Pregnancy and its outcomes in hemodialysis patients in Turkey.

BACKGROUND/AIM: This study aimed to investigate pregnancy frequency and evaluate the factors affecting live births in hemodialysis (HD) patients. MATERIALS AND METHODS: Female HD patients whose pregnancy was retrospectively reported between January 1, 2014, and December 31, 2019. The duration of HD, primary disease, whether the pregnancy resulted in abortion, stillbirth, or live birth, whether the HD duration was prolonged after diagnosing the pregnancy and whether it accompanied preeclampsia were recorded. RESULTS: In this study, we reached 9038 HD female patients? data in the study. A total of 235 pregnancies were detected in 145 patients. The mean age was 35.42 (35 ± 7.4) years. The mean age at first gestation was 30.8 ± 6.5 years. The average birth week was 32 (28 - 36) weeks. 53.8% (no = 78) of the patients had live birth, 51.7% (no = 70) had at least one abortion in the first 20 weeks, and 13.1% (no = 19) had at least one stillbirth after 20 weeks. The rate of patients' increased numbers of dialysis sessions during pregnancy was 71.7%. The abortion rate was 22.4% in those with increased HD sessions, whereas 79.3% in those not increased HD sessions (p < 0.001). Live birth frequency was 67.2% in the increased HD sessions group and 3.4% in those who did not differ in HD sessions (p < 0.001). CONCLUSION: For the first time, we reported pregnancy outcomes in HD female patients, covering all regions of Turkey. It has been observed that; increasing the number of HD sessions in dialysis patients will decrease fetal and maternal complications and increase live birth rates.

Increase in interventricular septum thickness may be the first sign of cardiovascular change in kidney donors.

BACKGROUND: Because of the inadequate number of deceased kidney donors, living kidney donation remains an important issue for kidney transplantation. Previous studies have shown that living donation does not differ life expectancy and progression to end-stage renal disease compared with the normal population. In this study, we investigated short-term cardiovascular changes after donor nephrectomy. METHODS: Thirty-four patients who underwent donor nephrectomy between January 2015 and July 2015 at Ege University Renal Transplantation Unit were included in the study. Arterial stiffness, multifrequency bioimpedance analysis, renal ARFI elastography, and echocardiography performed prior to the donor nephrectomy and 6 months after nephrectomy. RESULTS: A total of 34 kidney donors were enrolled in this study. Twenty donors were female (59%) and 14 donors were male (41%). The pathological evaluation of donor kidneys using implantation renal biopsy sample revealed mean Karpinski Renal Score of 1.5 and the mean glomerulosclerosis ratio was 5% for all donated kidneys. Arterial stiffness, systolic and diastolic blood pressure measures, body fluid composition, and left atrial size did not change significantly during the follow-up. However, interventricular septum thickness of donors increased by 1 mm during a 6-month period (9.6 mm vs 10.6 mm, P = .002). CONCLUSION: We observed an increase in interventricular septum thickness in kidney donors during a 6-month follow-up. In order to evaluate the net effect of this change on donor morbidity, prospective studies investigating an increased number of donors with long-term follow-up should be needed.

Evaluation of prognosis and nephrotoxicity in patients treated with colistin in intensive care unit.

INTRODUCTION: Nephrotoxicity is the most important adverse effect of colistin therapy. We investigated the frequency of nephrotoxicity, risk factors related to nephrotoxicity, and its relationship with mortality in patients who received intravenous colistin in intensive care units (ICUs). MATERIALS AND METHODS: We retrospectively reviewed the data of patients who received intravenous colistin in ICUs between 2011 and 2017. Acute kidney injury (AKI) diagnosis and staging were made based on the Kidney Disease Improving Global Outcome criteria. RESULTS: There were 149 patients included in the study with 61% being male. The mean age was 58.7 ± 20.3 years. AKI was detected in 96 (64.4%) patients. There were 25 patients with AKI stage 1 (16.8%) and 71 patients with AKI stage 2 or 3 (47.7%). Advanced age (65.0 vs. 47.4 years; p < .001), diabetes mellitus (p < .001), heart failure (p = .01), high APACHE II score (31.7 vs. 28.08, p = .019), and inotrope usage (p = .01) were found as risk factors for AKI. The 14-day mortality rate was higher in the AKI group (p = .027). DISCUSSION: Higher AKI and mortality rates are observed in patients with diabetes, heart failure, advanced age and the hemodynamically impaired. However, it is a fact that there are no alternative therapies other than colistin in the treatment of multidrug-resistant Gram-negative bacterial infections. Therefore, the development of AKI in this patient group should not be considered a sufficient reason for discontinuing colistin treatment. Understanding the risk factors in this potential nephrotoxic treatment can provide a more careful patient follow-up.

[Evaluation of Infections in Intensive Care Units: A Multicentre Point-Prevalence Study]. / Yogun Bakim Ünitelerindeki Enfeksiyonlarin Degerlendirilmesi: Çok Merkezli Nokta Prevalans Çalismasi.

