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Öğe The association of relative hydration status with nt-probnp, ivc index and blood pressure in newly diagnosed stage 5 chronic kidney disease(Acta Medica Mediterranea, 2013) Yilmaz Z.; Yildirim Y.; Zaydin F.Y.; Aydin E.; Kadiroglu A.K.; Yilmaz M.E.Introduction: Accurate and sensitive methods are very important for the assessment of volume status in chronic kidney disease (CKD). Bioelectrical impedance analysis (BIA) is a simple, non-invasive and promising method to assess volume status in patients with CKD. Objective: The aim of this study was to evaluate the association between BIA derived relative hydration status (RHS) and clinical findings and other markers of volume status in patients who were newly diagnosed with stage 5 CKD. Patients and method: Totally 85 patients who were newly diagnosed with stage 5 CKD and have not received any renal replacement therapy were enrolled in this study. Hydration status was assessed by multi-frequency BIA device (Body Composition Monitor, Fresenius). Relative hydration status was defined as the overhydration (OH) to extracellular water (ECW) ratio and clinical overhydration was considered as an overhydration-to-extracellular water ratio of 1>% 15. The patient population was divided into 2 groups; group 1: RHS >% 15, group 2: RHS ? %15. Inferior vena cava (IVC) diameter was measured by echocardiography and indexed for body surface area as IVC index (mm/m2). NT-proBNP was measured by immunoassay. Results: Among subjects, 57.6% of the patients had RHS >% 15. Systolic blood pressure (SBP), diastolic blood pressure (DBP), proteinuria, OH, ECW, IVC index, and NT-proBNP were significantly higher, while serum albumin and residual urine were significantly lower in group 1 than group 2 (p<0.05). There was a significant positive correlation between RHS and SBP, DBP, proteinuria, OH, ECW, NT-proBNP and IVC index and a negative correlation with albumin and residual urine (p<0.05). Conclusions: RHS may be an important measuring parameter of volume overload in patients with CKD. RHS is correlated with NT-proBNP, blood pressure and IVC index.Öğe Crescentic glomerulonephritis requiring hemodialysis and elevated MPO-ANCA level and vasculitis allergica cutis in a 21-year-old girl.(2002) Kara I.H.; Yilmaz M.E.; Sari Y.; Gür A.; Büyükbayram H.Microscopic polyangiitis (mPA) is a systemic necrotizing nongranulomatous vasculitis that affects small blood vessels. Clinical features include constitutional symptoms such as fever, anorexia, fatigue, and weight loss. Skin lesions include purpura and splinter hemorrhages, which occur in 50% of patients. Another characteristic feature is rapidly progressive glomerulonephritis, which often affects the kidneys in the early stages of the condition. Diagnosis is based on typical clinical features, biopsy, and presence of antineutrophil cytoplasmic antibodies (ANCA). This disorder tends to involve middle-aged and older persons, with a predilection for males; it is very rare in children. A 21-year-old female patient with mPA who did not respond well to treatment, required hemodialysis, developed vasculitis allergica cutis (VAC) later, and had a relatively short-term survival is reported herein.Öğe Evaluation of central venous catheter-related infections in uremic patients: Incidence, pathogens and patient characteristics(Turkiye Klinikleri, 2005) Yilmaz M.E.; Kadiro?lu A.K.; Kara I.H.; Işiko?lu B.Objective: To determine the incidence of central venous catheter (CVC)-related infections, types of pathogenic microorganisms encountered, as well as to annotate the characteristics of patients undergoing catheterization in the nephrology clinic. Material and Methods: CVCs were inserted in 106 consecutive patients hospitalized with uremia during the 2001 calendar year in the nephrology clinic at the hospital of the Medicine Faculty of Dicle University. The predisposing factors of each patient were recorded. The catheter lumen was washed with saline after every hemodialysis session and saline along with low-moleculer weight heparin (LMWH, enoxaparin, 2000U/ml) was injected into both catheter lumen. The catheter tip as well as a blood sample were cultured from patients suspected of catheter-related infection. Results: A total of 122 transient CVCs were inserted in the 106 patients. Infectious signs were established in 22 patients (20.7%). Staphylococcus aureus was isolated in the catheter tip culture of eleven, coagulase-negative staphylococci in seven, and two cases each manifesting Escherichia coli and Pseudomonas aeroginosa. Blood culture was positive in five patients (22.7%). The microorganisms isolated from blood cultures were Staphylococcus aureus in three patients, Staphylococcus epidermidis in one patient and Pseudomonas aeroginosa in another. Septicemia developed as a complication of CVC-related bacteriemia in one patient, who subsequently succumbed. The incidence of CVC-related bacteriemia was established as 4.7/1000 catheter days and the mortality rate was 9/1000. The characteristics of patients who had CVC-related bacteriemia were: age 60 years old and over, male gender, duration of indwelling catheter longer than 21 days, more than one instance of catheter use, anemia and urinary tract infections. Conclusion: The results of our study were similar to those seen in reference studies. Staphylococcus aureus and coagulase-negative staphylococcus were the most prevalent pathogens isolated in blood and catheter tip cultures. Copyright © 2005 by Türkiye Klinikleri.Öğe Evaluation of the antioxidant and renoprotective effects of ellagic acid on ischemia / reperfusion induced nephropathy in rats(Acta Medica Mediterranea, 2014) Yildirimi Y.; Aba Adıyaman, Özlem; Yilmaz Z.; Kadiroglu A.K.; Yilmaz M.E.; Gül M.; Ketani A.Aims: Renal ischemia-reperfusion (I/R) injury is one of the important cause of acute kidney injury (AKI). Reactive oxygen species and inflammatory cytokines play major role in the pathogenesis of IR injury. Ellagic acid (EA), a phenolic compound, have shown to exert antioxidants, anti-inflammatory, anticarcinogenic, antihyperlipidemic effects. We aim to evaluate, the effect of EA on renal I/R induced nephropathy in rats. Materials and methods: Twenty-eight male Sprague-Dawley rats were divided into four groups; control, control + EA, I/R, and EA+I/R. EA (85 mg/kg, perorally) was administered 30 min prior to the ischemia. Rats were unilaterally nephrectomized and subjected to 45 min of renal pedicle occlusion followed by 60 min of reperfusion. Both groups were subsequently studied by renal function tests, oxidant and antioxidant parameters, and kidney histology. Results: Serum/kidney TAC, NO and paraoxonase levels were significantly higher, while serum urea and creatinine, serum/kidney MDA and TOS were significantly lower in EA+I/R group compared to I/R group (p<0.05). Histopathologic examination revealed that the severity of damage was significantly lower in the EA+I/R group compared to the I/R alone group. Conclusion: Administration of EA appears to have beneficial effects on I/R induced renal injury by reducing oxidative stress, thus preventing histological injuries and bringing about an improvement in renal function.Öğe The evaluation of the prevalence of extrahepatic findings in chronic hepatitis-C virus infection(Turkiye Klinikleri, 2005) Kadiro?lu A.K.; Göral V.; Şit D.; Çelik M.; Yilmaz M.E.Objective: To evaluate the prevalence of clinical and biological extrahepatic findings in HCV infection. Material and Methods: Forty anti-HCV (+) patients and 40 HbsAg (+) patients were evaluated in the study. In the anti-HCV (+) group, 35 of 40 (87.5%) manifested chronic liver disease and 5 of 40 (12.5%) had liver cirrhosis. In the HbsAg (+) group, 33 of 40 (82.5%) were seen to have chronic liver disease and 7 of 40 (17.5%) liver cirrhosis. HCV and HBV infections were confirmed by ELISA and polymerase chain reaction (PCR). Biochemical, hematological and immunological tests were performed for both anti-HCV (+) and HbsAg (+) groups. They were as well evaluated for other clinical presentations, such as rheumatological, dermatological, neurological, and psychiatric symptoms. Results: In the anti-HCV (+) group, the mean age was 49.0 ± 15.7 years, the mean duration of disease was 38.1 ± 51.8 months. In the HbsAg (+) group, they were, respectively, 36.4 ± 13.2 years and 35.3 ± 42.1 months. Extrahepatic clinical presentations in the anti-HCV (+) group versus HbsAg (+) group were as follows: 25% arthralgia and 5% arthritis versus 5% arthralgia (p= 0.031); 10% paresthesia and 12.5% peripheral neuropathy versus 5% paresthesia (p= 0.041); 10% pruritus versus 5% pruritus (p= 0.045); 50% depression and 2.5% anxiety versus 7.5% depression (p= 0.000); 