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Kurultak I, Gungor O, Ozturk S, Dirim AB, Eren N, Yenigün E, Dal EA, Dincer MT, Bora F, Akgur S, Sumnu A, Dursun B, Sipahi S, Cetinkaya H, Sahin I, Sahin G, Yilmaz M, Vatansever B, Aydın E, Ulu MS, Gundogdu A, Ustundag S, Sayarlioglu H, Kumru G, Elcioglu OC, Aydın Z, Selcuk NY, Onal Guclu C, Oruc M, Kucuk M, Aktas N, Derici U, Suleymanlar G. Clinical and histopathological characteristics of primary focal segmental glomerulosclerosis in Turkish adults. Sci Rep 2024; 14:6748. [PMID: 38514826 PMCID: PMC10957996 DOI: 10.1038/s41598-024-57305-6] [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: 08/04/2023] [Accepted: 03/16/2024] [Indexed: 03/23/2024] Open
Abstract
The data regarding primary FSGS (pFSGS) from different parts of the world differ. While the prevalence of pFSGS has been increasing in Western countries like the USA, it follows an inconsistent trend in Europe and Asia and a decreasing trend in Far Eastern countries such as China in the last two decades. There are undetermined factors to explain those national and geographic discrepancies. Herein, we aimed to reveal the current prevalence with clinical and histopathological characteristics of pFSGS in Turkish adults. This study includes the biopsy-proven pFSGS patients data recorded between 2009 and 2019, obtained from the national multicenter primary glomerulonephritis registry system of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database. 850 of the 3875 primer glomerulonephritis patients(21.9%) have pFSGS. The mean age is 40.5 ± 14.2 and 435 (51.2%) of patients are male. Nephrotic syndrome is the most common biopsy indication (59.2%). 32.6% of patients have hematuria, 15.2% have leukocyturia and 7.8% have both. Serum creatinine, albumin, and proteinuria are 1.0 mg/dL (IQR = 0.7-1.4) mg/dl, 3.4 ± 0.9 g/dl, 3400 mg/day(IQR, 1774-5740), respectively. Females have lower mean arterial pressure (- 2.2 mmHg), higher eGFR (+ 10.0 mL/min/1.73 m2), and BMI (+ 1.6 kg/m2) than males. Thickened basal membrane(76.6%) and mesangial proliferation (53.5%) on light microscopy are the major findings after segmental sclerosis. IgM (32.7%) and C3 (32.9%) depositions are the most common findings on immunofluorescence microscopy. IgM positivity is related to lower eGFR, serum albumin, and higher proteinuria. The prevalence of pFSGS is stable although slightly increasing in Turkish adults. The characteristics of the patients are similar to those seen in Western countries.
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Affiliation(s)
- Ilhan Kurultak
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Trakya University, 22030, Edirne, Turkey.
| | - Ozkan Gungor
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Sutcu Imam University, Kahramanmaras, Turkey
| | - Savas Ozturk
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul, Turkey
| | - Necmi Eren
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Kocaeli University, Kocaeli, Turkey
| | - Ezgi Yenigün
- Department of Internal Medicine, Division of Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Elbis Ahbab Dal
- Department of Internal Medicine, Division of Nephrology, Health Science University, Istanbul Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Feyza Bora
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Akdeniz University, Antalya, Turkey
| | - Suat Akgur
- Department of Internal Medicine, Division of Nephrology, Kutahya Health Science University, Evliya Celebi Yuksek Ihtisas Training and Research Hospital, Kutahya, Turkey
| | - Abdullah Sumnu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Medipol University, Istanbul, Turkey
| | - Belda Dursun
- Faculty of Medicine, Department of InternalMedicine, Division of Nephrology, Pamukkale University, Denizli, Turkey
| | - Savas Sipahi
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Sakarya University, Sakarya, Turkey
| | - Hakki Cetinkaya
- Department of Internal Medicine, Division of Nephrology, Sultan Abdulhamid Training and Research Hospital, Istanbul, Turkey
| | - Idris Sahin
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Inonu University, Malatya, Turkey
| | - Garip Sahin
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Murvet Yilmaz
- Department of Internal Medicine, Division of Nephrology, Health Science University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Bulent Vatansever
- Department of Internal Medicine, Division of Nephrology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Emre Aydın
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Dicle University, Diyarbakir, Turkey
| | - Memnune Sena Ulu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Afyon Kocatepe University, Afyon, Turkey
| | - Ali Gundogdu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Erciyes University, Kayseri, Turkey
| | - Sedat Ustundag
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Trakya University, 22030, Edirne, Turkey
| | - Hayriye Sayarlioglu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Samsun 19 Mayis University, Samsun, Turkey
| | - Gizem Kumru
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Ankara University, Ankara, Turkey
| | - Omer C Elcioglu
- Department of Internal Medicine, Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Zeki Aydın
- Department of Internal Medicine, Division of Nephrology, Darıca Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Nedim Yılmaz Selcuk
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Selcuk University, Konya, Turkey
