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Öğe Could immune cells be associated with nephropathy in Fabry disease patients?(Springer, 2023) Turkmen, K.; Karaselek, M. A.; Celik, S. C.; Esen, H. H.; Ozer, H.; Baloglu, I.; Ozturk, Y.BackgroundIn Fabry Disease (FD), although the primary factor initiating kidney damage is glycosphingolipid accumulation, secondary conditions such as increased inflammation and fibrosis may cause this damage to progress. These processes may be induced by immune cells. Therefore, we aimed to investigate the peripheral lymphocyte subgroup analysis of the patients with FD and compare these results with healthy individuals. In addition, we performed T, B, NK, and plasma cell analyses in kidney biopsy materials and compared these kidney biopsy results with the biopsy results of patients whose kidney functions were impaired after 4 years of regular ERT.Materials and methods18 FD and 16 healthy individuals were included in the study. T-B lymphocyte and NK-cell populations were determined. We performed kidney biopsies (KBx) on 13 patients with FD prior to ERT. Of these, 4 patients had rebiopsy after 4 years of regular ERT. Immunohistochemical staining was performed to define immune cell infiltration.ResultsThere was no statistically significant difference in terms of total, helper and cytotoxic T-lymphocyte and CD3(-)CD16(+)CD56(+) natural killer (NK)-cell count (p = 0.20; p = 0.12; p = 0.76; p = 0.75, respectively).According to KBx findings prior to ERT, all patients had interstitial fibrosis (IF), podocyte vacuoles (PV), and podocyte inclusion (PI), CD3, CD4, CD8, CD16, and CD56 positivity at different levels. None of the patients had CD19, CD20, and CD138 positivity at the first biopsies. When we compared the first and the second KBx results of the two progressors, we also demonstrated that CD3(+)4(+)T-cells infiltration remained the same, whereas CD8(+)T cells, CD16(+) and 56(+)NK-cells infiltration were significantly decreased. In contrast, CD20(+)B cells and CD138(+)plasma cell infiltration were significantly increased despite 4 years of ERT (15 fold and sixfold, respectively). The CD20(+)B and CD138(+) plasma cells and IF were positively correlated with proteinuria.ConclusionsThe progression of FD nephropathy and proteinuria is increased despite a long-term ERT. Immune cells, primarily B and plasma cells, might cause these unwanted consequences.Öğe Fabry disease: where are we now?(Springer, 2020) Turkmen, K.; Baloglu, I.Fabry disease (FD) is a multisystemic X-linked disorder characterized by the accumulation of lysosomal globotriaosylceramide (Gb3) secondary to decreased activity of alpha-galactosidase in cells. Generally, males are more severely affected due to the X-linked inheritance pattern of the disease. However, females are asymptomatic or have a less severe pattern of disease. Enzyme replacement therapy (ERT) is the cornerstone of the treatment of FD. At present, there are two forms of ERT that can be applied to FD patients. Novel therapeutic approaches including chaperone therapy, substrate reduction therapy, and gene therapy have been introduced in the era of treatment of FD. In this review, we aimed to discuss the prevalence, clinical and genetic features, pathophysiology, diagnosis, and therapeutic options in FD patients with nephropathy.Öğe The LDL/HDL ratio and atherosclerosis in ankylosing spondylitis(Springer Heidelberg, 2017) Kucuk, A.; Uslu, A. Ugur; Icli, A.; Cure, E.; Arslan, S.; Turkmen, K.; Toker, A.In ankylosing spondylitis (AS) patients, cardiac and vascular involvement may manifest as atherosclerosis and coronary artery disease. Systemic inflammation, oxidative stress, increased low-density lipoprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterol constitute a significant risk for atherosclerosis. This study investigated the relationship between carotid intima-media thickness (CIMT), LDL/HDL ratio, total oxidant status (TOS; an indicator of oxidative stress) and ischemic modified albumin (IMA; an ischemic marker in AS patients). Sixty AS patients were diagnosed using the Modified New York Criteria; 54 age- and gender-matched participants were included as controls. CIMT, LDL/HDL ratio, TOS and IMA were measured using the most appropriate methods. IMA was higher in AS patients compared to controls (p < 0.0001). TOS was also increased in AS patients (p = 0.005); as was CIMT (p < 0.0001). The LDL/HDL ratio was also greater in AS patients compared to controls (p = 0.047). A positive correlation was found between CIMT and LDL/HDL ratio among AS patients. Elevated CIMT, IMA and TOS levels suggest an increased risk of atherosclerotic heart disease in AS patients. The LDL/HDL ratio was higher in AS patients compared to controls, and there was a correlation between LDL/HDL ratio and CIMT, albeit statistically weak. Therefore, the LDL/HDL ratio is not a reliable marker to predict atherosclerotic heart disease in AS patients.