Background Each year, millions face natural disasters, encountering mass fatalities and severe medical issues such as crush injuries and crush syndrome. Crush syndrome, marked by acute kidney injury (AKI) and hyperkalemia, correlates with mortality. This study focuses on presenting epidemiological data on kidney disease resulting from the February 6, 2023 earthquakes centered in Kahramanmaras. Methods This retrospective analysis included patients diagnosed with crush syndrome after the 2023 Kahramanmaras earthquakes, treated in regional hospitals or referred elsewhere in Turkey. Patient data were documented using the web-based system developed by the Turkish Nephrology Association Renal Disaster Working Group. Results Of the 1024 analyzed patients from 46 centers, 515 (50.3%) were women. The mean age was 41 ± 16 years, with a median duration of 12 h under rubble, and the median presentation time to the first health facility was 4 h after extrication from the rubble. Upon admission, 79.8% received intravenous fluid therapy, all potassium-free. Initial serum creatinine, K⁺, and creatinine kinase levels averaged 2.59 ± 2 mg/dl, 5.1 ± 1 mmol/L 38,305 ± 54,303 U/L, respectively. Intensive care unit (ICU) admissions were 53.6%, with mean hospital and ICU stays of 20 and 11 days, respectively. Compartment syndrome occurred in 40.8% of patients, with 75.8% undergoing fasciotomy. Acute kidney injury developed in 67.9% of patients, with 70.3% undergoing hemodialysis, totaling 3016 sessions on 488 patients. The overall in-hospital mortality rate was 9.8%. Conclusion Earthquakes have a significant impact on kidney health. Although our study indicates some progress compared to previous earthquake responses, there remains a crucial need for drills emphasizing post-earthquake initial response, fluid-electrolyte balance management, and emergency dialysis protocols. Graphical abstract

Objective Older adults with comorbidities 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 April 17, 2020, and December 31, 2020. Hospitalized patients aged 18 years or older with confirmed COVID-19 diagnosis suffering from stage 3-5 chronic kidney disease(CKD) or on maintenance hemodialysis(HD) treatment were included in the database. Non-uremic hospitalized 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 HD group was 49.0%(n=150/306) and in the control group was 30.4%(n=70/300). Comorbidities 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%, 16.1%, respectively). Among older patients, the intensive care unit(ICU) admission rate was significantly higher in the CKD and HD group 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 group (26.7% and 30.1%) compared to 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, comorbidities, clinical and laboratory data on admission.

AAbstract Background/aim: Hospital-acquired acute kidney injury (HA-AKI) may commonly develop in Covid-19 patients and is expected to have higher mortality. There is little comparative data looking for the effect of HA-AKI on mortality of chronic kidney disease (CKD) patients and a control group of general population suffering from Covid-19. HA-AKI development was assessed in a group of stage 3-5 CKD patients and control group without CKD among adult patients hospitalized for Covid-19. The role of AKI development on the outcome (in-hospital mortality and admission to the intensive care unit [ICU]) of patients with and without CKD was compared. Among 621 hospitalized patients (age 60 [IQR:47-73]), women: 44.1%), AKI developed in 32.5% of the patients, as stage 1 in 84.2%, stage 2 in 8.4% and, stage 3 in 7.4%. AKI developed in 48.0 % of CKD patients, whereas in 17.6% of patients without CKD. CKD patients with HA-AKI had the highest mortality rate of 41.1 % compared to 14.3 % of patients with HA-AKI but no CKD (p<0.001). However, patients with AKI+non-CKD had similar rates of ICU admission, mechanical ventilation, and death rate as patients with CKD without AKI. Adjusted mortality risk of the AKI+non-CKD group (HR: 9.0, 95%CI:1.9-44.2) and AKI+CKD group (HR: 7.9, 95%CI:1.9-33.3) were significantly higher than non-AKI+non-CKD group. AKI frequently develops in hospitalized patients due to Covid-19 and is associated with high mortality. HA-AKI has worse outcome whether it develops in patients with or without CKD, but the worst outcome was seen in AKI+CKD patients.

Calciphylaxis is usually a fatal condition that develops in a few chronic renal failure patients, and it is characterized by calcifications in subcutaneous arteries, infarcts in skin, and the neighboring subcutis. Calciphylaxis, once considered as a rare condition, has been reported to have an annual incidence of 1% and a prevalence of 4% in dialysis patients. We describe our clinical experience in six end-stage renal disease patients on dialysis that presented with calciphylaxis and died due to sepsis, and review the pathogenesis, epidemiology, clinical and histopathologic features, and treatment of calciphylaxis. Physicians should initially consider the possibility of calciphylaxis in case of development of skin lesions in chronic renal failure patients with impaired calcium, phosphorus, and parathyroid hormone levels. The most important cause of mortality in this condition is infection. Therefore, differential diagnosis of these lesions from systemic vasculitis in their early stages and withdrawal of immunosuppressive therapy that increases the tendency to infections are essential.

We aimed to investigate the performance of various creatinine based glomerular filtration rate estimation equations that were widely used in clinical practice in Turkey and calculate a correction coefficient to obtain a better estimate using the isotope dilution mass spectrometry (IDMS)-traceable Modification of the Diet in Renal Disease (MDRD) formula. This cross-sectional study included adult (>18 years) outpatients and in patients with chronic kidney disease as well as healthy volunteers. Iohexol clearance was measured and the precisions and bias of the various estimation equations were calculated. A correction coefficient for the IDMS-traceable MDRD was also calculated. A total of 229 (113 male/116 female; mean age 53.9 ± 14.4 years) subjects were examined. A median iohexol clearance of 39.21 mL/min/1.73 m² (range: 6.01–168.47 mL/min/1.73 m²) was found. Bias and random error for the IDMS-traceable MDRD equation were 11.33 ± 8.97 mL/min/1.73 m² and 14.21 mL/min/1.73 m², respectively. MDRD formula seems to provide the best estimates. To obtain the best agreement with iohexol clearance, a correction factor of 0.804 must be introduced to IDMS-traceable MDRD equation for our study population.