Background and Objectives: Anemia is a frequent complication of chronic kidney disease (CKD), primarily attributed to erythropoietin deficiency. Interstitial fibrosis (IF), which disrupts the renal interstitium where erythropoietin-producing cells reside, may contribute to anemia independent of glomerular filtration rate (GFR). However, data in primary glomerulonephritis (PGN) are limited and conflicting. Materials and Methods: In this nationwide multicenter registry analysis (TSN-GOLD), 2794 adults with biopsy-proven PGN were included. Interstitial fibrosis was graded semi quantitatively (0-3). Anemia was defined according to KDIGO/WHO criteria. Multivariable logistic regression models were constructed to evaluate the independent association between IF severity and anemia, adjusting for age, sex, eGFR, log-transformed proteinuria, hypertension, diabetes mellitus, and biopsy diagnosis. Interaction between IF and eGFR was assessed. A predefined subgroup analysis was performed in patients with preserved renal function (eGFR ≥ 60 mL/min/1.73 m2). Results: Anemia was present in 34.4% of patients. Although moderate-to-severe IF was more frequent among anemic patients (p < 0.001), IF severity was not independently associated with anemia in multivariable analysis (p-trend = 0.72). Female sex and lower eGFR were independently associated with anemia. A statistically significant IF×eGFR interaction was observed (p = 0.0029), indicating effect modification across renal function levels. The model demonstrated moderate discrimination (AUC = 0.705). In patients with preserved renal function, IF severity was not associated with anemia. Conclusions: In this large multicenter cohort of PGN patients, interstitial fibrosis severity was not independently associated with anemia after adjustment for renal function and clinical covariates. These findings suggest that the association between interstitial fibrosis and anemia in PGN appears largely mediated by renal functional status rather than fibrosis severity alone.

Peritoneal dialysis (PD) has been reported as a long-term maintenance treatment of refractory congestive heart failure (RCHF). In this study, we aimed to evaluate the outcome of 24 PD patients with RCHF and Stage IV chronic kidney disease. The continuous ambulatory PD program consisted of two or three exchanges daily and one exchange nightly. In the follow-up period, clinical and echocardiographic biochemical findings and the need for hospitalization were recorded. Fifteen patients (66.7%) were male, and the mean age was 62.75 years. Under the PD treatment, the average daily urine volume and ultrafiltration of the patients were 800-1000 mL and 1000-15,000 mL, respectively. Ten patients were followed for 24 months and eight patients were followed for 12 months. During the follow-up period, there was a regression in the New York Heart Association heart failure class (from Class IV to Class II in 18 patients), and a decrease in body weights and an increase in serum sodium levels in all patients. Only two patients were hospitalized for cardiovascular disease over 2 years. During the follow-up period, one patient was transferred to hemodialysis because of peritonitis. In conclusion, in patients with RCHF and chronic renal failure without dialysis, PD in addition to standard treatment may be a safe treatment choice.

OBJECTIVES:Kidney transplant recipients are at increased risk for avascular necrosis due to steroid use and accompanying comorbidities. Concerning risk factors, uncertainty still exists. We evaluated the clinical characteristics and risk factors of avascular necrosis in kidney transplant recipients. MATERIALS AND METHODS:Symptomatic avascular necrosis was found by magnetic resonance imaging in 33 of 360 kidney transplant patients between 2005 and 2021. The patients' clinical characteristics, biochemical testing, and medications were evaluated. RESULTS:We found the frequency of avascular necrosis to be 9.7% during the follow-up period. If the total steroid dosage used was more than 4 g in the first 3 months, the risk of developing avascular necrosis increased 4.08 times, and the presence of cytomegalovirus disease increased the risk by 4.03 times. Avascular necrosis was observed bilaterally in 60.6% of cases and at the femoral head in 66.7%. The frequency of avascular necrosis was highest in the first and second years posttransplant. CONCLUSIONS:We found that avascular necrosis appears most frequently in the first 2 years after kidney transplant and the most important risk factors are cumulative steroid dose and cytomegalovirus disease. In the follow-up of kidney transplant patients, it is important to use low-dose steroid doses if possible. Of note, preventing the development of cytomegalovirus disease by screening and prophylaxis for cytomegalovirus is also important in reducing the development of avascular necrosis.

