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Öğe An Adolescent Girl with the Recurrent Attacks of Different Type of Thromboses(Galenos Publ House, 2023) Selcuk, Senay Zirhli; Öncül, Yurday; Durmus, Hanim; Sozeri, Betul; Tabel, YilmazIntroduction: Thrombosis is less common in childhood compared to adults and is usually acquired. Here, we present a patient who had recurrent thrombosis in different organs and was diagnosed with lupus secondary antiphospholipid syndrome (APS) when the lupus anticoagulant test was positive in the follow-up, which we treated quickly and effectively considering possible catastrophic prognosis due to kidney involvement in the same week. Case Report: Fifteen-year-old girl who presented to the emergency department with complaints of sensitivity, pain, and swelling in her left leg. Her medical history revealed recurrent thrombosis attacks and development of mental retardation after a seizure at around the age of three, and no underlying disease had been identified to date. Her family history revealed that her aunt had complained of hand swelling after cold exposure. No significant finding was detected in her thrombophilia panel. A thrombophilia panel was conducted, but no significant findings were detected. Due to a positive lupus anticoagulant test, the patient was diagnosed with APS. The diagnosis of systemic lupus erythematosus was also considered secondary to APS after positive results for anti-nuclear antibody (ANA) and dsDNA tests. Due to the recurrent thrombosis attacks and kidney involvement, a possible catastrophic outcome was considered. In addition to the on going heparin, warfarin, and aspirin therapy, high-dose steroids, cyclophosphamide, intravenous immunoglobulin, and 5 sessions of plasmapheresis were administered, and all treatments were met with a positive response. Conclusion: In this case presentation, we wanted to emphasize that despite the difficulties in the differential diagnosis of thrombosis in children and especially the diagnosis of catastrophic antiphospholipid syndrome (CAPS), prompt and effective treatment can be life-saving.Öğe Clinicopathological Analysis of Our Ten-Year Pediatric Percutaneous Kidney Biopsies(Galenos Publ House, 2022) Selcuk, Senay Zirhli; Elmas, Ahmet Taner; Akpolat, Nusret; Tabel, YilmazIntroduction: Our aim in this study is to evaluate the data of native and transplant kidney biopsies in our tertiary pediatric nephrology center in terms of demographics and clinico-pathology, to determine biopsy indications and to evaluate the compatibility of indication and histopathological diagnosis. Materials and Methods: In our study, the files and biopsy results (a total of 134 biopsy results) of 126 pediatric patients aged 1-17 years who were followed up in our Pediatric Nephrology clinic and underwent percutaneous kidney biopsy between 2011 and 2021 were evaluated retrospectively. All patients' age, gender, biopsy adequacy, compliance with the indication and histopathological diagnosis, and follow-up status were recorded. Results: Of 126 patients who underwent kidney biopsy, 62 (49.2%) were male; 64 (50.8%) were girls; mean age was 9.5 +/- 4.1 years. The most common biopsy indication was nephrotic syndrome (32.5%). Immunoglobulin A nephropathy (IgAN) was the most common histopathological diagnosis (23%). The concordance between clinical preliminary diagnosis and histopathological diagnosis was as high as 82.6%. Conclusion: The high rate of compatibility between the histopathological diagnosis and our preliminary diagnoses should not question the necessity of pathological evaluation, and even all kinds of examinations should be used to reach the most accurate diagnosis with the contribution of genetic studies.Öğe Crush Syndrome of Children in Kahramanmaraş Earthquake: A Single Center Experience in Malatya(Aves, 2024) Selcuk, Senay Zirhli; Elmas, Ahmet Taner; Tabel, YilmazObjective: Natural disasters cause enormous environmental, economic, and human losses. Children are the most vulnerable group and face severe consequences. While the primary cause of post -traumatic death is direct injury, the secondary cause is crush syndrome (CS). In this study, we aimed to share our experience in the management of children with CS during disasters by evaluating the clinical and laboratory outcomes of a group of 26 paediatric patients. Materials and Methods: Age, weight, length of time under rubble, laboratory results, and characteristics of crush injuries were assessed in 26 paediatric patients admitted to the emergency department after the earthquake. Diagnostic criteria for CS were established and the need for dialysis, hyperbaric oxygen or amputation and its determinants were assessed. Results: Crush syndrome was observed in 10 of the 26 patients. Significant differences in creatinine, aspartate