Person: GÜRSU, MELTEM
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Publication Open Access Comparative Evaluation of Orthostatic Hypotension in Patients with Diabetic Nephropathy.(2021-07-20T00:00:00Z) Aytaş, Gamze; Elçioğlu, Ömer C; Kazancıoğlu, Rümeyza; Gürsu, Meltem; Artan, A Serra; Yabacı, Ayşegül; Soysal, PINAR; Bilgi, Kadir; Özçelik, Semra; KAZANCIOĞLU, RÜMEYZA; ELÇİOĞLU, ÖMER CELAL; GÜRSU, MELTEM; YABACI TAK, AYŞEGÜL; SOYSAL, PINAR; ÖZÇELİK, SEMRAIntroduction: Orthostatic hypotension (OH) affects 5-20% of the population. Our study investigates the presence of OH in diabetic nephropathy (DNP) patients and the factors affecting OH in comparison with nondiabetic chronic kidney disease (NDCKD) patients. Method: Patients presented to the nephrology clinic, and those who consented were included in the study. DNP was defined by kidney biopsy and/or clinical criteria. NDCKD patients of the same sex, age, and eGFR were matched to DNP patients. Demographic parameters and medications were obtained from the records. OH was determined by Mayo clinic criteria. The same researcher used an electronic device to measure blood pressure (BP). All samples were taken and analyzed the same day for biochemical and hematologic parameters and albuminuria. Results: 112 (51 F, 61 M, mean age: 62.56 ± 9.35 years) DNP and 94 (40 F, 54 M, mean age: 62.23 ± 10.08 years) NDCKD patients were included. There was no significant difference between DNP and NDCKD groups in terms of OH prevalence (70.5 vs. 61.7%, p = 0.181). Male patients had significantly higher OH prevalence than female patients (74.7 vs. 60.0%, p = 0.026). There was no significant difference in change in systolic BP between the groups (24.00 [10.00-32.00] mm Hg vs. 24.00 [13.75-30.25] mm Hg, p = 0.797), but the change in diastolic BP was significantly higher in the DNP group (8.00 [2.00-13.00] mm Hg vs. 6.00 [2.00-9.00] mm Hg, p = 0.025). In the DNP group, patients with OH had significantly higher uric acid levels than those without OH (7.18 ± 1.55 vs. 6.36 ± 1.65 mg/dL, p = 0.017). And, 73.7% of patients on calcium channel blockers developed OH (p = 0.015), and OH developed in 80.6% of 36 patients on alpha-blockers (p = 0.049). Conclusion: OH prevalence is very high in CKD, and etiology of CKD does not have a statistically significant effect on the frequency of OH, despite a difference that could be meaningful clinically. Therefore, patients with CKD are checked for OH, with or without concurrent diabetes mellitus. Evaluation of postural BP changes should be a part of nephrology practice.Publication Open Access Acute kidney injury in Turkey: epidemiological characteristics, etiology, clinical course, and prognosis(2022-10-01T00:00:00Z) GÜRSU, Meltem; Yegenaga, Itir; TUĞLULAR, ZÜBEYDE SERHAN; DURSUN, BELDA; GÖKÇAY BEK, SİBEL; Bardak, Simge; ONAN, ENGİN; Demir, Serap; DERİCİ, ÜLVER; DOĞUKAN, AYHAN; Sevinc, Mustafa; KOÇYİĞİT, İSMAİL; Altun, Eda; Haras, Ali Burak; ALTIPARMAK, Mehmet Rıza; TONBUL, HALİL ZEKİ; GÜRSU, MELTEMBackground: This study aimed to evaluate the etiologies, comorbidities, and outcomes of acute kidney injury (AKI) in Turkey and determine any potential differences among different geographical parts of the country. Methods: This prospective observational study was conducted by the Acute Kidney Injury Working Group of the Turkish Society of Nephrology. Demographical and clinical data of patients with AKI at the time of diagnosis and at the 1st week and 1st, 3rd, and 6th months of diagnosis were evaluated to determine patient and renal survival and factors associated with patient prognosis. Results: A total of 776 patients were included (54.7% male, median age: 67 years). Prerenal etiologies, including dehydration, heart failure, and sepsis, were more frequent than other etiologies. 