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Öğe The 2-year follow-up results of lyso-GB3 levels in patients with Fabry disease(Academic Press Inc Elsevier Science, 2018) Turkmen, Kultigin; Selcuk, Nedim Yilmaz; Tonbul, Halil Zeki; Baloglu, Ismail[Abstract Not Availabe]Öğe Are Kidney Donor Risk Index/Kidney Donor Profile Index Scores Predictor of Future Graft Function?(Wolters Kluwer Medknow Publications, 2021) Baloglu, Ismail; Tonbul, Halil; Turkmen, Kultigin; Selcuk, Nedim; Iyisoy, Mehmet SinanKidney donor profile index (KDPI) is a method developed to assess donor kidney quality for cadaveric transplants. We investigated the relationship between kidney donor risk index (KDRI) and KDPI scores of cadaveric transplants in the last five years in our clinic and current graft conditions. Forty people (12 females, 28 males; mean age, 46.35 + 8.94 years), who underwent cadaveric transplantation between January 2013 and March 2018, were participated in this study. At the same time, the KPDI and KDRI scores of the donor's kidneys were calculated and then compared with that of the recipients' data. The mean KDRI value of donors was 1.11 & PLUSMN; 0.33 and the median KDPI value was 60.50%. KDRI/KDPI scores were found to be high in women (P = 0.021) and, when the posttransplant findings of the recipients were evaluated by bivariate correlation analysis KDRI/KDPI scores were positively correlated with the day when creatinine (Cr) values started to fall off spontaneously (r = 0.457, P = 0.003). It was observed that recipients who were transplanted from the donors with high KDRI/KDPI scores had higher Cr levels (P < 0.01) and this relationship did not change over time (P = 0.115). When the donors were grouped as the standard-criteria donor and expanded-criteria donor (ECD); we found that the relationship between KDRI/KDPI, creatinine, and time was more significant in the ECD group (P = 0.04). KDRI/KDPI scores are closely related to graft outcomes especially in recipients that have kidneys from marginal donors. Therefore, evaluation of KDRI/KDPI scores might be required in marginal donors.Öğe BK Virus Nephropathy in Renal Transplantation: Case Series and Review of the Literature(Aves, 2020) Baloglu, Ismail; Turkmen, Kultigin; Esen, Haci Hasan; Selcuk, Nedim Yilmaz; Tonbul, Halil ZekiObjective: BK virus nephropathy (BKVN) is an important cause of kidney transplant failure. In this study, we aimed to evaluate our center's experience with BKVN in patients who had undergone renal transplantation and also discussed important aspects of the disease in this patient population. Materials and Methods: In this study, 8 patients with BKVN were evaluated retrospectively, having been selected from a group of 330 patients (178 females, 152 males; mean age: 48.37 +/- 13.25 years) who had undergone renal transplantation between 2007 and 2017 and were followed up at our center. Results: BKVN was detected in 8 of 330 renal transplantation patients (4 females, 4 males; mean age: 51.25 +/- 11.14 years). Their immunosuppressive regimen consisted of tacrolimus (FK), mycophenolate mofetil (MMF), and methylprednisolone. To reduce immunosuppressive dose, FK was discontinued in 3 patients, and they were switched to everolimus. In 2 of 7 patients, MMF was discontinued, and they were switched to azathioprine. FK or MMF doses were reduced in the8 patients with BKVN. Out of the 8 patients, cidofovir was administered to 1 patient, whereas intravenous immunoglobulins were administered to 3 patients. Additionally, pulse steroid treatment was administered to 1 patient who was diagnosed with acute rejection based on allograft biopsy findings. Among the 8 patients with BKVN, 1 (12.5%) experienced graft loss and was returned to hemodialysis treatment. Conclusion: Although new alternative treatments are available, immunosuppressive dose reduction is still considered the most effective treatment. Therefore, we believe that effective screening and preemptive strategies should be defined more clearly instead of focusing on treatment strategies.