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Öğe 25 (OH) Vitamin D in Patients with Chronic Kidney Disease and Dialysis Patients(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2012) Ulutas, Ozkan; Taskapan, HulyaIn addition to its role on calcium homeostasis, vitamin D exhibits local (paracrine) effects on cell proliferation differentiation and immune function. Most cells in the body express Vitamin D receptors and 1 alpha-hydroxylase, thereby permitting local production of 1,25 dihydroxycholecalciferol, which has therapeutic implications (paracrine effects). Studies have shown that chronic vitamin D deficiency may have serious adverse consequences such as increased risk of hypertension, multiple sclerosis, rheumatoid arthritis, cancer of the colon, prostate, breast, ovary, and type 1 diabetes. However, information about the effect of vitamin D supplementation and replacement, and cardiometabolic outcomes is very limited. Studies on Vitamin D replacement in patients with chronic kidney disease and dialysis patients are needed.Öğe Arm circumference: its importance for dialysis patients in the obesity era(Springer, 2013) Akpolat, Tekin; Kaya, Coskun; Utas, Cengiz; Arinsoy, Turgay; Taskapan, Hulya; Erdem, Emre; Yilmaz, M. EminThe purposes of this study were to investigate the association between arm circumference and body mass index (BMI) and to discuss problems, mainly arm circumference and cuff size mismatch, that could affect the reliability of home blood pressure monitoring (HBPM) among peritoneal dialysis (PD) and hemodialysis (HD) patients. 525 PD and 502 HD patients from 16 centers were included in the study. A two-part questionnaire was used to gather information from the participants. Arm circumferences were categorized into four groups according to the British Hypertension Society cuff size recommendations. Mean BMI and arm circumference of all participants were 25.0 kg/m(2) and 27.6 cm, respectively. There was a significant correlation between BMI and arm circumference. The mean BMI and arm circumference values were higher in PD patients than in HD patients. Requirement of a large-sized adult cuff was more common among PD patients compared to HD patients (14 % vs 8 %, p = 0.002). Since HBPM is a useful tool for clinicians to improve BP control, nephrologists should be aware of the problems related to HBPM in dialysis patients and take an active role to increase the reliability of HBPM.Öğe BK virus-induced acute motor-axonal polyneuropathy in a renal transplant patient(Springer Japan Kk, 2016) Taskapan, Hulya; Kayabas, Uner; Otlu, Baris; Kamisli, Ozden; Yaprak, Cisel Yilmaz; Sahin, Fatma TerziogluNeurological complications are not uncommon in patients with renal transplantation, mostly affecting the central nervous system, and less frequently the peripheral nerves. BK virus infection is relatively common in transplant recipients and in some cases may lead to neurological complications. In this report, we present an interesting case of a patient who developed acute axonal motor polyneuropathy in the course of BK virus infection 3 months after kidney transplantation. After BK virus clearence in blood, a significant improvement was noted in her polyneuropathy. In patients with acute axonal motor polyneuropathy after transplantation BK virus-induced polyneuropathy should be excluded.Öğe Contrast Media Nephrotoxicity(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2006) Serbest, Selda Tekes; Taskapan, Hulya[Abstract Not Available]Öğe Correlation between vitamin D status and Wechsler Adult Intelligence Scale's comprehension subtest in patient with end-stage renal diseases(Wiley-Blackwell, 2016) Karaoglan, Mehmet; Emre, Memet Hanifi; Demirtas, Yasemin; Sahin, Idris; Taskapan, Hulya[Abstract Not Available]Öğe Diabetic muscle infraction: An unusual cause of muscle pain in a diabetic patient on hemodialysis(Springer, 2005) Sahin, Ibrahim; Taskapan, Cagatay; Taskapan, Hulya; Baysal, Tamer; Bentli, Recep; Tekes, Selda; Kosar, FeridunDiabetic muscle infarction (DMI) is a rare, painful and potentially serious complication in patients with poorly controlled diabetes mellitus and frequently misdiagnosed clinically as abscess, neoplasm, or myositis. A 36-year-old diabetic woman referred to our clinic with severe pain in the left anteromedial thigh. She had a 15-year history of Type 2 diabetes mellitus (DM). She was complicated by diabetic nephropathy and requiring hemodialysis. She had first noticed pain and swelling in her left thigh after a minimal trauma for 2 days prior to presentation. Clinical and laboratory evaluation, and muscle biopsy revealed the diagnosis of muscle infarctions. She did no respond to the conservative therapy. Pain and swelling in her thigh worsened progressively. She underwent surgical debridment and then, her clinical status improved. We describe the characteristic clinical and pathologic findings and the course of the illness with emphasis on the importance of recognition of the syndrome so that unnecessary investigation and overzealous therapy can be avoided.