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Öğe Association of fetuin - A levels with carotid intima media thickness and valvular calcification in hemodialysis and peritoneal dialysis patients(2013) Solak Y.; Inal A.; Atalay H.; Kayrak M.; Biyik Z.; Türkmen K.; Yeksan M.Background: Fetuin-A is a negative acute-phase reactant which prevents vascular calcification. Coronary artery disease (CAD) is the most important cause of mortality in patients undergoing renal replacement therapy (RRT). The key element of cardiovascular disease (CVD) seen in end-stage renal disease patients who are on dialysis treatment is accelerated calcific atherosclerosis. There are a limited number of studies in which HD and PD is compared in terms of fetuin-A level. OBJECTIVE: We aimed to investigate the association of serum fetuin-A level with valvular calcification and predictors of CAD in hemodialysis (HD) and peritoneal dialysis (PD) patients. MATERIAL and METHODS: 39 HD (24 males, 15 females) and 39 PD (25 males, 14 females) patients were included in the study. We determined carotid artery intima media thickness (CIMT) and evaluated heart valve calcification via echocardiography. We also measured serum fetuin-A level, CRP, ferritin, fibrinogen and serum albumin level. According to fetuin-A level, patients were stratified into quartiles. RESULTS: Fetuin-A level was significantly lower in HD patients when compared with that of PD patients (28.6±5.934 ng/ml, 32±4.8 ng/ml respectively p<0.001). There was a significant negative correlation between CIMT and fetuin-A level. CIMT was found to be lower in PD patients than in HD patients. We found a positive correlation between fetuin-A and dialysis adequacy and albumin level. There was a negative correlation of fetuin-A with age, fibrinogen, ferritin and CRP. Fetuin-A level was lower in patients with aortic calcification. Conclusion: Fetuin-A level was found to be lower in HD patients. Fetuin-A may be a novel marker for CVD in patients undergoing RRT.Öğe The comparison of four different dialysates on QT dispersion and arrhythmias in hemodialysis patients(2012) Türkmen K.; Mil S.; Solak Y.; Türk S.OBJECTIVES: Sudden cardiac death (SCD) is common in patients with end-stage renal disease receiving hemodialysis. SCD may be caused by electrolyte imbalance or malignant arrhythmias in hemodialysis patients. We aimed to evaluate the effects of four different dialysates on QT dispersion and arrhythmia. MATERIAL and METHODS: Twenty-one patients receiving hemodialysis were enrolled. Four different dialysates were used and twelve-lead ECG measurements were recorded to determine QTc and QTc dispersion. Holter ECG was performed to assess arrhythmia. RESULTS: In group 1 (1.0 K +, 1.5 Ca++), predialytic and postdialytic QTc dispersion measurements were 52.3±11.7 and 59.2± 13.1 msec respectively and this is statistically significant (p=0.007). In group 2 (2.0 K +, 1.5 Ca++), group 3 (1.0K +, 1.75Ca++), and in group 4 (2.0 K +, 1.75Ca++), QTc dispersion measurements were 53.5±14.4 and 53.2± 15.0 msec, 53.5±14.4 and 53.2±15.0 msec, 50.8±12.0 and 52.2±13.3 msec, 51.3±12.2 and 52.1±12.3 msec, respectively, and these were not statistically significant. CONCLUSION: In group 1, patients had higher QTc dispersion. There was no statistically significant difference regarding QTc dispersion among the four groups. We also could not find an increased rate of arrhythmias in the groups. These results suggest that there may be other causative risk factors that can affect QT dispersion and arrhythmias in hemodialysis patients.Öğe Dilated cardiomyopathy in a patient with antibody-negative Goodpasture's syndrome and pulmonary relapse.