| | - Ceren Onal Guclu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Hacettepe University, Ankara, Turkey
| | - Meric Oruc
- Department of Internal Medicine, Division of Nephrology, Kartal Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Mehmet Kucuk
- Department of Internal Medicine, Division of Nephrology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Nimet Aktas
- Department of Internal Medicine, Division of Nephrology, Health Science University, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ulver Derici
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Gazi University, Ankara, Turkey
| | - Gultekin Suleymanlar
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Akdeniz University, Antalya, Turkey
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Aydin Z, Yilmaz M, Sipahioglu M, Dervisoglu E, Aydemir N, Uzun S, Istemihan Z, Unsal O, Tatar E, Berktas HB, Ozdemir A, Sumnu A, Kumru G, Cetinkaya H, Kazan S, Kocyigit I, Gokalp C, Hasbal B, Artan AS, Ozelsancak R, Taymez D, Yadigar S, Alagoz S, Aslan BB, Yaylaci S, Jabrayilov J, Turgutalp K, Dursun B, Sahin G. Demographic, clinical and laboratory characteristics of adult-onset minimal change disease in Turkey: Turkish Society of Nephrology-Glomerular Diseases (TSN-GOLD) Working Group. Int Urol Nephrol 2023; 55:975-982. [PMID: 36178610 DOI: 10.1007/s11255-022-03382-3] [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: 02/24/2022] [Accepted: 09/24/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE In our study, diagnostic and demographic characteristics of patients diagnosed with minimal change disease (MCD) by biopsy, clinical and laboratory findings in our country were investigated. METHODS Data were obtained from the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group database. Demographic characteristics, indications for biopsy, diagnosis of the glomerular diseases, comorbidities, laboratory and biopsy findings of all patients were recorded. The data presented are cross-sectional and includes application data for the biopsy period. RESULTS Of 3875 patients, 233 patients with MCD (median age 35.0 years) were included in the study, which constitutes 6.0% of the total glomerulonephritis database. Renal biopsy was performed in 196 (84.1%) patients due to nephrotic syndrome. Median serum creatinine was 0.7 (0.6-1.0) mg/dl, mean eGFR was 104 ± 33 ml/min/1.73 m2 and median proteinuria 6000 mg/day. The number of patients under the age of 40 years was 139 (59.7%) (Group A), and the number of patients aged 40 years and over was 94 (40.3%) (Group B). Compared to Group A, global sclerotic glomeruli (24 vs. 43, p < 0.001) interstitial inflammation (15 vs. 34, p < 0.001), interstitial fibrosis (20 vs. 31, p = 0.001, vascular changes (10 vs. 25, p < 0.001) and tubular atrophy (18 vs. 30, p < 0.001) were found to be significantly higher in Group B. There was no difference in immunofluorescent staining properties between the two groups. CONCLUSION Our data are generally compatible with the literature. Chronic histopathological changes were more common in patients aged 40 years and older than younger patients. Studies investigating the effects of these different features on renal survival are needed.
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Affiliation(s)
- Zeki Aydin
- Department of Nephrology, Darica Farabi Training and Research Hospital, University of Health Sciences, Fevziçakmak, Dr. Zeki Acar Ave. No: 62, 4170, Darica, Kocaeli, Turkey.
| | - Murvet Yilmaz
- Department of Nephrology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Sipahioglu
- Division of Nephrology, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Erkan Dervisoglu
- Division of Nephrology, Department of Internal Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Nihal Aydemir
- Department of Nephrology, Ankara Numune Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sami Uzun
- Department of Nephrology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zulal Istemihan
- Division of Nephrology, Department of Internal Medicine, Istanbul University School of Medicine, Istanbul, Turkey
| | - Oktay Unsal
- Division of Nephrology, Department of Internal Medicine, Uludag University School of Medicine, Bursa, Turkey
| | - Erhan Tatar
- Department of Nephrology, Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Haci Bayram Berktas
- Division of Nephrology, Department of Internal Medicine, Inonu University School of Medicine, Malatya, Turkey
| | - Arzu Ozdemir
- Department of Nephrology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Abdullah Sumnu
- Department of Nephrology, Medipol University School of Medicine, Istanbul, Turkey
| | - Gizem Kumru
- Division of Nephrology, Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Hakki Cetinkaya
- Department of Nephrology, Sultan Abdülhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sinan Kazan
- Department of Nephrology, Afyonkarahisar School of Medicine, University of Health Sciences, Afyonkarahisar, Turkey
| | - Ismail Kocyigit
- Division of Nephrology, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Cenk Gokalp
- Division of Nephrology, Department of Internal Medicine, Trakya University School of Medicine, Edirne, Turkey
| | - Baris Hasbal
- Department of Nephrology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Bezm-I Alem Vakif University School of Medicine, Istanbul, Turkey
| | - Ruya Ozelsancak
- Division of Nephrology, Department of Internal Medicine, Cukurova University School of Medicine, Adana, Turkey
| | - Dilek Taymez
- Department of Nephrology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Serap Yadigar
