Effect of lifestyle interventions of pregnant women on their dietary habits, lifestyle behaviors, and weight gain: a randomized controlled trial

Background: Although it is known that lifestyle behaviors of pregnant women are closely related to maternal and fetal health, number of data concerning efficacy of intervention on lifestyle during pregnancy is limited. The purpose of this study is to determine the effect of lifestyle interventions on improving dietary habits and lifestyle behaviors, ensuring gestational weight gain (GWG) within recommended levels and limiting postpartum weight retention (PWR)

Controversies and problems of volume control and hypertension in haemodialysis

WOS: 000379736100033PubMed ID: 27226131Extracellular volume overload and hypertension are important contributors to the high risk of cardiovascular mortality in patients undergoing haemodialysis. Hypertension is present in more than 90% of patients at the initiation of haemodialysis and persists in more than two-thirds, despite use of several antihypertensive medications. High blood pressure is a risk factor for the development of left ventricular hypertrophy, heart failure, and mortality, although there are controversies with some study findings showing poor survival with low-but not high-blood pressure. The most frequent cause of hypertension in patients undergoing haemodialysis is volume overload, which is associated with poor cardiovascular outcomes itself independent of blood pressure. Although antihypertensive medications might not be successful to control blood pressure, extracellular volume reduction by persistent ultrafiltration and dietary salt restriction can produce favourable results with good blood pressure control. More frequent or longer haemodialysis can facilitate volume and blood pressure control. However, successful volume and blood pressure control is also possible in patients undergoing conventional haemodialysis

Can strict volume control be the key for treatment and prevention of posterior reversible encephalopathy syndrome in hemodialysis patients?

WOS: 000313751100014PubMed ID: 22360471Posterior reversible encephalopathy syndrome (PRES) is a rare but if diagnosed late an irreversible disease. The majority of the patients present with severe hypertension, and effective blood pressure control is the mainstay of therapy. In this case report, we present three cases with PRES, treated successfully with strict volume control policy and propose that strict volume control policy may be a key element for the treatment of PRES

NEW ONSET HYPERCALCEMIA AFTER RENAL TRANSPLANTATION: AN INFECTIOUS ETIOLOGY BEYOND PERSISTENT HYPERPARATHYROIDISM

[No Abstract Available

Interplay of volume, blood pressure, organ ischemia, residual renal function, and diet: certainties and uncertainties with dialytic management

WOS: 000409301100009PubMed ID: 28581677Extracellular fluid volume overload and its inevitable consequence, hypertension, increases cardiovascular mortality in the long term by leading to left ventricular hypertrophy, heart failure, and ischemic heart disease in dialysis patients. Unlike antihypertensive medications, a strict volume control strategy provides optimal blood pressure control without need for antihypertensive drugs. However, utilization of this strategy has remained limited because of several factors, including the absence of a gold standard method to assess volume status, difficulties in reducing extracellular fluid volume, and safety concerns associated with reduction of extracellular volume. These include intradialytic hypotension; ischemia of heart, brain, and gut; loss of residual renal function; and vascular access thrombosis. Comprehensibly, physicians are hesitant to follow strict volume control policy because of these safety concerns. Current data, however, suggest that a high ultrafiltration rate rather than the reduction in excess volume is related to these complications. Restriction of dietary salt intake, increased frequency, and/or duration of hemodialysis sessions or addition of temporary extra sessions during the process of gradually reducing postdialysis body weight in conventional hemodialysis and discontinuation of antihypertensive medications may prevent these complications. We believe that even if an unwanted effect occurs while gradually reaching euvolemia, this is likely to be counterbalanced by favorable cardiovascular outcomes such as regression of left ventricular hypertrophy, prevention of heart failure, and, ultimately, cardiovascular mortality as a result of the eventual achievement of normal extracellular fluid volume and blood pressure over the long term

The association of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with clinical outcomes in geriatric patients with stage 3-5 chronic kidney disease