Öğe Diabetic nephropathy: diagnosis, prevention and treatment(İnönü Üniversitesi, Tıp Fakültesi, Nefroloji Anabilim Dalı, Malatya, Türkiye, 2016) Yigit, Irem Pembegul; Taskapan, HulyaÖz: Diyabetik nefropati (DN) hem tip 1 hem tip 2 Diabetes Mellitus (DM)'da görülen mikrovasküler bir komplikasyon olup sıklığı tüm dünyada artmaktadır. Patogenezinde hemodinamik, metabolik ve genetik faktörler sorumlu tutulmaktadır. İlk bulgusu mikroalbuminüri (30-300 mg/gün veya 20-200 µ/dk). Mikroalbuminüri için tarama Tip 1 DM'de tanıdan 5 yıl sonra, tip 2 DM de tanı konduğunda yılda bir kere yapılmalıdır. DN oluşumunda ve ilerlemesinde hiperglisemi, hipertansiyon, sigara içme, yüksek proteinli diyet, hiperlipidemi, cinsiyet, ırk, obezite ve genetik yatkınlık bağımsız risk faktörleridir. İyi glisemik kontrol (HbA1c < 7%), hipertansiyonun tedavisi (< 130/80 mmHG veya proteinüri > 1 gr/gün ise < 125/75 mmHg), hiperlipidemi tedavisi (LDL < 100 mg/dl) ve düşük proteinli diyet ile mikroalbuminüri gelişimi ve DN'nin ilerlemesini engelleyecek etkili tedavilerdirÖğe 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 THE EFFECTS OF MUSCLE STRENGHT AND PHYSICAL FUNCTION ON BALANCE IN PERITONEAL DIALYSIS PATIENTS(Oxford Univ Press, 2017) Baysal, Ozlem; Taskapan, Hulya[Abstract Not Available]Öğe An Epidermolysis Bullosa Patient Complicated with Chronic Renal Failure(Galenos Yayincilik, 2013) Ulutas, Ozkan; Taskapan, Hulya; Sari, Funda; Senol, MustafaA 32-yr-old man with epidermolysis bullosa presented with clinical and laboratory findings of chronic renal failure. The patient was supposed to be suffering from mesangial IgA glomerulonephritis in view of the repeated persistent macroscopic episodes of hematuria and raised serum IgA levels, especially polimeric IgA. Because continuous vascular access could not be established, the patient died due to uremia and sepsis. Renal complications are associated with life-threatening problems in this inherited mechanobullous disease because it is impossible to obtain a continuous vascular access or a continuous peritoneal access. The possibility of IgA nephropathy should be considered in patients with epidermolysis bullosa. They should be periodically set up screened for IgA levels and hematuria.Öğe Evaluation of Risk Factors for Arteriovenous Fistula Failure in Patients Undergoing Hemodialysis(Aves, buyukdere cad 105-9, mecıdıyekoy, sıslı, ıstanbul 34394, turkey, 2016) Sari, Funda; Taskapan, Hulya; Sigirci, Ahmet; Akpinar, BesirObjective: The aim of the present study is to evaluate the relationship between demographic characteristics, hematological and biochemical parameters, and elements of the coagulation system that may predispose a person to thrombosis or to anatomical and functional parameters in Doppler ultrasonography scanning and the maturation and adequacy of arteriovenous fistulas. Materials and Methods: Overall, 36 patients who underwent a native arteriovenous fistula operation were included. Biochemical parameters, hematological parameters, the coagulation system, and a Doppler ultrasonography evaluation were performed before an arteriovenous fistula operation on day 1 after the fistula operation and at the time point when the arteriovenous fistula became dysfunctional. Results: A thrombus occurred between 1 and 73 days (mean: 28.4 +/- 26.1) in 10 patients. It was found that the female gender (p<0.001), presence of thrill (p=0.014), quality of vein (p<0.001), peak systolic velocity and end-diastolic velocity of the radial artery at the snuffbox region on day 1 after the operation (p=0.035 and p=0.049, respectively), and the cephalic vein diameter in the Brescia-Cimino region (p=0.011) were associated with thrombosis formation. No relation was found among blood pressure, fistula region, quality of artery, spasm of artery and vein, hematologic and biochemical parameters, coagulation parameters, active protein C resistance, anti-cardiolipin antibody, D-dimer, C-reactive protein, or erythrocyte sedimentation rate and thrombosis formation (p>0.05). Conclusion: Thrombosis occurs at a relatively early period in approximately a quarter of arteriovenous fistulas. Female gender, quality of vein, and the absence of thrill in the post-operative period are important factors in thrombosis formation.