RESUMO
BACKGROUND: Kidney transplant recipients have an increased risk of complications from COVID-19. However, data on the risk of allograft damage or death in kidney transplant recipients recovering from COVID-19 is limited. In addition, the first and second waves of the pandemic occurred at different times all over the world. In Turkey, the Health Minister confirmed the first case in March 2020; after that, the first wave occurred between March and August 2020; afterward, the second wave began in September 2020. This study aims to demonstrate the clinical presentations of kidney transplant recipients in the first two waves of the pandemic in Turkey and explore the impact of COVID-19 on clinical outcomes after the initial episode. METHODS: Patients with COVID-19 from seven centers were included in this retrospective cohort study. Initially, four hundred and eighty-eight kidney transplant recipients diagnosed with COVID-19 between 1 March 2020 to 28 February 2021 were enrolled. The endpoints were the occurrence of all-cause mortality, acute kidney injury, cytokine storm, and acute respiratory distress syndrome. In addition, longer-term outcomes such as mortality, need for dialysis, and allograft function of the surviving patients was analyzed. RESULTS: Four hundred seventy-five patients were followed up for a median of 132 days after COVID-19. Forty-seven patients (9.9%) died after a median length of hospitalization of 15 days. Although the mortality rate (10.1% vs. 9.8%) and intensive care unit admission (14.5% vs. 14.5%) were similar in the first two waves, hospitalization (68.8% vs. 29.7%; p < 0.001), acute kidney injury (44.2% vs. 31.8%; p = 0.009), acute respiratory distress syndrome (18.8% vs. 16%; p = 0.456), and cytokine storm rate (15.9% vs. 10.1%; p = 0.072) were higher in first wave compared to the second wave. These 47 patients died within the first month of COVID-19. Six (1.4%) of the surviving patients lost allografts during treatment. There was no difference in the median serum creatinine clearance of the surviving patients at baseline (52 mL/min [IQR, 47-66]), first- (56 mL/min [IQR, 51-68]), third- (51 mL/min [IQR,48-67]) and sixth-months (52 mL/min [IQR, 48-81]). Development of cytokine storm and posttransplant diabetes mellitus were independent predictors for mortality. CONCLUSIONS: Mortality remains a problem in COVID-19. All the deaths occur in the first month of COVID-19. Also, acute kidney injury is common in hospitalized patients, and some of the patients suffer from graft loss after the initial episode.
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Injúria Renal Aguda , COVID-19/complicações , Transplante de Rim , Transplantados , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/mortalidade , COVID-19/epidemiologia , COVID-19/mortalidade , Estudos de Coortes , Síndrome da Liberação de Citocina , Humanos , Transplante de Rim/efeitos adversos , Pandemias , Diálise Renal , Síndrome do Desconforto Respiratório/epidemiologia , Síndrome do Desconforto Respiratório/etiologia , Estudos Retrospectivos , SARS-CoV-2 , Turquia/epidemiologiaAssuntos
Síndrome Hemolítico-Urêmica Atípica/diagnóstico , Cardiomiopatias/etiologia , Complicações na Gravidez/diagnóstico , Nascimento Prematuro/etiologia , Insuficiência Renal/etiologia , Síndrome Hemolítico-Urêmica Atípica/imunologia , Feminino , Humanos , Período Pós-Parto , Gravidez , Complicações na Gravidez/imunologia , Diálise Renal , Insuficiência Renal/terapia , Adulto JovemRESUMO
INTRODUCTION: Peritoneal dialysis (PD) remains understudied in disaster nephrology. This retrospective multicenter study explores the experiences of PD survivors following the February 6, 2023, Kahramanmaras Earthquake. METHODS: Adult PD patients from 11 affected cities were analyzed to assess challenges faced during and postearthquake, alongside clinical outcomes. RESULTS: Among 101 participants (median age: 45 years, median PD duration: 24 months), 57 were female, with 79 on continuous ambulatory PD. Challenges included power outages and water shortages, with primary shelter in kin's houses (33%) and homes (28%). Twelve patients experienced PD program delays, and three lacked assistance postdisaster. Sixteen patients changed PD modalities, with seven experiencing postearthquake peritonitis. Clinical parameters remained stable, except for a slight decrease in hemoglobin levels. CONCLUSION: Despite challenges, PD survivors exhibited resilience, highlighting the importance of addressing peritonitis and unusual pathogens in disaster preparedness initiatives.