Öğe Peri-aortic fat tissue and malnutrition-inflammation-atherosclerosis/calcification syndrome in end-stage renal disease patients(Springer, 2013) Turkmen, K.; Tonbul, H. Z.; Erdur, F. M.; Guney, I.; Kayikcioglu, H.; Altintepe, L.; Ozbek, O.Thoracic peri-aortic fat tissue (PFT) is considered as a metabolically active organ in atherosclerosis. Malnutrition, inflammation and atherosclerosis/calcification (MIAC) are the most commonly encountered risk factors of cardiovascular disease in end-stage renal disease (ESRD) patients. Calcification of the aorta was found to be an important cardiovascular risk marker predicting future events, morbidity and mortality in this population. We aimed to investigate the relationship between PFT, MIAC syndrome and thoracic aortic calcification (TAC) in ESRD patients. Seventy-nine ESRD patients receiving hemodialysis (HD) or peritoneal dialysis (PD) and 20 control subjects were enrolled in this cross-sectional study. PFT and TAC were assessed using a 64-MDCT scanner. Patients with serum albumin < 3.5 g/dL were defined as patients with malnutrition; those with serum C-reactive protein level > 10 mg/L had inflammation, and those with coronary artery calcification score (CACS) > 10 had atherosclerosis/calcification. TAC and PFT were significantly higher in ESRD patients compared with control subjects. There was a statistically significant relationship between PFT and TAC in ESRD patients (r = 0.458, p < 0.0001). PFT was found to be significantly increased when the MIAC components increased. PFT was positively associated with age, BMI, uric acid, hemoglobin and CAC. The multivariate analysis revealed that age and uric acid were independent predictors of increased PFT. Twenty-four (30.4 %) patients had none, 30 (37.9 %) had one component, 17 (21.5 %) had two components, and 8 (10.2 %) had all MIAC components. PFT was highest among patients having all three components (28.6 cm(3)) and lowest among those who do not have the MIAC syndrome (8.54 cm(3)). TAC was highest among patients having all three components (179.2 HU) and lowest among those who do not have the MIAC syndrome (0 HU). We found a relationship between PFT and MIAC syndrome in ESRD patients.Öğe The prevalance of masked hypertension and blood pressure variability in patients with renal transplantation(Oxford Univ Press, 2012) Kayrak, M.; Gul, E. E.; Kaya, C.; Turkmen, K.; Solak, Y.; Yazici, R.; Gul, I.[Abstract Not Availabe]Öğe THE RELATION BETWEEN INFLAMMATION, CAROTID INTIMA-MEDIA THICKNESS AND LOW-DENSITY LIPOPROTEIN CHOLESTEROL-HIGH-DENSITY LIPOPROTEIN CHOLESTEROL RATIO IN ANKYLOSING SPONDYLITIS PATIENTS(Bmj Publishing Group, 2015) Kucuk, A.; Uslu, A. U.; Arslan, S.; Turkmen, K.; Toker, A.; Kayrak, M.[Abstract Not Availabe]Öğe The relationship between colonization of Oxalobacter formigenes serum oxalic acid and endothelial dysfunction in hemodialysis patients: From impaired colon to impaired endothelium(Churchill Livingstone, 2015) Turkmen, K.; Erdur, F. M.Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in chronic kidney disease (CKD) patients receiving hemodialysis (HD). Oxalic acid is a uremic retention molecule that has been extensively studied in the pathogenesis of calcium-oxalate stones. Oxalobacter formigenes (O. formigenes), a component of the colonic microbiota, plays an important role in oxalate homeostasis. Little is known regarding the colonization of HD patients by O. formigenes and the exact role of this bacterial species in oxalic acid metabolism in these patients. We hypothesized that oxalic acid may be insufficiently degraded in HD patients due to under colonization of the colon by O. formigenes in these patients. To test this hypothesis, we sought to quantitatively measure fecal O. formigenes levels and serum oxalic acid levels in HD patients. We also suggest that increased oxalic acid levels may be associated with endothelial dysfunction and aortic stiffness, both of which are commonly observed in HD patients. Increased colonization with O. formigenes via the ingestion of prebiotics and probiotics could potentially decrease serum oxalic acid levels and improve cardiovascular outcomes in HD patients. (C) 2015 Elsevier Ltd. All rights reserved.Öğe THYROID DISORDERS PREVALENCE IN A COHORT OF KIDNEY TRANSPLANT RECIPIENTS(Editura Acad Romane, 2020) Karakose, S.; Cordan, I; Gonulalan, G.; Karakose, M.; Kurtgorz, P. O.; Baloglu, I; Turkmen, K.Context. As the life expectancy prolongs, malignancy has become an important issue in renal transplant recipients (RTRs). Thyroid cancer is the most common endocrine malignancy with ongoing increase in incidence all over the world. Objective and design. This is a cross-sectional study that investigates the thyroid disorders and the prevalence of thyroid nodule and cancer in RTRs. Subjects and methods. 204 RTRs were evaluated for the thyroid diseases with ultrasonography, serum thyroid stimulating hormone, free T4, free T3 levels, antithyroglobulin antibody and anti-thyroid peroxidase antibody levels; FNAB was carried if required. Results. 191 patients (94.1%) had normal thyroid function. Subclinical hypothyroidism was diagnosed in 11 patients, subclinical hyperthyroidism in 1 patient and low T3 syndrome in 4 patients. The FNAB was performed in 17 (27.9%) from 61 patients with thyroid nodule. The cytological examination of biopsy materials revealed that 2 (11.8%) nodules were suspicious for malignancy, 13 (76.5%) were benign, and 2 (11.8%) with non diagnostic cytology. Thyroid cancer prevalence was 0.2% in Turkey but we detected that 0.98% of RTRs had thyroid cancer. Conclusions. Screening the RTRs for thyroid disorders is necessary, so that early diagnosis and appropriate treatment of thyroid disease and cancer may improve the quality of life.
