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ABSTRACT: The effects of calcineurin inhibitors on oxidative stress after renal transplant are obscure. This study sought to investigate the changes in plasma oxidative stress and lipid levels in patients receiving cyclosporine or tacrolimus before and after renal transplant for 6 months.
Twenty-one patients and 15 healthy controls were involved in our study. Twelve of the patients were treated with cyclosporine and 9 were treated with tacrolimus. Plasma malondialdehyde, nitrite/nitrate, vitamin C, vitamin E, and plasma glutathione levels, as well as total cholesterol and triglyceride levels, were evaluated before and after transplant for 6 months.
Before the transplant, patients had higher malondialdehyde and plasma glutathione levels than did healthy controls (3.76 ± 0.79 nmol/mL vs 3.21 ± 0.57 nmol/mL; P < .05, and 66.6 ± 23.2 μmol/L vs 43.3 ± 26.9 μmol/L; P < .05). In the overall group of patients, a significant increase in malondialdehyde levels was detected 3 and 6 months after transplant (3.76 ± 0.79 nmol/mL vs 4.38 ± 0.87 nmol/mL in the third month; P = .02; and 3.76 ± 0.79 nmol/mL vs 4.28 ± 0.69 nmol/mL in the sixth month; P = .04). A significant reduction in plasma glutathione levels 1 month after transplant and nitrite/nitrate levels 6 months after transplant was found. No changes in vitamin C and vitamin E levels were detected before and after transplant. After 3 and 6 months of transplant, cyclosporine-treated patients had higher levels of total cholesterol and triglycerides when compared with tacrolimus-treated patients.
An enhancement in plasma malondialdehyde levels was found after transplant at 6-month follow-up. However, no significant change in vitamin C, vitamin E, nitrite/nitrate levels between patients and controls was recorded. Although both calcineurin inhibitors showed similar effects on oxidative stress, cyclosporine-treated patients had higher levels of total cholesterol and triglycerides.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 07/2012; 10(5):439-45.
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ABSTRACT: Increased numbers of circulating endothelial cells (CECs) have previously been reported after various diseases associated
with endothelial injury. The aim of this study was to evaluate the CECs in patients with Behçet’s disease and to demonstrate
a possible association between CECs and disease activity. Sixty individuals (45 Behçet’s disease patients and 15 healthy controls)
with normal renal function are included in the study. Peripheral blood samples are first incubated with antiCD146 antibody
and subsequently conjugated to immunomagnetic beads to isolate CECs. Cells are stained with UEA-1 before counting. Behçet’s
patients [7–135 cells/mL, mean 50cells/mL, median 43cells/mL (SD 35), P<0.001] have elevated numbers of CECs compared to controls [3–14cells/mL, mean 9cells/mL, median 8cells/mL (SD 4)]. The
number of CECs is higher in the active period of the disease compared to the inactive period. Further studies are needed to
demonstrate the potential prognostic importance of CECs in Behçet’s vasculitis.
Rheumatology International 04/2012; 29(2):159-162. · 1.88 Impact Factor
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ABSTRACT: Technetium-99m diethylenetriaminepentaacetic acid ((99m)Tc-DTPA) is an ideal radioisotopic method having a high correlation with inulin clearance for the determination of glomerular filtration rate (GFR). Different formulas like creatinine clearance (CrCl) in 24 h urine samples, Cockroft-Gault formula (CGF), and modification of diet in renal disease (MDRD) are being used to come up with an estimate. In this study, we compared (99m)Tc-DTPA with the formulas mentioned above in an attempt to best identify the method that would yield the nearly ideal GFR estimates in the elderly.
In 76 patients who were admitted to our clinic, we measured 24 h urine volume (V), urine creatinine (Ucr), and serum creatinine (Scr) levels together with CrCl, Scr, serum urea (Su), and albumin (Alb) levels. By using coefficients identified for age, gender, and race, we calculated modification of diet in renal disease 1 (MDRD1). Different from MDRD1, we calculated modification of diet in renal disease 2 (MDRD2) that does not include Su and Alb parameters and formulas like CGF that include Scr, age, gender, and weight parameters to come up with GFR levels. All patients underwent (99m)Tc-DTPA procedure.