(2010) Solak Y.; Selcuk N.Y.; Polat I.; Atalay H.; Turkmen K.The Goodpasture's syndrome, also known as anti-GBM disease, is an uncommon disease, responsible for 20% of all cases of rapidly progressive glomerulonephritis. Anti-GBM antibodies are directed against non-collagenous domain (NC-1) of the alpha-3 chain of type IV collagen. When conventional ELISA assays are used, these antibodies can be detected in almost all the patients. Nevertheless, some reports have described antibody-negative relapsing disease. Some aggravating factors, namely, smoking, pulmonary infection and hypervolemia, may expose embedded antigenic target and may be responsible for the relapse. In addition, these antibody-negative relapses also respond to standard treatment, which comprises of plasma exchange, pulse steroids and cyclophosphamide. Herein, we report a patient who presented at the Selcuk University Meram School of Medicine, Meram, Konya, Turkey, with the pulmonary-renal syndrome. He was also found to have idiopathic dilated cardiomyopathy (DCM). To our knowledge, this is the first report describing co-existence of DCM and anti-GBM disease. There is growing evidence showing strong relation of both DCM and anti-GBM disease with HLA. Although not proven, this might have occurred in our patient. In our opinion, volume overload was facilitated by anuria and DCM and led to an antibody-negative pulmonary relapse. The relapse was treated just as the first episode and the patient improved satisfactorily.Öğe Efficiency of silver coated urinary catheter in catheter-associated urinary tract infection in critical care unit(AVES, 2010) Teke T.; Yavuz Z.; Atalay H.; Maden E.; Solak Y.; Uzun K.Aim: Urinary tract infection (UTI) is the most prevalent cause of nosocomial infections, with an incidence of 40%. The incidence of urosepsis occurs in approximately 16% of the ICU patient populations. The purpose of this study was to determine the efficacy of a silver coated urinary catheter in prevention of catheter-associated UTI. Material and Methods: We investigated 21 patients (mean age with 71.4±9.0 year and 14 M, 7 F) foley silicon urinary catheter and 20 patients (mean age with 67.6±8.7 year and 15 M, 5 F) with silver coated urinary catheter. In all patients, foley urinary catheters were changed with silver coated catheter in critical care unit. Results: The most common cause of infection was Klebsiella (33%). The susceptibility of gram negative microorganisms against antimicrobial agents were amicacin, piperacillin-tazobactam and carbapenem. The cost of antibiotic was higher in foley catheter group than silver coated group (p<0.001). Conclusion: Silver coated urinary catheter is expensive, it is cost effect according to urinary infection and antibiotic cost.Öğe Evaluation of adrenal function in chronic obstructive pulmonary disease patients receiving invasive and noninvasive mechanical ventilation(AVES, 2010) Atalay H.; Teke T.; Yavuz Z.; Maden E.; Kiyici A.; Solak Y.; Uzun K.Stress and severe disease states in the intensive care unit (ICU) cause release of adrenocorticoid hormone from the hypophysis and cortisol from the adrenal cortex by activating hypothalamo-pituitary adrenal axis. While adrenal insuffi ciency (AI) is seen in less than 0.01% of the normal population, its frequency is over 28% of cases in intensive care units (ICU). The aim of this study was to evaluate adrenal function in 36 cases with COPD, in pulmonary diseases ICU, receiving invasive mechanical ventilation (IMV) (n:23) and noninvasive mechanical ventilation (NIMV) (n:13). For this purpose, after obtaining a blood sample for baseline cortisol level, 1mg ACTH was given to patients in the fi rst day of admission to ICU. Cortisol levels were checked at the 30th and 60th minutes of ACTH test. Of all cases, mean age was 67.3±9.2, duration of hospitalization 12.9±9.3 days, APACHE II score 20.9±5.4, systolic blood pressure (bp) 103.5±28.2 mmHg, diastolic bp 64.6±19.2, mean arterial blood pressure 81.5±20.5 mmHg, sodium 138.3 ±6.3, potassium 4.3±1.2, urea 83.8±62.5 and creatinine was1.38±0.9 respectively. According to baseline cortisol levels, AI was present in 22 (45%) patients. Of these cases, 11 were in NIMV and 11 in IMV groups. When the baseline, 30th minute and 60th minute cortisol levels were compared, a statistically signifi cant difference was present (p<0.05, for all). In conclusion, we consider that adrenal insuffi ciency is encountered frequently in COPD patients with respiratory failure and further studies are needed tobetter delineate this association.