Browsing by Author "Turgut, Didem"

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ANALYSIS OF INTRA-PATIENT VARIABILITY OF TACROLIMUS IN TRANSPLANT PATIENTS WITH DATA MINING
(2020) Topcu, Deniz Ilhan; Turgut, Didem; Celebi, Zeynep Kendi; Haberal, Mehmet A.
COVID-19: a novel menace for the practice of nephrology and how to manage it with minor devastation?
(2020) Ulu, Sena; Gungor, Ozkan; Gok Oguz, Ebru; Hasbal, Nuri Baris; Turgut, Didem; Arici, Mustafa; 0000-0001-7474-5927; 32713282; AAI-9418-2021
Coronavirus disease 19 (COVID-19) became a nightmare for the world since December 2019. Although the disease affects people at any age; elderly patients and those with comorbidities were more affected. Everyday nephrologists see patients with hypertension, chronic kidney disease, maintenance dialysis treatment or kidney transplant who are also high-risk groups for the COVID-19. Beyond that, COVID-19 or severe acute respiratory syndrome (SARS) due to infection may directly affect kidney functions. This broad spectrum of COVID-19 influence on kidney patients and kidney functions obviously necessitate an up to date management policy for nephrological care. This review overviews and purifies recently published literature in a question to answer format for the practicing nephrologists that will often encounter COVID-19 and kidney related cases during the pandemic times
Do Hemodialysis Patients Need Immune Boosting with Vitamin, Mineral, and Probiotic Supplementation during COVID-19 Pandemic?
(2021) Gungor, Ozkan; Ulu, Sena; Hasbal, Nuri Baris; Onan, Engin; Turgut, Didem; Arici, Mustafa
Coronavirus disease 2019 (COVID-19) has been accepted as a global pandemic, and poses a greater risk to the elderly and those with comorbidities. Comorbid diseases (particularly end-stage kidney disease with hemodialysis) and impaired immunity place patients in the high-risk group for COVID-19. In recent studies, it was also mentioned that exaggerated inflammation and a cytokine storm were the underlying causes related to the high mortality in COVID-19 patients. Currently, treatment modalities to balance the immune system of such vulnerable patient groups are essential, to protect them from the disease. Several vitamins (like vitamins C, D, and E), trace elements like zinc, and probiotics have been proposed as immune boosters to protect and combat infectious conditions. It is well known that these vitamins and elements are insufficient in hemodialysis patients. In this review, we aimed to evaluate the immune-boosting mechanisms of vitamins C, D, E, zinc, and probiotics, the studies related to their beneficial effects against infections, and their possible benefits for hemodialysis patients during the COVID-19 pandemic.
DO THE BLOOD GROUPS AND HLA TYPES HAVE A ROLE IN END STAGE CHRONIC RENAL FAILURE PATHOGENESIS? A COMPARATIVE RETROSPECTIVE SINGLE-CENTER STUDY
(2020) Musabak, Ugur; Turgut, Didem; Sayin, Cihad Burak; Colak, Turan; Karakaya, Emre; Haberal, Mehmet A.
Effect of Calcineurin Inhibitors and Mammalian Target of Rapamycin Inhibitors on the Course of COVID-19 in Kidney Transplant Recipients
(2021) Hasbal, Nuri Baris; Turgut, Didem; Oguz, Ebru Gok; Ulu, Sena; Gungor, Ozkan; 0000-0001-7474-5927; 33707409; AAI-9418-2021
Coronavirus disease 19 (COVID-19) has been an ongoing pandemic since December 2019. Unfortunately, kidney transplant recipients are a high-risk group during the disease course, and scientific data are still limited in this patient group. Beyond the dosage of immunosuppressive drugs, pharmacological immunosuppression may also alter the infection response in the COVID-19 course. The effects of immunosuppressive agents on the development and process of infection should not be decided only by determining how potent they are and how much they suppress the immune system; it is also thought that the direct effect of the virus, increased oxidative stress, and cytokine storm play a role in the pathogenesis of COVID-19 disease. There are data about immunosuppressive drugs like calcineurin inhibitors (CNI) or mammalian target of rapamycin inhibitors (mTORi) therapy related to their beneficial effects during any infection course. Limited data suggest that the use of CNI or mTORi may have beneficial effects on the process. In this hypothetical review, the probable impacts of CNI and mTORi on the pathogenesis of the COVID-19 were investigated.