- Department of Nephrology, Dr. Lutfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Selma Alagoz
- Division of Nephrology, Department of Internal Medicine, Istanbul Cerrahpasa University School of Medicine, Istanbul, Turkey
| | - Bilal Burcak Aslan
- Department of Nephrology, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Selcuk Yaylaci
- Division of Nephrology, Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| | - Jabrayil Jabrayilov
- Division of Nephrology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Kenan Turgutalp
- Division of Nephrology, Department of Internal Medicine, Mersin University School of Medicine, Mersin, Turkey
| | - Belda Dursun
- Division of Nephrology, Department of Internal Medicine, Pamukkale University School of Medicine, Denizli, Turkey
| | - Garip Sahin
- Division of Nephrology, Department of Internal Medicine, Osmangazi University School of Medicine, Eskisehir, Turkey
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Süsal C, Kumru G, Döhler B, Morath C, Baas M, Lutz J, Unterrainer C, Arns W, Aubert O, Bara C, Beiras-Fernandez A, Böhmig GA, Bösmüller C, Diekmann F, Dutkowski P, Hauser I, Legendre C, Lozanovski VJ, Mehrabi A, Melk A, Minor T, Mueller TF, Pisarski P, Rostaing L, Schemmer P, Schneeberger S, Schwenger V, Sommerer C, Tönshoff B, Viebahn R, Viklicky O, Weimer R, Weiss KH, Zeier M, Živčić-Ćosić S, Heemann U. Should kidney allografts from old donors be allocated only to old recipients? Transpl Int 2020; 33:849-857. [PMID: 32337766 DOI: 10.1111/tri.13628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 09/20/2019] [Revised: 11/06/2019] [Accepted: 04/22/2020] [Indexed: 02/05/2023]
Abstract
In several deceased donor kidney allocation systems, organs from elderly donors are allocated primarily to elderly recipients. The Eurotransplant Senior Program (ESP) was implemented in 1999, and since then, especially in Europe, the use of organs from elderly donors has steadily increased. The proportion of ≥60-year-old donors reported to the Collaborative Transplant Study (CTS) by European centers has doubled, from 21% in 2000-2001 to 42% in 2016-2017. Therefore, in the era of organ shortage it is a matter of debate whether kidney organs from elderly donors should only be allocated to elderly recipients or whether <65-year-old recipients can also benefit from these generally as "marginal" categorized organs. To discuss this issue, a European Consensus Meeting was organized by the CTS on April 12, 2018, in Heidelberg, in which 36 experts participated. Based on available evidence, it was unanimously concluded that kidney organs from 65- to 74-year-old donors can also be allocated to 55- to 64-year-old recipients, especially if these organs are from donors with no history of hypertension, no increased creatinine, no cerebrovascular death, and no other reasons for defining a marginal donor, such as diabetes or cancer.
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Affiliation(s)
- Caner Süsal
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gizem Kumru
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Morath
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marije Baas
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jens Lutz
- Division of Nephrology and Infectious Diseases, Medical Clinic, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany
| | | | - Wolfgang Arns
- Department of Nephrology and Transplantation, Cologne Merheim Medical Center, Cologne, Germany
| | - Olivier Aubert
- Service de Transplantation Rénale et Unité de Soins Intensifs, AP-HP, Hôpital Necker-Enfants Malades, Paris Descartes University, Paris, France
| | - Christoph Bara
- Division of Thoracic Transplantation and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
| | - Andres Beiras-Fernandez
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University, Mainz, Germany
| | - Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Claudia Bösmüller
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Fritz Diekmann
- Department of Nephrology and Renal Transplantation, ICNU, Hospital Clinic, Barcelona, Spain
| | - Philipp Dutkowski
- Department of Surgery and Transplantation, Swiss HPB and Transplantation Center, University Hospital Zurich, Zurich, Switzerland
| | - Ingeborg Hauser
- Department of Nephrology, Medinizische Klinik III, UKF, Goethe University, Frankfurt, Germany
| | - Christophe Legendre
- Service de Transplantation Rénale et Unité de Soins Intensifs, AP-HP, Hôpital Necker-Enfants Malades, Paris Descartes University, Paris, France
| | - Vladimir J Lozanovski
- Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Thomas Minor
- Department of Surgical Research, Clinic for General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Germany
| | - Thomas F Mueller
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Przemyslaw Pisarski
- Department for General and Visceral Surgery, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Lionel Rostaing
- Service de Néphrologie, Dialyse, Aphérèses et Transplantation, CHU Grenoble Alpes, Grenoble, France
| | - Peter Schemmer
- Department of Surgery, General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
| | - Stefan Schneeberger
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Vedat Schwenger
- Department of Nephrology and Autoimmune Diseases, Transplantation Center, Klinikum Stuttgart, Stuttgart, Germany
| | - Claudia Sommerer
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Richard Viebahn
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ondrej Viklicky
