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Nurhan Ozdemir

Publications and source records attributed to Nurhan Ozdemir.

15 recordsLinked to original sources
PubMed2006

Distribution of HCV genotypes in patients with end-stage renal disease according to type of dialysis treatment.

The objective of this study was to investigate the effects of types of dialysis treatments on hepatitis C virus infection and the epidemiologic properties of hepatitis C virus (HCV) infection at three Baskent University hospitals, in Ankara, Adana, and Izmir, Turkey, in 655, 326, and 118 patients with end-stage renal disease, respectively. One hundred thirty patients with HCV viremia among 271 patients with end-stage renal disease seropositive for HCV were included in this cross-sectional study. HCV RNA-positive patients were classified according to the renal replacement therapies (hemodialysis or continuous ambulatory peritoneal dialysis), and viral load, transaminase levels, and distribution of genotypes were compared between these subgroups. In the continuous ambulatory peritoneal dialysis group, 26 of 165 patients (16%) were serum anti-HCV positive, and 11 of 26 patients (42%) were serum HCV RNA positive. Twenty-six percent of the patients undergoing hemodialysis were anti-HCV positive, and 49% were HCV RNA positive. The prevalence of genotype 1b was 68% and 73% for patients in the continuous ambulatory peritoneal dialysis and hemodialysis groups, respectively. No significant differences were found between the genotype 1b and the non-1b groups or between different dialysis types with regard to age and sex and serum aspartate transaminase, alanine aminotransferase, and HCV RNA levels. We conclude that HCV seropositivity may differ between different types of dialysis treatments, although viral load and genotypes may be similar in persons with end-stage renal disease and those without.

Female↗
PubMed2006

Frequency of atrial fibrillation and factors related to its development in dialysis patients.

BACKGROUND: The frequency of atrial fibrillation is increased in patients with end-stage renal disease. In this study, we sought to determine the incidence of persistent and paroxysmal atrial fibrillation in patients with end-stage renal disease and to identify the risk factors associated with this arrhythmia. METHODS: Two hundred seventy-five patients with end-stage renal disease who were in a hemodialysis program for at least 4 months were included in the study. Patients with permanent, persistent, or paroxysmal atrial fibrillation were identified and recorded. All patients were evaluated for cardiac risk factors and arrhythmias. RESULTS: Thirty (10.9%) of the 275 patients were found to have atrial fibrillation. Ten (33.3%) of these patients had permanent or persistent atrial fibrillation, and 20 (66.6%) of these patients had paroxysmal atrial fibrillation. Patients with atrial fibrillation were older. Incidences of hypertension, coronary artery disease, left ventricular systolic dysfunction, right atrial diameters, and mitral and/or aortic calcification were significantly higher in patients with atrial fibrillation. Serum albumin and high-density lipoprotein levels were significantly lower in patients with atrial fibrillation. CONCLUSIONS: Our data indicate that atrial fibrillation is a frequent arrhythmia in patients with end-stage renal disease, and the most frequently encountered form is paroxysmal atrial fibrillation. In this patient group, presence of coronary artery disease, age, and right atrial diameter are independent factors for determination of the risk of development of atrial fibrillation.

Aged↗
PubMed2006

Isolated Brucella peritonitis in a CAPD patient.

Peritonitis is the most common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Brucellosis is a rare cause of bacterial peritonitis. Only 1 case was reported of a patient with brucella peritonitis during CAPD therapy. In that case, CAPD peritonitis was accompanied by acute brucellosis. We present the case of a patient with isolated brucella peritonitis receiving CAPD therapy without systemic manifestations of brucellosis who works as a farmer. Results of a serum agglutination test and blood cultures were negative; however, the patient's peritoneal fluid agglutination titer was 1:160 and samples inoculated into BACTEC (Becton Dickinson, NJ) bottles yielded Brucella melitensis. Because we were unable to isolate the organism in blood samples, transmission seems to be the result of direct inoculation, rather than hematogenous spreading. Therefore, our patient represents the first case of isolated brucella peritonitis during CAPD therapy. Successful treatment was obtained by using a treatment regimen of rifampin and doxycycline.

