A model for acute kidney injury in severe burn patients.

INTRODUCTION: In patients with severe burns, morbidity and mortality are high. One factor related to poor prognosis is acute kidney injury. According to the AKIN criteria, acute kidney injury has 3 stages based on urine output, serum creatinine level, and renal replacement therapy. In this study, we aimed to create a decision tree for estimating risk of acute kidney injury in patients with severe burn injuries. METHODS: We retrospectively evaluated 437 adult patients with ≥20% total burn surface area injury who were treated at the Baskent University Ankara and Konya Burn Centers from January 2000 to March 2020. Patients who had high-voltage burn and previous history of kidney disease were excluded. Patient demographics, medical history, mechanism of injury, presence of inhalation injury, depth of burn, laboratory values, presence of oliguria, need for renal replacement therapy, central venous pressure, and prognosis were evaluated. These data were used in a "decision tree method" to create the Baskent University model to estimate risk of acute kidney injury in severe burn patients. RESULTS: Our model provided an accuracy of 71.09% for risk estimation. Of 172 patients, 78 (45%) had different degrees of acute kidney injury, with 26 of these (15.1%) receiving renal replacement therapy. Our model showed that total burn surface area was the most important factor for estimation of acute kidney injury occurrence. Other important factors included serum creatinine value, burn injury severity score, hemoglobin value, neutrophil-to-lymphocyte ratio, and platelet count. CONCLUSION: The Baskent University model for acute kidney injury may be helpful to determine risk of acute kidney injury in burn patients. This determination would allow appropriate treatment to be given to high-risk patients in the early period, reducing the incidence of acute kidney injury.

Oxalosis Crystals' Redeposition in Cardiac Tissue Leading to New-Onset Fatal Cardiac Complication After Liver Transplant in Primary Oxalosis Patient: Case Report.

Primary oxalosis is a rare hereditary disorder of metabolism resulting in accumulation of calcium oxalate in almost all tissues of the body. All published data point out the improvement of cardiac function after transplant. Here, we report the first case in the literature of an 8-year-old patient with primary oxalosis in which oxalosis implantations increased in cardiac tissue after liver transplant and manifested as new-onset ventricular tachycardia and cardiomyopathy, leading to death.

The New Anterior Less Invasive Crescentic Incision for Living Donor Nephrectomy.

OBJECTIVES: Living-donor nephrectomy is a devoted procedure performed in a healthy individual; for these procedures, it is essential to complete the surgery with the lowest possible risk and morbidity and allow donors to regain their normal daily activity. To minimize anatomic and physiologic damage, we modified a surgical technique. Here, we report our experiences with the new anterior less invasive crescentic donor nephrectomy technique. MATERIALS AND METHODS: We retrospectively evaluated 728 donor nephrectomy patients who had the new anterior less invasive cresentic incision (n = 224), the classic open (n = 431), or the laparoscopic living-donor nephrectomy (n = 73) procedures. Demographic characteristics, preoperative and postoperative parameters, acute renal graft dysfunction, and firstyear graft and patient survival rates were compared between groups. RESULTS: During the operation, the new cresentic incision living-donor nephrectomy allowed a safe and comfortable position for the patient and the anesthesiologist. Also, it procures safe access especially for grefts with multiple vessels. Patients had lower pain scores (P = .010), shorter hospital stays (2.25 vs 3.49 days) than those who received the classic open living-donor nephrectomy. Patients who received laparoscopic living-donor nephrectomy had significantly longer mean operation time (P = .016) and warm ischemia time (P ≤ .001) than those who had the new cresentic incision technique. All groups showed similar rates of first-year survival and delayed graft dysfunction. CONCLUSIONS: The new anterior less invasive cresentic incision open-donor nephrectomy approach is a safe, comfortable, effective, and less invasive modification of the living donor nephrectomy. Also, it procures safe access for grefts with multiple vessels.

A huge extrarenal cell carcinoma developing from a heterotopic renal anlage with distant metastases: case report and literature review.

Renal cell carcinoma (RCC) is the most common type of renal tumor arising from the proximal renal tubules. Extrarenal RCC is a rare case in which a tumor is found outside the kidney with no primary kidney tumor. Some theories suggest that these tumors arise from mesoderm remnant. Here, we present a unique case, the fourth in literature, of peri-renal, Extrarenal RCC case and the first case with a huge mass with distant metastases and aggressive progression.

Coronavirus Disease (COVID-19) in Kidney and Liver Transplant Patients: A Single-Center Experience.

OBJECTIVES: The novel 2019 coronavirus (COVID-19) was first described in December 2019 in Wuhan, China and subsequently announced as a pandemic on March 12, 2020. In several studies, solid-organ transplant recipients were reported to have higher risk for COVID-19. Here, we aimed to determine the frequency of COVID-19 in our kidney and liver transplant patients. MATERIALS AND METHODS: Our study included 583 transplant patients who were admitted to our outpatient transplant clinics and emergency departments between March 1 and May 1, 2020. Seventy-four of them were liver transplant recipients (46 male, 28 female, of which 14 were pediatric and 60 were adult patients) and 509 of them were kidney transplant recipients (347 male, 162 female, of which 16 were pediatric and 493 were adult patients). We retrospectively evaluated demographic characteristics, currently used immunosuppressant treatment, present complaints, treatment and diagnosis of comorbid diseases, and results of COVID-19 tests. RESULTS: Of 583 transplant recipients, 538 were seen in our outpatient transplant clinics and 45 were seen in our emergency departments. Of these, 18 patients who had had cough and fever were evaluated by respiratory clinic doctors, and nasopharyngeal swab samples were taken. One kidney transplant recipient had a positive COVID-19 test; he was followed with home isolation. He received treatment with hydroxychloroquine (400 mg/day). The other 17 patients had negative tests. There were no mortalities due to COVID-19. CONCLUSIONS: Transplant patients also got affected during the COVID-19 pandemic. According to the data of our centers, this effect is not much more different from the normal population. We recommend that transplant recipients should be warned in terms of personal hygiene and should be closely monitored by organ transplant centers. If there is an indication for hospitalization, they should be followed in an isolated unit, with no aggressive changes made to immunosuppressive doses unless necessary.

Pelvic Myxoid Leiomyoma Mass between Vagina and Rectum.

Leiomyomas are the most common pelvic tumors in women. About 20-30% of women older than 35 are affected. Rare conditions of leiomyomas have extrauterine locations. Myxoid degeneration is a rare type of leiomyoma degeneration. We report a case of solid-cystic myxoid leiomyoma in a 53-year-old woman complained of constipation, urinary hesitation, and malodorous vaginal discharge with palpable 17 × 12 cm mass between vagina and rectum. Regarding the inferior location of the mass, a perineal approach was used to enucleate it. This rare location has not been mentioned before. The woman was finally diagnosed by pathologists which was myxoid leiomyoma.