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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 Assessment of abdominal aortic calcification at different stages of chronic kidney disease(Springer, 2016) Biyik, Zeynep; Selcuk, Nedim Yilmaz; Tonbul, Halil Zeki; Anil, Melih; Uyar, MehmetVascular calcifications that may cause cardiovascular disease are highly prevalent in chronic kidney disease (CKD). In this study, we aimed to determine abdominal aorta calcifications (AAC) in predialysis and hemodialysis patients by lateral lumbar radiography and to investigate factors that were associated with the calcifications. Two hundred and fifty-nine adult chronic hemodialysis patients, 300 predialysis CKD patients and 60 healthy subjects with normal kidney function as a control group were enrolled in the study. Lateral lumbar radiography was used to measure AAC. Calcified deposits of the abdominal aorta wall at the level of the first through fourth lumbar vertebrae were graded by a 24-point scoring system. AAC prevalence (AAC score aeyen1) was significantly different in hemodialysis, predialysis and control groups (71.8, 45.7 and 33.3 %, respectively; p < 0.001). AAC prevalence in CKD stages 1, 2, 3, 4 and 5 predialysis patients was 26.6, 43.3, 40, 58.3 and 55 %, respectively. AAC scores of the hemodialysis group were higher than of the predialysis group (p < 0.001) and the control group (p < 0.001). AAC scores of the predialysis group were not higher than of the control group (p = 0.314). AAC scores of the hemodialysis group were significantly higher than of the control group (p < 0.001) and stage 1 (p < 0.001), stage 2 (p = 0.001) and stage 3 predialysis groups (p = 0.002). Age (p < 0.001), presence of diabetes mellitus (p < 0.001) and serum phosphorus levels (p = 0.011) were found to be independent predictors of calcification in the hemodialysis group. Age (p < 0.001), serum phosphorus levels (p = 0.007) and history of cardiovascular disease (p = 0.014) were found to be independent predictors of calcification in the predialysis group. Abdominal aortic calcification is highly prevalent in the hemodialysis population. Strict phosphorus control should be implemented to the predialysis and hemodialysis patients.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 DETERMINATION OF RELIABILITY OF SOME TESTS IN EVALUATING AV FISTUL FLOW RATE IN HEMODIALYSIS PATIENTS(Oxford Univ Press, 2013) Yavuz, Yasemin Coskun; Selcuk, Nedim Yilmaz; Guney, Ibrahim; Altintepe, Lutfullah[Abstract Not Availabe]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 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 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 Influenza A/H1N1 Infection in a Renal Transplant Recipient: Early Recognition Prevented Unfavorable Results(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2011) Solak, Yalcin; Selcuk, Nedim Yilmaz; Atalay, Huseyin; Ozbek, Orhan; Genc, NejdetInfluenza A/H1N1 2009 rapidly created a pandemic after it was first reported in April 2009. This virus caused a wave of panic around the world because of the rapidity of transmission and the characteristics of the dying victims, which were apparently healthy young adults. The pandemic caused thousands of laboratory-confirmed cases and many deaths. Despite this high prevalence, few reports of infection and clinical results in renal transplant recipients have been described in the literature. Early recognition and prompt administration of oseltamivir may prevent severe respiratory disease. Here we describe a renal transplant recipient who presented early after symptom onset who was successfully treated with oseltamivir and broad spectrum antibiotics without dire clinical consequences.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 A Rare Cause of Hyperkalemia: Adrenal Insufficiency Due to Bilateral Adrenal Lymphoma(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2019) Baloglu, Ismail; Tonbul, Halil Zeki; Turkmen, Kultigin; Selcuk, Nedim Yilmaz; Baktik, Suleyman; Oltulu, PembeA 64-year-old female presented to the emergency department with complaints of fatigue, diarrhea, dizziness, and fever. Initial evaluation revealed hyperkalemia and primary adrenal insufficiency. Computed tomography of the abdomen revealed a bilateral adrenal mass. Ultrasonography-guided biopsy of the mass showed bilateral primary adrenal lymphoma, which is a rare condition, and its clinical findings differ from those other lymphomas, thereby resulting in a delay in the diagnosis and leading to adverse prognosis for the patient. Here we present a typical case of bilateral primary adrenal lymphoma presenting with hyperkalemia due to adrenal insufficiency.Öğe A Rare Cause of Secondary Hypertension; Fabry Disease(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2018) Turkmen, Kultigin; Baloglu, Ismail; Selcuk, Nedim Yilmaz; Tonbul, Halil ZekiFabry disease is an x-linked recessive metabolic storage disorder due to the deficiency of lysosomal alpha-galactosidase A, and the subsequent accumulation of glycosphingolipids, throughout the txxiy. Patients usually present with decreased sweating (anhidrosis or hypohidrosis), reddish-purple skin rash in the bathing trunk area (angiokeratomas), personal or family history of burning or hot pain in the hands and feet, particularly during fevers (acroparesthesias), cornea verticillata and proteinuria. In addition, patients can rarely present with severe hypertension. Here, we have reported a Fabry's patient who presented with severe hypertension as an unusual presentation.