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Öğe Co-existing proteinase 3-antineutrophil cytoplasmic antibody-associated vasculitis with immunoglobulin A nephropathy(Korean Assoc Internal Medicine, 2016) Kucuk, Adem; Solak, Yalcin; Gaipov, Abduzhappar; Bagcaci, Sinan; Esen, Hasan; Turk, Suleyman; Tunc, Recep[Abstract Not Availabe]Öğe Heparin-induced thrombocytopenia in a hemodialysis patient treated with fondaparinux: Nephrologists between two fires(Wiley-Blackwell, 2013) Solak, Yalcin; Demircioglu, Sinan; Polat, Ilker; Biyik, Zeynep; Gaipov, Abduzhappar; Acar, Kadir; Turk, SuleymanHeparin-induced thrombocytopenia (HIT) is caused by heparin exposure and presents with reduced platelet count. Patients undergoing hemodialysis (HD) treatment have increased risk of developing HIT due to prolonged exposure to unfractionated heparin or low-molecular weight heparin. We report a 79-year-old male patient with end-stage renal disease who developed type-II HIT during maintenance HD. Platelet count of the patient decreased gradually and antiplatelet factor IV antibody was found to be positive. The patient was treated with fondaparinux and continued heparin-free HD. Unfortunately, despite favorable initial response without any thrombotic episodes, the patient died due to severe sepsis complicated by gastrointestinal hemorrhage.Öğe The Predictive Value of Platelet/Lymphocyte Ratio in Hemodialysis Patients With Erythropoietin Resistance(Wiley-Blackwell, 2016) Taymez, Dilek Guven; Ucar, Esma; Turkmen, Kultigin; Ucar, Ramazan; Afsar, Baris; Gaipov, Abduzhappar; Turk, SuleymanThe most important cause of anemia in CKD is relative deficiency of erythropoietin (EPO) secretion from the diseased kidney and EPO therapy has become the standard treatment for anemia of CKD. However, some patients do not respond well to erythropoiesis stimulating agent (ESA), so-called ESA resistance. One of the most important causes of ESA resistance is chronic inflammation in hemodialysis (HD) patients. ESA hyporesponsiveness index (EHRI), calculated as the weekly dose of EPO divided by kilograms of body weight divided by the hemoglobin level, and has been considered useful to assess the EPO resistance. Neutrophil/lymphocyte (NLR) ratio and platelet/lymphocyte ratio (PLR) were also found to be associated with inflammation in HD patients. However, the relationship between NLR, PLR and EHRI has not been investigated before. HD patients underwent medical history taking, physical examination, calculation of dialysis adequacy and biochemical analysis and calculation of EHRI. Logarithmically converted EHRI (logEHRI) was correlated only with hemoglobin (r -0.381, P< 0.0001) and PLR (r= 0.227, P=0.021) but not with NLR. Comparison of PLR among 25th, 50th and 75th percentile of EHRI showed that PLR levels increased going from the 25th to 75(th) percentile (P=0.032). Posthoc analysis revealed that 25-75th percentile (P=0.014) and 50-75th percentile (P=0.033) were different with respect to PLR. In linear regression analysis, PLR (standardized = 0.296, confidence interval: 0.000-0.001, P=0.003) was independently associated with logEHRI. We found that PLR was independently associated with EHRI in HD patients. PLR, which is quite a simple and cheap method, may guide clinicians for detecting EPO resistance.Öğe Pregabalin versus gabapentin in the treatment of neuropathic pruritus in maintenance haemodialysis patients: A prospective, crossover study(Wiley, 2012) Solak, Yalcin; Biyik, Zeynep; Atalay, Huseyin; Gaipov, Abduzhappar; Guney, Figen; Turk, Suleyman; Covic, AdrianAim: Pruritus is common in dialysis patients. Peripheral neuropathy is also prevalent in this patient population. However, the role of neuropathy in the genesis of uraemic itch has not been adequately studied to date. Therefore, we aimed to investigate the effects of gabapentin and pregabalin on uraemic pruritus along with neuropathic pain in patients receiving haemodialysis. Methods: This is a 14 week long randomized, prospective, cross-over trial. Haemodialysis patients with established neuropathy and/or neuropathic pain were included. Fifty patients were randomly assigned to gabapentin 300 mg after each haemodialysis session and pregabalin 75 mg daily. After 6 weeks of treatment, cross-over was performed and patients received the other