The importance of miR-122 in patients with hepatocellular carcinoma.

TEZ8827Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2012.Kaynakça (s. 62-74) var.xi, 75 s. : res. ; 29 cm.Introduction and Objective: It is very important to determine hepatocellular carcinoma at an early stage for prognosis and patient management. There is still no ideal marker to detect hepatocellular carcinoma at early stage. MicroRNA-122 may be a novel biomarker for hepatocellular carcinoma. Materials and methods: This study was performed in 2011-2012 at Cukurova University, Faculty of Medicine, Balcalı Hospital with 43 hepatocellular carcinoma and 43 control patients. The peripheral blood was collected from patients and controls. MicroRNA-122 levels were determined by using real-time-PCR method. Results: Serume miR-122 amount in hepatocellular carcinoma group was significantly higher than the level found in the control group. (0.030173+- 0.053>0.00493+-0.015, p<0.0001). According to the area under the ROC curve (0.724) the patient group were identified for the cut-off value of miR-122. In addition, patient's other diagnostic, clinical and prognostic data were compared with miR-122 levels. Conclusion: In our study we showed amounts of circulating miR-122 in different clinical stages of hepatocellular carcinoma in patient's serume with real time-PCR method, also we compared patient's circulating miR-122 with other diagnostic, prognostic and clinical values. MicroRNA's are thought to be novel serum biomarkers in cancer diagnosis, prognosis and follow-up. To become a novel biomarker, miR-122 needs large-scale studies. In this period the value of the patient's own serum miR-122 can be used in the situations of viral hepatitis, hepatocellular carcinoma, liver tumour resection or liver transplant before and after these procedures. But serume miR-122 alone may not be a good biomarker to show diagnosis, prognosis and surveillance of hepatocellular carcinoma. To use other diagnostic, clinical, prognostic indicators in conjunction with miR-122 may be more meaningful.Giriş ve Amaç: Hepatoselüler karsinomanın erken evrede saptanması prognoz ve hasta yönetimi açısından çok önemlidir. Hepatoselüler karsinomayı erken aşamada tespit edecek ideal bir marker henüz yoktur. MicroRNA-122, Hepatoselüler karsinoma'da anlamlı olabilecek yeni bir biyomarker olabilir. Gereç ve Yöntem: Bu çalışmada, Çukurova Üniversitesi Tıp Fakültesi, Balcalı Hastanesinde 2011-2012 yıllarında tedavi gören 43 hepatoselüler karsinoma hastasının ve 43 sağlıklı kontrol grubunun serumunda real time-PCR metodu kullanılarak microRNA-122 düzeyleri saptandı. Bulgular: Hepatoselüler karsinomalı hasta grubunun serum miR-122 değeri kontrol grubuna göre anlamlı olarak daha yüksek bulundu.( hasta grubu ort.: 0,030173+-0,053, kontrol grubu ort.: 0,00493+-0,015, p<0.0001 ) ROC eğrisi altında kalan alana göre (0,724) hasta grubunda miR-122 için cut-off değer belirlendi. Ayrıca hastaların miR-122 değerleri, Hepatoselüler karsinoma'da anlamlı olan diğer diagnostik, klinik, prognostik verilerle karşılaştırıldı. Sonuç: Çalışmamızda farklı kliniklerde takip edilen farklı evrelerdeki hepatoselüler karsinoma hastalarının serumunda real-time PCR metodu ile miR-122'yi gösterdik ve bu değerleri hastaların diğer diagnostik, klinik, prognostik verileriyle karşılaştırdık. MicroRNA'ların yakın dönemde yeni ve iyi biyomarkerlar olarak rutin kullanıma geçeceği düşünülmektedir. Şu dönemde hastanın serum miR-122 değeri viral hepatit, hepatoselüler karsinom, karaciğer tümör rezeksiyonu ya da karaciğer transplantı gibi durumlarda tedavi öncesi ve sonrası, ameliyat öncesi ve sonrasında bakılan kontrollerle karaciğerdeki nekroinflamasyonun giderildiğinin ciddi bir göstergesi olabilir. Ancak miR-122 tek başına hepatoselüler karsinomada tanı, prognoz ve surveyansı göstermede iyi bir biyomarker olmayabilir. Diğer tanısal, klinik, prognostik göstergelerle birlikte kullanılması daha anlamlı olabilir.Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi tarafından desteklenmiştir. Proje No: TF2012LTP21

