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Öğe 2003-2011 Yılları arasında meram tıp fakültesi organ nakli merkezinde yapılan böbrek nakli olgularının sonuçları(2013) Türkmen, Kültigin; Erdur, Fatih Mehmet; Gaipov, Abduzhappar; Yeksan, Mehdi; Selçuk, Nedim Yılmaz; Türk, Süleyman; Erikoğlu, Mehmet; Çolak, Bayram; Tekin, Ahmet; Tonbul, Halil Zeki; Tavlı, ŞakirAMAÇ: Son dönem böbrek yetmezliği (SDBY) hastalarında en iyi tedavi şekli böbrek naklidir. Çalışmamızda, son 8 yılda merkezimizde kadavra ve canlıdan yapılan böbrek nakillerinin(BN) demografik verileri ile birlikte böbrek fonksiyonları ve posttransplant medikal komplikasyonları, hasta- graft sağkalımını araştırmayı hedefledik. GEREÇ ve YÖNTEMLER: Çalışmaya 40ı kadavradan, 26sı canlıdan BN yapılan 66 hasta (kadın/ erkek: 36/30) dahil edildi. Nakil sonrası nefroloji polikliniğine başvurularda yaş, cinsiyet, böbrek yetmezliği nedeni, diyaliz türü-süresi, nakil türü, aldıkları indüksiyon tedavileri, kullandığı idame immünsupresif tedaviler, akut rejeksiyon sayısı ve verilen tedaviler, nakil sonrası 1., 6., 12., 24. ve 60. aylardaki biyokimya-hemogram parametreleri ve medikal komplikasyonlar hasta dosyalarından retrospektif olarak elde edildi. BULGULAR: Alıcıların ortalama yaşı 4111,6 yıldı. Ortalama nakil sonrası süre 32,231,4 ay, kreatinin değerleri 1,40,9 mg/dl tespit edildi. En sık uygulanan immünsüpresif tedavi protokolü ko rtikosteroidtakrolimusmikofenolat mofetil/sodyumdu. Gecikmiş graft fonksiyonu, kronik allograft disfonksiyonu ve akut rejeksiyon oranları sırasıyla %27,3, %25,7 ve %13,6 idi. 1 ve 5 yıllık hasta sağkalımı canlıdan yapılan BNlerinde sırasıyla %100 ve %100, kadavradan yapılan BNlerinde ise %85 ve %85 olarak bulundu. 1 ve 5 yıllık graft sağkalımı canlıdan BN yapılanlarda sırasıyla %100 ve %100, kadavradan BN yapılanlarda ise %80 ve %80 olarak saptandı. En sık görülen medikal komplikasyonlar yeni gelişen diyabet ve dislipidemiydi. Erken ve geç dönemde en sık karşılaşılan enfeksiyon idrar yolu enfeksiyonuydu. SONUÇ: BN, hasta-graft sağkalımının yüksek olduğu bir renal replasman tedavi seçeneğidir. Bununla birlikte metabolik komplikasyonlar açısından yakın takip gereklidir.Öğe Apoptosis, autophagy & endoplasmic reticulum stress in diabetes mellitus(Wolters Kluwer Medknow Publications, 2016) Demirtas, Levent; Guclu, Aydin; Erdur, Fatih Mehmet; Akbas, Emin Murat; Ozcicek, Adalet; Onk, Didem; Turkmen, KultiginThe prevalence of diabetes mellitus (DM) is increasing secondary to increased consumption of food and decreased physical activity worldwide. Hyperglycaemia, insulin resistance and hypertrophy of pancreatic beta cells occur in the early phase of diabetes. However, with the progression of diabetes, dysfunction and loss of beta cells occur in both types 1 and 2 DM. Programmed cell death also named apoptosis is found to be associated with diabetes, and apoptosis of beta cells might be the main mechanism of relative insulin deficiency in DM. Autophagic cell death and apoptosis are not entirely distinct programmed cell death mechanisms and share many of the regulator proteins. These processes can occur in both physiologic and pathologic conditions including DM. Besides these two important pathways, endoplasmic reticulum (ER) also acts as a cell sensor to monitor and maintain cellular homeostasis. ER stress has been found to be associated with autophagy and apoptosis. This review was aimed to describe the interactions between apoptosis, autophagy and ER stress pathways in DM.