Öğe C3 glomerulopathy and atypical hemolytic uremic syndrome: an updated review of the literature on alternative complement pathway disorders(Springer, 2021) Turkmen, Kultigin; Baloglu, Ismail; Ozer, HakanThe complement system plays a significant role within the pathological process of C3 glomerulopathy (C3GP) and atypical hemolytic uremic syndrome (aHUS). In daily practice, clinicians should differentiate the subgroups of C3GP because of they should apply different treatment modalities. In the past, C3GP was considered as a part of membranoproliferative glomerulonephritis (MPGN). MPGN is defined as glomerular capillary thickening secondary to the synthesis of the new glomerular basement membrane and mesangial cellular hyperplasia with mesangial matrix expansion. Atypical hemolytic uremic syndrome is an ultra-rare disease that can be outlined by the triad of Coombs negative microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Recent advances demonstrated that these diseases share common abnormalities of the control of the alternative complement system. Therefore, nowadays, most researchers advocate that there may be overlap in the pathogenesis of C3GP and aHUS. This review will provide recent novel mechanisms and treatment options in these diseases. For the purposes that we mentioned above and to help clinicians, we aimed to describe the etiology, pathophysiology, and treatment of C3GP and aHUS in this comprehensive review.Öğe Can Resistance Be Resolved with Lanthanum Carbonate in the Treatment of Hyperphosphatemia? A Multicenter Experience(Aves, 2023) Tonbul, Halil Zeki; Baloglu, Ismail; Ozer, Hakan; Oymak, Oktay; Altintepe, Lutfullah; Ersoy, Fettah FevziObjective: Kidney osteodystrophy is a condition that both reduces the quality of life and shortens the life span in patients with chronic kidney disease. Lanthanum carbonate is a phosphorus-binding agent that forms very tight complexes with phosphate ions, has low systemic absorption potential, and does not contain calcium and aluminum. The aim of this study was to evaluate the efficacy of lanthanum carbonate in patients with resistant hyperphosphatemia. Methods: One hundred four hemodialysis patients (44 females and 60 males; mean age: 59.5 +/- 4 years) whose serum phosphorus level was above 6 mg/dL despite the use of phosphorus-binding drugs (calcium acetate, calcium carbonate, and/or sevelamer) were included in this study. The patients were followed prospectively for 6 months. Results: Twenty (19.2%) patients included in the study could not use the drug regularly due to difficulties in using it and nausea, while 84 (28 females and 56 males) patients used the drug regularly for 6 months. Lanthanum carbonate was used at a dose of 3 x 750 mg in 37 patients and 3 1000 mg in 47 patients. While 72.6% of the patients used the drug by mixing it with food, the rest drank it with water. The most common side effects were nausea, constipation, and itching. Four different centers from 3 cities in Turkey participated in the study. When the patients who used it regularly were evaluated, after lanthanum carbonate use, the mean phosphorus level decreased from 6.9 +/- 0.7 mg/dL to 5.97 +/- 0.9 mg/dL (P =.02). The levels of calcium-phosphorus products were 62.12 +/- 9.89 before lanthanum carbonate treatment and 57.6 +/- 11.52 after treatment (P =.023).The levels of. It was observed that the mean parathormone levels decreased from 657 +/- 48 pg/mL to 521 +/- 36 pg/mL after treatment (P =.031). While none of the patients could take vitamin D due to hyperphosphatemia before the treatment, 52 patients could use vitamin D together with lanthanum carbonate. When 36 patients whose serum phosphorus level decreased with treatment but did not fall below 5.5 mg/dL were examined, it was observed that the mean parathyroid hormone level (708 +/- 27 vs. 558 +/- 30 pg/mL, P =.041) and the rate of patients using cinacalcet were higher in this group (41% vs. 8%). Conclusion: We found that serum phosphorus, calcium-phosphorus products, and parathyroid hormone levels decreased significantly with lanthanum carbonate treatment in patients with resistant hyperphosphatemia. As a result of our findings, we think that resistant hyperphosphatemia can be effectively treated with lanthanum carbonate in most hemodialysis patients without severe hyperparathyroidism.