Alparslan Ersoy

Angiotensin-II receptor antagonist losartan reduces microalbuminuria in hypertensive renal transplant recipients

In recent years, it has been demonstrated that losartan lowers macroproteinuria in diabetic or non‐diabetic renal transplant recipients (RTx) similar to angiotensin converting enzyme (ACE) inhibitors. Microalbuminuria (MAU) may reflect subclinical hyperfiltration damage of the glomerulus. It could be a marker of kidney dysfunction in renal transplantation. The aim of the study was to assess the efficacy of losartan in hypertensive RTx with MAU. This study was conducted in 17 (M/F: 4/13) stable RTx. No change was made in the medical treatment of the patients. All cases received 50 mg/day losartan therapy for 12 wk. Renal functions and MAU were determined 12 and 6 wk and just before the treatment as well as sixth and twelfth week of the treatment in all patients. Losartan satisfactorily lowered systemic blood pressure. A significant reduction in MAU was observed from 103 ± 53 μg/min at the beginning to 59 ± 25 μg/min in the sixth week and 47 ± 24 μg/min in the twelfth week (p=0.0007 and 0.0005, respectively). From the sixth week of the treatment, the therapy significantly decreased hemoglobin, hematocrit and erythrocyte levels but did not change mean leukocyte and platelet counts, urea, creatinine levels and creatinine clearances. No serious side‐effect was observed during the study.

Long-term Effects of Losartan on Proteinuria and Renal Function in Patients with Renal Amyloidosis

Objective : To investigate the effect of the angiotensin II receptor antagonist losartan on proteinuria in secondary amyloidosis cases. Material and Methods : Sixteen patients with renal biopsy-proven AA amyloidosis with proteinuria were included in the study. All the patients had received colchicine treatment for at least 18 months. The patients were divided into two groups with similar age and gender distributions. Eight patients were given losartan at a dose of 50 mg/day for 12 months and the other 8 patients served as controls. Mean arterial blood pressure, proteinuria, serum albumin level and renal function were determined at the initiation of the study and after 1 and 12 months. Results : There were no significant differences in proteinuria, serum albumin level, renal function or mean arterial blood pressure at the initiation of the study. In the losartan group daily proteinuria decreased significantly from 5.2 - 0.7 g at the initiation of the study to 3.9 - 1.2 g at 1 month and 3.6 - 0.8 g at 12 months, while in the control group it changed from 4.6 - 1.0 g to 4.7 - 1.0 g and 6.1 - 1.2 g, respectively. The increment at 12 months was significant. After 12 months of treatment with losartan, proteinuria was significantly lower in comparison to the degree of proteinuria in the control group. Serum albumin level increased significantly in the losartan group but was unchanged in the control group. In the control group, creatinine clearance showed a significant decrease. There was no significant difference in mean arterial blood pressure measurements, serum creatinine levels, total protein, albumin and creatinine clearance levels between the two groups. Conclusions : Losartan seemed to prevent an increase in proteinuria without altering the creatinine clearance level in patients with amyloidosis type AA during a 12-month period. This indicates that losartan may be used to decrease proteinuria in this patient group. However, our results are only preliminary and need to be confirmed by larger studies.

Adiponectin, leptin, nitric oxide, and C-reactive protein levels in kidney transplant recipients: comparison with the hemodialysis and chronic renal failure

