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Öğe Acute Renal Failure Secondary to Malignant Hypertension Induced Thrombotic Microangiopathy(Saudi Med J, 2010) Türkmen, Kültigin; Solak, Yalçın; Esen, Hasan; Tonbul, Halil Z.The thrombotic microangiopathy (TMA) represents a discreet group of disorders with common pathological features including fibrinoid necrosis, endothelial cell injury, and obstruction of vessels.1 The clinical presentation ofTMA includes microangiopathic hemolytic anemia, thrombocytopenia, and functional impairment of various organ systems. Hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are among the common causes of TMA. Patients with malignant hypertension are prone to TMA.Öğe Association of fetuin-a levels with carotid ıntima media thickness and valvular calcification in hemodialysis and peritoneal dialysis patients(2013) Solak, Yalçın; Atalay, Hüseyin; Bıyık, Zeynep; Türkmen, Kültigin; Yeksan, Mehdi; Türk, Süleyman; İnal, AliGİRİŞ: Fetuin A vasküler kalsifikasyonu önleyen bir negatif akut faz reaktanıdır. Koroner arter hastalığı (KAH) renal replasman tedavisi almakta olan hastalarda en önemli ölüm sebebidir. Diyalize giren son dönem böbrek yetmezliği hastalarında görülen kardiyovasküler hastalığın ana elementi hızlanmış kalsifik aterosklerozdur. Fetuin A seviyeleri açısından hemodiyaliz (HD) ve periton diyalizini(PD) karşılaştıran sınırlı sayıda çalışma mevcuttur. AMAÇ: HD ve PD hastalarında KAH prediktörleri ve valvüler kalsifikasyon ile serum fetuin A düzeyleri arasındaki ilişkiyi araştırmayı amaçladık. GEREÇ ve YÖNTEMLER: 39 HD (24 erkek, 15 kadın) ve 39 PD (25 erkek, 14 kadın) hastası çalışmaya alındı. Karotis intima media kalınlığı (KIMK) ultrason ile ölçüldü ve kalp kapağı kalsifikasyonları ekokardiyografi ile değerlendirildi. Ayrıca serum fetuin-A, CRP, ferritin, fibrinojen, ve albumin seviyeleri saptandı. Fetuin-A düzeylerine göre hastalar çeyreklere ayrıldı. Bulgular: Fetuin-A seviyesi HD hastalarında PD hastalarına göre daha düşüktü (hemodiyaliz 28,65,934 ng/ml, PD 324,8 ng/ml, p0,001). KIMK ile fetuin-A seviyesi arasında anlamlı negatif korelasyon vardı. KIMK, PD hastalarında HDe göre daha düşüktü. Fetuin-A seviyesi ile diyalizÖğe Culture-Negative Bilateral Emphysematous Pyelonephritis Presented as Acute Renal Failure and Managed Medically Only(LIPPINCOTT WILLIAMS & WILKINS, 2010) Solak, Yalçın; Türkmen, Kültigin; Atalay, Hüseyin; Türk, SüleymanEmphysematous pyelonephritis is a life-threatening infection especially seen in patients with poorly-controlled diabetes mellitus. Imaging modalities (preferably computed tomography) are required to establish the diagnosis. Treatment modalities include volume resuscitation, broad-spectrum antibiotics, percutaneous drainage, and, as a last resort, nephrectomy. We present a case of a 46-year-old female who had hypertension and type-2 diabetes mellitus and presented with complaints of dysuria, back pain, and decreased urine output. Renal ultrasound and abdominal computerized tomography (CT) revealed air-fluid levels at each perirenal region and collecting systems, consistent with emphysematous pyelonephritis. Her clinical situation improved with vigorous fluid resuscitation and broad-spectrum antibiotic treatment.