HOW CALCINEURIN INHIBITOR DOSAGE AND BLOOD TROUGH LEVELS AFFECT KIDNEY ALLOGRAFT SURVIVAL?
(2020) Turgut, Didem; Celebi, Zeynep Kendi; Ozdemir, B. Handan; Colak, Turan; Soy, Ebru H. Ayvazoglu; Haberal, Mehmet A.
THE IMPORTANCE OF COMPLEMENT LEVELS AND CLINICAL CHARACTERISTICS OF PRIMARY MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS IN TURKEY
(2020) Turgut, Didem; 0000-0001-7474-5927; AAI-9418-2021
INCIDENCE AND RISK FACTORS OF NEW ONSET DIABETES AFTER SOLID ORGAN TRANSPLANTATION: BASKENT UNIVERSITY EXPERIENCE
(2020) Kaban, Gokturk; Iyidir, Ozlem Turhan; Sayin, Burak; Turgut, Didem; Karakaya, Emre; Haberal, Mehmet A.
INTRA-PATIENT TACROLIMUS LEVEL VARIABILITY IN BK VIRUS ASSOCIATED NEPHROPATHY
(2020) Turgut, Didem; Topcu, Deniz Ilhan; Erdogmus, Siyar; Ozdemir, F. Nurhan; Kirnap, Mahir; Haberal, Mehmet A.
The Mutation Identified in TWEAK-Fn14 Pathway May Affect the Clinical Course of IgA Nephropathy/Henoch-Schonlein Purpura Nephritis: A Case Report
(2021) Celebi, Zeynep Kendi; Turgut, Didem; Erdogmus, Siyar; Avsaroglu, Ezgi; Musabak, Haci Ugur; Colak, Turan
The TNF-like weak inducer of apoptosis (TWEAK) gene was first discovered in 1997 and its receptor Fn14 in 2001. TWEAK can be protective or damaging, depending on the status of the tissue. While basal TWEAK and Fn14 concentrations were found to be low in the kidney under normal conditions, TWEAK levels and tissue receptor expression were found to be increased in the presence of an acute injury.We report here the first case with persistent microscopic hematuria since infancy with TWEAK gene mutation, who was diagnosed with IgA Nephropathy/Henoch-Schonlein Purpura Nephritis at the age of 18 during a kidney biopsy. The genetic mutation in this patient may have caused a better course of the disease.
PARAMETERS AFFECTING ESTIMATED GLOMERULAR FILTRATION RATE AND DEVELOPING HYPERTENSION AFTER DONOR NEPHRECTOMY
(2020) Celebi, Zeynep Kendi; Turgut, Didem; Sayin, Cihad Burak; Colak, Turhan; Kirnap, Mahir; Haberal, Mehmet A.
Plasma Exchange in the Treatment of Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Retrospective Analysis
(2022) Oguz, Ebru Gok; Paydas, Saime; Hasbal, Nuri Baris; Turgut, Didem; Sahin, Hatice; Kaya, Bulent; Bahcebasi, Zerrin Bicik; Yadigar, Serap; Gok, Serdal; Ayli, Mehmet Deniz
Objective: Immunosuppressive therapy in anti-neutrophil cytoplasmic antibody-associated vasculitis is indispensable for patient and kidney survival. There is a controversy about whether the risks of plasma exchange treatment override the probability of kidney-related outcomes. Hence, the question arises in which conditions the plasma exchange will be required? In this study, we aimed to evaluate the effect of plasma exchange adding to immunosuppressive therapy in anti-neutrophil cytoplasmic antibody-associated vasculitis patients. Methods: We retrospectively analyzed 57 patients with biopsy-proven anti-neutrophil cytoplasmic antibody-associated vasculitis. We grouped patients according to treatment options with or without plasma exchange. We investigated the 1-year and 5-year patients and kidney outcomes. Results: Thirty-six (63.2%) of 57 patients were treated with plasma exchange besides the routine immunosuppressive treatment. Sixteen (44.5%) of 36 patients were with active pulmonary hemorrhage and the remaining 20 (55.5%) were with vasculitic pulmonary involvement. The survival rate was 80.7% and 68.8% in the first and fifth year, respectively. In the multivariate Cox regression analysis model, risk factors affecting patient survival were age >50 years (hazard ratio = 17.11 P =.034), pulmonary involvement (hazard ratio = 13.25, P =.02), positive perinuclear anti-neutrophil cytoplasmic antibody-associated vasculitis (hazard ratio = 5.93, P =.036), and lower albumin level (hazard ratio = 0.18, P =.014). It is found that C-reactive protein level and plasma exchange did not relate to better patient and kidney outcomes (P >.05). Conclusions: In anti-neutrophil cytoplasmic antibody-associated vasculitis, although pulmonary hemorrhage and pulmonary involvement are serious complications, plasma exchange did not provide additional benefit to standard treatment.