Abstract Background: Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in patients with chronic kidney disease (CKD) including kidney transplant recipients (KTR). Secondary lipid metabolism disorders, endothelial dysfunction, and inflammation enhance the risk of CVD development in these patients. The aim of the present study was to investigate the lipid profile, adiponectin, leptin, nitric oxide (NO), and high sensitivity C-reactive protein (hs-CRP) levels in KTR and to compare these parameters with those of the patients with chronic renal failure (CRF), hemodialysis (HD) patients, and healthy controls. Methods: Serum adiponectin and leptin levels were measured by radioimmunoassay; hs-CRP was determined immunoturbidimetrically. Determination of NO was based on the Griess reaction. Results: Compared with the control group, serum NO and adiponectin levels were significantly higher in the KTR, CRF, and HD groups; hs-CRP levels were significantly higher in the KTR and HD groups; leptin levels were significantly higher in the KTR. In addition, serum NO level was significantly higher in the KTR compared to CRF cases. Adiponectin correlated positively with high density lipoprotein-cholesterol in the control and patient groups. A positive correlation was observed between hs-CRP and NO in the KTR and the patients with CRF. Serum adiponectin levels were inversely correlated with hs-CRP and leptin in the HD group. Conclusion: KTR suffer from inflammation and accompanying changes in levels of adipocytokines and NO which contribute to the increased risk of CVD in these patients.

Isolated ocular surface squamous neoplasia in a renal transplant recipient.

Ocular surface squamous neoplasia is a rare complication after a kidney transplant, related with increased risk and poor prognosis. Generally, ocular surface squamous neoplasia in kidney transplant patients is associated with skin lesions. We report a case of ocular surface squamous neoplasia without skin lesions in a kidney transplant recipient. Systematic periodic ophthalmic evaluation of recipients may help ensure the early diagnosis of subtle ocular surface squamous neoplasia.

Sexual Dysfunction and Risk Factors in Females Patients on Renal Replacement Therapy

Introduction Women with chronic kidney disease have a higher risk of sexual dysfunction (SD). The etiology is often multifactorial and may include psychological problems. A successful kidney transplantation can improve SD. This study aimed to investigate SD frequency, and risk factors in the females under renal replacement therapy (RRT) and in the healthy ones. Materials and Methods A total of 62 kidney transplant recipients (Tx), 43 hemodialysis (HD) and 35 predialysis (PreD) patients and 52 healthy females were included. Sociodemographic and risk factor survey forms, the hospital anxiety depression scale and the 36-Item Short Form Health Survey were used. Sexual function was assessed according to the Female Sexual Function Index (FSFI). Women with a score ⩽22.7 were classified as presenting sexual dysfunction. Results Control and Tx patients groups were significantly younger than HD and PreD patients. There were differences in the ratios of asthenia and fatigue, pelvic surgery, urinary incontinence, cystitis history, dyspareunia, smoking, use of antidepressant and beta blockers between the groups. The depression and anxiety ratios of the groups were similar. The physiological health scores of the control group were significantly higher than those of the PreD and Tx groups and also scores of the Tx group than those of the HD and PreD groups. Mental health scores of the control group were significantly higher than those of the PreD and HD groups. The SD ratio of Tx group with FSFI (n:10, 16.1%) was significantly lower than HD group (n:18, 41.9%, p=0.006). The SD ratio of PreD group was 31.4% (n:11). The SD ratio of control group was 23.1% (n:12). Desire scores of the Tx and control groups were higher than those of HD and PreD groups. Arousal scores of HD and PreD group were significantly lower than those of control (p=0.013 vs. HD, p=0.047 vs. PreD) and Tx (p=0.004 vs. HD, p=0.015 vs. PreD) groups. Lubrication score of HD group was lower than those of Tx (p=0.006) and control (p=0.014) groups. Orgasm score of HD group was lower than those of Tx (p=0.012) and control (p=0.009) groups, and PreD group score was lower than that of control group (p=0.046). The overall scores of the HD and PreD groups were significantly lower than those of Tx (p=0.001 vs. HD, p=0.002 vs. PreD) and control (p=0.003 vs. HD, p=0.005 vs. PreD) groups (Table 1). Logistic regression analysis showed that inadequate sexual information (OR:3.333, 95%CI: 1.426-7.790, p=0.005), presence of anxiety (OR:2.978, 95%CI: 1.093-8.117, p=0.033) and depression (OR:4.514, 95%CI: 1.676-12.156, p=0.003) increased SD risk. Kidney transplantation significantly reduced SD risk (OR:0.236, 95%CI: 0.073-0.766, p=0.016). Conclusion SD improve after successful transplant. Our results do not support the impact of the sociocultural and economic factors in sexual function of women on renal replacement treatment. However, psychological factors negatively affect sexual function in dialysis patients. Table. No title available.