Öğe Effects of Serum Selenium Level on Cell-Mediated Immunity and on Antibody Response to Multivalent Influenza Vaccine in Hemodialysis Patients(2012) Türkmen, Kültigin; Ecder, Tevfik; Türk, SüleymanOBJECTIVE: End-stage renal disease (ESRD) patients are more prone to serious influenza virus infection than healthy subjects. Selenium (Se) play an important role in cellular and humoral immunity and serum Se levels were lower in hemodialysis patients. Studies have demonstrated that Se deficiency results in less reboust immune responses to vaccination and infections. We aimed to investigate the effect of serum Se levels on immune parameters and antibody response to multivalent influenza vaccine (MIV) in HD patients. MATERIAL and METHODS: Twenty-six HD patients (Group 1) and 11 healthy subjects (Group 2) were vaccinated with a trivalent inactivated MIV. In both groups, serum Se levels, CD3, CD4, CD4/CD8 ratio, CD3+HLA-DR+ cell percentages and antibody response to MIV were determined before and 1 month after the vaccination. RESULTS: There were statistically significant differences between Group 1 and Group 2 in terms of baseline serum Se levels, CD8, CD4/CD8 ratio, and CD3+HLA-DR cell percentages. One month after the vaccination, no significant changes were observed in any of the parameters except antibody titers with to baseline levels. CONCLUSIONS: We did not observe any difference in terms of Se levels and the immune parameters mentioned above before and 1 month after MIV vaccination in HD patients. Further studies investigating the link between Se status and clinical outcomes are needed in dialysis patients.Öğe Effects of serum selenium level on cell-mediated ımmunity and on antibody response to multivalent ınfluenza vaccine in hemodialysis patients(2012) Türkmen, Kültigin; Ecder, Tevfik; Türk, SüleymanAMAÇ: Son dönem böbrek yetmezliği (SDBY) olan hastalar sağlıklı bireylere oranla ciddi influenza virüs enfeksiyonuna daha yatkındırlar. Selenyum (Se) hücresel ve hümoral bağışıklıkta önemli bir rol oynamaktadır ve hemodiyaliz hastalarında serum Se düzeyleri düşüktür. Yapılan çalışmalarda Se eksikliği olanlarda aşılara ve enfeksiyon hastalıklarına yeterli bağışıklık yanıtının oluşmadığı gösterilmiştir. Çalışmamızda SDBY hastalarında serum Se düzeyinin bağışıklık göstergeleri ve çok değerlikli influenza aşısına (MIV) antikor yanıtı üzerine etkisini göstermeyi hedefledik. GEREÇ ve YÖNTEMLER: 26 hemodiyaliz hastası (grup 1) ve 11 sağlıklı kontrol (grup 2) trivalan MIV ile aşılandı. Aşı öncesi ve 1 ay sonrasında serum Se, CD3, CD4, CD4/ CD8 oranı, CD3HLADR hücre oranları değerlendirildi. BULGULAR: Grup 1'deki hastaların grup 2'deki hastalara göre bazal serum Se düzeyleri, CD4/CD8 oranı düşük, CD8 ve CD3HLA-DR hücre yüzdeleri ise yüksek bulundu. Her iki grubta MIV aşılanma sonrasında antikor düzeyleri dışında Se düzeyleri, CD8, CD4/CD8 oranı ve CD3HLA-DR hücre yüzdelerinde anlamlı bir fark bulunmadı. SONUÇ: Hemodiyaliz hastalarında, MIV aşısı öncesi ve 1 ay sonrasında serum Se ve bağışıklık göstergeleri üzerinde herhangi bir fark saptamadık. Hemodiyaliz hasta grubunda Se düzeyi ile klinik sonuçları değerlendiren çalışmalara gereksinim vardır.Öğe Efficacy and Tolerability of Intravenous Paricalcitol in Calcitriol-Resistant Hemodialysis Patients with Secondary Hyperparathyroidism: 12-Month Prospective Study(TAYLOR & FRANCIS LTD, 2012) Tonbul, Halil Zeki; Solak, Yalçın; Atalay, Hüseyin; Türkmen, Kültigin; Altıntepe, LütfullahRationale/objectives: Data are limited regarding the use of paricalcitol in calcitriol-resistant patients with secondary hyperparathyroidism (SHPT). We aimed to evaluate the effects of paricalcitol in calcitriol-resistant hemodialysis patients with SHPT. Methods: This is a 12-month, open-label, prospective study. Forty patients with calcitriol-resistant and/or calcitriol-intolerant SHPT were included. After a washout period, all patients converted to paricalcitol with a 1: 3 conversion ratio. Serum calcium and phosphorus were monitored monthly, while serum intact parathyroid hormone (iPTH) once in every 3 months. Paricalcitol