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Terremotos , Diálise Peritoneal , Sobreviventes , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sobreviventes/psicologia , Adulto , Peritonite/epidemiologia , Peritonite/etiologia , Idoso , Resiliência Psicológica , Desastres , Planejamento em DesastresRESUMO
INTRODUCTION: In this study, it was aimed to investigate the clinical (real-life) impact of the vaccination protocol on patients undergoing kidney transplantation during the COVID-19 pandemic. METHODOLOGY: A total of 260 patients who underwent kidney transplantation between June 2012 and May 2022 were retrospectively evaluated. Patients chose vaccination Sinovac-CoronaVac (CoronaVac) and/or BNT162b2 (Biontech), the first vaccine available in the country) in line with the regulations and recommendations of the Ministry of Health. The relationship between vaccination, hospitalization, and mortality in cases diagnosed with COVID-19 was investigated. The prevalence of COVID-19 in patients, the rate of hospital admission, and the mortality of patients before and after the national vaccination program were examined. RESULTS: The study included a total of 260 kidney transplant patients (Female, n = 107 (41%); male, n = 153 (59%). The mean age of patients was 38.42 (11-75). A total of 108 (41.5%) patients were diagnosed with COVID-19. Seven (6.5%) patients died and 221 (85%) patients were vaccinated after the national vaccination program. During the follow-up period, 108 (41.5%) patients were diagnosed with COVID-19. There was no significant difference in terms of hospitalization between two groups. However, there was a significant difference in terms of admission to intensive care unit and mortality (p < 0.001). CONCLUSIONS: The majority of cases that died were unvaccinated. However, repeated vaccinations may not adequately protect all transplant recipients. There is a need to develop personalized treatment and prevention strategies in transplantation cases.
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COVID-19 , Transplante de Rim , Humanos , Feminino , Masculino , Vacina BNT162 , Vacinas contra COVID-19 , Pandemias , Estudos Retrospectivos , COVID-19/epidemiologia , COVID-19/prevenção & controle , VacinaçãoRESUMO
INTRODUCTION: The mortality rate for any infection is often higher in patients with a kidney transplant (KT) and hemodialysis (HD), which may also be the case in novel coronavirus disease 2019 (COVID-19). METHODOLOGY: In this study, the demographic, clinic, laboratory, and radiologic signs of KT and HD patients diagnosed with COVID-19 infection between 11th March 2020 and 11th March 2021 were evaluated prospectively. RESULTS: In the present study, 72 HD (median age, 57.5 Q1-Q3:43-65; female: 36/50%) and 58 KT patients (median age, 44.5 Q1-Q3:28.75-55.25; female: 21/36.2%) with COVID-19 infection were enrolled. Fifteen patients with HD (20.8%) died. Age, diabetes mellitus (DM), abnormal hemoglobin levels, albumin, C-reactive protein (CRP), ferritin, D-dimer, and procalcitonin were significant in the univariate analysis of survival in patients with HD. However, only age was significant in the Cox-regression analysis [Hazard ratio (HR) (95% CI 1.070 (19.016-1.126)]. Nine (15.5%) KT patients died. The median time from symptoms onset to admission was three days (2-5). This rate was two (2-3) and five (4-5.75) days, respectively, for patients followed up in our center and the external centers (p < 0.001). Although age, DM, shortness of breath, bilateral involvement in CT images, abnormal levels of CRP, urea, leukocyte count, ferritin, and follow-ups of patients from the external center were significant in the univariate analysis of survival in patients with KT, no variables were significant in the cox-regression analysis. CONCLUSIONS: Increased mortality is expected in both HD and KT patients. Early diagnosis of COVID-19 in those patients with COVID-19 infection can be life-saving.
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COVID-19 , Transplante de Rim , Diálise Renal , Adulto , Proteína C-Reativa , COVID-19/diagnóstico , COVID-19/mortalidade , Diabetes Mellitus , Feminino , Ferritinas , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , PandemiasRESUMO
Acute kidney injury (AKI) , proteinuria in the nephrotic or subnephrotic range and hematuria might be seen in patients with coronavirus disease 2019 (COVID-19) infection. In this case study we present a 59 years old manwho was diagnosed with immune-complex glomerulonephritis after development of rapidly progressive kidney failure accompanied by pulmonary hemorrhage, 2 months after COVID-19 infection. The patient was hospitalised with the diagnosis of acute kidney injury and nephrotic syndrome. Hemodialysis was performed due to uremic symptoms. Cyclophosphamide, methylprednisolone and plasmapheresis were started. Pathologic examination of kidney biopsy revealed features compatible with immune complex-related acute glomerulonephritis. Cyclophosphamide and plasmapheresis were discontinued , and treatment with 1 mg/kg/day methylprednisolone was continued. Immune-complex glomerulonephritis can be seen following COVID-19 infection. It is important to diagnose this disease entity as soon as possible . Steroidtherapy and other supportive modalities might be sufficient in the treatment. DOI: 10.52547/ijkd.6527.
