Non-diabetic nephropathy in diabetic patients: incidence, HbA1c variability and other predictive factors, and implications.

PURPOSE: Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD) in the population. In patients with diabetes mellitus, the incidence of non-diabetic nephropathy (NDNP) has been estimated to range from 3% to 69.5%. Personal judgment is frequently employed while deciding whether or not to do a kidney biopsy (KB) on diabetic patients. NDNP alters the prognosis and course of treatment for people with DM. In our study, we examined the incidence of NDNP concurrent with the progression of diabetes mellitus, as well as the laboratory and clinical indicators that could be utilized to forecast it. METHODS: A retrospective analysis of 76 diabetic patients who underwent KB was conducted. Based on the pathological diagnoses of these patients, they were categorized as DNP (diabetic nephropathy) or NDNP. The definition of HbA1c variability was determined by calculating the mean HbA1c and the average value of the HbA1c measurements, as well as the standard deviation (SD) for each participant. RESULTS: NDNP was detected in 50% of 76 patients. Among patients with NDNP, 36.8% had focal segmental glomerulosclerosis (FSGS), 23.6% had membranous glomerulonephritis, and 7.8% had IgA nephritis. The NDNP group exhibited significantly higher rates of female gender, absence of diabetic retinopathy, shorter time to diagnosis of diabetes mellitus, chronic kidney disease, and proteinuria, less intensive medication for diabetes mellitus, presence of hematuria and leukociduria, immunological serological marker positivity, and non-HbA1C variability. Risk factors for predicting non-diabetic nephropathy, as determined by multivariate analysis, included female gender, the absence of diabetic retinopathy, non-HbA1c variability and a positive immunological serological test. CONCLUSION: In this study, a significant number of diabetic patients with chronic kidney disease were diagnosed with NDNP. Identifying these patients allows for treatment of the specific underlying disease. Factors such as the absence of DR, non-HbA1c variability, female gender, and immunological serological test positivity can predict NDNP and guide the clinician's decision on kidney biopsy. Further prospective studies are warranted to validate the efficacy of potential predictive factors like HbA1c variability.

Incidence, Risk Factors, and Outcomes of Delayed Graft Function in Deceased Donor Kidney Transplantation.

OBJECTIVE: Delayed graft function (DGF) is the most significant complication of a cadaveric kidney transplant. We aim to evaluate the predictable risk factors of DGF and its effects on the recipient and graft survival. METHOD: From January 2014 to December 2017, the medical records from 62 patients who received a kidney transplant from a deceased donor were retrospectively reviewed. We classified recipients into 2 groups. The risk factors of DGF associated with donor, recipient, and transplant procedures were analyzed. DGF's effects on the graft survival were examined. RESULTS: The incidence rate of DGF was 43.5%. Older ages of donors, marginal donors (n = 15), length of stay in the intensive care unit, and terminal serum creatinine concentrations were observed to be statistically significant compared to recipients without DGF (P < .5). The ratio of serum creatinine concentrations before/after brain death was found to be significant for the groups with DGF (P < .05). Cold ischemia time (CIT) was examined as the most significant risk factor on DGF (P = .001). One-year patient survival rates were 94.5% and 92.3%, and graft survival rates were 92.1% and 87.5% (P = .05), respectively, for the groups with and without DGF. CONCLUSION: Older ages of donors, occurrence of acute kidney injury, its grade just before harvesting, and long duration of CIT are the most important risk factors for DGF. Brain death management, shortening the time between brain death and harvesting, and also shortening the duration of CIT can decrease the risk of DGF and can increase the graft survival.

Brown Tumors: A Case Report and Review of the Literature.

Brown tumors are focal bone lesions, encountered in patients with uncontrolled hyperparathyroidism. They can be located in any part of the skeleton. Clinically significant lesions in the craniofacial bones are rare. Craniofacial involvement may cause facial disfiguration and compromise social ease of the patient and normal functions, such as chewing, talking, and breathing. In this case report, we present a patient with a brown tumor of the craniofacial bones provoked by secondary hyperparathyroidism and review the last 10 years of craniofacial brown tumors associated with secondary hyperparathyroidism in the English literature.

Prophylactic Eculizumab Use in Kidney Transplantation: A Review of the Literature and Report of a Case with Atypical Hemolytic Uremic Syndrome.