dose was reduced or discontinued in case of hypercalcemia and/or hyperphosphatemia. Pre- and posttreatment electrolyte and iPTH values were compared with Student's t-test and Wilcoxon signed-rank test, respectively. Main findings: Forty patients completed the study. Mean initiation dose of paricalcitol was 23 +/- 7 mu g/week. Mean serum calcium was 8.9 +/- 0.8 mg/dL at baseline and 9.4 +/- 0.7 mg/dL at study end (p = 0.07). Mean monthly serum phosphorus levels stayed stable. Paricalcitol was effective in reducing iPTH levels when compared with pretreatment values (747.9 +/- 497.2 pg/mL, 307.3 +/- 417.1 pg/mL, respectively; p < 0.001). Thirty-two patients had to discontinue intravenous (IV) paricalcitol at some time during their treatment. Main reasons for discontinuation were as follows: hyperphosphatemia (58%), hypercalcemia (25%), and iPTH < 150 pg/mL (17%). Principle conclusions: Paricalcitol was found to be effective in reducing iPTH levels in calcitriol-resistant patients with SHPT despite relatively frequent drug discontinuation rates.Öğe Falls in elderly hemodialysis patients(OXFORD UNIV PRESS, 2011) Abdel-Rahman, Emaad M.; Turgut, Faruk Hilmi; Türkmen, Kültigin; Balogun, Rasheed A.The elderly, (age epsilon 65 years) hemodialysis (HD) patient population is growing rapidly across the world. The risk of accidental falls is very high in this patient population due to multiple factors which include aging, underlying renal disease and adverse events associated with HD treatments. Falls, the most common cause of fatal injury among elderly, not only increase morbidity and mortality, but also increase costs to the health system. Prediction of falls and interventions to prevent or minimize fall risk and associated complications will be a major step in helping these patients as well as decreasing financial and social burdens. Thus, it is vital to learn how to approach this important problem. In this review, we will summarize the epidemiology, risk factors, pathophysiology and complications of falls in elderly HD patients. We will also focus on available methods to assess and predict the patients at higher risk of falling and will provide recommendations for interventions to reduce the occurrence of falls in this population.Öğe Health-Related Guality of Life, Sleep Guality, and Depression in Peritoneal Dialysis and Hemodialysis Patients(Wiley-Blackwell, 2012) Türkmen, Kültigin; Yazıcı, Raziye; Solak, Yalçın; Güney, İbrahim; Altıntepe, Lutfullah; Yeksan, Mehdi; Tonbul, Halil ZekiHealth-related quality of life (HRQoL) and sleep quality (SQ) were impaired in patients with end-stage renal disease (ESRD). The impairment of both HRQoL and SQ and being in a depressive mood were found to be associated with increased morbidity and mortality in dialysis patients. We aimed to investigate the association between SQ, HRQoL, and depression, and to define independent predictors of SQ and depression in peritoneal dialysis (PD) and hemodialysis (HD) patients. Ninety HD patients (41 females, 49 males with mean age 50 +/- 15.7 years) and 64 PD patients (27 females, 37 males with mean age 52.4 +/- 15.3 years) receiving renal replacement therapy for at least 3 months were screened for the assessment of SQ, HRQoL, and depression in this cross-sectional study. A modified postsleep inventory, Short Form of Medical Outcomes Study (SF-36) and Beck depression inventory (BDI) were applied to all patients for evaluating SQ, HRQoL, and depression, respectively. HD and PD patients had similar total SQ scores. Physical and mental component scale of HRQoL were found to be significantly higher in HD patients (p?