Mehmet Ası Oktan

Objective: To evaluate the technical feasibility and procedural safety of carbon dioxide (CO₂) angiography during renal artery stenting compared with iodinated contrast angiography, and to identify baseline factors associated with postprocedural improvement in renal function. Materials and Methods: This single-center, retrospective study involved 99 patients who underwent renal artery stenting, with 37 in the CO₂ angiography group and 62 in the iodinated contrast medium control group. Kidney disease progression was described as a decline in the estimated glomerular filtration rate (eGFR) of ≥20% and/or evolution to end-stage disease. Improvement in function was stated as a ≥25% increment in eGFR within one month after the procedure. Demographic, periprocedural, and postprocedural variables were compared between the two groups (CO₂ versus control group). Receiver operating characteristic curve analyses were done to specify cut-off values for renal function improvement in the CO₂ group. Results: There were no significant differences in procedure time, complication rates, and technical challenges between the two groups. Improvement in kidney function after stenting was experienced more frequently in the CO₂ group. Exploratory ROC (Receiever operating characteristic) analyses identified baseline serum creatinine and eGFR cut-off values of 35 mL/min/1.73 m², respectively, for discriminating patients with renal function improvement. Conclusions: CO₂ can be safely and effectively used as an alternative contrast agent during renal artery stenting in patients with CKD (chronic kidney disease).

Introduction: Real-world epidemiological and longitudinal outcome data on autosomal dominant polycystic kidney disease (ADPKD) remain limited in underrepresented populations, including Türkiye. We aimed to characterize the epidemiology, regional distribution, and renal outcomes of ADPKD in a large multicenter national cohort. Methods: In this retrospective multicenter study, adult patients with ADPKD were identified across tertiary nephrology centers in six regions of Türkiye (2010–2025). Study-based prevalence was calculated using Turkish Statistical Institute population data. Longitudinal renal outcomes were evaluated using serial eGFR measurements and Cox regression models identified predictors of ≥ 40% eGFR decline. Results: A total of 2361 patients were included (mean age 38.6 ± 14 years; 51.8% female). Median province-level study-based prevalence was 3.86 per 100,000 population (IQR 2.92–5.49), with substantial regional variation, highest in the Black Sea region (13.46 per 100,000). Study-based prevalence increased significantly over time (annual percent change 14.4%; 95% CI 13.1–15.6; p < 0.001). During a median follow-up of 6 years, 23.9% experienced a ≥ 40% eGFR decline and 10.5% progressed to kidney failure (eGFR < 15 ml/min/1.73m2). Median annual eGFR decline was − 3.33 mL/min/1.73 m²/year. In multivariable analysis, age (adjusted HR 1.02; 95% CI 1.00–1.03; p = 0.010) and hypertension (adjusted HR 2.33; 95% CI 1.25–4.32; p = 0.007) were independently associated with renal progression, whereas tolvaptan use was associated with a lower risk of progression (adjusted HR 0.56; 95% CI 0.37–0.85; p = 0.004). The Mayo Imaging Classification remained independently predictive of renal outcomes (p = 0.027). Conclusions: This large real-world multicenter cohort highlights the geographically heterogeneous study-based burden of ADPKD across participating regions of Türkiye. Increasing prevalence over time likely reflects improved disease recognition, whereas the relatively low study-based prevalence suggests persistent under-recognition of ADPKD. These findings provide important longitudinal outcome data from an underrepresented population and support the need for earlier detection and improved risk stratification in ADPKD.

Although the autoimmune nature of membranous nephropathy (MN) was recognized over half a decade ago [1], the responsible antigen was found relatively recently [2]. The definition of the M-Type Phos...

Crescentic glomerulonephritis (GN) is among the most aggressive glomerular diseases, defined by extensive crescent formation and rapid loss of kidney function. To evaluate clinical, laboratory, and histopathologic determinants of end-stage kidney disease (ESKD) and overall survival (OS), and to identify associated factors of poor outcomes in patients with crescentic GN (cGN) and GN with crescent formation. This single-center retrospective cohort included 194 adults who underwent kidney biopsy between 2005 and 2024. The primary endpoints were progression to ESKD and OS. Cox proportional hazards and Kaplan - Meier analyses were performed. Immune complex GN was the predominant subtype (59.3%), followed by pauci-immune GN (38.1%) and anti-GBM disease (2.6%). cGN accounted for 25.2% of cases. Overall, 42.8% of patients progressed to ESKD, while 35.6% died during follow-up. In multivariate Cox analysis, maintenance steroid monotherapy was a strong independent associated factor of ESKD (HR 2.349, 95% CI 1.378-4.004, p = 0.002), along with baseline creatinine (HR 1.180, 95% CI 1.023-1.360, p = 0.023), proteinuria (HR 1.067, 95% CI 1.020-1.117, p = 0.005), global glomerulosclerosis (HR 4.103, 95% CI 1.083-15.540, p = 0.038), and IgA positivity (HR 0.758, 95% CI 0.587-0.979, p = 0.034). For OS, steroid monotherapy remained independently associated with mortality (HR 2.427, 95% CI 1.370-4.299, p = 0.002), along with older age and reduced eGFR. Maintenance steroid monotherapy was the strongest treatment-related factor associated with both ESKD and overall survival, highlighting the potential risks of inadequate maintenance immunosuppression in high-risk patients.

Fluid retention due to tyrosine kinase inhibitor administration might lead to pericardial effusion and right heart failure. Here, we present the case of a 63‐year‐old man with subacute cardiac tamponade complicated with heart failure, acute kidney injury, and generalized edema due to the bosutinib treatment.

