Background: Mushroom poisoning causes common gastrointestinal symptoms such as nausea and vomiting and is a well-known reason for acute hepatic failure. Acute kidney injury is a less common clinical presentation in mushroom poisoning. Recently, nephrotoxicity called Amanita nephrotoxic syndrome has been defined, caused by several Amanita mushrooms. It is characterized by moderate hepatotoxicity and oligoanuric acute kidney injury, which may require hemodialysis. Case presentation: Case 1 was a 51-year-old female patient who was hospitalized with oliguria, nausea, and vomiting after eating mushrooms, required hemodialysis due to acute kidney injury, and developed pulmonary hemorrhage during her follow-up. Case 2 was a 55-year-old male patient who was hospitalized with anuria, nausea, and vomiting after eating mushrooms, required hemodialysis due to acute kidney injury, and developed acute coronary syndrome during his follow-up. Case 3 was a 59-year-old male patient who was hospitalized with oliguria, nausea, and vomiting after eating mushrooms, required hemodialysis due to acute kidney injury, and developed moderate hepatotoxicity during his follow-up. All cases were hospitalized at the same time interval with similar clinical features. Acute kidney injury was the initial presentation of all the cases, and they had only mild transaminase elevation with normal INR levels. They all required hemodialysis, and kidney injury was fully recovered. Conclusions: Mushroom consumption must be questioned in acute kidney injury patients of unknown etiology where mushrooms are habitual despite deleterious consequences.

Background: Finerenone is associated with a lower, yet clinically relevant, risk of hyperkalemia compared with steroidal mineralocorticoid receptor antagonists in diabetic kidney disease (DKD) trials. However, real-world data on hyperkalemia and its associated factors are lacking. Methodology: FINE-TURK is a national, observational cohort of DKD patients who were initiated on finerenone. Eligible adults were included; demographic, clinical, and laboratory data were evaluated. The primary outcome (PO) was hyperkalemia risk signal (potassium ≥ 5.0 mEq/L), and the secondary outcome (SO) was clinically meaningful hyperkalemia (potassium ≥ 5.5 mEq/L). Multivariate logistic regression (LR) was used to define features associated with both PO and SO. LR, random forest (RF), gradient boosting, and CatBoost classifiers were used to define important features associated with the PO. Results: 699 patients were included. 259 (37.1%) reached the PO, and 51 (7.3%) reached the SO. Baseline potassium and estimated glomerular filtration rate (eGFR) were the most important variables associated with both outcomes and were consistently identified as the top features across all models. Thiazide use, presence of diabetic retinopathy, and diabetes duration were also associated with the PO. LR demonstrated the highest recall; random forest achieved the highest precision in performance. Discussion: Real-world data suggest that the risk of clinically meaningful hyperkalemia is similar to that in the clinical trials. In parallel with the safety analysis of clinical trials, baseline potassium and eGFR were consistently the most important factors associated with hyperkalemia risk.

Psoriasis is a chronic, recurrent, inflammatory and common skin disease of unknown aetiology. Amyloidosis is defined as a heterogeneous group of diseases in which generally soluble plasma proteins accumulate in the extracellular space as insoluble abnormal fibrils. Type AA amyloidosis is a late and severe complication of chronic inflammatory disorders and some chronic infections. Although psoriasis is a common inflammatory skin disease, the development of amyloidosis is rare. Herein, we presented a case of psoriasis who developed AA-type amyloidosis.

Although it has been reported rarely in the literature in patients who develop acute kidney injury after COVID-19 disease, ANCA-related vasculitis should also be kept in mind. Thus, it is possible to reduce mortality and morbidity. We presented a middle-aged male patient who was diagnosed with post-COVID ANCA-associated vasculitis.

Bu çalışmada metastatik kolorektal kanserli hastalarda tanı anındaki histopatolojik ve klinik özelliklerin RAS mutasyon durumuna göre karşılaştırılması amaçlandı. Bu kesitsel çalışma için, 01.04.2012-24.08.2017 tarihleri arasında bir üniversite hastanesinin onkoloji merkezinde takip ve tedavisi yapılmış toplam 530 kolorektal kanser tanısı almış hastanın dosyası retrospektif olarak incelendi. Çalışmaya 18 yaşından büyük, tanı anında metastatik hastalığa sahip veya takipleri boyunca metastaz gelişen ve RAS mutasyonu bakılmış 75 hasta dahil edildi. Rasmutant olan ve olmayan hastaların tümör lokalizasyonu, tanı anındaki metastaz yerleri, tümör belirteçleri, tümör diferansiyasyon derecesi ve genel sağkalım süreleri arasındaki farklılıklar analiz edildi. RAS mutasyonu sıklığı %50.7 olarak saptandı. Klinik ve patolojik özellikler açısından bakıldığında RAS mutant ve wild gruplar arasında istatistiksel anlamı farklılık saptamadık. RAS mutasyon durumuna göre genel sağkalım süreleri incelendiğinde, RAS wild tip olan hastaların 2 yıllık genel sağkalımı% 59 iken, RAS mutant hastalarımızın 2 yıllık genel sağkalımı %27.8 idi ve bu fark istatiksel olarak anlamlıydı (p=0.004). Ancak, RAS wild hastaların ilk hat tedavisinde bevacizumab veya cetuksimab/panitumumab alan hastaların ortalama sağkalımları arasında (sırasıyla %57.1'e karşı %70.7; p=0.221) istatistiksel fark saptanmadı. Bu çalışmada, metastatik kolorektal kanserli hastalarımızın RAS mutasyon durumunun daha ziyade Batılı ülkelere benzer olduğunu ve hastaların tanı anındaki klinik ve patolojik özelliklerinin RAS mutasyon durumundan bağımsız olduğunu saptadık. Ancak bu konuda yapılacak prospektif ve daha geniş katılımlı çalışmalara hala ihtiyaç duyulmaktadır.

Methotrexate (MTX) is an effective drug used to treat various diseases, especially rheumatological diseases. However, myelosuppression is a severe side effect, the frequency of which increases in patients with renal insufficiency. Here, we presented a chronic hemodialysis patient who developed pancytopenia and mucositis after using low-dose MTX to treat psoriasis.