The mean of the GFR values measured by (99m)Tc-DTPA was 54.3 ± 19.9. The means of GFR values calculated by CrCl, MDRD1, MDRD2, and CGF were 58.0 ± 30.5, 60.9 ± 22.1, 54.4 ± 20.1, and 57.9 ± 22.4, respectively. GFR as measured by (99m)Tc-DTPA showed statistically significant correlations with the results of other methods (p < 0.001 for all methods). The most significant correlation was with MDRD1.
MDRD1 can be used for next to ideal and accurate predictions of GFR in the elderly in the daily practice.
Renal Failure 01/2012; 34(4):435-41. · 0.82 Impact Factor
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ABSTRACT: Nitric oxide (NO), synthesized from LS: -arginine by the enzyme endothelial nitric oxide synthase (eNOS), is a potent vasodilator and has been implicated in mediating insulin-induced uptake and metabolism of glucose in skeletal muscle. Polymorphisms of the eNOS gene have been associated with altered eNOS activity and NO levels. Although several factors have been demonstrated for new onset diabetes mellitus after transplantation (NODAT), determining a genetic susceptibility for all patients requires further study. In our study, we evaluated the relationship between eNOS gene intron 4 polymorphism and NODAT in kidney allograft recipients.
A total of 82 consecutive patients who received their first kidney transplantation and maintained graft function for at least a 12-month post-transplant period and who used triple therapy including cyclosporin A (CsA) for maintenance immunosuppression were included. PCR-RFLP was used for genetic analyses.
Nine of 82 patients (11%) developed NODAT. Concerning the prevalence of eNOS intron 4 gene polymorphism, a significantly higher percentage of 4a allele carriers developed NODAT than non-carriers [6/26 (23.1%) versus 3/56 (5.4%), P = 0.02]. Compared with non-diabetics, NODAT patients were older (P = 0.04), had higher rate of hepatitis C (P < 0.05) and higher body mass index at the time of transplantation (P = 0.03). In regression analyses, having a 4a allele of the eNOS gene intron 4 polymorphism (P = 0.02) and HCV seropositivity (P = 0.03) were found to be independent risk factors for the development of NODAT.
These findings suggest that carrying a 4a allele of the eNOS gene intron 4 polymorphism is associated with NODAT. This may help us to further understand the individual risk for development of NODAT in kidney allograft recipients under CsA treatment.
International Urology and Nephrology 06/2011; 43(2):543-8. · 1.47 Impact Factor
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ABSTRACT: Both thrombomodulin (TM) and endothelial protein C receptor (EPCR) are candidate biomarkers of endothelial damage and have a role of anti-thrombotic defense mechanism in vascular structure. In this study, we aimed to investigate soluble EPCR (sEPCR), soluble TM (sTM) and tumor necrosis factor-alpha (TNF-alpha) levels in hemodialysis (HD) and renal transplant (RTx) recipients.
Twenty-seven RTx recipients and 15 HD patients were recruited to the study. RTx recipients were evaluated before and 3 months after transplantation. Plasma sEPCR, sTM and TNF-alpha levels were measured at baseline and 3 months later in both groups. Moreover, 27 healthy subjects were evaluated regarding sEPCR.
At baseline, there was no difference in sTM, sEPCR, TNF-alpha and C-reactive protein (CRP) between the groups. In paired analysis, sEPCR (266 ± 132 to 117 ± 72 ng/ml), sTM (635 ± 165 to 100 ± 41 ng/ml) and TNF-alpha (11.2 ± 4.3 to 6.0 ± 3.5 pg/ml) were significantly decreased in RTx patients (P < 0.0001) at 3 months, while there was no change in the HD group. In the healthy subjects, sEPCR was found to be 79 ± 26 ng/ml at baseline, which was lower than in both groups.
We showed that the recently proposed endothelial damage biomarkers, sTM and sEPCR, are elevated in HD patients and significantly decrease after kidney transplantation.
