Erol Demir

Pregnant Woman with Atypical Hemolytic Uremic Syndrome Delivered a Healthy Newborn under Eculizumab Treatment

Pregnancy-associated thrombotic microangiopathy is a very rare condition; however, it significantly increases fetal or maternal morbidity and mortality. Pregnancy may trigger atypical hemolytic uremic syndrome (aHUS) or thrombotic thrombocytopenic purpura. The risk for pregnancy-associated aHUS is highest during the second pregnancy. The outcome is usually poor with 50–60% mortality; renal dysfunction and hypertension are the rule in those who survive the acute episode. After the development of complement regulation mechanisms and aHUS pathogenesis, eculizumab has been widely used as a first-line treatment in aHUS. Eculizumab has been produced to minimize immunogenicity and Fc-mediated functions, including recruitment of inflammatory cells and complement activation, and using eculizumab in first-line treatment improves kidney function. Recent studies showed that early diagnosis and rapid use of eculizumab in first-line treatment improve outcomes. We demonstrate a case with pregnancy-triggered aHUS occurring in the second trimester, who was successfully treated and delivered a healthy baby under eculizumab treatment.

A Rare Clinical Entity: Staphylococcus-Related Glomerulonephritis

Staphylococcus aureus is a rare cause of postinfectious glomerulonephritis, and Staphylococcus-related glomerulonephritis primarily occurs in middle-aged or elderly patients. Patients with Staphylococcus-related glomerulonephritis also present with hematuria, proteinuria of varying degrees, rising serum creatinine levels, and/or edema. The severity of renal insufficiency is proportional to the degree of proliferation and crescent formation. Here, we present a diabetic patient admitted with a history of 1 week of left elbow pain. Laboratory results revealed that erythrocyte sedimentation rate was 110 mm/hour, serum creatinine level was 1 mg/dL, C-reactive protein level was 150 mg/L, and magnetic resonance imaging showed signal changes in favor of osteomyelitis at the olecranon level, with diffuse edematous appearance in the elbow skin tissue and increased intra-articular effusion. After diagnosis of osteomyelitis, ampicillin/sulbactam and teicoplanin were administered. After day 7 of admission, the patient developed acute kidney injury requiring hemodialysis under antibiotic treatment. Kidney biopsy was performed to determine the underlying cause, which showed Staphylococcus-related glomerulonephritis. Recovery of renal functions was observed after antibiotic and supportive treatment.

Serratia marcescens, Morganella morganii, Klebsiella oxytoca related peritonitis attacks in a patient on automated peritoneal dialysis: A case report

acterial peritonitis is a common complication of peritoneal ialysis.1 We report here a case presented with peritonitis ttacks caused by rarely reported unusual pathogens, probably elated with poor home environment and hygienic conditions. A 57-year-old female patient had a history of end-stage enal disease secondary to hypertensive nephrosclerosis and ndergone dialysis for 4 years. She was sharing a small house n poor hygienic conditions with eleven other family memers with low socioeconomic status. Five months after the nitiation of automated peritoneal dialysis (APD), the patient resented with abdominal pain and nausea to our PD clinic. he was febrile (38 ◦C), had involuntary abdominal guarding nd rebound tenderness on physical examination. Dialysate hite blood cell count was 1100/mm3 (79% neutrophils). mpiric antibiotherapy was initiated with intraperitoneal efazolin (1 g/day) and oral ciprofloxacin (250 mg every 12 h). A pure growth of Serratia marcescens was obtained in both ifferent culture media. The organism was resistant to cefaolin, ceftriaxone, piperacillin/tazobactam, but sensitive to efepime. Cefazolin was stopped; cefepime could not be used ue to a drug shortage; instead, intraperitoneal gentamicin 0.6 mg/kg/day). Oral ciprofloxacin was also continued based pon the susceptibility results. Following the treatment modfication, high-sensitivity CRP level decreased from 240 mg/L o 9 mg/L. Peritoneal effluent became clear and drainage fluid eukocyte count was 100/mm3 (10% neutrophils) on the third eek of admission. The patient was readmitted to the hospital with similar

Serum and Urinary Levels of Tumor Necrosis Factor-Alpha in Renal Transplant Patients

OBJECTIVES Allograft rejection is an important cause of early and long-term graft loss in kidney transplant recipients. Tumor necrosis factor-alpha promotes T-cell activation, the key reaction leading to allograft rejection. Here, we investigated whether serum and urinary tumor necrosis factor-alpha levels can predict allograft rejection. MATERIALS AND METHODS This study included 65 living related-donor renal transplant recipients with mean follow-up of 26 ± 9 months. Serum and urinary tumor necrosis factor-alpha levels were measured at pretransplant and at posttransplant time points (days 1 and 7 and months 3 and 6); serum creatinine levels were also monitored during posttransplant follow-up. Standard enzyme-linked immunoabsorbent assay was used to detect tumor necrosis factor-alpha levels. Clinical variables were monitored. RESULTS Nine of 65 patients (13.8%) had biopsy-proven rejection during follow-up. Preoperative serum and urinary tumor necrosis factor-alpha levels were not significantly different when we compared patients with and without rejection. Serum tumor necrosis factor-alpha levels (in pg/mL) were significantly higher in the allograft rejection versus nonrejection group at day 7 (11.5 ± 4.7 vs 15.4 ± 5.8; P = .029) and month 1 (11.1 ± 4.8 vs 17.8 ± 10.9; P =.003). Urinary tumor necrosis factor-alpha levels (in pg/mL) were also elevated in the allograft rejection versus the nonrejection group at days 1 (10.2 ± 2.5 vs 14.1 ± 6.8; P = .002) and 7 (9.8 ± 2.2 vs 14.5 ± 2.7; P < .001) and at months 1 (8.0 ± 1.7 vs 11.8 ± 2.4; P < .001), 3 (7.7 ± 1.6 vs 9.6 ± 1.7; P = .002), and 6 (7.4 ± 1.6 vs 8.9 ± 0.9; P = .005). CONCLUSIONS Our preliminary findings suggest that tumor necrosis factor-alpha has a role in diagnosing renal transplant rejection. Serum and urinary tumor necrosis factor-alpha levels may be a possible predictor for allograft rejection.