Öğe Extrapulmonary tuberculosis in ten hemodialysis patients: a single center experience(İnönü Üniversitesi, Tıp Fakültesi, Nefroloji Anabilim Dalı, Malatya, Türkiye, 2016) Yigit, Irem Pembegul; Taskapan, Hulya; Gurel, Ali[Abstract Not Acailable]Öğe Factors Affecting eGFR Slope of Renal Transplant Patients During the First 2 Years(Elsevier Science Inc, 2019) Atay, Feyza Firat; Taskapan, Hulya; Berktas, Bayram; Yildirim, Okan; Dogan, Murat; Piskin, TurgutPurpose. In healthy individuals, glomerular filtration rate decreases by 1 mL/min/y after a peak level of 125.0 mL/min has been reached in adulthood. Any reduction greater than this is a progressive slope (slope more negative than 1 mL/min/y, stable [-1 to +1]), or an improvable slope if it shows more of an increase, that is, greater than +1.0 mL/min/y). The aim of the study was to determine the factors affecting estimated glomerular filtration rate (eGFR) slope during the first 2 years of renal transplant in patients with negative pretransplant panel-reactive antibody. Materials and Methods. The characteristics of 59 renal transplant patients, such as age, sex, etiology, and 2 years of laboratory data, were collected retrospectively. For each patient, the eGFR decline rate (slope) (mL/min-1/1.73 m(2)-1/y-1) was determined by linear regression analysis using all calculated eGFR values over the study period. Findings. Of 59 patients, 7 (11.8%) had a progressive slope, 22 (37.2%) had a stable slope, and 30 (50.8%) had an improvable slope. The first-year mean tacrolimus level was lower in patients with progressive slope than in the patients with stable slope and improvable slope (P < .022). The determinants of eGFR slope in multiple regression analysis were post-transplant hypertension (beta = 0.393; P = .002) and the first-year mean tacrolimus level (beta = 0.320; P =.01), whereas age, serum albumin, and 2-year mean tacrolimus level did not reach the level of significance. Conclusion. Keeping tacrolimus levels high in the first year to prevent eGFR declining is important.Öğe Good response to HBsAg vaccine in dialysis patients is associated with high CD4+/CD8+ ratio(Springer, 2012) Sari, Funda; Taskapan, HulyaChronic renal failure is accompanied by various abnormalities of innate and acquired, cellular and humoral immunity. We aimed to investigate whether positive Candida skin test results, CD4+ and CD8+, before the first dose of vaccination could be a predictor for antibody response to hepatitis B vaccination and the relation of these parameters with hepatitis B antibody levels 1 month after the last dose of vaccination. The present study was carried out in 57 dialysis patients. All patients received recombinant hepatitis B vaccine (40 mu g) given intramuscularly in the deltoid muscle in a four-dose schedule at 0, 1, 2, and 6 months. Candida skin test and lymphocyte subsets (CD4+ and CD8+) were determined before the first dose of vaccination and 1 month after the fourth inoculation of hepatitis B vaccine. Ten patients (17.5%) were non-responders (HBsAb < 10 IU/L), while 47 patients (82.5%) were responders (HBsAb a parts per thousand yen 10 IU/L). However, 29 patients (50.9%) were weak responders (HBsAb:10-100 IU/L), 18 patients (31.6%) good responders (HBsAb > 100 IU/L), which was determined 1 month after the fourth dose of vaccination. Thirty-nine patients (68.4%) and 44 patients (77.2%) were anergic to Candida skin test before the first dose and 1 month after fourth inoculation of hepatitis B vaccine, respectively. There was no relationship between Candida skin test and response to hepatitis B vaccination. Mean age was lower, and CD4+/CD8+ ratio measured both before and after vaccination was higher in good responders compared with that of weak responders and that of non-responders. Females were better responders than males. High skin test anergy rate and low seroconversion rate after hepatitis B vaccination are important problems in patients on dialysis. Females, younger patients, and patients with higher CD4+/CD8+ ratio have better HBsAb antibody response to hepatitis B vaccination.