Background and Aims Mental retardation in patients with chronic kidney disease is a relative contraindication for kidney transplantation. Currently, in the literature there are limited outcome data in renal transplant recipients with mental retardation and approaches to decision of transplantation changes in different centers. The aim of this study is to evaluate the results of kidney transplantation recipients with mental retardation in our center. Method In this study, we examined retrospectively 8 kidney transplant recipients with mental retardation in Renal Transplantation Unit of Ankara University School of Medicine between 2006-2018 years. Results The cause of mental retardation in these patients were; genetic syndromes in three patients, meningoencephalitis in one patient, prematurity in one patient, and chromosomal abnormality in one patient. In two patients, the cause of mental retardation is unknown. All patients had good social support for drug compliance and follow-up. The causes of end-stage renal failure were; cystic kidney disease in three patients, hypertensive nephropathy in one patient and vesicoureteral reflux in one patient. In three patients, the etiology of kidney disease is unknown. At the time of pretransplantation period evaluation, six candidates were receiving hemodialysis and two candidates were receiving peritoneal dialysis respectively. Mean dialysis duration before transplantation was 50.7±22.8 months (min 4-max 180). Cadaveric kidney transplantation was performed in three of eight patients (deceased donor kidney allocated to patient with medical urgency in the event of potential imminent loss of dialysis access in one patient and in normal conditions in two patients) and living kidney transplantation was performed in five patients. The mean follow-up period after transplantation was 54.1±48.0 months. Three patients had early posttransplant complications; including urinary tract infection in three patients, deep vein trombosis in one patient and cardiopulmoner arrest with septic shock secondary to femoral graft infection and parailiac abscess in one patient (Table). No patients underwent graft biopsy and no patients experienced acute rejection episode. At the end of the follow-up time, graft and patient survival were 100%. Conclusion Mental retardation is not a contraindication for kidney transplantation in candidates without the history of noncompliance with proper social support.
Background and Aims Cytomegalovirus (CMV) infection is an important complication in immunocompomised patients. Although approach to CMV infection is well-defined in stem cell and solid organ transplant recipients, less is known about the frequency and risk factors of CMV disease in patients with glomerulonephritis (GN). As few studies have shown that cyclophosphamide (CYC) treatment is a risk factor for CMV infection in GN patients, we aimed to describe the frequency and risk factors of CMV infection in GN patients treated with CYC. Method 268 patients diagnosed GN between January 2017 and November 2019 in Ankara University İbni Sina Hospital, Nephrology Department. We recruited 43 GN patients who were treated with CYC and screened all patients for viral DNA monthly. CMV infection defined by CMV DNA detected >500 copies/µl. Patients developed CMV and no-CMV infection were compared for age, sex, glomerular pathology, renal function and clinical status before and after treatment. Results CMV infection was detected in 10 (23,3%) patients at 2±1 (min:1 max:3) months of CYC treatment (Table-1). 7 patients were treated for CMV infection with parenteral ganciclovir, while the other 3 patients with low CMV DNA level (509, 538 and 540 copies/ml) and no disease symptoms were monitored without antiviral treatment. Patients with CMV infection had higher serum creatinine (4,2±3,2 vs. 1,9±1,8 mg/dl, p=0,006), lower estimated glomerular filtration rate (29±11 vs. 65±8 (ml/min/1.73 m2, p=0.016), lower low-density lipoprotein (144±71 vs. 221±83 mg/dl, p=0,012) at diagnosis compared with no-CMV infection patients (Table-2). Also more patients were diagnosed with rapidly proggressive GN (80,0% vs. 27.3%, p=0,007), and secondary GN was the most common GN diagnosis (80,0% vs. 27.3%, p=0.007) in CMV infection group. Conclusion CMV infection is a common complication in GN patients treated with CYC. Routine monitoring and prophylaxis should be considered for the patients who have risk factors for CMV infection.
