Yaşar ÇALIŞKAN
Yaşar ÇALIŞKAN
A 70-year-old woman is hospitalized after a fall that resulted in a right femoral neck fracture. Her medical history includes obesity, type 2 diabetes mellitus, hypertension, and chronic kidney disease (CKD). She has smoked a pack of cigarettes daily for 40
years. Results of the patient’s initial workup in the emergency department demonstrated the right femoral neck fracture, serum
creatinine of 1.8 mg/dL, and a negative noncontrast head CT. She was admitted to the hospital and the following day underwent
surgical repair. The procedure was uncomplicated. However, on postoperative day 4 the patient is developed sudden onset
chest pain and shortness of breath. The acute coronary syndrome work-up is negative. Current medications include prophylactic subcutaneous heparin, insulin glargine, omeprazole, and paracetamol. Temperature is 37.8°C, blood pressure is 110/65 mm
Hg, pulse is 116/min, and respirations are 30/min. Pulse oximetry is 88% on room air. Lung auscultation revealed decreased
breath sounds at the bilateral bases. Cardiac rhythm is regular with normal S1 and S2. The surgical incision shows no surrounding erythema or purulent drainage. The patient follows commands and moves all extremities except the left leg. Laboratory
results are as follows: Complete blood count: Leukocytes 12,000/mm3
, Hemoglobin 11 g/dL, Platelets 250,000/mm3
, Serum biochemical tests: Sodium 135 mEq/L, pH: 7.48, pCO2: 30,mmHg, pO2: 85 mmHg, Bicarbonate 24 mEq/L, serum creatinine: 1.8 mg/
dL, Glucose 170 mg/dL, Troponin T is undetectable. Chest x-ray shows slight bibasilar atelectasis without focal consolidation,
pleural effusion, or pulmonary edema. ECG shows sinus tachycardia but is otherwise unremarkable.
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Objective: Several studies have shown that local renin–angiotensin system (RAS) activity in the kidneys may play a role in
the pathogenesis of hypertension and kidney damage in patients with chronic kidney disease. In this study, we aimed to
investigate the effect of local RAS activity on hypertension and residual renal function (RRF) in patients undergoing peritoneal dialysis (PD).
Materials and Methods: Fifty patients with residual urine undergoing PD were included in the study. They were divided
into the hypertensive (n=30) and non-hypertensive (n=20) groups. The urine angiotensinogen-to-creatinine ratio, which is
an indicator of local RAS activity, was compared between the two groups. Factors affecting this ratio were also investigated.
Results: There was no significant difference in the mean urine angiotensinogen-to-creatinine ratios between the two
groups. A correlation analysis revealed that the urine angiotensinogen-to-creatinine ratio had a significant negative correlation with RRF determined by 24-hour creatinine excretion (r=−0.391, p=0.005). There was a positive correlation between
the urine angiotensinogen-to-creatinine ratio with proteinuria (r=0.289, p=0.04) and negative correlation with serum albumin (r=−0.280, p=0.049). However, we could not find any association between the urine angiotensinogen-to-creatinine ratio
and blood pressure values.
Conclusion: Local RAS activation in the kidney reflected by urinary angiotensinogen is associated with RRF and proteinuria
in patients undergoing PD; however, high blood pressure was not correlated with urinary angiotensinogen levels.
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Selçuk MISTIK, Demet ÜNALAN, Hümeyra ASLANER, Merve ÇALIŞKAN, Hacı Ahmet ASLANER, Bülent TOKGÖZ
Selçuk MISTIK, Demet ÜNALAN, Hümeyra ASLANER, Merve ÇALIŞKAN, Hacı Ahmet ASLANER, Bülent TOKGÖZ
Objective: The aim of the present study was to determine the quality of sleep and depression scores of hemodialysis patients and to search their relationship.
Materials and Methods: This cross-sectional study was performed on 150 patients at the Erciyes University Health Application and Research Center and a private dialysis center between July 2017 and November 2017. A questionnaire form
including the demographic sociocultural properties of the patients and Pittsburgh Sleep Quality Index (PSQI) and Beck
Depression Inventory (BDI) was used as data collection tools.