Infection control is a top priority for hospitals, especially in intensive care units (ICU). In intensive care units, prevalence of infection is estimated to be 30% worldwide, which is a major cause of morbidity and mortality. Many factors are known to increase the risk of infection in ICU patients. Since each of these may lead to different infections, it is important to recognize and identify predisposing factors for early diagnosis and treatment. The regional health care-associated infections (HCAI) prevalence and distribution of risk factors are important strategies in infection control. In this regard, the aim of this point prevalence study was to obtain data related to infections, the prevalence of HCAI among these infections, the epidemiology, agents and antibiotics used among adult ICU patients in the university hospitals, training and research hospitals and public hospitals located in eight of the cities of our region. In the light of these data, we aimed to review and emphasize the guidelines on HCAI prevention. The study included adult ICU patients followed up in nine hospitals in the Eastern and South-eastern Anatolia Regions of eight different cities (Sivas, Erzurum, Mardin, Batman, Diyarbakir Elazig, Van, Adiyaman) in Turkey. Of the hospitals six were university hospitals, one was training and research hospital, and two were public hospitals. The number of beds ranged from 358 to 1418. A specific day was determined on which the researchers concurrently carried out a prospective surveillance in all adult intensive care unit patients. The researchers collected data and recorded the demographic characteristics (age, gender), underlying diseases, length of hospital stay, presence of invasive intervention (urinary catheter, central venous catheter, external ventricular drainage, mechanical ventilator, presence of risk factors such as burn, trauma and surgery, number of infection cases, type of infection (hospital-acquired, community-acquired), type of microorganisms and whether polymicrobial or monomicrobial, which antibiotics were administered, and duration of antibiotic treatment. Our study assessed data of 429 inpatients in the adult ICU of nine hospitals in eight different cities. There were a total of 881 intensive care beds in these hospitals, and 740 (84%) beds were occupied. Of the study group 49.7% was male with a mean age (min-max) of 64.08 ± 18.78 (2-97) years. The point prevalence of HCAI was 21.7% (n= 93). Of the patients who were followed-up 182 (42.4%) presented infections. Of these infections, 21.4% were diagnosed as community-acquired pneumonia, 18.6% were ventilator-associated pneumonia (VAP), 16.3% were communityacquired urinary tract infection (UTI), and 16.3% were bloodstream infection. In addition, the most commonly administered antibiotics in the study group were piperacillin/tazobactam, carbapenem, quinolone and ceftriaxone, respectively. The most common types of HCAI were community-acquired pneumonia (10.7%), ventilator-associated pneumonia (8.9%) and bloodstream infections (8.2%). The mean length of hospital stay was 32.05 ± 66.85 (1-459) days and the mean duration of antibiotic therapy in patients with HCAIs was 7.76 ± 7.11 (1-41) days. The most widely accepted method to handle infection is to carry out active, prospective and patient-based surveillance studies on a regular basis, and to take control measures and arrange appropriate treatment in the light of the data obtained. We attribute the high prevalence of HCAI in our region to lack of personnel, lack of materials, inappropriate use of antibiotics, insufficiency of physical conditions, and little support for infection control committees. In conclusion, we emphasize that it is of importance to work closely with the hospital administration to take measures and that necessary assistance is provided.

Successful Treatment of COVID-19-Related Immune- Complex Glomerulonephritis, Case Report.

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.

Evaluation of changes in lens optical densitometry using Pentacam HR after renal transplantation: A prospective study.

BACKGROUND: To compare the optical densitometric changes in the lens of patients with renal transplantation with those of a healthy group using Pentacam HR. METHODS: Twenty-four right eyes of 24 healthy patients (Group 1) were compared with 24 right eyes of 24 kidney transplant recipients. Kidney transplant recipients were evaluated thrice (preoperatively: Group 2a, postoperative 1st month: Group 2b, postoperative 12th month: Group 2c). Corneal endothelial cell count, intraocular pressure, and central corneal thickness of all participants were measured. Lens optical densitometry was measured with Pentacam HR using 3D scanning mode. The optical density of the lens was analyzed by taking the corneal apex as the center and analysing the 12 mm diameter area. (Zone 1: 2.0 mm, Zone 2: 4.0 mm, and Zone 3: 6.0 mm). RESULTS: Corneal endothelial cell count was 2571.2±106.7 cells/mm2 in Group 1 and 2462.8±127.6 cells/mm2 in Group 2a (p=0.001). For lens optical densities, significant differences were observed between the groups in Zone 1 and Zone 3, but the difference in Zone 2 was not significant (p=0.003, p=0.164, p=0.009, respectively). There was a positive correlation between dialysis time and preoperative lens optical densitometry in Zone 1, Zone 2, and Zone 3 (r= 0.496, r= 0.131, r= 0.463, respectively). CONCLUSIONS: Although a decrease in lens transparency was observed after kidney transplantation, steroids may cause an increase in lens transparency in the postoperative period. Patients with renal transplantation should be followed closely for possible lens changes in the post-transplant period.

Successful Treatment of Conjunctival Kaposi Sarcoma in a Human Immunodeficiency Virus-Negative Kidney Transplant Recipient: A Case Report.

Kaposi sarcoma (KS) is the most common tumor in patients with human immunodeficiency virus (HIV), and its frequency is increasing after organ transplantation in HIV-negative patients. A 28-year-old woman had preemptive kidney transplantation from her 48-year-old mother. In the postoperative ninth month, an exophytic mass was found in the upper medial conjunctiva of the right eye. The lesion was excised under local anesthesia, and cryotherapy was applied to the surgical area. The biopsy result was reported as KS. Treatment with tacrolimus was switched to everolimus (EVO), but EVO was discontinued because of pneumonitis. The patient was followed without any recurrences after the excision of the conjunctival lesion. No local or systemic recurrence was observed in the 14th month after surgical excision and local cryotherapy. Local treatment and the reduction of immunosuppressive therapy may be effective in the treatment of conjunctival KS.