Key words: Diabetes mellitus; insulin resistance; oncostatin M; metabolic syndrome

ANCA-associated glomerulonephritis (ANCA-GN) is a leading cause of pauci-immune crescentic GN. Recent evidence indicates that complement activation, marked by C3 deposition in glomeruli, may contribute to more severe renal injury and influence renal outcomes. We aim to evaluate the clinical, histopathological, and prognostic implications of C3 deposition in ANCA-GN. We retrospectively analyzed 195 patients with biopsy-proven ANCA-GN from the Turkish Society of Nephrology Glomerular Diseases registry from 2002 to 2022. Patients were classified as C3-positive or C3-negative according to kidney biopsy immunofluorescence findings. Clinical characteristics, histopathologic lesion profiles, and follow-up outcomes (remission, relapse, and survival) were compared between the two groups. Of 195 patients, 54 (27.7%) had C3 deposition. The C3-negative group was more likely to exhibit PR3-ANCA positivity, whereas the C3-positive group was strongly associated with the presence of MPO-ANCAs (22.2% vs. 77.8%; p = 0.001). Compared with C3-negative patients, C3-positive patients had higher levels of proteinuria (2026 mg/day vs. 1790 mg/day; p = 0.049) and lower HDL levels (30 mg/dL vs. 37 mg/dL; p = 0.009). Fibrocellular crescents were more common in C3-positive patients than in C3-negative patients (p < 0.001). Immune complex deposits, including IgG (26.4% vs. 3.5%; p < 0.001), IgA (14.8% vs. 0.7%; p < 0.001), IgM (25.0% vs. 3.5%; p < 0.001), and C1q (13.7% vs. 0.8%; p < 0.001) were significantly greater in the C3-positive group. However, no significant difference was detected in overall survival (85.8% for C3-negative patients vs. 88.9% for C3-positive patients; p = 0.249). Similarly, the remission (62.1% vs. 59.4%; p = 0.786) and relapse rates (14.8% vs. 11.1%; p = 0.532) did not differ between the groups. In ANCA-GN, glomerular C3 deposition is associated with an MPO-ANCA serotype, greater proteinuria, and more severe renal histology (including immune-complex deposition and more fibrocellular crescents), indicating more pronounced complement activation and tissue injury. However, C3 deposition did not predict worse patient or renal survival in our cohort. Not applicable.

Objectives: In this study, we aimed to research the frequency of musculoskeletal manifestations of patients receiving hemodialysis treatment, and evaluate the relationship between quality of life and musculoskeletal manifestations of these patients. Methods: Patients undergoing hemodialysis for at least 6 months were included in our study. Patients were asked to complete a questionnaire that formed by the investigators including demographic, clinical features, and musculoskeletal symptoms that frequently seen in patients who receive hemodialysis. Kidney Disease Quality of Life Short Form Version 1.3 (KDQOL-SF 1.3) and Short Form Health Survey (SF 36) questionnaires were completed by the patients and the control group. Blood urea nitrogen, serum creatinine, serum albumin, C-reactive protein (CRP), parathormone (PTH), ferritin, calcium, phosphate, hemoglobin, and Kt/V were measured. Also, the patients were divided into two subgroups according to musculoskeletal symptoms and these subgroups were compared in terms of dialysis adequacy, quality of life scoring and laboratory findings. Results: Seventy-four patients (42 males, 32 females) were enrolled in our study. The mean age of the patients was 60.85 ± 12.29 years. Six-five (87.83%) patients had musculoskeletal symptoms. There was statistically major difference in terms of smoking between subgroups (p = 0.046). We did not detect any correlation between two groups in terms of Kt/V (p = 0.411). Pain in shoulder/neck (41.9%), pain in limbs (58.1%) and pain in back (56.8%) were the most detected musculoskeletal symptoms of the patients. There was statistically significant difference between genders in terms of joint swelling, muscle cramps, pain in limbs, back and neck /shoulder (p = 0.015, p = 0.001, p = 0.008, p = 0.001, and p = 0.004, respectively). We detected that all subunits of KDQOL scores were higher in control group than patients who were included in our study. There was statistically significant relation between emotional role and energy subunits of KDQOL scores and CRP (p = 0.031 and p = 0.025, respectively). Conclusion: The results of our study were not as significant as the results of similar studies, however they are valuable because they show demographic, clinical characteristics, and quality of life of patients receiving hemodialysis in our region.

Aim: Alexithymia is a disorder associated with difficulty in recognizing and expressing feelings, which can lead to an increased susceptibility to disease development that makes alexithymia a possible risk factor for chronic kidney disease (CKD). This study was performed to evaluate for alexithymia in pre-dialysis CKD and end-stage renal disease patients undergoing hemodialysis. Material and Method: The study was conducted in the Nephrology Outpatient Department and Hemodialysis unit of Ümraniye Research and Training Hospital. The patients had to have a diagnosis of CKD. Demographic data form, routine biochemical follow up data of patients, Toronto Alexithymia Scale (TAS), and Hospital Depression and Anxiety Scale (HADS) were used in this study. The statistical significance level was determined as p0.05). The results showed that increased incidence of depression resulted in a 4.47-fold (p=0.035) increase in the incidence of alexithymia. Conclusion: Alexithymia has been found to be high in patients with chronic kidney disease. Therefore, it is essential that we be aware of patients’ emotional stress and assess them for depression, anxiety, and alexithymia.