Öğe The Characteristics of Patients Returning to Hemodialysis due to Nonfunctioning Graft in Turkey(Wolters Kluwer Medknow Publications, 2019) Altun, Ilkem; Selcuk, N. Yilmaz; Baloglu, Ismail; Turkmen, Kultigin; Tonbul, H. ZekiRenal transplantation is the most effective treatment modality for end-stage renal failure. According to the Ministry of Health Organ Transplant Registration System, despite the presence of 14,936 renal transplant recipients in Turkey, there are not enough data about the prognosis of these patients. Therefore, we aimed to ascertain the rate of patients returning to hemodialysis (HD) due to nonfunctioning graft in our country. One thousand four hundred and ninety-eight (males: 826, females: 672) HD patients who undergo HD at 22 HD centers in total, from different geographical regions to represent our country were examined retrospectively. The informations were obtained from patient registry files and anamnesis which were in HD centers. The number of patients returning to HD due to the loss of graft function was 77 (males: 56, females: 21). Eleven of the patients had transplantation from cadavers (14%) and 66 from living donors (86%). Prevelance of patients, who return to HD after the failure of renal transplantation, between HD patients was 5.1. The mean duration of return to HD after renal transplantation was 6.7 +/- 5.9 years for all patients. There was no significant difference in the duration without HD after transplantation between two groups when cadaveric and living donor transplants were compared (P = 0.759). There was no statistically significant difference in duration without HD after transplantation between patients receiving HD treatment before transplantation and preemptive transplant (P = 0.212). The prevelance of patients, who return to HD due to nonfunctioning graft among HD patients was 5.1. The duration without HD were similar after transplantation from both cadavers and living donors. The duration without HD was found longer among those who were operated before 2000.Öğe The effect of Ramadan fasting on kidney function in patients with chronic kidney disease(Springer, 2020) Baloglu, Ismail; Turkmen, Kultigin; Kocyigit, Ismail; Altunoren, Orcun; Demirtas, Levent; Zararsiz, Gokmen; Eroglu, ErayPurpose Because of the increase in globalization, clinicians all over the world are confronted the questions about safety of Ramadan fasting. However, there is no clear information about whether there is an obstacle for fasting patients with chronic disease. Hence, in the present study, we aimed to investigate the effects of Ramadan fasting on kidney and the factors affecting this relationship in patients with chronic kidney disease. Methods This study involving 117 patients [36 females, 81 males; mean age, 60 (46.0-70.0) years] with stage 2-3 chronic kidney and fasting. Patients were evaluated every 10 days for acute kidney injury (AKI) in Ramadan month. And, patients with acute kidney injury and patients without AKI were grouped. Results When the patients were evaluated for AKI, we observed that in 27 patients had acute kidney injury. While patients without AKI fasted for more days (p < 0.001), urea levels and frequency of hypertension were higher in the group with AKI (p = 0.019;p = 0.025 respectively). We also performed univariate and multiple binary logistic regression analysis to identify the risk factors of AKI. Hypertension and number of fasting day were found to be predictive of AKI (p = 0.02;p < 0.001 respectively). Conclusions We found a significant relationship between hypertension, the number of fasting days and acute kidney injury. Patients with chronic kidney damage and hypertension should be evaluated more carefully, informed about the importance of hydration after fasting and should be followed frequently for AKI.Öğe The Effect of Two Different Bicarbonate-Containing Dialysis Solutions on Acidosis Control in Hemodialysis Patients(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2017) Baloglu, Ismail; Tonbul, Halil Zeki; Selcuk, Nedim Yilmaz; Turkmen, KultiginOBJECTIVE: In hemodialysis patients; there is a continuing tendency to metabolic acidosis. In studies, the relationship between serum bicarbonate concentration and dialysis mortality has been determined. In our study, the effect of 32 and 36 mmol/L bicarbonate-containing dialysis solution on acidosis control was investigated. MATERIAL and METHODS: In a hemodialysis clinic, a 32 mmol/L bicarbonate-containing dialysate was used in the first six months and a 36 mmol/L bicarbonate-containing dialysate was used in the second six months. The study was performed on 91 (43M/48F) patients. Plasma bicarbonate levels before and after dialysis were compared. RESULTS: In the first period, only 