Background Immunoglobulin A nephropathy (IgAN) is a common primary glomerulonephropathy. There is evidence that mesangial C3 deposition plays a role in the development of the disease. The aim of this study was to examine the effect of C3 deposition on the prognosis of IgAN patients. Method The study included 1135 patients with biopsy-confirmed IgAN from the database of the Turkish Nephrology Association Glomerular Diseases Working Group (TSN-GOLD). Patients were excluded from the study if they were aged < 18 or > 75 years or if C3 staining had not been performed in the immunofluorescent analysis. C3 deposition was defined as an immunofluorescence intensity of C3 ≥ 2 + within the mesangium. The primary endpoints were the development of end-stage renal disease, a 30% decrease in glomerular filtration rate compared to the basal value or an elevation in proteinuria to a nephrotic level (3.5 gr/day). Results Mesangial C3 deposition was observed in 603 (53.1%) patients. No statistically significant difference was found at baseline between the groups with and without mesangial C3 deposition, as for age, sex, BMI, proteinuria level, or the presence of hypertension. In the follow-up period with a mean duration of 78 months, no significant difference was found between the two groups regarding the primary endpoints (p = 0.43). A significant correlation between C3 deposition and segmental glomerulosclerosis (S1) according to the Oxford MEST-C classification was found (p = 0.001). Conclusion Although a correlation was observed between mesangial C3 deposition and the S1 MEST-C classification, mesangial C3 deposition was not a prognostic factor in IgAN. Graphical abstract

The most common cause of hypercalcemia is parathyroid hyperplasia and carcinoma. Tuberculosis(TB) and sarcoidosis are the most common granulomatous diseases of the parathyroid. We report a case of parathyroid adenoma that can mimic many lesions. A 46-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) with symptoms and signs of hypercalcemia. Laboratory findings were consistent with tertiary hyperparathyroidism. She underwent elective parathyroidectomy due to high PTH values despite effective treatment including calcimimetics and vitamin D receptor activators. Subtotal thyroidectomy and three and a half of parathyroid adenomas were removed. Histopathological examination revealed features of parathyroid adenoma with granulomatosis infection that supports tuberculosis. In order to confirm the pathological findings, the PCR study was performed on the pathology specimens. After obtaining a negative result, the treatment was stopped. We have reported a case of parathyroid adenoma that mimicking tuberculosis.

Falls in older adults represent a significant public health concern. Specific drug categories represent a significant risk factor for falls, yet there is a paucity of awareness regarding this issue. The use of diuretics in the treatment of hypertension has been associated with an increased risk of complications related to electrolyte imbalance. The objective of this study was to evaluate the role of hyponatremia and antihypertensives in patients who have experienced a fall. The study included a total of 322 patients who had been admitted to the hospital with a diagnosis of fall-related injuries. At the time of hospital admission, the following data were recorded: age, gender, presence of disease, medications, presence of fracture, and laboratory values. Two groups, with and without hyponatremia, were compared. A p-value of less than 0.05 was considered statistically significant. The mean age of the participants was 73.28 years (±14.26), and 60.2 % were female. The use of antihypertensive drugs such as hydrochlorothiazide (HCT) (p=.037), angiotensin-converting enzyme inhibitor (ACE) (p=.045), beta-blocker (p=.041) and ACE+HCT (p=.046) was significantly higher in the group with Na≤135 mEq/L than in the group with Na≥136 mEq/L. Logistic regression analysis showed that hyponatremia was 2.2 times and female gender was 1.9 times more effective in the occurrence of fracture, furosemide use was 2.2 times, and SSRI use was 1.8 times more effective in the development of hyponatremia. Careful use of antihypertensives that cause hyponatremia in older adults will be effective in preventing falls and their complications.

AMAÇ: Ailevi Akdeniz Ateşi (AAA) ateş ve serozit atakları ile karakterize otozomal resesif geçişli genetik bir hastalıktır. Tanı Tel-hashomer kriterlerine göre konulur. Genetik testler tanıyı desteklemeye yönelik yardımcı yöntemlerdir. Çalışmamızın amacı genetik testlerin fenotip, subklinik inflamasyon ve komplikasyonlarla ilişkisini değerlendirmektir. GEREÇ VE YÖNTEM: Çalışmaya 2000-2020 yılları arasında nefroloji polikliniğinde takip edilen, ek hastalıkları olmayan, genetik testleri çalışılmış 97 AAA hastası alındı. Tüm hastaların demografik,klinik özellikleri ve laboratuvar verileri kaydedildi. . Hastalar genetik özelliklerine göre üç gruba ayrıldı. Grup I M694 V homozigot mutasyonu olan, grup II M694V heterozigot veya M694V birleşik heterozigot olan, grup III M694 V dışı homozigot, heterozigot veya birleşik heterozigot olan hastalardan oluştu. Verilerin karşılaştırılması yapıldı. BULGULAR: Hastaların yaş ortalaması 36.64±10.78, teşhis yaşı 25.05±1.47, takip süresi 6.3±4 yıldı. En sık görülen semptom %88.7 ile karın ağrısıydı. Hastaların %26.8’de subklinik inflamasyon tespit edildi. %13.4’üne böbrek biyopsisi yapıldı. Tanı anında hastaların %16.5’da kronik böbrek hastalığı varken 6.3 yıllık takip sonrası bu oran %27.8 yükseldi. Üç grup arasında klinik bulgular açısından anlamlı farklılık bulunmadı. Ancak grup-1’de kas-iskelet sistemi bulguları daha ön plandaydı. CRP ve fibrinojen düzeyi grup-I ve II’de anlamlı yüksek bulundu. SONUÇ: AAA hastalarında genetik test yaptırılıp özellikle M694V homozigot muatsyon tespit edildiyse ataklar ve subklinik inflamasyon açısından hastalar yakın takip edilmelidir. Kontrollere geldiklerinde atak döneminde olmasalar bile CRP, fibrinojen gibi inflamatuvar parametreler ölçülmelidir. Yüksek değerlere sahip olan hastalar, AA amiloidoz, kronik böbrek hastalığı gibi komplikasyonlara karşı yakın takip edilmelidir.