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Rolf Weimer
- Department of Internal Medicine, University of Giessen, Giessen, Germany
| | - Karl-Heinz Weiss
- Department of Internal Medicine IV, Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stela Živčić-Ćosić
- Department of Nephrology, Dialysis and Kidney Transplantation, Faculty of Medicine, Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Guler HS, Tulunay Kaya C, Kumru G, Kosku H, Ozyuncu N, Sengul S, Kutlay S. Acute stunning effect of hemodialysis on myocardial performance: A three-dimensional speckle tracking echocardiographic study. Artif Organs 2020; 44:1081-1089. [PMID: 32279336 DOI: 10.1111/aor.13698] [Citation(s) in RCA: 5] [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: 02/16/2020] [Revised: 03/28/2020] [Accepted: 04/03/2020] [Indexed: 11/30/2022]
Abstract
The effects of acute changes during hemodialysis (HD) on the myocardium are not yet known. The invention of three-dimensional speckle tracking echocardiography (3DSTE) has offered clinicians a new method to assess the movements of ventricular segments simultaneously in three spatial directions. The aim of this study was to evaluate the effect of first weekly standard HD process on the left ventricle (LV) and right ventricle (RV) global and regional myocardial function in patients with normal left ventricle ejection fraction using 3DSTE-derived indices. Patients (n=38) receiving maintenance HD in our clinic who have no known cardiovascular disease are examined just before and after a HD session using 3DSTE. Demographic and comorbidity data, renal replacement treatment characteristics, and laboratory test results are recorded. 3DSTE analysis is performed to calculate the LV global longitudinal, circumferential area and radial peak systolic strain, as well as RV septum and free-wall longitudinal strain and fractional area change. Patients are aged 52.8 ± 13.6 years and 52.6% of them are male. Mean dialysis duration is 56 months. The LV strain values of the patients changed markedly before and after HD (GLS: -14.2 ± 5.2, -11.1 ± 4.6 [P < .001], GCS: -14.8 ± 4.2, -12.4 ± 5.28 [P < .009]; GRS: 41.5 ± 16, 33.3 ± 16.5 [P = .003]; AREA -24.7 ± 7.2, -20.1 ± 7.6 [P = .001], respectively). We could not demonstrate any improvement in RV strain values before or after HD. LV strain values are positively correlated with blood pressure variability during the dialysis sessions. LV function is preserved better after HD in patients on beta or calcium channel blocker therapy compared to those who do not use these agents (P < .001, P < .01, respectively). HD treatment results in deterioration in all LV strain directions but not in RV. Strain assessment may improve vascular risk stratification of patients on chronic HD.
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Affiliation(s)
- Hasan Selim Guler
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Cansin Tulunay Kaya
- Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey
| | - Gizem Kumru
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Hakan Kosku
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Nil Ozyuncu
- Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey
| | - Sule Sengul
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Sim Kutlay
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
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5
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Erdogmus S, Kutlay S, Kumru G, Ors Sendogan D, Erturk S, Keven K, Ceylaner G, Sengul S. Fabry Disease Screening in Patients With Kidney Transplant: A Single-Center Study in Turkey. EXP CLIN TRANSPLANT 2020; 18:444-449. [PMID: 32281532 DOI: 10.6002/ect.2019.0279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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 Fabry disease is a rare X-linked multisystemic lysosomal storage disorder of the glycosphingolipid metabolic pathway. Nephropathy is one of the most important complications of Fabry disease, and patients with classical phenotype are at risk of developing endstage kidney disease. In this study, we investigated the use of screening for Fabry disease in kidney transplant recipients at our center. MATERIALS AND METHODS We screened 301 kidney transplant recipients with functioning grafts. Analyses for α-galactosidase A gene mutation were performed in all female and male kidney transplant recipients. We also measured leukocyte α-galactosidase A enzyme activity in patients with identified GLA mutation. RESULTS In 301 kidney transplant recipients, mean age was 42.9 ± 12.5 years, and the number of male patients was 180 (60%). Mean time after transplant was 79 ± 56 months, and estimated glomerular filtration rate was 66.8 ± 21 mL/min/1.73 m². One male patient who was diagnosed with Fabry disease before kidney transplant was also evaluated (mutation in the α-galactosidase A gene, c.1093_1101dup [p.Tyr365_lle367dup]). In 2 female patients, p.A143T (c.427G>A) mutation of unknown significance and p.D313Y (c.937G>T) heterozygous mutation were identified; however, leukocyte ?-galactosidase A enzyme activity was normal in these patients (63.7 and 67.3 nmol/h/mg protein). In the patient diagnosed with Fabry disease, family screening revealed 4 additional affected family members. DISCUSSIONS Although prevalence was shown to be low in our center (1/301 patients; 0.33%), screening studies in kidney transplant recipients may help to detect new patients before they develop life-threatening complications such as renal involvement.