Öğe Asymmetric Dimethylarginine and Homocysteine Levels in Dialysis Patients(2013) Erdem, S. Sami; Yerlikaya, Fatma Hümeyra; Tonbul, Zeki; Türkmen, Kültigin; Erdur, Fatih Mehmet; Taner, Alpaslan; Çiçekler, Hümeyra; Mehmetoğlu, İdrisKardiyovasküler hastalıklar ve endotelyal disfonksiyon son dönem böbrek yetmezliği hastalarında en önemli ölüm nedenleridir. Periton diyalizi ve hemodiyaliz gibi tedavi yöntemlerinin farklı parametreler üzerine farklı etkileri vardır. Asimetrik dimetilarjinin endojen nitrik oksit sentaz inhibitörüdür ve kronik böbrek yetmezliğinin progresyonunda yeni bir belirteç olduğu gösterilmiştir. Homosistein endotel hasarı, damar düz kas hücre proliferasyonu ve koagülasyon anormallikleri yoluyla trombogenez ve atero- geneze neden olur. Daha önceki çalışmalarda periton diyalizi (PD) ve hemodiyalizin (HD) oksidan ve antioksidan sistemler üzerine etkisiyle ilgili çelişkili bulgular vardır. Bu çalışmada HD, PD ve sağlıklı kişilerde ADMA, homosistein ve CRP düzeylerini belirlemeyi amaçladık. Çalışmaya 44 PD (23E,21K), 26HD (13E,13K) hastası ve 29 (15E,14K) sağlıklı kişi katıldı. ADMA, homosistein, arjinin ve CRP düzeyleri ölçüldü. Son dönem böbrek yetmezliği (SDBY) hastalarının ADMA, homosistein ve CRP düzeyleri sağlıklı kontrol grubuna göre yüksek (p0.001), arjinin düzeyleri düşük olarak bulundu(p0.001). HD ve PD gruplarında ADMA, homosistein ve CRP seviyeleri açısından farklılık bulunamadı (sırasıyla p:0.287, p: 0.587, p: 0.835) Bizim sonuçlarımız HD,PD hastalarında sağlıklı kontrole göre ADMA ve homosistein düzeylerinin yüseldiğini gösterdi. Bu bulgular; diyaliz hastalarında endotel disfonksiyonu, inflamasyon ve oksidatif stresin arttığını ve ADMA ve homosistein düzeylerinin diyaliz tedavi yönteminden etkilenmediğini göstermektedir.Öğe Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients(Wiley, 2013) Turkmen, Kultigin; Erdur, Fatih Mehmet; Ozcicek, Fatih; Ozcicek, Adalet; Akbas, Emin Murat; Ozbicer, Aysu; Demirtas, LeventNeutrophil-to-lymphocyte ratio (NLR) was introduced as a potential marker to determine inflammation in end-stage renal disease (ESRD) patients. Recently, platelet-to-lymphocyte ratio (PLR) and NLR were found to positively correlated with inflammatory markers including tumor necrosis factor- (TNF-) and interleukin (IL)-6 in cardiac and noncardiac patients. Data regarding PLR and its association with inflammation are lacking in hemodialysis (HD) and peritoneal dialysis (PD) patients. Hence, we aimed to determine the relationship between PLR, NLR, and inflammation in ESRD patients. This was a cross-sectional study involving 62 ESRD patients (29 females, 33 males; mean age, 49.6 +/- 14.6 years) receiving PD or HD for 6 months in the Dialysis Unit of Necmettin Erbakan University. PLR, NLR, C-reactive protein, TNF-, IL-6 levels were measured. PLR, NLR, serum high sensitive C-reactive protein, IL-6, and TNF- levels were significantly higher in PD patients when compared with HD patients. ESRD patients with PLR140 had significantly higher NLR, IL-6, and TNF- levels when compared to patients with PLR<139. In the bivariate correlation analysis, PLR was positively correlated with NLR, IL-6, and TNF- in this population. When we compared the association of PLR and NLR with IL-6 (r=0.371, P=0.003 vs. r=0.263, P=0.04, respectively) and TNF- (r=0.334, P=0.008 vs. r=0.273, P=0.032, respectively), PLR was found to be superior to NLR in terms of inflammation in ESRD patients. Simple calculation of PLR can predict inflammation better than NLR in ESRD patients.Öğe The Prevalence of Fabry Disease in Patients with Chronic Kidney Disease in Turkey: The TURKFAB Study(Karger, 2016) Turkmen, Kultigin; Guclu, Aydin; Sahin, Garip; Kocyigit, Ismail; Demirtas, Levent; Erdur, Fatih Mehmet; Sengul, ErkanBackground/Aims: Fabry disease is a treatable cause of chronic kidney disease (CKD) characterized by a genetic deficiency of a-galactosidase A. European Renal Best Practice (ERBP) recommends screening for Fabry disease in CKD patients. However, this is based on expert opinion and there are no reports of the prevalence of Fabry disease in stage 1-5 CKD. Hence, we investigated the prevalence of Fabry disease in CKD patients not receiving renal replacement therapy. Methods: This prospective study assessed a-galactosidase activity in dried blood spots in 313 stage 1-5 CKD patients, 167 males, between ages of 18-70 years whose etiology