Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Secondary Hyperparathyroidism Is Associated with Pulmonary Hypertension in Older Patients with Chronic Kidney Disease and Proteinuria(2015) Genctoy, Gultekin; Arikan, Serap; Gedik, Olcay; 0000-0002-5145-2280; 0000-0001-5752-3812; 25537827; AAJ-5551-2021; AAM-4084-2021; AAJ-1289-2021Hyperparathyroidism is associated with pulmonary vascular calcification and pulmonary hypertension (PH) in a chronic kidney failure dog model, and increased prevalence of PH and a PH-hyperparathyroidism relationship in pre-dialysis chronic kidney disease (CKD) and hemodialysis patients are reported. This study investigated the prevalence of PH and relationships between PH and metabolic abnormalities in patients with stage 1-4 proteinuria CKD. One-hundred and ninety patients (mean age 61 +/- A 17.4, 116 males) with proteinuria CKD and no coronary diseases, congestive heart failure, smoking history, and pulmonary diseases were enrolled. Estimated glomerular filtration rate was 39.7 +/- A 23 ml/min. CKD etiology was diabetes mellitus in 52 (27.3 %), chronic glomerulonephritis or tubulointerstitial nephritis in 56 (29.4 %), hypertension in 36 (19 %), and other etiologies (nephrolithiasis, obstructive nephropathy, and amyloidosis) in 46 (25.3 %) patients. Echocardiography was performed, and systolic pulmonary artery pressure (PAP) and left ventricular ejection fraction were determined. Laboratory tests examined lipid parameters, serum albumin, urea, creatinine, calcium, phosphorus, C-reactive protein, parathyroid hormone, ferritin, and hemoglobin levels. PH (PAP > 35 mmHg) was detected in 68 patients (35.9 %). Patients with PH were older (68 +/- A 12.3 vs. 52.1 +/- A 16.7, p = 0.03), had lower ejection fractions (51.3 +/- A 13.4 vs. 60.8 +/- A 9.1 %, p = 0.003), lower hemoglobin (11.3 +/- A 1.5 vs. 12.1 +/- A 1.9, p = 0.05), and higher parathyroid hormone (218 +/- A 159.3 vs. 127.7 +/- A 67.4 pg/ml, p = 0.05) levels. The remaining parameters were similar between groups. Older age, lower ejection fraction, and secondary hyperparathyroidism may contribute to PH in stage 1-4 proteinuria CKD.Item Clinicopathologic Study of Kidney Biopsies in Patients Before or After Liver Transplant(2014) Terzi, Aysen; Ozdemir, Binnaz Handan; Taslica, Firdevs Zeynep; Ozdemir, Fatma Nurhan; Kirnap, Mahir; Haberal, Mehmet; https://orcid.org/0000-0002-1225-1320; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0002-5682-0943; https://orcid.org/0000-0002-3462-7632; 24635810; F-7546-2013; X-8540-2019; AAK-1697-2021; AAH-9198-2019; AAJ-8097-2021Objectives: The purpose of this study was to evaluate the causes of kidney impairment associated with liver transplant in patients who had kidney biopsy before or after liver transplant. Materials and Methods: In 408 patients who had liver transplant from January 1990 to December 2012, there were 10 patients who had kidney biopsy (total, 19 kidney biopsies) for evaluation of kidney dysfunction. A retrospective review of clinical records and kidney biopsies was performed. Results: There were 7 male and 3 female patients (median age at liver transplant, 43 y; range, 10 to 62 y). The most frequent reason for liver transplant were hepatitis B virus cirrhosis (4 patients). There were 3 patients who had a kidney transplant before or concurrent with liver transplant. Increased serum creatinine level was the most common clinical finding at the time of kidney biopsy. The median interval from liver transplant to kidney biopsy was 495 days (mean, 1025 d; range, 10-4980 d). The most common pathology in the kidney biopsies was immune complex glomerulonephritis (total, 7 patients: IgA nephropathy, 4 patients; lupus nephritis, 2 patients; membranoproliferative glomerulonephritis, 1 patient). There were 4 patients who had allergic tubulointerstitial nephritis, 2 patients who had chronic calcineurin inhibitor nephrotoxicity, and 1 patient who had karyomegalic nephropathy. There were 7 patients who died at mean 34 months (range, 1-70 mo) after liver transplant. The other 3 patients were alive at mean 128 months (range, 67-193 mo) after liver transplant and had a functioning liver graft and chronic kidney disease. Conclusions: Chronic kidney disease after liver transplant has a major effect on mortality. The frequency of immune complex glomerulonephritis associated with liver transplant may be greater than previously recognized.Item Assessment of Myocardial Mechanics in Patients with End-Stage Renal Disease and Renal Transplant Recipients Using