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Öğe Adrenal Insufficiency Secondary to Peritoneal Dialysis-Related Peritonitis: A Case Report(Karger, 2019) Gokalp, Cenk; Yildiz, Faruk; Tuzun, Simge; Karadag, Gorkem; Kurultak, Ilhan; Ustundag, SedatPeritoneal dialysis (PD)-related peritonitis is one of the most important factors affecting the long-term success of PD. Adrenal insufficiency is a clinical manifestation of inadequate production of glucocorticoids with accompanying deficiency of mineralocorticoids and adrenal androgens. We present a 58-year-old PD patient who admitted to hospital with fever, abdominal pain, vomiting, and confusion. The patient was treated with cephazolin and ceftazidime after the confirmation of peritonitis. Despite the resolution of peritonitis after 2 weeks with appropriate antibiotic treatment, the patient continued to suffer from vomiting, hypotension, and confusion. After the evaluation of basal serum cortisol and 250 mu g ACTH stimulation test, the patient had been diagnosed as adrenal insufficiency and treated with fludrocortisone 0.1 mg/day. Patients remaining vomiting, hypotension, and confusion symptoms were corrected after the fludrocortisone therapy. Following 2 months of successful treatment of adrenal insufficiency, the patient had adherence problem with fludrocortisone for 3-4 weeks. On an outpatient visit, serum ACTH and cortisol levels were normal despite the discontinuation of fludrocortisone and so the patient had been evaluated as partial adrenal insufficiency secondary to PD-related peritonitis. In conclusion, adrenal insufficiency should be kept in mind in PD patients suffering from hypotension and peritonitis.Öğe Continuous venovenous hemodialysis may be effective in digoxin removal in digoxin toxicity: A case report(Wiley, 2020) Gokalp, Cenk; Dogan, Aysun Fatma; Aygun, Guray; Kurultak, Ilhan; Ustundag, SedatDigoxin is a cardiac glycoside that is used for the treatment of heart failure and atrial fibrillation. Besides its careful close follow-up, toxicity affects nearly 1% of congestive heart failure patients. Cessation of the drug, appropriate electrolyte and rhythm control and digoxin-Fab antibody are the mainstay for toxicity treatment in these patients. As known, hemodialysis and peritoneal dialysis are not effective by the means of digoxin removal. We present a 66-year-old patient who admitted to hospital with digoxin toxicity and severe acute kidney injury. The patient was treated with continuous venovenous hemodialysis because of her hypervolemia, hyperkalemia, cardiac instability, and the thought of probable decrease in digoxin levels concerning the continuous nature of solute clearance. Without the treatment using digoxin-specific Fab antibodies, the patient's digoxin level was decreased successfully with continuous venovenous hemodialysis. In conclusion, continuous venovenous hemodialysis may be a treatment option in digoxin toxicity especially those who suffer from severe renal dysfunction and cannot access digoxin antidote.Öğe Contraception and Child Birth in Kidney Transplant Patients: What Are We Missing as Physicians?(Aves, 2020) Gunay, Emrah; Gokalp, CenkObjective: The primary aim of our study was to evaluate the knowledge of young female patients about pregnancy and contraception after kidney transplantation and to reveal the role of physicians in patient information processes. The secondary aim was to determine the pregnancy outcomes. Materials and Methods: Women who were not older than 40 years at the time of transplantation were included in the study. A questionnaire consisting of 30 questions was prepared. Results: Sixty-six patients were examined. The mean age was 30.3 years, and the mean transplantation time was 49.8 months. Twenty patients (30.3%) were not offered contraception at the time of transplantation. Contraception was recommended to 46 patients. Only 19.5% of recommenders were physicians. When the questionnaire was administered, 23 of 29 sexually active patients were using contraception. Withdrawal (52%), condom (30.4%), and intrauterine device (IUD) (8.6%) were the preferred contraception methods. Nine patients conceived successfully. For all six live births, the mode of delivery was cesarean section. Five of them were premature. Three pregnancies are ongoing. When we asked the patients which drugs should not be used during pregnancy, 38 of them (57.5%) replied they did not know; 16, 7, and 5 patients reported that mycophenolate mofetil, mycophenolate sodium, and tacrolimus should not be used during pregnancy, respectively. Conclusion: Before and after a kidney transplant, the recommendation of contraceptive choices and protection from pregnancy in female patients are being overlooked. We conclude that physicians mostly pay attention to this matter when the patient expresses a desire to become pregnant.Öğe Deceased donor kidney allocation schemes and international exchange(Lippincott Williams & Wilkins, 2020) Heemann, Uwe; Oberbauer, Rainer; Sprangers, Ben; Gokalp, Cenk; Bemelman, FrederikePurpose of review In this review, we summarize different allocation schemes around the world and identify ways to exchange organs between countries. Recent findings The primary goal of transplantation is prolongation of patient survival and an improved quality of life. Most allocation systems try to match the potential survival of the organ with the life expectancy of its recipient. Kidney transplantation enables cost reductions by the avoidance of dialysis for the healthcare system, which is sometimes the driving force for state interventions to enhance donor recruitment The major benefit from international exchange is the possibility to transplant highly sensitized patients or patients with rare HLA allele. In a broad international exchange system, there are three possibilities: exchange of surplus organs, exchange of organs to support patients with a potentially excessive waiting time because of HLA antibodies or rare alleles, and exchange of organs to make the best possible match between donor and recipient. It is possible to shape a hierarchical allocation scheme, which could be applicable in the majority of populations despite different geographical and socioeconomic conditions: allocation to recipients with special requirements (high-urgency, highly sensitized); identification of a within the region/country; in case no suitable recipient can be identified, offer countrywide or between countries; for every organ transferred to another country, there must be an obligation to give one back.