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Öğe Assessment of acute renal failure patients treated in our nephrology clinic between 1996 and 2002(ELSEVIER SCIENCE INC, 2004) Altıntepe, Lütfullah; Guney, I; Tonbul, Z; Demir, M; Turk, S; Yeksan, MAcute renal failure (ARF) is a cause of high morbidity and mortality associated with long hospital stay, and expensive treatment. The initial approach to patients with ARF should be focused on preventing future injury to the kidney. Two hundred eighty-three ARF patients, treated from January 1996 to June 2002, were retrospectively investigated for their etiology, clinic features, and laboratory characteristics, as well as treatment results and mortality rate. The mean age was 52.3 +/- 18.7 years. Patients with hospital-acquired ARF comprised 38.8% of the sample. Renal causes (60%) were responsible for most ARF patients. They were medical (63.95%), surgical (23.67%), and obstetric (12.4%) causes. Twenty-five percent of patients with ARF had multiple etiologies. Hemolysis elevated liver enzymes low platelets (HELLP) syndrome was seen in the most of the obstetric-related ARF cases. Signs of hypervolemia were present in approximately 50% of the cases. Oliguric patients comprised 59.7% of the sample, and the mean time to oliguria was 5.2 +/- 4.1 days. The necessity of dialysis was greater in oliguric patients (42.6%) and the ratio of complete/partial improvement (82.2%) was greater among non-oligoanuric patients. However, there was no significant difference between mortality rates. Irreversible renal insufficiency did not develop in the non-oliguric cases. Also, 7.4% of ARF patients died, with the main causes being infection (31.8%) and cardiovascular events (27.2%). Medical problems are important in the etiology of ARF as well as obstetric cases. The mortality rate was low in our cases, a situation that may be explained by medical causes being of importance in the etiology. We are of the opinion that early refferral of patients to a nephrologist and following treatment in the nephrology clinic may positively affect the outcome.Öğe Effect of 1,25 (OH)2D3 Treatment on Glucose İntolerance in Uraemia(OXFORD UNIV PRESS UNITED KINGDOM, 1992) Türk, S; Yeksan, M; Tamer, N; Gürbilek, M; Erdoğan, Y; Erkul, İThe aim of this study was to evaluate the effect of calcitriol treatment on glucose intolerance in uraemia. Thirty one patients on haemodialysis who had never been treated with vitamin D or related drugs, and 12 healthy control subjects with normal renal functions were studied. Uraemic patients were randomly divided into two groups; 16 patients were treated with oral calcitriol (0.5 mug/day) for 8 weeks, and 15 uraemic patients and 12 healthy subjects were given a placebo. In all these cases, before and 8 weeks after treatment, baseline serum glucose, insulin, calcium, parathormone (PTH), and 1,25 (OH)2D3 were measured. After an oral load of 75 g glucose, blood glucose and insulin were determined at 30, 60, 90, and 120 min. The same measurements were repeated after 8 weeks. HbA1c and fructosamine were also measured at 0 and 8 weeks. Baseline serum insulin was significantly elevated after calcitriol treatment (7.81 versus 11.63 muIU/ml) there was also a significant increase in insulin following calcitriol treatment at 30, 60, 90, and 120 min. On the other hand, glycosylated haemoglobin (HbA1c) and fructosamine decreased after calcitriol treatment (HbA1c 7.09% versus 5.22% P < 0.01 and fructosamine 2.92 versus 2.50 mmol/l P < 0.01). Blood glucose significantly decreased after calcitriol treatment at 0, 30, 60, 90, and 120 min. In the other two groups there were no significant changes in any parameters. These results seem to confirm that vitamin D influences pancreatic beta (beta) cell secretion and suggest that calcitriol may improve glucose intolerance in uraemic haemodialysis patients. This effect of calcitriol is probably due to normalization of serum PTH and regulation of intracellular calcium concentration.Öğe The effects of rHuEPO administration on pulmonary functions in haemodialysis patients(WICHTIG EDITORE, 1996) Uçok, K; Gökbel, Hakkı; Yeksan, M; Bediz, C. S.; Eser, C; Türk, S; Ergene, NThe aim of this study was to investigate the effects of erythropoietin therapy on pulmonary functions in haemodialysis patients. Thirteen patients with chronic renal failure on regular haemodialysis and in need of treatment for anaemia were treated with 45-60 U/kg erythropoietin three times a week. Thirteen haemodialysis patients constituted the control group. Patients receiving erythropoietin were given pulmonary function tests prior to the treatment and after Hb levels had reached 10 g/dl. The interval between first and second pulmonary function tests was similar for both the control group and the erythropoietin group. There was no significant difference between the results of the first and the second pulmonary function tests of the control group. However, in the erythropoietin group, the diffusing capacity, maximal voluntary ventilation, forced vital capacity and peak expiratory flow rate values increased significantly. The existence of a relationship between the diffusing capacity and anaemia is well known. Rises in other parameters following erythropoietin administration might be the result of a gain in respiratory muscle strength consequent to aneamia correction.