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Affiliation(s)
- Siyar Erdogmus
- From the Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
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6
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Sendogan DO, Saritas H, Kumru G, Erdogmus S, Tuzuner A, Keven K, Sengul S. Therapeutic Effect of Plasmapheresis and Intravenous Immunoglobulin in Recipients of Kidney Transplant With High Panel-reactive Antibody Levels: A Single-center Experience. Transplant Proc 2019; 51:2254-2256. [PMID: 31474291 DOI: 10.1016/j.transproceed.2019.04.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/15/2018] [Revised: 03/01/2019] [Accepted: 04/17/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE High panel-reactive antibody (PRA) levels limit patients' access to kidney transplantation from potential living donor candidates and decrease renal graft survival by causing acute antibody-mediated rejection (AAMR). In this article, we report our experiences about the efficiency of plasmapheresis (PP) and intravenous immunoglobulin (IVIG) in reduction of serum PRA levels in candidates for renal transplantation and in patients with AAMR. METHODS We examined retrospectively 47 patients with high PRA levels (18 for desensitization (DS) and 29 with AAMR) at Ankara University. The reduction in PRA class 1 and PRA class 2 levels before and after the PP, IVIG, and rituximab or eculizumab therapy were evaluated. RESULTS In the DS group, mean reduction in PRA class I ± SD was 28.0 ± 9.10 to 22.1 ± 8.14 (P <.05), and mean reduction in PRA class II ± SD was 40.3 ± 6.89 to 32.2 ± 5.68 (P < .05). In the AAMR group; mean reduction in PRA class I ± SD was 23.9 ± 9.56 to 17.8 ± 8.64 (P > .05), and mean reduction in PRA class II ± SD was 28.1 ± 8.37 to 26.7 ± 7.96 (P > .05). In total, mean reduction in PRA class I was 25.7 ± 6.66 to 19.7 ± 6.00 (P < .01). Mean reduction in PRA class II was 33.8 ± 5.93 to 29.2 ± 4.96 (P > .05). In the DS group, 3 (16.7%) patients were treated with rituximab. In the AAMR group, 9 (31.0%) patients were treated with rituximab, and 1 (5.5%) patient received eculizimab.In the DS group, the mean follow-up period in years ± SD was 5.06 ± 3.01 and no patient had graft loss. In the AAMR group, the mean follow-up period in years was 5.06 ± 2.74 and 6 (33.3%) patients had graft loss with acute rejection. CONCLUSIONS PP and IVIG treatment provide significant reduction in PRA levels and can be used in DS protocols.
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Affiliation(s)
- Damla Ors Sendogan
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey.
| | - Hazen Saritas
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Gizem Kumru
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Siyar Erdogmus
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Acar Tuzuner
- Department of General Surgery, Ankara University Medical School, Ankara, Turkey
| | - Kenan Keven
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Sule Sengul
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
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Sarıtaş H, Sendogan DO, Kumru G, Sadioglu RE, Duman N, Erturk S, Nergisoglu G, Tuzuner A, Sengul S, Keven K. Long-term Results of Kidney Transplantation in Patients With Familial Mediterranean Fever and Amyloidosis. Transplant Proc 2019; 51:2289-2291. [PMID: 31400971 DOI: 10.1016/j.transproceed.2019.04.074] [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: 12/15/2018] [Revised: 02/19/2019] [Accepted: 04/17/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Amyloid A amyloidosis is most commonly caused by familial Mediterranean fever (FMF) in Turkey. Amyloidosis secondary to FMF is an important cause of end-stage renal failure, and kidney transplantation (KT) in these cases can be complicated, with long-term results oftentimes inferior compared with organ transplant in patients without FMF. The present study aims to show the long-term results of patients with secondary amyloidosis caused by FMF undergoing KT . METHODS We enrolled 27 patients with a history of FMF amyloidosis undergoing KT and a control group of 614 patients undergoing KT between 2005 and 2018 at Ankara University Medical School. All data were recorded retrospectively from patients files. RESULTS Twenty-two patients (81.5%) were treated with triple immunosuppressive therapy consisting of mycophenolate mofetil, tacrolimus, and a steroid; 5 patients (18.5%) were treated with tacrolimus, azathioprine, and prednisolone. Acute cellular rejection was seen in 3 patients (11.1%), and acute cellular- and antibody-mediated rejection occurred in 1 patient (3.7%). During the follow-up period, graft loss due to acute cellular rejection was observed in only 1 patient. One patient was lost to follow-up.