drug for another 6 weeks. Short Form of McGill Pain Questionnaire and Visual Analogue Scale were used to evaluate pain and pruritus, respectively. At each week's visit, patients were interrogated in terms of adverse effects of study drugs. Baseline laboratory data and demographic characteristics were recorded from patient charts. Results: Forty (12 males, 28 females) out of 50 patients completed the study. Mean age was 58.2 +/- 13.7. Overall, 29 out of 40 patients (72.5%) had pruritus symptoms at baseline evaluation. Fifteen patients (37.5%) were diabetic. Thirty-one out of 40 patients (77.5%) had electromyography (EMG)-proven peripheral neuropathy. Twenty three patients (57.5%) had both EMG-proven neuropathy and pruritus. Gabapentin and pregabalin improved both neuropathic pain and pruritus significantly. There was no difference between the study drugs in terms of efficacy against pain and pruritus. Conclusion: Treatment of neuropathic pain with either pregabalin or gabapentin effectively ameliorates uraemic itch.Öğe THE RELATIONSHIP BETWEEN NEUTROPHIL-TO-LYMPHOCYTE RATIO AND CORONARY ARTERY CALCIFICATION IN END-STAGE RENAL DISEASE PATIENTS(Oxford Univ Press, 2013) Turkmen, Kultigin; Ozcicek, Fatih; Erdur, Fatih; Turk, Suleyman; Yeksan, Mehdi; Tonbul, Halil[Abstract Not Availabe]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 Serum Zinc Levels and Tumor Markers in Hemodialysis Patients(Modestum Ltd, 2014) Turkmen, Kultigin; Ecder, Tevfik; Turk, SuleymanThe incidence of neoplasia is increased in end-stage renal disease (ESRD) patients. Zinc (Zn) deficiency is associated with neoplasia and also commonly seen in ESRD patients. However, the data regarding the relationship between Zn levels and tumor markers is scant in this population. We aimed to investigate the relationship between Zn levels and tumor markers in hemodialysis patients. Twenty-six hemodialysis patients (11 male, 15 female, mean age 41.6 +/- 14.3 years) and 11 healthy subjects (6 male and 5 female, mean age 38.7 +/- 7.2 years) were included. Serum Alpha fetoprotein (AFP), carcinoembriyonic antigen (CEA), CA 19-9, CA 15-5, CA 125, beta subunit of human corionic gonadotrophin (beta-HCG) and beta-2 microglobulin (beta 2M) and Zn levels were measured. Data were analysed by Student's t test. Serum Zinc levels were significantly lower in ESRD patients (group 1) compared to healthy subjects (group 2) (p<0.0001, for all). Serum CEA and beta 2M levels were also significantly higher in group 1 patients compared to group 2 subjects (p<0.005, p<0.0001, respectively). Serum Ca15-3 and CA-125 levels were found to be significantly lower in group 1 patients compared to group 2 subjects (p<0.005, p<0.001, respectively). There were no statistically significant difference in terms of serum CA 19-9, beta-HCG and AFP between group 1 and group 2 patients. In group 1 patients, there was a negative correlation between serum Zn levels and AFP, while a positive correlation was obsorved between serum Zn levels and CA15-3. The measurement of AFP may be beneficial in HD patients. Further studies are needed.Öğe The Relationship Between Serum Zinc Levels and Tumor Markers in Hemodialysis Patients(Modestum Ltd, 2014) Turkmen, Kultigin; Ecder, Tevfik; Turk, SuleymanThe incidence of neoplasia is increased in end-stage renal disease (ESRD) patients. Zinc (Zn) deficiency is associated with neoplasia and also commonly seen in ESRD patients. However, the data regarding the relationship between Zn levels and tumor markers is scant in this population. We aimed to investigate the relationship between Zn levels and tumor markers in hemodialysis patients. Twenty-six hemodialysis patients (11 male, 15 female, mean age 41.6 +/- 14.3 years) and 11 healthy subjects (6 male and 5 female, mean age 38.7 +/- 7.2 years) were included. Serum Alpha fetoprotein (AFP), carcinoembriyonic antigen (CEA), CA 19-9, CA 15-5, CA 125, beta subunit of human corionic gonadotrophin (beta-HCG) and beta-2 microglobulin (beta 2M) and Zn levels were measured. Data were analysed by Student's t test. Serum Zinc levels were significantly lower in ESRD patients (group 1) compared to healthy subjects (group 2) (p<0.0001, for all). Serum CEA and beta 2M levels were also significantly higher in group 1 patients compared to group 2 subjects (p<0.005, p<0.0001, respectively). Serum Ca15-3 and CA-125 levels were found to be significantly lower in group 1 patients compared to group 2 subjects (p<0.005, p<0.001, respectively). There were no statistically significant difference in terms of serum CA 19-9, beta-HCG and AFP between group 1 and group 2 patients. In group 1 patients, there was a negative correlation between serum Zn levels and AFP, while a positive correlation was obsorved between serum Zn levels and CA15-3. The measurement of AFP may be beneficial in HD patients. Further studies are needed.