Sensitization Status of Patients on the Deceased Donor Kidney Transplant Waiting List: A Single-Center Experience
(2022) Erdogmus, Siyar; Celebi, Zeynep Kendi; Turgut, Didem; Sayin, Burak; Ozdemir, Fatma Nurhan; Colak, Turan; Haberal, Mehmet; 0000-0002-3462-7632; AAJ-8097-2021
Objectives: This study aimed to analyze the features of patients on the deceased donor kidney transplant waiting list and risk factors associated with sensitization that affect panel reactive antibody status in our center. Methods: Patients' data were collected retrospectively. Panel reactive antibody screening and definition tests were studied for class I (A, B, and C) and class II (DR, DP, DQ) antigens with Luminex every 6 months. Patients with panel reactive antibody >5% and antibody strength >1000 median fluorescence intensity were considered panel reactive antibody-positive. Based on the panel reactive antibody status, the patients were divided into 2 groups: the panel reactive antibody-positive group and -negative group. Results: A total of 338 patients (60% male, mean age: 52.6 +/- 14.6 years) were included in the analysis. Panel reactive antibody positivity was detected in 117 (34.6) patients on the waiting list. Compared with the panel reactive antibody-negative patient group, the panel reactive antibody-positive patient group had higher rate of women and lower age (P <.001 and P <.001, respectively). The patients in the panel reactive antibody-positive group also had longer dialysis vintage (P =.027), higher rate of blood transfusion history (P <.001), organ transplant (P <.001), and higher number of blood transfusion (P <.001). Female gender (odd ratio:4.094, 95% CI:2.275-7.368, P <.001), history of blood transfusion (odds ratio:2.027, 95% CI:1.131-3.633, P =.018), and organ transplant (odds ratio:16.894, 95% CI:7.212-39.578, P <.001) were independent risk factors associated with panel reactive antibody positivity. Conclusion: Updates of the organ allocation system to consider sensitized patients and new strategies to expand the donor pool and donation rates are needed in Turkiye.
Serum growth differentiation factor-15 analysis as a malnutrition marker in hemodialysis patients
(2021) Turgut, Didem; Topcu, Deniz Ilhan; Alperen, Cemile Cansu; Baskin, Esra; 0000-0002-1219-6368; 0000-0001-7474-5927; 34247467; E-3717-2019
Background/aim: Growth differentiation factor (GDF)-15 is related to inflammation and mortality in many conditions. We aimed to determine if an elevated serum GDF-15 level is related to nutritional status of patients on hemodialysis (HD) and mortality. Materials and methods: Routine HD patients (n = 158) were included in the study and followed for 18 months. Some malnutrition/ inflammation scoring indexes (malnutrition/inflammation score (MIS), controlling nutritional status (CONUT) score, and prognostic nutritional index (PNI)), biochemical parameters, and GDF-15 were used to build Cox regression multivariate models to study the association with mortality. Results: Among the patients, 90 (57 %) had a high MIS ( _8), which associates with worse status. The serum GDF-15 level was higher in the same group (p = 0.003). The serum GDF-15 level differentiated malnutrition/inflammation according to the MIS (p = 0.031). Age, GDF15, and C-reactive protein (CRP) were significantly associated with higher all-cause mortality risk. Patients with both age and GDF-15 above the mean had a hazard ratio of 2.76 (p = 0.006) when compared with those both < mean. Conclusion: In HD patients, the GDF-15 level is increased in worse nutritional status. Beyond the MIS, age, GDF-15 and CRP would be used together to estimate the worse clinical outcome in these patients.