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Affiliation(s)
- Hazen Sarıtaş
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey.
| | - Damla Ors Sendogan
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Gizem Kumru
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | | | - Neval Duman
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Sehsuvar Erturk
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Gokhan Nergisoglu
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Acar Tuzuner
- Department of General Surgery, Ankara University Medical School, Ankara, Turkey
| | - Sule Sengul
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Kenan Keven
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
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Sarıtaş H, Şendoğan DÖ, Kumru G, Eyüboğlu Ş, Altıntaş ND, Kocaay AF, Tüzüner A, Şengül Ş, Keven K. Maintenance Immunosuppressive Treatment of Renal Transplant Recipients in the Critical Care Unit. Transplant Proc 2019; 51:2358-2360. [PMID: 31402252 DOI: 10.1016/j.transproceed.2019.03.052] [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: 12/15/2018] [Revised: 02/19/2019] [Accepted: 03/12/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND In intensive care unit (ICU), although there is no standard protocol for maintenance of immunosuppressive (IS) treatments for the kidney transplant recipients (KTx), the dose and the number of IS drugs are decreased according to the center's experience. The aim of this study is to evaluate the changes in IS treatment during stays in the ICU and to evaluate the safety and results of this modification on the IS treatment in the ICU arbitrarily. METHOD We evaluated retrospectively our kidney transplant recipients in ICU between 2012 and 2017. The immunosuppressive protocols and the results were taken from the ICU documents. RESULTS A total of 31 (18 male, 13 female) patients were suitable for the analysis. They were all under the triple IS protocol including Tacrolimus (Tac) + Mycophenolate mofetil (MMF) + steroid before the admission. The reason for ICU admission were severe sepsis in all patients. In ICU, 16 patients (51.6%) died, and a total of 10 patients were lost with functional graft. Change in IS treatment is as follows: a total of the 23 patients (74.2%) were given only steroids, and 8 patients (25.8%) were changed from triple to 2 drugs. Acute kidney injury developed in 42% (13 patients) of the patients in ICU. CONCLUSION In our study, we observed that life-threatening severe infections were the main cause of ICU admission in KTx. Reduction in IS treatments are common practice, and reduction to a single dose of steroid was the most frequently chosen IS treatment. Eighty percent of patients are discharged with reduction of steroid gradually. None of the patients developed acute rejection and permanent graft injury.
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Affiliation(s)
- Hazen Sarıtaş
- Siirt State Hospital Department of Nephrology, Siirt, Turkey.
| | - Damla Örs Şendoğan
- Ankara University Medical School, Department of Nephrology, Ankara, Turkey
| | - Gizem Kumru
- Ankara University Medical School, Department of Nephrology, Ankara, Turkey
| | - Şahin Eyüboğlu
- Ankara University Medical School, Department of Nephrology, Ankara, Turkey
| | | | | | - Acar Tüzüner
- Ankara University Medical School, General Surgery, Ankara, Turkey
| | - Şule Şengül
- Ankara University Medical School, Department of Nephrology, Ankara, Turkey
| | - Kenan Keven
- Ankara University Medical School, Department of Nephrology, Ankara, Turkey
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Sendogan DO, Saritas H, Kumru G, Eyupoglu S, Sadioglu RE, Tuzuner A, Sengul S, Keven K. Outcomes of Canakinumab Treatment in Recipients of Kidney Transplant With Familial Mediterranean Fever: A Case Series. Transplant Proc 2019; 51:2292-2294. [PMID: 31400972 DOI: 10.1016/j.transproceed.2019.03.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/21/2019] [Accepted: 03/12/2019] [Indexed: 11/28/2022]
Abstract
Familial Mediterranean fever (FMF) is an important and preventable cause of chronic kidney disease due to secondary amyloidosis. Although colchicine is the first-line therapy in patients with FMF with 60% to 65% complete remission rates, 5% to 10% of patients are colchicine-resistant and 5% to 10% of them are intolerant to the therapy. Anti-interleukin-1 agents, such as anakinra and canakinumab, are safe and efficient therapeutic options in patients with colchicine resistance or intolerance. However, the data on management of these targeted agents is limited in recipients of kidney transplant (RKT). In this case series, we aim to share our experience on canakinumab therapy of 4 RKTs with FMF-related amyloidosis, who were followed up in our clinic between 2010 and 2017. All of the 4 patients with end-stage renal disease were colchicine- resistant and on other alternative therapies, which provided poor disease control. For efficient control of secondary amyloidosis, canakinumab therapy was initiated in 1 of the patients before the renal transplant, and for the remaining patients after renal transplant. Any serious adverse effect, development of proteinuria, or graft dysfunction has not been observed in any of the patients. Under the canakinumab treatment, complete clinical responses, prevent typical familial Mediterranean fever attacks with fever and arthritis and abdominal pain, normalized serum amyloid A and C-reactive protein levels were achieved in all patients. Canakinumab treatment is a safe and effective therapeutic option for RKTs with FMF who are resistant or intolerant to colchicine and anakinra.
