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Öğe Acute renal infarction in Turkey: a review of 121 cases(Springer, 2018) Eren, Necmi; Kurultak, IlhanPurposeRenal infarction is a clinical condition which is caused by renal artery occlusion and leads to permanent renal parenchymal damage. In the literature, there are generally case reports on this subject, and few studies that include a large group of patients. Therefore, we aimed to present the data of a large group of patients who were diagnosed with acute renal infarction in our country in this retrospective study.MethodsThe data of patients who were diagnosed with acute renal infarction according to clinical and radiological findings in Turkey in the last 3years were examined. For this purpose, we contacted with more than 40 centers in 7 regions and obtained support from clinically responsible persons. Demographic data of patients, laboratory data at the time of diagnosis, tests performed for etiologic evaluation, given medications, and patients' clinical status during follow-up were obtained from databases and statistical analysis was performed.ResultsOne-hundred and twenty-one patients were included in the study. The mean age was 531.4 (19-91) years. Seventy-one (58.7%) patients were male, 18 (14.9%) had diabetes, 53 (43.8%) had hypertension, 36 (30%) had atrial fibrillation (AF), and 6 had a history of lupus+antiphospholipid syndrome (APS). Forty-five patients had right renal infarction, 50 patients had left renal infarction, and 26 (21.5%) patients had bilateral renal infarction. The examinations for the ethiologies revealed that, 36 patients had thromboemboli due to atrial fibrillation, 10 patients had genetic anomalies leading to thrombosis, 9 patients had trauma, 6 patients had lupus+APS, 2 patients had hematologic diseases, and 1 patient had a substance abuse problem. Fifty-seven (57%) patients had unknown. The mean follow-up period was 14 +/- 2months. The mean creatinine and glomerular filtration rate (GFR) values at 3months were found to be 1.65 +/- 0.16mg/dl and 62 +/- 3ml/min, respectively. The final mean creatinine and GFR values were found to be 1.69 +/- 0.16mg/dl and 62 +/- 3ml/min, respectively.Conclusions Our study is the second largest series published on renal infarction in the literature. More detailed studies are needed to determine the etiological causes of acute renal infarction occurring in patients.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 AMBULATORY BLOOD PRESSURE MONITORING AND CLINICAL SIGNIFICANCE IN PATIENTS WITH GASTROESOPHAGIAL REFLUX DISEASE(Oxford Univ Press, 2020) Arabaci, Sule Ozdemir; Kurultak, Ilhan; Tezel, Ahmet; Ustundag, Sedat[Abstract Not Available]Öğe Atypical Presentation of Rectus Sheath Hematoma in a Hemodialysis Patient: Recurrent Abdominal Pain After Dialysis Sessions(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2017) Kilic, Ilhan; Kurultak, Ilhan; Ustundag, SedatRectus sheath hematoma is a rare but well-known cause of acute abdominal pain. Rectus sheath hematoma is largely misdiagnosed as seen rarely. As a fatal disorder it must be suspected especially in patients receiving anticoagulant therapy for any reason. Heparin exposure during hemodialysis sessions and uremic bleeding diathesis causes chronic hemodialysis patients to be vulnerable to rectus sheath hematoma. Rectus sheath hematoma may be mild and self-limiting but also be so severe that it threatens life because of hypotensive shock and anemia-related risks. The patient may present without symptoms, with abdominal pain or with hemodynamic shock. We present a case report describing a patient with recurrent abdominal pain due to rectus sheath hematoma exacerbating after hemodialysis sessions.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 Effect of Local Polyhexanide Application in Preventing Exit-Site Infection and Peritonitis: A Randomized Controlled Trial(Wiley, 2020) Ceri, Mevlut; Yilmaz, Seref Rahmi; Unverdi, Selman; Kurultak, Ilhan; Duranay, MuratTopical antibiotic and antiseptic agents have been documented to reduce exit-site infection (ESI) and peritonitis in PD. The aim of this randomized controlled study was to evaluate the efficacy of polyhexanide in the prevention of ESI and peritonitis. Patients were excluded if they had active infection, > 18 years of age, ESI and peritonitis within the previous 4 weeks, received PD for less than 3-months and history of allergy to either drug. All patients were followed up until catheter removal, death, switch to dialysis, transplantation or the end of the study. ESI, tunnel infection, peritonitis, catheter removal and microorganism cause of catheter-related infection were recorded prospectively during clinic follow-up. A total of 88 patients (41 povidone-iodine group; 47 polyhexanide group) were enrolled with a total follow-up duration of 480 and 555 patient-months for povidone-iodine and alternating group, respectively. There were no significant differences in the age, sex, BMI, time of PD, rate of DM, and S. aureus carriage state. A total of 8 ESI and 25 peritonitis episodes were detected during the study. ESI and peritonitis rates tended to be lower in polyhexanide group compared with the povidone-iodine group (0.06 episodes/patient-year vs. 0.12 episodes/patient-year; 0.26 episodes/patient-year vs. 0.32 episodes/patient-year, respectively), but were not significant statistically. Moreover, catheter removal was similar in both groups (0.04 / patient-year vs. 0.05 / patient-year). Polyhexanide is efficient and safe for the prevention of ESI and peritonitis and it may be used as an alternative procedure for the care of healthy exit sites.