Speckle Tracking Echocardiography(2015) Pirat, Bahar; Bozbas, Huseyin; Simsek, Vahide; Sade, L. Elif; Sayin, Burak; Muderrisoglu, Haldun; Haberal, Mehmet; 0000-0002-9635-6313; 0000-0003-4576-8630; 0000-0003-3737-8595; 0000-0002-3462-7632; 0000-0001-8287-6572; 25894162; AAG-8233-2020; AAI-8897-2021; AAQ-7583-2021; AAJ-8097-2021; J-3707-2015Objectives: Velocity vector imaging allows quantitation of myocardial strain and strain rate from 2-dimensional images based on speckle tracking echocardiography. The aim of this study was to analyze the changes in myocardial strain and strain rate patterns in patients with end-stage renal disease and renal transplant recipients. Materials and Methods: We studied 33 patients with end-stage renal disease on hemodialysis (19 men; mean age, 36 +/- 8 y), 24 renal transplant recipients with functional grafts (21 men; mean age, 36 +/- 7 y) and 26 age- and sex-matched control subjects. Longitudinal peak systolic strain and strain rate for basal, mid, and apical segments of the left ventricular wall were determined by velocity vector imaging from apical 4- and 2-chamber views. The average longitudinal strain and strain rate for the left ventricle were noted. From short-axis views at the level of papillary muscles, average circumferential, and radial strain, and strain rate were assessed. Results: Mean heart rate and systolic and diastolic blood pressure during imaging were similar between the groups. Longitudinal peak systolic strain and strain rate at basal and mid-segments of the lateral wall were significantly higher in renal transplant recipients and control groups than end-stage renal disease patients. Average longitudinal systolic strain from the 4-chamber view was highest in control subjects (-14.5% +/- 2.9%) and was higher in renal transplant recipients (-12.5% +/- 3.0%) than end-stage renal disease patients (-10.2% +/- 1.6%; P <= .001). Radial and circumferential strain and strain rate at the level of the papillary muscle were lower in patients with end-stage renal disease than other groups. Conclusions: Differences in myocardial function in patients with end-stage renal disease, renal transplant recipients, and normal controls can be quantified by strain imaging. Myocardial function is improved in renal transplant recipients compared with end-stage renal disease patients.Item Urinary N-Acetyl-Beta-D Glucosaminidase Activity is Associated with Inflammation and Proteinuria in Diabetic and Non-Diabetic Patients with Different Stages of Chronic Kidney Disease(2015) Genctoy, Gultekin; Arikan, Serap; 0000-0002-5145-2280; 0000-0001-5752-3812; AAJ-5551-2021; AAM-4084-2021OBJECTIVE: Clinical studies have demonstrated that tubulointerstitial rather than glomerular pathology correlates with the degree and progression of renal impairment. Urinary n-acetyl-betaD- glucosaminidase (NAG) is a biomarker of tubular damage, shown to be elevated in patients with glomerulonephritis and acute kidney injury. However, it has not been assessed longitudinally in chronic kidney disease (CKD). The aim of the present study was to determine urinary NAG activity and its possible associations with metabolic and inflammatory parameters in CKD. MATERIAL and METHODS: A total of 72 patients (mean age: 64.5 +/- 15.7) with stage 1-5 CKD were included. Of the 72 patients 23 (32%) had diabetic nephropathy and 49 (68%) had different types of primary glomerular diseases. Fasting blood samples were collected to analyse complete blood count, urea, creatinine, albumin, lipid parameters, C-reactive protein, uric acid and parathyroid hormone. 24-hour urine was collected to determine protein excretion. Urinary NAG and creatinine levels were analysed from the first morning urine samples. The NAG index (urinary NAG/ creatinine) was used to exclude dilutional errors. RESULTS: Mean eGFR was 38.3 +/- 21.7 ml/min. The urinary NAG index was significantly higher in stage 3 compared to stage 2 (32.1 +/- 23.5 vs. 7.5 +/- 3.3 U/gr-creatinine; p=0.002) and lower in stage 5 compared to stage 3 CKD (8.2 +/- 7.6 vs. 32.1 +/- 23.5; p=0.017). The urinary NAG index was positively correlated with 24-hour urine protein excretion (r=0.43; p=0.0001) and serum CRP (r=0.549; p=0.04) and negatively correlated with hemoglobin levels (r-0.394; p=0.004). CONCLUSION: The present study demonstrated that urinary NAG correlates with systemic inflammation and proteinuria and may be associated with progression of CKD.Item Relation of Anxiety, Depression, and Behavioral Problems With Time Allocated to