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Öğe Akut böbrek yetmezliği ile prezente olan lenfoma olgusu(2017) Yaprak, Mustafa; İlhan, Gül; Bay, Feyyaz; Gezici Güneş, Ümran; Turgut, FarukKanser hastalarında da akut böbrek yetmezliği (ABY), normal popülasyonda olduğu gibi prerenal, renal ve postrenal nedenlere bağlı olarak ortaya çıkmaktadır. Böbreğe tümör infiltrasyonu genellikle yaygın değildir. Fakat akut lösemi veya lenfoma gibi hızlı büyüyen hematolojik malignitelerde tümör tutulumuna bağlı böbrek fonksiyonları bozulabilmektedir. Burada akut böbrek yetmezliği ile başvuran ve daha sonra lenf nodu biyopsisi ile B hücreli Nonhodgkin lenfoma tanısı alan bir olgu sunulmuştur. Tümör infiltrasyonuna bağlı ABY gelişmesi nadir olmakla birlikte, akut böbrek yetmezliği gelişimi açısından risk faktörü bulunmayan olgularda lösemik veya lenfomatöz infiltrasyon düşünülmelidir.Öğe The association of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with clinical outcomes in geriatric patients with stage 3-5 chronic kidney disease(Taylor & Francis Ltd, 2016) Tatar, Erhan; Mirili, Cem; Isikyakar, Tolgay; Yaprak, Mustafa; Guvercin, Guray; Ozay, Emine; Asci, GulayObjective: The purpose of this study was to investigate the association of the neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with the clinical outcomes in geriatric patients with stage 3-5 chronic kidney disease (CKD).Material and Methods: A total of 165 patients over the age of 65, with stage 3-5 CKD, were enrolled in the study. The primary endpoints were all-cause of deaths and requirement of renal replacement therapy. The patients were divided into two groups according to delta neutrophil/lymphocyte ratio such as increased (group 1) and decreased or stable (group 2) groups.Results: The mean age was 73.86.1years and the mean follow-up was 30 +/- 13months. Thirty-one (18.7%) patients died during the follow-up period and 21 (13.4%) patients required renal replacement therapy. The neutrophil/lymphocyte ratio increased in 95 (57.5%) patients. The mortality rate (24.2%, 11.4%; p=0.03) and requirement of renal replacement therapy (19.1%, 5.7%; p=0.01) were higher in group 1 compared to group 2. In the Cox regression analysis, the basal neutrophil/lymphocyte ratio was the independent predictor of death (HR: 1.23 (95% CI 1.02-1.47), p=0.02), and the basal eGFR was the independent predictor of requirement of renal replacement therapy (HR:0.938, 95% CI: 0.888-0.991, p=0.02). However, platelet/lymphocyte ratio was not associated with death and requirement of renal replacement therapy independently.Conclusion: The neutrophil/lymphocyte ratio predicts all-cause of mortality in geriatric patients with chronic kidney disease.Öğe A case of lymphoma presented with acute renal failure(2017) Yaprak, Mustafa; İlhan, Gül; Bay, Feyyaz; Gezici, Ümran Güneş; Turgut, FarukKanser hastalarında da akut böbrek yetmezliği (ABY), normal popülasyonda olduğu gibi prerenal, renal ve postrenal nedenlere bağlı olarak ortaya çıkmaktadır. Böbreğe tümör infiltrasyonu genellikle yaygın değildir. Fakat akut lösemi veya lenfoma gibi hızlı büyüyen hematolojik malignitelerde tümör tutulumuna bağlı böbrek fonksiyonları bozulabilmektedir. Burada akut böbrek yetmezliği ile başvuran ve daha sonra lenf nodu biyopsisi ile B hücreli Nonhodgkin lenfoma tanısı alan bir olgu sunulmuştur. Tümör infiltrasyonuna bağlı ABY gelişmesi nadir olmakla birlikte, akut böbrek yetmezliği gelişimi açısından risk faktörü bulunmayan olgularda lösemik veya lenfomatöz infiltrasyon düşünülmelidir.Öğe A Case of Severe Hypernatremia and Rhabdomyolysis Treated by Hemodialysis without Sequelae(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2016) Yaprak, Mustafa; Turgut, Faruk; Sunger, Osman; Dayanan, Ramazan; Sikgenc, Mehmet Mahfuz; Akin, Selcuk; Degirmen, ElifHypernatremia is defined as plasma sodium concentration above 145 mEq/L. While severe symptoms are generally seen in case of plasma sodium concentration of 158 mEq/L, higher levels above 180 mEq/L are associated with a high mortality rate. Herein, a case of severe hypernatremia with a sodium level of 189 mEq/L and rhabdomyolysis treated by hemodialysis was presented. A 24-year-old woman was brought to the emergency department because of impaired general condition and confusion. She had a history of tuberculosis meningitis 1.5 years ago and left hemiplegia. Urea, creatinine, sodium, LDH and CK were 95 mg/dL, 2.6 mg/dL, 