Publications (5)1.96 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: One of the most important mechanisms of allograft rejection is the production of donor-specific antibodies (DSA). Anti-major histocompatibility complex class-I chain-related antigen A (MICA) and anti-glutathione S transferase-T1 (GSTT1) antibodies cause graft dysfunction and reduce graft survival. The aim of this study was to examine the effects of anti-human leukocyte antigen class I-II, anti-MICA, and anti-GSTT1 antibodies in development of antibody-mediated rejection. Among the 32 renal transplant patients included in this study 65% experienced antibody-mediated rejection (AMR; chronic active AMR [CAMR], n = 17; acute AMR [AAMR], n = 4) and 35%, ACR. The anti-HLA class I-II and anti-MICA antibodies were determined by using LUMINEX, anti-GSTT1 antibodies by enzyme-linked immunosorbent assay. GSTT1 genotyping of patients and donors was performed by polymerase chain reaction. Antibody was detected in 19 of 21 patients undergoing antibody-mediated rejection (90%). We detected anti-GSTT1 in 4, anti-MICA in 8, anti-HLA class I in 5, and anti-HLA class II in 9 patients with CAMR (P = .007). If the patients were divided into 2 groups according to being C4d(+) and C4d(-) both anti-HLA class I and class II antibodies were found significantly more frequently among the C4d(+) group (P = .019, P = .024). No difference was determined between AMR and ACR groups in terms of anti-GSTT1 and anti-MICA antibodies. In this study, we observed the role of anti-HLA class II antibodies in the development of CAMR and in long-term allograft survival. It is observed that anti-MICA and anti-GSTT1 antibodies showed no effect on rejection mechanisms.
    No preview · Article · Apr 2013 · Transplantation Proceedings
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: The primary objective of our study was to investigate effects of antiproteinuric treatment on lipid levels of patients with idiopathic focal segmental glomerulosclerosis (FSGS) or membranous glomerulonephritis (MGN). MATERIAL and METHODS: The clinical and laboratory data of the patients were recorded at three-month intervals during 18 months of follow-up. Patients with non-nephrotic proteinuria without hypoalbuminemia received conservative treatment while those with more severe disease received steroid therapy as well. Lipid parameters in the two groups and the factors effective on these parameters were investigated. RESULTS: Sixty eight patients (36 with FSGS, 32 with MG) were included. The mean age of the patients and the follow-up period were 39.6±16.6 years and 16.4±8.9months, respectively. 36 (53%) patients received steroid therapy. The percentage of patients taking antilipemic treatment was statistically significantly higher in the group taking steroid therapy. LDL cholesterol levels were higher at the beginning in patients taking steroid therapy but the difference disappeared after the ninth month. Total and LDL cholesterol levels showed a negative correlation with albumin levels and a positive correlation with proteinuria level. CONCLUSION: Treatment of hyperlipidemia in nephrotic syndrome should be directed towards increasing serum albumin levels, and therefore treatment of the glomerular disease. Antilipidemic therapies should be considered in patients who do not respond to other antiproteinuric treatment.
