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Öğe The effect of mycophenolate mofetil on primary and secondary treatment of primary glomerulonephritis and lupus nephritis(Springer, 2009) Paydas, Saime; Kurt, Cemal; Taskapan, Hulya; Balal, Mustafa; Sertdemir, Yasar; Pembegul, IremMycophenolate mofetil (MMF) has shown to be a reliable choice in the treatment of glomerulonephritis. We retrospectively reviewed the clinical course and response to MMF therapy in 49 patients with primary glomerulopathy (37 patients) and lupus nephritis [class III (five patients) and IV (seven patients)]. Patients were treated with MMF for more than 6 months as a primary (18 patients) or an adjunctive treatment (31 patients). Patients were also on methylprednisolone (2-20 mg/day) and angiotensin converting enzyme inhibitor/angiotensin receptor blocker. The mean age of the patient cohort was 33.69 +/- A 12.4 years (range 19-59 years). Twenty-four-hour urinary protein excretion was reduced from 3.50 +/- A 3.08 g prior to the commencement of MMF drug therapy to 1.21 +/- A 1.44 and 0.99 +/- A 1.34 g at the sixth and 12th months of MMF therapy, respectively (P < 0.05 for all). During this same period, significant increases in serum total protein (from 5.92 +/- A 1.38 to 6.59 +/- A 0.79 and 6.81 +/- A 0.77 g/dl) and albumin levels (from 3.23 +/- A 1.10 to 3.93 +/- A 0.67 and 4.21 +/- A 0.50 g/dl) were detected, whereas total cholesterol and low-density lipoprotein levels were found to be significantly decreased (P < 0.05 for all). Serum creatinine levels did not significantly change. The efficacy of MMF in reducing proteinuria was similar in both first line and an adjunctive therapy. The efficacy of MMF therapy began at the third month of treatment and continued through to the 12th month. Mycophenolate mofetil therapy was found to be useful in achieving improvements in proteinuria and nephrotic syndrome and stabilizing renal function. It was also a well-tolerated drug by the majority of the patients. Based on our results, we suggest that MMF may be alternative therapy for resistant/relapsing primary glomerulopathies and lupus nephritis.Öğe Geriatric Nutrition Risk and Creatinine Indexes in Estimating the Nourishment Situation of Elderly Hemodialysis Patients(Mattioli 1885, 2022) Yakaryilmaz, Funda Datli; Pembegul, Irem; Kara, MuratObjective: Malnutrition is a common complication in hemodialysis (HD) patients, although it cannot be evaluated adequately due to the limitations of available malnutrition screening tools. The aim of our study is to evaluate the relationship between Mini nutritional Assesment-Short Form (MNA-SF) and objective malnutrition tool Geriatric Nutritional Risk Index (GNRI) and Creatinine Index (CI) in HD patients. Methods: This is a cross-sectional study of 129 patients aged 65 years and older (female=61 (47.3%) and male=68 (52.7%), 68.88 ?? 7.24 years) receiving maintenance HD therapy. Malnutrition was diagnosed with MNA-SF. GNRI and CI were calculated using existing formulas. Results: Of the participants, 26 (20.15%) were diagnosed with severe malnutrition, 25 patients (19.4%) were at risk of malnutrition and 78 (60.45%) were diagnosed with normal nutritional status. The optimal cut-off value for GNRI <95 was determined in predicting malnutrition with GNRI, sensitivity and specificity 85.4% and 88.6%, respectively. CI (< 20) was not found effective in determining malnutrition patients due to its low sensitivity and specificity (sensitivity and specificity of 35.9% and 45.0%, respectively). GNRI (<95) is a better predictor of malnutrition screening than CI (<20). Conclusions: In the evaluation of undernourished elderly HD patients, GNRI was as effective as MNA-SF, but CI was insufficient in detecting malnutrition individuals.Öğe Lercanidipine-induced Chyloperitoneum in a Geriatric Patient with Peritoneal Dialysis(Galenos Publ House, 2023) Pembegul, Irem; Yakaryilmaz, Funda Datli; Balseven, OzgulPeritoneal dialysis is one of the renal replacement therapy modality for patients with end-stage renal disease. Hypertension is a common comorbidity in these patients and calcium channel blockers are the most commonly prescribed drugs. Chyloperitoneum is a non-infectious cause of cloudy peritoneal effluent. Lercanidipine is a lipophilic, third generation calcium channel blocker and a widely used antihypertensive agent. Herein, we presented a case of geriatric peritoneal dialysis patient admitted to hospital cloudy effluent after the use of lercanidipine for hypertension. The peritoneal effluent returned to normal after after the cessation of lercanidipine.