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Injúria Renal Aguda , COVID-19 , Glomerulonefrite , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Ciclofosfamida , Feminino , Glomerulonefrite/diagnóstico , Glomerulonefrite/tratamento farmacológico , Humanos , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-IdadeRESUMO
AIM: Patients in chronic renal failure suffer impaired cellular immunity and have an increased risk of tuberculosis (TB). Our aim in this multicenter study was to determine the incidence of TB and to evaluate latent tuberculosis infection (LTBI) in hemodialysis patients. METHODS: We retrospectively evaluated the frequency of TB in 779 dialysis patients at 13 hemodialysis centers in five different cities in Southeast Turkey. The tuberculin skin test (TST) was conducted in 733 patients to detect LTBI. RESULTS: The mean age of the patients was 51.2 +/- 15.9 years; 398 (51.1%) of the patients were female, and 53.9% of patients had a BCG scar. The mean dialysis duration time was 35.1 +/- 33.4 months. TB was diagnosed in 34 cases. The incidence rate of TB in patients undergoing hemodialysis was 3.1%. Ten patients had a history of TB before beginning hemodialysis, and 24 patients had a history of TB after beginning hemodialysis. A diagnosis of TB was made based on clinical data in eight patients and microbiologically or pathologically in 26 patients. The median time between the initiation of dialysis to the diagnosis of TB was 11 months. Extrapulmonary TB occurred in 45.8% of cases, and the most common site of involvement was the lymph nodes. The TST was positive in 61.8% of TB patients and in 37.5% of those with no history of TB. CONCLUSIONS: The incidence of TB is high in hemodialysis patients, and they should be evaluated periodically to exclude insidious infection and reduce morbidity and mortality.
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Falência Renal Crônica/complicações , Tuberculose/complicações , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Endêmicas , Feminino , Humanos , Incidência , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
The most difficult problem a physician encounters is the management of patients with idiopathic thrombocytopenic purpura (ITP), who has persistent severe thrombocytopenia after failure of initial treatment with glucocorticoids and splenectomy. Most of the patients refractory to corticosteroids and splenectomy will become refractory to other available agents, such as intravenous immunoglobulin (IVIg), danazol or chemotherapy. In this study, we investigated the effect of rituximab on 17 splenectomized refractory chronic ITP patients. Here, we showed that the anti-CD20 antibody, rituximab, induces a clinically significant response in severe chronic ITP patients, who are unresponsive to other therapeutic options. After sixth month, 10 out of 14 responders were still maintaining their durable and significant platelet responses (platelet counts >50 x 10(9)/l), without requirement to any other ITP medication. Therefore, we suggest that, rituximab is an effective treatment option in splenectomized refractory or relapsed ITP patients. Rituximab was well tolerated without severe side effects.
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Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Terapia de Salvação/métodos , Adulto , Idoso , Anticorpos Monoclonais , Anticorpos Monoclonais Murinos , Doença Crônica , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Indução de Remissão/métodos , Rituximab , Esplenectomia , Resultado do Tratamento , Adulto JovemRESUMO
Current treatment options of essential mixed cryoglobulinemia (EMC); include immunosuppressive approaches, such as corticosteroids, cyclophosphamide, plasma exchange, other cytotoxic drugs in moderate to severe manifestations. Some controlled studies have been carried out to assess the efficacy of anti-CD20 monoclonal antibody, rituximab in patients with hepatitis C (HCV) related cryoglobulinemia (CG) and in patients with autoimmune disorders. Recent trials and some case reports demonstrate a beneficial role for rituximab in HCV related mixed CG. Although, the published evidence for treatment of EMC with rituximab is restricted to case reports, which have shown positive results. Several diseases include lymphoproliferative and myeloproliferative disorders, solid tumors, immunological disorders, cardiovascular disorders and some drugs associated with acquired von Willebrand disease (avWD). CG, which is a kind of immune complex disease, may be related with development of autoantibodies to various autoantigens. In this present case report, we showed the efficacy of rituximab in a 21-year-old female patient, suffered from neuropathy and arthralgia related with EMC, and developed avWD, presented with mucosal bleeding associated with CG. von Willebrand factor activity of our patient also increased with controlling the underlying disease, EMC by rituximab. This case demonstrate that rituximab may be an effective treatment option in EMC and avWD mainly related to CG.