Adult↗
PubMed2006

Comparison of the non-invasive methods estimating dry weight in hemodialysis patients.

BACKGROUND: The treatment of deranged water homeostasis of hemodialysis (HD) patients needs focusing on an accurate assessment of dry weight (DW). However, the correct estimation of post-dialysis DW is still a problem. Echocardiography of inferior caval vein diameter (ICVD) was recently considered as a reliable technique to estimate DWs of HD patients, whereas conductivity measurements and biochemical parameters remain controversial. In this study, we aimed to compare the noninvasive methods estimating DW in HD patients. METHODS: We enrolled 60 patients: 30 hypervolemic (HV) (12 M, 18 F, with a mean age of 41.9 +/- 13.6 years, mean HD duration of 38 +/- 45 months) and 30 normovolemic (NV) patients (19 M, 11 F, with a mean age of 42.2 +/- 14 years, mean HD duration of 62 +/- 51.5 months) according to clinical sign and symptoms as well as the findings on chest x-ray. Furthermore, the DWs of patients were evaluated in post-HD period in terms of echocardiography parameters [ICVD and collapse index (CI) determined by Cheriex], plasma ANP (pANP) levels (RIA), and total body water (TBW) by bioelectrical impedance (BEI). RESULTS: Forty-one of 60 patients had hypervolemic findings (68%) and 19 patients had normovolemia (32%) according to echocardiography parameters. Determination of "hypervolemia" by clinical acumen and pANP levels were not reliable, especially negative predictive values were lower as follows: sensitivity, specificity, positive predictive value, negative predictive values of clinical acumen and pANP levels: 63%, 69%, 87%, 50%, and 67%, 59%, 79%, 43%, respectively. TBW established by BEI did not correlate with ICVD and CI after HD (p > 0.05). The TBW of HV group according to echocardiography parameters was greater than NV group, but the difference was not statistically significant (27.4 +/- 6.6 kg versus 26.4 +/- 5.8 kg, respectively, p > 0.05). However, there was not any difference in the divided BSA values (1.58 +/- 0.2 kg/m2 versus 1.60 +/- 0.2 kg/m2, respectively, p > 0.05). Hypertension was seen in 37 (90%) of the echocardiographically hypervolemic patients, and the blood pressure was kept under control by previously given medication in only 7 (19%) patients. After the dry weight of the patients was corrected echocardiographically to normal limits, the blood pressure of 31 patients (86%) was normalized without antihypertensive treatment, but only in 6 patients remained the necessity of antihypertensive treatment. In addition, in 8 of 11 normotensive patients using antihypertensive drugs, assessment of their clinical and radiological findings showed normovolemia but ICVD > 11.5 mm/m2; however, the need for antihypertensive drugs disappeared when the ICVD reduced to 8-11.5/m2. CONCLUSIONS: Clinical and radiological assessment, pANP levels, and TBW established by BEI appeared to be less valuable in interpreting DW's of HD patients. In accordance with the literature, echocardiography findings have proven to be reliable, and they are important noninvasive tools that can establish an effective and rational antihypertensive treatment.

Adult↗
PubMed2006

Expression of hepatocyte growth factor in chronic hepatitis: effect of hemodialysis.