Öğe A Hepatitis C-Positive Patient with New Onset of Nephrotic Syndrome and Systemic Amyloidosis Secondary to Common Variable Immunodeficiency(K Faisal Spec Hosp Res Centre, 2010) Türkmen, Kültigin; Anıl, Melih; Solak, Yalçın; Atalay, Hüseyin; Esen, Hasan; Tonbul, Halil Z.Common variable immunodeficiency (CVID) is a heterogenous group of predominantly antibody deficiency disorders that make up the greatest proportion of patients with symptomatic primary hypogam maglobulinemia The rare coincidence of amyloidosis and hypogamma globulinemia has been reported previously Contrary to the usual insidious slowly progressive disease following hepatitis C infection a rapidly progressive cirrhotic form can develop in hypogammaglobulinemic patients We report a HCV positive patient with a new onset of nephrotic syndrome and systemic amyloidosis secondary to CVID Blood analyses showed serum creatininne of 1 8 mg/dL and serum albumin of 3 1 gm/dL 24 h urinary protein was 11 800 mg/day Serum immunoglobulin levels were IgG 340 mg/dL IgM 18 mg/dL IgA 11 mg/dL Duodenal biopsy revealed AA type amvloidosis with potassium permanganite and Congo red staining After a month of antiprotemuric therapy the proteinurin was reduced to 3350 mg/dayÖğe An Incidental Finding While Investigating Secondary Hypertension: Severe Abdominal Aortic Pseudocoarctation(2009) Solak, Yalçın; Atalay, Hüseyin; Türkmen, Kültigin; Anıl, Melih; Türk, Süleyman; Solak, YalçınA 46-year-old female patient presented with uncontrolled hypertension to investigate a possible secondary underlying cause. Her hypertension was incidentally diagnosed when she was being evaluated preoperatively for uterine fibroma. She had no family history of hypertension. Her initial blood pressure was 190/110 mmHg from both arms. No abdominal bruit was audible over the trajectory of renal arteries or abdominal aorta. Bilateral upper and lower extremity arterial pulses were symmetrically palpated. We performed renal Doppler ultrasound along with endocrinologic workup. Doppler ultrasound of the kidney revealed normal renal arteries and a kinking in the infrarenal part of the abdominal aorta. Thus, we performed magnetic resonance angiography of the abdominal aorta and renal arteries to further clarify the aforementioned findings on ultrasound. It revealed leftward severe abdominal aortic kinking below the renal arteries’ origins (Figure 1). No mass lesion was seen to depress the aorta. All other work-ups proved to be unremarkable in terms of revealing an underlying cause for the patient’s hypertension. We managed to control the hypertension with olmesartan 40 mg qid, bisoprolol 10 mg qid and amlodipin 10 mg qid treatment.Öğe Insulin Resistance and Coronary Flow Velocity Reserve in Patients With Autosomal Dominant Polycystic Kidney Disease(Wiley, 2012) Türkmen, Kültigin; Tufan, F.; Alpay, Nilüfer; Kaşıkcıoğlu, E.; Oflaz, H.; Ecder, S. A.; Ecder, T.Background: Cardiovascular problems are a major cause of morbidity and mortality in patients with autosomal dominant polycystic kidney disease (ADPKD). Aim: The aim of this study was to investigate coronary flow velocity reserve (CFVR) as a marker of endothelial dysfunction, carotid intima media thickness (CIMT) as a marker of subclinical organ damage and insulin resistance (IR) as a cardiovascular risk factor in patients with ADPKD. Methods: Twenty-two normotensive ADPKD patients with well-preserved renal function and 19 healthy subjects were included in the study. Creatinine clearances were calculated by the Cockcroft-Gault formula. The homeostasis model of IR (HOMA-IR) was used to measure IR. CIMT was measured by high-resolution vascular ultrasound. CFVR was calculated as the