Browsing by Author "Alici T."

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    Multiple myeloma and renal failure; [Multipl miyelom ve böbrek yetersizliǧi]
    (2001) Özgür B.; Alici T.; Kürşat S.
    MM should be suspected in every patient with acute renal failure of uncertain ethiology because in this situation a prompt therapy should be administered in order to prevent sustained renal failure. Patients with known MM should be investigated for potential renal impairment. The MM therapy includes two major sides: General measures and chemotherapy. Preventive measures against dehydration, hypercalcaemia, infection, septicaemia and the use of nephrotoxic agents are the backbones of the general approach to MM. The early mortality of MM patients with renal failure is up to 30%. This is due mainly to infection and septicaemia and is favoured by the immunosupsressive effects of myeloma per se, of renal failure, and of the administration of corticosteroids and cytostatic drugs. Prevention, early diagnosis and optimal therapy for infections are recommended. Chemotherapy should be started as soon as possible. To achieve fast reduction in the myeloma protein load we recommend VAD chemotherapy for patients up to the age of 65 years. Patients with renal failure should be treated in hospital to detect infections at an early stage in order to start antibiotic therapy. Patients older than 65 years should be treated with cyclophosphamide plus prednisone or melphalan plus prednisone, because the incidence of complications caused by high-dose pulsed immunosuppressive glucocorticoid therapy is high in this age bracket. In addition, chemotherapy with alkylating agents could induce leucocytopenia in MM patients. Antibiotic prophylaxis is recommended for patients with MM at the time of chemotherapy. Factors affecting the recovery of renal function are the degree of renal failure, the presence of hypercalcaemia and the amount of protein excreted. Effective treatment of renal failure in combination with myeloma therapy will reduce adverse events and prolong survival.
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    Effect of ultrafiltration on blood pressure variability in hemodialysis patients
    (Dustri-Verlag Dr. Karl Feistle, 2003) Kürsat S.; Özgü B.; Alici T.
    Aim: Increased blood pressure variability (BPV) in end-stage renal disease (ESRD) patients is proved to be a risk factor for cardiovascular disease [Tozawa et al. 1999]. The effect of ultrafiltration (UF) on BPV in hemodialysis (HD) patients has not been reported in the literature. This study was undertaken to define the effect of a single UF on BPV in HD patients. Methods: Prior and after HD with UF, 24-hour ambulatory BP monitoring (ABPM) was applied to each patient and then diurnal and nocturnal BP and BPV parameters (both before and after UF) were compared and correlated with UF values Results: Increase in BPV after single UF in all groups was statistically significant (p < 0.05). Only the daytime systolic (DS) BPV increase (median 42.4%) was in positive correlation with δ body weight (body wt) (median 3.07%) or UF amount (r = 0.649, p < 0.01). Conclusions: Large volume depletions and sympathetic hyperreactivity could explain the increase in BPV. Increased interdialytic weight gain requires more UF and subsequently BPV, morbidity and mortality also increase. Thus, considerable efforts must be made to prevent great interdialytic weight gain in HD patients.
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    A case of rhabdomyolysis induced acute renal failure secondary to statin-fibrate-derivative combination and occult hypothyroidism
    (Dustri-Verlag Dr. Karl Feistle, 2005) Kursat S.; Alici T.; Colak H.B.
    Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle contents into the systemic circulation. We hereby report a patient proved to be a case of unrecognized hypothyroidism presenting with rhabdomyolytic acute renal failure precipitated by the combined use of statin and fenofibrate. A 63-year-old woman was referred to our department because of fatigue, diffuse muscle pain and oliguria. On the basis of pathogenesis, clinical and laboratory examination the diagnoses of acute renal failure secondary to the statin-fibrate-derivative combination induced rhabdomyolysis and auto-immune thyroiditis induced hypothyroidism were made. Although saline, furosemide and sodium bicarbonate infusions enabled diuresis and have led to a rapid recovery of renal function and normalization of blood pressure in five days (creatinine level decreased from 4.5 mg/dl to 1.2 mg/dl), only thyroid replacement therapy (0,1 mg thyroxine) that begun after the exclusion of adrenal insufficiency resulted in complete resolution of rhabdomyolysis. This prompted the diagnosis of background, clinically silent rhabdomyolysis aggrevated by the statin-fibrate-derivative combination. To our knowledge this case illustrates the first example of rhabdomyolytic acute renal failure induced by a statin-fibrate-derivative combination with underlying hypothyroidism which was responsible for the basal clinically unobservable rhabdomyolysis. ©2005 Dustri-Verlag Dr. K. Feistle.
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    Blood pressure and ejection fraction changes due to ultrafiltration in hemodialysis
    (2006) Kursat S.; Aysel S.; Alici T.; Tezcan U.K.