Epidemiology and Clinical and Radiographic Characteristics of Pneumonia in Kidney Transplant Recipients; 24-Year Experience

OBJECTIVE: Pneumonia increases morbidity and mortality in kidney transplant (KT) recipients. This study aimed to investigate characteristics of pneumonias in KT recipients by focusing on clinical and radiographic findings and diagnostic methods over a long study period. MATERIAL and METHODS: The medical records of kidney transplant recipients who had a diagnosis of pneumonia from 1988 to 2011 were reviewed retrospectively. RESULTS: Among 406 consecutive KT recipients, 20% had pneumonia during the study period and total 111 episodes of pneumonia developed in these patients. Fifty-six percent of the pneumonias were community acquired and 44% nosocomial. Bacterial infections were the most common cause (20%) and 13 (12%) of the episodes were polymicrobial. Antibiotic usage in the last three months was significantly more common in fungal pneumonia episodes than others. Bronchoscopy had the highest final overall diagnostic yield. CONCLUSION: Community-acquired pneumonia was more common, but it showed a more benign clinical course. Bacterial pneumonia was the most common cause, but polymicrobial infection was present in a significant number of KT recipients. Fungi can invade KT recipients, in particular, patients in the interval of 1-6 month after transplantation and patients who have used antibiotics in the last three months. KEy wORDS: Pneumonia, Kidney transplantation, Radiography, Physical examination, Nosocomial

Clinical outcomes and survival in AA amyloidosis patients

AIM Amyloid A amyloidosis is a rare complication of chronic inflammatory conditions. Most patients with amyloid A amyloidosis present with nephropathy and it leads to renal failure and death. We studied clinical characteristics and survival in patients with amyloid A amyloidosis. METHODS A total of 81 patients (51 males, 30 females) with renal biopsy proven amyloid A amyloidosis were analyzed retrospectively. The patients were divided into good and poor outcomes groups according to survival results. RESULTS Most of the patients (55.6%) had nephrotic range proteinuria at diagnosis. Most frequent underlying disorders were familial Mediterranean fever (21.2%) and rheumatoid arthritis (10.6%) in the good outcome group and malignancy (20%) in the poor outcome group. Only diastolic blood pressure in the good outcome group and phosphorus level in the poor outcome group was higher. Serum creatinine levels increased after treatment in both groups, while proteinuria in the good outcome group decreased. Increase in serum creatinine and decrease in estimated glomerular filtration rate of the poor outcome group were more significant in the good outcome group. At the time of diagnosis 18.5% and 27.2% of all patients had advanced chronic kidney disease (stage 4 and 5, respectively). Median duration of renal survival was 65±3.54 months. Among all patients, 27.1% were started dialysis treatment during the follow-up period and 7.4% of all patients underwent kidney transplantation. Higher levels of systolic blood pressure [hazard ratios 1.03, 95% confidence interval: 1-1.06, p=0.036], serum creatinine (hazard ratios 1.25, 95% confidence interval: 1.07-1.46, p=0.006) and urinary protein excretion (hazard ratios 1.08, 95% confidence interval: 1.01-1.16, p=0.027) were predictors of end-stage renal disease. Median survival of patients with organ involvement was 50.3±16 months. CONCLUSION Our study indicated that familial Mediterranean fever constituted a large proportion of cases and increased number of patients with idiopathic amyloid A amyloidosis. Additionally, it was observed that patient survival was not affected by different etiological causes in amyloid A amyloidosis.

