Arzu Kahveci

Kidney transplant patients are prone to metabolic bone diseases. In this descriptive clinical study we aimed to evaluate the incidence of osteopenia osteoporosis, vertebral fractures in our group of renal transplant patients. Methods: Eighty seven patients (25 males and 62 females) aged from 20 to 67 years, who had undergone kidney transplantation 1 to 20 yrs. previously included in the study. Bone mineral densitometry was performed using dual-energy X-ray absorptiometry, Thoracolumbar lateral vertebral X-ray evaluated for fracture according to Genant classification. Serum parathormone (PTH), 25OH vitamin D, calcium, phosphate, Luteinizing hormone (LH) and Follicular stimulating hormone (FSH) levels were measured. Results: The incidence of osteoporosis was 26% (23 of 87 patients).and osteopenia was 52.8% (46 of 87 patients). Vertebral fracture was observed in 28.8% of the patients in thoracolumbar lateral vertebral X-ray evaluation. Serum Ca and P levels were in normal range while PTH levels were elevated and 25OH vitamin D levels were in deficient range. Vertebral fractures mostly observed in patients with osteopenia (17.2%). A negative correlation with post-transplantation duration with serum PTH levels (r: −0.16 PPP<0.001). Conclusion: Vertebral fractures observed more frequently in osteopenic group of renal transplant patients. Besides the BMD evaluation, vertebral fracture evaluation may help to make a proper therapy decision for metabolic bone disease in kidney transplant receipents

An 87 -year-old female who was undergoing peritoneal dialysis presented with peritonitis caused by Alcaligenes faecalis and Pantoea agglomerans in consecutive years. With the following report we discuss the importance of these unusual microorganisms in peritoneal dialysis patients.

Peritonitis is the most frequent complication of peritoneal dialysis. Diagnosis of peritonitis includes symptoms and signs of peritonitis with a cloudy aspirate of more than 100 WBC/ml, as well as positive cultures. Although sterile peritonitis has been reported in the literature, to the best of our knowledge this is the first report of an unusual presentation of peritonitis without any white blood cells in the peritoneal aspirate despite multiple positive peritoneal cultures.An 82-year-old Caucasian man who had been on continuous cycling peritoneal dialysis for 12 years was admitted to our hospital with general malaise, loss of appetite, weight loss and somnolence. He did not describe abdominal pain or fever. Even though his peritoneal fluid was consistently negative for leukocytes and clear, he had peritonitis with different organisms consecutively.Our case report shows that any patient on peritoneal dialysis presenting with evidence of infection (fever, peripheral leukocytosis) without an obvious cause should have aspirate cultures done even if the aspirate is clear and abdominal pain is absent. Our case report may change the initial work-up and management of these patients. We believe this report is of interest to general medicine and emergency room physicians as well as nephrologists.

We report the case of a 54-year-old hemodialysis patient who presented with recurrent fever due to Streptococcus bovis bacteremia related to colonic tubulovillous adenoma. Following polypectomy and broad-spectrum antibiotic therapy, the patient totally recovered. In this paper, we discussed the relation between S. bovis bacteremia, colonic adenomas, and hemodialysis. Awareness of this association is critical for early diagnosis and management.

Infectious complications are the leading causes of morbidity and mortality among renal transplant recipients. Hypogammaglobulinaemia may develop as a result of immunosuppressive therapy and is associated with an increased risk of opportunistic infections particularly in the 6-month post-transplant period. Rituximab, which is used for antibody-mediated rejection (AMR), may also contribute to the development of hypogammaglobulinaemia via B-cell depletion. Intravenous immunoglobulin replacement may be beneficial in this setting. With the following case report, we aim to increase the awareness of opportunistic infections and severe hypogammaglobulinaemia in renal transplant recipients treated with rituximab for acute AMR.