Browsing by Author "Akil I."
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Item Biochemical markers of bone metabolism and calciuria with inhaled budesonide therapy(2004) Akil I.; Yüksel H.; Ürk V.; Var A.; Onur E.We investigated the changes in renal excretion of calcium, sodium, and potassium in asthmatic children treated with inhaled budesonide, an inhaled glucocorticoid. Twenty-two asthmatic patients (7 female, 15 male, mean age 10.1±4.3 years) treated with 400-600 μg/day inhaled budesonide and 23 healthy children (6 female, 17 male, mean age 10.2±2.8 years) were enrolled in the study. The parameters recorded were serum sodium, potassium, calcium, phosphorus, alkaline phosphatase (ALP), type I collagen carboxyterminal telopeptide (ICTP), osteocalcin, intact parathyroid hormone (PTH) levels, first spot morning urine calcium/creatinine ratio, sodium/potassium ratio, and daily renal calcium excretion rate (UCa-ER). These parameters were measured in the control group and pre- and post-budesonide treatment in asthmatic children. Serum electrolytes, ALP, PTH, ICTP, and UCa-ER were in the normal ranges and were not significantly different between controls and asthmatic children. Serum levels of ICTP increased, while levels of osteocalcin decreased after budesonide therapy in the asthmatic group (P=0.001, P=0.005). UCa-ER was decreased after budesonide therapy in asthmatics (P=0.000). In conclusion, moderate doses of inhaled budesonide cause hypocalciuria and decreased bone turnover. These results may be attributed to a mechanism compensating for decreased absorption of calcium in the gut due to the topical effect of swallowed budesonide rather than the systemic effects of the drug. Increased bone metabolism and decreased turnover may have an important role in this compensatory mechanism. © IPNA 2004.Item Fulminant meningococcemia and acute renal failure in a 3-year-old boy(2004) Akil I.; Yüksel H.; Coskun S.; Yilmaz D.; Onag A.Acute renal failure is a common occurrence in sepsis, but is rarely reported in meningococcemia. We present a young child diagnosed with fulminant meningococcemia who had several poor prognostic factors, including hypotension, thrombocytopenia, purpura fulminans, seizures, the absence of meningitis with meningococcemia, and acute renal failure, which was successfully treated with peritoneal dialysis. Peritoneal dialysis was started on the 5th day because the patient had been anuric for 48 h. At that time, analysis showed that the child was both hypokalemic and hypophosphatemic. His serum blood urea nitrogen was 61 mg/dl, creatinine 2.75 mg/dl, potassium 2.8 mEq/l, and phosphorus 0.7 mg/dl. Urine output began on the 12th day post admission and normalization of serum creatinine was achieved on the 26th day. In conclusion, renal failure is an important complication of meningococcemia and, to be effective, sometimes long-term peritoneal dialysis is required. Profound metabolic abnormalities, such as hypokalemia and hypophosphatemia, may occur paradoxically in the presence of oliguria.Item Hypernatremic dehydration and renal vein thrombosis in a case with Cornelia de Lange syndrome associated with holoprosencephaly; [Corneli̇a de Lange sendromuna eşli̇k eden holoprosensefali̇li̇ olguda hi̇pernatremi̇k dehi̇dratasyon ve renal ven trombozu](2004) Akil I.; Yüksel H.; Gözmen S.; Tarhan S.Cornelia de Lange syndrome (CDL) has characteristic features such as microcephaly, synophrys, long philtrum and intrauterine growth retardation, and mental and motor retardation. The syndrome is usually sporadic, although autosomal dominant and recessive inheritance might be a factor in some cases. Although midline malformations of the brain are common in CDL, holoprosencephaly is not usual. In this paper, we discussed hypernatremic dehydration and renal vein thrombosis complications in a case with CDL associated with holoprosencephaly.Item Repeated subcutaneous administration of dermatophagoides allergen does not cause immune or non-immune glomerular injury in wistar-albino rats(2004) Akil I.; Yuksel H.; Ayhan S.; Nese N.; Giray G.We aimed to investigate the risk of immune or non-immune mediated glomerular injury associated with immunotherapy with dermatophaogoides allergen. Three groups of 7 male rats aged 10 weeks were gathered. Group 1 received 1250 units of dermatophaogoides allergen injection 3 times with an interval of 2-weeks via subcutaneous route, group 2 received 2500 units of dermatophaogoides allergen injection, and the control group received isotonic saline solution equal in volume to the