WOS: 000380152400004PubMed ID: 27309205Objective: The purpose of this study was to investigate the association of the neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with the clinical outcomes in geriatric patients with stage 3-5 chronic kidney disease (CKD).Material and Methods: A total of 165 patients over the age of 65, with stage 3-5 CKD, were enrolled in the study. The primary endpoints were all-cause of deaths and requirement of renal replacement therapy. The patients were divided into two groups according to delta neutrophil/lymphocyte ratio such as increased (group 1) and decreased or stable (group 2) groups.Results: The mean age was 73.86.1years and the mean follow-up was 30 +/- 13months. Thirty-one (18.7%) patients died during the follow-up period and 21 (13.4%) patients required renal replacement therapy. The neutrophil/lymphocyte ratio increased in 95 (57.5%) patients. The mortality rate (24.2%, 11.4%; p=0.03) and requirement of renal replacement therapy (19.1%, 5.7%; p=0.01) were higher in group 1 compared to group 2. In the Cox regression analysis, the basal neutrophil/lymphocyte ratio was the independent predictor of death (HR: 1.23 (95% CI 1.02-1.47), p=0.02), and the basal eGFR was the independent predictor of requirement of renal replacement therapy (HR:0.938, 95% CI: 0.888-0.991, p=0.02). However, platelet/lymphocyte ratio was not associated with death and requirement of renal replacement therapy independently.Conclusion: The neutrophil/lymphocyte ratio predicts all-cause of mortality in geriatric patients with chronic kidney disease

Do Antithymocyte Globulin-Free Acute Rejection Therapies Increase the Risk of Polyoma Nephropathy in Renal Transplant Recipients?

12th Congress of the Turkish-Transplantation-Centers-Coordination-Association (TTCCA) -- OCT 18-21, 2018 -- Trabzon, TURKEYSen, Sait/0000-0002-1100-6657;WOS: 000500179300023PubMed: 31101182Introduction. BK virus nephropathy is a serious complication that can lead to allograft kidney loss. Excessive immunosuppression increases the risk. We aimed to evaluate whether there is an increased risk of BK viremia and nephropathy in patients who underwent high-dose immunosuppression because of the development of acute rejection in the early period after kidney transplantation. Methods. This retrospective cohort study was performed betweenApril 2015 and March 2016. Twenty-nine patientswho had biopsy-proven acute rejection in the first 3 months were evaluated for BK viremia and nephropathy. Thirty patients who had transplantations at the same period were the control group. Plasma BK-DNA values were examined at 1, 2, 3, 6, 9, and 12 months after the rejection treatment and at 3, 6, 9, and 12 months in the control group. Presence of polyoma nephropathy was examined with surveillance biopsies at the 6 and 12 months. Results. Acute rejection treatment was started on the 12th day after transplantation (2-37 days). Seventeen cellular rejections and 12 humoral rejections were reported by biopsy. Two of the 12 humoral rejections were suspicious. Only pulse steroid (PS) (n = 18); PS, plasmapheresis, and intravenous immunoglobulin (n = 8); PS and intravenous immunoglobulin (n = 2); and PS and plasmapheresis (n = 1) treatments were performed. in 21 patients in the rejection group and 25 patients in the control group, BK-DNA was not positive at all. Two patients had graft loss at 11 and 36 months in the rejection group. Graft losses were secondary to rejection. Conclusions. Treatment with antithymocyte globulin-free regimens after acute rejection episodes did not lead to an increase in BK viremia.Turkish Transplantat Ctr Coordinat Asso

A histopathological scoring and grading system to predict outcome for patients with AA amyloidosis

Sen, Sait/0000-0002-1100-6657WOS: 000539787900001PubMed: 32529382Purpose Renal involvement is associated with significant morbidity and mortality in AA amyloidosis. Extend of amyloid deposition in kidney biopsies may be predictive for clinical manifestations and outcomes. the aim of our study is to assess clinical features of patients with biopsy-proven renal AA amyloidosis and to evaluate the relationship between histopathological scoring and grading of renal amyloid deposition with clinical findings and outcomes. Methods the study included 86 patients who were diagnosed with renal AA amyloidosis. the demographic and clinical features at the time of biopsy and follow-up data were retrospectively collected. Amyloid deposition in glomeruli, interstitium, vessels and tubulointerstitial findings were scored and renal amyloid prognostic score (RAPS) was assigned by adding all scores. RAPS was further divided into three grades (RAPS grade I, II, III). Results Median age was 50 (36-59) years. Familial Mediterranean fever was the leading cause. RAPS grade and interstitial inflammatory infiltration were associated with baseline eGFR and glomerular amyloid deposition was associated with proteinuria. During the follow-up period (median 50 months), 39 patients developed ESRD. Extensive (involving > 50%) glomerular amyloid deposition, baseline eGFR and proteinuria were independent risk factors for progression to end stage renal disease. Death censored renal survival was significantly lower among patients with RAPS grade III compared to those with RAPS grade I and II. Patient survival rate was not different according to RAPS grade. Conclusions Degree of renal amyloid accumulation is associated with renal function and outcome. the scoring and grading system may be predictive in clinical outcome and contribute to understanding of disease mechanism