Background/Objectives: In patients with malignancy, fluid electrolyte imbalance and renal dysfunction have been demonstrated to increase mortality and morbidity. The objective of this study was to evaluate body composition, and clinical and laboratory tests at baseline and at 3 months during chemotherapy and standard fluid therapy in patients with malignancy. Methods: This study included patients with an ECOG performance status of 0-1 who did not have clinically evident organ failure, brain tumors, or a need for intensive care treatment. All received standard fluid therapy and chemotherapy. Examinations, routine laboratory tests, and body composition measurements were performed at the beginning of chemotherapy and again after three months. Results: The number of hypervolemic patients increased. Although the body mass index (BMI) did not change compared to the baseline, serum levels of B-type natriuretic peptide (BNP), calcium, albumin, total cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides increased at the second measurement. By month three, the frequency of overhydration (OH) increased. There was a significant, positive, moderate correlation between the difference in OH and the difference in BNP (p = 0.001). The leukocyte, neutrophil, neutrophil-to-lymphocyte ratio, and neutrophil-to-albumin ratio decreased (p < 0.05 for all). Body composition monitor (BCM) measurements revealed that the extracellular fluid/intracellular fluid ratio (E/I) increased at the second measurement (p = 0.001). Conclusions: The frequency of OH and BNP levels increased at three months. An initial fluid deficit or OH was associated with mortality. OH may mask sarcopenia in patients. Therefore, objective assessment of body composition is important for patient management to avoid OH and predict mortality. However, more studies with larger patient populations and long-term follow-up are needed.

OBJECTIVE: Latent tuberculosis infection (LTBI) screening is strongly recommended in the pre -transplant evaluation of solid organ transplant (SOT) recipients, although it remains inadequate in many transplant centers. We decided to investigate pre -transplant TB risk assessment, LTBI treatment, and registry rates in T & uuml;rkiye. MATERIAL AND METHODS: Adult SOT recipients who underwent tuberculin skin test (TST) and/or interferon -gamma release test (IGRA) from 14 centers between 2015 and 2019 were included in the study. An induration of >= 5 mm on TST and/or probable/positive IGRA (QuantiFERON-TB) was considered positive for LTBI. Demographic features, LTBI screening and treatment, and pre -/post -transplant TB history were recorded from the electronic database of transplantation units across the country and pooled at a single center for a unified database. RESULTS: TST and/or IGRA were performed in 766 (33.8%) of 2266 screened patients most of whom were kidney transplant recipients (n = 485, 63.4%). LTBI screening test was positive in 359 (46.9%) patients, and isoniazid was given to 203 (56.5%) patients. Of the patients treated for LTBI, 112 (55.2%) were registered in the national registry, and 82 (73.2%) completed the treatment. Tuberculosis developed in 6 (1.06%) of 563 patients who were not offered LTBI treatment. CONCLUSION: We determined that overall, only one-third of SOT recipients in our country were evaluated in terms of TB risk, only 1 of the 2 SOT recipients with LTBI received treatment, and half were registered. Therefore, we want to emphasize the critical importance of pretransplant TB risk stratification and registration, guided by revised national guidelines.