Television, Computer, and Smartphone in Children Receiving Renal Replacement Therapy(2022) Taner, Hande Ayraler; Baskin, Esra; Kaya, Zulal Torenli; Sari, Burcu Akin; Taskiran, Candan; Akdur, Aydincan; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0003-1428-0739; https://orcid.org/0000-0002-9730-7206; https://orcid.org/0000-0002-3462-7632; 35384817; AAK-7065-2021; S-3910-2019; AAJ-8097-2021Objectives: Children and adolescents with chronic diseases have more screen exposure time compared with their healthy peers. In this study, we investigated screen exposure time of children who received renal replacement therapy, which included kidney transplant and dialysis treatment, versus a healthy control group. Materials and Methods: Our study included 55 children and adolescents between the ages of 8 and 18 years. Although 28 participants did not have any chronic disease, 27 had chronic diseases and received renal replacement therapy. Among these patients, 17 had kidney transplant and 10 were receiving dialysis. A sociodemographic information form and the Conners Short-Form Parent Rating Scale were given to parents. Pediatric and adolescent patients completed the Children's Depression Inventory and Spielberger State-Trait Anxiety Scale-2. We analyzed differences between the groups with and without renal replacement therapy and examined relations between continuous variables. Results: Duration of television screen time was significantly higher in children and adolescents receiving renal replacement therapy. Patients in the renal replacement therapy group showed a positive correlation between the Conners Short-Form Parent Rating Scale anxiety subscores and duration of smartphone use. In the kidney transplant recipient group, smartphone and computer durations were positively correlated and television duration was negatively correlated with the Conners Short-Form Parent Rating Scale behavioral problems subscores. Conclusions: Children on renal replacement therapy may be at risk in terms of excessive television exposure. Children who are on dialysis and have had a kidney transplant may be more prone to the negative effects of screen exposure than healthy peers who do not have chronic illnesses. These children and adolescents should be closely monitored to avoid the negative effects of excessive screen exposure.Item Aortic Root Dissection After Coronary Artery Bypass Operation(2017) Altay, Hakan; Gulmez, Oyku; Ozker, Emre; 0000-0002-9429-5430; AAE-1392-2021; ABC-7134-2021Item Follow-Up Results of Patients with ADCK4 Mutations and the Efficacy of Coq10 Treatment(2017) Atmaca, Mustafa; Gulhan, Bora; Korkmaz, Emine; Inozu, Mihriban; Soylemezoglu, Oguz; Candan, Cengiz; Bayazit, Aysun Karabay; Elmaci, Ahmet Midhat; Parmaksiz, Gonul; Duzova, Ali; Besbas, Nesrin; Topaloglu, Rezan; Ozaltin, Fatih; https://orcid.org/0000-0003-2373-1837; 28337616; AAM-2935-2021ADCK4-related glomerulopathy is an important differential diagnosis in adolescents with steroid-resistant nephrotic syndrome (SRNS) and/or chronic kidney disease (CKD) of unknown origin. We screened adolescent patients to determine the frequency of ADCK4 mutation and the efficacy of early CoQ10 administration. A total of 146 index patients aged 10-18 years, with newly diagnosed non-nephrotic proteinuria, nephrotic syndrome, or chronic renal failure and end-stage kidney disease (ESKD) of unknown etiology were screened for ADCK4 mutation. Twenty-eight individuals with bi-allelic mutation from 11 families were identified. Median age at diagnosis was 12.4 (interquartile range [IQR] 8.04-19.7) years. Upon first admission, all patients had albuminuria and 18 had CKD (6 ESKD). Eight were diagnosed either through the screening of family members following index case identification or during genetic investigation of proteinuria in an individual with a history of a transplanted sibling. Median age of these 8 patients was 21.5 (range 4.4-39) years. CoQ10 supplementation was administered following genetic diagnosis. Median estimated glomerular filtration rate (eGFR) just before CoQ10 administration was 140 (IQR 117-155) ml/min/1.73m(2), proteinuria was 1,008 (IQR 281-1,567) mg/m(2)/day. After a median follow-up of 11.5 (range 4-21) months following CoQ10 administration, proteinuria was significantly decreased (median 363 [IQR 175-561] mg/m(2)/day, P=0.025), whereas eGFR was preserved (median 137 [IQR 113-158] ml/min/1.73m(2), P=0.61). ADCK4 mutations are one of the most common causes of adolescent-onset albuminuria and/or CKD of unknown etiology