Öğe Guillain-Barre syndrome variant as a rare complication of leptospirosis(Oxford Univ Press Inc, 2021) Gokalp, Cenk; Yildiz, Cagla; Tunc, Busra; Kurultak, Ilhan; Ustundag, Sedat[Abstract Not Available]Öğe Investigation of the Factors Affecting Allograft Kidney Functions: Results of 10 Years(Elsevier Science Inc, 2019) Gunay, Emrah; Celebi, Tugba; Sen, Sait; Asci, Gulay; Kumbaraci, Banu Sarsik; Gokalp, Cenk; Yilmaz, MumtazIntroduction. Significant improvements in patient and graft survival and reductions in the frequency of acute rejection were obtained in the early period after renal transplantation, but this success was not sufficiently reflected in the long term. Allograft kidney losses in the long term remain a significant problem. In this study, we investigated the specific causes of graft losses in patients who had a good clinical course in the first year but developed graft loss in the long term. Methods. A total of 118 patients who underwent kidney transplantation in 2005 and 2006 in the Organ Transplantation Center of Ege University Medical Faculty Hospital were evaluated. The inclusion criteria were to be older than 18 years and have a serum creatinine value of <2 mg/dL at the 12th month after transplantation. Results. Sixty-one percent of the recipients were male, and the mean age at the time of transplantation was 34 +/- 11 years (18 to 61). We observed 29 graft losses during the mean follow-up period of 129 +/- 35 months (27 to 162). Three of the graft losses were death by functional graft. Of the 26 patients with graft loss, 16 had chronic rejection, and 8 had recurrent glomerulonephritis. The relationship between nonimmune causes and graft loss was not detected. Conclusions. In conclusion, nonimmune factors may not be as important as we think in relatively young and healthier recipients. Chronic rejection and recurrent glomerulonephritis are the main causes of long-term graft loss of patients with good graft function at the end of the first year. Improvement of long-term survival will be possible with the prevention and effective treatment of these 2 problems.Öğe Plasmapheresis for the Treatment of Crescentic Postinfectious Glomerulonephritis: A Case Report(Karger, 2020) Gokalp, Cenk; Turkoglu, Rabia Gizem; Yildiz, Faruk; Usta, Ufuk; Kurultak, Ilhan; Ustundag, SedatPostinfectious glomerulonephritis (PIGN) is an immune-mediated glomerulonephritis caused by bacterial infections. Treatment of PIGN includes appropriate treatment of underlying infection and supportive treatment of the nephritic syndrome. Immunosuppressive drugs may be used to treat PIGN who have a renal failure with or without crescents and suggested only to the patients who does not have an active infection. We report a case who had PIGN secondary to a chronic foot infection and successfully treated with plasmapheresis for the first time in the literature.Öğe Serum estradiol level predicts acute kidney injury in medical intensive care unit patients(Springer-Verlag Italia Srl, 2022) Gokalp, Cenk; Ilgen, Ufuk; Otman, Eda; Dogan, Fulya; Bozkurt, Devrim; Bacakoglu, Feza; Gurgun, CemilPrevious studies have shown that serum estradiol (E2) levels can predict mortality in intensive care unit patients. Our study investigated the predictive role of admission estradiol level on patient mortality and development of acute kidney injury in medical intensive care unit patients with a wide range of diagnoses. We conducted a prospective cohort study using serum samples from hospitalized patients in medical, cardiac, and pulmonary intensive care units at the Ege University Hospital within 6 months. Serum estradiol levels from 118 adult patients were collected within 48 h of hospitalization. Receiver operating curves and multiple logistic regression analyses were performed to investigate its relationship with acute kidney injury development and mortality. Serum estradiol levels were significantly higher in non-survivor patients than in survivor patients [85 (19-560) pg/mL vs. 32 (3-262) pg/mL, p < 0.001]. Admission estradiol levels were significantly higher in patients with AKI on admission than in patients with chronic kidney disease (p = 0.002) and normal renal function (p = 0.017). Serum E2 levels were higher in patients with renal deterioration during follow-up than patients with stable renal functions [62 (11-560) pg/mL vs. 38 (3-456) pg/mL, p = 0.004]. An admission estradiol level of 52.5 pg/mL predicted follow-up renal deterioration with 63% sensitivity and 74% specificity. A combined (APACHE II-E) score using APACHE II and serum estradiol level predicted overall mortality with 66% sensitivity and 82% specificity. Admission estradiol level is a good marker to predict the development of acute kidney injury and mortality in medical intensive care unit patients.Öğe Serum pentraxin-3 follows a logarithmic distribution particularly at low expected levels(Wiley, 2019) Ilgen, Ufuk; Yayla, Mucteba Enes; Gokalp, Cenk; Emmungil, Hakan; Duzgun, Nursen[Abstract Not Available]