Öğe Hypovitaminosis D and insulin resistance in peritoneal dialysis patients(Springer, 2011) Bindal, Mehmet E.; Taskapan, HulyaAn association between hypovitaminosis D and insulin resistance has been highlighted. Effects of vitamin D are not only mediated via the vitamin D receptors by active vitamin D metabolites, but 25(OH)D(3) also acts through VDR-independent pathways directly. It was reported that acute and chronic intravenous 1,25-dihydroxycholecalciferol therapy corrects insulin resistance in dialysis patients. There are no studies in patients on dialysis which evaluated relationship between 25(OH)D levels and insulin resistance. The aim of this study was to evaluate relationship between serum 25 (OH) D levels and insulin resistance in nondiabetic patients on peritoneal dialysis (PD). We studied 53 nondiabetic patients on PD and in 25 age-, gender- and body mass index-matched healthy controls. Insulin resistance was evaluated by the homeostasis model assessment method (HOMA-IR) using fasting glucose and insulin levels. Vitamin D deficiency was defined if 25(OH)D(3) levels are equal to or less to 15 ng/ml. Mean HOMA-IR index in patients on PD (3.1 +/- A 3.3) was significantly higher than those of controls (1.7 +/- A 1.9) (P < 0.05). The mean 25 (OH)D level in PD patients was (21.1 +/- A 19.0 ng/ml) lower than those of controls (27.5 +/- A 9.3 ng/ml) (P < 0.05). Twenty-five (47.2%) PD patients had vitamin D deficiency [mean 25(OH)D: 7.2 +/- A 3.2 ng/ml], and in 28 of them (52.8%) 25 (OH)D levels were more than 15 ng/ml (mean 33.5 +/- A 18.7 ng/ml). In PD patients with vitamin D deficiency, mean HOMA-IR index (4.2 +/- A 3.8) was significantly higher than that of PD patients whose 25 (OH)D levels were more than 15 ng/ml (2.2 +/- A 2.4) (P < 0.05). Twenty-one (84.0%) of PD patients with vitamin D deficiency, and 22 (78.6%) PD patients whose 25 (OH)D levels were more than 15 ng/mL have been receiving active vitamin D compounds for parathyroid hormone (PTH) control (P > 0.05). There was no significant difference between two PD groups according to mean duration of PD, age, gender, PTH, serum calcium, phosphorus, percentage of fat, and body mass index. There was a negative correlation between HOMA-IR index and 25 (OH)D levels in PD patients (r: -0,368, P < 0,05). In multiple regression analyses, the independent predictors of HOMA-IR index were 25(OH)D3 levels, duration of dialysis, and percentage of fat (measured by bioelectrical impedance) in PD patients. Our findings show a negative correlation of 25(OH)D levels with insulin resistance in PD patients. PD patients with hypovitaminosis D are at higher risk of insulin resistance even if they are on treatment with active vitamin D for PTH control. Further studies are required to explore the relation between vitamin D deficiency and insulin resistance in PD patients.Öğe Investigation of Cognitive Functions with Wechsler Adult Intelligence Scale's Comprehension Subtest and Mini-Mental State Examination in Patient with End-Stage Renal Diseases(Wiley-Blackwell, 2015) Karaoglan, Mehmet; Emre, Memet Hanifi; Demirtas, Yasemin; Sahin, Idris; Taskapan, Hulya[Abstract Not Available]Öğe Investigation of cognitive functions with Wechsler Adult Intelligence Scale's comprehension subtest and Mini-Mental State Examination in patients with end-stage renal diseases(Wiley-Blackwell, 2015) Karaoglan, Mehmet; Emre, M. Hanifi; Demirtas, Yasemin; Sahin, Idris; Taskapan, Hulya[Abstract Not Available]Öğe Is 24,25(OH)D level really high in dialysis patients with high FGF23 levels?(Springer, 2012) Taskapan, HulyaDeficiency of 1,25-dihydroxyvitamin D [1,25(OH)(2)D] and excessive fibroblast growth factor (FGF23) are suggested to be associated with increased mortality in patients with chronic kidney disease (CKD). Generally, 24-hydroxylation has been considered the first step in the degradation pathway of 1,25(OH)(2)D and 25(OH)D. 24,25-dihydroxyvitamin D [24,25(OH)(2)D] was believed to be a degradation product, with no important biological effects. However, some data have accumulated showing that 24,25(OH)(2)D has biological effects on its own. Under conditions of eucalcemia, the synthesis of 24,25(OH)(2)D is increased, and the synthesis of 1,25(OH)(2)D is decreased. In patients with CKD, both high parathyroid hormone levels, which decrease the activity of enzyme CYP24A1 (24-hydroxylase), and high FGF23 levels, which increase the activity of enzyme CYP24A1, were often detected. However, information about 24,25(OH)(2)D levels in these patients is very limited. Whether compensatory changes in levels of FGF23 and 24,25(OH)(2)D in CKD patients are protective or harmful remain unknown issues. Therefore, more studies are needed to identify the nature of the interactions between these molecules and to fully elucidate their clinical significance.