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AIM: BK polyomavirus infection is a challenging complication of renal transplantation. The management is not standardized and is based on reports from transplantation centers' experiences, usually with small sample sizes. Therefore, we aimed to present our countrywide experience with BK virus nephropathy (BKVN) in renal transplant recipients. MATERIALS AND METHODS: Our study was carried out with the participation of 30 transplantation centers from all regions of Turkey. Only cases with allograft biopsy-proven BKVN were included in the study. RESULTS: 13,857 patients from 30 transplantation centers were screened, and 207 BK nephropathy cases were included. The mean age was 46.4 ± 13.1 years, and 146 (70.5%) patients were male. The mean time to diagnosis of BK nephropathy was 15.8 ± 22.2 months after transplantation. At diagnosis, the mean creatinine level was 1.8 ± 0.7 mg/dL, and the mean estimated glomerular filtration rate was 45.8 ± 19.6 mL/min/1.73m2 . In addition to dose reduction or discontinuation of immunosuppressive drugs, 18 patients were treated with cidofovir, 11 patients with leflunomide, 17 patients with quinolones, 15 patients with intravenous immunoglobulin (IVIG), 5 patients with cidofovir plus IVIG, and 12 patients with leflunomide plus IVIG. None of the patients receiving leflunomide or leflunomide plus IVIG had allograft loss. During follow-up, allograft loss occurred in 32 (15%) out of 207 patients with BK nephropathy. CONCLUSION: BKVN is still a frequent cause of allograft loss in kidney transplantation and is not fully elucidated. The results of our study suggest that leflunomide treatment is associated with more favorable allograft outcomes.
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SUMMARY: Somatotype characters have been defined for many diseases. However, there is insufficient information on the somatotype characters of chronic kidney patients. The first aim of our study was to define the specific somatotype in patients diagnosed with CKD. The second aim was to investigate the relationship between somatotype characters and physical activity and depression in CKD patients. A total of 88 (52.7 %) patients diagnosed with CKD between January and December 2021 at the Department of Nephrology, Inonu University Hospital (Malatya, Turkey) and 79 (47.3 %) healthy volunteers were included in the study. Somatotype analysis was performed using the Heath-Carter method. Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ) and depressive symptoms with the Beck Depression Inventory (BDI). Analysis revealed that patients had greater medial calf girth (p = 0.036), higher triceps (p = 0.007) and suprailiac (p = 0.042) skinfold thicknesses and higher body mass index (p = 0.007) compared to controls. Patients also had significantly higher endomorphy (patients: 6.57±1.35 vs. controls: 6.04±1.3; effect size (ES): 0.40, p=0.010) and significantly higher mesomorphy (patients: 7.44±2 vs. controls: 6.85±2.3; ES: 0.27, p=0.039) as well as significantly lower ectomorphy (patients: 0.71±0.69 vs. controls: 1.10±0.93; ES: 0.47, p=0.006). Significant positive correlations were also observed between mesomorphy and IPAQ (rho = 0.219, p = 0.04), endomorphy and BDI (rho = 0.423, p 0.001). Significant negative correlations were observed between ectomorph and BDI (rho = -0.325, p = 0.002). We observed that the dominant somatotype was endomorphic mesomorph in patients with CKD. In addition, the fact that CKD patients with ectomorphic body structure have lower depressive symptoms could have an impact on their well-being.