Therapeutic Apheresis and DialysisEarly View LETTER TO THE EDITOR Two successful pregnancies in a woman with Fabry continuing enzyme replacement therapy Saime Paydas, Corresponding Author Saime Paydas [email protected] orcid.org/0000-0001-6651-8265 Departments of Internal Medicine Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey Correspondence Saime Paydas, Departments of Internal Medicine Nephrology, Cukurova University Faculty of Medicine, Sarıcam/Adana 01330, Turkey. Email: [email protected]Search for more papers by this authorCigdem Akcabay, Cigdem Akcabay orcid.org/0000-0003-2068-7412 Departments of Obstetrics, Cukurova University Faculty of Medicine, Adana, TurkeySearch for more papers by this author Saime Paydas, Corresponding Author Saime Paydas [email protected] orcid.org/0000-0001-6651-8265 Departments of Internal Medicine Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey Correspondence Saime Paydas, Departments of Internal Medicine Nephrology, Cukurova University Faculty of Medicine, Sarıcam/Adana 01330, Turkey. Email: [email protected]Search for more papers by this authorCigdem Akcabay, Cigdem Akcabay orcid.org/0000-0003-2068-7412 Departments of Obstetrics, Cukurova University Faculty of Medicine, Adana, TurkeySearch for more papers by this author First published: 08 November 2023 https://doi.org/10.1111/1744-9987.14081Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Brady R. Enzymatic abnormalities in diseases of sphingolipid metabolism. Clin Chem. 1967; 14: 565–577. 10.1093/clinchem/13.7.565 CASWeb of Science®Google Scholar 2Madsen CV, Christensen EI, Nielsen R, Mogensen H, Rasmussen ÅK, Feldt-Rasmussen U. Enzyme replacement therapy during pregnancy in Fabry patients: review of published cases of live births and a new case of a severely affected female with Fabry disease and pre-eclampsia complicating pregnancy. JIMD Rep. 2019; 44: 93–101. 10.1007/8904_2018_129 PubMedGoogle Scholar 3Whybra C, Wendrich K, Ries M, Gal A, Beck M. Clinical manifestation in female Fabry. Contrib Nephrol. 2001; 136: 245–250. 10.1159/000060196 PubMedWeb of Science®Google Scholar 4Fernández P, Fernández SO, Gonzalez JGM, Fernández T, Fernández CC, Fernández SP. Enzyme replacement therapy in pregnant women with Fabry disease: a case series. JIMD Rep. 2019; 45: 77–81. 10.1007/8904_2018_141 PubMedGoogle Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Aim: Post-transplant hypomagnesemia is a frequently encountered and significant electrolyte disorder and is more common in patients using calcineurin inhibitors (CNIs). This study aimed to evaluate the frequency of hypomagnesemia and accompanying conditions in the outpatient follow-up of renal transplant recipients. Methods: This cross-sectional study included 236 renal transplant patients. Demographic characteristics of the patients and their biochemical values, including drug levels, were recorded. Results: Of the patients, 69 (29.2%) were female, and 194 (82.3%) were living donor recipients. The mean age of the entire group was 43.1 years. The frequency of hypomagnesemia was 40% (10/25) in the first 12 months, 26.1% (23/88) between the 12th and 60th months, 26% (32/123) after 60 months, and 27.5% (65/236) in all patients. In patients with higher levels of tacrolimus compared to those with the target level, the frequency of hypomagnesemia increased in those with a posttransplant period of 12-60 months (40.9% vs. 20.8%, p: 0.018) and over 60 months (44% vs. 26%, p: 0.046). In addition, the magnesium (Mg+2) level was lower in patients using tacrolimus compared to those using cyclosporine (CsA) (1.80±0.18 vs 1.91±0.25, p: 0.003). The effect of hypomagnesemia on graft functions was statistically insignificant in all groups. Conclusion: Hypomagnesemia is a common electrolyte disorder in the early and late periods after transplantation. In our study, hypomagnesemia did not differ according to proton pump inhibitor (PPI) use, gender, fasting blood glucose, and glomerular filtration rate. However, the frequency increased in patients using tacrolimus and those with above-target serum tacrolimus levels.

Introduction: Kidney transplant recipients(KTRs) may have high level of serum uric acid(SUA) due to greft dysfunction and immunosuppressives. In this study, we evaluated effect of high SUA levels and allopurinol therapy in KTRs on renal functions. Patients and Methods: 113 of 233 KTRs had elevated SUA level(G1). Fiftyseven of G1 received allopurinol treatment(G1A+) and 56 patients G1A-) did not. 56 of 118 patients who were followed for five years(G5) were hyperuricemic(G5-1) and 26 of G5-1 treated with allopurinol(G5-1A+) and 30 of them did not(G5-1A-). 62 patients were normourisemic(G5-2). GFR