Öğe Endocarditis and Calcific Uremic Arteriolopathy: Is it a Coincidence or an Association? Case Report(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2016) Kurultak, Ilhan; Kilic, Ilhan; Sezer, Betul; Tuncel, Sedat; Tastekin, Ebru; Ustundag, SedatThe uncommon complications regarding CKD tend to increase in clinical setting because of the chronic kidney disease (CKD) population has been expanding every passing day. Perhaps the most important one of these is calcific uremic arteriolopathy (CUA, calciphylaxis). Calcific uremic arteriolopathy is a clinical syndrome which includes systemic calcification of the small vessels, causes to ischemia, subcutaneous necrosis and it has high mortality and morbidity rates (1,2). There is a large body of data in literature about CUA although very little for its cardiac involvement. Herein we presented a case of calcific endocarditis with CUA and the review of the literature. According to our observation, parathyroidectomy was effective to provide clinical and radiological improvement in the presented case. The clinician should consider adding parathyroidectomy to conventional strategies immediately if the risk of such uncontrolled hyperparathyroidism is present.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 Incidence of Staphylococcus aureus Nasal Carriage in Patients With Diabetic Foot Wounds and Related Risk Factors(Aves, 2015) Kurultak, Ilhan; Altay, Mustafa; Cesur, Salih; Yildiz, Eda; Duranay, MuratObjective: In this study, we aimed to detect the incidence and risk factors of Staphylococcus aureus nasal carriage and possible relationship between wound culture and nasal carriage in patients with diabetic foot (DF) wounds. Methods: Three groups each one comprising 40 patients were established with nondiabetics (Group 1), diabetics without DF wounds (Group 2), and diabetics with DF wounds (Group 3). Wagner grading was used for classification of DF lesions. The incidence of S. aureus nasal carriage and effects of determined factors to nasal carriage were investigated. The relationship between nasal carriage and result of wound culture was also investigated in the last group. Results: The incidence of S. aureus nasal carriage were 17.5%, 20% and 10% in Groups 1, 2 and 3, respectively (p=0.47). Age, sex, use of insulin/oral anti-diabetic drugs, duration of diabetes, HbA1c level, fasting and after meal glucose measures did not affect the S. aureus nasal carriage. We observed a higher possibility of nasal swab positivity for MRSA in diabetic patients compared to the controls. We did not detect any relationship between Wagner grade and culture results of wounds and S. aureus nasal carriage in Group 3. Conclusions: We detected that having DF wound or diabetes did not alter the risk of S. aureus nasal carriage, and likewise nasal carriage did not affect the results of wound cultures.Öğe Missed Diagnosis of Aspergillus Niger Peritonitis in a Peritoneal Dialysis Patient with Standard Culture: Might Enriched Blood Culture Materials have an Advantage?(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2016) Kurultak, Ilhan; Ceri, Mevlut; Arican, Kenan; Kinalp, Can; Cesur, Salih; Evrenkaya, T. RifkiPeritonitis is a major complication of peritoneal dialysis (PD). Although bacteria are the most responsible pathogens, fungi can also be the cause of this condition. Candida species (spp.) are common agents in fungal peritonitis with a rate of 70% while Aspergillus spp. is rare. Aspergillus spp. can lead to severe life threatening peritonitis in PD patients. Early diagnosis is essential for a good outcome but it may be difficult to detect the pathogen. Our observation in this case supports the hypothesis that the enriched culture materials designed for detecting blood pathogens can provide an advantage for determining the cause of peritonitis in peritoneal fluid. Clinicians should remember this clue when managing peritonitis, especially in patients who are refractory to empiric antibiotic therapy.