Browsing by Author "Kürşat S."

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    The unmasking of hyperreninemic hypovolemia by captopril test in a hypertensive HD patient unaccompanied by autonomic neuropathy
    (S. Karger AG, 2000) Kürşat S.; Özgür B.; Yurtman G.
    [No abstract available]
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    Serum levels of total acid phosphatase, prostatic acid phosphatase, total and free prostate-specific antigen in patients within chronic hemodialysis program
    (2001) Gümüş B.; Lekili M.; Uyanik B.S.; Temeltaş G.; Büyüksu T.; Kürşat S.
    Objective: To investigate the effect of terminal renal failure with chronic hemodialysis on prostatic disease markers [total acid phosphatase (TAP), prostatic acid phosphatase (PAP), prostate-specific antigen (PSA) and free prostate-specific antigen (fPSA)]. Patients and Method: Total acid phosphatase (TAP), prostatic acid phosphatase (PAP), prostate-specific antigen (PSA) and free prostate-specific antigen (fPSA) were measured in 28 patients over 40 years of age on terminal renal failure with chronic hemodialysis. Correlation was calculated between the dialysis duration and prostatic disease marker levels. Results: There was no evidence of artefactual elevation of prostatic disease markers. TAP, PAP, PSA and fPSA levels were in the normal range in all of the patients. However, PSA and fPSA levels decreased as the dialysis duration increased. Conclusion: Prostatic disease markers were useful in the routine screening of men receiving long-term dialysis, but the clinicians should be on alert when the dialysis duration increases.
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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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    Increased incidence of tuberculosis in chronic hemodialysis patients
    (2001) Kürşat S.; Özgür B.
    We encountered 9 cases of tuberculosis out of our 157 chronic HD patients in 36 months. Four pulmonary, 4 lymph nodal and one isolated dermal involvement were detected. Therapy was commenced without waiting for absolute cultural or pathologic diagnosis because of the high index of clinical suspicion. All cases except one recovered completely. Among associated conditions, peptic ulcer disease, anti-HCV positivity, and diabetes mellitus were noted, though the last two did not reach statistical significance. Prompt institution of the specific therapy and close supervision of the cases during treatment enabled us to obtain a cure in all cases except one and to discern adverse drug effects immediately and to make appropriate changes in the therapy. Thus, no morbidity due to the disease itself or drugs was observed. Copyright © 2001 S. Karger AG, Basel.
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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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    Effects of nutritional parameters on nocturnal blood pressure in patients undergoing hemodialysis
    (2013) Tekçe H.; Kürşat S.; Bahadir Çolak H.; Aktaş G.
    Background: Malnutrition is a common problem in uremic patients. It is unclear whether there is an association between the degree of malnutrition and 24-h ambulatory blood pressure patterns in patients undergoing hemodialysis. In the present study, we observed the relationship between the degree of malnutrition and deterioration of the rhythm of diurnal blood pressure, which are both risk factors for cardiovascular morbidity - mortality and associated with hypervolemia. Method: We observed 148 patients undergoing hemodialysis in the Nephrology Department of Celal Bayar University Hospital. All cases were assessed for body weight alterations, dietary food intake, gastrointestinal symptoms, loss of subcutaneous fat and muscle tissue, presence and severity of comorbidities, functional capacity (subjective global assessment), and anthropometric indices. Ambulatory blood pressure measurements were performed for all cases on the day between the two hemodialysis sessions. Results: We found that the circadian blood pressure rhythm deteriorated in patients with a high-malnutrition score, and that malnutrition was more common and severe in those subjects with the non-dipper and reverse-dipper blood pressure patterns. Malnutrition score was positively correlated with the nighttime systolic and nighttime mean blood pressures and mean 24-h arterial blood pressure (all p<0.01). We identified a positive correlation between malnutrition score and the reduction in serum albumin and anthropometric indices. Conclusion: This is the first study to demonstrate an association between malnutrition and deterioration in the circadian blood pressure rhythm in a hemodialysis population. Nutritional disturbance is associated with an increase in night-time blood pressure. Low serum albumin levels and hypervolemia may contribute this situation. © 2013 Informa Healthcare USA, Inc. All rights reserved: reproduction in whole or part not permitted.