Results: The patients’ mean PSQI point was 11.82±2.81, and the BDI mean point was 15.1±9.65. The BDI mean point was
significantly higher in patients with chronic disease other than chronic renal failure than in patients without other chronic
diseases (p<0.05). The PSQI and BDI mean points were both significantly high in patients reporting change in life due to
the disease (p<0.05). The BDI mean points were significantly high in patients feeling extremely tired after dialysis (p<0.05).
There was a weak positive correlation between the PSQI and the BDI points (p<0.01).
Conclusion: The depression points of patients with chronic disease other than chronic renal insufficiency were higher.
Quality of sleep was low in patients with high depression points.
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Zuhal Atan UÇAR, Yener KOÇ, Taner BAŞTÜRK,
Feyza BAYRAKTAR ÇAĞLAYAN , Tamer SAKACI, Elbis AHBAP, Ayşe SİNANGİL, Mustafa SEVİNÇ,
Arzu KAYALAR , Nuri Barış HASBAL, Abdülkadir ÜNSAL
Objective: The aim of the present study was to investigate peritonitis episodes and causative agents in patients undergoing peritoneal dialysis (PD), to examine the effects of peritonitis on technical and patient survival, and to determine whether the number of peritonitis episodes and causative agents was a risk factor or not.
Materials and Methods: The medical records of 387 patients who started PD between January 2001 and January 2015
were evaluated retrospectively. Patients without peritonitis (Group 1 (n=123 patients)) and with detected peritonitis (Group
2 (n=243 patients)) were divided into two groups. Group 2 patients were subdivided according to the number of peritonitis
(Group 2a 1 episode and Group 2b ≥2 episodes). Sociodemographic data and clinical courses were compared, and the reasons for PD withdrawal were obtained between the groups. Survival analysis was performed, and the effects of peritonitis
on mortality were investigated.
Results: A total of 427 peritonitis episodes were detected. The most common organism was Staphylococcus aureus (36%).
The leading cause of death was cardiovascular disease in Group 1, whereas it was infection in Group 2a and Group 2b.
Technique survival and mortality rates were similar among the groups. Risk factors for patient survival were history of peritonitis more than once and history of catheter exit site/tunnel infection. History of catheter exit site/tunnel infection was
the only risk factor for technique survival.
Conclusion: Our study has shown that even though the causes for mortality were different, mortality rates, and technique
survival were similar between the two main groups. Infectious complications may affect patient and technical survival.
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Bülent YARDIMCI, Tevfik ECDER
Bülent YARDIMCI, Tevfik ECDER
Smoking is the leading preventable cause of death worldwide. Smoking affects all systems of the organism. Smoking stimulates the sympathetic nervous system, increases blood pressure and albuminuria, and decreases renal function. Smoking
increases renal functional loss in patients with chronic kidney disease. Moreover, smoking accelerates the course of atherosclerosis, causing cardiovascular complications and premature death. Smoking decreases graft survival in kidney transplant
patients. As a result, all physicians and health care providers should acknowledge all patients who smoke about the deleterious effects of smoking and continuously motivate them to stop smoking.
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Amir Hossein ABEDI, Eray EROĞLU, İsmail KOÇYİĞİT, Aydın ÜNAL, Murat Hayri SİPAHİOĞLU, Bülent TOKGÖZ, Oktay OYMAK
Amir Hossein ABEDI, Eray EROĞLU, İsmail KOÇYİĞİT, Aydın ÜNAL, Murat Hayri SİPAHİOĞLU, Bülent TOKGÖZ,
... Devamını oku
Familial Mediterranean fever (FMF) is an autosomal recessive hereditary disease characterized by recurrent attacks of fever,
usually accompanied by sterile polyserositis. Although colchicine is the main medical treatment option for FMF, potential
adverse effects and drug interactions should be considered during the follow-up of these patients. Herein, we presented a
case of a hemodialysis patient with FMF, who developed rhabdomyolysis due to concomitant use of colchicine and clarithromycin for pneumonia treatment.
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Tuba Elif ŞENEL, Sami UZUN, Egemen CEBECİ, Oktay ÖZKAN, Ahmet BEHLÜL, Ayça EROĞLU, Yasemin ÖZLÜK, Savaş ÖZTÜRK
Tuba Elif ŞENEL, Sami UZUN, Egemen CEBECİ, Oktay ÖZKAN, Ahmet BEHLÜL, Ayça EROĞLU,
... Devamını oku
Goodpasture’s syndrome is a rare autoimmune disease in which anti-glomerular basement membrane antibodies damage
the glomerular and alveolar basement membrane. Its relapse is very rare, compared to other pulmonary-renal syndromes.