189 mEq/L, 1630 U/L, and 12601 U/L, respectively. The patient was diagnosed with hypernatremia, rhabdomyolysis and acute renal failure. Hemodialysis was performed because of anuria, increased urea and creatinine levels and metabolic acidosis. On the 5th day, the sodium level was reduced to 140 mEq/L. She was discharged from hospital uneventfully after the acute renal failure improved. In conclusion, both hypernatremia itself and its quick correction carry a risk of high mortality and morbidity. Therefore, in patients with chronic hypernatremia and need of dialysis, dialysate sodium should be lower than 10 mEq/L of serum sodium level, and if this is impossible, the duration of dialysis and blood flow rate should be reduced.Öğe Electrolyte Abnormalities in Patients with Type 2 Diabetes Mellitus(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2017) Ozsan, Muge; Yaprak, Mustafa; Ozcan, Oguzhan; Kiriktir, Esra; Turgut, FarukOBJECTIVE: The aim of the was is to evaluate electrolyte changes and the relationship between electrolytes and glucose regulation in type 2 diabetic patients. MATERIAL and METHODS: Data of diabetic patients aged 30-90 years who came to the Endocrinology and Metabolism and the Nephrology outpatient clinics between 01.02.2015 and 30.12.2015 for any reason were reviewed. Patients with type 1 diabetes mellitus, using diuretics, renin-angiotensin-aldosterone system blockers or combination of these drugs, or calcium, magnesium, vitamin D supplementation, patients with vomiting and diarrhea, serious heart failure, cirrhosis, active malignancy, estimated glomerular filtration rate <= 60 mL/min 1.73 m(2), and those diagnosed with diabetic ketoacidosis are excluded from the study. RESULTS: According to the inclusion and exclusion criteria, 323 type 2 diabetic patients consisting of 161 women and 162 men were evaluated. Hypomagnesemia was the major electrolyte problem in our study group with a prevalence of 20.2%. A negative correlation was observed between serum glucose and sodium (p<0.05; r=-0.28). There was no correlation between glucose and other electrolytes (potassium, calcium, phosphorus and magnesium). CONCLUSION: Electrolyte imbalances are frequently seen in diabetic patients because of physiopathologic changes and therapeutic drugs as well as comorbidities. Evaluation of electrolytes during the follow up period of these patients, and in the case of any electrolyte abnormalities their appropriate management is important for decreasing both mortality and morbidity.Öğe Hatay ilinde yüksek hemodiyaliz hasta sayısı ve olası nedenler(2016) Turgut, Faruk; Yaprak, Mustafa; Özsan, Müge; Güler, Gökhan; Bardakçı, MehmetHatay ilinde hemodiyaliz tedavisi alan hasta sayılarının ve altta yatan böbrek hastalığı nedenlerinin tüm Türkiye değerleri ile karşılaştırılması ve nedenlerinin tartışılması amaçlandı. GEREÇ ve YÖNTEMLER: Çalışmamızda, Hatay ilinde kronik hemodiyaliz programında olan hasta sayıları ve altta yatan böbrek hastalığı nedenleri hemodiyaliz merkezlerinden toplanarak kaydedildi. Türkiye geneli ve komşu illerde hemodiyaliz programında olan hasta verileri için; Sağlık Bakanlığı Türkiye Diyaliz Bilgi Yönetim Sistemi (DYOB) verileri ve Türk Nefroloji Derneği kayıt sistemi verileri kullanıldı. BULGULAR: Hatay'a komşu iller ile kıyaslandığında hemodiyalize giren hasta sayısının milyon nüfus başına oldukça yüksek olduğu gözlendi. 2014 yılı sonu itibari ile hemodiyaliz tedavisi almakta olan hasta sayısı 1.487 olup, milyon nüfus başına prevalans 978, insidans 156 olarak bulundu. Bölgemizde Türkiye geneli ile karşılaştırıldığında hem prevalans hem de insidans belirgin olarak daha yüksek saptandı. Hatay ilinde hemodiyaliz hastalarında son dönem böbrek hastalığının altta yatan etiyolojik nedenlerine bakıldığında diyabet %46,2 ile en sık, hipertansiyon %27,1 ile ikinci en sık neden olarak bulundu.SONUÇ: Çalışmamızda, SDBH prevalansı ve diyabete bağlı böbrek hastalığı ülkemiz geneli ile karşılaştırıldığında bölgemizde daha yüksek bulunmuştur ve diyabetin bölge için önemli bir sağlık sorunu olduğu ortaya konmuşturÖğe The High Number of Hemodialysis Patients in Hatay Province and Possible Causes(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2016) Turgut, Faruk; Yaprak, Mustafa; Ozsan, Muge; Guler, Gokhan; Bardakci, MehmetOBJECTIVE: We aimed to compare the number of the patients receiving hemodialysis therapy and the causes of underlying renal disease in Hatay and