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Öğe ASSOCIATION OF MULTIPLE PLASMA BIOMARKER LEVELS WITH KIDNEY DISEASE ACTIVITY IN FABRY DISEASE(Oxford Univ Press, 2023) Ozcan, Seyda Gul; Atli, Zeynep; Eren, Necmi; Dincer, Mevlut Tamer; Turkmen, Kultigin; Ozer, Hakan; Trabulus, Sinan[Abstract Not Availabe]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 Exploring the genetic diversity and population structure of fenugreek (Trigonella foenum-graecum L.) genotypes through inter-primer binding site (iPBS)-retrotransposon marker system(Springer, 2024) Haliloglu, Kamil; Ozer, Hakan; Melik, Seda; Coban, Furkan; Turkoglu, ArasFenugreek, a key medicinal-aromatic plant, offers rich bioactive compounds and nutritional value. Its diverse applications in cuisine and pharmaceuticals, coupled with health benefits like anti-diabetic and antioxidant properties, underscore its significance. Assessing genetic diversity becomes crucial for effective conservation and utilization. In this study, we examined the molecular diversity and population structure of 34 fenugreek genotypes collected from 18 countries worldwide using 24 inter-primer binding site (iPBS) markers. The iPBS primers produced 499 bands, with the total number of bands per primer ranging from 15 (iPBS-2224) to 26 (iPBS-2077), averaging 20.79. Polymorphism information content (PIC) ranged from 0.03 (iPBS-2374) to 0.34 (iPBS-2237), averaging 0.23. In the molecular analysis, the G1 genotype (Isfahan/Iran) exhibited the maximum effective number of alleles (Ne), Nie's gene diversity (He), and Shannon's information index (I) at 1.946, 0.486, and 0.679, respectively. Conversely, the G34 genotype (India/B) displayed the lowest values at 1.539, 0.350, and 0.535, respectively. Utilizing the unweighted pair-group means average (UPGMA) method, the iPBS-based tree revealed three distinct groups corresponding to the genomic constitution of fenugreek genotypes, a pattern partially corroborated by principal component analysis (PCA). Further model-based cluster analysis classified the 34 genotypes into four subpopulations, with expected heterozygosity (He) values of 0.428, 0.390, 0.426, and 0.007, respectively. The F-statistic (Fst) values for these subpopulations were 0.197, 0.210, 0.187, and 0.356, respectively. These findings underscored significant genetic variation among the tested fenugreek genotypes, thereby demonstrating the efficacy of iPBS markers in accurately assessing genetic diversity and phylogenetic relationships within fenugreek populations.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 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 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.Öğe The relationship between FGF23 and anemia in HD and renal transplant patients(Springer, 2022) Baloglu, Ismail; Ozer, Hakan; Ozturk, Yasin; Erdur, Mehmet Fatih; Tonbul, Halil Zeki; Turkmen, KultiginPurpose Recent studies claim that FGF23 is also associated with anemia and inflammation. In this study, the relationship between FGF23 and anemia in hemodialysis (HD) and renal transplantation patients (RTx patients) patients was investigated. Methods This was a cross-sectional study involving 40 RTx patients (13 females, 27 males; mean age, 45.93 +/- 12.49 years) who had transplantation at least 6 months before, 25 HD patients (12 females, 13 males; mean age, 54.72 +/- 15.5 years), and 20 healthy control subjects (13 females, 7 males; mean age, 36.7 +/- 9.38 years). FGF23 was studied using Elisa method. Parameters such as iron, ferritin, total iron binding capacity, and transferrin saturation were assessed. Results FGF23 level was significantly higher in HD patients when compared with the RTx patients and control groups. In the bivariate correlation analysis, hemoglobin was positively correlated with albumin (r = 0.681, p = 0.000), ferritin (r = 0.446, p = 0.043), and negatively correlated with CRP (r = - 0.476, p = 0.016) and FGF23 (r = 0.493, p = 0.043). FGF23 was found to be an independent predictor of decreased hemoglobin in HD patients. In addition, this association was observed to disappear after transplantation. Conclusion While FGF23 is closely related to hemoglobin levels in HD patients, we have shown that this relationship disappears after transplantation.Öğe The Relationship of Epicardial Adipose Tissue and Cardiovascular Disease in Chronic Kidney Disease and Hemodialysis Patients(Mdpi, 2022) Turkmen, Kultigin; Ozer, Hakan; Kusztal, MariuszCardiovascular diseases remain the most common cause of morbidity and mortality in chronic kidney disease patients undergoing hemodialysis. Epicardial adipose tissue (EAT), visceral fat depot of the heart, was found to be associated with coronary artery disease in cardiac and non-cardiac patients. Additionally, EAT has been proposed as a novel cardiovascular risk in the general population and in end-stage renal disease patients. It has also been shown that EAT, more than other subcutaneous adipose tissue deposits, acts as a highly active organ producing several bioactive adipokines, and proinflammatory and proatherogenic cytokines. Therefore, increased visceral adiposity is associated with proinflammatory activity, impaired insulin sensitivity, increased risk of atherosclerosis, and high morbidity and mortality in hemodialysis patients. In the present review, we aimed to demonstrate the role of EAT in the pathophysiological mechanisms of increased cardiovascular morbidity and mortality in hemodialysis patients.Öğe Sclerostin and TNF-related weak inducer of apoptosis: can they be important in the patients with glomerulonephritis?