Öğe A New Artificial Urine Protocol to Better Imitate Human Urine(Nature Portfolio, 2019) Sarigul, Neslihan; Korkmaz, Filiz; Kurultak, IlhanArtificial urine has many advantages over human urine for research and educational purposes. By closely mimicking healthy individuals' urine, it may also be important in discovering novel biomarkers. However, up until now, there has not been any specific protocol to prove the similarity in terms of the chemical composition at the molecular level. In this study, a new artificial urine protocol is established to mimics the urine of healthy individuals. The multi-purpose artificial urine (MP-AU) presented here is compared with two other protocols most cited in literature. Furthermore, these three protocols are also compared with samples from 28 healthy young individuals. To do so, attenuated total reflection-Fourier transform infrared spectroscopy (ATR-FTIR) is used, according to which MP-AU shows a significantly close similarity with human urine. In formulating MP-AU, the infrared spectra of nine compounds is provided, making possible the band assignment of some absorption bands to certain compounds. Given its properties, the MP-AU protocol introduced here is both economical and practical, making it useful when designing comparative-controlled experiments.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 THE PREVALENCE, CLINICAL AND PATHOLOGICAL CHARACTERISTICS OF PRIMARY FOCAL SEGMENTAL GLOMERULOSCLEROSIS IN TURKISH ADULTS: THE DATA FROM TSN-GOLD (TURKISH SOCIETY OF NEPHROLOGY GLOMERULAR DISEASES) WORKING GROUP(Oxford Univ Press, 2020) Kurultak, Ilhan; Gungor, Ozkan; Ozturk, Savas; Dirim, Ahmet Burak; Eren, Necmi; Yenigun, Ezgi; Dal, Elbis Ahbap[Abstract Not Available]Öğe The Prevelance and Related Risk Factors of Intradialytic Hypertension in Hemodialysis Patients(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2016) Mescigil, Pinar; Kurultak, Ilhan; Calayoglu, Reyhan; Erturk, SehsuvarOBJECTIVE: We aimed to evaluate the prevalence and clinical correlations of intradialytic hypertension (IDHT) in chronic hemodialysis (HD) patients. MATERIAL and METHODS: Seventy-six patients who had been receiving hemodialysis in our unit for at least 3 months were included. Demographics and laboratory data were recorded for all patients. Systolic and diastolic blood pressure levels, and UF rate were calculated as the mean values of the last 12 hemodialysis sessions. In addition, 24 hour ambulatory blood pressure monitoring and aortofemoral pulse wave velocity measurements were recorded. An increase of >= 10 mmHg in blood pressure reaching 130/80 mmHg and over during more than half of the HD sessions was defined as IDHT. RESULTS : Systolic IDHT (sIDHT) was detected in 10 of 76 patients (13.2%); either systolic or diastolic IDHT (dIDHT) was detected in 17 of 76 patients (22.4%). There was a positive correlation between IDHT and age, existence of HT, number of antihypertensive drugs, pulse pressure, and aortafemoral pulse wave velocity and a negative correlation with time of HD treatment, rate of UF, serum albumin and Kt/V urea negatively. The independent predictors were age and UF rate for sIDHT and albumin and HT for dIDHT. CONCLUSION: IDHT is a relatively common complication in HD patients and is correlated with poor prognostic factors. Clinicians should be aware of this insidious complication.Öğe PULSE WAVE VELOCITY AND AMBULATORY BLOOD PRESSURE IN PATIENTS WITH RENAL HYPERFILTRATION(Oxford Univ Press, 2023) Kodal, Nil; Kurultak, Ilhan; Karagoz, Ferdi; Ustundag, Sedat[Abstract Not Available]Öğe Relapsing Serratia peritonitis resulting in peritoneal catheter loss(Wolters Kluwer Medknow Publications, 2018) Kilic, Ilhan; Gungor, Kultural; Kurultak, Ilhan; Ustundag, SedatSerratia marcescens (SM) is an opportunistic Gram-negative bacterium. It can cause technique failure or severe sepsis despite being a rare agent causing peritonitis. We present a case of a 40-year-old woman with end-stage renal disease secondary to chronic glomerulo-nephritis on continuous ambulatory peritoneal dialysis (PD). She presented with severe abdominal pain and a cloudy peritoneal fluid. The fluid was cultured according to our unit protocol. The organism isolated was identified as SM; this was after the patient was treated for SM peritonitis one week earlier. The response to treatment with ceftazidime was poor despite being sensitive in vitro. The peritoneal catheter was removed due to rapid clinical deterioration. Piperacillin-tazobactam (PIP/TAZ) monotherapy was successfully administered subsequently. Eventually, she was transferred to hemodialysis (HD). SM is an uncommon cause of PD-related peritonitis. It may cause catheter loss and even death. In our case, the infection could be controlled only after catheter removal, and she was transferred to HD. Cephalosporins should rapidly be changed to PIP/TAZ when SM is isolated from the peritoneal fluid.