antigen. Kidneys were evaluated by both light and immunofluorescence microscopy. Urine was analyzed with urinalysis strips and light microscopy. Some cases demonstrated mesangial proliferation as well as an increase in mesangial matrix and tubulointerstitial inflammation. However, these changes did not differ statistically significantly between the groups (P>0.05 for mesangial proliferation, increase in mesangial matrix and tubulointerstitial inflammation). Neither hematuria nor proteinuria was detected in control or treatment groups at the beginning or at the end of the study. This study demonstrated that repeated inoculation of dermatophagoides allergen, as required for subcutaneous allergen specific immunotherapy, did not result in any non-immune or immune complex induced glomerular injury. Thus, despite the fact that dermatophagoides allergen are exogenous macromolecules, subcutaneous allergen specific immunotherapy using these purified allergens may not have any risk for glomerular injury.Item Hepatorenal syndrome; [Hepatorenal sendrom](2004) Akil I.; Kasiraga E.Hepatorenal syndrome (HRS) is the development of renal dysfunction in patients with severe acute or chronic liver diseases in the absence of any other identifiable causes of renal pathology. Many aspects of HRS are therefore still poorly understood. Renal and systemic vasoconstriction could be due to amplified splanchnic reduced vascular - resistance and vasodilatation resulting from portal hypertension and cirrhosis appear to be primary factors in pathogenesis. Sodium retention, impaired free-water excretion, decreased GFR and renal perfusion due to renal vasoconstriction are the main renal function abnormalities in cirrhosis. The onset of each abnormality differs in time and follows a progressive course. The aim of the current article is to provide an updated review of the pathophysiology, diagnosis, clinical features, and therapy of HRS.Item Septic pulmonary emboli presenting with deep venous thrombosis secondary to acute osteomyelitis(2004) Yüksel H.; Özgüven A.A.; Akil I.; Ergüder I.; Yilmaz D.; Çabuk M.[No abstract available]Item Histopathological and ultrastructural effects of Losartan on embryonic rat kidney(Elsevier GmbH, 2005) Akil I.; Inan S.; Gurcu B.; Nazikoglu A.; Ozbilgin K.; Muftuoglu S.The aim of our study was to investigate the histopathological, immunohistochemical and ultrastructural effects of Losartan (a selective angiotensin II type-1 receptor blocker) on renal development in rats. Twelve pregnant rats were divided into control and experimental groups. In the experimental group, Losartan (10 mg/kg/day) was given via nasogastric tube, between the sixth day of implantation and time of sacrifice on embryonic days 18 and 20. All formalin-fixed, paraffin wax-embedded renal tissue sections were stained with hematoxylin and eosin or labelled for binding of primary antibodies against transforming growth factor-β (TGF-β 1,-2,-3) using an avidin-biotin-peroxidase method. For electron microscopic examination, samples were fixed with glutaraldehyde and osmium tetroxide and embedded in araldite. Glomerular basement membrane (GBM) thickness was measured and compared using an unpaired t-test. Angiotensin II type-1 receptor antagonism by Losartan inhibited renal growth and delayed nephron maturation. Increased immunoreactivity of TGF-β's was observed in developing nephron precursors and interstitial cells in the experimental group. Electron microscopical examination showed that thickening of the GBM was normal in the control group but an irregular thickening was seen in the experimental group (p<0.001). It was also seen that epithelial cells of developing tubules underwent apoptosis in the experimental group. Thus, renal development in rats seems to depend on an intact renin-angiotensin system. © 2005 Elsevier GmbH. All rights reserved.Item Premedication during micturating cystourethrogram to achieve sedation and anxiolysis(2005) Akil I.; Ozkol M.; Ikizoglu O.Y.; Polat M.; Tuncyurek O.Y.; Taskin O.; Yuksel H.Micturating cystourethrogram (MCUG) is an imaging technique indicated in the diagnosis and follow-up of many diseases. We investigated the reliability and the efficacy of midazolam and chloral hydrate in sedation and anxiolysis during micturating cystourethrogram. Fifty-three children of similar ages (39 girls, 14 boys, mean age of 5.8±3.5 years) were randomized to midazolam (n=17), chloral hydrate (n=18) and control groups (n=18). Oral midazolam 0.6 mg/kg or chloral hydrate 25 mg/kg or saline were administered to the study groups 