Öğe Management of non-vascular complications following renal transplantation using percutaneous approach(Edizioni Luigi Pozzi, 2018) Yildirim, Ismail Okan; Berktas, Bayram; Saglik, Semih; Piskin, Turgut; Dogan, Murat; Sahin, Idris; Taskapan, HulyaOBJECTIVE: Non-vascular complications following renal transplantation can cause graft failure. In this study, we present our two-year experience with percutaneous treatment for non-vascular complications following renal transplantation. PATIENTS AND METHODS: A total of 30 patients who underwent percutaneous radiological treatment between March 2014 and July 2016 were included in the study. RESULTS: Following renal transplantation, a total of 36 percutaneous radiological procedures which includes hydronephrosis secondary to ureteral stricture (n. 15), clinical symptom producing lymphocele due to pressure (14) and creatinine elevated nondilated grafts (n. 7) after excluding other reasons of creatinine elevation, were performed. Six patients received percutaneous treatment for both ureteral stricture and lymphocele. The patients underwent balloon dilatation and double-J ureteral stent due to ureteral stricture. The mean pre- and post-procedural creatinine levels were 4.36 +/- 2.84mg/dL and 2.17 +/- 1.24 mg/dL respectively (p=0.004), indicating a significant difference. For lymphocele treatment, sclerosing agents were injected and lymphatic leakage areas were injected with percutaneous glue. The mean pre- and post-procedural creatinine values were 2.97 +/- 1.78 mg/dL and 1.75 +/- 1.18 respectively (p=0.002), indicating a significant difference. Nephrostomy catheters were placed for patients with elevated creatinine levels and non-dilated collecting system. The mean pre- and post- nephrostomy creatinine levels were 3.55 +/- 2.36 mg/dL and 2.57 +/- 1.82 mg/dL respectively (p>0.05), indicating no statistically significant difference. CONCLUSION: The results of our study suggest that percutaneous treatment is an effective method for the treatment of non-vascular complications following renal transplantation, and, therefore, should be the first option for the preservation of graft functions.Öğe Management of non-vascular complications following renal transplantation using percutaneousapproach(Edızıonı luıgı pozzı, vıa panama 68, 00198 rome, ıtaly, 2018) Yildirim, Ismail Okan; Berktas, Bayram; Saglik, Semih; Piskin, Turgut; Dogan, Murat; Sahin, Idris; Taskapan, Hulya; Sarac, KayaOBJECTIVE: Non-vascular complications following renal transplantation can cause graft failure. In this study, we present our two-year experience with percutaneous treatment for non-vascular complications following renal transplantation. PATIENTS AND METHODS: A total of 30 patients who underwent percutaneous radiological treatment between March 2014 and July 2016 were included in the study. RESULTS: Following renal transplantation, a total of 36 percutaneous radiological procedures which includes hydronephrosis secondary to ureteral stricture (n. 15), clinical symptom producing lymphocele due to pressure (14) and creatinine elevated nondilated grafts (n. 7) after excluding other reasons of creatinine elevation, were performed. Six patients received percutaneous treatment for both ureteral stricture and lymphocele. The patients underwent balloon dilatation and double-J ureteral stent due to ureteral stricture. The mean pre- and post-procedural creatinine levels were 4.36 +/- 2.84mg/dL and 2.17 +/- 1.24 mg/dL respectively (p=0.004), indicating a significant difference. For lymphocele treatment, sclerosing agents were injected and lymphatic leakage areas were injected with percutaneous glue. The mean pre- and post-procedural creatinine values were 2.97 +/- 1.78 mg/dL and 1.75 +/- 1.18 respectively (p=0.002), indicating a significant difference. Nephrostomy catheters were placed for patients with elevated creatinine levels and non-dilated collecting system. The mean pre- and post- nephrostomy creatinine levels were 3.55 +/- 2.36 mg/dL and 2.57 +/- 1.82 mg/dL respectively (p>0.05), indicating no statistically significant difference. CONCLUSION: The results of our study suggest that percutaneous treatment is an effective method for the treatment of non-vascular complications following renal transplantation, and, therefore, should be the first option for the preservation of graft functions.