Öğe Renal artery embolization in severe nephrotic syndrome(Wiley-Blackwell, 2016) Solak, Yalcin; Koc, Osman; Ucar, Ramazan; Ozbek, Orhan; Ergenc, Hasan; Gaipov, Abduzhappar; Turk, SuleymanIntroduction Severe nephrotic syndrome is associated with increased morbidity and mortality. Renal artery embolization (RAE) has been used in a number of renal diseases such as renal tumors, arteriovenous fistulas etc. However, data regarding benefits of RAE in patients with symptomatic severe proteinuria is limited. We decided to evaluate role of RAE in the setting of severe symptomatic nephrotic syndrome. Methods Eight patients who had undergone transcatheter renal artery embolization with polyvinyl alcohol (PVA) were included. Clinico-demographic characteristics as well as baseline laboratory data including level of proteinuria, serum albumin, C-reactive protein and LDL cholesterol levels were recorded for each patient. After RAE, outpatient clinic control laboratory values were also assessed. Findings All patients except one underwent bilateral RAE (four simultaneous or three sequential). Two patients experienced postembolization syndrome characterized by flank pain, fever, and leukocytosis, which was self-limited and responded to analgesics in all patients. There was no technical complications associated with RAE procedure. All patients became anuric except one. Serum albumin levels increased and serum LDL-cholesterol levels decreased considerably in treated patients. Discussion Renal artery embolization with the purpose of amelioration in nephrotic syndrome complications was effective and free of major technical complications in our patients.Öğe Uric Acid Level and Erectile Dysfunction in Patients with Coronary Artery Disease(Elsevier Sci Ltd, 2014) Solak, Yalcin; Akilli, Hakan; Kayrak, Mehmet; Aribas, Alpay; Gaipov, Abduzhappar; Turk, Suleyman; Perez-Pozo, Santos E.Introduction Erectile dysfunction (ED) is a frequent complaint of elderly subjects and is closely associated with endothelial dysfunction and cardiovascular disease (CVD). Uric acid is also associated with endothelial dysfunction, oxidative stress, and CVD, raising the hypothesis that an increased serum uric acid might predict ED in patients who are at risk for coronary artery disease (CAD). Aim This study aims to evaluate the association of serum uric acid levels with presence and severity of ED in patients presenting with chest pain of presumed cardiac origin. Methods This is a cross-sectional study of 312 adult male patients with suspected CAD who underwent exercise stress test (EST) for workup of chest pain and completed a sexual health inventory for men survey form to determine the presence and severity of ED. Routine serum biochemistry (and uric acid levels) were measured. Logistic regression analysis was used to assess risk factors for ED. Main Outcome Measures The short version of the International Index of Erectile Function questionnaire diagnosed ED (cutoff score <= 21). Serum uric acid levels were determined. Patients with chest pain of suspected cardiac origin underwent an EST. Results One hundred forty-nine of 312 (47.7%) male subjects had ED by survey criteria. Patients with ED were older and had more frequent CAD, hypertension, diabetes and impaired renal function, and also had significantly higher levels of uric acid, fibrinogen, glucose, C-reactive protein, triglycerides compared with patients without ED. Uric acid levels were associated with ED by univariate analysis (odds ratio = 1.36, P = 0.002); however, this association was not observed in multivariate analysis adjusted for estimated glomerular filtration rate. Conclusion Subjects presenting with chest pain of presumed cardiac origin are more likely to have ED if they have elevated uric acid levels.
