Objective: The presence of autoantibodies against M-type phospholipase A2 receptor (anti-PLA2R) is a characteristic of id-iopathic membranous nephropathy (IMN). This study aimed to evaluate the presence, levels, and relationship of these an-tibodies with clinical parameters in idiopathic and secondary membranous nephropathy (MN) and IgA nephropathy (IgAN) in our country by indirect immunofluorescence (IFT) method.
Materials and Methods: A total of 152 adult patients (97 IMN, 11 secondary MN, and 44 IgAN) were included. Serum an-ti-PLA2R levels were measured by IFT. All the kidney biopsies were evaluated in the same pathology laboratory.
Results: A total of 54 of all patients with IMN were found to be anti-PLA2R-positive, but the patients with secondary MN and IgAN were anti-PLA2R-negative (p<0.001). At the time of diagnosis, when no treatment was administered yet, 42 patients were examined for anti-PLA2R, and 32 (76.1%) patients were found to be positive; 64.3% of the patients with currently ac-tive disease were anti-PLA2R-positive, and 82.6% of patients with partial or complete remissions were negative (p<0.001). In determining the disease activity, the sensitivity of anti-PLA2R was calculated as 73%, specificity as 82%, positive pre-dictive value as 92%, and negative predictive value as 51%. Anti-PLA2R titration was found to be positively correlated with proteinuria. In multivariate analysis of the factors affecting the level of proteinuria, only the presence of anti-PLA2R was significant.
Conclusion: Anti-PLA2R was the main target in most Turkish patients with IMN, and investigation of the presence of an-ti-PLA2R using IFT is a very sensitive and unique method.
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Objective: Secondary renal AA amyloidosis (RAAA) presents with proteinuria and/or as nephrotic syndrome and progress-es to end stage renal disease (ESRD) insidiously. However, some patients with secondary amyloidosis show a more rapid renal disease progression than the usual course. In this study, we aimed to investigate the underlying cause of the rapidly progressive renal disease in the patients with secondary amyloidosis.Materials and Methods: Patients with kidney biopsy proven secondary RAAA were divided into 2 groups: the rapidly pro-gressive group (estimated glomerular filtration rate >60 mL/min, who needed renal replacement therapy within one year of diagnosis) and the control group. Biopsy specimens were reevaluated for glomerular-vascular amyloid load, tubular atrophy, interstitial fibrosis, and interstitial inflammation. The biopsy characteristics and biochemical parameters were compared between the groups. Results: Histopathological examination showed global amyloid deposition, vascular pole involvement, peritubular capil-lary amyloid deposition, and severe interstitial inflammation associated with rapidly progressive disease. Estimated glo-merular filtration rate was lower and proteinuria was higher in the rapidly progressive group than in the control group. Vascular pole amyloid deposition was found to be a predictor of ESRD in multivariate analysis. Conclusion: This study shows that higher amyloid deposition and severe inflammation revealed in in kidney biopsy of secondary RAAA cases can be risk factors for rapidly progressive renal failure.
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Özger AKARSU ,
Orhan BAYSAL ,
Serhat KARADAĞ ,
Meltem GÜRSU ,
Oktay ÖZKAN ,
Sami UZUN ,
Ahmet GÜRDAL ,
Egemen CEBECİ ,
Abdullah SUMNU ,
Ahmet BEHLUL ,
Savas OZTURK
Objective: There is a relationship between inflammation and cardiovascular disease (CVD) in patients with chronic kidney disease. Visfatin is an adipocytokine, which has been shown to be associated with inflammation, endothelial dysfunction, and CVD. Our study aimed to examine the relationship of visfatin with metabolic and echocardiographic parameters in patients on peritoneal dialysis (PD).
Materials and Methods: A total of 50 patients (mean age, 51.9±15.3 years; 29 women) followed up in our unit, and 31 healthy controls were enrolled in our study. Demographic characteristics, routine laboratory tests, echocardiographic findings, flow-mediated dilatation (FMD) percentages, and visfatin levels of the individuals were recorded.