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    Functional bowel disorders and associated risk factors in hemodialysis patients in Turkey
    (Turkish Society of Gastroenterology, 2017) Gök E.G.; Ýnci A.; Çoban M.; Kutsal D.A.; Kürşat S.
    Background/Aims: Functional bowel disorders (FBDs) impair the quality of life in patients with end-stage renal disease (ESRD). The aim of our study was to determine the prevalence and distribution of the subtypes of FBDs in hemodialysis (HD) patients. Materials and Methods: This prospective, cross-sectional study included 80 patients who received HD for more than 3 months (patient group) and 80 healthy controls (control group). FBDs were diagnosed according to the Rome II diagnostic criteria by excluding organic pathologies. Results: Forty-six (57.5%) patients were males, and their average age was 62.13±;12.92 (23-90) years. The mean duration of dialysis was 57.48±;59.23 (3-312) months, and the mean Kt/V (K: dialyzer clearance of urea, t: dialysis time, V: volume of distrubition of urea) value was 1.53±;0.31. The rate of FBDs was significantly higher in the patient group than in the control group (p=0.01). In total, 7.5% of the patients had irritable bowel syndrome, 3.8% had functional bloating, and 16.3% had functional constipation. FBDs were significantly higher in women (p=0.004). While there was no statistically significant difference between patients with and those without FBDs in terms of the presence of additional diseases, smoking, alcohol use, educational level, marital status, and residential areas (p>0.05), serum phosphorus (P) levels were significantly higher in the patients with FBDs (p=0.03). Conclusion: FBDs and their functional constipation subtype are more common in HD patients than in the healthy population in Turkey. FBDs are most frequently observed in females and housewives with high serum P levels. © Copyright 2017 by The Turkish Society of Gastroenterology.
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    Relationship between angiotensin-converting enzyme gene polymorphism and QT dispersion in hemodialysis patients
    (Iranian Society of Nephrology, 2017) Toraman A.; Çolak H.; Tekçe H.; Cam S.; Kürşat S.
    Introduction. The angiotensin-converting enzyme (ACE) gene insertion or deletion in long-term hemodialysis patients may be associated with corrected QT interval prolongation, leading to fatal arrhythmias. The ACE D allele is known to increase the risk of malignant ventricular arrhythmias and is also associated with increased QT dispersion after myocardial infarction and hypertension. This study aimed to evaluate the relationship between ACE gene polymorphism and QT dispersion in hemodialysis patients. Materials and Methods. In 70 hemodialysis patients, electrocardiography was performed and QT dispersion was calculated. Corrected QT interval was calculated using Bazett Formula. The ACE gene polymorphism was determined by polymerase chain reaction. Results. The mean age of the patients was 60 ± 12 years. The mean QT dispersion and corrected QT dispersion were 61.71 ± 21.99 and 73.18 ± 25.51, respectively. QT dispersion inversely correlated with serum calcium and potassium levels and positively correlated with ACE gene polymorphism and residual urine. Calcium level was the predictor factor for QT dispersion. The ACE genotype correlated with QT dispersion, corrected QT dispersion, hemoglobin, and residual urine, and inversely correlated with serum potassium. Corrected QT dispersion correlated with ACE gene polymorphism and residual urine. The DD genotype of ACE had significally greater QT dispersion and corrected QT dispersion than the II and ID genotypes. Conclusions. Our study showed that the most important parameter affecting corrected QT dispersion was ACE gene polymorphism on the background of D allelle. Patients carrying this allelle need special attention regarding optimal suppression of renin-angiotensin-aldosteron system activity. © 2017, Iranian Society of Nephrology. All rights reserved.