    No preview · Article · Jan 2013
  • Source
    S.U. Akgul · F.S. Oguz · Y Çalişkan · C Kekik · H Gürkan · A Türkmen · I Nane · F Aydin
    [Show abstract] [Hide abstract]
    ABSTRACT: The balance between oxidative stress and anti-oxidant defense systems after renal transplantation may explain the development and progression of allograft dysfunction. Glutathione S-transferase (GST) decreases the damage from oxidative stress. In contrast, recipient antibodies against GSTT1 expressed on the graft are believed to cause its dysfunction. The aim of our research was to study the probable relationship to rejection between GST gene polymorphisms and anti-GSTT1 antibodies. We included 122 patients transplantations from living donors and 51 healthy individuals as controls group in our study. The patient groups were comprised of 57 patients who did and 65 who did not experienced rejection episode. Polymerase chain reactions were used to detect GSTM1 and GSTT1 polymorphisms, whereas PCR-RFLP (restriction fragment length polymorphism), for GSTP1 polymorphism. An enzyme-linked immunosorbent assay method was used for anti-GSTT1 antibody scans. There was no significant difference between the groups for allele and genotype frequencies of GSTT1, GSTM1, GSTP1 polymorphisms of the recipients, donors, and controls. Within the rejection group the frequency of patients with the GSTM1 null genotype was higher among subjects prescribed cyclosporine A versus tacrolimus (P = .029). Among the entire patient group, 46 subjects with GSTT1 null genotype were scanned for anti-GSTT1 antibody which was detected in 5 of 8 patients with an acute rejection episode (P = .04). Anti-GSTT1 antibody was observed more frequently albeit not significantly, among the cyclosporine versus tacrolimus patient group (P = .16). This study suggested that GSTM1 genotype may be important for cyclosporine detoxification and for allograft outcomes due to drug nephrotoxicity. After transplantation, antigens distinct from the HLA system such as GSTT1 protein may also be targets for alloimmune responses.
    Full-text · Article · Jul 2012 · Transplantation Proceedings
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: We compared the efficacy and safety of 12 months of three different treatment regimens. MATERIAL and METHODS: We retrospectively investigated the pathological and clinical features of 70 patients with FSGS confirmed by biopsy. Patients with secondary FSGS, estimated glomerular filtration rate <30 mL/min/1.73 m2 and history of diabetes mellitus were excluded. Eligible 51 patients were randomly assigned to receive treatment with renin-angiotensin system (RAS) inhibitors (group 1, n=13), steroid (group 2, n=22) or steroid + Cyclosporine (CsA) (group 3, n=16). RESULTS: At the end of the one year, remission ocurred in 7 patients (53.8%) (4 complete and 3 partial) in group 1, 15 patients (68%) (12 complete and 3 partial) in group 2 and 8 patients (50%) (6 complete and 2 partial) in group 3 (p=0.483). The baseline proteinuria levels of patients in group 2 (5.41±3.91 g/day) and group 3 (5.96±4.83 g/day) were significantly decreased to 2.03±3.16 g/day (p=0.004) and 2.03±2.40 g/day (p=0.012), respectively. However, the baseline proteinuria levels of patients in group 1 were not significantly decreased at one year of treatment. CONCLUSION: Steroid treatment or CsA in combination with low-dose steroids show similar efficacy in inducing remission in patients with idiopathic FSGS.
    No preview · Article · Jan 2011
  • [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION: Treatment of membranoproliferative glomerulonephritis (MPGN) is often unrewarding with approximately 60% of patients progressing to end-stage renal failure within 10 years. In our study, we compared the efficacy of CS alone versus low dose CS + another immunosuppressive agent retrospectively. MATERIAL and METHODS: Twenty-nine patients (17 male) with MPGN were retrospectively grouped according to treatment protocols with CS (methylprednisolone 1mg/kg) (group 1, n=14); low dose CS + another immunosuppressive agent (group 2, n=15) [CS+MMF (n=6), CS+AZA (n=3), CS + CYC (n=6)]. Patients in all groups also received renin-angiotensin system (RAS) inhibitors. RESULTS: All patients received treatment for 12 months. Remission occurred in 12 patients (85.7%) (9 complete and 3 partial) in group 1 and 10 patients (66.6%) (7 complete and 3 partial) in group 2 (p=0.316). No patients required dialysis within the one year of follow up complications. At one year of treatment the baseline proteinuria levels of patients in group 1 (5.83+2.91 g/day) and group 2 (5.37+4.05 g/day) significantly decreased to 0.21+0.42 g/day (p=0.005) and 1.92+3.31 g/day (p=0.037), respectively. In the first year of treatment mean glomerular filtration rate (GFR) values of patients in group 1 (105+40 mL/min) was significantly higher than the group 2 (66+23 mL/min) (p=0.005). CONCLISION: There is no significant extra benefit in treating adult MPGN patients with combination therapy including low dose CS plus various immunosuppressive agents.
    No preview · Article · Jan 2011