25% ANA (+), 2.5% ASMA (+) and 7.5% [ANA + ASMA + AMA] (+) versus only 5% ANA (+). A positive correlation was found between clinic status and age (r = 0.429, p= 0.006, r= 0.461, p= 0.003), between clinic status and duration of disease (r= 0.516, p= 0.001, r= 0.517, D= 0.001) and between serum albumin and hct levels (r= 0.561, p= 0.000, r= 0.649, p= 0.000) in the anti-HCV (+) and HbsAg (+) groups, respectively. The relative risk values of each of the extrahepatic findings were established in both groups. Conclusion: Extrahepatic findings such as rheumatological, neurological, psychiatric and dermatological clinical presentations, as well as autoantibody positivity, were more frequently observed in the anti-HCV (+) group. It was also observed that the prevalence of extrahepatic findings in this clinical setting was more increased in variable ratio in those with chronic HCV infection rather than in normal individuals. Copyright © 2005 by Türkiye Klinikleri.Öğe Evaluation of the rate of S aureus nasal carriage in nurses and dialysis patients in a dialysis center(2005) Yilmaz M.E.; Süner A.; Kara I.H.; Köko?lu Ö.F.Staphylococcus aureus carriage in hospital staff members are more responsible for epidemy of S aureus. Hemodialysis (HD) patients are tender to the infections due to chronic renal failure (CRF) and in this patients, eradication of S aureus nasal-carriage is important. In this study, in Hemodialysis Center of Dicle University, Faculty of Medicine, from 18 patients in HD program (16 female, two male) and from 16 nurses, cultures of nasal swab were taken to determine the nasal carriage of S. aureus on their nose. The strain of isolated microorganism was defined by Vitec Bio-Meriéux, and classic method. Antibiotic susceptibility was determined by the method of Vitec Bio-Meriéux, nasal carriage of S aureus was determined 8 of 18 HD patients and 6 of 16 nurses. A methicillin-resistant strain of S aureus (MRSA) isolated in 2 of 6 strain of S aureus isolated from hospital staff member, and 4 of 8 strain isolated from HD patients. When totally 14 strain isolated from HD patients and nurses were investigate to susceptibility, of these strains were found to susceptible to vancomisin and teicoplanine as 100%, respectively; however, the all strains were resistant to penicilline G and ampiciline.Öğe Hyaluronic acid as a new biomarker to differentiate acute kidney injury from chronic kidney disease(Iranian Society of Nephrology, 2017) Akin D.; Ozmen S.; Yilmaz M.E.Introduction. It may be difficult to differentiate acute kidney injury from chronic kidney disease in patients with no past medical reports of kidney function. This study aimed to investigate the role of serum hyaluronic acid (HA), which is known as a marker of fibrosis, in differential diagnosis of kidney failure. Materials and Methods. A total of 90 patients (52 women and 38 mne) admitted to our renal unit with uremia for the first time were included. Serum HA level was measured. The diagnostic role of the test was investigated using the receiver operator curve curves. Results. The mean age of the patients was 54.6 ± 17.9 years. The diagnosis was chronic kidney disease (CKD) in 41.1%, acute kidney injury (AKI) in 48.9%, AKI on CKD in 6.7% (3 died without a diagnosis). The mean serum HA was significantly higher in the CKD group (146.1 ± 119.3 ng/mL) than the AKI group (68.9 ± 69.1 ng/ mL; P <.001). Serum HA significantly correlated with proteinuria (r = 0.717, P <.001) and serum albumin level (r = - 0.599, P <.001) in the CKD group only. Serum HA cutoff level of 61 ng/dL had a sensitivity of 82% and specificity of 67% for differential diagnosis of AKI and CKD. Conclusions. Serum HA level may be used as tool to differentiate AKI from CKD. Further larger studies are warranted to clarify the definite the role of this marker. © 2017, Iranian Society of Nephrology. All rights reserved.Öğe A rare cause of anemia in a patient with end stage renal disease: Pulmonary hemorrhagic syndrome: Case report(Turkiye Klinikleri, 2007) Şit D.; Kadiroğlu A.K.; Kayabaşi H.; Büyükbayram H.; Yilmaz M.E.; Işikoğlu B.The association of pulmonary hemorrhagic syndrome and end stage renal disease is a rare condition. Severe anemia that occurred suddenly in a 27 years old male patient who was undergoing chronic HD program was investigated. Platelet count was normal but bleeding time was prolonged. Pulmonary hemorrhagic syndrome was considered secondary to platelet dysfunction. The diagnosis was confirmed by pulmonary biopsy. The patient was successfully treated with conservative approach. Copyright © 2007 by Türkiye Klinikleri.