aminotransferase, alanine aminotransferase, creatine kinase, hematocrit, pH, HCO3, and myoglobin levels were observed between patients with and without CS. None of the individuals rescued from the rubble within the first 6 hours had symptoms associated with CS. These 10 patients who developed CS were rescued within the first 48 hours of the earthquake, while 2 siblings were rescued after 81 hours and did not develop CS. Conclusion: The fact that the children were rescued from the rubble after 81 hours without developing CS shows the importance of patience in rescue operations. In addition, the very cold weather conditions during this earthquake may have prevented the development of dehydration and acute kidney injury and reduced the possibility of CS.Öğe Fifteen Years of Experience in Ambulatory Blood Pressure Monitoring in Children at a Single Center(Erciyes Univ Sch Medicine, 2023) Sapcioglu, Mustafa; Selcuk, Senay Zirhli; Elmas, Ahmet Taner; Tabel, YilmazObjective: This study was conducted at a tertiary medical center in a region where similar studies had not been previously conducted. It aimed to analyze 15 years of data obtained from the ambulatory blood pressure monitoring (ABPM) program and to address the challenges associated with diagnosing hypertension (HT).Materials and Methods: This study included 1,859 children aged 5-18 years who were admitted between 2005 and 2020 and diagnosed with HT according to clinical measurements. All necessary demographic and clinical data were collected retrospectively. Measurements were performed using the Mobil-O-Graph device. Results: A total of 1,859 cases, comprising 1,098 (59.1%) boys and 761 (40.9%) girls, were included in the study. Of these cases, 327 (17.6%) were obese, and 1,532 (82.4%) were of normal weight. According to ABPM data, 30.7% of all cases were normotensive. Additionally, the rate of HT in obese subjects (79.2%) was significantly higher than in non-obese subjects (67.2%). Logistic regression analysis of the study showed that older age, obesity, and being in the diastolic non-dipper group were associated with a higher risk of invalid measurement.Conclusion: This study emphasizes the high prevalence of white coat HT in children in our region, despite the difficulties related to measurement adequacy, and thus highlights the importance of using ABPM in the diagnosis and follow-up of hypertension.Öğe Hypertension in Children with Unilateral Multicystic Dysplastic Kidney: A Common but Rarely Diagnosed Condition(Aves, 2022) Elmas, Ahmet Taner; Selcuk, Senay Zirhli; Tabel, YilmazObjective: In this study, we aimed to determine the frequency of hypertension by performing 24 hours ambulatory blood pressure monitoring in children with unilateral multi-cystic disease of kidney without ipsilateral and/or contralateral kidney and/or urinary system anomalies. Methods: This study enrolled 24 patients with unilateral multi-cystic disease of kidney and age- and height-matched 20 healthy children. Blood pressure was measured by 2 approaches as follows: manual blood pressure and ambulatory blood pressure monitoring. Day-time, night-time, and 24 hours heart rate, pulse pressure, systolic and diastolic blood pressure, median arterial pressure, and systolic and diastolic blood pressure loads (%) were compared. Results: Ambulatory blood pressure monitoring measurements showed the presence of masked hypertension in 12 patients (45.8%), although 2 (8.3%) unilateral multi-cystic disease of kidney patients were hypertensive with manual blood pressure measurements. We detected that systolic blood pressure loads (%) (day-time, night-time, and 24 hours) and disatolic blood pressure loads (%) (night-time and 24 hours) were considerably higher than those of healthy children (P =.030, P =.012, P =.005, P =.012 and P =.005, respectively). Conclusion: Children with unilateral multi-cystic disease of kidney are more likely to have masked hypertension. Manual blood pressure measurements are not accurate in ruling out hypertension in children with unilateral multi-cystic disease of kidney. Ambulatory blood pressure monitoring contributes to more susceptible outcomes in proportion to manual blood pressure measurement in these patients, and it should be considered in clinical practice instead of manual blood pressure measurements.Öğe A hypertensive girl with failure to thrive accompanied by gastrointestinal symptoms: Answers(Springer, 2021) Selcuk, Senay Zirhli; Elmas, Ahmet Taner; Yildirim, Ismail Okan; Sigirci, Ahmet; Sozeri, Betul; Tabel, Yilmaz[Abstract Not Available]Öğe A hypertensive girl with failure to thrive accompanied by gastrointestinal symptoms: Questions(Springer, 2021) Selcuk, Senay Zirhli; Elmas, Ahmet Taner; Yildirim, Ismail Okan; Sigirci, Ahmet; Sozeri, Betul; Tabel, Yilmaz[Abstract Not Available]