30 patients' bicarbonate levels were 22 mmo1/1, or more. In the second period, the mean bicarbonate level was 23.59 +/- 3.3 mmol/L. However, the level of bicarbonate after dialysis was above 30 mmol/L in 19 patients. In patients with predialysis acidosis, the interdialytic mean weight gain was higher than in the group without acidosis (p<0.05). There were no significant differences between the two periods in terms of predialysis urea, Kt/V, albumin, potassium and CRP levels. CONCLUSION: Acidosis control is better with the use of a dialysis solution containing 36 mmol/L bicarbonate. But at the end of dialysis, severe metabolic alkalosis developed on approximately twenty percent of patients. This situation can trigger arrhythmia. We therefore think that it is necessary to adjust the machine bicarbonate in the use of high bicarbonate solution in patients with arrhythmia or alkalosis tendency.Öğe Evaluation of Hemodialysis Adequacy: Correlation between Kt/Vurea and Other Methods(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2019) Baloglu, Ismail; Selcuk, N. Yilmaz; Evran, Hatice; Tonbul, Halil Zeki; Turkmen, KultiginObjective: Uremic toxins must be adequately cleared to reduce mortality and morbidity in chronic hemodialysis patients. The second-generation Daugirdas formula (D) is recommended for measurement of hemodialysis adequacy according to the guidelines specified by Kidney Disease Outcomes Quality Initiative (KDOQI) in guidelines. We aimed to compare the Kt/V ratio obtained by D (D Kt/V) to the urea reduction ratio (URR) and the Online Clearance Monitor (OCM (R)). Materials and Methods: Our research is across-sectional study on 48 patients who are on maintenance hemodialysis (HD). A total of 1990 HD sessions were performed 3 times a week for 4 hours each day for 3 months. Ionic dialysate was measured by OCM module of the Fresenius 4008 C machine. In the same HD session, URR and Kt/V ratio were calculated using a single-pool Daugirdas formula. Results: This study included 48 (Male: 24, Female: 24) adult chronic HD patients. Mean age of the patients was 54.5 +/- 18.1 years (16-81 years). Mean Kt/V value was found be higher when calculated using D formula (1.54 +/- 0.36) than what was measured by ionic dialysate (1.37 +/- 0.32) (p<0.0001). Comparison between D Kt/V and URR showed a statistically relevant significance (p<0.0001, r=0.92). Mean ultrafiltration (UF) was 1521 +/- 1054 milliliters per session. When D Kt/V was calculated without UF, the mean Kt/V value measured by ionic dialysate was not different from D Kt/V without considering UF (1.43 +/- 0.32) (p=0.101). In spite of the fact that URR was positively correlated with two formulas, the relationship between D Kt/V and URR was statistically more significant. Conclusion: In our study, Kt/V calculated with D formula was higher than Kt/V measured by OCM. If the Daugirdas formula was calculated without considering UF, the Kt/V found by both methods was similar. Even though the URR correlated with two formulas, the relationship between D Kt/V and URR was statistically more significant. OMC is a practical tool that can help us to assess hemodialysis adequacy.Öğe EVALUATION OF LONG TERM THIRST DUE TO RAMADAN FASTING IN TERMS OF ACUTE KIDNEY INJURY(Oxford Univ Press, 2017) Pektas, Fatih; Tonbul, H. Zeki; Baloglu, Ismail; Turkmen, Kultigin; Selcuk, N. Yilmaz; Erdur, F. Mehmet[Abstract Not Availabe]Öğe Evaluation of Long-Term Thirst due to Ramadan Fasting in Terms of Acute Kidney Injury(Aves, 2020) Baloglu, Ismail; Pektas, Fatih; Tonbul, Halil Zeki; Selcuk, Nedim Yilmaz; Turkmen, KultiginObjective: Acute kidney injury (AKI) is characterized by a rapid decline (i.e., within hours and days) of renal function. Longterm thirst due to fasting may cause a decrease in both the intravascular volume and kidney perfusion. The aim of this study was to investigate the relationship between long-term thirst due to fasting and AKI. Materials and Methods: Forty-five individuals (24 females, 21 males; mean age, 75 +/- 12 years) whose kidney function was normal and who were fasting during the month of Ramadan in 2014 participated in the study. The participants were divided into three groups: the first group was aged >60 years and using angiotensin-converting enzyme inhibitors for hypertension, the second group was aged >60 years and did not use drugs, and the third group was aged <40 