ratio of hyperaemic to baseline diastolic peak velocities by echocardiography. Results: There was no significant difference between the two groups regarding age, gender, body mass index, systolic and diastolic blood pressures, cholesterol and triglyceride levels. However, CIMT and HOMA-IR were significantly increased and CFVR was significantly decreased in patients with ADPKD compared with healthy subjects. Conclusions: The findings of decreased CFVR, increased CIMT and increased IR suggest that cardiovascular risk is elevated even in the early stages of ADPKD.Öğe Kronik Böbrek Hastalığında Vasküler Kalsifikasyon(2010) Türkmen, Kültigin; Tonbul, Halil ZekiSon dönem böbrek yetersizliği gelişen hastalarda en sık ölüm nedeni kardiyovasküler hastalıklardır. Diyaliz hastalarında görülen vasküler kalsifikasyon (VK) kardiyovasküler hastalıklar için bir risk faktörüdür. İleri yaş, diyaliz yeterliliği, D-vitamin tedavisi ve kalsiyum içeren fosfat bağlayıcılar VK için ek klinik risk faktörleridir. Bununla birlikte VK dinamik ve programlanmış bir süreçtir ve sadece pasif kalsiyum-fosfat depolanması ile açıklanamaz. Osteoprotegerin, nükleer faktör kappa-B reseptör aktivatörü (RANK) ve bu molekülün reseptörü (RANKL), monosit stimule edici faktör (M-CSF) ve transkripsiyon factor bağlayıcı protein (Cbfa-1) ile birlikte VK olayında önemli rol oynamaktadır. Buna karşılık Fetuin-A, matriks Gla protein ve osteopontin VK inhibisyonunda rol almaktadır. Tanıda multi dedektör bilgisayarlı tomografi (MDCT) veya elektron beam bilgisayarlı tomografi (EBCT) kullanılmaktadır.Öğe Neutrophil-to-lymphocyte ratio, insulin resistance, and endothelial dysfunction in patients with autosomal dominant polycystic kidney disease(2013) Türkmen, Kültigin; Tufan, Fatih; Selçuk, Engin; Akpınar, Timur Selçuk; Oflaz, H.; Ecder, T.Endothelial dysfunction (ED), insulin resistance (IR), and inflammation are risk factors for increased cardiovascular morbidity and mortality in autosomal dominant polycystic kidney disease (ADPKD). ADPKD patients may have increased carotid intima-media thickness (CIMT) and decreased coronary flow velocity reserve (CFVR). The neutrophil-to-lymphocyte ratio (NLR) was introduced as a marker to determine inflammation in various disorders. We aimed to investigate the relationship between NLR and IR, CFVR, CIMT, and the left ventricular mass index (LVMI) in normotensive ADPKD patients. Twentynine ADPKD patients (age 38.8 ± 10.2 years; 8 men and 21 women) and 19 healthy controls (age 33.8 ± 7.4 years; 8 men and 11 women) were included in this cross-sectional study. CFVR was calculated with echocardiography as the ratio of hyperemic to baseline diastolic peak coronary flow velocities. CIMT was measured in the distal common carotid artery by using a 10-MHz linear echocardiography probe. HOMA-IR was calculated NLR was calculated as the ratio of the neutrophil and lymphocyte counts. Age, sex, body mass index, and levels of glucose, creatinine, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides, C-reactive protein (CRP), microalbuminuria, and creatinine clearance were similar between ADPKD patients and healthy subjects. NLR, CIMT, LVMI, and HOMA-IR were significantly higher and CFVR values were significantly lower in patients with ADPKD compared to that in healthy subjects. NLR showed positive correlation with CIMT, HOMA, insulin, glucose, and HDL cholesterol levels, while it was inversely correlated with CFVR and albumin level in all subjects. In patients with ADPKD, NLR showed positive correlation with HDL cholesterol level and inverse correlation with LVMI and albumin level. NLR that was found to be increased in patients with ADPKD may be a readily available marker of inflammation and ED. © 2013 Indian Journal of Nephrology.