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Affiliation(s)
- Damla Ors Sendogan
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey.
| | - Hazen Saritas
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Gizem Kumru
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Sahin Eyupoglu
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | | | - Acar Tuzuner
- Department of General Surgery, Ankara University Medical School, Ankara, Turkey
| | - Sule Sengul
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
| | - Kenan Keven
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
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Kumru G, Altintas ND, Sengul S. Severe Hypermagnesemia Caused by Laxative Use in Patients without Pre-Existing Renal Disfunction. Turk J Nephrol 2019. [DOI: 10.5152/turkjnephrol.2019.3443] [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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Erdogmus S, Kendi Celebi Z, Akturk S, Kumru G, Duman N, Ates K, Erturk S, Nergizoglu G, Kutlay S, Sengul S, Keven K. Profile of renal AA amyloidosis in older and younger individuals: a single-centre experience. Amyloid 2018; 25:115-119. [PMID: 29775082 DOI: 10.1080/13506129.2018.1474733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 10/16/2022]
Abstract
OBJECTIVE In epidemiological studies of amyloid A (AA) amyloidosis from Turkey, the most frequently cause was familial Mediterranean fever (FMF) and it occurs generally in young age population. However, there are no sufficient data regarding aetiology, clinical presentation and prognosis of renal AA amyloidosis in advanced age patients. In this study, we aimed to investigate demographic, clinical presentation, aetiology and outcomes of adults aged 60 years or older patients with biopsy-proven renal AA amyloidosis. METHODS This is a retrospective study involving 53 patients who were diagnosed with AA amyloidosis by kidney biopsy from 2006 to 2016. In all patients, kidney biopsies were performed due to asymptomatic proteinuria, nephrotic syndrome and/or renal insufficiency. The patients were separated into two groups on the basis of age (group I: ≥60 years and group II: <60 years). Outcomes of patients in terms of the requirement of renal replacement therapy and mortality were recorded. RESULTS In patients with group I, the causes of AA amyloidosis were as follows: FMF 16 (50%), bronchiectasis 7 (23%), chronic osteomyelitis 2 (6%), inflammatory bowel disease 2 (6%), rheumatoid arthritis 2 (6%), ankylosing spondylitis 1 (3%) and unknown aetiology 2 (6%). The underlying disorders of AA amyloidosis in group II patients were as follows: FMF 17 (81%), Behcet's disease 1 (5%) and unknown aetiology 3 (14%). No statistically significant differences were detected between two groups with regard to systolic and diastolic blood pressures, albumin, proteinuria and lipids. The combination of chronic kidney disease and nephrotic syndrome was the most common clinical presentation in group I (73%) and group II (43%) (p = .05). Compared to the group II, estimated glomerular filtration rate was significantly lower in group I at the time of kidney biopsy (p = .003). At 12-month follow-up, 61% of the group I and 33% of the group II developed end-stage kidney disease requiring dialysis, while 11% of the group I died. CONCLUSION Our results indicated that renal AA amyloidosis is a rare disease in advanced age patients. At baseline and follow-up period, advanced age patients had worse kidney disease and outcomes.
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Affiliation(s)
- Siyar Erdogmus
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Zeynep Kendi Celebi
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Serkan Akturk
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Gizem Kumru
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Neval Duman
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Kenan Ates
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Sehsuvar Erturk
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Gokhan Nergizoglu
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Sim Kutlay
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Sule Sengul
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Kenan Keven
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
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Erdogmus S, Kutlay S, Celebi ZK, Aydın T, Ors Sendogan D, Kumru G, Keven K, Nergizoglu G, Erturk S, Sengul S. Clinical Correlates of Ambulatory Blood Pressure Phenotypes at a Tertiary Care Hospital in Turkey. Kidney Blood Press Res 2018; 43:690-700. [PMID: 29763911 DOI: 10.1159/000489742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/28/2018] [Accepted: 05/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Hypertension and its complications are major public health issues worldwide due to their association with high cardiovascular morbidity and mortality. Despite significant progress in health, the prevalence of hypertension is increasing. Ambulatory blood pressure monitoring (ABPM) is becoming increasingly important for the management of hypertension. In this study, we aimed to investigate the clinical and laboratory correlates of ambulatory blood pressure (ABP) phenotypes at a tertiary care hospital in Turkey. METHODS The characteristics of 1053 patients were retrospectively obtained from the hospital database. Hypertension was defined as patients with office blood pressure (BP) ≥140/90 mmHg and/or previously diagnosed hypertension and/or the use of antihypertensive medication. According to the office BP and ABPM results patients were identified namely: (1) sustained normotensive (SNT) patients (both office BP and ABPM were normal), (2) sustained hypertensive (SHT) patients (both office BP and ABPM were high), (3) masked hypertensive (MHT) patients (office BP were normal, but ABPM were high), (4) white coat hypertensive (WCHT) patients (office BP were above limits, but ABPM were normal). RESULTS A total of 1053 patients were included to the study (female/male: 608/445 and mean age 55 ± 15 years). The mean age of patients with hypertension was significantly higher than without hypertension (p< 0.0001). Hypertension was more frequent in females (p=0.009). The rates of history of diabetes mellitus (DM), hyperlipidemia (HL), and chronic kidney disease (CKD) were higher in patients with hypertension (p< 0.0001). Among patients with hypertension (n=853, 81%), ABPM results showed that 388 (45%) of patients had SHT, 92 (11%) had MHT, and 144 (17%) had WCHT, whereas 229 (27%) had SNT. Patients with MHT were significantly older than patients with SNT (p=0.025). The prevalence of SHT was higher in men than in women, whereas the prevalence of WCHT was higher in women than in men (p< 0.0001). There was no significant difference between 4 groups with regard to body mass index (p=0.142), a history of DM (p=0.189) and smoking status (self-reported) (p=0.306). Patients with SHT had the highest prevalence of history of hypertension, HL and CKD (p< 0.0001). Among patients without hypertension, 26 (13%) of patients had MHT and none of those patients was on antihypertensive treatment. CONCLUSION Potential usages of ABPM in Turkey may include screening of high risk individuals who have traditional cardiovascular risk factors. It also provides clinicians valuable information on abnormal ABP phenotypes. Future studies are needed to clarify the risk factors of different ABP phenotypes and to evaluate the role of ABPM on detection and control of hypertension.