years. The thirst period was 18 hours. The Acute Kidney Injury Network (AKIN) criteria were used for AKI diagnosis. Results: When all groups were evaluated according to the AKIN-urinary output criteria, the first 6-hour period was the AKI stage1, and the final 12-hour period was the AKI stage 2. There was a small (0.06 mg/dL) but significant increase in the mean serum creatinine level in all groups (p=0.001). Cases could not be evaluated in terms of the AKIN creatinine criteria because the thirst period was not 48 hours long and the increase in creatinine levels was not >0.3 mg/dL. Conclusion: The thirst due to fasting did not increase the risk of AKI in the population with a normal kidney function, and the AKIN-urinary output criteria alone were not adequate to evaluate AKI in patients who were fasting during the month of Ramadan.Öğe FGF-23 AND KLOTHO LEVELS IN RENAL TRANSPLANT PATIENTS AND COMPARISON WITH HEMODIALYSIS PATIENTS(Oxford Univ Press, 2017) Baloglu, Ismail; Turkmen, Kultigin; Selcuk, N. Yilmaz; Tonbul, H. Zeki; Erdur, F. Mehmet[Abstract Not Availabe]Öğe How effective are the 6 European Society of Immunodeficiency warning signs for primary immunodeficiency disease?(Elsevier Science Inc, 2016) Arslan, Sevket; Ucar, Ramazan; Caliskaner, Ahmet Zafer; Reisli, Ismail; Guner, Sukru Nail; Sayar, Esra Hazar; Baloglu, IsmailBackground: The European Society of Immunodeficiency (ESID) developed 6 warning signs to promote the awareness of adult primary immunodeficiency disease (PID). Objective: To screen adult patients for the presence of PID using these 6 warning signs to determine the effectiveness of this protocol. Methods: Questions related to the ESID warning signs for adult PID were added to the standard outpatient clinic file system and asked of 3,510 patients who were admitted to our clinic for any reason. Patients with signs and/or suspicion of PID based on their medical history underwent immunologic investigation. Results: In total, 24 patients were diagnosed as having a PID. The most common reason that patients with PID were admitted was frequent infection (n = 18 [75%]), and the most common PID subgroup was common variable immunodeficiency (n = 12 [50%]). Twenty patients with PID had at least one positive finding according to the ESID warning signs. Two patients with gastrointestinal concerns and 2 with dermatologic symptoms were also diagnosed as having a PID, although they did not have any of the ESID warning signs. Conclusion: The ESID warning signs do not specify the need for symptoms to diagnose a PIDs and do not include a comprehensive list of all signs and symptoms of PIDs. As a result, more than infection-centric questions are needed to identify adult patients with immunodeficiencies. (C) 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.Öğe The importance of Oxalobacter formigenes and oxalic acid in the pathogenesis of chronic kidney disease(Springer, 2018) Baloglu, Ismail; Turkmen, Kultigin[Abstract Not Availabe]Öğe Individualized hemodialysis: Is similar hemodialysis adequacy possible using less water?(Tubitak Scientific & Technological Research Council Turkey, 2023) Aktas, Ali; Ozer, Hakan; Baloglu, Ismail; Tonbul, Halil Zeki; Guney, Ibrahim; Selcuk, Nedim YilmazBackground and aim: There are over 60,000 hemodialysis (HD) patients in Turkiye, and the number of patients is increasing yearly. Dialysate flow rate (Qd) is a factor in HD adequacy. Approximately 150 L of water are consumed per session to prepare the dialysate. We aimed to investigate whether HD effectiveness can be achieved at a low Qd in different patient groups for the purpose of saving water. Materials and methods: This prospective study included 81 HD patients from 2 centers. The patients underwent an aggregate total of 486 HD sessions, including 3 sessions at a Qd of 500 mL/min and 3 sessions at a Qd of 300 mL/min for each patient. We used online Kt/V readings recorded at the end of each dialysis session to compare the effectiveness of these 2 types of HD session performed at a different Qd. Results: The online Kt/V readings were similar between the standard (500) and low (300) Qd HD (1.51 +/- 0.41 and 1.49 +/- 0.44, respectively, p = 0.069). In the subgroup analyses, men had higher online Kt/V values at the standard Qd compared to the low Qd (1.35 +/- 0.30 and 1.30 +/- 0.32, respectively, p = 0.019), but the Kt/V values were