Demographic and Clinical Features and Factors Associated with Survival in Patients with Primary Glomerulonephritis: Single Tertiary Center Experience

Aim:Primary glomerulonephritis (GN) is a rare disease that has many different subtypes and is a significant health problem. Patients with primary GN (PGN) often do not achieve a complete cure, typically require immunosuppressive therapy, and can have serious co-morbidities due to the disease, which often progresses to end-stage renal disease (ESRD). The current study aimed to investigate the epidemiological, clinicodemographic characteristics and long-term outcomes of PGN patients.Materials and Methods:The current study retrospectively evaluated the demographic characteristics and complaints as well as the physical examination and laboratory findings of PGN patients who were followed-up and treated in the nephrology department of our university hospital between January 2000 and June 2016.Results:Of the 485 included patients, 265 were male (55%) and 220 were female (45%). The median age at diagnosis was 38.5 years (range; 18-77). The most frequent indication for biopsy was nephrotic syndrome (53.2%). The most common histopathological diagnoses were IgA nephritis (33.2%), focal segmental GN (31.1%), and membranous GN (19.6%), respectively. It was observed that male gender (p=0.01), systemic hypertension (p=0.01) at the time of diagnosis, proteinuria (p=0.001) in the nephrotic range, and histological diagnosis of crescentic GN (p=0.001) contributed negatively to renal survival. The mean follow-up duration after diagnosis was 59.1±48.5 months. The median overall survival was 153 (range; 1-197) months. Survival was significantly lower in patients with ESRD compared to those without ESRD (p=0.003). On clinical follow up, 48 patients died (9.9%), and 94 patients (19.3%) progressed to ESRD.Conclusion:Clearly defining the etiology of PGN as well as determining the factors leading to ESRD may decrease morbidity and mortality

The Charlson Comorbidity Index: can it predict the outcome in acute kidney injury?

Purpose Comorbidity has a significant impact on the health status and treatment outcome of a patient. The Charlson comorbidity index (CCI) is a frequently used scoring system, which evaluates the prognosis based on the patient's comorbid conditions. The aim of this study was to evaluate the usefulness of CCI in predicting the mortality and renal recovery in non-critically ill patients with severe AKI. Methods A total of 530 adult patients who were referred from the emergency department and underwent intermittent urgent hemodialysis (uHD) were enrolled in the study. Personal history for comorbidities were recorded and then assessed using the CCI. Results The mean CCI score was 3.3 +/- 2.6. In our multivariate analysis, higher white blood cell count was associated with mortality (p = 0.023). The other parameters including CCI score were not found to be significantly associated with mortality excluding patients with sepsis. Moreover, the CCI was not significantly useful in the discrimination of patients with complete recovery from patients who remained dependent to dialysis. Conclusions We could not find significant association between CCI and short-term hospital mortality and renal outcome. Whereas, malnutrition, inflammation and general aging may have impact on short-term mortality among patients

Mycobacterium tuberculosis infections after renal transplantation

The incidence of tuberculosis was found to be 5.8% (16/274) in 274 kidney graft recipients in our centre between 1986 and 1998, The kidney recipients were evaluated retrospectively. A total of 51 recipients received isoniazid prophylaxis for 6 months. The prevalence of tuberculosis was found similar (6% vs. 8,8%, p = 0.15) between recipients with prophylaxis and no prophylaxis, Eight patients were recipients of cadaveric donor kidneys and 8 were recipients of living donor kidneys. Lungs were the most frequently affected site, as in the normal population. M, tuberculosis grew in 7 patients. In 5 patients, M. tuberculosis was also detected on direct microscopy and polymerase chain reaction. In 4 patients, diagnosis was made on clinical grounds and later confirmed by positive response to therapy. In 8 patients, invasive procedures were performed for diagnosis. Five patients had miliary tuberculosis at the time of diagnosis. In 3 patients dissemination occurred during follow-up. Nine patients responded to anti-tuberculous therapy while still preserving their graft function, 1 patient rejected the graft while under treatment and returned to haemodialysis. Five patients (31%) died. Since the risk of dissemination of tuberculosis is high in these patients, anti-tuberculous therapy should be started whenever clinical findings suggestive of tuberculosis are present, even in the absence of any microbiological and/or histological evidence

Temporary catheter infections in hemodialysis patients

In this study, we aimed to determine the frequencies of catheter exit-site infection (CESI), catheter-related bloodstream infection (CR-BSI) and catheter colonization (CC); causative microorganisms; and resistance patterns in patients with temporary hemodialysis catheters. From March 1999 to March 2000, 67 hemodialysis patients (38 males, 29 females; median age: 52, range: 17-84) were evaluated. The CDC criteria were used to diagnose CESI, CR-BSI and CC. The tips of catheters were cultured by Maki's method. At the same time, two different blood Cultures, one from peripheral vein and the other through the catheter lumen were drawn. Swab cultures from the catheter exit sites were also performed. The isolation and identification of bacteria were performed by conventional methods and the Susceptibility testing by the Kirby-Bauer method. CESI, CR-BSI and CC were found in, respectively, 20 (29.8%), 16 (23.8%) and 11 (16.4%) patients. The etiologic agents in CR-BSI were as follows: Staphylococcus aureus (5), coagulase-negative staphylococci (2), Enterococcus sp. (1), Escherichia coli (1), Acinetobacter sp. (1) and Proteus sp. (1). Methicillin-resistant coagulase-negative staphylococci and methicillin-resistant S. aureus were found in proportions of 45.5% and 63.6% in CESI and CR-BSI+CC. The only risk factor for the development of CR-BSI and CC was intravenous drug use. In our center, the majority of CESI, CR-BSI and CC were due to staphylococci and there was a high rate of methicillin resistance

Arteriovenous fistula as the vascular access contributes to better survival of hemodialysis patients with COVID-19 infection

Background

Systemic fungal infections after renal transplantation

In a retrospective evaluation. the incidence of systemic fungal infections (SFIs) in 296 kidney graft recipients admitted to our center between 1986 and 1999 was found to be 4%. Eighteen percent of 28 recipients transplanted in India and 8% of 12 recipients transplanted in Russia developed SFI. In contrast, SFI was encountered in only 2% of recipients transplanted at our center. The median time of diagnosis of SFI was 5 months after transplantation. The lungs and central nervous system were the most frequently affected sites. The most common etiologic agent was Aspergillus fumigatus (n=7) but Candida spp. (n = 1), Rhizopus spp. (n = 1) and Cryptococcus neoformans (n = 1) were also encountered. In 2 patients, 2 different pathogens were isolated at the same time: A. fumigatus and Rhizopus spp. in I patient and Candida spp. and A. fumigatus in another. In order to determine predisposing factors for SFI, patients admitted immediately before and after those with SFI were used as controls: long-term hospitalization, long-term antibiotic use and post-transplant diabetes mellitus were found to be predisposing factors. Eight patients were treated with antifungal drugs and a good response to liposomal amphotericin B therapy was obtained in 3/5. Nine patients (75%) with SFI died. As SFIs are associated with a high mortality rate in renal transplant recipients, antifungal therapy, especially with liposomal amphotericin B, should be started whenever fungal infection is suspected, even before the results of microbiologic and/or histologic examinations are known