Turkey, and to discuss the possible causes. MATERIAL and METHODS: The number of the patients on chronic hemodialysis, and the causes of underlying renal disease were recorded from hemodialysis centers in Hatay. The Ministry of Health of Turkey Dialysis Information Management System data and Turkish Society of Nephrology Registry data were used to obtain data of the patients on chronic hemodialysis in Turkey in general and in the neighboring provinces. RESULTS: It was observed that the number of hemodialysis patients per million population was quite high compared to the neighboring provinces. By the year 2014, the number of patients receiving hemodialysis was 1.487 with a prevalence of 978 and an incidence of 156 per million population. Both the prevalence and incidence were quite high in our region compared with the general numbers for Turkey. When we looked at the causes of underlying renal disease in hemodialysis patients in Hatay province, the most common cause was diabetes at 46.2% and hypertension was the second most common cause at 27.1%. CONCLUSION: The prevalence of end-stage renal disease and diabetic kidney disease was found to be quite high compared to the general numbers for Turkey and the results showed that diabetes is an important health problem for the region.Öğe Higher Serum Bisphenol A Levels in Diabetic Hemodialysis Patients(Karger, 2016) Turgut, Faruk; Sungur, Sana; Okur, Ramazan; Yaprak, Mustafa; Ozsan, Muge; Ustun, Ihsan; Gokce, CumaliBackground: Bisphenol A (BPA) has been implicated as an 'endocrine disruptor'. We aimed at exploring the association between serum BPA levels and patient characteristics, particularly the presence of diabetes mellitus, and laboratory parameters in hemodialysis patients. Methods: This study included 47 chronic hemodialysis patients. Patient characteristics were recorded. Blood was drawn before and after hemodialysis session. Serum BPA levels were measured by the high-performance-liquid-chromatography and laboratory parameters were measured by using standard methods. Results: In hemodialysis patients, postdialysis serum BPA levels were significantly higher than predialysis after a single hemodialysis session (5.57 +/- 1.2 vs. 4.06 +/- 0.73, p < 0.0001). Predialysis serum BPA levels were significantly higher in patients with diabetes than non-diabetics (4.4 +/- 0.6 vs. 3.9 +/- 0.7, p = 0.025). No association was found between serum BPA levels and patient characteristics, and particularly laboratory parameters. Conclusion: Serum BPA levels were rising significantly after a single dialysis session. Diabetic hemodialysis patients had higher predialysis serum BPA levels. (C) 2016 S. Karger AG, BaselÖğe Pathophysiological insights of hypertension in patients with chronic kidney disease(Springer International Publishing, 2017) Turgut, Faruk; Yaprak, Mustafa; Tokmak, Faruk[No abstract available]Öğe Platelet-to-lymphocyte ratio predicts mortality better than neutrophil-to-lymphocyte ratio in hemodialysis patients(Springer, 2016) Yaprak, Mustafa; Turan, Mehmet Nuri; Dayanan, Ramazan; Akin, Selcuk; Degirmen, Elif; Yildirim, Mustafa; Turgut, FarukPurpose Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were established showing the poor prognosis in some diseases, such as cardiovascular diseases and malignancies. The risk of mortality in patients with end-stage renal disease (ESRD) was higher than normal population. In this study, we aimed to investigate the relationship between NLR, PLR, and all-cause mortality in prevalent hemodialysis (HD) patients. Methods Eighty patients were enrolled in study. NLR and PLR obtained by dividing absolute neutrophil to absolute lymphocyte count and absolute platelet count to absolute lymphocyte count, respectively. The patients were followed prospectively for 24 months. The primary end point was all-cause mortality. Results Mean levels of neutrophil, lymphocyte, and platelet were 3904 +/- 1543/mm(3), 1442 +/- 494/mm(3), 174 +/- 56 x 10(3)/mm(3), respectively. Twenty-one patients died before the follow-up at 24 months. Median NLR and PLR were 2.52 and 130.4, respectively. All-cause mortality was higher in patients with high NLR group compared to the patients with low NLR group (18.8 vs. 7.5 %, p = 0.031) and in patients with higher PLR group compared to patients with lower PLR group (18.8 vs. 7.5 %, p = 0.022). Following adjusted Cox regression analysis, the association of mortality and high NLR was lost (p = 0.54), but the significance of the association of high PLR and mortality increased (p = 0.013). Conclusion Although both NLR and PLR were associated with all-cause mortality in prevalent HD patients, only PLR could independently predict all-cause mortality in these populations.