in Turkey. CoQ10 supplementation appears efficacious at reducing proteinuria, and may thereby be renoprotective.Item Utility Of Continuous Performance Test (MOXO-CPT) In Children With Pre-Dialysis Chronic Kidney Disease, Dialysis And Kidney Transplantation(2022) Buyukkaragoz, Bahar; Soysal Acar, A. Sebnem; Ekim, Mesiha; Bayrakci, Umut Selda; Bulbul, Mehmet; Caltik Yilmaz, Aysun; Bakkaloglu, Sevcan A.; 000829126000001Background Children with chronic kidney disease and on kidney replacement therapy may have neurocognitive and psychosocial disorders. Although kidney transplantation improves quality of life, psychological problems may exist in children who undergo kidney transplantation. Herein, we aimed to investigate attention-deficit hyperactivity disorder-like symptoms with MOXO-continuous performance test in children with pre-dialysis chronic kidney disease, dialysis and kidney transplantation. Methods The MOXO-continuous performance test measures four domains of attention-deficit hyperactivity disorder-like symptoms, including attention, timeliness, hyperactivity and impulsivity. Patients with at least three scores < - 1.5 standard deviations were considered as positive to MOXO-continuous performance test. Test scores of the pre-dialysis chronic kidney disease, dialysis (divided into peritoneal dialysis and hemodialysis subgroups) and kidney transplantation groups were compared. Correlations of test scores with the patient's clinical and laboratory characteristics and effects of hospitalizations and schooling were assessed. Results Seventy-two patients aged 13.3 +/- 3.4 years (23 with kidney transplantation, 23 on dialysis and 26 with pre-dialysis chronic kidney disease) were evaluated. Overall MOXO-continuous performance test positivity was 29%. No differences were detected between the three groups concerning total or z scores. Attention and timeliness z scores were significantly higher in females (p = 0.004 and p = 0 .008 , respectively). Age was positively correlated to attention and timeliness total scores (p = 0.000, r = 0.445 and p = 0.004, r = 0.243, respectively), and inversely correlated to hyperactivity total scores (p = 0.000, r = - 0.415). Conclusions Prevalence of attention-deficit hyperactivity disorder-like symptoms in the study population was much higher than that of pediatric attention-deficit hyperactivity disorder. We believe that the MOXO-continuous performance test is a valid supportive measure for evaluation of attention-deficit hyperactivity disorder diagnosis in children with various stages of chronic kidney disease or on kidney replacement therapy.Item Associations between nutritional factors and excessive daytime sleepiness in older patients with chronic kidney disease(2021) Heybeli, Cihan; Soysal, Pinar; Oktan, Mehmet Asi; Smith, Lee; Celik, Ali; Kazancioglu, Rumeyza; 0000-0001-7903-1106; 34448151; AHC-6473-2022Background Excessive daytime sleepiness (EDS) is prevalent in not only older adults, but also patients with chronic kidney disease (CKD), and is associated with higher risks of morbidity and mortality. Aims The aim of the present study is to determine associations between EDS and nutritional status and serum nutrient levels in older patients with CKD. Methods This cross-sectional study included 367 patients (aged >= 65 years) with CKD (eGFR < 60 ml/min/1.73 m(2) and/or > 30 mg/day of albuminuria for > 3 months). EDS was recorded using the Epworth Sleepiness Scale (a score of >= 11). Malnutrition was diagnosed according to the Mini Nutritional Assessment (MNA) tool (a score of < 17). Results The mean age was 81 +/- 7 years, and 248 (67%) were female. EDS was seen in 99 (26.9%) patients. Those with EDS had significantly lower MNA scores and more frequent malnutrition than those without EDS (p < 0.05). In multivariable analysis adjusted for age, sex, cerebrovascular disease, dementia, number of drugs, and number of urinations at night, and the Charlson Comorbidity Index the relationship between malnutrition and EDS persisted (OR 2.58, 95% CI 1.38-4.83, p = 0.003). There was no significant difference between the presence of EDS and serum levels or deficiencies of vitamin D, vitamin B-12, and folate (p > 0.05). Conclusions EDS is associated with malnutrition in older patients with CKD. Therefore, EDS and nutritional status should be evaluated together in clinical practice. However, future studies are needed to determine the direction of the association between malnutrition and EDS and to evaluate if dietary intervention can improve EDS.