Objective/Aim: C-reactive protein to albumin ratio (CAR) has recently been recognized as an independent prognostic marker for vasculitides. This study aims to investigate CAR and its relationship with disease activity and damage in prevalent ANCA associated vasculitis (AAV) patients. Methods: Fifty-one patients with AAV and 42 age-sex-matched healthy controls were enrolled in this crosssectional study. Birmingham vasculitis score (BVAS) was used to assess vasculitis activity and vasculitis damage index (VDI) to provide information on disease damage. Results: The median (25th-75th) age of the patients were 55 (48-61) years. CAR was significantly higher in AAV patients than controls (1.9 +/- 2.7 vs 0.7 +/- 0.4; p=0.006). The 75th percentile of BVAS was defined as high BVAS (BVAS >= 5) and ROC curve analysis showed that CAR >= 0.98 predicted BVAS >= 5 with 70.0% sensitivity and 68.0% specificity (AUC:0.660, CI: 0.482-0.837, p=0.049). When patients with CAR >= 0.98 were compared to those without, BVAS [5.0 (3.5-8.0) vs. 2.0 (0-3.25), p<0.001], BVAS >= 5 [16 (64.0%) vs 4 (15.4%) patients, p:0.001], VDI [4.0 (2.0-4.0) vs. 2.0 (1.0-3.0), p=0.006], and CAR [1.32 (1.07-3.78) vs. 0.75 (0.60-0.83), p<0.001] were higher whereas albumin [3.8 (3.1-4.3) vs. 4.1 (3.9-4.4) g/dL, p=0.025] and haemoglobin [12.1 (10.4-13.4) vs. 13.0 (12.5-14.2) g/dL, p=0.008] were lower. Multivariate analysis revealed that BVAS [OR(95% CI):1.313 (1.003-1.719), p=0.047] was an independent factor associated with CAR >= 0.98 in patients with AAV. Furthermore, correlation analysis showed that CAR significantly correlated with BVAS (r: 0.466, p=0.001). Conclusion: In this study, we observed that CAR was significantly associated with disease activity in AAV patients and can be used to monitor disease activity.

Abstract Background and Aims The purpose of the study is to investigate at the incidence and risk factors for post-transplant diabetes mellitus (PTDM) in non-diabetic kidney transplant patients (KTrs). Method The study included 120 KTRs who did not have diabetes in the pretransplant period. The diagnosis of PTDM was made according to the 2003 ADA DM diagnostic criteria. The relationship between PTDM and clinical and laboratory data on the 0th, 1st, 3rd, 6th, 12th and 24th months was investigated. Results The mean age of the patients was 33.3±11.5 years, 65% (78) of them were male. PTDM was developed in 29.1% (35) and 80% of PTDM at first 3 months. The risk factors for PTDM were found to be older (4.4%), family history of diabetes mellitus (5.24 times), beta-blocker use (2.55 times). KTRs with and without PTDM; Pretransplant dialysis type (Hemodialysis (P=0.822) and Peritoneal dialysis (P = .583)), living donor (101/84.2%)/cadaveric donor (19/ 15.8%), donor age and gender were similar. Serum magnesium and potassium were different only in the first month between the groups with and without PTDM (P = .019 and 0.008 respectively). The negative effect of PTDM on GFR was not observed in the 2-year follow-up. Conclusion It can be predicted that diabetes mellitus may develop with a family history of diabetes, advanced age and the use of beta-blockers. The risk of developing PTDM is higher in the first 3 months and hypomagnesemia in the first month may contribute to diabetes development.