BACKGROUND AND AIMS: Elevated serum levels of hepatocyte growth factor (HGF) have been documented in patients on chronic hemodialysis (HD) and with chronic hepatitis (CH). The aim of this study was to determine the presence and density of HGF in liver tissue and the source of this factor in HD patient with CH. MATERIAL AND METHODS: Seventy-five hepatic needle-biopsy specimens were investigated, 11 from CH patients (Group 1) and 44 from CH patients on HD (Group 2), plus 20 liver biopsies obtained from healthy individuals as controls (Group 3). All specimens were analyzed immunohistochemically with an HGF antibody. RESULTS: Groups 1 (CH only) and 2 (CH + HD) had significantly (p < 0.05) more HGF-positive nonparenchymal cells than the control group. Also, specimens from CH-only patients (Group 1) had significantly (p < 0.05) more positive staining than those from CH patients on HD (Group 2). Groups 1 and 2 had similar results for grading of CH and fibrosis score. No association was found between the number of HGF-positive cells and necroinflammatory or fibrosis score. CONCLUSIONS: The expression of HGF in liver tissue in CH patients on HD was much lower than in CH-only patients. The extrahepatic tissue might be the source of increased HGF serum levels in HD patients.

Biopsy, Needle↗
PubMed2006

Fulminant liver failure secondary to mushroom poisoning in children: importance of early referral to a liver transplantation unit.

Patients poisoned with toxic mushrooms have a spectrum of clinical presentations ranging from gastrointestinal symptoms to fulminant liver failure, and outcomes range from complete recovery to the need for liver transplantation. We reviewed the clinical presentation, course, outcome and management of four children poisoned with mushrooms who developed fulminant liver failure. Although one patient survived, two children died and one underwent living related liver transplantation. Early referral to specialized centers for treatment and for liver transplantation is emphasized.

Child↗
PubMed2006

Is low blood magnesium level associated with hemodialysis headache?

OBJECTIVE: The aim of this study was to evaluate the prevalence, demographic, clinical features, and possible risk factors for hemodialysis headache (HDH). BACKGROUND: HDH has been recognized for many years, but the pathophysiology of this condition is not known. High arterial blood pressure, decreased serum osmolality, sodium washout, and high blood urea nitrogen level are reported risk factors for HDH. Low serum magnesium (Mg) level is known to cause some types of headache, including migraine (menstrual migraine in particular), tension-type headaches, and cluster and posttraumatic headaches. Low Mg has also been reported in HDH patients. METHODS: A total of 250 hemodialysis (HD) patients were questioned about problems with headache. Of these, 75 were diagnosed with HDH according to the revised International Headache Society criteria for 2003. Eighty age- and sex-matched HD patients without HDH were selected as a control group. For each HDH and control subject, arterial diastolic and systolic blood pressure, body weight, and serum levels of sodium, blood urea nitrogen, creatinine, and Mg were measured before and after one HD session. Urea reduction rate and ultrafiltration were determined. Serum levels of phosphorus, calcium, albumin, and parathormone were measured only before the session. Findings in the HDH and control group were statistically compared. RESULTS: As noted, 75 (30%) of the total 250 HD patients surveyed were diagnosed with HDH. The mean headache duration in this group was 5.17 +/- 5 hours. Vertex location, bilateral headache, dull nature, and moderate severity were the most prevalent features of HDH. There were no statistically significant differences between the HDH and control groups with respect to causes of end-stage renal disease. There were no significant differences between the HDH and control groups with respect to predialysis values for blood urea nitrogen, body weight, and arterial blood pressure (P > .05), and the same was true for comparisons of the postdialysis values for these parameters. The mean predialysis sodium level in the HDH group was higher than in the control group (P= .003). Both the mean predialysis and mean postdialysis Mg levels in the HDH group were significantly lower than the corresponding levels in the control group (P= .05 and P= .02, respectively). CONCLUSIONS: The results suggest that low blood Mg level and high blood sodium level may be risk factors for HDH. Magnesium supplementation may help patients with HDH whose serum Mg levels are found to be low.

Adolescent↗
PubMed2005

Valve replacement surgery in patients with end-stage renal disease: long-term results.

