Murat Gursoy

Interferon therapy in haemodialysis patients with acute hepatitis C virus infection and factors that predict response to treatment

In view of the high rate of chronicity of acute hepatitis C and the low efficacy of interferon (IFN) treatment in advanced liver disease, it may be beneficial to treat patients during the acute phase of the infection. Here we assessed the effects of variable‐dose IFNα‐2b treatment in haemodialysis patients with acute hepatitis C virus (HCV) infection, and identified factors that may predict response to this therapy. The study population included 67 patients, but 14 were excluded due to side‐effects or because they were lost to follow‐up. Seventeen patients who received no specific treatment were used as controls (Group 1). Sixteen and 20 patients received low‐(3 MU) and high‐dose (6–10 MU) IFNα‐2b three times weekly for 3 months (Groups 2 and 3, respectively). Virological end‐of‐treatment response (ETR) was observed in 1 (5.6%), 13 (56.5%), and 17 (65.4%) patients in Groups 1, 2, and 3, respectively, and virological sustained response (SR) was observed in 1 (5.6%), 6 (26.1%), and 13 (50%) patients in the three groups. The rates of virological ETR and SR in the treated groups were significantly higher than those of the control group (P < 0.01 for all comparisons). In multivariate logistic regression analysis, single stranded confirmational polymorphysm (SSCP) band number (P=0.02) was the only factor that was significantly associated with virological SR. In conclusion, IFN‐α treatment initiated during the acute phase of HCV infection is associated with a higher rate of virological ETR and SR. This study suggested that quasispecies heterogeneity has predictive value with regard to virological SR.

Ocular complications with high-dose interferon alpha in chronic active hepatitis

Purpose Interferon alpha, which is used to treat various systemic disorders, has many reversible side-effects involving various organ systems. In this study, chronic active hepatitis patients undergoing interferon alpha therapy were followed with regard to the ocular side-effects.Methods Thirty-six patients with chronic active hepatitis undergoing subcutaneous interferon alpha therapy for 1 year were enrolled. Complete ocular examination and photographic documentation were performed at baseline of the therapy and monthly thereafter. Fishers exact chi-squared test and Mann-Whitney U-test were employed in the statistical evaluation of the results.Results Trichomegaly was noted in 2 (6%) patients. Fifteen patients (42%) were found to have retinopathy with cotton wool spot formation and splinter haemorrhages.Conclusions These findings emphasise the need to monitor these retinal complications, which may result in loss of vision in patients receiving interferon alpha therapy.

Gastroesophageal reflux disease in chronic renal failure patients with upper GI symptoms: multivariate analysis of pathogenetic factors.

OBJECTIVE:The association between gastroesophageal reflux disease and end-stage renal disease remains unclear. We aimed to assess the prevalence of gastroesophageal reflux disease and also to identify possible pathogenetic factors in the development of reflux in symptomatic end-stage renal disease patients.METHODS:The study involved 42 end-stage renal disease patients with upper GI symptoms (group I) and 46 age- and sex-matched controls who did not have renal disease but had the same symptoms (group II). Endoscopy, endoscopic biopsies, and 24-h esophageal pH studies were used to diagnose gastroesophageal reflux disease. Subjects were also investigated for Helicobacter pylori gastritis and GI amyloidosis.RESULTS:The prevalences of gastroesophageal reflux disease in the two groups were similar (81% vs 84.8%, p = 0.423). The prevalence of H. pylori infection was significantly lower in group I than in group II (38.1% vs 67.4%, p = 0.01). There were 11 cases of GI amyloidosis in group I. Multivariate logistic regression analysis in group I showed that GI amyloidosis (OR = 7.28, 95% CI = 1.13–46.93), chronic ambulatory peritoneal dialysis treatment (OR = 5.54, 95% CI = 1.01–30.43), and absence of H. pylori infection (OR = 3.75, 95% CI = 1.01–13.9) were significantly associated with reflux esophagitis.CONCLUSIONS:Upper GI symptoms are important in predicting gastroesophageal reflux disease in end-stage renal disease patients. Chronic ambulatory peritoneal dialysis, GI amyloidosis, and absence of H. pylori infection seem to be risk factors for the development of gastroesophageal reflux disease in end-stage renal disease patients.

Lamivudine in renal transplant candidates with chronic hepatitis B infection

CHRONIC hepatitis B virus (HBV) is one of the most common and serious infectious diseases throughout the world, currently affecting 400 million persons globally. Although the incidence of chronic HBV infection among patients on hemodialysis has declined, the illness remains an important problem in renal transplant recipients. HBV infection is a frequent and major risk factor for acute and chronic liver disease, causing increased morbidity and mortality both before and after transplantation. Treatment of HBV in kidney recipients is difficult but probably necessary to reduce morbidity and mortality. Interferon has been associated with an increased incidence of rejection and limited success. Recent reports have noted promising results with the antiviral agent lamivudine, a pyrimidine nucleoside analogue. Lamivudine therapy significantly decreases serum HBV-DNA levels and improves the histologic findings, reduces serum aminotransferase levels, and slows progression to cirrhosis in patients with chronic HBV. In renal transplant patients with recurrent hepatitis B, it stabilizes liver enzymes and decreases HBV replication. Our aim in this study was to assess the efficacy and safety of lamivudine in renal transplant candidates with replicative HBV.

Colonoscopy Findings in Renal Transplant Patients With Abdominal Symptoms

THE number of chronic renal failure patients undergoing successful renal transplantation has increased substantially in recent years. Success of this procedure is highly dependent on prevention of rejection. The consequences of the necessary immunosuppression, including opportunistic infections and neoplasms in the long term, make careful follow-up of these patients obligatory. Colonic complications following transplantation occur in approximately 3% of all renal transplant cases. The most frequently encountered complications are ischemic changes, ranging from mild mucosal ulcerations to necrosis; diverticulitis; perforation; pseudomembranous colitis caused by antibiotic use; hemorrhagic proctitis; and appendicitis. Infection with cytomegalovirus (CMV) is a substantial cause of morbidity and mortality among immunocompromised patients, and symptomatic CMV can occur at all levels of the gastrointestinal tract in renal transplant patients. These individuals have a greater likelihood of colonic involvement with CMV. Tuberculosis and fungal and other opportunistic infections of the colon are also known factors in the morbidity and mortality of renal transplant recipients. In this study, we performed colonoscopy on 13 renal transplantation patients who had symptoms related to the lower gastrointestinal system. During the procedure we obtained biopsies when any apparent lesion was present. Colonoscopic findings were normal in six patients. We detected nonspecific and coincidental findings in two patients. However, the detection of specific diseases, namely intestinal tuberculosis, cytomegalovirus (CMV) colitis, and pseudomembranous colitis in three patients, reflects the importance of colonoscopy in diagnosing and directing treatment in renal transplantation patients. The aim of this study was to emphasize the importance of colonoscopy in the diagnosis of diseases that cause lower gastrointestinal symptoms in renal transplant patients.