Results: No significant difference was found in the mean serum visfatin level of patients on PD compared with that of the control group (11.95±4.37 ng/mL and 13.43±6.68 ng/mL, respectively; p=0.384). Visfatin was positively correlated with serum glucose level (r=0.298, p=0.036), levels of uric acid (r=0.404, p=0.004), sodium (r=0.313, p=0.027), alanine aminotransferase (r=0.344, p=0.015) and negatively correlated with left ventricle end-diastolic diameter (LVEDD) (r=-0.305, p=0.031) in univariate analyses. Other echocardiographic parameters and FMD showed no correlation with visfatin. Significant association was found between visfatin and LVEDD (cm) (B=-0.087, beta=-0.334, p=0.011), uric acid (mg/dL) (B=0.042, beta=0.287, p=0.033), and sodium (mmol/L) (B=0.012, beta=0.277, p=0.038) in linear regression analysis.
Conclusion: Visfatin is an adipocytokine with a potential relationship with cardiac remodeling, metabolic diseases, and water-salt balance in patients on PD.
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Objective: Autosomal dominant polycystic kidney disease (ADPKD), one of the most common causes of end-stage renal disease, is a monogenic, multisystemic disease characterized by renal cysts and various extrarenal findings. ADPKD is caused by mutations in the polycystic kidney disease 1 (PKD1) (16p13.3) and PKD2 (4q22.1) genes. The genetic analysis of the PKD1 gene is complex because of its large size, the presence of 6 pseudogenes, and allelic heterogeneity. In this study, we aimed to identify the mutations of the PKD1 gene in patients with ADPKD in Sivas, Turkey.
Materials and Methods: A total of 27 patients who were diagnosed with ADPKD were included in this study. Their mean age and body mass indices were determined. The gene variants were analyzed by targeted next-generation sequencing method.
Results: In 17 (64.3%) of the 27 patients, the variants were detected in PKD1 and/or PKD2 genes. There were 13 patients (48.1%) with PKD1 gene variants and 5 (18.5%) with PKD2 gene variants. Of the 17 patients, 1 had both PKD1 and PKD2 gene variants. We observed that 16 patients with ADPKD (66.6%) had hypertension, and liver cysts were detected in 9 (33.3%) patients.
Conclusion: PKD1 gene mutations were found in a significant number of patients with ADPKD, and hypertension is a fre-quently observed finding in them. In some patients, liver cysts may accompany the clinical picture of ADPKD. Our findings provide important insights for the genetic counseling of these patients.
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Peritonitis is the most common complication of peritoneal dialysis. Peritoneal dialysis associated peritonitis caused by Delftia acidovorans has been reported only once in the literature before. Here, we present the second case of D. acidovorans peritonitis in a 60-year old male patient undergoing peritoneal dialysis. The patient was treated with intraperitoneal ceftazidim and oral ciprofloxacin, to which the organism was sensitive. The catheter was removed because of refractory peritonitis.
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Renal arteriovenous malformation (AVM) is a rare disorder. The diagnosis of the disease is difficult unless it is symptomatic. The most common clinical presentation is hematuria. Hypertension, left ventricular hypertrophy, cardiac failure, and abdominal and/or lumbar pain are other clinical signs of renal AVM. Here we presented an interesting case of a patient with congenital renal AVM who was admitted to our hospital with massive hematuria and was treated with catheter embolization. Renal ultrasonography of the patient demonstrated hematoma in the urinary bladder and solid hyperechoic nodular cortical masses within the right kidney. In contrast-enhanced computed tomography of the abdomen, mild hydronephrosis and approximately 2-cm-diameter saccular aneurysm associated with segmental arteries were revealed in the lower pole of the right kidney. Right renal arteriography showed a large cirsoid-type renal AVM with aneurysm in the lower pole of the kidney. Renal artery embolization was performed in the patient. At follow-up, no recurrence of hematuria was observed. Congenital renal AVM is one of the rare causes of hematuria, and it should be kept in mind that it may lead to macroscopic hematuria. Renal artery embolization can be considered as a safe and effective treatment for renal AVM.
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Objective: In recent years, paracetamol has been shown to have toxic effects on the kidneys. Sialic acid (SA), an important component of the cell membranes, increases in many pathological conditions. This study aimed to investigate the effects of different doses of paracetamol on the kidney tissue and serum total SA (TSA) and lipid-bound SA (LSA) levels.