not different for women. While the low Qd did not reduce online Kt/V in patients using small surface area dialysis membranes (1.75 +/- 0.35 for 300 Qd and 1.75 +/- 0.32 for 500 Qd, p = 0.931), it was associated with reduced online Kt/V in patients using large surface area dialysis membranes (1.12 +/- 0.25 for 300 Qd and 1.17 +/- 0.24 for 500 Qd, p = 0.006). The low Qd did not result in differences in online Kt/V among low-weight patients. However, online Kt/V values were better with the standard Qd in patients weighing 65 kg and above. Conclusion: In our study, dialysis adequacy at a reduced dialysate flow was not inferior for women, patients with low body weight, or patients using small surface area membranes. Individualized HD at a reduced Qd of 300 mL/min in eligible patients can save 48 L of water per HD session and an average of 7500 L of water per year.Öğe THE INFILTRATION OF T AND B LYMPHOCYTES AND NK CELLS IN KIDNEY BIOPSIES OF PATIENTS WITH FABRY DISESE UNDER ENZYME REPLACEMENT THERAPHY(Oxford Univ Press, 2020) Turkmen, Kultigin; Esen, Hasan; Karaselek, Mehmet Ali; Celik, Seyma Celikbilek; Baloglu, Ismail; Guner, Sukru; Reisli, Ismail[Abstract Not Availabe]Öğe Liver-Spleen Ratio: Can It Be Used for the Prediction of Coronary Artery Disease?(Aves, 2022) Poyraz, Necdet; Ozer, Hakan; Baloglu, Ismail; Kadiyoran, Cengiz; Yilmaz, Pinar Diydem; Sertdemir, Ahmet Lutfu; Turkmen, KultiginBackground: Considering that ectopic fat accumulation in various organs, especially the heart and liver, is a cardiometabolic risk factor, the need for easily accessible markers of ectopic fat accumulation is inevitable. The main starting point of the study is based on the hypothesis of predicting cardiovascular disease risk through the link that can be established between the liver-spleen ratio, which is one of the strong indicators of hepatosteatosis, and epicardial adipose tissue volume. Methods: This was a retrospective study. The records of 283 consecutive patients who underwent coronary computed tomography angiography in our Radiology Department were reviewed retrospectively from our hospital's system. All patients' epicardial adipose tissue volume and liver-spleen ratio were calculated using appropriate criteria on non-contrast computed tomography images. Additionally, the Coronary Artery Disease-Reporting and Data System was calculated on contrast computed tomography images. The participating patients were divided into groups according to the liver-spleen ratio and Coronary Artery Disease-Reporting and Data System score. Results: We found that while there was a negative correlation between the liver-spleen ratio and epicardial adipose tissue volume in the hepatosteatosis group, this relationship was not observed in the non-steatosis group. In addition, we observed that the family history of cardiovascular disease and the frequency of cardiovascular disease were higher in the hepatosteatosis group than in the other group, and there was a correlation between cardiovascular disease and the liver-spleen ratio. Also, we found that age and liver- spleen ratio values were found to be independent predictors of coronary artery disease. Conclusion: In our study, we found that the frequency of cardiovascular disease was lower in patients with a high liver-spleen ratio. We also demonstrated in the study that the liver-spleen ratio, which indicates a low level of epicardial adipose tissue volume accumulation, is an independent predictor of cardiovascular disease. In addition, the use of liver-spleen ratio, which is more valuable than liver attenuation in predicting hepatic steatosis, may be more useful in evaluating the risk of hepatosteatosis-related cardiovascular disease.Öğe Membranous Nephropathy: Current Understanding in The Light of New Advances(Aves, 2023) Ozer, Hakan; Baloglu, Ismail; Fervenza, Fernando C.; Turkmen, KultiginMembranous nephropathy is the most common cause of primary nephrotic syndrome in adults. The most important mech-anism in its pathogenesis is loss of immune tolerance. New developments in membranous nephropathy are mostly related to the diagnosis and treatment of the disease, and until recently, the gold standard method in diagnosis was a kidney biopsy. In recent years, many membranous nephropathy-associated antigens and antibodies have been identified. The increased availability of these biomarkers is beneficial