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Affiliation(s)
- Siyar Erdogmus
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey,
| | - Sim Kutlay
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Zeynep Kendi Celebi
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Tolga Aydın
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Damla Ors Sendogan
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Gizem Kumru
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Kenan Keven
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Gokhan Nergizoglu
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Sehsuvar Erturk
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Sule Sengul
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
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Kumru G, Akturk S, Erdogmus S, Coruh AG, Tuzuner A, Sengul S, Keven K. Cavitary lung disease in renal transplant recipients: A single center experience. Transplantation Reports 2017. [DOI: 10.1016/j.tpr.2018.01.001] [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: 11/17/2022] Open
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Aktürk S, Erdoğmuş Ş, Kumru G, Elhan AH, Şengül Ş, Tüzüner A, Keven K. Average Tacrolimus Trough Level in the First Month After Transplantation May Predict Acute Rejection. Transplant Proc 2017; 49:430-435. [PMID: 28340806 DOI: 10.1016/j.transproceed.2017.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although tacrolimus is one of the essential drugs used for the prevention of rejection in kidney recipients, target trough levels are not well established. In this study, we aimed to investigate the association between average tacrolimus trough levels (TTLs) of the first month after transplantation and biopsy-proven acute rejection (BPAR) during the first 12 months after transplant. METHODS A total of 274 patients who underwent kidney-alone transplantation between 2002 and 2014 were enrolled in the study. Average TTLs of the first month were assessed by means of receiver operating characteristic (ROC) curve analysis to discriminate patients with and those without BPAR. Univariate and multivariate Cox proportional hazards models were used to determine the effect of average TTLs of the first month on BPAR. RESULTS According to ROC curve analysis, the highest area under the curve (AUC) was obtained from 8 ng/mL (AUC = 0.73 ± 0.11; 95% confidence interval [CI], 0.62-0.84). Forty-two (31.8%) of the 132 patients with average TTLs <8 ng/mL and 13 (9.1%) of 142 patients with ≥8 ng/mL had BPAR during the first 12 months after transplant (P < .001). In univariable analysis, average TTLs of the first month <8 ng/mL were associated with higher risk of BPAR (P < .001), and the significance remained in Cox multivariable analysis (hazard ratio, 2.79; 95% CI, 1.76-3.82; P = .001). No significant differences were observed in the glomerular filtration rate, cytomegalovirus, BK viremia, or BK nephropathy between groups at post-transplant month 12. CONCLUSIONS Keeping the average TTLs of the first month after transplantation at ≥8 ng/mL not only prevents BPAR occurrence but also minimizes the toxic effects of the use of a single-trough level.
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Affiliation(s)
- S Aktürk
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey.
| | - Ş Erdoğmuş
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - G Kumru
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - A H Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Ş Şengül
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - A Tüzüner
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - K Keven
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
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Erdogmus S, Kendi Celebi Z, Akturk S, Kumru G, Kutlay S, Sengul S, Nergizoglu G, Erturk S, Ates K, Duman N, Keven K. SP454NON-DIABETIC RENAL DISEASE IN TYPE 2 DIABETIC PATIENTS: PREVALENCE, CLINICAL PREDICTORS ANDOUTCOMES. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx149.sp454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Erdogmus S, Kumru G, Kutlay S, Sengul S, Nergizoglu G, Erturk S, Ates K, Duman N, Keven K. MP155RENAL AA AMYLOIDOSIS IN ELDERLY PATIENTS: CLINICAL MANIFESTATIONS, ETIOLOGIES AND OUTCOMES. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx164.mp155] [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: 11/13/2022] Open
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Akturk S, Kumru G, Kendi Celebi Z, Erdogmus S, Tuzuner A, Erturk S, Sengul S, Keven K. SP845CLİNİCAL OUTCOME OF ACUTE REJECTİON EPİSODES IN KIDNEY RECIPIENTS: ANALYSİS OF 12 YEARS OF SİNGLE CENTER EXPERIENCE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv202.71] [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: 11/14/2022] Open
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Karaarslan F, Coker I, Kumru G, Caglayan S. Disturbed systemic immune balance in periodontal disease. Autoimmunity 1998; 27:123-4. [PMID: 9583743 DOI: 10.3109/08916939809008042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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