Analysis of liver function test abnormalities in kidney transplant recipients: 7 year experience

Objective: Immunosuppressive drugs, antimicrobial agents and infectious complications may cause liver function test abnormalities (LFTA) in kidney transplant recipients (KTR). The objectives of this study were to identify the outcome of (LFTA). To identify the risk factors affecting development and severity of hepatotoxicity in KTR. Methods: We retrospectively evaluated the medical records of KTR. Hepatotoxicity attacks were defined as impairment in liver function tests that was responsive to drug dose reduction or discontinuation, or treatment of specific causes such as infectious complications. Results: One hundred-fifty-six episodes of hepatotoxicity occurred in 107 patients in 281 KTR, with an incidence of 38%. Patients with hepatotoxicity episodes had a high total mortality rate, higher incidence of positive pre-transplant cytomegalovirus (CMV) IgM test, higher creatinine values during the first month post-transplant, underwent additional acute rejection episodes, and received fewer cyclosporin A based ID. Only positive CMV IgM testing was identified as a significant independent risk factor for hepatotoxicity in our multiple analysis. Mycophenolatemofetil (MMF) related hepatotoxicity was the most common cause of drug related LFTA. Conclusions: Patients with LFTA can have significant complications. Pre-transplant positive CMV IgM tests predispose transplant recipients to the development of LFTA during the post-transplant period. MMF can be a serious hepatotoxic drug.

Effect of ADMA levels on severity of erectile dysfunction in chronic kidney disease and other risk factors

INTRODUCTION Hormonal, neurogenic, vasculogenic, and psychogenic impairments, as well as endothelial dysfunction may play a role in erectile dysfunction (ED) in patients with chronic kidney disease (CKD). Asymmetrical dimethylarginine (ADMA) is an inhibitor of nitric oxide, which is the key element of ED. ADMA levels are increased in CKD. We aimed to evaluate the effect of serum ADMA, prolactin, testosterone, and hemoglobin levels on erectile function of patients with CKD and control subjects. METHODS A total of 42 men with CKD and 25 age-matched controls were enrolled. The patients with CKD were categorized into group 1 and group 2 based on whether they had ED according to their response to International Index of Erectile Function questionnaire (IIEF-EFD). Group 3 was a control group. Serum ADMA, total testosterone prolactin, and hemoglobin levels of the patients were evaluated. RESULTS Serum ADMA, testosterone, and hemoglobin levels were similar between group 1 and 2, serum prolactin level was significantly high in group 1 than in group 2 or 3 (control group). There was no correlation between ADMA levels and IIEF-EFD scores of patients with CKD. CONCLUSIONS The results of this study suggest serum ADMA level is not related with ED in patients with CKD. Also, low testosterone and hemoglobin levels were not significant factors. High levels of serum prolactin are related with ED in patients with CKD.

Effects of calcineurin inhibitors on paraoxonase and arylesterase activity after a kidney transplant.

OBJECTIVES Cardiovascular disease is a common cause of morbidity and mortality in patients with chronic kidney failure, before and after a kidney transplant. Oxidation of lipoproteins that contain apolipoprotein B may contribute to the initiation of atherosclerosis. Paraoxonase may prevent cardiovascular disease. We compared the effects of different calcineurin inhibitors on risk factors for cardiovascular disease in kidney transplant recipients. MATERIALS AND METHODS In 16 kidney transplant recipients, treatment included tacrolimus in 8 patients and cyclosporine in 8 patients. Hemoglobin, glucose, renal function, lipid parameters, high-sensitivity C-reactive protein, homocysteine, malondialdehyde, paraoxonase activity, and arylesterase activity were measured before transplant and at 1, 6, and 12 months after the transplant. RESULTS The levels of homocysteine and malondialdehyde did not change significantly in patients who received either tacrolimus or cyclosporine. The high-sensitivity C-reactive protein was decreased (tacrolimus group, 1 mo) and increased (cyclosporine group, 6 and 12 mo) after the kidney transplant. Paraoxonase activity was increased (tacrolimus group, 1 mo). Arylesterase activity was increased (tacrolimus group, 1, 6, and 12 mo; cyclosporine group, 1 and 6 mo). The percentage of change in arylesterase activity was higher at 12 months in the tacrolimus than in the cyclosporine group. CONCLUSIONS Tacrolimus may be more effective than cyclosporine in improving risk factors for cardiovascular disease after kidney transplant.