Öğe Relationship between fluid status as assessed by bioimpedance analysis and NT-pro BNP, blood pressure and left ventricular mass index in hemodialysis patients(Societa Editrice Universo, 2014) Yilmaz Z.; Yildirim Y.; Aydin F.Y.; Aydin E.; Kadiroglu A.K.; Yilmaz M.E.; Ulgen M.S.Aims: Maintenance of fluid status within an optimal range and accurate assessment of dry weight (DW) is essential in patients on intermittent haemodialysis (HD) treatment. In this study, we aimed to investigate the association of fluid status measured by bioimpedance analysis (BIA) with N-terminal pro-B natriuretic peptide (NT-proBNP), blood pressure and left ventricular mass index (LVMI) in hemodialysis patients. Materials and Methods: A total of 45 hemodialysis patients were enrolled in the study. N-terminal pro-B natriuretic peptide (NT-proBNP) was measured by immunoassay. Blood pressure (BP) was recorded. Echocardiographic examinations were performed in all patients. Multifrequency bioimpedance analysis was used to assess pre- and post-dialysis fluid status. Overhydration/ extracellular water (OH/ECW) ratio was used as fluid status index and OH/ECW ratio >0.15 was defined as clinical overhydration. Patients were divided into two groups; overhydrated (OH/ECW>0.15) and non-overhydrated (OH/ECW?0.15). Results: OH/ECW, systolic blood pressure (SBP), diastolic blood pressure (DBP), LVMI and NT-proBNP levels were significanly reduced after hemodialysis session. The presence of overhydration was more frequent in pre-HD patients compared to post-HD patients (31.1% vs 13.3%, p=0.004). OH/ECW was positively correlated with pre-and post-HD SBP, DBP, LVMI and NT-proBNP (p<0.05). Overhydrated patients had significantly higher values of pre-HD and post-HD SBP, DBP, LVMI and NT-proBNP compared to non-overhydrated patients. In addition, SBP, DBP, LVMI and NT-proBNP levels were significantly reduced after hemodialysis in both overhydrated and non- overhydrated patients group. Conclusions: This study revealed that OH/ECW ratio was significantly associated with SBP, DBP, LVMI and NT-proBNP. © Società Editrice Universo (SEU).Öğe Seroprevalence and risk factors of HCV in dialysis patients in a university hemodialysis center of southeast Anatolia, Turkey(2001) Yilmaz M.E.; Kara I.H.; Sari Y.; Düzen S.; Usul Y.; Işikog?lu B.Nowadays, the increased seroprevalence of hepatitis C virus (HCV) in hemodialysis (HD) patients is an important problem. The aim of this study was to investigate the seroprevalence and risk factors that lead to the spread of HCV in HD and continuous ambulatory peritoneal dialysis (CAPD) patients. Sixty-seven HD and 35 CAPD patients were enrolled in the study, 44 (43.1%) of whom were female and 58 (56.9%) of whom were male. Any risk factor for HCV infection was questioned. In our HD center, all precautions have been taken for the prevention of the spread of HCV. Rooms and dialysis machines used by HCV (+) patientsmean age, 41.6 ± 15.3 yr (range, 19-75 yr) are separated from the others. All HCV (+) cases except two had received blood transfusions, and all cases had at least one surgical intervention (central venous catheter and/or arteriovenous shunting operation). Eight (7.8%) of the cases had dental interventions, including conservative tooth treatment or tooth extractions. There was no relation between socioeconomic status or duration on dialysis with a higher prevalence of HCV in the dialysis patients (p > O.05). In general, anti-HCV seropositivity in our center was 41%, and these cases were generally asymptomatic except for elevated liver enzyme levels and slightly decreased albumin levels. All cases had at least one risk factor. The seroconversion rate/yr of our anti-HCV (-) patients was 0.148/patient-yr in HD patients and 0.002/patient-yr in CAPD patients. The seroconversion rate/yr and prevalence of HCV were higher in the HD patients than in the CAPD patients. It is necessary to take additional measures with regard to universal precautions for the prevention of the spread of HCV, including separation of dialysis machines, education of nurses, and the regular changing of gloves when moving from patient to patient.
