Browsing by Author "Kursat S."
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Item Diabetic nephropathy and angiotensin converting enzyme inhibition; [Diabetik nefropati ve anjiotensin donusturucu enzim inhibisyonu](1998) Saruc M.; Kursat S.; Kiliccioglu B.Diabetic nephropathy is the single most common cause of renal failure leading to end stage renal disease. The cost of providing dialysis for uremic diabetics is very expensive. Diabetic nephropathy is also associated with markedly increased morbidity and mortality for the patient with diabetes mellitus who develops this complication. Angiotensin converting enzyme inhibition has protective effects on renal functions and structure in diabetic nephropathy. This protection is probably independent of the systemic hypotensive effect of these agents. That is why effective antihypertensive treatment with angiotensin converting enzyme inhibitors in patients with diabetic nepropathy results in a large reduction in albuminuria and a low rate of decline in kidney function. As a conclusion, all patients with diabetes and documented diabetic glomerulopathy should be treated with an angiotensin converting enzyme inhibitor.Item Prevalence of anti-HCV positivity in hemodialysis patients [4](2000) Sivrel Arisoy A.; Kursat S.; Gazi H.; Kurutepe S.; Ozbakkaloglu B.[No abstract available]Item 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.Item 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.Item 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]Item Pulmonary hypertension in patients with chronic renal failure(2007) Havlucu Y.; Kursat S.; Ekmekci C.; Celik P.; Serter S.; Bayturan O.; Dinc G.Background: Many etiologies causing pulmonary hypertension (PH) have been reported, and one of the background disease seen with patients with PH is chronic renal failure (CRF); however, the pathogenesis of PH in this group of patients is not explained satisfactorily. Objectives: The aims of this study were to evaluate the incidence of unexplained PH among patients with CRF and to suggest possible etiologic factors. Methods: Two hundred and eleven patients with CRF were evaluated and the ones who have comorbid conditions that cause PH were excluded. Pulmonary arterial pressure (PAP) and cardiac functions were evaluated by Doppler echocardiography. Arteriovenous fistula (AVF) flow was measured by Doppler sonography. The patients were followed for at least 6 months. Results: Forty-eight CRF patients (20 males, 28 females) were included: 23 were predialysis patients, and 25 patients received hemodialysis via AVF. Patients were followed for 7.5 ± 1.01 months. Systolic PAP >35 mm Hg was found in 56% (14/25) of patients receiving hemodialysis (36.8 ± 10.7 mm Hg) and in 39.1% (9/23) of predialysis patients (29.5 ± 9.5 mm Hg). The parathyroid hormone level, cardiac output values and CRF duration were found to be increased in patients with elevated systolic PAP (p < 0.05). AVF flow and AVF duration were positively correlated with systolic PAP in patients receiving hemodialysis (p < 0.05). There was a negative correlation between systolic PAP and residual urine volume (p < 0.05). AVF compression in hemodialysis patients decreased systolic PAP from 36.8 ± 10.7 to 32.8 ± 10.5 mm Hg. Systolic PAP values were increased at the end of the study in the predialysis group, whereas they were decreased at the end of the follow-up in the hemodialysis group (36.9 ± 10.5 and 32.04 ± 10.5 mm Hg, respectively). Conclusions: This study demonstrates a high incidence of PH among patients with CRF. CRF duration, AVF flow, parathyroid hormone level and cardiac output may be involved in the pathogenesis of PH. The effective hemodialysis and dry weight reduction decreased systolic PAP values. Copyright © 2007 S. Karger AG.Item 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.Item Relation of RAS gene polymorphisms with impaired glucose tolerance in patient with end stage renal failure(Kamla-Raj Enterprises, 2013) Oz D.; Toraman Avcu A.; Kursat S.; Colak Bahadir H.; Sir Cam F.Renin angiotensin system (RAS) is a system that is the role of renal hemodynamics, blood pressure