Fabry is a multisystemic disease mainly affecting heart, kidney, central nervous system and endocrine system with intralysosomal glycolipid accumulation. Although thyroid and adrenal gland involvement has been demonstrated in limited studies, glycolipid accumulation in the pituitary could not be exhibited. A 66-year-old female patient diagnosed with Fabry Disease revealed a low level of pituitary hormone levels. Moreover, an empty sella was found in pituitary MRI. We argued that pituitary function seems impaired due to Fabry Disease, and endocrine workup should be periodically performed in patients with Fabry Disease

Introduction: Evidence suggests a relationship between electrocardiography (ECG) aVR (augmented voltage right) T wave and cardiovascular mortality in hemodialysis patients. The aim of our study was to investigate the relationship between ECG T aVR positivity and overall mortality together with other known risk factors in hemodialysis patients. Materials and methods: One hundred and one hemodialysis patients were retrospectively screened for ECG T aVR wave positivity. In parallel, the relationship between T aVR positivity and age, gender, calcium phosphorus index, heart rate, ECG and echocardiographic parameters, mortality, smoking, presence of diabetes mellitus, hypertension, myocardial infarction were investigated. RESULTS: Univariate analyzes revealed that patients with positive T aVR (16%) had a statistically lower dialysis time and ejection fraction compared to patient with negative T aVR (p=0.041 and p=0.046, respectively). Survival analysis revealed statistically significantly better prognosis for T aVR-negative patients compared to T aVR-positive patients (5-year survival 70.9%, and 45.5%, respectively; p=0.027). Among tested parameters, independent risk factors affecting survival in hemodialysis patients were found to be age (hazard ratio, HR: 1.03), high heart rate (HR: 1.03), smoking (HR: 3.37) and presence of diabetes mellitus (HR: 2.91). CONCLUSIONS: Our results indicate that routine monitorization of T wave in aVR derivation together with evaluation of other risk factors may provide information about the cardiovascular risk profile, mortality and life habits of hemodialysis patients.

Purpose: The effect of subclinical thyroid pathologies on erythropoietin (EPO) treatment has not been well defined. The aim of the study is to compare the frequency and dose of EPO administration in patients with subclinical thyroid pathology and euthyroid hemodialysis patients. Methods: A cross-sectional and retrospective study was conducted with 210 patients. Special conditions were excluded, a total of 191 patients were included. Patients were divided into three groups. Results: The incidences of subclinical hypothyroidism, subclinical hyperthyroidism and euthyroidism were 10.5%, 3.1%, and 86.4%, respectively. Statistically significant difference was found between subclinical hypothyroid and euthyroid patients in terms of the number of patients using EPO (p = 0.0207), monthly total EPO doses (p = 0.003), and total monthly EPO doses per weight (p = 0.001). Conclusion The EPO dose required to achieve similar hemoglobin levels in hemodialysis patients was significantly higher in subclinical hypothyroid patients than in euthyroid patients.

Amaç: Böbrek nakli, böbrek yetmezliğinin en önemli ve başarılı tedavi yöntemidir. Bu çalışmada, böbrek nakli alıcılarında nakil öncesi ve nakil sonrası ilk altı ayda Cytomegalovirus (CMV), BK virüs (BKV) ve bakteriyel etkenlerin sıklığının araştırılması amaçlanmıştır. Gereç ve Yöntem: Fakültemiz Organ Nakli Merkezinde böbrek nakli yapılan hastalardan, nakilden bir hafta önce ve nakilden sonra birinci, üçüncü ve altıncı aylarda alınan kan örneklerinde Real-time PCR ile CMV ve BKV araştırıldı. Kan, idrar, balgam/yara (gerekiyor ise) kültürleri yapıldı. İdrar sitolojisinde Decoy hücreleri değerlendirildi. Bulgular: Böbrek nakli alıcılarının yaş ortalaması 32,60±11,71 28 (% 62,2)’i erkek ve 39 (% 86,7)’u akraba olan canlı vericili, altısı kadavra vericili idi. Nakil sonrası 11/38 (% 28,9) hastada BKV, 25/41 (% 60,9) hastada CMV, 11/31 (% 35,4) hastada Decoy hücre pozitiflikleri saptandı. Real-time PCR pozitifliği en yüksek oran BKV için üçüncü ve altıncı aylarda iken, CMV için birinci ay olup altıncı aya doğru giderek azalma gösterdi. İdrar kültüründe Escherichia coli, Klebsiella pneumoniae, albicans-dışı Candida, Enterococcus faecalis, kan kültüründe Staphylococcus hominis, Streptecoccus epidermidis, solunum yolu örneklerinin kültüründe Acinetobacter baumannii, Klebsiella pneumoniae, Aspergillus fumigatus ve Candida albicans üredi.. Sonuç: Böbrek nakli alıcılarımızda bakteriyel enfeksiyonlar erken dönemde gelişti. Real-time PCR pozitiflik oranı en yüksek BKV için üçüncü ve altıncı aylarda iken CMV için birinci ay olup altıncı aya doğru giderek azalma gösterdi. Böbrek nakil hastalarında Decoy hücre pozitifliği de BKV enfeksiyonu tanısı için önemli olabilir.