Öğe Mediastinal Tuberculosis Lymphadenitis Complicated with Pulmonary Tuberculosis(Bilimsel Tip Publishing House, 2007) Yetkin, Ozkan; Pembegul, Irem; Mutlu, Levent Cem; Yildirim, ZekiTuberculosis is a growing health problem especially in developing countries. Tuberculosis lymphadenitis is the most frequent occurrence of extrapulmonary tuberculosis. In our case, there was widening of upper mediastinum on chest x-ray and thoracic CT scans demonstrated multilocular abscess on the upper mediastinum which was laying to paratracheal site. Acit-fast bacilli was positive on pus obtained by USG guided fine needle aspiration. Antituberculosis treatment was given. Homogenius infiltration were determined in chest X-ray on the left upper zone 7th day of treatment and fever increased. Although extended spectrum antibiotics treatment were given fever continued and no regression on chest X-ray. Acit-fast bacilli was positive on sputum analysis. We though that mediatinal abcess fistulised to lung parenchima because initial sputum acit-fast bacilli was negative and patient described sputum with pus. Antituberculosis treatment was continued and acit-fast bacilli became negative on sputum.Öğe Post-COVID-19 outcomes of non-dialysis dependent chronic kidney disease patients: a national, multicenter, controlled study(Springer, 2023) Karadag, Serhat; Ozturk, Savas; Arici, Mustafa; Gorgulu, Numan; Akcali, Esra; Pembegul, Irem; Taymez, Dilek GuvenPurpose Coronavirus disease 2019 (COVID-19) has a higher mortality in the presence of chronic kidney disease (CKD). However, there has not been much research in the literature concerning the outcomes of CKD patients in the post-COVID-19 period. We aimed to investigate the outcomes of CKD patients not receiving renal replacement therapy. Methods In this multicenter observational study, we included CKD patients with a GFR < 60 ml/min/1.73 m(2) who survived after confirmed COVID-19. Patients with CKD whose kidney disease was due to diabetic nephropathy, polycystic kidney disease and glomerulonephritis were not included in this study. CKD patients with similar characteristics, who did not have COVID-19 were included as the control group. Results There were 173 patients in the COVID-19 group and 207 patients in the control group. Most patients (72.8%) were treated as inpatient in the COVID-19 group (intensive care unit hospitalization: 16.7%, acute kidney injury: 54.8%, needing dialysis: 7.9%). While there was no significant difference between the baseline creatinine values of the COVID-19 group and the control group (1.86 and 1.9, p = 0.978, respectively), on the 1st month, creatinine values were significantly higher in the COVID-19 group (2.09 and 1.8, respectively, p = 0.028). Respiratory system symptoms were more common in COVID-19 patients compared to the control group in the 1st month and 3rd month follow-ups (p < 0.001). Mortality at 3 months after the diagnosis of COVID-19 was significantly higher in the COVID-19 group than in the control group (respectively; 5.2% and 1.4%, p:0.037). Similarly, the rate of patients requiring dialysis for COVID-19 was significantly higher than the control group (respectively; 8.1% and 3.4%, p: 0.045). Conclusions In CKD patients, COVID-19 was associated with increased mortality, as well as more deterioration in kidney function and higher need for dialysis in the post-COVID-19 period. These patients also had higher rate of ongoing respiratory symptoms after COVID-19.Öğe Relationship between symptom burden and dialysis adequacy in patients with chronic kidney disease undergoing hemodialysis(Kare Publ, 2023) Karaaslan, Tahsin; Pembegul, IremOBJECTIVE: The aim of this study was to reveal the relationship between hemodialysis (HD) adequacy and dialysis symptom index (DSI) in patients with end-stage kidney disease (ESKD).METHODS: This prospective study included 92 ESKD patients who underwent HD three times a week. Data including sex, age, education status, marital status, economic status, employment status, dependency status, type of vascular access, and duration of HD were recorded. Biochemical and hematological analyses were carried out. Dialysis adequacy was assessed based on clinical and biochemical analysis. The DSI was used to evaluate the emotional and physical symptoms of HD patients.RESULTS: Of the patients, 55 were males and 37 were females, with a mean age of 59.95 +/- 14.9 years. The median duration of HD was 60.0 months (interquartile range: 20.8-103.5). The mean DSI score was 54.35 +/- 26.0, with a significantly higher score in female patients (p<0.001). There was a significant correlation between DSI and increasing age (p<0.05). The single pool Kt/V (spKt/V) ratio of HD patients with AVF access was significantly higher, and the mean DSI was significantly lower than that of those receiving HD with a central venous catheter (p<0.001). The mean DSI score was significantly higher in patients with a spKt/V ratio of <1.2 than those with a spKt/V ratio of >= 1.2 (p<0.001). In multivariate regression analysis using biochemical parameters, the spKt/V ratio was a significant and independent predictor of DSI scores (R-2=0.64, p<0.001). In addition, a significant and independent relationship was found between DSI and gender, age, and economic status in the regression analysis (R-2=0.36, p<0.001).CONCLUSION: Dialysis adequacy is an independent predictor of DSI. If an adequate dialysis dose is ensured to be delivered, symptom burden may dramatically decrease.