A multicenter study of the clinical, laboratory characteristics and potential prognostic factors in patients with aa amyloidosis on hemodialysis

Introduction While light chain (AL) amyloidosis is more common in western countries, the most common type of amyloidosis is amyloid A (AA) amyloidosis in Eastern Mediterranean Region, including Turkey. Although worse prognosis has been attributed to the AL amyloidosis, AA amyloidosis can be related to higher mortality under renal replacement therapies. However, there are no sufficient data regarding etiology, clinical presentation, and prognostic factors of AA amyloidosis. The objective of our study is to evaluate the clinical, laboratory characteristics, and possible predictive factors related to mortality in patients with AA amyloidosis undergoing hemodialysis (HD). Methods This multicenter, cross-sectional study was a retrospective analysis of 2100 patients on HD. It was carried out in 14 selected HD centers throughout Turkey. Thirty-two patients with biopsy-proven AA amyloidosis and thirty-two control patients without AA amyloidosis undergoing HD were included between October 2018 and October 2019. There was no significant difference between the groups in terms of age and dialysis vintage. Causes of AA amyloidosis, treatment (colchicine and/or anti-interleukin 1 [IL] treatment), and the number of familial Mediterranean fever (FMF) attacks in the last year in case of FMF, systolic and diastolic blood pressures, biochemical values such as mean CRP, hemoglobin, serum albumin, phosphorus, calcium, PTH, ferritin, transferrin saturation, total cholesterol levels, EPO dose, erythropoietin-stimulating agents resistance index, interdialytic fluid intake, body mass indexes, heparin dosage, UF volume, and Kt/V data in the last year were collected by retrospective review of medical records. Findings Prevalence of AA amyloidosis was found to be 1.87% in HD centers. In amyloidosis and control groups, 56% and 53% were male, mean age was 54 +/- 11 and 53 +/- 11 years, and mean dialysis vintage was 104 +/- 94 and 107 +/- 95 months, respectively. FMF was the most common cause of AA amyloidosis (59.5%). All FMF patients received colchicine and the mean colchicine dose was 0.70 +/- 0.30 mg/day. 26.3% of FMF patients were unresponsive to colchicine and anti-IL-1 treatment was used in these patients. In AA amyloid and control groups, erythropoietin-stimulating agents resistance index were 7.88 +/- 3.78 and 5.41 +/- 3.06 IU/kg/week/g/dl, respectively (p = 0.008). Additionally, higher CRP values (18.78 +/- 18.74 and 10.61 +/- 10.47 mg/L, p = 0.037), lower phosphorus (4.68 +/- 0.73 vs. 5.25 +/- 1.04 mg/dl, p = 0.014), total cholesterol (135 +/- 42 vs. 174 +/- 39 mg/dl, p < 0.01), and serum albumin (3.67 +/- 0.49 mg/dl, 4.03 +/- 0.22, p < 0.01) were observed in patients with AA amyloidosis compared to the control group. Discussion In this study, we found that long-term prognostic factors including higher inflammation, malnutritional parameters, and higher erythropoietin-stimulating agents resistance index were more frequent in AA amyloidosis patients under HD treatment