Continuous ambulatory peritoneal dialysis (CAPD) is one of the treatment modalities used in end-stage renal disease. The most common cause of failure is catheter-related complications. Dialysate leak represents a major noninfectious complication of PD. Here, we aimed to present the results of patients who had pericatheter dialysate leak following PD catheterization and who were administered a hemostatic agent (HaemoCer Plus, BioCer, Germany) around the catheter and the tunneled segment under the subcutaneous tissue under local anesthesia. We performed a local procedure on six patients in total. No major complications developed in any of the patients at postoperative follow-up. Five patients started to receive PD uneventfully within postoperative 3 days with no dialysate leak. We believe that this practice is effective in the management of peritoneal dialysate leak. The hemostatic agents administered in the present study can manage dialysate leak and ensure safe use of the catheter.

Acil tıbbı, tüm yönleriyle tanı, tedavi ve uygulamalar açısından irdelediğimiz kitabımızın, üçüncü ve genişletilmiş basımını sizlerle paylaşmaktan büyük mutluluk duymaktayım

Abstract BACKGROUND AND AIMS Glucocorticoids are used as primary treatment in IgA nephropathy (IgAN), and they manifest their effects by binding to intracellular glucocorticoid receptors. Studies have shown that GCR expression correlates with the degree of steroid response in various diseases. Therefore, we aimed to evaluate renal GCR expression, Oxford MEST score in clinical course of IgAN patients. METHOD This study included 110 patients with biopsy-proven IgAN. Patients were treated with ACEI/ARB, methylprednisolon (80% patients). In renal biopsies, Oxford-MEST score was calculated and GCR expression was determined immunohistochemically. KDIGO criteria (2020) were accepted for remission. Clinical course, eGFR, proteinuria and other biochemical tests test were recorded during 1-year follow-up period. RESULTS Demographic and laboratory data did not correlate with renal GCR staining rate. İn patients with M1 of the MEST score, GCR staining was more prominent than those with M0. GFR values were higher and proteinuria was lower in patients with T0 compared with patients with T1 and T2 (P < .05 for all) . Patients with E1 had significantly higher systolic blood pressure (BP), increased proteinuria and lower eGFR than patients with E0. Poor prognostic factors for achieving remission were higher systolic/diastolic BP, increased levels of white blood cell (WBC) count/neutrophil count, PTH, BUN, creatinine, uric acid, potassium, magnesium, MCV, Mentzer index, total cholesterol, LDL and higher sclerosis in biopsy at baseline during follow up period for 1 year. CONCLUSION Clinical presentation and outcome at 1 year in IgAN patients were well predicted by the Oxford-MEST score, but not by renal GCR expression. GCR staining intensity was only correlated with M1 score. Baseline higher BP, increased serum creatinine, uric acid and PTH were poor prognostic factors. Interestingly higher WBC and neutrophils counts, increased serum LDL and Mentzer index at baseline were also correlated with clinical course.