Öğe The Relationship Between Visceral Adiposity Index and Epicardial Adipose Tissue in Patients with Type 2 Diabetes Mellitus(Georg Thieme Verlag Kg, 2021) Baloglu, Ismail; Turkmen, Kultigin; Selcuk, Nedim Yilmaz; Tonbul, Halil Zeki; Ozcicek, Adalet; Hamur, Hikmet; Iyisoy, SinanIntroduction and aim Cardiovascular diseases remain the most common cause of morbidity and mortality in patients with diabetes. 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. Increased visceral adiposity is associated with proinflammatory activity, impaired insulin sensitivity, increased risk of atherosclerosis and high mortality. In the present study we aimed to investigate the relationship between EAT and visceral adiposity index (VAI) in patients with diabetes. Methods This was a cross-sectional study involving 128 patients with type 2 diabetes mellitus (73 females, 55 males; mean age, 54.09++9.17 years) and 32 control subjects (23 females, 9 males; mean age, 50.09++7.81 years). EAT was measured by using a trans-thoracic echocardiograph. Parameters such as waist circumference (WC), body mass index (BMI), triglyceride and high density lipoprotein (HDL) cholesterol were used to calculate VAI. Result EAT and VAI measurements were significantly higher in patients with diabetes when compared to control subjects. In the bivariate correlation analysis, VAI was positively correlated with uric acid level (r=0.214, p=0.015), white blood cell count (r=0.262, p=0.003), platelet count (r=0.223, p=0.011) and total cholesterol levels (r=0.363, p<0.001). Also, VAI was found to be the independent predictor of EAT. Conclusion Simple calculation of VAI was found to be associated with increased EAT in patients with type 2 diabetes.Öğe Retrospective Evaluation of Therapeutic Plasma Exchange in Nephrology Clinic: A Single-Center Experience(Aves, 2023) Serin, Hatice Ozge; Baloglu, Ismail; Tonbul, Halil Zeki; Turkmen, Kultigin; Selcuk, Nedim YilmazObjective: The indication for use of therapeutic plasma exchange has been increasing in recent years. It is a method that contributes significantly to the reduction of mortality and morbidity with immunosuppressive treatments in many life -threatening diseases. The aim of this study is to examine, research, and develop therapeutic plasmapheresis procedures performed in a nephrology department.Methods: In this study, we retrospectively reviewed the therapeutic plasma exchange procedures performed in our center. The demographic characteristics, clinical features, and laboratory results before and after the procedure of all patients were screened.Results: A total of 67 patients (36 females, 31 males; mean age, 45.73 +/- 15.89 years) and 398 apheresis sessions were analyzed. The most common nephrological indication of the therapeutic plasma exchange was acute humoral rejection (40.3%). When the laboratory values of the patients before and after the procedure were examined, it was observed that there was a statistically significant decrease in creatinine and platelet values after the procedure and a significant increase in bicarbonate values. When therapeutic plasma exchange was performed for hemolytic uremic syndrome, it was found that there was a decrease in lactate dehydrogenase level and an increase in platelet count. Complications were detected in 2 of the patients during the procedure.Conclusion: Therapeutic plasmapheresis exchange can be performed by many different indications in a nephrology department. Acute humoral rejection was the most common indication for plasmapheresis in our center. We think that the procedure performed with the right indications will contribute to better outcomes.Öğe THERAPEUTIC PLASMAPHERESIS EXPERIENCE DUE TO NEPHROLOGICAL INDICATIONS(Oxford Univ Press, 2020) Baloglu, Ismail; Serin, Hatice Ozge; Tonbu, Halil Zeki; Selcuk, Nedim Yilmaz; Turkmen, Kultigin[Abstract Not Availabe]Öğe Thrombotic thrombocytopenic purpura secondary to ABO group incompatible blood transfusion in a patient after cardiac surgery(Jaypee Brothers Medical Publishers Pvt Ltd, 2013) Solak, Yalcin; Selcuk, Nedim Yilmaz; Gaipov, Abduzhappar; Ucar, Ramazan; Biyik, Zeynep; Acar, KadirThe triggers of secondary thrombotic thrombopcytopenic purpura (TTP) include drug toxicity, radiation and high-dose chemotherapy, angioinvasive infections, surgery and acute graft versus host disease. TTP secondary to surgery have been reported in a number of cases. Most of the cases have been occurred after open heart surgery. Extensive endothelial damage is held responsible as the initiating mechanism in postoperative TTP cases. However, there is no report of secondary TTP describing development owing to ABO incompatible blood transfusion. Here, we describe a patient who developed TTP after transfusion of ABO incompatible blood during hospitalization for bypass surgery. We also propose a hypothesis which may account for the possible underlying mechanism.Öğe Thrombotic thrombocytopenic purpura secondary to ABO group incompatible blood transfusion reply(Medknow Publications & Media Pvt Ltd, 2014) Solak, Yalcin; Selcuk, Nedim Yilmaz; Gaipov, Abduzhappar; Ucar, Ramazan; Biyik, Zeynep; Acar, Kadir[Abstract Not Availabe]