International Urology and Nephrology 10/2009; 42(4):1093-8. · 1.47 Impact Factor
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Ali Ozden,
Zeygam Süleyman,
Gülseren Seven,
Mutlu Arat,
Alper Akin,
Ozden Sener,
Işinsu Kuzu, Kenan Keven,
Arzu Ensari,
Ayşe Erden,
Ersin Tan
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ABSTRACT: A 43-year-old female patient admitted with a 2.5-year history of lower extremity symmetrical sensorimotor polyneuropathy, hypertrichosis, sweating, diarrhea, weight loss, and hyperpigmentation. The clinical evaluation met the criteria for the diagnosis of POEMS syndrome. The patient was initially treated with prednisolone and responded well. We planned high-dose chemotherapy with autologous stem cell rescue and introduced a more immunosuppressive regimen containing cyclophosphamide and dexamethasone. We present a case differing from the other cases with her 2 g/day proteinuria and hypertrophic osteoarthropathy.
The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 01/2009; 19(4):276-80. · 0.47 Impact Factor
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ABSTRACT: Fungal infections in solid organ transplant recipients are of concern due to the related high mortality and morbidity. Aspergillus species are one of the major opportunistic fungal pathogens causing invasive pulmonary infections which rarely involve extrapulmonary organs. The occurrence varies by type of transplantation, with aspergillosis more frequently associated with heart, liver and lung transplantation cases than those involving kidney recipients. Several risk factors have been proposed, with cases occurring early and late after the transplantation. Although pulmonary involvement is the main presentation, invasive extrapulmonary aspergillosis can on rare occasions be observed and is associated with poor prognosis. Herein, we report two cases that presented with extrapulmonary invasive aspergillosis, i.e., one presented with cerebral abscess and the second with soft tissue abscess in the right posterior thigh. While the cerebral abscess was not surgically treated, the soft tissue abscess was surgically drained. When the primary focus was investigated, pulmonary nodulars were found in both cases. Both patients were treated with long-term amphotericin B; however, one patient was lost with functioning graft and the kidney of the second patient failed due to decreased immunosuppression and he died while on maintenance hemodialysis. Invasive extrapulmonary presentation of aspergillosis rarely occurs in kidney transplant recipients and is associated with a high mortality rate.
Medical Mycology 09/2008; 46(7):713-7. · 2.46 Impact Factor
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ABSTRACT: Increased numbers of circulating endothelial cells (CECs) have previously been reported after various diseases associated with endothelial injury. The aim of this study was to evaluate the CECs in patients with Behçet's disease and to demonstrate a possible association between CECs and disease activity. Sixty individuals (45 Behçet's disease patients and 15 healthy controls) with normal renal function are included in the study. Peripheral blood samples are first incubated with antiCD146 antibody and subsequently conjugated to immunomagnetic beads to isolate CECs. Cells are stained with UEA-1 before counting. Behçet's patients [7-135 cells/mL, mean 50 cells/mL, median 43 cells/mL (SD 35), P<0.001] have elevated numbers of CECs compared to controls [3-14 cells/mL, mean 9 cells/mL, median 8 cells/mL (SD 4)]. The number of CECs is higher in the active period of the disease compared to the inactive period. Further studies are needed to demonstrate the potential prognostic importance of CECs in Behçet's vasculitis.
Rheumatology International 08/2008; 29(2):159-62. · 1.88 Impact Factor
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Nephrology Dialysis Transplantation 06/2008; 23(5):1773-4; author reply 1774. · 3.40 Impact Factor
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Nephrology Dialysis Transplantation 12/2007; 22(11):3358-9; author reply 3359. · 3.40 Impact Factor
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ABSTRACT: Renal tubular acidosis (RTA) is a non-anion gap metabolic acidosis and is generally mild and asymptomatic in kidney recipients. Although calcineurin inhibitors, suboptimal allograft function, donor age and acute rejection have been associated with RTA, no detailed study has been conducted to investigate the prevalence and clinical implications of RTA in long-term kidney recipients.