BACKGROUND: The life expectancy of patients with chronic renal failure who are dependent on dialysis is very poor. This study was undertaken to determine time-related outcomes in dialysis patients requiring cardiac valve replacement. METHODS: From 1994 to 2001, 29 end-stage renal disease (ESRD) patients on hemodialysis (HD) program underwent 30 valve replacement operations: 29 received mechanical valves (97%), and one received bioprosthetic valves. The sites of valve replacement were 11 aortic (36.7%), 18 mitral (60%), and one both aortic and mitral (3.3%). Mean age was 42.46 +/- 14.26 years (range 17-75 years). Follow-up was completed in 28 patients (96.5%). RESULTS: Early postoperative mortality (in the first 30 days) was 3.4% (n = 1). The overall estimated Kaplan-Meier survival was 56.7% at 36 months, 46.7% at 60 months, and 43.3% at 96 months. HD program was discontinued for two patients after renal transplantation in the follow-up period. All patients, except the one with bioprosthesis, used warfarin sodium for anticoagulation and none of them had bleeding. One of the patients had a major cerebrovascular accident (CVA) and another one had a minor CVA at the follow-up (6.7%). CONCLUSIONS: Life quality is better and life expectancy is longer after valve replacement in ESRD patients who have valvular disease. Also, longer life expectancy increases the probability for finding donors for kidney transplantation.

Adolescent↗
PubMed2003

Infectious complications after mass disasters: the Marmara earthquake experience.

The Marmara earthquake occurred on 17 August 1999. There were 639 renal victims, of whom 477 needed some form of renal replacement therapy. Although several medical complications have been reported in the literature, there has been no detailed description of infectious complications in patients with crush syndrome after earthquakes. Data from 35 hospitals considering clinical and laboratory findings, as well as infectious complications and the results of microbiological examinations, were analysed. 223 out of 639 (34.9%) patients had infectious complications, which comprised the most frequent medical problem in the renal victims. The patients who suffered from infections had a higher mortality rate than those who did not (p = 0.03). Sepsis and wound infection were the main presentation of the infectious complications. 121 (18.9%) patients suffered from sepsis; the mortality rate was higher in these patients (27.3%) than in victims who did not suffer from sepsis (12.4%, p < 0.0001). In a multivariate model, sepsis was associated with increased mortality (p = 0.0002, odds ratio 2.45, 95% confidence interval 1.52-3.96). 53 (8.2%) and 41 (6.4%) patients had wound and pulmonary infections, respectively. Most of the infections were nosocomial in origin and caused by Gram-negative aerobic bacteria and Staphylococcus spp. Infectious complications are common in renal victims of catastrophic earthquakes and are associated with increased mortality when complicated by sepsis.

Bacteremia↗
PubMed2002

Bronchiectasis-related amyloidosis as a cause of chronic renal failure.