Idiopathic Retroperitoneal Fibrosis Presenting with Hypertension and Acute Renal Failure

Abdominal aort anevrizması, aortik plaklardaki inflamatuar hücrele- rin retroperitoneal bölgeye kaçağına bağlı olarak nadir olarak retro- peritoneal fibrozise neden olabilir. Biz de abdominal aort anevrizma- sı ve buna sekonder retroperitoneal fibrozisi hipertansiyon ve akut böbrek yetmezliği ile prezente olan hastayı sunmayı amaçladıkAbdominal aortic aneurysm can rarely cause retroperitoneal fibrosis secondary to the leakage of inflammatory cells from aortic plaques to the retroperitoneal area. In this study, we present a case with severe hy- pertension and acute renal failure secondary to retroperitoneal fibrosis related to abdominal aortic aneurys

Idiopathic Retroperitoneal Fibrosis Presenting with Hypertension and Acute Renal Failure

WOS: 000398932800008Abdominal aortic aneurysm can rarely cause retroperitoneal fibrosis secondary to the leakage of inflammatory cells from aortic plaques to the retroperitoneal area. In this study, we present a case with severe hypertension and acute renal failure secondary to retroperitoneal fibrosis related to abdominal aortic aneurysm

Böbrek nakil hastasında metforminle ilişkili laktik asidoz

Although metformin is a well tolerated anti-hyperglycemic drug it may cause lactic acidosis which has high mortality. In this paper we reported a renal transplant patient with lactic acidosis. Fifty-five year old renal transplant patient was admitted to our hospital with confusion and lactic acidosis. Her confusion improved dramatically after restoring blood glucose, supportive therapy and hemodialysis. Her obstructive ureteral stone was removed with ureteral catheterization. In follow up period her renal function was similar to baseline. In summary rapid diagnosis and also appropriate treatment including hemodialysis can prevent morbidity/ mortality in a patient with metformin associated lactic acidosis. Metformin users, especially renal transplant receivers who have high risk of acute renal failure, should be educated about the discontinuation of the drug when their urine volume decreased.Metformin iyi tolere edilen bir anti-hiperglisemik ilaç olmasına rağmen tedavisi sırasında mortalitesi yüksek laktik asidoza neden olabilir. Burada laktik asidoz ve böbrek yetersizliği gelişen bir böbrek nakil hastası rapor edilmiştir. Ellibeş yaşında böbrek nakil hastası hastanemize şuur bozukluğu, hipoglisemi ve laktik asidoz ile getirildi. Hastada postrenal akut böbrek yetersizliği saptandı. Hipoglisemi ve destek tedavisini takiben hemodiyaliz sonrası hastanın konfüzyonu dramatik olarak düzeldi. Üreteral taşın çıkarılmasından sonra böbrek fonksiyonları önceki değerlerde normal seyretti. Metformine bağlı gelişen laktik asidozda erken tanı ve geciktirilmeden hemodiyaliz dahil destek redavisi ile morbidite ve mortaliteyi önleyebilir. Ayrıca, akut böbrek yetersizliği gelisme riski yüksek transplant hastaları dahil metformin kullanan hastaların idrar azalması durumunda metformine ara vermesi konusunda eğitilmesi önemli olabilir

Metformin associated lactic acidosis in a renal transplant patient

Metformin iyi tolere edilen bir anti-hiperglisemik ilaç olmasına rağmen tedavisi sırasında mortalitesi yüksek laktik asidoza neden olabilir. Burada laktik asidoz ve böbrek yetersizliği gelişen bir böbrek nakil hastası rapor edilmiştir. Ellibeş yaşında böbrek nakil hastası hastanemize şuur bozukluğu, hipoglisemi ve laktik asidoz ile getirildi. Hastada postrenal akut böbrek yetersizliği saptandı. Hipoglisemi ve destek tedavisini takiben hemodiyaliz sonrası hastanın konfüzyonu dramatik olarak düzeldi. Üreteral taşın çıkarılmasından sonra böbrek fonksiyonları önceki değerlerde normal seyretti. Metformine bağlı gelişen laktik asidozda erken tanı ve geciktirilmeden hemodiyaliz dahil destek redavisi ile morbidite ve mortaliteyi önleyebilir. Ayrıca, akut böbrek yetersizliği gelisme riski yüksek transplant hastaları dahil metformin kullanan hastaların idrar azalması durumunda metformine ara vermesi konusunda eğitilmesi önemli olabilir.Although metformin is a well tolerated anti-hyperglycemic drug it may cause lactic acidosis which has high mortality. In this paper we reported a renal transplant patient with lactic acidosis. Fifty-five year old renal transplant patient was admitted to our hospital with confusion and lactic acidosis. Her confusion improved dramatically after restoring blood glucose, supportive therapy and hemodialysis. Her obstructive ureteral stone was removed with ureteral catheterization. In follow up period her renal function was similar to baseline. In summary rapid diagnosis and also appropriate treatment including hemodialysis can prevent morbidity/ mortality in a patient with metformin associated lactic acidosis. Metformin users, especially renal transplant receivers who have high risk of acute renal failure, should be educated about the discontinuation of the drug when their urine volume decreased