of CKD was unknown and were not receiving renal replacement therapy. The diagnosis was confirmed by GLA gene mutation analysis. Results: Three (all males) of 313 CKD patients (0.95%) were diagnosed of Fabry disease, for a prevalence in males of 1.80%. Family screening identified 8 aditional Fabry patients with CKD. Of a total of 11 Fabry patients, 7 were male and started enzyme replacement therapy and 4 were female. The most frequent manifestations in male patients were fatigue (100%), tinnitus, vertigo, acroparesthesia, hypohidrosis, cornea verticillata and angiokeratoma (all 85%), heat intolerance (71%), and abdominal pain (57%). The most frequent manifestations in female patients were fatigue and cornea verticillata (50%), and tinnitus, vertigo and angiokeratoma (25%). Three patients had severe episodic abdominal pain attacks and proteinuria, and were misdiagnosed as familial Mediterranean fever. Conclusions: The prevalence of Fa bry disease in selected CKD patients is in the range found among renal replacement therapy patients, but the disease is diagnosed at an earlier, treatable stage. These data support the ERBP recommendation to screen for Fabry disease in patients with CKD of unknown origin. (C) 2016 The Author(s) Published by S. Karger AG, BaselÖğe The relationship between neutrophil-to-lymphocyte ratio and vascular calcification in end-stage renal disease patients(Wiley-Blackwell, 2014) Turkmen, Kultigin; Ozcicek, Fatih; Ozcicek, Adalet; Akbas, Emin Murat; Erdur, Fatih Mehmet; Tonbul, Halil ZekiChronic inflammation was found to be correlated with coronary (CAC) and thoracic peri-aortic calcification (TAC) in end-stage renal disease (ESRD) patients. Neutrophil-to-lymphocyte ratio (NLR) was introduced as a potential marker to determine inflammation in cardiac and noncardiac disorders. Data regarding NLR and its association with TAC and CAC are lacking. We aimed to determine the relationship between NLR and vascular calcification in ESRD patients. This was a cross-sectional study involving 56 ESRD patients (22 females, 34 males; mean age, 49.9 +/- 14.2 years) receiving peritoneal dialysis or hemodialysis for >= 6 months in the Dialysis Unit of Necmettin Erbakan University. TAC and CAC scores were measured by using an electrocardiogram-gated 64-multidetector computed tomography. NLR was calculated as the ratio of the neutrophils and lymphocytes. There was a statistically significant correlation between NLR, TACS and CACS in ESRD patients (r = 0.43, P = 0.001 and r = 0.30, P = 0.02, respectively). The stepwise linear regression analysis revealed that age, as well as NLR were independent predictors of TACS. However, increased age was the only independent predictor of CACS according to linear regression analysis. Simple calculation of NLR can predict vascular calcification in ESRD patients.Öğe The Relationship between Oxidative Stress and Coronary Artery Calcification in Patients Undergoing Peritoneal Dialysis or Hemodialysis(Modestum Ltd, 2015) Erdur, Fatih Mehmet; Turkmen, Kultigin; Kayikcioglu, Hatice; Ozcicek, Fatih; Toker, Aysun; Ozbek, Orhan; Turk, SuleymanVascular calcification and increased oxidative stress are commonly seen in patients with end-stage renal disease (ESRD). Nitrotyrosine is one of the end products of nitric oxide metabolism and is accepted as an indicator of oxidative stress. Nitrotyrosine levels have been found to be high in ESRD patients. The aim of our study is to investigate the relation between coronary artery calcification and oxidative stress in peritoneal dialysis (PD) and hemodialysis (HD) patients. 46 PD and 34 HD patients are included in the study. Coronary artery calcification scoring (CACS) is made by multi slice computed tomography. Patients are divided into 4 groups according to their CACS values as Group 1 (CACS: 0), Group 2 (CACS: 1-99), Group 3 (CACS: 100-399) and Group 4 (CACS: >= 400). Serum nitrotyrosine levels were measured. Nitrotyrosine levels were significantly increased in HD patients compared to PD patients. Nitrotyrosine levels were found to be elevated in accordance with increased CACS in PD patients. However, we could not find this relationship in HD patients. There might be an important relationship between CACS and oxidative stress in PD patients.