Bronchiectasis is defined as acquired and permanent abnormal dilation and destruction of the bronchial walls. Secondary amyloidosis is a disorder characterized by the deposition of amyloid A (AA) in multiple organs and tissues in the body. End-stage renal disease (ESRD) secondary to bronchiectasis-related amyloidosis has only been mentioned in case reports. Little is known about the complications of bronchiectasis-related amyloidosis and the outcomes in patients who develop ESRD due to amyloid deposition in the kidneys. The aim of this study was to identify the clinical characteristics of this patient group, and to report the outcomes of these cases relative to bronchiechtasis type. We assessed the records of 40 patients with AA-type amyloid nephropathy and ESRD who were on hemodialysis (HD) at Baskent University Hospital between 1997 and 2000. The diagnosis of amyloidosis was based on histopathological findings in kidney, rectum, bone marrow, lymph node, thyroid, bladder, liver, and stomach biopsies. Bronchiectasis was diagnosed on the basis of history and findings on physical examination, chest X-ray, and thoracic high-resolution computerized tomography (HRCT). The patients' records were retrospectively evaluated for cause of secondary amyloidosis, and cases with causes other than bronchiectasis were excluded. Secondary amyloidosis due to bronchiectasis and recurrent pulmonary infection was identified in 40% (16 patients) of the 40 patients. For each of these 16 cases, we recorded patient age, duration of bronchiectasis, duration of HD, amount of lung involvement, and biopsy site(s). The means for age, duration of bronchiectasis, and duration of HD in the 16 patients were 50.6 +/- 13.5 years, 22.18 +/- 12.02 years (range, 6-42 years), and 30.81 +/- 36.94 months (range, 4-144 months), respectively. The most common biopsy site was the rectum (n = 8). Thoracic HRCT revealed cystic bronchiectasis in 8 cases (50%). Four of these 8 patients (25% of the group of 16) died from sepsis within 3-year follow-up period. Two of the four patients who died had bilateral cystic bronchiectasis, and the other two had unilateral cystic bronchiectasis. In the other eight patients in the group, thoracic HRCT showed chronic fibrotic changes in the pulmonary parenchyma and minimal traction bronchiectasis. Four of these patients exhibited apical fibrosis and bronchiectasis (25% of the group of 16), and these radiological findings were considered sequelae of previous tuberculosis infections. In conclusion, chronic respiratory infections and associated bronchiectasis remain a serious problem in Turkey due to insufficient prevention, diagnosis, and treatment. It is important that patients with progressive cystic and diffuse bronchiectasis be followed carefully, as they may develop amyloidosis and ESRD in time. Also, the clinical course in patients with cystic bronchiectasis may be worse than that in other types of bronchiectasis due to complicating pulmonary infections.

Adult↗
PubMed2002

Gastroesophageal reflux disease in chronic renal failure patients with upper GI symptoms: multivariate analysis of pathogenetic factors.

OBJECTIVE: The association between gastroesophageal reflux disease and end-stage renal disease remains unclear. We aimed to assess the prevalence of gastroesophageal reflux disease and also to identify possible pathogenetic factors in the development of reflux in symptomatic end-stage renal disease patients. METHODS: The study involved 42 end-stage renal disease patients with upper GI symptoms (group I) and 46 age- and sex-matched controls who did not have renal disease but had the same symptoms (group II). Endoscopy, endoscopic biopsies, and 24-h esophageal pH studies were used to diagnose gastroesophageal reflux disease. Subjects were also investigated for Helicobacter pylori gastritis and GI amyloidosis. RESULTS: The prevalences of gastroesophageal reflux disease in the two groups were similar (81% vs 84.8%, p = 0.423). The prevalence of H. pylori infection was significantly lower in group I than in group II (38.1% vs 67.4%, p = 0.01). There were II cases of GI amyloidosis in group I. Multivariate logistic regression analysis in group I showed that GI amyloidosis (OR = 7.28, 95% CI = 1.13-46.93), chronic ambulatory peritoneal dialysis treatment (OR = 5.54, 95% CI = 1.01-30.43), and absence of H. pylori infection (OR = 3.75, 95% CI = 1.01-13.9) were significantly associated with reflux esophagitis. CONCLUSIONS: Upper GI symptoms are important in predicting gastroesophageal reflux disease in end-stage renal disease patients. Chronic ambulatory peritoneal dialysis, GI amyloidosis, and absence of H. pylori infection seem to be risk factors for the development of gastroesophageal reflux disease in end-stage renal disease patients.

Adult↗
PubMed2002

Treatment modalities and outcome of the renal victims of the Marmara earthquake.