The results of bedside pulmonary consultations

Göğüs Hastalıkları Konsültasyonu (GHK) istenen olguların klinik özelliklerini, konsültasyon sırasında yapılan incelemeler ve varılan sonuçları değerlendirmek amacıyla Gülhane Askeri Tıp Akademisinde Kasım 2002-Haziran 2003 tarihleri arasında 7 ay boyunca yatağında GHK istenen olgular prospektif olarak kayıt edildi. Yaş ortalamaları 5718 (16-102) olan 220 kadın (%43.1), 290 erkek (%56.9) toplam 510 hastaya yatağında konsültasyon yapıldı. Konsültasyonlar, 15 dahili (%56.7), 10 cerrahi (%43.5) olmak üzere toplam 25 ayrı bölümden istenmişti. Doksan dört (%18.4) hastaya acil GHK istenmişti. En sık GHK istek nedeni solunumsal semptomlar %42.7 (218) ve radyolojik bulgular %19.4 (99) idi. GHK yapılan olguların %32.5 (166)'inde akciğer grafisi normal bulundu. En sık görülen radyolojik anormallik plevral opasite (%14.5) idi. Olguların %39.4 (201)'ünde hipoksemi söz konusuydu. Toplam 136 olguda (%26.7) bilgisayarlı tomografi, 76 olguda (%14.9) balgamda ARB, 64 olguda (%12.5) solunum fonksiyon testi istendi. Olguların %19 (97)'unda normal solunum sistemi bulguları, %13.7 (70)'sinde pulmoner enfeksiyon, yine %13.7 (70)'sinde obstruktif akciğer hastalığı, %10.2 (52)'sinde kardiyak patoloji tespit edildi. Medikal tedavi olarak 191 (%37.5) olguya antibiyotik, 137 (%26.9) olguya bronkodilatatör, 93 %18.2) olguya heparin ve 75 (%14.7) olguya steroid (inhalesistemik) önerildi. Cerrahi bilimlere yapılan GHK'nın (222) %28.8 (64)'i preoperatif, %71.2 (158)'si ise postoperatif dönemde idi. Sonuç olarak, cerrahi kliniklerde post-operatif solunumsal komplikasyonların, dahili kliniklerde ise pulmoner enfeksiyonların ve obstruktif akciğer hastalıklarının en sık Göğüs Hastalıkları sorunları olduğu gözlendi. "Bedside pulmonary consultations (BPC) in Gülhane Military Medical Academy during 7 month-period were recorded prospectively in order to evaluate clinical characteristics of the cases, the investigations performed during BPC and the conclusions. Five hundred and ten patients 220 (43.1%) of whom were female, 290 of whom (56.9%) were male and mean age of whom was 57±18 (16-102) were consulted at bedside. BPC requests were made from 15 (56.7%) internal and 10 (43.2%) surgery departments. Ninetyfour (18.4%) were consulted as emergency. The most frequent reasons for BPC were respiratory symptoms and radiological abnormalities in 218 (42.7%) and 99 (19,4%) of the cases respectively and the most frequent radiological finding was pleural effusion (14.5%). Hypoxemia was detected in 39.4% (201) of the patients. Computed tomography, sputum examination for acid-fast bacillus and tuberculosis culture and pulmonary function testing were ordered in 136 (26.7%), 76 (14,9%) and 64 (12.5%) of the cases respectively. Pulmonary infection, an obstructive lung disease and a cardiac disease were diagnosed and normal respiratory system finding were detected in 70 (13.7%), 70 (13.7%), 52 (10.2%) and 97 (19%) of the cases respectively. As medication, bronchodilator, heparin and steroids (inhaled or systemic) were ordered in 191 (37.5%), 137 (26.9%) and 93 (18.2%) of the cases. Of the BPCs requested from surgery departments 64 (28.8%) were in preoperative and 158 (71.2%) were in postoperative period. As a result, postoperative pulmonary complications in surgery departments and pulmonary infections and obstructive pulmonary diseases in internal departments were determined more frequently with BPC

