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    Biopsy-proven BK virus nephropathy in renal transplant recipients: A multi-central study from Turkey (BK-TURK STUDY)
    (Dustri-Verlag Dr Karl Feistle, 2024) Gungor, Ozkan; Dheir, Hamad; Islam, Mahmud; Toz, Huseyin; Yildiz, Abdulmecit; Sinangil, Ayse; Tatar, Erhan
    Aim: BK polyomavirus infection is a challenging complication of renal transplantation. The management is not standardized and is based on reports from transplantation centers' experiences, usually with small sample sizes. Therefore, we aimed to present our countrywide experience with BK virus nephropathy (BKVN) in renal transplant recipients. Materials and methods: Our study was carried out with the participation of 30 transplantation centers from all regions of Turkey. Only cases with allograft biopsy-proven BKVN were included in the study. Results: 13,857 patients from 30 transplantation centers were screened, and 207 BK nephropathy cases were included. The mean age was 46.4 +/- 13.1 years, and 146 (70.5%) patients were male. The mean time to diagnosis of BK nephropathy was 15.8 +/- 22.2 months after transplantation. At diagnosis, the mean creatinine level was 1.8 +/- 0.7 mg/dL, and the mean estimated glomerular filtration rate was 45.8 +/- 19.6 mL/min/1.73m2. 2 . In addition to dose reduction or discontinuation of immunosuppressive drugs, 18 patients were treated with cidofovir, 11 patients with leflunomide, 17 patients with quinolones, 15 patients with intravenous immunoglobulin (IVIG), 5 patients with cidofovir plus IVIG, and 12 patients with leflunomide plus IVIG. None of the patients receiving leflunomide or leflunomide plus IVIG had allograft loss. During follow-up, allograft loss occurred in 32 (15%) out of 207 patients with BK nephropathy. Conclusion: BKVN is still a frequent cause of allograft loss in kidney transplantation and is not fully elucidated. The results of our study suggest that leflunomide treatment is associated with more favorable allograft outcomes.
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    Characteristics and outcomes of hospitalised older patients with chronic kidney disease and COVID-19: A multicenter nationwide controlled study
    (John Wiley & Sons Ltd, 2021) Özturk, Savaş; Turgutalp, Kenan; Arıcı, Mustafa; Gök, Mahmut; İslam, Mahmud; Altıparmak, Mehmet Rıza; Aydın, Zeki; Döner, Barıs; Eren, Necmi; Şengül, Erkan; Karadağ, Serhat; Özler, Tuba Elif; Dheir, Hamad; Pembegül, İrem; Taymez, Dilek Güven; Şahin, Garip; Dolarslan, Murside Esra; Soypaçacı, Zeki; Hür, Ender; Kara, Ekrem; Baştürk, Taner; Öğütmen, Melike Betül; Görgülü, Numan; Şahin, İdris; Ayli, Mehmet Deniz; Tuğlular, Zübeyde Serhan; Şahin, Gülizar; Tokgöz, Bülent; Tonbul, Halil Zeki; Yıldız, Alaattin; Sezer, Siren; Odabaş, Ali Rıza; Ateş, Kenan; Bakırdöğen, Serkan
    Objective Older adults with co-morbidities have been reported to be at higher risk for adverse outcomes of coronavirus disease 2019 (COVID-19). The characteristics of COVID-19 in older patients and its clinical outcomes in different kidney disease groups are not well known. Methods Data were retrieved from a national multicentric database supported by Turkish Society of Nephrology, which consists of retrospectively collected data between 17 April 2020 and 31 December 2020. Hospitalised patients aged 18 years or older with confirmed COVID-19 diagnosis suffering from stage 3-5 chronic kidney disease (CKD) or on maintenance haemodialysis (HD) treatment were included in the database. Non-uraemic hospitalised patients with COVID-19 were also included as the control group. Results We included 879 patients [388 (44.1%) female, median age: 63 (IQR: 50-73) years]. The percentage of older patients in the CKD group was 68.8% (n = 188/273), in the HD group was 49.0% (n = 150/306) and in the control group was 30.4% (n = 70/300). Co-morbidities were higher in the CKD and HD groups. The rate of presentation with severe-critical disease was higher in the older CKD and HD groups (43.6%, 55.3% and 16.1%, respectively). Among older patients, the intensive care unit (ICU) admission rate was significantly higher in the CKD and HD groups than in the control group (38.8%, 37.3% and 15.7%, respectively). In-hospital mortality or death and/or ICU admission rates in the older group were significantly higher in the CKD (29.3% and 39.4%) and HD groups (26.7% and 30.1%) compared with the control group (8.6% and 17.1%). In the multivariate analysis, in-hospital mortality rates in CKD and HD groups were higher than control group [hazard ratio (HR): 4.33 (95% confidence interval [CI]: 1.53-12.26) and HR: 3.09 (95% CI: 1.04-9.17), respectively]. Conclusion Among older COVID-19 patients, in-hospital mortality is significantly higher in those with stage 3-5 CKD and on maintenance HD than older patients without CKD regardless of demographic characteristics, co-morbidities, clinical and laboratory data on admission.