BACKGROUND/AIMS: Treatment of renal problems during natural catastrophes is highly complicated both for medical and logistic reasons. The therapeutic interventions applied to and the outcome of 639 victims with acute renal problems during the catastrophic Marmara earthquake have been the subject of this study. METHODS: Questionnaires regarding information about 63 clinical and laboratory variables were sent to 35 reference hospitals that treated the victims. Information considering therapeutic interventions and outcome obtained through these questionnaires was submitted to analysis. RESULTS: At least one form of renal replacement therapy was administered to 477 (74.6%) of the 639 victims. Of these, 437, 11, and 4 were treated solely by intermittent hemodialysis, continuous renal replacement therapy, and peritoneal dialysis, respectively; 25 victims needed more than one dialysis modality. In total, 5,137 hemodialysis sessions were performed. Also, 2,981, 2,837 and 2,594 units of blood, fresh frozen plasma, and human albumin were administered, respectively. Transfusion of these products was usually associated with higher rates of dialysis needs and mortality. Ninety-seven patients (15.2%) died. The mortality rate of dialyzed victims was higher as compared to nondialyzed ones (17.2 vs. 9.3%, p = 0.015). CONCLUSIONS: Massive amounts of dialysis treatment as well as blood and blood product transfusions can be necessary in the treatment of catastrophic earthquake victims with nephrological problems. Despite the potential risk of a high mortality, in the case of appropriate and energetic medical interventions, reasonable final outcomes can be achieved.

Acute Kidney Injury↗
PubMedDate not supplied

Doppler tissue imaging of the heart in secondary amyloidosis.

Secondary amyloidosis (SA) affects cardiac texture and function by interstitial fibrosis. Doppler tissue imaging (DTI) may quantify heart function through the assessment of myocardial velocities. Echocardiographic findings of early cardiac amyloidosis (CA) without heart failure (HF) caused by SA were determined both by standard methods and DTI. It was then determined whether DTI is superior to conventional echocardiography in documenting early CA due to SA. Twenty-five patients with SA who had CA without HF (group 1) were compared with 25 healthy control subjects (group 2). After standard echocardiography, systolic (s), early (e) and late diastolic (a) velocities of interventricular septum, anterolateral, and anterior and inferior walls were measured from mitral annulus by DTI. The averages were called (s(mean)), (e(mean)), and (a(mean)), respectively. Fractional shortening (FS) and ejection fraction (EF) values of groups 1 and 2 were similar. Standard Doppler echocardiographic values were not typical for a specific diastolic abnormality. The (s(mean)) and (e(mean)) for group 1 were lower but (a(mean)) was higher compared with group 2 (all P < .05). The group 1 (e(mean)/a(mean)) was lower (P < .0001) and (E/e(mean)) was higher (P = .003) than in group 2 (both P < .05). (E/e(mean)) and (E/e(lateral wall)) ratios were positively correlated (r = 0.74, P < .05). In patients with early CA due to SA without HF, by DTI, (s(mean)) and (e(mean)) velocities decrease and (a(mean)) velocity increases. These may be markers of subclinical CA of SA when standard echocardiography is not informative. (E/e(mean)) ratio may be an alternative index to (E/e(lateral wall)).

Adult↗
PubMedDate not supplied

Effects of hemodialysis on myocardial performance index.

The myocardial performance index (MPI) reflects global ventricular function. Chronic hypervolemia and uremia may negatively affect the myocardium of both ventricles. The aims of this study were to investigate how chronic renal failure (CRF) affects biventricular MPI and to determine whether preload reduction by hemodialysis (HD) affects left ventricular MPI (LVMPI) and right ventricular MPI (RVMPI) in CRF. Twenty-one patients with CRF (group 1) were examined 1 hour before and 1 hour after an HD session and 17 healthy control patients (group 2) were examined once by echocardiography. The MPI for each ventricle was calculated as the sum of isovolumic time intervals divided by the ejection time. Before HD, the LVMPI of group 1 was similar to that in group 2 (P>.05), but the RVMPI of group 1 was significantly higher (P=.007). After the HD session, LVMPI and RVMPI remained unchanged (P>.05 for both). The LVMPI and RVMPI were not correlated either before or after HD in group 1 (P>.05 for both), whereas they were correlated in group 2 (r=0.671, P=.003). Chronic renal failure causes isolated RV dysfunction, as reflected by increased RVMPI values. Preload reduction by HD does not affect LVMPI or RVMPI. Patients with CRF also do not exhibit the correlation of LVMPI and RVMPI that is observed in healthy individuals.

Adult↗