Postoperative pulmonary complications

Postoperatif (PO) solunumsal komplikasyonları değerlendirmek amacıyla, Kasım 2002-Haziran 2003 tarihleri arasında cerrahi kliniklerden PO dönemde istenen konsültasyonlar prospektif olarak kaydedildi. On ayrı cerrahi kliniğinde yaş ortalamaları 5318 (20-102) olan 66’sı kadın (%41.8), 92’si erkek (%58.2) toplam 158 hasta PO dönemde konsülte edildi. En sık PO konsültasyon isteği nedeni, dispne (%31 [49/158]) ve radyolojik bulgulardı (%17.7 [28/158]). Olguların %36.1’inde (57) hipoksemi söz konusuydu. Olguların %38’inde (60) akciğer grafisi normal bulundu. En sık görülen radyolojik anormallik plöreziydi (%17.1 [27/158]). Toplam 28 olguda (%17.7) bilgisayarlı tomografi, 16 olguda (%10.1) ventilasyon-perfüzyon sintigrafisi istendi. Olguların %13.3’ünde (21) normal solunum sistemi bulguları, %64.6’sında (102) PO pulmoner komplikasyonlar tespit edildi. PO en sık görülen solunumsal komplikasyonlar %20.6 (21/102) diyafragmatik disfonksiyon, %18.6 (19) kronik obstrüktif akciğer hastalığında kötüleşme (bronkospazm), %17.6 (18) atelektazi, %14.7 (15) pnömoniydi. Üst batın ve toraks cerrahilerinden sonra PO uzamış mekanik ventilasyon ve plevral efüzyon, alt batın ve diğer cerrahilerdekine göre anlamlı olarak yüksek bulundu (p0.05).The aim of this study was to evaluate postoperative pulmonary complications of patients undergoing operations in 10 different surgery clinics between November 2002 and June 2003. A total of 158 patients, 66 (41.8%) females and 92 males (58.2%), whose mean age was 53±18 (20-102) were included in the study. The study was mainly based on the postoperative consultations requested by these clinics. The most common causes of consultation requests were dyspnea (31% [49/158]) and abnormal radiological findings (17.7% [28/158]). Hypoxemia was detected in 36.1% (57) of the patients. Chest X rays of 38% (60) of patients were found as normal. Pleural effusion was the most common radiological abnormality (17.1% [27/158]). Thoracic computed tomography was performed in 28 (17.7%) patients, ventilation perfusion lung scan was performed in 16 (10.1%) patients. Respiratory system examination was normal in 13.3% (21) of patients while postoperative pulmonary complications were detected in 64.6% (102) of patients. The most common respiratory complications observed postoperatively were diaphragmatic dysfunction 20.6% (21/102), worsening of obstructive lung disease (bronchospasm) 18.6% (19), atelectasis 17.6% (18) and pneumonia 14.7% (15) respectively. Upper abdominal and thoracic surgeries had significantly higher rates of prolonged mechanical ventilation and pleural effusion complications than other surgeries (p<0.05)

The results of bedside pulmonary consultations [Yata?inda gö?üs hastaliklari konsültasyonu sonuçlari]

Bedside pulmonary consultations (BPC) in Gülhane Military Medical Academy during 7 month-period were recorded prospectively in order to evaluate clinical characteristics of the cases, the investigations performed during BPC and the conclusions. Five hundred and ten patients 220 (43.1%) of whom were female, 290 of whom (56.9%) were male and mean age of whom was 57±18 (16-102) were consulted at bedside. BPC requests were made from 15 (56.7%) internal and 10 (43.2%) surgery departments. Ninety-four (18.4%) were consulted as emergency. The most frequent reasons for BPC were respiratory symptoms and radiological abnormalities in 218 (42.7%) and 99 (19,4%) of the cases respectively and the most frequent radiological finding was pleural effusion (14.5%). Hypoxemia was detected in 39.4% (201) of the patients. Computed tomography, sputum examination for acid-fast bacillus and tuberculosis culture and pulmonary function testing were ordered in 136 (26.7%), 76 (14,9%) and 64 (12.5%) of the cases respectively. Pulmonary infection, an obstructive lung disease and a cardiac disease were diagnosed and normal respiratory system finding were detected in 70 (13.7%), 70 (13.7%), 52 (10.2%) and 97 (19%) of the cases respectively. As medication, bronchodilator, heparin and steroids (inhaled or systemic) were ordered in 191 (37.5%), 137 (26.9%) and 93 (18.2%) of the cases. Of the BPCs requested from surgery departments 64 (28.8%) were in preoperative and 158 (71.2%) were in postoperative period. As a result, postoperative pulmonary complications in surgery departments and pulmonary infections and obstructive pulmonary diseases in internal departments were determined more frequently with BPC