ABSTRACT
Abstract Introduction: The aim of the study is to compare clinical data of primary focal segmental glomerulosclerosis patients with other data in the literature. In addition, initial immunosuppressive therapy (steroid, calcineurin inhibitors) responses are aimed to be compared with the results in the literature. Methods: Forty seven patients, who were followed up for at least 12 months with primary focal segmental glomerulosclerosis as a result of kidney biopsy. Results of biochemical tests and treatment modalities were evaluated. Results: The mean age of the 47 patients with primary focal segmental glomerulosclerosis was 45.68 (± 13.92). Twenty-one (44.6 %) of 47 patients had anangiotensin converting enzyme inhibitor / angiotensin receptor blocker, 7 (14.8 %) had only corticosteroids, and 6 (12. 7%) had calcineurin inhibitor + low-dose corticosteroids treatment. Thirteen patients (27.6 %) used calcineurin inhibitor + low-dose corticosteroids after receiving corticosteroids treatment. The patients who received corticosteroids or calcineurin inhibitor + low-dose corticosteroids treatment as the initial treatment were compared at the 0, 6 and 12 months of treatment in terms of laboratory and clinical features. At the end of the first year, 4 out of 6 (66 %) patients with low-dose corticosteroids and calcineurin inhibitor and 6 out of (86 %) of 7 patients with corticosteroids had remission (p>0.05). Conclusion: We found the initial steroid treatment and calcineurin inhibitor treatment to be equally effective. We thought that patients with steroid intolerance could be given calcineurin inhibitor in the first step, but if the cost is considered, the first option, such as The Kidney Disease Improving Global Outcomes recommendation, was again steroid.
Resumen Introducción:El objetivo del estudio es comparar los datos clínicos de pacientes con glomeruloesclerosis segmentaria focal primaria con otros datos de la bibliografía. Asimismo, se busca comparar las respuestas de la terapia inmunosupresora inicial (esteroides, inhibidores de la calcineurina) con los resultados en las publicaciones citadas. Material y métodos: Se incluyeron 47 pacientes con glomeruloesclerosis segmentaria focal primaria como resultado de una biopsia renal, y cuyo seguimiento duró, al menos, 12 meses. Se evaluaron los resultados de las pruebas bioquímicas y las modalidades de tratamiento. Resultados: La edad media de los 47 pacientes con glomeruloesclerosis segmentaria focal primaria fue de 45,68 (± 13,92). 21 (44,6 %) del total de los pacientes tenían un inhibidor de la enzima convertidora de la angiotensina / bloqueante del receptor de la angiotensina. Siete pacientes (14,8 %) solo tenían corticosteroides y 6 (12,7 %) tenían un inhibidor de la calcineurina + un tratamiento con esteroides en dosis bajas. Se aplicóinhibidores de la calcineurina + dosis bajas de corticoesteroides en13 pacientes (27,6 %) después de recibir tratamiento con ciclosporina. Los pacientes que recibieron ciclosporina o inhibidores de la calcineurina+ dosis bajas de esteroides como tratamiento inicial se compararon al inicio del tratamiento, a los 6 y 12 meses en sus parámetros de laboratorio y características clínicas. Al final del primer año, 4 de 6 pacientes (66,7 %) con dosis bajas de ciclosporina e inhibidores de la calcineurina y 6 de 7 pacientes (85,7 %) con ciclosporina presentaron remisión (p>0,05). Conclusión: Se encontró que el tratamiento inicial con esteroides y el tratamiento con inhibidores de la calcineurinason igualmente efectivos. Pensamos que, a los pacientes con intolerancia a los esteroides, se les podría administrarinhibidores de la calcineurinaen el primer paso, pero si se considera el costo, la primera opción son nuevamente los esteroides, como lo recomienda el consorcio Kidney Disease Improving Global Outcomes.
ABSTRACT
Aims: BK virus (BKV) infection in renal transplant recipients is an important problem. Although pre-transplant hemodialysis (HD) patients undergo routine screening for cytomegalovirus, herpes virus and other viruses, and post-transplantation receive antifungal, antibacterial and CMV prophylaxis, BKV infection, including viruria and viremia, has been ignored. In this study, we investigated the prevalence of plasma BKV positivity in 100 HD patients. Study Design: Prospective observational study. Place and Duration of Study: Department of Nephrology, Hemodialysis and Transplantation, Turkiye Higher Education Hospital, and Department of Nephrology, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Nephrology Department, Turkey; between March 2014- June 2014. Methods: The study population consisted of 41 female and 59 male (mean age: 46.1±12.3 years) HD patients from different units (median dialysis history: 60 months; range 24–132), who were awaiting renal transplantation and 25 age- and sex-matched healthy controls (10 females and 15 males; mean age: 44.6±7.8 years). The exclusion criteria for patient selection were HD patients with residual diuresis and age > 65 years. Because the absence of diuresis was among the study’s inclusion criteria, only the prevalence of BKV in plasma was determined using quantitative real-time polymerase chain reaction. Results: BKV replication was not detected in the plasma samples of either the controls or the HD patients. Conclusions: Whether there is virological variance and changing virulence in BKV over time in pre- or post-transplant patients remains to be determined in future studies.