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Anticorpos Monoclonais/uso terapêutico , Crioglobulinemia/complicações , Crioglobulinemia/tratamento farmacológico , Doenças de von Willebrand/tratamento farmacológico , Anticorpos Monoclonais Murinos , Artralgia , Hemorragia , Humanos , Masculino , Rituximab , Adulto Jovem , Doenças de von Willebrand/etiologia , Fator de von Willebrand/metabolismoRESUMO
Nonsteroidal anti-inflammatory drugs (NSAIDs) cause gastrointestinal (GI) damage primarily due to the inhibition of prostaglandin synthesis in gastric mucosa, which is an important factor in mucosa protection. Platelets are a cardinal feature of vascular repair. A variety of angiogenic stimulators are stored in platelets and are released during clotting at the wound. When there is a defect in any of these functions and/or platelet number, haemostasis is usually impaired and there may be an associated increased risk and severity of bleeding. While the mechanism of mucosal injury and bleeding are well documented with the use of NSAIDs, very little is known about the platelet function abnormalities and their effects on severity of upper GI bleedings. We performed a prospective analysis of 49 patients who had a history of NSAIDs use to investigate the association between the platelet function impairment associated with NSAIDs and severity of upper GI haemorrhages. Thirty-six of 49 patients (73.5%) had deteriorated platelet function. Mean severity score of patients with deteriorated platelet functions was 3.39, and that of patients with normal platelet functions was 2.46. Mean severity score was statistically significantly higher in patients with deteriorated platelet functions. In conclusion, impaired platelet functions associated with NSAIDs may cause more severe upper GI bleeding. Clinicians should be alert for GI complications especially in older patients and in those with a history of ulcer bleeding.
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Anti-Inflamatórios não Esteroides/efeitos adversos , Plaquetas/metabolismo , Hemorragia Gastrointestinal/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/administração & dosagem , Feminino , Hemorragia Gastrointestinal/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Função Plaquetária , Índice de Gravidade de DoençaRESUMO
Most episodes of fistula thrombosis are consequences of underlying physioanatomic abnormalities. However, some dialysis access thrombosis develops independent from any obvious anatomic cause. We aimed to clarify the role of thrombophilias in primary and secondary AVF failure. One hundred eighty nine arteriovenous fistulas in 116 adults on maintenance hemodialysis were analyzed. All subjects were evaluated for many thrombotic factors. Fistula information was obtained both from the patients' self reports, and from their medical records. Twenty-seven AVFs in 18 cases (14.3%) had pAVFF. The percentage of subjects with a BMI < 20 kg/m(2) was significantly lower than no-pAVFF group (P = 0.03). ATIII levels and albumin values were significantly lower in patients with sAVFF compared to those with no sAVFF. Other parameters were similar. There was no statistically significant difference between pAFFF versus No-pAFFF and sAFFF versus No-sAFFF groups with respect to all mutant alleles count. Routine extended analyses of all thrombophillic factors are not recommended in AVFF.
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Derivação Arteriovenosa Cirúrgica/efeitos adversos , Diálise Renal/efeitos adversos , Trombofilia/etiologia , Adulto , Antitrombina III/análise , Índice de Massa Corporal , Feminino , Testes Genéticos , Humanos , Masculino , Pessoa de Meia-Idade , Albumina Sérica/análise , Trombofilia/genética , Trombose/etiologiaRESUMO
Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent inflammatory attacks of serosal membranes. Several studies have focused on the differences between frequency of the mutations and their phenotypical manifestations. The aim of this study was to evaluate whether or not this phenotypical variation is associated with the existence of particular mutations. Twelve MEFV (Mediterranean fever) gene mutations were investigated in 119 patients suffering from FMF. Heterozygote M694V (21/119), heterozygote E148Q (21/119), homozygote M694V (17/119) and heterozygote V726A (12/119) mutations were the most common mutations. Patients were grouped according to the presence of the M694V mutation: group I was M694V/M694V, group II was M694V/others, and group III was other/other. Mean severity scores for the groups were 13.94 +/- 4.10, 10.79 +/- 3.01 and 8.31 +/- 2.26, respectively. There were statistically significant differences between the mean severity scores of groups I and II (p = 0.029), groups I and III (p < 0.0001), and groups II and III (p < 0.0001). Diagnosis of amyloidosis was established in four (23%) patients of group I, and three (8%) patients of group II, but in none of the patients in group III. There was also a statistically significant difference between groups I and III (p = 0.046), but not between groups II and III (p = 0.083) and groups I and II (p = 0.317) in terms of amyloidosis development. In conclusion, we found a higher disease severity score and higher prevalence of amyloidosis in FMF patients who were M694V mutation carriers. Many ethnic groups live in Anatolia and more ethnic origin-based studies are needed to determine the real effect of these mutations on disease severity and amyloidosis.
