Multiple Systemic Infarctions as a Complication of Bronchial Artery Embolization With Polyvinyl Alcohol: A Case Report

Bronchial artery embolization (BAE) is a widely used modality of treatment for massive hemoptysis which has well known complications such as chest pain, groin hematoma and transverse myelitis but systemic embolization of the material used in the procedure is very rare and was reported only four times in the literature which were all caused by the use of microspheres. Herein we report a case of a 41-year-old caucasian male who had a history of tuberculosis 10 years ago. He had BAE with polyvinyl alcohol (PVA) for the treatment of recurrent hemoptysis. After the procedure, the patient complained of severe pain on the left upper quadrant and bilateral costovertebral regions and in abdominal CT, multiple infarcts in the subcapsular area of the spleen and kidneys were observed. This is the first reported case of inadvertent systemic embolization secondary to BAE with PVA. Although the risk of systemic embolization is greater with microspheres, still potentially serious and life threatening complications may occur with PVA

Two Cases Presenting with Acute Renal Failure: One with Renal Lymphoma and Other with Lung Cancer Metastases to the Kidneys

Acute renal failure (ARF) due to tumor cell infiltration to the renal parenchyma is a rare condition. Here, we report two cases; first one with lung carcinoma metastasis to renal parenchyma and the second one with non-Hodgkin lymphoma infiltration of renal parenchyma both presenting with acute renal failure and diagnosed by renal biopsy. Case 1: A 66-year-old female patient was admitted with dyspnea, pretibial edema and oliguria (200 cc/day). On physical examination a blood pressure of 160/110 mmHg, bilateral pretibial edema and hepatomegaly palpable 5 cm below the costal margin were noticed. Laboratory test results were significant for a Blood Urea Nitrogen (BUN) level of 141 mg/dL, serum creatinine level of 5.9 mg/dL, LDH level of 2562 IU/L, anemia, leukocytosis (WBC: 20.000/mu L), 2(+) proteinuria, microscopic hematuria and pyuria. Intractable metabolic acidosis developed despite conservative treatment and hemodialysis was therefore initiated. Bilateral enlargement of the kidneys was noted in urinary system ultrasonography (USG). Percutaneous kidney biopsy was performed and pathologic examination of biopsy specimens was significant for diffuse malignant lymphoid infiltration of the renal tubulointerstitium. Immunohistochemical examination (IHE) revealed CD20, CD10 and MUM1 positive neoplastic cells. High grade diffuse large B cell lymphoma was diagnosed. Case 2: A 65-yearold male patient was diagnosed with squamous cell lung carcinoma and underwent left pneumonectomy in April 2009. At that time, his serum creatinine level was 1.2/mg/dl. Macroscopic hematuria and 0.5g/day proteinuria was detected 11 months after the diagnosis. On physical examination pallor, absence of breath sounds on left hemithorax and hepatomegaly palpable 2 cm below the right costal margin were noticed. His laboratory tests were significant for anemia, a BUN level of 85 mg/dl and serum creatinin level of 4.2 mg/dl. The sizes of both kidneys and their parenchymal thicknesses were within normal limits on urinary USG. Pathology examination of percutaneous kidney biopsy specimens demonstrated malignant cell infiltration of the renal tubulointersititium. IHE of the specimens were negative for cytokeratin-20 and thyroid transcription factor-1 (TTF-1) but were positive for P63. A diagnosis of squamous cell carcinoma metastasis to kidneys was made. Conclusion: Tumor cell infiltration of kidneys from a distant source is a rare cause of ARF. Kidney biopsy should be performed to reveal the underlying etiology of ARF in cases where there is a high degree of suspicion

The Clinical Significance of Uric Acid and Complement Activation in the Progression of IgA Nephropathy

Background/Aims: The aim of this study is to investigate the utility of clinical [age, gender, mean arterial pressure (MAP)] and laboratory parameters [eGFR, hemoglobin (Hgb), serum levels of creatinine, uric acid, albumin, proteinuria, hematuria] and also histopathological lesions (Oxford classification parameters, crescents, intensity and pattern of staining for C3, C1Q, IgA, IgG, IgM) as progression markers in patients with IgA Nephropathy (IgAN). Methods: A total of 111 IgAN patients with a follow-up period >1 year or who reached kidney failure [GFR category G5 chronic kidney disease (CKD)] Results: Mean follow-up period was 33±29 months. Thirty-seven (33.3%) patients progressed to kidney failure and 4 (3.6%) patients developed eGFR decline ≥50% from the baseline after a median of 23 and 65 months, respectively. In multivariate Cox regression analysis, baseline levels of Hgb (HR:0.782, 95% CI 0.559-0.973, p=0.037), serum uric acid (HR:1.293, 95% CI 1.023-1.621, p=0.046), eGFR (HR:0.966, 95% CI 0.947-0.984, p=0.004) and intensity of C3 staining (HR:1.550, 95% CI 1.198-1.976, p=0.049) predicted primary endpoint. Serum uric acid level was associated independently with T score (β=0.303, p=0.005) in patients with eGFR>30 ml/min/m2. Conclusions: Hyperuricemia and the deposition of C3 are independent risk factors for IgAN progression

