Avascular Necrosis in Renal Transplant Patients.

OBJECTIVES: Kidney transplant recipients are at increased risk for avascular necrosis due to steroid use and accompanying comorbidities. Concerning risk factors, uncertainty still exists. We evaluated the clinical characteristics and risk factors of avascular necrosis in kidney transplant recipients. MATERIALS AND METHODS: Symptomatic avascular necrosis was found by magnetic resonance imaging in 33 of 360 kidney transplant patients between 2005 and 2021. The patients' clinical characteristics, biochemical testing, and medications were evaluated. RESULTS: We found the frequency of avascular necrosis to be 9.7% during the follow-up period. If the total steroid dosage used was more than 4 g in the first 3 months, the risk of developing avascular necrosis increased 4.08 times, and the presence of cytomegalovirus disease increased the risk by 4.03 times. Avascular necrosis was observed bilaterally in 60.6% of cases and at the femoral head in 66.7%. The frequency of avascular necrosis was highest in the first and second years posttransplant. CONCLUSIONS: We found that avascular necrosis appears most frequently in the first 2 years after kidney transplant and the most important risk factors are cumulative steroid dose and cytomegalovirus disease. In the follow-up of kidney transplant patients, it is important to use low-dose steroid doses if possible. Of note, preventing the development of cytomegalovirus disease by screening and prophylaxis for cytomegalovirus is also important in reducing the development of avascular necrosis.

Post-COVID-19 outcomes of non-dialysis dependent chronic kidney disease patients: a national, multicenter, controlled study.

PURPOSE: Coronavirus disease 2019 (COVID-19) has a higher mortality in the presence of chronic kidney disease (CKD). However, there has not been much research in the literature concerning the outcomes of CKD patients in the post-COVID-19 period. We aimed to investigate the outcomes of CKD patients not receiving renal replacement therapy. METHODS: In this multicenter observational study, we included CKD patients with a GFR < 60 ml/min/1.73 m2 who survived after confirmed COVID-19. Patients with CKD whose kidney disease was due to diabetic nephropathy, polycystic kidney disease and glomerulonephritis were not included in this study. CKD patients with similar characteristics, who did not have COVID-19 were included as the control group. RESULTS: There were 173 patients in the COVID-19 group and 207 patients in the control group. Most patients (72.8%) were treated as inpatient in the COVID-19 group (intensive care unit hospitalization: 16.7%, acute kidney injury: 54.8%, needing dialysis: 7.9%). While there was no significant difference between the baseline creatinine values of the COVID-19 group and the control group (1.86 and 1.9, p = 0.978, respectively), on the 1st month, creatinine values were significantly higher in the COVID-19 group (2.09 and 1.8, respectively, p = 0.028). Respiratory system symptoms were more common in COVID-19 patients compared to the control group in the 1st month and 3rd month follow-ups (p < 0.001). Mortality at 3 months after the diagnosis of COVID-19 was significantly higher in the COVID-19 group than in the control group (respectively; 5.2% and 1.4%, p:0.037). Similarly, the rate of patients requiring dialysis for COVID-19 was significantly higher than the control group (respectively; 8.1% and 3.4%, p: 0.045). CONCLUSIONS: In CKD patients, COVID-19 was associated with increased mortality, as well as more deterioration in kidney function and higher need for dialysis in the post-COVID-19 period. These patients also had higher rate of ongoing respiratory symptoms after COVID-19.

Primary glomerulonephritis in diabetic patients.

BACKGROUND: Primary glomerulonephritis (PGN) has a significant part in non-diabetic kidney disease (NDKD) in diabetes mellitus (DM) patients. In our study, we compared the clinical, demographic and laboratory features of patients with biopsy-proven diabetic nephropathy (DN) and PGN with type 2 DM. METHODS: In our retrospective study, type 2 DM patients who underwent kidney biopsy between 2011 and 2019 were included. Demographic, clinical and laboratory characteristics of DN and PGN patients were compared. RESULTS: Seventy patients with a mean age of 55.7 ± 9.4 and 43 (61.4%) males were included. About 38 (54.3%) of the patients had DN and 32 (45.7%) had PGN. In the PGN, membranous GN (20, 62.5%) was most common. In DN patients, diabetes duration was longer; complications such as retinopathy, neuropathy, hypertension, coronary artery disease, heart failure were more frequent. At the time of renal biopsy, blood sugar, HbA1C, blood pressure, serum albumin and proteinuria values were similar in two groups. The pathological damage findings of kidney biopsy in DN patients were more severe. In the first year after kidney biopsy decrease in eGFR was higher in DN patients, whereas eGFR did not change in PGN patients. CONCLUSION: In a diabetic patient, fasting blood sugar, hbA1C, serum albumin and proteinuria did not differ in the differential diagnosis of DN and PGN, whereas complications of DM (retinopathy, neuropathy, hypertension, coronary artery disease) were more characteristic in differentiation. Detection of PGN in a diabetic patient is crucial for the success of the treatment, according to DN.

Podocyte Injury in Cases with Newly Diagnosed Multiple Myeloma.

Renal impairment is a frequent complication of multiple myeloma (MM). Our aim was to assess the expression of podocyte-associated nephrin, podocin, and vascular endothelial growth factor (VEGF) A and their relation to renal function, proteinuria, and clinical outcome in patients with newly diagnosed multiple myeloma. This study included 27 patients with newly diagnosed MM and 20 healthy volunteers as control. Patients were evaluated for clinical and laboratory parameters, renal function, proteinuria, and podocyturia at the time of diagnosis and at six months. Seven patients died before completing of treatment (within the first 6 months). Proteinuria was measured in daily urine samples. First-morning spot urine RNA was isolated, cDNA was produced, and polymerase chain reaction (PCR) was processed. Podocytes were identified by PCR tagging nephrin, podocin, and VEGF-A. The mean ages were 59.63 ± 10.21 and 34.75 ± 12.07 for patients and controls, respectively. After six months proteinuria decreased from 885.45 ± 2033.12 mg/day to 398.55 ± 811.34 mg/day (P = 0.002). Comparing to baseline urinary nephrin/creatinine, podocin/creatinine, VEGF-A/creatinine were significantly increased (P = 0.039, P = 0.001, P = 0.001 respectively) while renal function and proteinuria were improved in patients. In controls urinary protein and nephrin/creatinine were lower than that of patients (P = 0.001, P = 0.044). The presence of renal failure at the initial diagnosis was the most important for death (P <0.029). Proteinuria and renal dysfunction were found in 74% and 33%, in patients with newly diagnosed MM, respectively. The presence of podocyte injury at the beginning and also increase after therapy while improvement of proteinuria and renal failure, suggests that podocyte injury can be seen in MM and is affected with treatment. This is the first report about podocyte injury in MM.