Öğe Role of ultrasonographic chronic kidney disease score in the assessment of chronic kidney disease(Springer, 2017) Yaprak, Mustafa; Cakir, Ozgur; Turan, Mehmet Nuri; Dayanan, Ramazan; Akin, Selcuk; Degirmen, Elif; Yildirim, MustafaUltrasonography (US) is an inexpensive, noninvasive and easy imaging procedure to comment on the kidney disease. Data are limited about the relation between estimated glomerular filtration rate (e-GFR) and all 3 renal US parameters, including kidney length, parenchymal thickness and parenchymal echogenicity, in chronic kidney disease (CKD). In this study, we aimed to investigate the association between e-GFR and ultrasonographic CKD score calculated via these ultrasonographic parameters. One hundred and twenty patients with stage 1-5 CKD were enrolled in this study. The glomerular filtration rate was estimated by the Chronic Kidney Disease Epidemiology Collaboration equation. US was performed by the same radiologist who was blinded to patients' histories and laboratory results. US parameters including kidney length, parenchymal thickness and parenchymal echogenicity were obtained from both kidneys. All 3 parameters were scored for each kidney, separately. The sum of the average scores of these parameters was used to calculate ultrasonographic CKD score. The mean age of patients was 63.34 +/- 14.19 years. Mean kidney length, parenchymal thickness, ultrasonographic CKD score and median parenchymal echogenicity were found as 96.2 +/- 12.3, 10.97 +/- 2.59 mm, 6.28 +/- 2.52 and 1.0 (0-3.5), respectively. e-GFR was positively correlated with kidney length (r = 0.343, p < 0.001), parenchymal thickness (r = 0.37, p < 0.001) and negatively correlated with CKD score (r = -0.587, p < 0.001) and parenchymal echogenicity (r = -0.683, p < 0.001). Receiver operating characteristic curve analysis for distinction of e-GFR lower than 60 mL/min showed that the ultrasonographic CKD score higher than 4.75 was the best parameter with the sensitivity of 81% and positive predictivity of 92% (AUC, 0.829; 95% CI, 0.74-0.92; p < 0.001). We found correlation between e-GFR and ultrasonographic CKD score via using all ultrasonographic parameters. Also, our study showed that ultrasonographic CKD score can be useful for distinction of CKD stage 3-5 from stage 1 and 2. We suggested that the ultrasonographic CKD score provided more objective data in the assessment of CKD.Öğe Tip 2 diyabetli hastalarda elektrolit bozuklukları(2017) Özsan, Müge; Yaprak, Mustafa; Özcan, Oğuzhan; Kiriktir, Esra; Turgut, FarukAMAÇ: Tip 2 diyabetli hastalardaki elektrolit değişikliklerini ve bunların glisemi regülasyonu ile ilişkisini değerlendirmektir. GEREÇ ve YÖNTEMLER: Çalışmada, 01.02.2015-30.12.2015 tarihleri arasında hastanemiz Endokrinoloji ve Metabolizma polikliniği ve Nefroloji polikliniklerine değişik nedenlerle başvuran 30- 90 yaş arası diyabet tanısı olan hastaların kayıtları değerlendirildi. Tip 1 Diabetes Mellitus, diüretik, renin anjiotensin aldosteron sistemi blokeri veya bunların kombinasyonunu alanlar, diyare ve kusması olanlar, ciddi kalp yetmezliği, karaciğer sirozu, aktif malignitesi olanlar, tahmini glomerüler filtrasyon hızı <= 60 mL/dk 1.73 m2 olanlar, kalsiyum, magnezyum, D vitamini replasmanı alanlar ve aktif diyabetik ketoasidoz tanısı olanlar değerlendirme dışında bırakıldı. BULGULAR: Çalışmaya alınma ve dışlama kriterleri sonucunda 161' i kadın, 162'si erkek olmak üzere toplam 323 tip 2 diyabetik hasta alındı. Çalışma grubunda en sık gözlenen elektrolit bozukluğu hipomagnezemi idi (%20,2). Serum glukoz düzeyleri ve serum sodyum düzeyleri arasında negatif korelasyon saptandı (p<0,05; r=-0,28). Glukoz ile diğer elektrolitler (potasyum, kalsiyum, fosfor ve magnezyum) arasında herhangi bir korelasyon tespit edilmedi. SONUÇ: Tip 2 diyabet gerek hastalığın fizyopatolojisi gerekse kullanılan ilaçlar ve komorbit durumlar nedeniyle elektrolit bozukluklarının sık görüldüğü bir durumdur. Bu hastaların takibinde elektrolitlerin değerlendirilmesi ve herhangi bir bozukluk tespit edildiğinde bu durumu düzeltmeye yönelik önlemler alınması mortalite ve morbiditenin azaltılması açısından önemlidir.