15-30 min prior to the urinary catheterization. Brietkopf and Buttner, Frankl and Houpt scales and Spielberger's State Anxiety Inventory and parent's impressions were used to assess the level of sedation and anxiety. The Brietkopf and Buttner classification of emotional status and Houpt behavior rating scale demonstrated a significantly better emotional status and sedation in the midazolam group when compared to controls (P=0.01 and P=0.018, respectively). The catheterization was described as a more unpleasant and distressing event by the parents of the control and the chloral hydrate groups when compared to the parents of the midazolam group (P<0.05). Bladder capacity and frequency of detection of residual urine were not statistically different between the three study groups (P>0.05). Vital signs did not change significantly in any child. Sedation with midazolam does not have adverse effects on the results of micturating cystourethrogram, while it reduces the discomfort in children undergoing this radiological technique. © IPNA 2005.Item Juvenile dermatomyositis resistant to steroids(2005) Polat M.; Akil I.; Ikizoǧlu T.; Serter S.; Özkol M.; Yilmaz Ikizoǧlu Ö.; Coşkun Ş.[No abstract available]Item Evaluation of histologic changes in the urinary tract of hypercalciuric rats(2006) Akil I.; Kavukçu S.; Inan S.; Yilmaz O.; Atilla P.; Işlekel H.; Neşe N.; Müftüoǧlu S.Idiopathic hypercalciuria (IH) has been speculated to have a predisposing role in the development of urinary tract infection (UTI), due to the uroepithelial cell damage it leads to. In this study, we aimed to investigate the effects of hypercalciuria on the bladder, ureters, and kidneys in rats with experimentally induced hypercalciuria. Normocalcemic hypercalciuria was induced by furosemide (60 mg/100 mL of drinking water) administration to 16-week-old male Wistar Albino rats for 14 days. Calciuria (calcium/creatinine ratio, mg/mg, Ca/Cr) increased from 0.07±0.01 at the beginning of administration to 0.41±0.1 on day 14 (p=0.000). The Ca/Cr ratio was 0.14±0.06 at the beginning of the study and 0.25±0.06 on day 14 in the control group rats (p=0.002 vs. the hypercalciuric group rats on day 14). Bladder, ureter, and kidney specimens of the rats, dissected on the 14th day, were fixed in 10% formalin and 2.5% gluteraldehyde solutions for light and electron microscopic examination, respectively. Histopathological and ultrastructural examination of the hypercalciuric rats revealed proliferation and apical cytoplasmic vacuole formation in transitional epithelial cells, mitotic activity in the intermediate cell line, vasodilatation, edema, and separation of collagen fibers in the bladder and ureter specimens. Light microscopic examination of the kidney specimens revealed a lot of erythrocyte in the glomerular capillary lumen, while electron microscopy revealed vacuolization of proximal and distal tubules, tubular degeneration, interstitial edema, and vasodilatation. In this study, hypercalciuria was observed to have adverse effects on the cell architecture of the uroepithelium and disruption of the epithelial barrier of the bladder and ureters and all kidney structures, especially on the proximal epithelial cells. © IPNA 2006.Item Evaluation of voiding dysfunctions in children with chronic functional constipation(2006) Kasirga E.; Akil I.; Yilmaz Ö.; Polat M.; Gözmen S.; Egemen A.There are controversial results about the role of dysfunctional bowel emptying in disorders of the urinary tract like urinary tract infection (UTI), vesicoureteral reflux (VUR) and enuresis. Constipation may cause UTI, enuresis and VUR due to the uninhibited bladder contraction. The aim of this study was to investigate the frequency of nocturnal enuresis, UTI and instability symptoms in chronic functional constipation (CFC). This study included 38 children with CFC and 31 children as the control group. Detailed past and present history of UTIs or symptoms pointing to this diagnosis, enuresis, encopresis, urgency and urge incontinence was obtained from both groups as well as the family history of UTI. Urinalysis, urine culture and stool parasite analysis as well as abdominal ultrasonography were performed on both groups. Age range of the children with CFC was 6-192 months (mean±standard deviation (SD) 63.5±51 months); that of the control group was 4-180 months (mean±SD 82±46.2 months). Frequency of UTI and urgency was significantly higher in the CFC group. However, frequencies of urge incontinence, nocturnal enuresis, and genitourinary abnormalities were not different between the two groups. In conclusion, risk of UTI and urgency is increased in CFC, but that of other voiding dysfunctions like urge incontinence do not change significantly. Therefore, we suggest that UTI and urgency should be questioned in children with CFC and vice versa.Item The effect of seasonal changes on blood pressure and urine specific gravity in children living in Mediterranean climate.