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  • Küçük Resim
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    Clinicopathological results of percutaneous transplant kidney biopsies: single center nine years' experience
    (Gaziantep İslam Bilim ve Teknoloji Üniversitesi, 20 Temmuz 2023) Uçar, Zuhal Atan; Sinangil, Ayşe; Elcircevi, Ala; Özçilsal, Mustafa Emre; Sever, İbrahim Halil; Server, Sadık; Yıldız, Alaattin; Ecder, Tevfik; Akin, Emin Barış
    Background: Based on clinical criteria alone, the cause of graft dysfunction cannot be accurately predicted in 40-70% of cases. Therefore, renal allograft biopsy is still the gold standard for accurate diagnosis. We performed this study to evaluate the causes of renal graft dysfunction detected in renal allograft biopsies in our center. Methods: The results of 90 patients who underwent renal allograft biopsy between May 2013 and June 2022 from kidney transplant patients were evaluated retrospectively. Results: It was determined that 92 biopsies were performed from 90 patients and all were ‘cause’’ biopsies. The mean age was 40.03±14.29 years. 82 of the kidney transplants were from living donors. 21 patients had preemptive transplantation. The type of renal replacement therapy before transplantation was hemodialysis in 52 patients, PD in 3 patients, PD and HD in 3 patients. The reason for biopsy was high creatinine in 67 patients, proteinuria in 23 patients, and BKV viremia in 2 patients. The mean discharge creatinine value was 1.64±1.11mg/dl, and the mean creatinine before biopsy was 3.06±2.07mg/dl. Although there was kidney tissue in one of the allograft biopsies, there was no glomeruli. The mean number of cores taken was 2.94±0.61, and the number of glomeruli was 21.33±11.64. In one of the 92 biopsies performed, bleeding requiring transfusion developed. No other biopsy-related complications were observed. Graft loss was observed in 46 of 90 patients during the follow-up period. Conclusions: Evaluation of serum creatinine and urinalysis may be useful in predicting histological graft diagnosis, but an allograft biopsy is necessary for definitive diagnosis.
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    The effect of chewing gum on dry mouth, interdialytic weight gain, and intradialytic symptoms: a prospective, randomized controlled trial
    (2021) Özen, Nurten; Sayılan, Aylin Aydın; Mut, Dilek; Sayılan, Samet; Avcıoğlu, Zeynep; Kulakaç, Nursen; Ecder, Tevfik; Akyolcu, Neriman
    Introduction: The major salivary glands can be stimulated by chewing gum to increase saliva flow and decrease xerostomia. The aim of this study was to investigate the effect of chewing gum on dry mouth, interdialytic weight gain, and intradialytic symptoms in hemodialysis (HD) patients. Methods: This prospective randomized controlled single-blind study was conducted with patients who had been treated for at least 6 months with sessions 3 days a week for 4 hours at two HD units. Patients were randomly allocated to chewing gum group or the control group. In the chewing gum group, gum was chewed for 10 minutes six times a day, and when the patients felt mouth dryness or were thirsty. In the nonchewing gum group, gum was not chewed. The patients were followed-up for 3 months. A total of three saliva samples were taken before starting treatment at the first, 12th, and 36th HD session. Data were collected with the "Visual Analogue Scale (VAS)," "Hemodialysis Patients Fluid Control Scale," "Dialysis Symptom Index," and "Hospital Anxiety and Depression Scale" at baseline, week 4, week 8, and week 12. Findings: The study was completed with a total of 44 patients consisting of 22 patients in the each group. The second and third month VAS values (xerostomia) of the patients in the chewing gum groups were statistically significantly lower than those in the control group (P = 0.014, P < 0.001, respectively). The third month salivary flow rate in the chewing gum group was higher than the values in the control group patients (P < 0.001). Discussion: It is anticipated that this study will raise nurses' awareness of dry mouth and encourage future studies on interventions to increase the salivary flow rate to prevent or treat dry mouth.
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    The significance of finerenone as a novel therapeutic option in diabetic kidney disease: a scoping review with emphasis on cardiorenal outcomes of the finerenone phase 3 trials
    (Frontiers media SA, 2024) Arıcı, Mustafa; Altun, Bülent; Araz, Mustafa; Atmaca, Ayşegül; Demir, Tevfik; Ecder, Tevfik; Güz, Galip; Gogas Yavuz, Dilek; Yıldız, Alaattin; Yılmaz, Temel
    This scoping review prepared by endocrinology and nephrology experts aimed to address the significance of finerenone, as a novel therapeutic option, in diabetic kidney disease (DKD), based on the biological prospect of cardiorenal benefit due to non-steroidal mineralocorticoid receptor antagonist (MRA) properties, and the recent evidence from the finerenone phase 3 program clinical trials. The importance of finerenone in slowing DKD progression was critically reviewed in relation to the role of MR overactivation in the pathogenesis of cardiorenal disease and unmet needs in the current practice patterns. The efficacy and safety outcomes of finerenone phase III study program including FIDELIO-DKD, FIGARO-DKD and FIDELITY were presented. Specifically, perspectives on inclusion of patients with preserved estimated glomerular filtration rate (eGFR) or high albuminuria, concomitant use of sodium-glucose co-transporter-2 inhibitor (SGLT2i) or glucagon-like peptide 1 receptor agonist (GLP-1 RA), baseline glycated hemoglobin (HbA1c) level and insulin treatment, clinically meaningful heart failure outcomes and treatment-induced hyperkalemia were addressed. Finerenone has emerged as a new therapeutic agent that slows DKD progression, reduces albuminuria and risk of cardiovascular complications, regardless of the baseline HbA1c levels and concomitant treatments (SGLT2i, GLP-1 RA, or insulin) and with a favorable benefit-risk profile. The evolving data on the benefit of SGLT2is and non-steroidal MRAs in slowing or reducing cardiorenal risk seem to provide the opportunity to use these pillars of therapy in the management of DKD, after a long-period of treatment scarcity in this field. Along with recognition of the albuminuria as a powerful marker to detect those patients at high risk of cardiorenal disease, these important developments would likely to impact standard-of-care options in the setting of DKD.