Öğe Lower erythropoietin and iron supplementation are required in hemodialysis patients with hepatitis C virus infection(DUSTRI-VERLAG DR KARL FEISTLE, 2004) Altıntepe, Lütfullah; Kurtoğlu, E; Tonbul, Halil Zeki; Yeksan, M; Yildiz, A; Turk, SBackground: Chronic hepatitis C virus (HCV) infection is a common infectious agent in chronic hemodialysis (HD) patients. In this prospective case-control study, we aimed to investigate the influence of chronic HCV infection on erythropoietin (EPO) and iron requirement in HD patients. Patients and methods: 49 HD patients (24 male, 25 female, mean age 47 +/- 15 years) were included. The mean time spent on dialysis was 39 +/- 38 months, and follow-up time was 1 year for this study. Biochemical analyses and complete blood counts together with iron status of the patients (transferrin saturation and serum ferritin levels) were measured monthly. Highly sensitive C-reactive protein (hs-CRP) levels were measured within 3-month intervals. Endogenous EPO levels were measured by enzyme-linked immunoassay 2 weeks after cessation of EPO treatment. Results: Eleven of the HD patients (22%) were anti-HCV(+). There was no difference in age, sex, time on dialysis, distribution of primary renal diseases, predialytic BUN, Kt/V, albumin and i-PTH levels between HCV(+) and (-) patients. Anti-HCV-positive patients required significantly lower weekly doses of EPO (87 +/- 25 IU/kg vs 129 +/- 11 IU/kg, p = 0.042) and iron (16.8 +/- 12.2 mg vs 32.6 +/- 16.1 mg, p = 0.02) replacement than anti-HCV(-) group; hs-CRP levels were similar between study groups. Serum endogenous EPO levels were significantly higher in HCV(+) patients than HCV(-) HD patients (9.43 +/- 6.47 mU/ml vs 3.59 +/- 2.08 mU/ml, p = 0.008). Conclusion: Anti-HCV(+) HD patients had higher serum EPO levels and required less EPO and iron replacement as compared to anti-HCV(-) patients. Because of the changes in iron metabolism, iron treatment should be carefully administered in HD patients with HCV.Öğe Quality of life in male hemodialysis patients - Role of erectile dysfunction(KARGER, 2004) Turk, S; Guney, I; Altıntepe, Lütfullah; Tonbul, Halil Zeki; Yildiz, A; Yeksan, MBackground: Health-related quality of life (QOL) is affected in hemodialysis patients (HD). A number of factors such as age, anemia, and comorbidity had been implicated in decreased QOL. Erectile dysfunction (ED) is a frequent and potentially treatable complication in HD patients. In this cross-sectional study, we aimed to evaluate the possible relation between the QOL and ED in HD patients. Patients and Methods: Among the 511 chronic HD patients dialyzed in 11 outpatient HD centers, 148 male patients (mean age: 46 +/- 9 years) were included. The mean time on dialysis was 41 +/- 35 months (range: 3-203 months). Biochemical parameters such as BUN, creatinine, hemoglobin, serum albumin and Kt/V were measured. The QOL of the patients were measured with the short form of Medical Outcomes Study (SF-36), physical component scores (PCS) and mental component scores (MCS) were calculated. The ED was evaluated by the International Index of Erectile Function (IIEF). Results: One hundred and four of the 148 patients (70%) had ED. Hemoglobin levels were correlated with PCS (r = 0.197, p = 0.02) and MCS (r = 0.20, p = 0.019). Patients with ED had lower scores in nearly all the components related to PCS and MCS as compared to patients without ED. IIEF score was correlated with PCS (r = 0.369, p < 0.001) and MCS (r = 0.308, p < 0.001). In linear regression analysis, IIEF score and hemoglobin levels were the independent variables that predicted both PCM and MCS. Conclusion: ED, a frequent complication in HD patients, was related to QOL together with anemia. Successful treatment of ED and anemia may lead to improvement in QOL in HD patients. Copyright (C) 2004 S. Karger AG, Basel.Öğe Serum amyloid A protein levels in haemodialysis patients(OXFORD UNIV PRESS UNITED KINGDOM, 1996) Polat, H; Yeksan, M; Dalmaz, M; Kaptanoğlu, B; Koşar, A; Akkuş, İdris[Abstract not Available]