(2006) Polat M.; Akil I.; Yuksel H.; Coskun S.; Yilmaz D.; Erguder I.; Onag A.BACKGROUND: We aimed to evaluate the effects of seasonal changes on urinary specific gravity, blood pressure and urinary erythrocyte number in children living in Mediterranean climate. MATERIAL/METHODS: The study was conducted on 547 children who presented for routine follow up to healthy-child care department between January 1997 and December 2002. Age, sex, weight, height, blood pressure, urinary specific gravity and urinary erythrocyte number were recorded by retrospective evaluation of files. Then, the parameters during summer were compared with those during winter. Additionally, correlation between the blood pressure, urinary specific gravity and urinary erythrocyte number was assessed separately during summer and winter. RESULTS: Anthropometrical measurements and mean age of the patients in summer and winter groups were similar. There was no significant change in urinary specific gravity (p > 0,05), while systolic and diastolic blood pressures were significantly higher in winter (p = 0.031 and p = 0.028 respectively). Temperature and humidity levels did not change significantly among different years but mean air temperatures during summer positively correlated with time from 1997 till 2002 (r = 0.965, p = 0.002). Blood pressure and urinary specific gravity were not correlated to each other at any time. Contrarily, there was a positive correlation between urinary specific gravity and erythrocyte number in summer (p = 0.01). The number of children with hematuria and degree of hematuria did not differ significantly between summer and winter. CONCLUSIONS: Seasonal changes in Mediterranean climate do not lead to changes in hydration status or in urinary erythrocyte number in children. Therefore, the decrease in blood pressure during summer can not be attributed to the hydration status.Item Influence of oral intake of Saccharomyces boulardii on Escherichia coli in enteric flora(2006) Akil I.; Yilmaz O.; Kurutepe S.; Degerli K.; Kavukcu S.Enteric flora constitutes 95% of the cells in the human body. It has been shown that the bacterial content of this flora is affected by diet and changes in nutrition. Considering that urinary tract infections (UTI) are mostly due to ascending infections from the gut flora, the importance of the elements of this flora and their characteristics becomes more evident. The aim of this study was to evaluate the influence of oral Saccharomyces boulardii (S.boulardii) intake on the number of Escherichia coli (E.coli) colonies in the colon. This study was carried out with 14 boys and 10 girls (total of 24 children) aged between 36 and 192 months (mean: 104.3±45.1 months). A commercial capsule or powder containing 5 billion colony-forming units (cfu) of S.boulardii was administered once a day for 5 days. The number of E.coli and yeast colonies was measured in the stool samples of the study group before and after the use of this drug. Before treatment, the mean number of E.coli colonies in g/ml stool was 384,625±445,744. This number decreased significantly to 6,283±20,283 after treatment (p=0.00). S.boulardii was not detected in stool before treatment and the number of colonies increased to 11,047±26,754 in g/ml stool. S.boulardii may be effective in reducing the number of E.coli colonies in stool. The influence of this finding on clinical practice such as prevention of UTI needs to be clarified by further studies. © IPNA 2006.Item Evaluation of association between hepatitis A and Helicobacter pylori infections and routes of transmission(2006) Egemen A.; Yilmaz Ö.; Akil I.; Altuǧlu I.Previous research about coexistence of Helicobacter pylori (HP) and hepatitis A virus (HAV) infections and the factors that increase their prevalence has suggested that the route of transmission of HP infection includes oral-oral and water-foods as well as the fecal-oral route. The aim of this study was to evaluate the routes of transmission of HP by comparing the seroprevalences of HP and HAV in children. One hundred and two children aged 1-18 years living in rural and urban regions of İzmir were included in this study. Anti-HP IgG and anti-HAV IgG antibodies were measured via enzyme immunoassay method. Seropositivities for HP and HAV were 56.8% and 51.9%, respectively. Seroprevalence for both infections increased with increasing age. However, a significant difference could not be detected between rural and urban areas. Sex did not have a significant effect. There was no infection in 22.1% of children, while 30.8% had both of the infections. 