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    Vascular calcification and growth arrest specific protein 6 levels in chronic renal disease; [Calcificación vascular y niveles de la proteína específica del gen 6 de la detención del crecimiento en la enfermedad renal crónica]
    (Asociacion Regional de Dialisi y Transplantes Renales de Capital Federal y Provincia de Buenos Aires, 2019) Toraman A.; Cetintepe L.; Elbi H.; Taneli F.; Yildiz R.; Duzgun F.; Pabuscu Y.; Horasan G.D.; Kürşat S.
    Introduction: Cardiovascular disease is the main cause of mortality and morbidity in chronic renal failure. It’s known that vascular calcification (VC) and carotid intima media thickness (CIMT) are strongly associated with cardiovascular diseases. Growth arrest specific protein 6 (Gas6) is a vitamin K-dependent protein and regulates various processes such as proliferation, cell survival, migration and inflammation. Gas6 is known to protect endothelial cells and vascular smooth muscle cells against apoptosis by inhibiting Bcl-2 induced Caspase 3 activation. The relationship between Gas6 and cardiovascular diseases has been demonstrated in many mouse models and cell cultures. However, there are conflicting reports whether Gas6 levels are increasing or decreasing in human studies of diabetic and/or chronic renal failure. In present study the aim was to examine plasma Gas6 levels and its relation with CIMT and coronary artery calcification score (CACS) in chronic kidney disease (CKD) patients. Methods: Total of 137 patients of which 32 chronic hemodialysis and 105 predialysis patients as well as 73 healthy controls were enrolled in the study. Human Gas6 levels in serum samples were studied by ELISA method. CIMT was measured by ultrasonography. CACS was measured by multislice computed tomography. Results: The mean age was 54.37±16.61 years in dialysis group, 55.20±14.80 years in predialysis group and 53.26±9.04 years in control group. Serum creatinine was 0.78±0.16 mg/dl in the control group and 1.96±1.64 mg/dl in the predialysis and 5.94±1.55 mg/dl in the dialysis group. 24 hours urine protein levels were significally higher in the dialysis group than the predialysis and the control group. CIMT values were similar in predialysis and dialysis groups. These values were significantly higher than control group. Although CACS was higher in dialysis group than predialysis and control group, the results were not statistically significant since the distribution range was very wide. Gas6 was 98.84±53.32 ng/mL in the control group and statistically higher than dialysis (63.85±38.92 ng/mL) and predialysis groups (54.96±38.49 ng/mL) (p=0.001). Gas6 levels were lower in diabetic patients than non-diabetics (53.69±35.26 ng/mL, 69.26±47.50 ng/mL, p=0.023, respectively). Negative correlation was detected between Gas6 and age, BMI, CACS, carotid IMT and proteinuria. In the logistic regression analysis, Gas6 remained significantly associated with BMI, CIMT and proteinuria. Conclusion: In our study, a negative correlation of Gas6 with BMI, CACS, CIMT and proteinuria and lower Gas6 levels in diabetic patients support that decreased Gas6 levels in chronic renal failure may have a role in vascular calcification through altered glucose tolerance, chronic inflammation, endothelial dysfunction and increased apoptosis. Our study has an importance because it is the first study showing a relation between Gas6 and proteinuria, CACS and carotid IMT in patients with chronic renal failure. © 2019, Asociacion Regional de Dialisi y Transplantes Renales de Capital Federal y Provincia de Buenos Aires. All rights reserved.
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    Association between neutrophil-lymphocyte & platelet lymphocyte ratios with prognosis & mortality in rapidly progressive glomerulonephritis
    (Wolters Kluwer Medknow Publications, 2019) Toraman A.; Neşe N.; Özyurt B.; Kürşat S.