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a common hereditary kidney disorder characterized by bilateral cyst formation and progressive kidney damage. Predicting prognosis at diagnosis and during follow-up can be challenging. Beyond genetics and total kidney volume, clinical features such as blood pressure profile and proteinuria may be valuable. We evaluated 116 ADPKD patients from medical records in terms of demographic and clinical parameters, as well as two new variables: average blood pressure (calculated as the mean across all visits) and average proteinuria (also calculated across all visits). Univariate and multivariate analyses of these parameters were performed to assess their association with renal replacement therapy and other renal outcome measures. The study included 116 ADPKD patients with a median age of 44.5 years and a follow-up period of 55 months. Hypertension was common (76.7%), with most patients receiving RAS blockade therapy. A lower eGFR at presentation was a key predictor of worse renal outcomes. Diastolic blood pressure and RAS blockade were significantly associated with disease progression. However, multivariate analysis did not confirm proteinuria, smoking, or extrarenal manifestations as independent predictors of creatinine doubling or eGFR halving time. Efforts to predict prognosis in ADPKD using clinical features beyond genetics remain a subject of debate. Future studies with larger cohorts are needed to validate the role of these parameters in predicting ADPKD progression.

Chronic kidney disease,COVID-19,peritoneal dialysis,peritonitis

Atherosclerotic renovascular disease (ARVD) is the most common cause of renal artery stenosis (RAS). ARVD is associated with an increased risk of progression of kidney disease and high mortality. In this regard, the aim was to evaluate the effects of the factors on kidney functions in short- and long-term follow-ups. Patients with RAS treated with renal artery stenting since January 2015 were evaluated retrospectively in a single center. The primary endpoint was a decline in the estimated glomerular filtration rate (eGFR) of ≥ 20 ml/min and/or evolution to end stage kidney disease. Predictors of the primary endpoint were determined using the Cox regression model. Of the 95 patients included, 57 (56.4%) were male, and the mean age was 68.7 ± 10.4. Median serum creatinine (mg/dl) and eGFR (ml/min/1.73 m2) at presentation were 1.57 (IQR, 1.11–2.12) and 40 (27–58). The median follow-up was 31 months. Indications for renal artery revascularization included high blood pressure (34 patients, 35.8%), kidney failure (29 patients, 30.5%), or a mixture of these (32 patients, 33.7%). RAS was unilateral in 67 (70%) patients. In the multivariate Cox regression analysis, serum creatinine (HR 2.03, 95% CI 1.3–3.2, p = 0.002), peak systolic velocity (HR 1.005 per 10 ms, 95% CI 1.001–1.010, p = 0.007), and acute kidney injury after revascularization (HR 10.18, 95% CI 2.3–45.4, p < 0.001) were independent predictors of progression of chronic kidney disease. Serum creatinine level, peak systolic velocity of the renal artery before revascularization, and acute kidney injury after angiographic intervention are independent predictors of the progression of chronic kidney disease in patients who underwent renal artery stenting.

Background: This study aimed to analyze the association between monocyte-to-lymphocyte ratio (MLR) and nutritional indicators in peritoneal dialysis (PD) patients Methods: Among the 228 maintenance PD patients 44 of those were included in this retrospective analysis. The geriatric nutrition risk index (GNRI) was calculated by using serum albumin and body weight, and the prognostic nutrition index (PNI) was by serum albumin and lymphocyte count. Monocyte-to-lymphocyte ratio (MLR) and nutritional indicators were analyzed by Spearman correlation and linear regression analysis. Results: During the follow-up of 25 months, median GNRI and PNI values showed an increase from a median baseline GNRI of 86.7 (IQR, 92.9, 104.9) to 100.5 (IQR, 92.7, 109.0) (p=0.03) and PNI values of baseline 43.1 (IQR, 41.0, 46.3) to 46.1 (IQR, 39.1, 50.5) (p=0.02). MLR showed a decrease from the baseline median value of 0.38 (IQR, 0.28, 0.58) to 0.36 (IQR, 0.29, 0.47) p=0.03. There were no changes in leukocyte and hs-CRP levels. There were statistically significant negative correlations between MLR and PNI (rs -0.452; p=0.002), GNRI (rs -0.400 p=0.008), and BMI (rs -0.308; p=0.04). No significant correlation was observed with albumin levels (rs =0.221; p=0.154). MLR was statistically significantly associated with GNRI, PNI, and body mass index (BMI) except albumin, however, hs-CRP level was only associated with serum albumin in both univariate and multivariate regression analysis. Conclusion: This study indicates that the higher MLR values were associated with lower GNRI and PNI values in PD patients. MLR may help clinicians to identify the nutritional status of this population.

The prevalence of chronic kidney disease (CKD) is increasing, reflecting the rising incidence of chronic diseases. With the continuous growth of the global geriatric population, a significant portion of individuals with CKD consists of those aged over 65. Regardless of the chosen treatment method, protein-energy loss in patients undergoing renal replacement therapy (RRT) has been associated with elevated morbidity and mortality rates. This is a retrospective, single-center study of incident adult PD patients on peritoneal dialysis (PD) from 1998 to 2022. We aimed to compare the survival outcomes of geriatric patients on PD with changing BMI measurements. In the geriatric patient group exhibiting a reduced BMI after dialysis initiation, BMI significantly and negatively influenced survival (p = 0.01). The negative effect of BMI on survival was independent of known risk factors such as diabetes mellitus, a history of cardiovascular disease, gender, residual renal function, and history of hemodialysis before peritoneal dialysis (HD before PD) (p = 0.04). Although BMI is easy and extensively measured, it is not considered the perfect monitoring parameter for dialysis patients. However, regular follow-up of BMI, especially in geriatric cases, can be a guiding tool for estimating patients’ prognoses.