and fluid electrolyte balance regulation with progression to end-stage renal disease (ESRD). Angiotensin II (AII),the main mediatör of this system, is thought to cause a functional impairment in insulin receptor and post receptor signaling pathways. Our aim; was to show the relation of angiotensin-converting enzyme (ACE), angiotensin II receptor type 1 (AT1 R) and angiotensinogen gene (AGT) polymorphisms, that cause genetic susceptibility to over activation of RAS, to glucose intolerance in patient with end stage renal failure. The study included one hundredth patients. Based on fasting plasma glucose values and oral glucose tolerance test second hours glucose values, patients were grouped as normal patients and patients with glucose intolerance [impaired fasting glycemia (IFG), impaired glucose tolerance (IGT) and diabetes mellitus (DM)]. Insulin resistance was calculated by HOMA-IR method and insülin sensitivity index was calculated by ISI-S method. ACE, AT1 R, AGT polymorphisms were detected by polymerase chain reaction (PCR) method. There was no statistically significant difference between distribution of ACE, AT1R and AGT genotypes and glucose intolerance groups, and insulin resistance. There was a statistically significant difference between MM and TT genotypes and average insulin resistance values (p < 0,04). We have obtained results suggesting a relation between ACE gene D allele and glucose intolerance in patients with end stage renal failure (p=0.06). Moreover, a relation has been shown between AGT gene T allele and insulin resistance (p=0.04). © Kamla-Raj 2013.Item Correlation of the Volume Control Parameters with Health Related Quality of Life in Renal Transplant Patients(Elsevier USA, 2015) Colak H.; Sert I.; Ekmekci C.; Tugmen C.; Kurtulmus Y.; Kursat S.; Töz H.Introduction Transplantation is the most effective treatment strategy for end-stage renal failure. We aimed to investigate the correlation of volume control parameters with health-related quality of life (HRQoL) in renal transplantation patients during the pre- and post-transplantation periods. Material and Methods Seventy-seven patients who underwent renal transplantation from deceased donors between January 2011 and January 2013 were included in the study. The biochemical markers, complete blood count, and creatinine levels were measured during pretransplantation and at post-transplantation month 6. The Turkish version of the Short Form 36 (SF-36) health survey questionnaire was used for the assessment of HRQoL. Blood pressure (BP) and echocardiographic measurements were used to evaluate the volume status. Results Significant improvements were achieved in all echocardiographic measurements, biochemical parameters except Ca++, and SF-36 questionnaire domain scores (DSs) except vitality in the post-transplantation period. Systolic BP (SBP), the left atrium index, vena cava inferior collapsibility index (VCCI), and diastolic BP were associated with vitality (P =.02,.03,.05, and.04, respectively); SBP was associated with social functioning (P <.01) and role emotional (P <.01); and left ventricular mass index was associated with mental health (P =.05) DSs during the pretransplantation period. In the post-transplantation period, VCCI, left ventricular mass index, and SBP were associated with general health (P =.02,.05, and.05, respectively); VCCI and SBP were also associated with mental health (P =.05 and.01, respectively); and left atrium index was associated with role emotional (P =.05) DSs. Conclusion Concomitant improvement in the volemic status may contribute to improvements in HRQoL after renal transplantation. © 2015 Elsevier Inc. All rights reserved.Item Relationship Between Epicardial Adipose Tissue, Inflammation and Volume Markers in Hemodialysis and Transplant Patients(2015) Çolak H.; Kilicarslan B.; Tekce H.; Tanrisev M.; Tugmen C.; Aktas G.; Kursat S.Cardiovascular (CV) diseases are still the most important cause of morbidity and mortality in both patients receiving hemodialysis (HD) treatment and individuals with renal transplantation (Rtx). Measurement of epicardial adipose tissue (EAT) thickness is an