Basol Canbakan

En tr Aim: BK virus (BKV) nephropathy is an important cause of allograft failure in renal transplant recipients that is linked to highly potent immunosuppressive therapy. The risk factors associated BKV viremia and BKV associated nephropathy (BKVN) and response to therapy were also evaluated in this study. Material and Method: We retrospectively analyzed 107 renal transplant patients from cadaveric or living related donors between 2008 and 2014. After transplantation, w e performed BKV polymerase chain reaction (PCR) assay screening for the presence of viremia in all patients. Peripheral blood samples were collected for screening monthly for first three months, after then every three months until the end of the first transplant year. BKV DNA copies were measured by real time PCR. Allograft biopsies were performed in the presence of clinical indication. All biopsies were analyzed according to Banff criteria and evaluated for the presence of BKVN. Results: BK virus associated disease was totally detected in 14 patients (13,1%) (12 viremia/6 BKVN) of 107 patients. Demographic, clinical and laboratory findings of BKV-related patients (Group I, n: 14) and non-BKV related patients (Group II, n: 93) were compared. Serum creatinine levels were statistically significantly higher in patients with BKV related disease. Additionally, it was detected that older age and tacrolimus usage are important risk factors for developing BKVN (p< 0.05). In all cases with BKV associated diseases were managed by reducing immunosuppression and, we used oral 500 mg/day levofloxacin for 1 month for all patients. Additionally in three patients with persistent allograft dysfunction following BKVN, the mycophenolic acid was stopped and oral 40 mg/day leflunomide was subsequently started. Leflunomide therapy continued until the BKV viremia disappeared and graft function was improved in the patients Conclusion: The use of tacrolimus for BKVN development is associated with a significantly higher risk than cyclosporine. Because BKVN leads to graft loss, renal transplant patients should be screened regularly for BKV replication. Nowadays, reduction of dose immunosuppression is the most common treatment approach. In addition, the use of leflunomide appears to be an additional treatment option. Amaç: BK virüs (BKV) nefropatisi, böbrek transplant alıcılarında allogreft başarısızlığının önemli bir nedeni olup, yüksek derecede potent olan immünsupresif tedaviye bağlıdır. Bu çalışmada BKV viremisi ve BKV ile ilişkili nefropati (BKVN) ile ilişkili risk faktörleri ve tedaviye yanıt da değerlendirildi. Gereç ve Yöntem: 2008 ve 2014 yılları arasında kadavra kökenli veya canlı ilişkili vericilerden retrospektif olarak 107 renal transplant hastasını analiz ettik. Transplantasyondan sonra, tüm hastalarda vireminin varlığı için BKV polimeraz zincir reaksiyonu (PCR) taraması yaptık. Periferik kan numuneleri ilk üç ayda bir tarama için, daha sonra her üç ayda bir ilk nakil yılının sonuna kadar toplandı. BKV DNA kopyaları gerçek zamanlı PCR ile ölçüldü. Allogreft biyopsileri klinik endikasyona göre yapıldı. Tüm biyopsiler Banff kriterlerine göre analiz edildi ve BKVN varlığı açısından...

INTRODUCTION AND AIMS: Cardiovascular disease (CVD) is an important cause of mortality and morbidity in haemodialysis (HD) patients. Iron accumulation in arterial wall is increased in atherosclerotic lesions. Hepcidin is a key hormone in iron balance. Studies showed an association between hepcidin and atherosclerotic disease. The aim of this study is to investigate the relation of serum hepcidin-25 (SH-25) and atherosclerosis measured by carotid intima-media thickness (CIMT) and mortality in HD patients.

We aimed to investigate the association between atherosclerotic changes in the common carotid artery (CA) and conjunctival and corneal calcification (CCC) in maintenance hemodialysis (MHD) patients. Fifty eyes of MHD patients with the highest CCC scores were enrolled. CCCs were scored according to the method described by Tokuyama et al. The eyes with the highest CCC scores were selected for further analysis. According to their CCC scores, the patients were classified into 3 groups: mild (0-2 score), moderate (3-5), and severe (6-10 score). Atherosclerosis of the common CA was evaluated by determination of intima-media thickness (IMT), peak systolic (PSV) and end diastolic (EDV) flow velocities, pulsatility index, and resistive index values by using Doppler ultrasonography. The mean IMT of the CA was 0.61 ± 0.09 mm in the mild group, 0.82 ± 0.16 mm in the moderate group, and 1.21 ± 0.32 mm in the severe group (P < 0.001). The PSV and EDV were significantly higher in the severe group than in the mild and moderate groups (all, P < 0.001). The CCC score was positively correlated with the duration of hemodialysis, ocular surface disease index score, IMT, PSV, EDV, lymphocyte, calcium, and sedimentation rate. In multiple stepwise linear regression analysis, IMT was the best predictive factor for the CCC score (R = 0.812, β = 9.526 ± 1.05, and P < 0.001). Our results suggest that chronic ocular ischemia due to atherosclerotic changes may have a role in the formation or progression of CCC in MHD patients.