Assuntos
Substituição de Aminoácidos , Amiloidose/genética , Proteínas do Citoesqueleto/genética , Febre Familiar do Mediterrâneo/genética , Mutação de Sentido Incorreto , Adolescente , Adulto , Amiloidose/diagnóstico , Amiloidose/epidemiologia , Amiloidose/etiologia , Criança , Febre Familiar do Mediterrâneo/complicações , Febre Familiar do Mediterrâneo/epidemiologia , Feminino , Heterozigoto , Homozigoto , Humanos , Masculino , Fenótipo , Prevalência , Pirina , TurquiaRESUMO
Our objective was to elucidate potential causes of higher rates of suicide attempts in females compared to males in southeastern Turkey through a 1-year survey. Gender-related differences observed in 96 subjects who attempted suicide by poisoning for the first time were as follows: in comparison to male, females were predominantly within the age interval of 15-24 years, experienced more stressful events in the previous week before suicide attempt, had lower education level, and had a lower rate of employment. One year after the suicide attempt, unfavorable attitude of family, lack of support, persisting unfavorable lifestyle comparable with that prior to the first attempt, and higher rates of domestic violence were more pronounced in females compared to males. These findings might be contributing factors to the higher suicide attempt rates observed in females compared to the males.
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Intoxicação/epidemiologia , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Manual Diagnóstico e Estatístico de Transtornos Mentais , Violência Doméstica/psicologia , Violência Doméstica/estatística & dados numéricos , Escolaridade , Emoções Manifestas , Saúde da Família , Feminino , Humanos , Acontecimentos que Mudam a Vida , Estudos Longitudinais , Masculino , Intoxicação/psicologia , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Qualidade de Vida/psicologia , Fatores Sexuais , Apoio Social , Turquia/epidemiologia , Desemprego/estatística & dados numéricosRESUMO
We report an adult case of ureterosigmoidostomy-associated quadriparesis, rhabdomyolysis, and tetany which may be the first such case in the literature. A 32-year-old female patient was brought to the emergency room of our hospital, having been unable to walk or use her arms for 24 h. Neurological examination revealed quadriparesis. She had severe hypokalemia (1.27 mmol/l) and metabolic acidosis (pH=7.05). Creatine kinase value was 2,590 U/l on the third day. She received intensive therapy to correct the hypokalemia and acidosis. On the third day of hospitalization tetany was detected in her upper extremities. The patient regained full muscle power after intravenous potassium chloride, bicarbonate, and calcium replacement therapy.
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Colostomia/efeitos adversos , Hipopotassemia/complicações , Quadriplegia/etiologia , Rabdomiólise/etiologia , Tetania/etiologia , Ureterostomia/efeitos adversos , Acidose/tratamento farmacológico , Acidose/etiologia , Adulto , Colo Sigmoide , Feminino , Humanos , Hipopotassemia/tratamento farmacológico , Tetania/tratamento farmacológico , Falha de Tratamento , Resultado do TratamentoRESUMO
We present a case of hypotension developing after reperfusion of a living-donor kidney transplant and performing a graft nephrectomy and successful retransplant with the same kidney 12 hours later. Preemptive kidney transplant was performed on a 51-year-old woman who had a chronic kidney disease because of hypertension. Her 55-year-old husband was the living kidney donor. The patient was stable before reperfusion. After declamping, pink color of the transplanted kidney, thrill from the renal artery, and urinary output were seen. But shortly after reperfusion, the invasive arterial blood pressure of the patient abruptly decreased from 130/70 mm Hg to 70/40 mm Hg, her pulse was approximately 80 to 110 beats/minute. The thrill disappeared from the renal artery, but blood flow continued. A graft nephrectomy was performed 45 minutes after reperfusion. Invasive arterial blood pressure of the patient was stabilized at approximately 110/70 mm Hg in the intensive care unit, and the patient was retransplanted with the same kidney. The patient was well, with a serum creatinine level of 1.4 mg/dL, 12 months after the operation. Resistant hypotension that occurs after kidney transplant may cause a loss of the graft and the patient. To prevent graft loss, and to stabilize the patient, a graft nephrectomy and retransplant of the graft under suitable circumstances may be considered.