Acute kidney injury in Turkey: epidemiological characteristics, etiology, clinical course, and prognosis

Background This study aimed to evaluate the etiologies, comorbidities, and outcomes of acute kidney injury (AKI) in Turkey and determine any potential differences among different geographical parts of the country. Methods This prospective observational study was conducted by the Acute Kidney Injury Working Group of the Turkish Society of Nephrology. Demographical and clinical data of patients with AKI at the time of diagnosis and at the 1(st) week and 1(st), 3(rd), and 6(th) months of diagnosis were evaluated to determine patient and renal survival and factors associated with patient prognosis. Results A total of 776 patients were included (54.7% male, median age: 67 years). Prerenal etiologies, including dehydration, heart failure, and sepsis, were more frequent than other etiologies. 58.9% of the patients had at least one renal etiology, with nephrotoxic agent exposure as the most common etiology. The etiologic factors were mostly similar throughout the country. 33.6% of the patients needed kidney replacement therapy. At the 6(th) month of diagnosis, 29.5% of the patients had complete recovery; 34.1% had partial recovery; 9.5% developed end-stage kidney disease; and 24.1% died. The mortality rate was higher in the patients from the Eastern Anatolian region; those admitted to the intensive care unit; those with prerenal, renal, and postrenal etiologies together, stage 3 AKI, sepsis, cirrhosis, heart failure, and malignancy; those who need kidney replacement therapy; and those without chronic kidney disease than in the other patients. Conclusion Physicians managing patients with AKI should be alert against dehydration, heart failure, sepsis, and nephrotoxic agent exposure. Understanding the characteristics and outcomes of patients with AKI in their countries would help prevent AKI and improve treatment strategies

COVID-19 Infection in Peritoneal Dialysis Patients: A Comparative Outcome Study with Patients on Hemodialysis and Patients without Kidney Disease

Objectives: There is limited data about coronavirus disease-19 (COVID-19) characteristics and results in peritoneal dialysis (PD) patients. This study aimed to investigate the characteristics and outcomes among PD patients and compare them with matched hemodialysis (HD) patients and a control group without kidney disease

Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey

Background. Chronic kidney disease (CKD) and immunosuppression, such as in renal transplantation (RT), stand as one of the established potential risk factors for severe coronavirus disease 2019 (COVID-19). Case morbidity and mortality rates for any type of infection have always been much higher in CKD, haemodialysis (HD) and RT patients than in the general population. A large study comparing COVID-19 outcome in moderate to advanced CKD (Stages 3-5), HD and RT patients with a control group of patients is still lacking. Methods. We conducted a multicentre, retrospective, observational study, involving hospitalized adult patients with COVID-19 from 47 centres in Turkey. Patients with CKD Stages 3-5, chronic HD and RT were compared with patients who had COVID-19 but no kidney disease. Demographics, comorbidities, medications, laboratory tests, COVID-19 treatments and outcome [in-hospital mortality and combined in-hospital outcome mortality or admission to the intensive care unit (ICU)] were compared. Results. A total of 1210 patients were included [median age, 61 (quartile 1-quartile 3 48-71) years, female 551 (45.5%)] composed of four groups: Control (n = 450), HD (n = 390), RT (n = 81) and CKD (n = 289). The ICU admission rate was 266/ 1210 (22.0%). A total of 172/1210 (14.2%) patients died. The ICU admission and in-hospital mortality rates in the CKD group [114/289 (39.4%); 95% confidence interval (CI) 33.9-45.2; and 82/289 (28.4%); 95% CI 23.9-34.5)] were significantly higher than the other groups: HD = 99/390 (25.4%; 95% CI 21.3-29.9; P<0.001) and 63/390 (16.2%; 95% CI 13.0-20.4; P<0.001); RT = 17/81 (21.0%; 95% CI 13.2-30.8; P = 0.002) and 9/81 (11.1%; 95% CI 5.7-19.5; P = 0.001); and control = 36/450 (8.0%; 95% CI 5.8-10.8; P<0.001) and 18/450 (4%; 95% CI 2.5-6.2; P<0.001). Adjusted mortality and adjusted combined outcomes in CKD group and HD groups were significantly higher than the control group [hazard ratio (HR) (95% CI) CKD: 2.88 (1.52- 5.44); P = 0.001; 2.44 (1.35-4.40); P = 0.003; HD: 2.32 (1.21- 4.46); P = 0.011; 2.25 (1.23-4.12); P = 0.008), respectively], but these were not significantly different in the RT from in the control group [HR (95% CI) 1.89 (0.76-4.72); P = 0.169; 1.87 (0.81-4.28); P = 0.138, respectively]. Conclusions. Hospitalized COVID-19 patients with CKDs, including Stages 3-5 CKD, HD and RT, have significantly higher mortality than patients without kidney disease. Stages 3-5 CKD patients have an in-hospital mortality rate as much as HD patients, which may be in part because of similar age and comorbidity burden. We were unable to assess if RT patients were or were not at increased risk for in-hospital mortality because of the relatively small sample size of the RT patients in this study

Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: A nationwide analysis from Turkey

© The Author(s) 2020.Background. Chronic kidney disease (CKD) and immunosuppression, such as in renal transplantation (RT), stand as one of the established potential risk factors for severe coronavirus disease 2019 (COVID-19). Case morbidity and mortality rates for any type of infection have always been much higher in CKD, haemodialysis (HD) and RT patients than in the general population. A large study comparing COVID-19 outcome in moderate to advanced CKD (Stages 3-5), HD and RT patients with a control group of patients is still lacking. Methods. We conducted a multicentre, retrospective, observational study, involving hospitalized adult patients with COVID-19 from 47 centres in Turkey. Patients with CKD Stages 3-5, chronic HD and RT were compared with patients who had COVID-19 but no kidney disease. Demographics, comorbidities, medications, laboratory tests, COVID-19 treatments and outcome [in-hospital mortality and combined in-hospital outcome mortality or admission to the intensive care unit (ICU)] were compared. Results. A total of 1210 patients were included [median age, 61 (quartile 1-quartile 3 48-71) years, female 551 (45.5%)] composed of four groups: Control (n = 450), HD (n = 390), RT (n = 81) and CKD (n = 289). The ICU admission rate was 266/ 1210 (22.0%). A total of 172/1210 (14.2%) patients died. The ICU admission and in-hospital mortality rates in the CKD group [114/289 (39.4%); 95% confidence interval (CI) 33.9-45.2; and 82/289 (28.4%); 95% CI 23.9-34.5)] were significantly higher than the other groups: HD = 99/390 (25.4%; 95% CI 21.3-29.9; P<0.001) and 63/390 (16.2%; 95% CI 13.0-20.4; P<0.001); RT = 17/81 (21.0%; 95% CI 13.2-30.8; P = 0.002) and 9/81 (11.1%; 95% CI 5.7-19.5; P = 0.001); and control = 36/450 (8.0%; 95% CI 5.8-10.8; P<0.001) and 18/450 (4%; 95% CI 2.5-6.2; P<0.001). Adjusted mortality and adjusted combined outcomes in CKD group and HD groups were significantly higher than the control group [hazard ratio (HR) (95% CI) CKD: 2.88 (1.52- 5.44); P = 0.001; 2.44 (1.35-4.40); P = 0.003; HD: 2.32 (1.21- 4.46); P = 0.011; 2.25 (1.23-4.12); P = 0.008), respectively], but these were not significantly different in the RT from in the control group [HR (95% CI) 1.89 (0.76-4.72); P = 0.169; 1.87 (0.81-4.28); P = 0.138, respectively]. Conclusions. Hospitalized COVID-19 patients with CKDs, including Stages 3-5 CKD, HD and RT, have significantly higher mortality than patients without kidney disease. Stages 3-5 CKD patients have an in-hospital mortality rate as much as HD patients, which may be in part because of similar age and comorbidity burden. We were unable to assess if RT patients were or were not at increased risk for in-hospital mortality because of the relatively small sample size of the RT patients in this study