SYSTOLIC BLOOD PRESSURE RESPONSE TO EXERCISE IN UNAFFECTED FAMILY MEMBERS OF AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE PATIENTS
(2019) Turgut, Didem; Coskun, Ezgi Yenigun
Tacrolimus intrapatient variability in BK virus nephropathy and chronic calcineurin toxicity in kidney transplantation
(2021) Turgut, Didem; Sayin, Burak; Soy, Ebru Ayvazoglu; Topcu, Deniz İlhan; Ozdemir, Binnaz Handan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-0993-9917; 35017328; AAJ-8097-2021; AAC-5566-2019
Intrapatient variability (IPV) in tacrolimus has been increasingly acknowledged as a risk factor for poor graft survival after kidney transplantation. Although past studies have mainly accounted for IPV in acute or chronic rejection states as due to underimmunosuppression, this is not yet clear. So far, tacrolimus IPV for BK virus-associated nephropathy (BKVN) and chronic calcineurin inhibitor toxicity (CNIT) has not been investigated. Here, we evaluated IPV in tacrolimus for BKVN and chronic CNIT, which are mainly considered as overimmunosuppression states. In this caseucontrol study, kidney allograft biopsies conducted between 1998 and 2018 were included, with patients grouped by biopsy results as BKVN alone group, CNIT alone group, and normal graft function (control group). IPV was estimated as mean absolute deviation. Our study groups included 25 kidney transplant recipients with BKVN alone, 91 patients with CNIT alone, and 60 patients with normal 5-year graft survival (control group). In analyses of IPV in tacrolimus six months before graft biopsy, IPV was highest in the BKVN group (P = 0.001). The BKVN group also had the highest IPV in tacrolimus at 12 months after biopsy (P = 0.001), with all pairwise comparisons statistically different between groups. At 12 months after biopsy, five patients (20%) in the BKVN group and 10 patients (10.9%) in the CNIT group had graft loss. Among other risk factors, BKVN and chronic CNIT are consequences related to high IPV. Quantification of IVP for tacrolimus in clinical practice would help to optimize kidney transplant outcomes.
TYROSINE KINASE INHIBITORS AND RENAL EFFECTS
(2019) Turgut, Didem; Yucel, Sebnem; Bilgin, Burak
Urinay neutrophil gelatinase-associated lipocalin as a biomarker in different renal problem
(2020) Turgut, Didem; Piskinpasa, Serhan Vahit; Yenigun, Ezgi Coskun; Aydemir, Nihal; Dede, Fatih; 0000-0001-7474-5927; 32927927; AAI-9418-2021
Background/aim: Neutrophil gelatinase-associated lipocalin (NGAL) is used previously to estimate the etiology, severity, and clinical outcomes of acute kidney injury (AKI). However, the role of urinary NGAL (uNGAL) in the postrenal setting is not clear. In our study, we aimed to discover the cut-off value of uNGAL that can be used in the differential diagnosis of underlying AKI etiologies. Materials and methods: In this prospective cross-sectional study, we examined 82 subjects in four groups: patients that had (1) postrenal AKI; (2) AKI other than postrenal etiologies; (3) stable chronic kidney disease; and (4) healthy subjects. A renal function assessment was carried out by measuring serum creatininc (sCr) and uNGAL at the time of diagnosis [0th min (T0)]. We followed the study group for three months. Results: At the time of diagnosis, sCr (T0) was highest in the postrenal AKI and AKI groups in contrast to stable chronic kidney disease patients and healthy subjects (P < 0.001), as expected. T0 median uNGAL was highest in the postrenal group (P < 0.001). Area under curve (AUC) of uNGAL to estimate postrenal AKI presence was 0.957 (95% CI, 0.897-1.000; P < 0.001). The cut-off point of uNGAL was 42.625 ng/mL for this estimation. Conclusion: Patients with AKI must be classified according to the underlying etiologies as soon as possible. uNGAL may be useful to estimate the etiologies, and whether the problem is acute or chronic in the course. In postrenal kidney problems, to plan the urgency of the urologic procedures, it is crucial.