Öğe The Relationship between Oxidative Stress and Coronary Artery Calcification in Patients Undergoing Peritoneal Dialysis or Hemodialysis(Modestum Ltd, 2015) Erdur, Fatih Mehmet; Turkmen, Kultigin; Kayikcioglu, Hatice; Ozcicek, Fatih; Toker, Aysun; Ozbek, Orhan; Turk, SuleymanVascular calcification and increased oxidative stress are commonly seen in patients with end-stage renal disease (ESRD). Nitrotyrosine is one of the end products of nitric oxide metabolism and is accepted as an indicator of oxidative stress. Nitrotyrosine levels have been found to be high in ESRD patients. The aim of our study is to investigate the relation between coronary artery calcification and oxidative stress in peritoneal dialysis (PD) and hemodialysis (HD) patients. 46 PD and 34 HD patients are included in the study. Coronary artery calcification scoring (CACS) is made by multi slice computed tomography. Patients are divided into 4 groups according to their CACS values as Group 1 (CACS: 0), Group 2 (CACS: 1-99), Group 3 (CACS: 100-399) and Group 4 (CACS: >= 400). Serum nitrotyrosine levels were measured. Nitrotyrosine levels were significantly increased in HD patients compared to PD patients. Nitrotyrosine levels were found to be elevated in accordance with increased CACS in PD patients. However, we could not find this relationship in HD patients. There might be an important relationship between CACS and oxidative stress in PD patients.Öğe The Relationship between Oxidative Stress, Inflammation, and Atherosclerosis in Renal Transplant and End-Stage Renal Disease Patients(Informa Healthcare, 2012) Turkmen, Kultigin; Tonbul, Halil Zeki; Toker, Aysun; Gaipov, Abduzhappar; Erdur, Fatih Mehmet; Cicekler, Humeyra; Anil, MelihObjectives: Cardiovascular risk is increased in the early stages of chronic kidney disease (CKD) and is also found to be ongoing in renal transplant (Rtx) patients. As a sign of atherosclerosis, increased carotid intima-media thickness (CIMT) has been widely accepted as a strong predictor of cardiovascular disease (CVD) and mortality in the end-stage renal disease (ESRD) patients. Ischemia-modified albumin (IMA), pentraxin-3 (PTX-3), and neutrophil-to-lymphocyte ratio (NLR) were introduced as oxidative stress and inflammatory biomarkers in ESRD. The role of Rtx in terms of atherogenesis, oxidative stress, and inflammation is still unclear. We aimed to investigate the relationship between IMA, PTX-3, NLR, and CIMT in Rtx patients without overt CVD and to compare these results with those obtained from healthy subjects and ESRD patients receiving hemodialysis (HD) and peritoneal dialysis (PD). Design and methods: Cross-sectional analysis in which CIMT measurements, NLR, and serum PTX-3 and IMA levels were assessed in 18 Rtx patients (10 females; mean age: 40.0 +/- 13.3 years), 16 PD patients (7 females; 40.2 +/- 12.9 years), 14 HD patients (8 females; 46.6 +/- 10.7 years), and 19 healthy subjects (9 females; 36.9 +/- 8.9 years). Results: IMA, PTX-3, and high-sensitive C-reactive protein (hs-CRP) levels, NLR, and CIMT of Rtx patients were found to be significantly higher compared with healthy subjects (p = 0.04, p < 0.0001, p < 0.005, p = 0.005, and p = 0.005, respectively). IMA level was positively correlated with hs-CRP and PTX-3 levels, NLR, and CIMT when all participants were included (r = 0.338, p = 0.005; r 0.485, p < 0.0001; r = 0.304, p = 0.013; and r = 0.499, p < 0.0001, respectively). Conclusion: There has been ongoing inflammation, oxidative stress, and atherosclerosis in Rtx patients.