    Background: Nocturnal hypertension (NH) is an unsolved problem in hemodialysis (HD) patients. The effect of ultrafiltration (UF) on NH and myocardial performance has not been systematically investigated in HD patients. Methods: Seventeen reverse-dipper (RD) HD patients were subjected to intensified UF. Before and after UF, echocardiographic and blood pressure (BP) measurements were taken. Results: Excluding daytime diastolic BP, all BP parameters (mmHg), namely daytime systolic BP (138.1 ± 15.1; 131.1 ± 12.5), night-time systolic BP (150.4 ± 17.6; 125.3 ± 16.5), night-time diastolic BP (87.3 ± 10.3; 76.5 ± 11.6), daytime pulse pressure (56.1 ± 7.6; 50.5 ± 5), night-time pulse pressure (63.3 ± 9.4; 48.7 ± 7), significantly decreased (p<0.001 for all comparisons). Thirteen patients converted to non-dipper and two patients converted to dippers, whereas two patients remained on RD. Unit for measurement of diameters was mm. Ejection fractions (EF) increased (51.23 ± 9.01; 64.05 ± 7.23, p<0.001), left atrial diameters (LAD) decreased (35 ± 8.29; 32.05 ± 7.12, p<0.001), the vena cava inferior collapse index increased (VCICI) [24.82 ± 8.20 (%); 51.76 ± 9.65 (%), p<0.001], left ventricular end-systolic (LVES) and diastolic diameters (LVED) decreased (3.19 ± 0.60; 2.77 ± 0.51, p<0.001; 4.39 ± 0.65; 4.18 ± 0.56, p=0.002, respectively). Percentage reduction in night-time diastolic BP correlated with the percentage reduction in LAD (p=0.038). Percentage reduction in night-time pulse pressure correlated with the percentage increase in EF (p<0.013). Similarly, percentage reductions in night-time systolic BP, night-time diastolic BP and night-time mean BP correlated with the percentage reduction in LVESD (p=0.014, p<0.001 and p=0.001, respectively). Conclusions: NH in HD patients is a volume dependent phenomenon. Improved night-time BP parameters have a more profound effect on myocardial function than daytime BP parameters. © Società Italiana di Nefrologia.
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    Chylous ascites and chylothorax due to membranous nephropathy [2]
    (Dustri-Verlag Dr. Karl Feistle, 2007) Colak H.B.; Alici T.; Tekce H.; Öz D.; Erol A.; Aras F.; Kursat S.
    [No abstract available]
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    Relationship between the degree of malnutrition and echocardiographic parameters in hemodialysis patients
    (2007) Kürşat S.; Tekçe H.; Ekmekçi C.; Çolak H.B.; Alici T.
    Background: The aim of this study is to investigate the relationship between the degree of malnutrition and inadequate volume control evidenced by echocardiography. Methods: In this study 72 chronic hemodialysis patients were investigated in a cross-sectional manner. The malnutrition score was calculated using Subjective Global Assessment. M-mode echocardiography was performed in all patients. Results: The highest malnutrition score (23.2 ± 1.5 points) and lowest vena cava inferior collapse index (35 ± 2%) were observed in the eccentric left ventricular hypertrophy group. The malnutrition index was found to be in positive relationship with the left atrium diameter and index, left ventricular mass and index, and left ventricular end-diastolic diameter. On the other hand, a negative correlation was detected with the vena cava inferior collapse index. When all parameters that were found to be related to malnutrition were assessed by multivariate analyses, a statistically significant relation was found between the left ventricular end-diastolic diameter and the malnutrition index. Conclusion: The results of our study show that the progressive worsening of the nutritional status follows a parallel course along with the deterioration in the echocardiographic parameters concerning hypervolemia. This in turn suggests that increasing degrees of malnutrition are associated with more profound derangements in the volume status. Volume excess might be a mechanism explaning the increased mortality and morbidity caused by malnutrition in hemodialysis patients. Owing to its cross-sectional design, this study cannot provide unequivocal evidence regarding the cause and effect relationship between volume overload and malnutrition in hemodialysis patients. Copyright © 2007 S. Karger AG.
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    The relationship between depression - Malnutrition and echocardiographic-blood pressure parameters in chronic hemodialysis patients
    (2008) Kursat S.; Colak H.B.; Toraman A.; Ekmekci C.; Tekce H.; Alici T.
    Aims: The aim is to research the relationship between the degree of depression - malnutrition and inadequate volume control. Methods: The mean age of the 52 patients was 55 ± 14.6 years. Malnutrition score [subjective global assessment (SGA)] and depression score [Taiwanese Depression Questionnaire (TDQ)] of each chronic hemodialysis (CHD) patient were calculated. Then an echocardiographic assessment was carried out with the same device 1 day before the second HD session of the week. The 24 h blood pressure monitoring was performed 1 day before the second HD session of the week. Results: TDQ scores (TDQS) were ≥19 in 41 and <19 in 11 patients. TDQS was found to be significantly high in women (p = 0.01) who were older than 40 years (p = 0.03) and who have low family income (p = 0.03). TDQS was found to be significantly correlated with HD duration (p = 0.034), vena cava inferior collapse index (p = 0.02), malnutrition score (p = 0.011), residual renal function (ml/day) (p = 0.03), level of albumin (p = 0.0009), and iron (p = 0.015). A positive correlation was detected between TDQS and the ratio of mean nighttime blood pressure/ mean daytime blood pressure (p = 0.005, r = 0.394). Depression score was found to be significantly different between normal geometry and left ventricular hypertrophy (eLVH), concentric remodeling and eLVH, and concentric LVH and eLVH. Conclusions: The results show that lesser degrees of nocturnal dip and eLVH are associated with increased degrees of depression, implying that hypervolemia is strongly associated with depression and might be a component of strong relationships involving malnutrition, inflammation, and atherosclerosis in CHD patients. © Springer Science+Business Media B.V. 2008.