Öğe Paid living-unrelated renal transplantation abroad: Too much unknown(2012) Solak, Yalçın; Türkmen, Kültigin; Güney , İbrahim; Erikoğlu, Mehmet; Tonbul, Halil Zeki; Türk, SüleymanOBJECTIVE: Despite the unethical characteristic and unfavorable consequences, paid living-unrelated renal transplantation is still considered as an option for end-stage renal disease patients. This study aimed to compare the medical and surgical complications along with allograft functions of PLURT patients with age and gender matched transplant recipients who received a living or deceased donor kidney at our center. MATERIAL and METHODS: End-stage renal disease patients received PLURT (group 1) in a foreign country and age, and gender matched renal transplant recipients that received renal transplantation from living-related donors (LRT patients; group 2) and deceased donors (DDRT patients; group 3) followed between 2003-2010 at our transplantation center were included in the study. RESULTS: There were no significant differences between groups (Group 1&2 and group 1&3) regarding age, sex, urea, creatinine, creatinine clearance, and proteinuria. Data about patients that received renal transplantation from living-related and deceased-donors at our center were sufficient when compared with PLURT patients. PLURT has a negative impact on patients' survival because of surgical and medical problems. CONCLUSION: In the present study, PLURT, LRT and DDRT patients had early and late complications of renal transplantation which were similarly seen in recent studies. The main problem for unfavorable results of PLURT is the commercial aspect of renal transplantation without considering the risks for ESRD patients.Öğe Periton diyaliz hastalarında kemik mineral dansitometresi ile damar kireçlenmesi (Vasküler kalsifi kasyon) arasındaki ilişki(2012) Türkmen, Kültigin; Erdur, Fatih Mehmet; Özbek, Orhan; Kayıkçıoğlu, Hatice; Sağlam, Mustafa; Tombul, Halil ZekiAMAÇ: Son dönem böbrek yetersizliği (SDBY) gelişen hastalarda damar kireçlenmesi (DK) ve kemik mineral metabolizma (KMM) bozukluğu yaygın olarak gözlenmektedir. SDBY hastalarında fetuin-A düzeyinin ileri derecede düşük olduğu saptanmıştır. Çalışmamızın amacı periton diyaliz (PD) hastalarında koroner arter kireçlenmesi (KAKS), KMM ve fetuin-A arasındaki ilişkiyi incelemektir. GEREÇ ve YÖNTEMLER: Çalışmamıza 46 PD (E/K28/18) hastası alınmıştır. Hastalara çok kesitli bilgisayarlı tomografi ile koroner arter kalsiyum skorlaması (KAKS) yapıldı. KAKS değerlerine göre hastalar Grup 1 (KAKS 0), Grup 2 (KAKS: 1-99), Grup 3 (KAKS: 100-399) ve Grup 4 (KAKS: 400) olmak üzere 4 gruba ayrıldı. Serumda fetuin-A düzeyi çalışıldı. DEXA ile kemik mineral dansitometresi ölçüldü. BULGULAR: Periton diyaliz hastalarının KAKS ile femur T skorları arasında istatistiksel olarak anlamlı ilişki saptanmıştır. Hastalarının KAKS'ı arttıkça femur T skoru azalmaktaydı. Buna ek olarak T skoru -2'nin altında ve üstünde olan hastalar karşılaştırıldığında KAKS değerleri bakımından anlamlı bir farklılık saptanmamıştır. İstatistiksel açıdan anlamlı olmamakla birlikte osteopenik olan PD hastaları daha yaşlıydı ve bu hastaların fetuin-A değerleri daha düşüktü. SONUÇ: Periton diyaliz hastalarında KAKS ile kemik mineralizasyonu arasındaki anlamlı bir ilişki saptadık.