Öğe Infuenza A/H1N1 infection in a renal transplant recipient: Early recognition prevented unfavorable results(2011) Solak Y.; Selçuk N.Y.; Atalay H.; Öbek O.; Genç N.Influenza 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 A retrospective analysis of five year data of end-stage renal disease patients: A single center experience(2011) Türkmen K.; Tunç A.; Solak Y.; Türk S.OBJECTIVES: CKD is a worldwide threat to public health. Approximately 1.8 million people are currently being treated with renal replacement therapy including hemodialysis, peritoneal dialysis and transplantation. The etiology and factors affecting the progression of chronic kidney disease to endstage renal disease (ESRD) differ in industrialized and underdeveloped countries. STUDY DESIGN: The aim of the study was to investigate the etiologies of ESRD, factors affecting progression to ESRD and mortality rates of patients between 2000-2004, in Konya, a city in the Middle Anatolian region of Turkey. MATERIAL and METHODS: We included 417 end-stage renal disease patients (207 female and 210 male) between 16-90 years old receiving RRT for the first time in the study. CKD was diagnosed by GFR measurement that was calculated by MDRD formula. Co-morbidity was expressed using Wright-Khan index. RESULTS: We showed that there was an increased rate of diabetic nephropathy between 2003 and 2004. The increased rate of diabetic nephropathy was found to be statistically significant in the last two years (p<0.005). There was also significant negative correlation between mortality and diastolic BP (r: -0.143, p: 0.05) and the education level of the patients (r: -0.159, p: 0.0002). There was a positive correlation between mortality and serum urea levels (r: 0.193, p: 0.0001), HD through a catheter for the first time (r: 0.140, p: 0.0006), and receiving HD by a continuous RRT modality (r: 0.163, p: 0.0001). CONCLISION: Our study showed that advanced age, increased mean arterial BP before the first RRT, having CVD or DM as an etiology of ESRD, increased erythrocyte sedimentation rate (ESR), decreased serum albumin levels and the presence of co-morbid diseases were the main factors that affected survival of the patients.Öğe Spontaneous retroperitoneal hemorrhage presenting as hemoperitoneum secondary to renal cyst rupture in a peritoneal dialysis patient with acquired cystic kidney disease(Medknow Publications, 2015) Biyik Z.; Solak Y.; Gaipov A.; Ozbek O.; Esen H.; Turk S.Spontaneous retroperitoneal hemorrhage (SRH) is a rare and potentially fatal condition. Acquired cystic kidney disease (ACKD) may cause SRH in hemodialysis patients. However, presentation of retroperitoneal hematoma as hemoperitoneum in peritoneal dialysis (PD) patients is exceedingly rare. We report a 44-year-old male PD patient who presented with hemoperitoneum secondary to retroperitoneal hematoma. The reason of SRH was rupture of the cysts of ACKD. The patient underwent unilateral nephrectomy with subsequent disappearance of hemoperitoneum. The importance of this case lies in the fact that the patients who have been receiving dialysis for a long time should be under surveillance in terms of ACKD development and potential associated complications such as cyst hemorrhage and malignancy.Öğe Utility of double filtration plasmapheresis in acute antibody mediated renal allograft rejection: Report of three cases(2011) Solak Y.; Atalay H.; Polat I.; Anil M.; Türkmen K.; Biyik Z.; Yeksan M.Plasmapheresis is an extracorporeal procedure, which is often employed to rapidly lower circulating titers of autoantibodies, immune complexes or toxins. There are two types of plasmapheresis namely, regular plasmapheresis (RPP) by centrifugation and membrane filtration, and double filtration plasmapheresis (DFPP) which is a special form of membrane filtration in which two membranes called as plasma separator and plasma fractionator are employed to filter macromolecules more selectively. DFPP have several advantages over RP. Despite widespread utilization of DFPP in the setting of ABO blood group incompatible kidney transplantation, there is no report regarding DFPP in patients with antibody mediated acute renal allograft rejection who are good candidates for beneficial effects of DFPP. Here we report three renal transplant recipients in whom DFPP was applied as a component of anti-rejection treatment regimen.