Background and Aims We aimed to study the impact of major surgical operations on clinical outcome in patients with end-stage kidney disease treated with haemodialysis (HD) or peritoneal dialysis (PD). Method We retrospectively evaluated the records of all patients on HD and PD, who had been treated for at least 3 months at our outpatient clinics between January 1, 2014 and December 31, 2018. In addition to clinical and laboratory parameters, data on all major surgical operations were recorded. Results Among the 202 patients, 133 (66%) were on HD and 69 (34%) on PD. The mean age (±SD) was 58.3±14.5 years, 48% were female and 28% had diabetes mellitus. Forty-seven patients (23%) had a major surgical operation. The operation types were cardiovascular in 14 patients, orthopaedic in 11, gastrointestinal in 8, genitourinary in 6, parathyroidectomy in 5 and brain, pulmonary and breast in 1 patient each. Operations were emergent in 10 patients (21%) and elective in the others (79%). Among the whole study population, 59 patients (29%) died during the study period. In Kaplan-Meier analysis (Figure), mean (95% CI) survival time in operated patients was 43 months (37 to 49 months), while it was 49 months (46 to 52 months) in the others (p=0.023). Fifteen out of 23 deaths (65%) among the operated patients occurred in the first month after surgery. Severe perioperative complications (arrhythmias, hypervolemia, hypotension, bleeding, acute coronary syndrome, respiratory failure and cerebrovascular event) were recorded in 17 (36%) of the operated patients, of whom 16 died (p=0.001). Although did not reach a significant level, mortality rate tended to be higher after emergent operations than that after elective operations. Cox regression analyses revealed that age (RR 1.033, 95% CI 1.010-1.057, p=0.005), diabetes (RR 2.581, 95% CI 1.474-4.521, p=0.001), preoperative C-reactive protein level (RR 1.005, 95% CI 1.002-1.007, p<0.0001) and having a major surgical operation (RR 1.868, 95% CI 1.068-3.268, p=0.028) were the independent predictors of mortality. Conclusion Although prospective studies with a higher patient number are needed to confirm, our study shows that, in addition to age, diabetes and inflammatory status, having a major surgical operation is an independent risk factor for mortality in dialysis patients. The prevention and management of perioperative complications properly may result in more favourable outcomes in these patients.
Introduction: Infections can play an important role in the mortality and morbidity of patients with glomerulonephritis. However, the frequency of infectious complications in primary glomerulonephritis and their burden to the healthcare managements are not clear. Methods: We evaluated the infectious complications in patients with biopsy-proven focal segmental glomerulosclerosis, membranous glomerulonephritis, IgA nephropathy, minimal change disease, membranoproliferative glomerulonephritis, and chronic glomerulonephritis during the last 10 years in a single center. We recorded the demographic, clinical, and laboratory characteristics; treatment modalities; infectious episodes; and infection-related mortality and morbidity of the patients. Results: Of the patients, 154 (63.6%) received immunosuppressive treatment and 88 (34.4%) were followed up under conservative treatment. Overall, 118 infectious episodes were noted in 64 patients, with an infection rate of 0.20 per patient-year. Total infectious complications were higher in the immunosuppressive group than in the conservative group (42.1 vs. 23.3%, p = 0.005). Infection-related hospitalizations were also higher in the immunosuppressive group (p = 0.01). The most frequently infected area was the lungs (15.7%). Although bacterial infections were the most common in both groups, 14.9% of the immunosuppressive group had cytomegalovirus (CMV) replication. Age >50 years (OR 2.19, p = 0.03), basal serum albumin <2.5 g/dL (OR 2.28, p = 0.02), cyclophosphamide (OR 2.43, p = 0.02), and cyclosporine (OR 2.30, p = 0.03) were independently associated with experiencing infectious episodes. Conclusions: Because of high seropositivity for CMV in Turkey, it might be a wise approach to use prophylactic antiviral drugs in patients treated with immunosuppressive treatments. Close monitoring of patients with primary glomerulonephritis, especially those treated with immunosuppressive therapy, is important for reducing infection-related morbidity and mortality.
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