Öğe Relationship between Plasma Pentraxin-3, Neutrophil-to-Lymphocyte Ratio, and Atherosclerosis in Renal Transplant Patients(Karger, 2012) Turkmen, Kultigin; Erdur, Fatih Mehmet; Guney, Ibrahim; Ozbiner, Huseyin; Toker, Aysun; Gaipov, Abduzhappar; Ozbek, OrhanBackground/Aims: Atherosclerosis and inflammation are the most important risk factors in the pathogenesis of cardiovascular diseases (CVD) in patients with end-stage renal disease (ESRD). Pentraxin-3 (PTX-3) was shown to predict inflammation and atherosclerosis in ESRD patients. However, the role of renal transplantation (Rtx) in terms of atherogenesis is still unclear. We aimed to investigate the relationship between PTX-3, neutrophil-to-lymphocyte ratio (NLR), and carotid intima-media thickness (CIMT) in Rtx patients and healthy controls. Methods: This was a cross-sectional study involving 29 Rtx patients (12 females, 40.1 +/- 11.9 years) without overt CVD and 19 healthy subjects (9 females, 36.9 +/- 8.9 years), testing the relationship between CIMT, assessed by ultrasonography, and selected biomarkers. Results: CIMT, PTX-3, and high-sensitivity C-reactive protein (hs-CRP) levels of Rtx patients were found to be significantly higher compared to healthy subjects. CIMT was positively correlated with age, creatinine, uric acid, triglyceride, PTX-3, hs-CRP, and NLR, and negatively correlated with estimated glomerular filtration rate in all participants. In Rtx patients, CIMT was positively correlated with age, BMI, serum phosphorus, low-density lipoprotein, and hs-CRP. The multivariate analysis revealed that hs-CRP was found to be an independent variable of CIMT in Rtx patients. Conclusion: Our data showed that inflammation and atherosclerosis persist in Rtx patients. Serum hs-CRP might be a useful marker to assess these parameters in this population. Copyright (C) 2012 S. Karger AG, BaselÖğe Risk factors that can affect the progression of chronic kidney disease in patients with poststreptecoccal glomerulonephritis history(Elsevier Science Inc, 2013) Turkmen, Kultigin; Erdur, Fatih Mehmet; Kucuk, Adem[Abstract Not Availabe]Öğe Soluble TWEAK independently predicts atherosclerosis in renal transplant patients(Biomed Central Ltd, 2013) Turkmen, Kultigin; Tonbul, Halil Zeki; Erdur, Fatih Mehmet; Toker, Aysun; Biyik, Zeynep; Ozbiner, Huseyin; Gaipov, AbduzhapparBackground: Cardiovascular risk is increased in the early stages of chronic kidney disease (CKD) and also found to be ongoing in renal transplant (Rtx) patients. As a sign of atherosclerosis, increased carotid intima-media thickness (CIMT) has been widely accepted as a strong predictor of cardiovascular disease (CVD) and mortality in CKD patients. A novel markers, soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and neutrophil-to-lymphocyte ratio (NLR) were introduced as potential markers in inflammatory disorders including CKD. The role of Rtx in terms of atherogenesis is still unclear. We aimed to investigate the relationship between sTWEAK, NLR and CIMT in Rtx patients without overt CVD and to compare these results with those obtained from healthy subjects. Methods: Cross-sectional analysis in which CIMT measurements, NLR and serum TWEAK levels were assessed in 70 Rtx patients (29 females; mean age, 40.6 +/- 12.4 years) and 25 healthy subjects (13 females, mean age; 37.4 +/- 8.8 years). Results: sTWEAK levels were significantly decreased (p=0.01) and hs-CRP, NLR and CIMT levels of Rtx patients were significantly increased compared to healthy subjects (p<0.0001, p=0.001, p<0.0001, respectively). sTWEAK was also found to be decreased when eGFR was decreased (p=0.04 between all groups). CIMT was positively correlated with sTWEAK and NLR in Rtx patients (r=0.81, p<0.0001 and r=0.33, p=0.006, respectively). sTWEAK was also positively correlated with NLR (r=0.37, p=0.002). In the multivariate analysis only sTWEAK was found to be an independent variable of increased CIMT. Conclusion: sTWEAK might have a role in the pathogenesis of ongoing atherosclerosis in Rtx patients.