In this cross-sectional study, we enrolled 109 patients (74 males, 35 females) for the study [patients with glomerular filtration rate (GFR) <30 ml/min/1.73 m(2), unstable allograft function, diarrhoea, and respiratory disease were excluded]. Thirty-six patients (33%) were found to have RTA on the basis of plasma bicarbonate, arterial pH, urine and serum anion gap measurements.
Deceased donor transplantation [P = 0.034, 95% confidence interval (CI): 1.10-13.27], female gender (P = 0.017, 95% CI: 1.23-8.50), and lower GFR (55.8 +/- 19.4 in RTA and 66.1 +/- 15.9 ml/min/1.73 m(2) in non-RTA, P = 0.002, 95% CI: 1.10-13.27) were independent risk factors for RTA. Also, C-reactive protein was found to be higher in the RTA group (2.7 +/- 1.5 vs 2.0 +/- 1.5 mg/dl, P = 0.03), while no difference was noticed in body mass index or serum albumin. Analysis of the prevalence of osteoporosis and osteopenia in patients with RTA and without RTA, respectively, revealed no difference in frequency of osteoporosis (33% vs 31%) or osteopenia (33% vs 47%).
Although long-term kidney recipients have a relatively high prevalence of RTA, it is usually mild and subclinical. Further studies are needed to clarify long-term effects of RTA in kidney recipients.
Nephrology Dialysis Transplantation 04/2007; 22(3):906-10. · 3.40 Impact Factor
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ABSTRACT: Renal infarction is a rare cause of acute abdominal and flank pain. Whether it occurs due to thrombosis or embolism, the occlusion of the renal arteries always results in renal infarction. Cigarette smoking is a known risk factor for arterial thrombosis. Both vasoconstrictor and pro-thrombotic effects of smoking lead to arterial thrombosis. Herein, we report a case of acute renal infarction in a heavy smoker. The definite diagnosis was made by contrast-enhanced abdominal computerized tomography and renal arteriography.
International Urology and Nephrology 02/2007; 39(3):951-4. · 1.47 Impact Factor
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ABSTRACT: The aim of the present study is to determine the prevalence and predictors of left ventricular hypertrophy in patients with stage 3 or 4 chronic kidney disease. Thirty-four patients were included. In addition to hematological and biochemical evaluations, echocardiography and ambulatory blood pressure monitoring were performed both at the beginning and at the end of the first year. Echocardiographic left ventricular mass was calculated and indexed to body surface area to calculate left ventricular mass index (LVMI). Left ventricular hypertrophy was diagnosed if LVMI >131 g/m(2) in male and >100 g/m(2) in female patients. During the follow-up period, estimated glomerular filtration rate decreased from 36.6+/-11.7 to 31.0+/-14.0 mL/min (p = 0.03), while LVMI increased from 130.2+/-35.6 to 140.5+/-30.5 g/m(2) (p = 0.055). Left ventricular hypertrophy was detected in 67.6% of the patients at the baseline and in 89.7% at the end of the study (p = 0.011). The independent predictors of the final LVMI were age (p = 0.035), baseline day-time systolic blood pressure (p = 0.01), baseline C-reactive protein (p = 0.001), and the decrease in glomerular filtration rate during the follow-up (p = 0.002). Left ventricular hypertrophy is quite frequent among patients with stage 3 or 4 chronic kidney disease, and its prevalence increases while glomerular filtration rate decreases during the follow-up. The early detection of left ventricular hypertrophy and both prevention of the deterioration of renal function and aggressive blood pressure control may help to achieve a decrease in cardiovascular morbidity and mortality in these patients.
Renal Failure 01/2007; 29(3):303-7. · 0.82 Impact Factor
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ABSTRACT: Thrombophilia has been implicated in the development of avascular necrosis (AVN) in various diseases. We aimed to search for the relation of both prothrombin gene G20210A mutation and factor V G1691A (factor V Leiden) mutation with AVN among kidney transplant recipients.