THE IMPORTANCE OF GLOMERULAR C3 ACCUMULATION IN ELDERLY PATIENTS WITH PRIMARY MEMBRANOUS NEPHROPATHY

Objective: The purpose of this study was to investigate the impact of glomerular C3 accumulation density on clinical, histopathological parameters and outcomes in elderly (>60 years) individuals with primary membranous nephropathy (PMN)

COVID-19 in Kidney Transplant Recipients: A Multicenter Experience from the First Two Waves of Pandemic

Background Kidney transplant recipients have an increased risk of complications from COVID-19. However, data on the risk of allograft damage or death in kidney transplant recipients recovering from COVID-19 is limited. In addition, the first and second waves of the pandemic occurred at different times all over the world. In Turkey, the Health Minister confirmed the first case in March 2020; after that, the first wave occurred between March and August 2020; afterward, the second wave began in September 2020. This study aims to demonstrate the clinical presentations of kidney transplant recipients in the first two waves of the pandemic in Turkey and explore the impact of COVID-19 on clinical outcomes after the initial episode. Methods Patients with COVID-19 from seven centers were included in this retrospective cohort study. Initially, four hundred and eighty-eight kidney transplant recipients diagnosed with COVID-19 between 1 March 2020 to 28 February 2021 were enrolled. The endpoints were the occurrence of all-cause mortality, acute kidney injury, cytokine storm, and acute respiratory distress syndrome. In addition, longer-term outcomes such as mortality, need for dialysis, and allograft function of the surviving patients was analyzed. Results Four hundred seventy-five patients were followed up for a median of 132 days after COVID-19. Forty-seven patients (9.9%) died after a median length of hospitalization of 15 days. Although the mortality rate (10.1% vs. 9.8%) and intensive care unit admission (14.5% vs. 14.5%) were similar in the first two waves, hospitalization (68.8% vs. 29.7%; p < 0.001), acute kidney injury (44.2% vs. 31.8%; p = 0.009), acute respiratory distress syndrome (18.8% vs. 16%; p = 0.456), and cytokine storm rate (15.9% vs. 10.1%; p = 0.072) were higher in first wave compared to the second wave. These 47 patients died within the first month of COVID-19. Six (1.4%) of the surviving patients lost allografts during treatment. There was no difference in the median serum creatinine clearance of the surviving patients at baseline (52 mL/min [IQR, 47-66]), first- (56 mL/min [IQR, 51-68]), third- (51 mL/min [IQR,48-67]) and sixth-months (52 mL/min [IQR, 48-81]). Development of cytokine storm and posttransplant diabetes mellitus were independent predictors for mortality. Conclusions Mortality remains a problem in COVID-19. All the deaths occur in the first month of COVID-19. Also, acute kidney injury is common in hospitalized patients, and some of the patients suffer from graft loss after the initial episode

CHARACTERISTICS AND SURVIVAL RESULTS OF PERITONEAL DIALYSIS PATIENTS SUFFERING FROM COVID-19 IN TURKEY: A MULTICENTER NATIONAL STUDY

INTRODUCTION: We aimed to study the characteristics of peritoneal dialysis (PD) patients with coronavirus disease-19 (COVID-19), determine the short-term mortality and other medical complications, and delineate the factors associated with COVID-19 outcome. METHODS: In this multicenter national study, we included PD patients with confirmed COVID-19 from 27 centers. The baseline demographic, clinical, laboratory, and radiological data and outcomes at the end of the first month were recorded. RESULTS: We enrolled 142 COVID-19 patients (median age: 52 years). 58.2% of patients had mild disease at diagnosis. Lung involvement was detected in 60.8% of patients. Eighty-three (58.4%) patients were hospitalized, 31 (21.8%) patients were admitted to intensive care unit and 24 needed mechanical ventilation. Fifteen (10.5%) patients were switched to hemodialysis and hemodiafiltration was performed for four (2.8%) patients. Persisting pulmonary symptoms (n = 27), lower respiratory system infection (n = 12), rehospitalization for any reason (n = 24), malnutrition (n = 6), hypervolemia (n = 13), peritonitis (n = 7), ultrafiltration failure (n = 7), and in PD modality change (n = 8) were reported in survivors. Twenty-six patients (18.31%) died in the first month of diagnosis. The non-survivor group was older, comorbidities were more prevalent. Fever, dyspnea, cough, serious-vital disease at presentation, bilateral pulmonary involvement, and pleural effusion were more frequent among non-survivors. Age (OR: 1.102; 95% CI: 1.032–1.117; p: 0.004), moderate-severe clinical disease at presentation (OR: 26.825; 95% CI: 4.578–157.172; p < 0.001), and baseline CRP (OR: 1.008; 95% CI; 1,000–1.016; p: 0.040) were associated with first-month mortality in multivariate analysis. DISCUSSION/CONCLUSIONS: Early mortality rate and medical complications are quite high in PD patients with COVID-19. Age, clinical severity of COVID-19, and baseline CRP level are the independent parameters associated with mortality