Öğe Periton Diyaliz Hastalarında Kemik Mineral Dansitometresi ile Damar Kireçlenmesi (Vasküler Kalsifikasyon) Arasındaki İlişki(2012) Türkmen, Kültigin; Erdur, Fatih Mehmet; Özbek, Orhan; Kayıkçıoğlu, Hatice; Sağlam, Mustafa; Tonbul, Halil ZekiOBJECTIVE: Vascular calcifi cation (VC) and disturbed bone mineral metabolism (BMM) are commonly seen in patients with end-stage renal disease (ESRD). Fetuin-A has been found to be signifi cantly low in ESRD patients. The aim of our study was to investigate the relation between coronary artery calcifi cation, BMM and fetuin-A in peritoneal dialysis (PD) patients. MATERIAL and METHODS: 46 PD (M/F=28/18) patients were included in the study. Coronary artery calcifi cation scoring (CACS) was performed by multi slice computed tomography. The patients were 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 levels of fetuin-A were measured. Bone mineral densitometry was measured by dual energy X-ray absorptiometer (DEXA). RESULTS: There was a statistically signifi cant difference difference between CACS and femur T scores in PD patients. Femur T scores were found to be decreased while CACS values are increased. We could not fi nd any differences in terms of CACS when we separated patients according to T scores greater or lower than -2. Osteopenic patients were found to be older and they also had low fetuin-A levels. CONCLUSION: We found an important relationship between CACS and bone mineralization in PD patients.Öğe The Predictive Value of Platelet/Lymphocyte Ratio in Hemodialysis Patients With Erythropoietin Resistance(WILEY-BLACKWELL, 2016) Taymez, Dilek Güven; Uçar, Esma; Türkmen, Kültigin; Uçar, Ramazan; Afşar, Barış; Gaipov, Abduzhappar; Türk, SüleymanThe 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 The Protective Effect of Mammalian Target of Rapamycin (mTOR) in Cisplatin Induced Nephropathy(2009) Türkmen, KültiginCisplatin, a simple inorganic compound, has been one of the leading antitumor drugs especially for solid tumors for near 30 years. The mechanisms of cisplatin include denaturation of DNA and cell mitochondria, arresting cell cycle in the G2 phase and eventually causing apoptosis, inflammation, necrosis and death in cells. Apoptosis is a process of programmed cell death through cystein proteases named 'caspases'. Pathways of caspase-mediated apoptosis can classified as 'mitochondrial' pathway and 'death receptor' pathway Especially caspase-3 plays a crucial role in cisplatin-induced nephrotoxicity through the pathways of apoptosis. The mammalian target of rapamycin (mTOR), is a serine/threonine kinase that regulates both cell growth and cell cycle progression through the phosphotidyl 3 kinase (PI3K)/protein kinase B (Akt) signaling pathway. mTOR regulates both cell growth, cell cycle progression and angiogenesis. By targeting mTOR, the immunsuppressant and antiproliferative agent Rapamycin inhibits signals required for cell cycle progression, cell growth, cell proliferation and angiogene-sis. Angiogenesis is extremely important in tumor progression and metastasis. Although rapamycin is proapoptotic agent especially in cancers, there is an evidence that rapamycin can also have antiapoptotic properties through pleiotropic function in the regulation of cell death depending on the cell type and activation state as well as downstream targets of antiapoptotic molecules such as p53 and Bcl-2 proteins. Activation of caspase signaling pathways and dysregulation of pro- and antiapoptotic Bcl-2 proteins have been described previously. So there are links between the mTOR and caspase signaling pathways. Despite its effectiveness, the dose of cisplatin that can be administered is limited by its nephrotoxicity such as acute tubuler necrosis (ATN) causing acute renal failure (ARF). Several agents have been tested to see whether they could ameliorate or augment the nephrotoxicity of cisplatin. Therefore, we hypothesize that mTOR inhibitor rapamycin can inhibit cisplatin induced ATN and ARF through the mechanisms including PI3K/Akt signaling and mitochondrial cell death pathway by affecting apoptosis. If this hypothesis will be proved by experimental and clinical studies, the patients with solid tumors receiving cisplatin may also be treated with mTOR inhibitors to reduce cisplatin induced nephrotoxicity.