Nineteen patients with AVN and 38 control patients without AVN were included. Clinical information was collected, and gender, age, type of renal allograft, duration and type of dialysis, presence of acute rejection, and cumulative doses of ciclosporin and corticosteroid administration were taken into consideration. Genotypes of factor V G1691A and prothrombin G20210A were determined by direct sequencing of genomic DNA.
Factor V Leiden mutation was detected in six patients (31.6%) among patients with AVN and in only three patients (7.9%) in the control group (P = 0.048). Two patients (10.5%) in the AVN group were determined to have prothrombin G20210A mutation, while no prothrombin G20210A mutation was detected in the control group. When both of the mutations causing thrombophilia were considered, a total of eight patients (42.1%) in the AVN group and three patients (7.9%) in the control group were identified (P = 0.004).
Thrombophilia seems to be an important risk factor for development of AVN. More studies are needed to clarify the role of factor V G1691A and prothrombin G20210A mutation for AVN.
Nephrology Dialysis Transplantation 01/2007; 21(12):3555-8. · 3.40 Impact Factor
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ABSTRACT: In this study, we investigated the impact of pre- and posttransplantation sCD30 monitoring on early (<6 months) acute rejection (AR) risk and analyzed the effect of different immunosuppressive regimens on posttransplantation sCD30 levels in kidney recipients. Fifty patients receiving kidney allograft and 10 healthy donors were included in this retrospective cohort study. Eight patients developed biopsy-proven AR (19%). In pretransplantation samples, patients showed a significantly higher sCD30 than healthy controls. The pretransplantation and posttransplantation (day-15) sCD30 levels were significantly elevated in rejecting patients compared to non-rejecting patients. No significant differences among immunosuppressive regimens were found in posttransplantation sCD30 levels. High pretransplantation and posttransplantation (day 15) sCD30 levels are associated with increased risk of early AR, and sCD30 can be another tool to evaluate immunological risk prior to kidney transplantation. There was no difference in immunosuppressive regimens used in this study on posttransplantation sCD30 levels at the first month.
Transplantation 05/2006; 81(8):1216-9. · 4.00 Impact Factor
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ABSTRACT: Although there is a well-documented risk of acute renal failure (ARF) with the iodinated contrast agents, intravenous gadolinium-based contrast agents are considered non-nephrotoxic and have been widely used for magnetic resonance imaging (MRI). However, debate continues regarding the safety issue of gadolinium, especially in patients with kidney failure. Therefore, we aimed to evaluate the safety of gadolinium in patients with stage 3 and 4 renal failure as well as risk factors for nephrotoxicity.
We retrospectively analysed 473 patients with chronic renal failure who underwent angiographic MRI procedures in our centre from February 1999 to March 2005 in whom gadolinium was used as the sole contrast agent at a dose of 0.2 ml/kg. Among them, 91 patients with stage 3 or 4 renal failure according to K/DOQI definition, who had available data in their files, were enrolled in the study. The ARF was defined as an increase of at least 0.5 mg/dl in serum creatinine level over baseline after using gadolinium.
Eleven of 91 (52 males, 39 females; median age 59 years; median estimated glomerular filtration rate (eGFR) 33 ml/min/1.73 m2) patients developed ARF (12.1%). The median eGFR was lower in patients with ARF than in those who did not develop ARF. The risk factors for ARF were baseline eGFR, older age, diabetic nephropathy and low baseline haemoglobin and albumin levels. Baseline eGFR and diabetic nephropathy were determined as the independent risk factors in regression analysis.
An ARF can occur after gadolinium-based contrast agents in patients with moderate to severe chronic renal failure. Risk factors for ARF after gadolinium toxicity include diabetic nephropathy and low GFR.
Nephrology Dialysis Transplantation 04/2006; 21(3):697-700. · 3.40 Impact Factor
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Transplantation 01/2006; 80(11):1638. · 4.00 Impact Factor
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Nephrology Dialysis Transplantation 01/2006; 20(12):2870. · 3.40 Impact Factor
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Nephrology Dialysis Transplantation 11/2005; 20(10):2279-81. · 3.40 Impact Factor
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Kidney International 08/2005; 68(1):411. · 6.61 Impact Factor