RESUMEN: Se han definido caracteres de somatotipo para muchas enfermedades. Sin embargo, no hay suficiente información sobre los caracteres somatotípicos de los pacientes renales crónicos. El primer objetivo de nuestro estudio fue definir el somatotipo específico en pacientes diagnosticados de ERC. El segundo objetivo fue investigar la relación entre los caracteres del somatotipo y la actividad física y la depresión en pacientes con ERC. Se incluyeron en el estudio un total de 88 (52,7 %) pacientes diagnosticados con ERC entre enero y diciembre de 2021 en el Departamento de Nefrología del Hospital Universitario de Inonu (Malatya, Turquía) y 79 (47,3 %) voluntarios sanos. El análisis del somatotipo se realizó mediante el método de Heath-Carter. La actividad física se evaluó con el Cuestionario Internacional de Actividad Física (IPAQ) y los síntomas depresivos con el Inventario de Depresión de Beck (BDI). El análisis reveló que los pacientes tenían una mayor circunferencia media de la pierna (pantorrilla) (p = 0,036), tríceps (p = 0,007) y pliegues cutáneos suprailíacos (p = 0,042) más altos y un IMC más alto (p = 0,007) en comparación con los controles. Los pacientes también tenían una endomorfia significativamente mayor (pacientes: 6,57±1,35 frente a controles: 6,04±1,3; tamaño del efecto (ES): 0,40, p=0,010) y una mesomorfia significativamente mayor (pacientes: 7,44±2 frente a controles: 6,85±2,3; ES: 0,27, p=0,039) así como una ectomorfia significativamente menor (pacientes: 0,71±0,69 vs. controles: 1,10±0,93; ES: 0,47, p=0,006). También se observaron correlaciones positivas significativas entre mesomorfia e IPAQ (rho = 0,219, p = 0,04), endomorfia y BDI (rho = 0,423, p 0,001). Se observaron correlaciones negativas significativas entre ectomorfo y BDI (rho = -0,325, p = 0,002). Observamos que el somatotipo dominante fue el mesomorfo endomórfico en pacientes con ERC. Además, el hecho de que los pacientes con ERC con estructura corporal ectomórfica tengan menos síntomas depresivos podría tener un impacto en su bienestar.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Somatotipos , Ejercicio Físico , Depresión , Insuficiencia Renal Crónica , Inventario de Personalidad , Encuestas y Cuestionarios , ObesidadRESUMEN
ABSTRACT Introduction: In some countries, organ donation is not widespread enough due to medical, cultural, ethical and socioeconomic factors. Living-donor kidney transplant constitutes the main source of kidney donation. Aim: To evaluate the causes of cancellation of living-donor kidney transplant and improve the effectiveness of transplant programs. Methods: Medical records of possible donors and recipients who were evaluated for living-donor kidney transplant at a tertiary medical center between November 2010 and September 2019 were reviewed retrospectively. Results: Evaluations were performed on 364 potential donors and 338 living-donor kidney transplant recipients; 207 of the latter (61.24%) underwent living-donor kidney transplant. Immune disorders represented the majority of cancellations (38.84%). Fifty-six donors (15.38%) were rejected mainly due to renal disorders (39%). Conclusion: Timely referral of patients to transplant centers must be guaranteed in order to overcome immune problems. Transplant centers should invest in programs adequate both for their resources and for their patients: paired kidney exchange, desensitization protocols, future research, etc.
RESUMEN Introducción: En algunos países la donación de órganos no es suficiente debido a factores médicos, culturales, éticos y socioeconómicos. El donante vivo de riñón constituye la principal fuente de donación de riñones. Objetivo: Evaluar las causas de cancelación de los donantes vivos de riñón y mejorar la eficacia de los programas de trasplante. Material y métodos: Se evaluaron retrospectivamente los registros médicos de posibles donantes y receptores para trasplante de riñón con donante vivo en un centro terciario, entre noviembre de 2010 y septiembre de 2019. Resultados: Se evaluaron 364 donantes potenciales y 338 receptores de trasplante de riñón con donante vivo; 207 receptores (61,24%) se sometieron a trasplante de riñón con donante vivo. Los problemas inmunológicos ocasionaron la mayoría de las cancelaciones (38,84%). A cincuenta y seis donantes (15,38%) se les negó la donación, principalmente debido a problemas renales (39%). Conclusión: La derivación oportuna de los pacientes a los centros de trasplante debe garantizarse para superar las barreras inmunológicas. Los centros de trasplante deberían invertir en programas adecuados, tanto por sus recursos como por los pacientes: protocolos de desensibilización, trasplante renal cruzado, investigación futura, etc.