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Pressão Sanguínea , Hipotensão/cirurgia , Transplante de Rim/efeitos adversos , Doadores Vivos , Nefrectomia , Pressão Sanguínea/efeitos dos fármacos , Resistência a Medicamentos , Feminino , Sobrevivência de Enxerto , Humanos , Hipotensão/diagnóstico , Hipotensão/etiologia , Hipotensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Reoperação , Resultado do Tratamento , Vasoconstritores/uso terapêuticoRESUMO
Brucellosis, a disease endemic in many countries including Turkey, is a systemic infectious disease. Brucellosis is rare in renal transplant recipients. Only 4 cases have been reported in the literature. In this report, we describe the clinical manifestations and laboratory findings of a brucellosis case with pulmonary involvement in a renal transplant recipient. A 20-year-old man who had a living-donor kidney transplant 4 months earlier presented to our transplant clinic with fever, cough, and right flank pain. Clarithromycin and ceftriaxone were started for the diagnosis of pneumonia. However, piperacillin/tazobactam, meropenem plus teicoplanin, and antituberculosis treatment were continued because the patient was unresponsive to the initial therapy. Serum Brucella agglutination titer was found to be 1/320. Treatment was started with a 6-week course of oral doxycycline and rifampin, resulting in cure. Brucellosis and especially its pulmonary involvement are rare after kidney transplant. However, in endemic areas,it should be considered as it mimics several other infectious diseases.
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Brucelose/microbiologia , Transplante de Rim/efeitos adversos , Insuficiência Renal Crônica/cirurgia , Infecções Respiratórias/microbiologia , Adulto , Antibacterianos/uso terapêutico , Brucelose/diagnóstico , Brucelose/tratamento farmacológico , Humanos , Masculino , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/tratamento farmacológico , Resultado do Tratamento , Adulto JovemRESUMO
Subcapsular hematoma after kidney transplant may result in kidney ischemia and graft loss. In this report, we present a patient who had a subcapsular hematoma that had no intraoperative enlargement but ruptured after surgery. A man who had chronic kidney disease secondary to hypertension had a preemptive living-donor kidney transplant from his wife. After declamping, appropriate renal perfusion and urinary output were observed. At perfusion, a subcapsular hematoma (diameter, 3 cm) was observed at the upper pole of the kidney. The hematoma did not enlarge during the surgery. Capsulotomy was not performed due to possible risks, and transplant surgery was completed with the plan for close postoperative ultrasonography and hemodynamic follow-up. Decreased urinary output was observed early after surgery. Renal Doppler ultrasonography showed decreased diastolic flow and a hematoma (width, 9 mm) that completely surrounded the transplanted kidney. The patient had emergency reoperation due to active hemorrhage from his surgical drain at 40 hours after surgery. Rupture of the capsule and hemorrhage from the surface of the kidney were observed. Extended capsulotomy and hemostasis of the kidney were performed. After surgery, urinary flow increased and renal Doppler ultrasonography findings improved. In summary, intervention for a subcapsular hematoma after kidney transplant is controversial. Capsulotomy should be considered for treatment of increased pressure to the graft, risk of permanent damage, and risk of graft loss.