(Assoc Medica Brasileira, 2023) Ozer, Hakan; Baloglu, Ismail; Aykut, Talat; Demirci, Mehmet Ali; Aydemir, Fatma Humeyra Yerlikaya; Turkmen, KultiginOBJECTIVE: Sclerostin is a protein produced by osteocytes, kidneys, and vascular cells and has many effects on kidney and vascular structures. Soluble TNF-related weak inducer of apoptosis is a proinflammatory cytokine that may cause glomerular and tubular injury and increase sclerostin expression. This study aimed to investigate serum sclerostin and soluble TNF-related weak inducer of apoptosis levels in patients with glomerulonephritis and the effects they may be associated with.METHODS: This cross-sectional study included 93 patients, 63 of whom were glomerulonephritis and 30 were healthy controls. Serum sclerostin, soluble TNF-related weak inducer of apoptosis, and 24-h urinary protein excretion were measured, and pulse wave velocity was calculated for arterial stiffness.RESULTS: Serum sclerostin and soluble TNF-related weak inducer of apoptosis were higher in glomerulonephritis patients than in the control group, and serum sclerostin and soluble TNF-related weak inducer of apoptosis levels were correlated with both proteinuria and pulse wave velocity. In addition, in the regression analysis, serum sclerostin and soluble TNF-related weak inducer of apoptosis levels were found to be independent predictors of proteinuria in patients with glomerulonephritis.CONCLUSION: This is the first study to show that serum sclerostin and soluble TNF-related weak inducer of apoptosis are elevated in glomerulonephritis patients, and these two markers correlate with arterial stiffness and proteinuria in these patients. Considering the effects of sclerostin and soluble TNFrelated weak inducer of apoptosis in patients with glomerulonephritis, we think these mechanisms will be the target of both diagnosis and new therapies.Öğe Sclerostin and TNF-related weak inducer of apoptosis: can they be important in the patients with glomerulonephritis?(Assoc Medica Brasileira, 2023) Ozer, Hakan; Baloglu, Ismail; Aykut, Talat; Demirci, Mehmet Ali; Aydemir, Fatma Humeyra Yerlikaya; Turkmen, KultiginOBJECTIVE: Sclerostin is a protein produced by osteocytes, kidneys, and vascular cells and has many effects on kidney and vascular structures. Soluble TNF-related weak inducer of apoptosis is a proinflammatory cytokine that may cause glomerular and tubular injury and increase sclerostin expression. This study aimed to investigate serum sclerostin and soluble TNF-related weak inducer of apoptosis levels in patients with glomerulonephritis and the effects they may be associated with.METHODS: This cross-sectional study included 93 patients, 63 of whom were glomerulonephritis and 30 were healthy controls. Serum sclerostin, soluble TNF-related weak inducer of apoptosis, and 24-h urinary protein excretion were measured, and pulse wave velocity was calculated for arterial stiffness.RESULTS: Serum sclerostin and soluble TNF-related weak inducer of apoptosis were higher in glomerulonephritis patients than in the control group, and serum sclerostin and soluble TNF-related weak inducer of apoptosis levels were correlated with both proteinuria and pulse wave velocity. In addition, in the regression analysis, serum sclerostin and soluble TNF-related weak inducer of apoptosis levels were found to be independent predictors of proteinuria in patients with glomerulonephritis.CONCLUSION: This is the first study to show that serum sclerostin and soluble TNF-related weak inducer of apoptosis are elevated in glomerulonephritis patients, and these two markers correlate with arterial stiffness and proteinuria in these patients. Considering the effects of sclerostin and soluble TNFrelated weak inducer of apoptosis in patients with glomerulonephritis, we think these mechanisms will be the target of both diagnosis and new therapies.Öğe Unknown criminals for kidney: Acute interstitial nephritis due to lavender tea(Elsevier Science Inc, 2023) Ozer, Hakan; Sayan, Zeynep Aybike; Baloglu, Ismail; Ozturk, Yasin; Yonet, Fethi; Turkmen, KultiginIntroduction: Spanish Lavender is an herbal from the lavender family and is widely used among people for the belief that it cures various diseases. Acute interstitial nephritis (AIN) is one of the common causes of acute kidney injury (AKI). Although drugs are the most common cause of AIN, the frequency of reporting AIN cases due to various herbals has been increasing in recent years. Case presentation: We present a 24-year-old male patient who developed AKI after consuming Spanish lavender tea to treat upper respiratory tract infection symptoms and was diagnosed with AIN. Aim and discussion: With this case report, we wanted to explain the fact that medicinal herbs, which are used frequently and carelessly today, can have serious consequences, as in acute interstitial nephritis associated with Spanish lavender.Öğe An update on diagnosis and treatment of ANCA associated renal vasculitis(Springer, 2023) Turkmen, Kultigin; Ozer, Hakan; Tesar, VladimirAnti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides are a group of diseases characterised by necrotizing inflammation of small vessels such as arterioles, venules, and capillaries. ANCA-associated vasculitides (AAV) are referred to as small vessel vasculitides. Three AAV subgroups, namely granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic GPA (EGPA), are defined according to clinical features. The most common disease with renal involvement in AAV is MPA Approximately 90% of patients with MPA have renal involvement. While this rate is 70-80% in GPA, less than half of EGPA patients have renal involvement. Untreated survival in AAVs is less than one year. With appropriate immunosuppressive therapy, the 5-year renal survival rate is 70-75%. Without therapy, the prognosis is poor but treatments, typically immunosuppressants, have improved survival, albeit with considerable morbidity from glucocorticoids and other immunosuppressive medications. Current challenges include improving the measures of disease activity and risk of relapse, uncertainty about optimal therapy duration and a need for targeted therapies with fewer adverse effects. In this review, we described the treatment of renal involvement in AAV in line with current studies.