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[LANGUAGE= \"English\"] INTRODUCTION: To examine the demographic, clinical, and laboratory data of patients diagnosed with pauci-immune necrotizing glomerulonephritis and to reveal the effects of remission induction and maintenance treatments on these patients.METHODS: A total of 41 patients diagnosed with pauci-immune necrotizing glomerulonephritis and followed between 01.01.2009 and 30.10.2018 were included in the study. The demographic and clinical data of the patients, remission induction and maintenance treatments, effects of the treatments on survival, and treatment-related side effects were analyzed.RESULTS: The mean age was 54.1±16.7 years; 53.7% of the patients were female. Anti-MPO positivity was observed in 58.3% of patients, and anti-PR3 positivity was seen in 29.3%. While 95% of patients required dialysis, plasma-pheresis was performed in 70.7%, and relapse occurred in 20% of the 25 patients who received maintenance treatment. Among patients needing dialysis at admission, 5 (23.8%) died, 7 (33.3%) continued to require dialysis, and 9 (42.8%) no longer needed dialysis. During follow-up, 8 out of 41 patients remained on dialysis, and 6 (14.6%) died.DISCUSSION AND CONCLUSION: Due to the high mortality of patients requiring dialysis at admission, immunosuppressive treatments should be prioritized, even though the treatment success rate is reduced by half in these patients.[LANGUAGE= \"Turkish\"] GİRİŞ ve AMAÇ: Çalışmamızın amacı, merkezimizde pauci-immun nekrotizan glomerülonefrit tanısıyla izlenen hastaların demografik, klinik ve laboratuvar verilerini incelemek ve verilen remisyon indüksiyonu ile idame tedavilerin hasta ve renal sağkalım üzerine etkisini ortaya koymaktır.YÖNTEM ve GEREÇLER: 01.01.2009 - 30.10.2018 tarihleri arasında pauci-immun nekrotizan glomerülonefrit tanısı ile takip edilen 41 hasta çalışmaya dahil edildi. Hastaların demografik ve klinik verileri, remisyon indüksiyon ve idame tedavileri, tedavilerin sağkalım üzerindeki etkileri ve tedavilere bağlı yan etkiler analiz edildi.BULGULAR: Hastaların ortalama yaşı 54,1±16,7 olup, %53,7’si kadındı. Anti-MPO pozitifliği %58,3, anti-PR3 pozitifliği %29,3 oranında saptandı. Hastaların %95’inde diyaliz ihtiyacı bulunurken, plazmaferez %70,7’sine uygulanmış; idame tedavisi alan 25 hastanın %20’sinde nüks görülmüştür. Yatışta diyaliz ihtiyacı olan hastaların 5’i (%23,8) ölürken, 7’sinin (%33,3) diyaliz ihtiyacı devam etmiş ve 9 hastanın (%42,8) artık diyaliz ihtiyacı kalmamıştır. Takipte 41 hastanın 8’i diyalize devam ederken, 6’sı (%14,6) hayatını kaybetmiştir.TARTIŞMA ve SONUÇ: Başvuru anında diyaliz ihtiyacı olan hastaların yüksek mortalitesi nedeniyle, bu hastalarda tedavi başarısı yarı yarıya azalsa da immünosupresif tedaviler tercih edilmelidir.

Prior small studies have shown multiple benefits of frequent nocturnal hemodialysis compared to conventional three times per week treatments. To study this further, we randomized 87 patients to three times per week conventional hemodialysis or to nocturnal hemodialysis six times per week, all with single-use high-flux dialyzers. The 45 patients in the frequent nocturnal arm had a 1.82-fold higher mean weekly stdKt/Vurea, a 1.74-fold higher average number of treatments per week, and a 2.45-fold higher average weekly treatment time than the 42 patients in the conventional arm. We did not find a significant effect of nocturnal hemodialysis for either of the two coprimary outcomes (death or left ventricular mass (measured by MRI) with a hazard ratio of 0.68, or of death or RAND Physical Health Composite with a hazard ratio of 0.91). Possible explanations for the left ventricular mass result include limited sample size and patient characteristics. Secondary outcomes included cognitive performance, self-reported depression, laboratory markers of nutrition, mineral metabolism and anemia, blood pressure and rates of hospitalization, and vascular access interventions. Patients in the nocturnal arm had improved control of hyperphosphatemia and hypertension, but no significant benefit among the other main secondary outcomes. There was a trend for increased vascular access events in the nocturnal arm. Thus, we were unable to demonstrate a definitive benefit of more frequent nocturnal hemodialysis for either coprimary outcome.

IntroductionDiffuse interstitial fibrosis (DIF) is present in early stage (eGFR <75 ml/min/1.73 m2) chronic kidney disease (CKD) and is associated with abnormal myocardial contractility. It is not known whether there is a graded relationship with declining renal function.Methods119 patients with CKD; stage 2–4 (eGFR 89–15 ml/min/1.72 m2) and stage 5 (pre-dialysis n=23, dialysis (CKD 5D) n=16) underwent CMR (1.5 T). T1 mapping (MOLLI), extracellular volume (ECV) and T2 mapping (T2-prepared SSFP) were used as markers of interstitial fibrosis and myocardial free water content respectively (MyoMaps, Siemens). Gadolinium was given if eGFR >30 ml/min/1.73 m2. Subjects with diabetes or known CV disease were excluded and asymptomatic ischaemic heart disease was excluded on exercise stress echocardiography.ResultsNative septal myocardial T1, T2, LV volumes, LV mass and NT-proBNP increased with worsening renal function. Myocardial T1 time was inversely associated with: eGFR r=−0.344, p<0.001, and haematocrit r=−0.374, p<0.001, and directly with indexed LV mass r=0.345, p<0.001, T2 time r=0.673, p<0.001 and NT-proBNP r=0.375, p<0.001. LV mass (p=0.876) and T2 times (p=0.074 ) were unchanged between CKD stages 2–4 despite an increase in T1 (r=−0.274, p=0.017). In CKD 5, there was no difference in T1 and T2 times with dialysis but LV mass was higher (100±42 g/m2 vs 73±16 g/m2, p=0.034).ConclusionAn inverse graded relationship between myocardial T1 time and eGFR supports the concept of increasing DIF with deteriorating renal function, which precedes the development of elevated LV mass seen in CKD 5D. Myocardial water content is higher in CKD 5 irrespective of dialysis suggesting further changes in myocardial composition.