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Hematoma/etiologia , Hemorragia/etiologia , Hipertensão/complicações , Transplante de Rim/efeitos adversos , Insuficiência Renal Crônica/cirurgia , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Hemorragia/diagnóstico por imagem , Hemorragia/cirurgia , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/etiologia , Reoperação , Fatores de Risco , Ruptura Espontânea , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia DopplerRESUMO
Hepatitis C virus (HCV) infection is associated with increased morbidity and mortality in patients undergoing hemodialysis for end-stage renal disease (ESRD). Eradication of HCV before transplantation is therefore of utmost importance in HCV-infected patients with ESRD who are candidates for kidney transplantation. The appropriate treatment for HCV infection in patients with ESRD and suboptimal response rates is still unclear. Here, we present our data from five cases who were being monitored by two healthcare centers for ESRD and HCV infection, who were candidates for kidney transplantation and were treated with a triple regimen containing telaprevir. All patients were started on triple therapy from the beginning including pegylated interferon-alfa2a (135 µg once a week), ribavirin (200 mg three times a week), and telaprevir (750 mg three times a day). Rapid virologic response was observed in all of the patients but treatment was discontinued in one patient at week 6 because the patient developed nausea and vomiting and was unable to feed orally. For the remaining four patients, side effects included weakness, lack of appetite, metallic taste, and mild anemia. The triple therapy with telaprevir seemed to be successful in HCV-infected patients who were candidates for renal transplantation.
Assuntos
Antivirais/efeitos adversos , Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Oligopeptídeos/efeitos adversos , Oligopeptídeos/uso terapêutico , Adulto , Quimioterapia Combinada , Feminino , Humanos , Interferon-alfa/efeitos adversos , Interferon-alfa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/efeitos adversos , Polietilenoglicóis/uso terapêutico , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Diálise Renal , Ribavirina/efeitos adversos , Ribavirina/uso terapêuticoRESUMO
BACKGROUND The most important purpose of transplantation is to improve quality of life (QOL) together with increasing life expectancy. The aim of this study was to compare the QOL of both donors and kidney transplant recipients and a control group at the 3rd and 9th postoperative months by using the SF36 health survey, to investigate the changes in this 6-month period and to evaluate descriptive data and satisfaction of patients and donors. MATERIAL AND METHODS Forty-seven donors and 47 kidney transplant recipients who were operated on in Diyarbakir Gazi Yasargil Training and Research Hospital between August 2012 and March 2015 and had been followed up for at least 9 months and 47 healthy controls were enrolled in the study. RESULTS Physical functioning (PF) was higher at the 9th postoperative month compared to the 3rd month in the recipient group (p=0.028). Donors had higher PF (p=0.007) and functioning physical role (PR; p=0.01) compared to recipients. Recipients had lower PF (p=0.016), PR (p=0.004), and functional-emotional role (ER; p=0.03) at the 3rd month and had lower PR (p=0.002) at the 9th month postoperatively comparing to the control group. Donors had lower PF (p=0.007) and PR (p=0.01) at the 3rd month and had lower PR (p=0.035) at the 9th month postoperatively comparing to the control group. Donors and recipients had similar QOL at the 9th month. CONCLUSIONS During follow-up, we observed an increase in QOL (in some subgroups) at 9 months postoperatively. Donors and recipients had similar QOL (except for PR) with the control group at the 9th month. QOL was better in younger and male patients and educated persons. Donors did not show any regret regarding their donation.
Assuntos
Transplante de Rim/psicologia , Doadores Vivos/psicologia , Satisfação do Paciente , Qualidade de Vida/psicologia , Transplantados/psicologia , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto JovemRESUMO
OBJECTIVES: There are studies that show that double J stenting (DJS) increase BK nephropathy (BKN) 4 fold. DJS may cause vesicoureteral reflux (VUR) with normal bladder contraction. The aim of this study is to comparison risk of BKN, urinary tract infections (UTI) and postoperative urologic complications with the use DJS with anti-reflux device (ARD-DJS) and standart double J stent (St-DJS). Matherial and methods: Ninety patients (male/female: 50/40) that had undergone kidney transplantations in Diyarbakir Training and Research Hospital and Dicle University, Faculty of Medicine Hospital between January 2012 and April 2015 were enrolled in the study. Demographic data, immunosuppression protocols, presence of rejection, graft loss, postoperative urologic complications, UTI, plasma BK levels of the patients were evaluated retrospectively. RESULTS: Median and IQR follow up time for ARD-DJS and St-DJS patients were 14 (12-18) months and 25 (16-30) months respectively. Five cases (5.5%) had BK viremia (P=0.025). All 5 cases with BK viremia were St-DJS users. CONCLUSION: As a result for postoperative UTI and postoperative urinary complication risk there were no statistically significant difference between ARD-DJS use and St-DJS use during ureteral anastomosis. BKN univariate analysis were significantly less than those st-DJS used. Risc factors were evaluated. But results were not statistically significant in the logistic regression analysis. We think that to demonstrate this benefit, we need randomized controlled studies with more patients and longer follow up.