AMAÇ: İmmünsüpresif tedaviden dolayı hepatit-B veya C enfeksiyonlarının böbrek nakilli hastalarda graft ve hasta sağ kalımına olumsuz etki ettiği konusu tartışmalıdır. Çalışmamızın amacı böbrek nakilli hastalarda hepatit-B ve C enfeksiyonlarının hasta ve graft üzerine etkilerini değerlendirmektir. GEREÇ VE YÖNTEMLER: Çalışmaya 66 böbrek nakil hastası alındı. Anti-HCVpozitif beş hasta ve Hbs-Ag pozitif dokuz hasta viral hepatit grubunu oluşturdu. Geri kalan 52 hasta (anti-HCV, Hbs-Ag negatif) viral hepatiti olmayan grubu oluşturdu. Hastane kayıtları retrospektif olarak tarandı. Nakil sonrası ilk üç yıllık AST, ALT, albumin, hesaplanmış glomerüler filtrasyon hızı (hGFH) not edildi. BULGULAR: Transplant sonrası takip süresi ortalama olarak viral hepatit grubunda 62,4 ±48,2 ay viral hepatiti olmayan grupta 35,3±15,7 ay idi. Cinsiyet, donör tipi, yaş, transplant sonrası nakil süresi açısından iki grup arasında anlamlı fark yoktu. Sadece nakil öncesi diyaliz süresi hepatit grubunda anlamlı daha uzundu. hGFH (sırasıyla viral hepatit olmayan grupta 73,5±22,7, 69,3±23, 63,5±22,1 mL/dk, viral hepatit grubunda 78,8±15,7, 70,6±12,5, 61,2±13,1 mL/dk), AST, ALT, albumin birinci, ikinci, üçüncü yıllarda iki grupta benzerdi Ancak üçüncü yılın sonundaki hGFH'deki düşüş hızı ve AST/ALT’deki artış hızı viral hepatit grubunda istatistiksel olarak anlamlı daha fazlaydı. hGFH'deki düşüşün kadınlarda daha hızlı olduğu tespit edilirken, kolerasyon analizinde yaş ve nakil öncesi diyaliz süresinin hGFH'deki düşüşe etkisi bulunmadı. SONUÇ: Üç yıllık takipte hGFH ve AST/ALT değerleri iki grupta benzerdi. Hiçbir hastada graft kaybı, karaciğer yetmezliği, ölüm gelişmedi. Günümüzde hepatit-C enfeksiyonu için başarılı tedaviler uygulanmakla birlikte anti viral tedavi uygulanmamış hepatiti pozitif olan son dönem böbrek yetmezlikli hastalarda böbrek nakli, iyi bir değerlendirme sonrası güvenli ve etkili bir tedavi seçeneği olarak kabul edilebilir.

Amaç: Diabetik nefropati (DN) son dönem böbrek yetersizliğinin önemli bir nedenidir. Vasküler hastalıklarda kullanılan ve anti-inflamatuar özellikleri olan pentoksifilinin diyabetik nefropatide olumlu etkileri olabileceği öne sürülmüştür. Bu çalışmada DN nedeni ile takipte olan ve pentoksifilin kullanan hastaların tedavi öncesi ve sonrası dönemdeki böbrek fonksiyonları ve proteinürileri değerlendirilmiştir. Gereç ve Yöntemler: Kliniğimizde takipte olup pentoksifilin (1200 mg/gün) tedavisi alan 36 diabetik nefropati hastası retrospektif olarak tarandı. Tedavi başlanmadan önceki 3. ve 6. ay; pentoksifilin tedavisinin 3., 6., 9. ve 12. aylardaki günlük proteinüri miktarı ve eGFR (estimated glomerular filtration rate, tahmini glomerüler filtrasyon hızı) değerleri kayıt edildi. Bulgular: Çalışmaya alınan 36 hastanın ortalama yaşı 51,9±12,3 yıl, 12’si erkek ve 16’sı Anjiotensin dönüştürücü enzim (Angiotensin converting enzyme inhibitor, ACEİ) ya da Anjiotensin reseptör blokeri (Angiotensin receptor blocker, ARB) kullanıyordu. Pentoksifilini 23 hasta ≤6 ay (A grubu) 13 hasta >6 ay (B grubu) süre kullanmıştı. Proteinüri miktarı ve eGFR kaybı yönünden her iki grupta anlamlı farklılık saptanmadı. Sonuç: Çalışmamızda diabetik nefropatili hastalarda 1 yıllık takip sırasında pentoksifilin tedavisinin proteinüri miktarı ve eGFR kaybına etkisi saptanamamıştır. Anahtar kelimeler: Diabetik nefropati, pentoksifilin, proteinüri