Materials and Methods: A total of 5 different groups were formed, with 8 rats in each group; 20 and 500 mg/kg/intraperitoneal paracetamol was applied to the groups once daily for 1 and 3 days, respectively. Renal pathology was evaluated with hematoxylin and eosin. TSA/LSA levels and urea/creatinine levels were measured from the blood samples taken from the rats.
Results: TSA levels were significantly higher in the groups in which paracetamol was administered in a single dose and 500 mg/kg dose for 3 days than control (p<0.05 and p<0.001). LSA levels were significantly higher in the groups that received 1 and 3 doses of 500 mg/kg/day and 3 doses of 20 mg/kg than control (p<0.05, p<0.001, and p<0.05).
Conclusion: SA levels may be a specific marker for kidney damage because of the increase in the SA levels in direct proportion to this level of renal degeneration.
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Objective: Kitāb al-Ḥāwī fī al-Ṭibb, also known as Liber Continens, is one of the most renowned and influential works of the Eastern and Western world written during the medieval times. Written by Abū Bakr Muḥammad b. Zakariyyā al-Rāzī (AD 865-925), who is known as Rhazes in the Western world, Kitāb al-Ḥāwī fī al-Ṭibb has great importance for the history of medicine. Indeed, it contains many valuable quotations from other ancient authors whose works could not endure the present day and Rhazes’ own comments on them. The purpose of this study is to present the fragments of Rhazes’ Kitāb al-Ḥāwī fī al-Ṭibb with quotes from the different works of Archigenes of Apamea, a famous physician living in Rome at the time of emperor Trajan (AD 98-117), in English. The quotes and comments deal with diseases of the kidney, urinary tract, and other related topics.
Materials and Methods: The tenth book of Kitāb al-Ḥāwī entitled fī amrāḍ al-kulā wa majārī al-bawl wa ghayrihā is on diseases of the kidneys, urinary tract, and others. First, quotations from Archigenes were identified in Arabic and Latin texts of al-Hāwī. Then, these fragments were compared with each other and translated into English.
Results: The fragments from Archigenes contains subjects such as kidney pain, hematuria, kidney stones, diabetes, and probable gonorrhea.
Conclusion: The fragments recorded in Kitāb al-Ḥāwī/Liber Continens on diseases of the urogenital system and written by Archigenes of Apamea are discussed and brought to English literature, to the best of our knowledge, for the first time, through this limited study.
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Hemodialysis is the most common form of renal replacement therapy employed in approximately 4 million patients world-wide. Patients on hemodialysis may need elective or emergent surgery related or unrelated to end-stage renal disease. These patients are at an increased risk of perioperative morbidity and mortality. Successful outcomes require meticulous multidisci-plinary teamwork coordinated by a nephrologist. The scarcity of studies further complicates this task. In this practical guide, we briefly summarize the available data.
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Objective: Diabetic kidney disease (DKD) is still a significant cause of morbidity in patients with diabetes. In this study, we examined the potential effects of continuous erythropoietin receptor activator (CERA) on oxidative stress, inflammation, and the renin-angiotensin system in a rat model of DKD induced by streptozocin.
Materials and Methods: A single intraperitoneal injection of streptozocin (65 mg/kg) was used in male Sprague Dawley rats to induce diabetes. The rats were randomly divided into 4 groups (n=8/group): diabetic (group D), CERA (group CR), CERA-treated diabetic group (group D+CR), and the control group (group C). The oxidative stress biomarkers, renal function parameters, messenger-ribonucleic acid expression of renin-angiotensin system parameters, and kidney histology were investigated.
Results: Creatinine clearance was found to be increased and the urinary albumin-to-creatinine ratio decreased in group D+CR compared with that of group D. Serum malondialdehyde levels were significantly lower, and glutathione and glutathione peroxidase levels were significantly higher in group D+CR than those of group D. Serum interleukin-1β, tumor necrosis factor-α, and interferon-γ levels were significantly lower; and monocyte chemoaatractant protein 1 levels were significantly higher in group D+CR than those in group D.
Conclusion: CERA can protect against DKD, in part, and is related to the suppression of the renal oxidative and inflammatory response.
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