Öğe The role of eNOS gene polymorphisms on contrast induced nephropathy development in chronic kidney disease patients(Wiley, 2023) Kilic, Ilhan; Palabiyik, Orkide; Kurultak, Ilhan; Sipahi, Tammam; Ustundag, SedatIntroduction Contrast nephropathy is a result of contrast media given through intravascular routes. Nitric oxide gene polymorphisms may alter the hemodynamic stability resulting in medullary ischemia Nitric oxide gene polymorphisms may have an enhancing role in contrast media related renal injury. The aim of this study was to investigate the role of eNOS intron 4a/b, T786C, and G894T gene polymorphisms on contrast-nephropathy risk. Methods Ninety-four chronic kidney disease patients with contrast nephropathy and 120 chronic kidney disease patients without contrast nephropathy were included. DNA isolation was performed and specific regions of DNA for eNOS G894T, T786C, and intron 4a/b genes were amplified by polymerase chain reaction technique. Results TT polymorphism of T786C gene and GG polymorphism of G894T gene were detected to be possibly protective from contrast induced nephropathy. Conclusion Endothelial nitric oxide synthase G894T gene polymorphisms, older age, and presence of diabetes mellitus may influence contrast nephropathy development.Öğe Scintigraphy as a Reliable Technique for Diagnosis and Follow-Up of Pleuroperitoneal Leakage in Peritoneal Dialysis Patients(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2016) Kilic, Ilhan; Kurultak, Ilhan; Aktas, Gul; Ustundag, Sedat; Sarikaya, AliMetabolic and mechanic complications can be seen due to peritoneal dialysis. Pleuroperitoneal leakage is rare but can be a life-threatening mechanic complication of peritoneal dialysis. Some techniques have been used to diagnose this entity. Radionuclide imaging can be used as a reliable technique in order to show the pleuroperitoneal passage and can be used to show the recovery. Herein we present the first case report in the literature about a patient with pleuroperitoneal shunt that was demonstrated scintigraphically during the leakage and after the resolution.Öğe Urinalysis of individuals with renal hyperfiltration using ATR-FTIR spectroscopy(Nature Portfolio, 2022) Kurultak, Ilhan; Sarigul, Neslihan; Kodal, Nil Su; Korkmaz, FilizAbnormal increased glomerular filtration rate (GFR), otherwise known as renal hyperfiltration (RHf), is associated with an increased risk of chronic kidney disease and cardiovascular mortality. Although it is not considered as a disease alone in medicine today, early detection of RHf is essential to reducing risk in a timely manner. However, detecting RHf is a challenge since it does not have a practical biochemical marker that can be followed or quantified. In this study, we tested the ability of ATR-FTIR spectroscopy to distinguish 17 individuals with RHf (hyperfiltraters; RHf (+)), from 20 who have normal GFR (normofiltraters; RHf(-)), using urine samples. Spectra collected from hyperfiltraters were significantly different from the control group at positions 1621, 1390, 1346, 933 and 783/cm. Intensity changes at these positions could be followed directly from the absorbance spectra without the need for pre-processing. They were tentatively attributed to urea, citrate, creatinine, phosphate groups, and uric acid, respectively. Using principal component analysis (PCA), major peaks of the second derivative forms for the classification of two groups were determined. Peaks at 1540, 1492, 1390, 1200, 1000 and 840/cm were significantly different between the two groups. Statistical analysis showed that the spectra of normofiltraters are similar; however, those of hyperfiltraters show diversity at multiple positions that can be observed both from the absorbance spectra and the second derivative profiles. This observation implies that RHf can simultaneously affect the excretion of many substances, and that a spectroscopic analysis of urine can be used as a rapid and non-invasive pre-screening tool.Öğe Urine analysis using FTIR spectroscopy: A study on healthy adults and children(Wiley-V C H Verlag Gmbh, 2021) Sarigul, Neslihan; Kurultak, Ilhan; Gokceoglu, Arife Uslu; Korkmaz, FilizUrine spectra from 108 healthy volunteers are studied by attenuated total refraction-Fourier transform infrared (ATR-FTIR) spectroscopy. The spectral features are correlated with observable urine components. The variation of spectra within a healthy population is quantified and a library of reference spectra is constructed. Using the band assignments, these spectra are compared with both age-wise and gender-wise. Children show the least intensity variations compared to both adult groups. Young adults show the highest variation, particularly in the 1650 to 1400 cm(-1) and 1200 to 900 cm(-1) regions. These results indicate the importance of the size of the control group in comparative studies utilizing FTIR. Age-wise comparisons reveal that phosphate and sulfate excretion decreases with age, and that the variance of phosphate among individuals is higher with adults. As for gender-wise comparisons, females show a slightly higher citrate content at 1390 cm(-1) regardless of the age and they show a higher variance in the 1200 to 1000 cm(-1) region when compared to men.