Herein, we present an unusual case of Goodpasture’s syndrome, which recurred despite immunosuppressive treatment. After
the initial treatment with corticosteroid and cyclophosphamide pulses, plasmapheresis, alveolar hemorrhage ended, and
the anti-glomerular basement membrane antibody finding became negative, but hemodialysis had to be continued. After
8 months of hemodialysis, anti-glomerular basement membrane antibodies were re-detected, and hemoptysis occurred a
month later. Then, plasmapheresis, intravenous immunoglobulin, and methylprednisone were given in addition to azathioprine treatment; however, the serum anti-glomerular basement membrane antibody positivity persisted.
Relapse of this syndrome is rare, and if observed, it generally strikes years following disappearance of anti-glomerular
basement membrane antibodies; however, in our case, relapse was observed within a few months. It should be kept in
mind that, in patients who achieve remission following immunosuppressive therapy, clinical and serological relapses are
rare, and the anti-glomerular basement membrane antibody positivity may persist despite the application of immunosuppressive agents in subjects who relapsed.
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Egemen ŞENEL,
Hasan BASIR , Betül GÜZEL, Murat BAYKARA, Ertuğrul ERKEN, Orçun ALTUNÖREN, Özkan GÜNGÖR
Nutcracker syndrome is a rare condition that manifests itself with abdominal pain and hematuria, usually resulting in compression of left renal vein between the aorta and the superior mesenteric artery. It is mostly seen in young women and the
treatment should be individualized on a patient basis. A 17-year-old female patient was admitted to our clinic for 2 months
of ongoing side pain, followed up with the diagnosis of Nutracker’s syndrome after doppler ultrasonography and treated
symptomatically.
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Gitelman syndrome (GS) is a genetically transmitted tubulopathy. It is caused by mutation in the thiazide-sensitive Na-Cl
cotransporter–coding gene, SLC12A3. In this case study, we have discussed a patient diagnosed with GS and referred with
muscular weakness and cramping complaints due to discontinuing potassium replacement in the follow-up. The patient
was diagnosed with rhabdomyolysis and acute kidney injury secondary to hypokalemia upon determination of 2.14 mEq/L
potassium, 27.610 U/L creatine kinase, and 3.09 mg/dL creatinine in further examination. Therefore, NaCl 100 cc/h isotonic
was administered to the patient in addition to oral and intravenous potassium replacement. The dose of given acetazolamide was 2×250 due to the presence of severe metabolic alkalosis. Clinical and laboratory findings were fully restored to
normal levels one week following the initiation of treatment.
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Ahmet AYKAS, Erhan TATAR
Ahmet AYKAS, Erhan TATAR
Objective: We aimed to retrospectively evaluate the follow-up results of living kidney donors (LKD) at our center since
1997.
Materials and Methods: LKD instances between 1997 and 2016 were evaluated. Followed-up by at least one year post-donation were included. The criterion for progression in renal failure (RF) was more than 25% reduction in the glomerular
filtration rate (GFR). The cases were divided into two groups: Group 1 (GFR<60 mL/min/1.73 m²) and Group 2 (GFR≥60 mL/
min/1.73 m²) according to the GFR values obtained at the last follow-up.
Results: In this study, 205 cases were included. The mean follow-up period was 57±46 (12–215) months. The prevalence of
hypertension (all of them were stage 1) and diabetes (83.3% of them were new diagnosis with no end-organ damage) before and after donation was 3.1 and 2.9% vs. 13.3 and 17.5%, respectively (p<0.05). Progressive decline in RF was observed
in 29 cases (14%). None of the donors progressed to end-stage renal disease (ESRD). When compared with Group 2, Group
1 patients were older, more frequently hypertensive, and had lower GFR and higher serum uric acid levels.
Conclusion: Despite the loss of GFR due to nephrectomy, the progression to RF is rare in LKD. Baseline GFR, uric acid, and
age are associated with RF progression. There is a need for a “national donor follow-up program” in Turkey.
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