BACKGROUND: Atypical hemolytic uremic syndrome (aHUS) is a very rare disease, which presents with microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Progression to end-stage renal disease (ESRD) from acute kidney injury is observed in 60% of aHUS cases. The prognosis of aHUS patients who undergo kidney transplantation (Ktx) is generally poor, but these patients should be treated prophylactically with eculizumab to prevent recurrence after transplantation. CASE REPORT: An 18-year-old man was referred to our center with a history of rapid progression to ESRD with unknown etiology. He had anemia, thrombocytopenia, high levels of LDH, and indirect bilirubin and creatinine on initial laboratory results. Our diagnosis was aHUS due to initial results, normal level of ADAMTS activity, and lack of predisposing factors seen in typical HUS. We planned to perform genetic analysis for the patient and the donor candidate (mother). The variations found on exon 7 of the CFH gene had not been reported previously. According to PolyPhen analysis, this mutation was reported as a potential cause for aHUS. We decided to perform Ktx under eculizumab prophylaxis. Weekly administration of prophylaxis was extended to 1 month. The graft functioned immediately after Ktx. The patient has completed his first year uneventfully in our follow-up, with a creatinine 0.79 mg/dl at his last control visit. CONCLUSIONS: We found favorable results of an aHUS case successfully treated with kidney transplantation combined with short-term prophylactic eculizumab therapy.

Approach to mushroom intoxication and treatment: can we decrease mortality?

BACKGROUND: Mushroom is widely consumed in Turkey because it is inexpensive and widely available. Intoxication with mushroom is a common health problem in Turkey with a high mortality rate. AIM: To identify the outcome of patients with wild mushroom intoxication who were diagnosed based on systematic criteria and had received a comprehensive treatment. METHODS: Seventy-seven patients admitted to the Emergency Department of our hospital with mushroom intoxication were retrospectively evaluated. The patients were administered a combined treatment of gastric lavage, activated charcoal, penicillin G, N-acetyl cysteine, silybin and hemofiltration. Demographic, clinical and laboratory data of patients and the outcomes of the treatment modality were recorded. RESULTS: A total of 77 patients, 46 (59.7%) females and 31 (40.3%) males were evaluated in the study. The mean age of the patients was 41.94 ± 15.40 years. They presented with nausea and vomiting within 4 to 48 hours. Sixteen patients (20.7%) had abdominal pain, six patients had (7.7%) diarrhea and five patients (6.5%) had jaundice. Seven patients (9%) developed acute liver failure and were referred to intensive care units. Five of these patients recovered without any liver transplantation; one patient had cadaveric liver transplantation but died in the early period after the transplantation and one patient died while waiting for transplantation. The rest of the patients were followed by us and they all have recovered. CONCLUSIONS: Our data indicate that clinical diagnosis based on systematic criteria and a comprehensive treatment regimen may be effective in decreasing the mortality in mushroom intoxication.

Inhibition of inducible nitric oxide synthase in murine visceral larva migrans: effects on lung and liver damage.

The roles of nitric oxide production and oxidative process were studied in mice infected with Toxocara canis and treated with aminoguanidine which is a specific inhibitor of inducible nitric oxide synthase (iNOS). Relations of nitric oxide synthase inhibition and tissue pathology were assessed by biochemical, histological and immunohistochemical methods. In experiments, Balb/c albino mice were inoculated with T. canis eggs either with or without aminoguanidine treatment or alone, at 24th, 48th hours and on 7th days. LPx and SOD values in liver tissue and plasma were measured. Liver and lung tissues were evaluated for the pathological lesions. The expression of eNOS and iNOS in both tissues were studied with immunohistochemistry in the same intervals. We observed significant differences between T. canis infected and aminoguanidine treated animals. Larval toxocarosis led to oxidative stress elevation in plasma. Microscopic examination of the liver histological sections revealed pathological lesions in the hepatic parenchyma in infected mice. In the mice received T. canis eggs plus aminoguanidine, the sinusoidal areas were enlarged. Histological lesions were more severe at 48 hours after infection. Numbers of eNOS and iNOS expressing epithelial cells were increased in the T. canis infected mice. The activities of eNOS and iNOS were also observed in the body of the larvae which have migrated to lung and liver. As a result, we have demonstrated that in vivo production of eNO and iNO during T. canis infection cause direct host damages and it is strongly related to the oxidative stress. We propose that larval NO can also be effective in larval migration, but it needs further investigation on distribution of NO in larvae.