ozluk Y, Kilicaslan I, Oguz FS, Sever MS, Aydin AE, Turkmen A. Infectious Complications of Induction Therapies in Kidney Transplantation. Ann Transplant 2019; 24:412-417. [PMID: 31296835 PMCID: PMC6652377 DOI: 10.12659/aot.915885] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Cytomegalovirus (CMV) and BK virus (BKV) are post-transplant opportunistic viral infections that affect patient and graft survival. This study was designed to evaluate the risk of BKV nephropathy and CMV disease in kidney transplant recipients who received induction therapy with ATG or basiliximab. Material/Methods We retrospectively analyzed information on 257 adult patients who underwent kidney transplantation between January 2007 and 2017. Patients were categorized into 3 groups according to the induction therapies. The primary endpoint was the onset of CMV disease or biopsy-confirmed BKV nephropathy. The secondary endpoints were biopsy-proven rejection episodes, graft loss, loss to follow-up, and death. Results We followed 257 patients for a median of 55.5 months. The incidence of CMV disease was significantly higher in the only ATG group compared to the group without induction treatment (p<0.001). There was no significant difference in the incidence of BKV nephropathy among groups (p>0.05). The dosage of ATG (OR, 10.685; 95% CI, 1.343 5 to 85.009; P=0.025) was independent risk factor for death. Conclusions This study demonstrated that a higher dosage of ATG in high-risk patients is associated with an increased risk of CMV disease and patient death, also, reducing the dosage may be a rational strategy for increasing graft and patient’s survival.
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Affiliation(s)
- Adem Bayraktar
- Department of General Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yunus Catma
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Arif Akyildiz
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Huseyin Bakkaloglu
- Department of General Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Riza Ucar
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sebahat Usta Akgul
- Department of Medical Biology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sonay Temurhan
- Department of Medical Biology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Fuat Kaan Gok
- Department of General Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Kilicaslan
- Department of Pathology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatma Savran Oguz
- Department of Medical Biology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Emin Aydin
- Department of General Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Savran Karadeniz M, Senturk Ciftci H, Tefik T, Oktar T, Nane I, Turkmen A, Oguz F, Tugrul KM. Effects of Different Volatile Anesthetics on Cytokine and Chemokine Production After Ischemia-Reperfusion Injury in Patients Undergoing Living-Donor Kidney Transplant. EXP CLIN TRANSPLANT 2019; 17:68-74. [PMID: 30777526 DOI: 10.6002/ect.mesot2018.o10] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Renal transplant is the treatment of choice for patients with end-stage renal disease. Ischemiareperfusion damage is a major cause of early renal dysfunction during the perioperative period. Ischemic hypoxic damage increases local inflammation, leading to secretion of cytokines and chemokines. Anesthetic conditioning is a widely described strategy to attenuate ischemia-reperfusion injury. Here, we compared the effects of desflurane and sevoflurane on serum proinflammatory cytokines and urine chemokines in living-donor kidney transplant recipients. MATERIALS AND METHODS Eighty donor-recipient couples were included in this randomized study. Anesthesia maintenance was provided by desflurane or sevoflurane. Patient demographic characteristics, immunologic data, clinical data, and hemodynamic parameters were recorded. Tumor necrosis factor α, interleukins 2 and 8, chemokines 9 and 10, and serum creatinine levels were studied from pretransplant, posttransplant days 1 and 7, and posttransplant months 1 and 3 sample results. Estimated glomerular filtration rates were calculated. Acute rejection episodes and graft loss within 6 months posttransplant were recorded. RESULTS Seventy donor-recipient couples completed the study. There were no significant differences in demographic, immunologic, and clinical data between desflurane and sevoflurane groups (P > .05). Tumor necrosis factor α, interleukin 2, chemokine 9, and chemokine 10 levels were similar preoperatively and on postoperative days 1 and 7 and months 1 and 3 (P > .05). Serum interleukin 8 levels were significantly higher in patients who received sevoflurane on postoperative days 1 (P = .045) and 7 (P = .037). No significant differences were detected in serum creatinine and estimated glomerular filtration rate between groups (P > .05). No graft loss occurred within 6 months posttransplant. CONCLUSIONS Although sevoflurane seemed to produce higher interleukin 8 levels posttransplant, both desflurane and sevoflurane had similar effects on posttransplant kidney function. We suggest that both agents have protective effects on ischemic-reperfusion damage in living-donor kidney transplant recipients.
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Affiliation(s)
- Meltem Savran Karadeniz
- From the Department of Anesthesiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Aksoy E, Mirioglu S, Uludag O, Ozluk Y, Demir E, Caliskan Y, Yazici H, Kilicaslan I, Turkmen A, Sever MS. SP181COMPARISON OF VARIOUS FEATURES AND OUTCOMES IN ADULT PATIENTS WITH IMMUNE COMPLEX MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS AND C3 GLOMERULOPATHY. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elif Aksoy
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Safak Mirioglu
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Omer Uludag
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Demir
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasar Caliskan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Kilicaslan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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49
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Mirioglu S, Dertsiz B, Caliskan Y, Ozluk Y, Ucar AR, Yazici H, Kilicaslan I, Turkmen A, Sever MS. SP196EFFICACY OF RITUXIMAB IN ADULT PATIENTS WITH REFRACTORY PRIMARY FOCAL SEGMENTAL GLOMERULOSCLEROSIS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Safak Mirioglu
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Berkay Dertsiz
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasar Caliskan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Riza Ucar
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Kilicaslan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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50
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Mirioglu S, Uludag O, Aksoy E, Caliskan Y, Ozluk Y, Usta-Akgul S, Ucar AR, Yazici H, Kilicaslan I, Turkmen A, Sever MS. SP782EFFECTS OF A STANDARDIZED TREATMENT APPROACH ON KIDNEY TRANSPLANT RECIPIENTS WITH ANTIBODY-MEDIATED REJECTION. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Safak Mirioglu
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Omer Uludag
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Elif Aksoy
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasar Caliskan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Ali Riza Ucar
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Kilicaslan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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