Introduction: Left ventricular hypertrophy (LVH) is one of the most common cardiac abnormalities in patients with end stage renal disease (ESRD). Hypertension, diabetes, increased body mass index, gender, age, anemia, and hyperparathyroidism have been described as risk factors for LVH in patients on dialysis. However, there may be other risk factors which have not been described yet. Recent studies show that renalase is associated with cardiovascular events. The aim of this study was to reveal the relation between renalase, LVH in patients under hemodialysis (HD) treatment. Methods: The study included 50 HD patients and 35 healthy controls. Serum renalase levels and left ventricle mass index (LVMI) were measured in all participants and the relation between these variables was examined. Findings: LVMI was positively correlated with dialysis vintage and C-reactive protein (CRP) (r = 0.387, p = 0.005 and r = 0.597, p < 0.001, respectively) and was negatively correlated with residual diuresis and hemoglobin levels (r = −0.324, p = 0.022 and r = −0.499, p < 0.001, respectively). There was no significant association of renalase with LVMI in the HD patients (r = 0.263, p = 0.065). Serum renalase levels were significantly higher in HD patients (212 ± 127 ng/mL) compared to controls (116 ± 67 ng/mL) (p < 0.001). Renalase was positively correlated with serum creatinine and dialysis vintage (r = 0.677, p < 0.001 and r = 0.625, p < 0.001, respectively). Discussion: In our study, LVMI was correlated with dialysis vintage, residual diuresis, CRP, and hemoglobin. LVMI tends to correlate with renalase and this correlation may be significant in studies with more patient numbers. The main parameters affecting renalase levels are dialysis vintage and serum creatinine.

Antibody-mediated rejections (AMRs) are critical clinical issues encountered in short- and long-term follow-up of kidney transplant patients. Whereas plasmapheresis is a mainstay treatment option in acute AMR cases, there is a paucity of data regarding its efficacy in management of chronic AMR. This report describes our experience addressing this issue. We retrospectively investigated the data of 7 kidney transplant patients diagnosed with chronic AMR who were on 5 sessions of plasmapheresis (1 to 2 volume exchanges with fresh frozen plasma) on alternate days and 200 mg/kg of intravenous immunoglobulin after each session of plasmapheresis. At 6 months after the initiation of treatment, 6 patients experienced partially improved kidney function. One patient had no response and her kidney function progressively deteriorated. Our preliminary results are encouraging for the combination of plasmapheresis and intravenous immunoglobulin as an adjunctive therapy for kidney transplant patients suffering from chronic AMR.

Synthetic cannabinoid (SC) products are called “Spice” in Europe, “K2” in the United States and “Bonsai” in Turkey and sold under the counter. Widespread uses of these substances and lack of specific regulations about them cause serious problems. It is not very clear what these psychoactive products contain and how much and how often they can be given. Their metabolic effects are not known well either. There is not much known about the effects of SCs other than the ones on the neurological and cardiovascular systems. In this report, we presented two cases of rhabdomyolysis developing after bonsai consumption and requiring dialysis. Two bonsai users have been brought to our emergency department in an unconscious state. Their physical examinations were normal except tachicardia. Laboratory investigations revealed increased urea, serum creatinine, creatinine phosphokinase, lactate dehydrogenase and transaminase levels. The histories of the cases suggested that they had rhabdomyolysis due to cannabinoid use. A single session hemodialysis was performed for both cases. Their clinical appearance reached to stabilisation in the second hospital day and blood tests were normalised in one week. The patients were discharged at the end of the week with the normal laboratory results and psyciatric recommendations. These two cases underline the risk of rhabdomyolysis development, apart from well-known side effects of SCs.

Endothelial dysfunction plays an important role in the pathogenesis of preeclampsia. Increased number of circulating endothelial cells (CECs) have previously been reported after various diseases associated endothelial injury. The aim of this study was to evaluate the CECs in patients with preeclampsia and to demonstrate any association between CECs and homocysteine, which is another marker of vascular injury. The study included 20 preeclamptic, 15 hypertensive women, 15 healthy pregnant and 15 healthy non-pregnant women. All subjects had normal renal function. Systolic and diastolic blood pressures, serum homocysteine levels were measured. To isolate CECs, peripheral blood was first incubated with anti-CD-146 antibody and subsequently conjugated to immunomagnetic beads. Cells were stained with acridine and counted. Preeclamptic patients had elevated numbers of CECs (13.25.2 cells/ml) compared with hypertensive patients (6.90.8 cells/ml), healthy pregnants (5.21.4 cells/ml) and non-pregnant controls (4.01.8 cells/ml), (Pmol/l) was significantly higher compared with healthy pregnants (6.00.6 mol/l), was not different from hypertensive patients (11.52.3 mol/l, P>0.05), but it was lesser compared with non-pregnant controls (12.23.3 mol/l, PPr=0.63), diastolic blood pressure (Pr=0.64) and serum homocysteine (Pr=0.55) levels were found in preeclamptic patients. CECs as a marker of endothelial injury were significantly higher in patients with preeclampsia than in hypertensive patients, healthy pregnants and normal controls. Further studies are needed for the prognostic and potential importance of CECs in preeclampsia.