21.1% were positive only for HAV while 26% were positive only for HP. No significant correlation between seroprevalences of HP and HAV was detected. This study suggests the existence of various other routes of transmission of HP apart from the fecal-oral route.Item Reno-vascular hypertension in childhood: A nationwide survey(2007) Bayazit A.K.; Yalcinkaya F.; Cakar N.; Duzova A.; Bircan Z.; Bakkaloglu A.; Canpolat N.; Kara N.; Sirin A.; Ekim M.; Oner A.; Akman S.; Mir S.; Baskin E.; Poyrazoglu H.M.; Noyan A.; Akil I.; Bakkaloglu S.; Soylu A.Renovascular disease accounts for 8-10% of all cases of paediatric hypertension, whereas, in adults, its incidence is approximately 1%. The Turkish Paediatric Hypertension Group aimed to create the first registry database for childhood renovascular hypertension in Turkey. Twenty of the 28 paediatric nephrology centres in Turkey responded to the survey and reported 45 patients (27 girls, 18 boys) with renovascular hypertension between 1990 and 2005. The age at presentation ranged from 20 days to 17 years. The mean blood pressure at the diagnosis was 169/ 110 mmHg. Chief complaints of symptomatic patients were headache (38%), seizure (18%), epistaxis (4%), growth retardation (4%), cognitive dysfunction (4%), polyuria (2%), palpitation (2%), and hemiplegia (2%). Renovascular hypertension was found incidentally in 11 children. The diagnosis of renovascular hypertension was established with conventional angiography in 39 patients, MR angiography in three, CT angiography in two, and captopril diethylene triamine penta-acetic acid (DTPA) scintigraphy in one patient. Twenty-one children had bilateral renal artery stenosis and 24 had unilateral renal artery stenosis. Of these, 14 (31%) had fibromuscular dysplasia; 12 (27%) Takayasu's arteritis; six (13%) neurofibromatosis; two (5%) Williams syndrome; one (2%) Kawasaki disease; one (2%) mid-aortic syndrome; one (2%) extrinsic compression to the renal artery, and eight (18%) unspecified bilateral renal artery stenosis. Hypertension was controlled with antihypertensive drugs in 17 patients. Percutaneous transluminal angioplasty (PTRA) or surgery had to be performed in 28 patients: PTRA in 16 patients, PTRA + surgery in one patient and surgery in 11 patients (four nephrectomies). The importance of vasculitic disease, especially Takayasu's arteritis, should not be underestimated in children with renovascular hypertension. © IPNA 2007.Item An evaluation of quality of life of mothers of children with enuresis nocturna(2008) Egemen A.; Akil I.; Canda E.; Ozyurt B.C.; Eser E.The aim of this study was to evaluate the impact of enuresis nocturna on quality of life of the mothers. Mothers who have a child with monosymptomatic nocturnal enuresis (n=28) and mothers who have a child without any health problems (n=38) were enrolled in the study. Groups were in balance for background variables (child's age, gender, and number of siblings; mother's age, marital status, highest year of education completed, and occupation; presence of health insurance; and type of residence). Short-Form Health Survey (SF-36) Questionnaire, the Beck Depression Inventory (BDI), and Spielberg's State-Trait Anxiety Inventory (STAI) were applied to all mothers. The mothers of children with enuresis had significantly lower quality-of-life scores in the SF-36 for the bodily pain (p=0.015) and role emotional (p=0.014) subscales. We observed significant difference between groups according to BDI; mean score was higher in mothers who have a child with enuresis nocturna (p=0.017). There was no significant difference between groups according to the STAI. Significant differences according to bodily pain and role emotional subscales of SF-36, and the BDI scores, show that the mothers were negatively affected by having a child with monosymptomatic nocturnal enuresis. © IPNA 2007.Item Kidney stone and urinary bladder telangiectasia in a patient with TAR syndrome(2008) Akil I.; Gözmen S.; Yilmaz Ö.; Taneli C.TAR syndrome is a congenital malformation syndrome characterized by bilateral absence of the radius and thrombocytopenia. The known urinary anomalies are duplex ureter, dilatation