Öğe The Relationship Between Epicardial Adipose Tissue and Coronary Artery Calcification in Peritoneal Dialysis Patients(KARGER, 2012) Türkmen, Kültigin; Özbek, Orhan; Kayıkçıoğlu, Hatice; Kayrak, Mehmet; Solak, Yalçın; Nayman, Alaaddin; Anıl, Melih; Babur, Hüseyin; Tonbul, Halil ZekiBackground: Atherosclerosis, endothelial dysfunction, coronary artery calcification (CAC), and left ventricular hypertrophy are the most commonly encountered risk factors in the pathogenesis of cardiovascular disease in end-stage renal disease patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT has been shown in healthy subjects and patients with a high risk of coronary artery disease. In the present study, we aimed to investigate the relationship between EAT and CAC in peritoneal dialysis (PD) patients. Patients and Methods: Forty-five PD patients (18 females, 27 males, with a mean age of 50.6 +/- 15 years) and 25 healthy subjects (12 females, 13 males, with a mean age of 52.4 +/- 10.7 years) were enrolled in the study. EAT and CAC score (CACS) measurements were performed by a multidetector computed tomography scanner. Results: EAT of the PD patients was significantly higher than that of the healthy subjects (p = 0.02). When patients were divided into two subgroups (group 1: CACS <= 10, n = 20; group 2: CACS >10, n = 25), EAT was also significantly higher in group 2 patients than in group 1 patients and healthy subjects. Age and EAT were also found to be correlated with CACS >= 10. Conclusion: There is a relationship between the anatomic assessment of coronary artery lesions by multidetector computed tomography and EAT in PD patients. This relationship might be attributed to increased inflammation and proinflammatory cytokines in uremic patients.Öğe The Relationship Between Neutrophil-to-lymphocyte Ratio and Inflammation in End-Stage Renal Disease Patients(INFORMA HEALTHCARE, 2012) Türkmen, Kültigin; Güney, İbrahim; Yerlikaya, Fatma Hümeyra; Tonbul, Halil ZekiBackground: Patients with end-stage renal disease (ESRD) have elevated serum levels of inflammatory mediators including C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), and interleukin (IL)-6. Systemic inflammation was found to be correlated with coronary artery disease (CAD) in this population. Neutrophil-to-lymphocyte ratio (NLR) was introduced as a potential marker to determine inflammation in cardiac and non-cardiac disorders. Data regarding NLR and its association with inflammation are lacking. We aimed to determine the relationship between NLR and inflammation in ESRD patients. Material and methods: This was a cross-sectional study involving 61 ESRD patients (25 females and 36 males; mean age: 48.3 +/- 14.5 years) receiving peritoneal dialysis (PD) or hemodialysis (HD) for >= 6 months in the Dialysis Unit of Selcuk University. NLR, CRP, TNF-alpha, and IL-6 levels were measured. Results: NLR, serum CRP, IL-6, and TNF-alpha levels were significantly higher in PD patients when compared with HD patients. ESRD patients with NLR >= 3.5 had significantly higher TNF-alpha levels when compared with patients with NLR < 3.5. In the bivariate correlation analysis, NLR was positively correlated with TNF-alpha in this population. Conclusions: Simple calculation of NLR can predict inflammation in ESRD patients.