    Background & objectives: Rapidly progressive glomerulonephritis (RPGN) is a clinical syndrome manifested by features of nephritic syndrome and progressive loss of renal function over a short time. The objective of this study was to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and prognostic factors and pathological findings of renal biopsy in RPGN. Methods: Consecutive newly diagnosed RPGN patients who had follow up for at least six months were retrospectively analyzed. The estimated glomerular filtration rate (EGFR) was calculated. Albumin, C-reactive protein (CRP) levels and CRP/albumin ratio were also calculated. Results: Fifty four patients were included in the study. The mean age was 48.92±20.12 years. Clinicopathological diagnosis was pauci-immune glomerulonephritis (GN) in 40 while two had postinfectious GN, six systemic lupus erythematosus, three IgA nephropathy, two Henoch-Schönlein purpura and one membranoproliferative GN. The mean NLR was 7.02±6.34 and mean PLR was 273.90±39.15. Positive correlations between NLR and CRP levels (P=0.009, r=0.511) and CRP/albumin ratios (P=0.005, r=0.542) were observed. PLR and CRP/albumin ratios (P=0.041, r=0.412) were correlated positively. The per cent of fibrocellular crescents was negatively correlated with NLR (P=0.019, r=-0.291), and positively correlated with the lymphocyte count (P=0.05, r=0.256). In secondary crescentic subgroup, the per cent of fibrinoid necrosis had a positive correlation with PLR (P=0.013, r=0.642). Both NLR (P=0.036) and PLR (P=0.051) detected at the first month of the treatment period, were observed to be significantly correlated with mortality. Interpretation & conclusions: This study showed that NLR could predict mortality in patients with RPGN; correlated with systemic inflammation; showed a negative correlation with the per cent of fibrocellular crescents and could be regarded as a measure of glomerular inflammatory state. Moreover, PLR may be considered to be an indicator of disease severity in acute phase of crescentic GN. © 2019 Indian Journal of Medical Research.
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    Which one is the predictor of carotid intima media thickness in patients with glomerulonephritis; neutrophil-to-lymphocyte ratio or proteinuria?; [Glomerülonefritli hastalarda karotis intima media kalınlığının prediktörü hangisidir; nötrofil-lenfosit oranı mı proteinüri mi?]
    (Pamukkale University, 2019) Toraman A.; Eren B.; Düzgün F.; Taneli F.; Kürşat S.
    Purpose: Glomerulonephritis is inflammation of the glomeruli and proteinuria itself is a reflection of the glomerular inflammation. In this study we aimed to investigate the relationship between carotid intima media thickness (CIMT) one of the earliest findings of atherosclerosis and markers of glomerular inflammation. Materials and Methods:40 patients with biopsy proven glomerulonephritis and 46 healthy controls were enrolled in the study. Human Growth arrest spesific protein 6 (Gas6) levels in serum samples were studied by ELISA. CIMT measurement was performed by the same radiologist. Neutrophil-lymphocyte ratio (NLR) was calculated by dividing the number of neutrophils by the number of lymphocytes. Results: The mean age was 42.88±15.41 in patient group and 38.26±9.04 in controls. The mean duration of illness was 29.07±52.90 mounts, proteinuria was 4027.05±4030.22 mg/day, Modification of Diet in Renal Diseases Study Glomerular Filtration Rate (MDRD-GFR) was 53.80±48.32 mL/min/1.73m2. CIMT was 0.62±0.17 mm in patient group, 0.46±0.10 mm in controls. Neutrophil-to-Lymphocyte Ratio (NLR) was 3.69±4.46 in patient group and significantly higher than control group (1.74±0.63). Gas6 levels were statistically higher in control group. CIMT was positively correlated with age, fibrinogen, ferritin, proteinuria and NLR and negatively correlated with HDL cholesterol and Gas6 in glomerulonephritis group. Age was the predictor for CIMT in the logistic regression model. In all group CIMT was positively correlated with age, creatinine, uric acid, fibrinogen, ferritin, CaxP product, proteinuria and NLR and negatively correlated with hemoglobin level, Gas6. In lineer logistic regression analysis carotid IMT was significantly associated with age and ferritin and proteinuria. Conclusion: We have shown that proteinuria is one of the main determinants of increased CIMT independent from the GFR levels in glomerulonephritis with relatively preserved glomerular filtration rate. © 2019, Pamukkale University. All rights reserved.