of renal pelvis, horseshoe kidney and functional problems like vesicoureteral reflux and pyelonephritis. In this report of a case with TAR syndrome, a kidney stone and bladder telangiectasia were found coincidentally during the investigation of hematuria. TAR syndrome is discussed in the light of the medical literature. To our knowledge, no case has been reported demonstrating nephrolithiasis and bladder telangiectasia in TAR patients.Item Enuresis nocturna and sleep quality(2008) Gozmen S.; Keskin S.; Akil I.Enuresis nocturna is a common problem. Numerous etiologic factors have been investigated, and various theories have been proposed. The objectives of our study were to establish the differences in the sleep quality of nocturnal enuretic patients from that of healthy voluntary subjects, and the changes after treatment with desmopressin acetate (DDAVP), among primary school children. The study comprised 19 children with primary nocturnal enuresis and 32 healthy children in the control group. Subjective assessment of sleep was determined with the Pittsburgh Sleep Quality Index (PSQI) questionnaire. PSQI scores for each patient and control subject were determined before the study was started and after a month time interval. The sleep quality of the nocturnal enuretic children was poor. We found lower scores after a month's treatment with DDAVP, and significant differences in two dimensions in the patient group: 'subjective sleep quality' and 'sleep disturbances'. When we asked the patients' group what caused the sleep disturbance, they replied 'the fear or the anxiety of bedwetting during sleep'. This anxiety or fear seemed to be a factor that probably affected their sleep quality. So, active treatment (medical or behavioral) should be started as soon as the child is ready to receive it or when the enuretic child wants to be dry when asleep. © IPNA 2008.Item Is Helicobacter pylori related to endothelial dysfunction during childhood?(2008) Coskun S.; Kasirga E.; Yilmaz O.; Bayindir P.; Akil I.; Yuksel H.; Polat M.; Sanlidag T.Background: Helicobacter pylori infection has been proposed to have a role in the development of atherosclerosis preceded by endothelial dysfunction. The aim of the present study was to determine if a relationship exists between H. pylori infection in childhood and endothelial dysfunction and level of high-sensitivity C-reactive protein (hsCRP). Methods: Between October 2003 and November 2004, 28 subjects who were anti-H. pylori IgG-positive and 25 who were anti-H. pylori IgG-negative were included in the study. Mean ages of the H. pylori-positive and negative groups were not significantly different. Endothelial functions were evaluated on Doppler ultrasonography of the brachial artery. Percent ratio of the change in systolic diameter during hyperemic phase to the basal diameter was evaluated. Each subject's serum was tested for hsCRP, homocysteine and lipids. Results: Percent ratio of the change in systolic diameters during hyperemic phase to the basal diameter was not significantly different between the H. pylori-negative and -positive groups (P > 0.29). Mean levels of hsCRP were also not significantly different (1.48 ± 1.8 g/dL vs 2.35 ± 3.33 g/dL; P > 0.24). Similarly, serum levels of lipids and homocysteine were not significantly different (P > 0.05 for all lipids). Conclusions: Non-invasive techniques used in the present study were not indicative of early findings of atherosclerosis in H. pylori infection during childhood. Further studies are required to evaluate the relationship between early endothelial dysfunction and H. pylori infection in children with cardiovascular risk factors. © 2008 Japan Pediatric Society.Item Autopsy findings of a case with oxalosis(2009) Doganavsargil B.; Akil I.; Sen S.; Mir S.; Basdemir G.Oxalosis, deposition of calcium oxalate in tissues, is the final stage of hyperoxaluric syndromes. Being a rare entity, it is often missed, or the diagnosis is delayed, since the definitive diagnosis requires special laboratory tests. Kidneys, the walls of blood vessels, and bones are the major sites for crystal deposition. We report the autopsy findings of a 4-year-old girl who presented with end-stage renal disease in which the clinical presentation was consistent with primary hyperoxaluria Type I. The case is unusual, as there was extensive crystal deposition throughout the body, including in tissues that are rarely involved, such as ovaries, fallopian tubes, uterus, thymus, salivary glands, pancreas, and bladder. © 2009 Society for Pediatric Pathology.