in predicting the treatment response, determining the treatment plan, and eliminating the necessity of kidney biopsy in the diagnosis of membranous nephropathy. Because of both the difference in treatment responses and the treatment-related side effects, membranous nephropathy treatment should be individualized. In addition, it is recommended to make a treatment plan by calculating the risk of progressive kidney fail-ure of the disease. Parallel to the changes in diagnosis and follow-up, treatment plans in membranous nephropathy have undergone severe changes in recent years. As the autoimmunity targets in the pathogenesis of the disease become clearer, treatment has turned to more specific therapies that are more selective in targeting antibody-producing cells, such as rituximab. This article described the new developments in the pathogenesis, diagnosis, and treatment of membranous nephropathy.Öğe Nephrological factors may cause kidney dysfunction in patients with common variable immunodeficiency(Tubitak Scientific & Technological Research Council Turkey, 2021) AytekIn, Gokhan; Baloglu, Ismail; Colkesen, Fatih; Yildiz, Eray; Arslan, Sevket; Turkmen, KultiginBackground/aim: Common variable immunodeficiency (CVID) is a heterogeneous primary deficiency characterized by hypogammaglobulinemia, recurrent infections, an increased risk of autoimmune disease, malignancy, and chronic inflammation. Proteinuria is one of the most important prognostic factors causing progression in kidney disease. Proteinuria causes tubulotoxicity, activates inflammatory markers that cause fibrosis, and consequently nephropathy progression. The data is scant in the literature regarding the inflammation and nephropathy in CVID. Hence, in the present study, we aimed to investigate the relationship between tubular dysfunction, proteinuria, and inflammation in patients with CVID. Materials and methods: This was a cross-sectional study involving 27 patients with CVID (15 females, 12 males; mean age, 39.88 +/- 13.47 years) and 18 control subjects (10 females, 8 males; mean age, 33.83 +/- 7.97 years). Patients were evaluated for kidney functions including glomerular filtration rate, fractional excretion of sodium, metabolic acidosis, serum/urine anion gap, 24-h urine proteinuria and, were grouped in terms of proteinuria. Blood samples obtained from the patients with CVID were taken into 2 mL EDTA tube to evaluate peripheral NK cell subgroups according to CD56 and CD16 expression and CD3, CD4, CD 8 expression to determine subtypes T cells. These cells were evaluated by flow cytometry technique. Results: Urinary density, fractional excretion of sodium, proteinuria, and metabolic acidosis are found to be higher in patients with CVID when compared to healthy controls. In the bivariate correlation analysis, proteinuria was positively correlated with age (r = 0.496, p = < 0.001), CD8+T cells percentage (r = 0.427, p = 0.02). Albumin, CRP, and CD8+T cell percentage were found to be independent variables of proteinuria. Conclusion: Increased chronic ongoing inflammation was found to be associated with proteinuria in patients with CVID. Hence, in routine outpatient clinics, proteinuria should not be overlooked in this group of patients.Öğe Overlooked factor in the etiology of pruritus in hemodialysis patients: Ultrafiltration volume(Wiley, 2023) Ozer, Hakan; Ozturk, Yasin; Yonet, Fethi; Baloglu, Ismail; Turkmen, Kultigin; Selcuk, Nedim Yilmaz; Tonbul, Halil ZekiIntroductionThis study investigated the relationship between ultrafiltration (UF) volume and pruritus severity based on the idea that skin perfusion and inflammatory changes occur in dialysis patients with high UF volume.Materials and MethodsThis observational study included 392 patients. Patients filled out the Numerical Rating Scale, Verbal Rating Scale, and Visual Analogue Scale, showing the severity of pruritis. UF volumes in the last 12 sessions were recorded and averaged.ResultsThe rate of patients with pruritis was between 59.4% and 67.5% in the three scales. In three pruritis scales, the severity of pruritis, age, body mass index (BMI), UF volume, and UF volume/body weight ratio were positively correlated. UF volume/body weight ratio, age, and BMI were independent predictors of pruritis severity.ConclusionLimiting interdialytic weight gain may be an important treatment approach in pruritus control.