easily applied, cheap, and useful recent method predicting increased CV risk. We aimed to compare EAT changes in HD and Rtx patients and the association between EAT and inflammatory and CV volume markers in both groups. A total of 124 patients: 45 Rtx, 43 HD patients and 36 healthy controls were enrolled in the study. Laboratory parameters and inflammatory markers (interleukin-6 [IL-6] and high sensitive C-reactive protein [Hs-CRP]) were evaluated from venous blood samples after an overnight fast. EAT thickness was measured with transthoracic echocardiography. The levels of Hs-CRP, IL-6, systolic and diastolic blood pressures, left atrial (LA) diameter, left atrial index (LAI), left ventricular mass (LVM) and LVM index (LVMI) were significantly higher in the HD patients than in the other groups. EAT was positively correlated with age, body mass index (BMI), time on dialysis, serum creatinine, total cholesterol, Low density lipoprotein-cholesterol, and LVM in Rtx group and positively correlated with age, BMI, duration of dialysis, Hs-CRP, IL-6, LAI and LVMI and inversely correlated with inferior vena cava collapse index (IVC-CI) in HD group. EAT thickness of RTx patients (whose previous HD duration was similar to those in HD group) are similar to the healthy population and significantly thinner than patients on HD. Therapeutic Apheresis and Dialysis. © 2015 International Society for Apheresis.Item Bone mineral density and biochemical markers of bone metabolism in predialysis patients with chronic kidney disease(Lippincott Williams and Wilkins, 2016) Fidan N.; Inci A.; Coban M.; Ulman C.; Kursat S.The aim of the study was to evaluate the usefulness of serum bone turnover markers (BTM) and bone mineral density (BMD) determined by dual-energy X-ray absorptiometry (DEXA) in predialysis patients with chronic kidney disease (CKD). We enrolled 83 patients with CKD, 41 (49.4%) males, 42 (50.6%) females, with mean estimated glomerular filtration rate (eGFR) 23.90±12 (range=6.0-56.0). BMD of the lumbar spine (LS) (anteroposterior, L2 through L4), femoral neck (FN) and femoral trochanter (FT) were measured by DEXA. Biochemical BTM, including calcium (Ca), phosphorus (P), intact parathyroid hormone (PTH), serum specific alkaline phosphatase (serum AP), bone-specific AP (BSAP), plasma bicarbonate and 25-hydroxy-vitamin D (25hD) were used for the prediction of BMD loss. T score results of LS and FN were worse than FT. BMD levels were lower in females than in males (all p<0.05). According to different BMD T score levels, patients with age ≥65 years and patients in menopause were significantly more osteopenic ( p=0.026) and there was no relation between different BMD T scores and presence of diabetes ( p=0.654). A positive correlation was identified between the BMD of FN T-Z scores (r=0.270, p=0.029, r=0.306, p=0.012), FT T-Z scores (r=0.220, p=0.076, r:0.250, p=0.043) and serum HCO3, while the correlation with serum alkaline phosphatase (AP) and BSAP was considered to be negative. No statistically significant association was found between BMD of all the measured skeletal sites and eGFR. Loss of BMD was identified mostly in females over ≥65 years of age and after menopause. Higher serum levels of BSAP and AP can be determined in the advanced stages of renal failure and they reflect fracture risk of the femur, but not spine. Measurements of BMD by DEXA are useful to demonstrate bone loss, but not technical enough to distinguish the quantity of bone loss between different stages of CKD. © 2016 American Federation for Medical Research.Item Is there a relationship between parathyroid hormone and neutrophil lymphocyte ratio or platelet lymphocyte ratio?(Acta Endocrinologica Foundation, 2019) Toraman A.; Aras F.; Hekimsoy Z.; Kursat S.Context. Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are recent prognostic markers associated with inflammation in many diseases such as chronic kidney disease (CKD), malignancies, myocardial infarction. Objective. In this study, we investigated the relationship between NLR-PLR and parathyroid hormone (PTH) and vitamin D in patients with high PTH levels. Design. The patients with high PTH levels in Nephrology and Endocrinolgy Outpatient clinics were evaluated retrospectively. Subjects and methods. The medical records of the patients were examined and clinical data, including demographic details, clinical and laboratory findings, treatment and follow-up data were obtained. NLR and PLR were calculated. Serum creatinine, calcium, phosphorus, magnesium, lipid levels, calcium phosphorus product, PTH and vitamin D values were investigated. The relationship between NLR-PLR and laboratory parameters, GFR (MDRD-GFR), PTH and vitamin D were investigated. Results. 48 male and 253 female patients were enrolled in this study. The mean age was 57.57±13.28. NLR correlated negatively with albumin, hemoglobin, vitamin D, calcium and cholesterol and it positively correlated with creatinine and PTH. Multiple regression analysis showed that main determinants of NLR were PTH, albumin, LDLcholesterol, hemoglobin and gender. Conclusions. In this study NLR and PLR correlated negatively with hemoglobin and cholesterol. Positive correlation between NLR and creatinine could be explained by increased degrees of inflammation associated with more pronounced degrees of renal dysfunction. The impact of PTH on NLR was independent of GFR. In multiple regression model this suggests that PTH could be a pro-inflammatory parameter independent of the degree of renal dysfunction. © 2019, Acta Endocrinologica Foundation. All rights reserved.Item Fragmented QRS as a predictor of subclinical cardiovascular disease in patients with chronic kidney disease(Blackwell Publishing, 2020) Toraman A.; Eren B.; Yılmaz I.; Duzgun F.; Taneli F.; Kursat S.Background: Fragmented QRS (fQRS) on surface electrocardiogram is correlated with increased cardiovascular risk and mortality in normal population. Aims: To investigate the presence of fQRS and its association with subclinical atherosclerosis and vascular calcification in chronic kidney disease (CKD) patients without cardiovascular disease. Methods: A total of 129 CKD (63 males and 66 females) patients was enrolled for the study. Carotid intima-media thickness (CIMT) measurement and coronary artery calcification score (CACS) were performed by the same radiologist. A 12-lead electrocardiogram recording was used to detect fQRS. Results: The mean age was 55.1 ± 15.1 years. fQRS was detected in 45% of patients. There was not any significant difference between patients with or without fQRS in terms of demographic parameters and comorbid diseases except for diabetes and hyperlipidaemia. The mean CIMT of CKD patients was 0.66 ± 0.18 mm and it was significantly higher in fQRS(+) group compared to the fQRS(−) group. Similarly CACS values were higher in fQRS(+) group. In the logistic regression analysis, fQRS remained significantly associated with CIMT (β = 0.220, t = 2.567, P = 0.011) (independent variables: CIMT, CACS, sodium and glomerular filtration rate (modification of diet in renal disease–glomerular filtration rate)). Conclusions: This is the first study in the literature showing the relation of fQRS with CIMT and CACS in patients with CKD without known cardiovascular disease. © 2020 Royal Australasian College of PhysiciansItem Exercise-induced acute renal failure with posterior reversible encephalopathy syndrome(ASEAN Neurological Association, 2020) Toraman A.; Kısabay A.; Eren B.G.; Batum M.; Kursat S.Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, mental changes, epileptic seizures, visual disturbances, and transient changes in the posterior circulation system of the brain. Rhabdomyolysis is a clinical condition characterized by muscle pain, weakness, dark-colored urine, and elevated creatine kinase levels. The common causes of rhabdomyolysis are trauma, excessive fatigue and intense exercise. A 23-year-old male soldier developed rhabdomyolysis-induced acute kidney injury after intense exercise and secondary PRES. The patient also had generalized convulsive seizures. There is no similar case of PRES from acute renal failure induced by muscle injury previously reported in the literature. © 2020, ASEAN Neurological Association. All rights reserved.