58.9% of the patients had at least one renal etiology, with nephrotoxic agent exposure as the most common etiology. The etiologic factors were mostly similar throughout the country. 33.6% of the patients needed kidney replacement therapy. At the 6th month of diagnosis, 29.5% of the patients had complete recovery; 34.1% had partial recovery; 9.5% developed end-stage kidney disease; and 24.1% died. The mortality rate was higher in the patients from the Eastern Anatolian region; those admitted to the intensive care unit; those with prerenal, renal, and postrenal etiologies together, stage 3 AKI, sepsis, cirrhosis, heart failure, and malignancy; those who need kidney replacement therapy; and those without chronic kidney disease than in the other patients. Conclusion: Physicians managing patients with AKI should be alert against dehydration, heart failure, sepsis, and nephrotoxic agent exposure. Understanding the characteristics and outcomes of patients with AKI in their countries would help prevent AKI and improve treatment strategies.Publication Open Access COVİD-19 infection in a membranous nephropathy patient treated with rituximab.(2020-09-04T00:00:00Z) Elcioglu, Omer Celal; Artan, Ayse Serra; Mirioglu, Safak; Gursu, Meltem; Durdu, Bulent; Koc, Meliha Meric; Okyaltirik, Fatmanur; Gultekin, Mehmet Ali; Kazancioglu, Rümeyza; ELÇİOĞLU, ÖMER CELAL; MİRİOĞLU, ŞAFAK; GÜRSU, MELTEM; DURDU, BÜLENT; MERİÇ KOÇ, MELİHA; OKYALTIRIK, FATMANUR; GÜLTEKİN, MEHMET ALİ; KAZANCIOĞLU, RÜMEYZAWhile COVID-19 pandemic continues to afect our country and most countries in the world, we have to make some changes both in our social life and our approach to healthcare. We have to struggle with the pandemic on one hand and also try to follow up and treat our patients with chronic diseases in the most appropriate way. In this period, one of our group of patients who are challenging us for follow-up and treatment are those who should start or continue to use immunosuppressive therapy. In order to contribute to the accumulation of knowledge in this area, we wanted to report a patient who was followed up with the diagnosis of COVID-19 and had been administered rituximab very recently due to a nephrotic syndrome caused by membranous nephropathy.Publication Open Access Is handgrip strength and key pinch measurement related with biochemical parameters of nutrition in peritoneal dialysis patients?(2015-07-01) YARDIMCI, Bulent; SUMNU, Abdullah; KAYA, Ibrahim; Gursu, MELTEM; Aydın, Zeki; KARADAG, Serhat; UZUN, Sami; tatlı, Emel; OZTURK, Savas; CETINUS, Ercan; Kazancioglu, RÜMEYZA; GÜRSU, MELTEM; KAZANCIOĞLU, RÜMEYZABackgrounds & objective: End-stage renal disease (ESRD) frequently causes Protein Energy Wasting (PEW), which is an important morbidity and mortality factor. Although it is difficult to assess PEW with a reliable method, there are various methods such as Handgrip strength test (HST), serum albumin, cholesterol, etc. HST is a simple and reliable antropometric method which is used for nutritional status and body muscle strength. This study aims to assess the relationship between HST and biochemical markers in evolution of nutritional status of ESRD patients. Methods: This cross-sectional study included 36 consecutive patients, who are on peritoneal dialysis and 36 healthy -control subjects. Jamar-hand dynamometer was used for handgrip strength test; a pinch gauge was used for key pinch. Other antropometric tests included skin fold thicknesses at biceps, triceps, umbilical, suprailiac and subscapular regions; circumferences at waist hip, neck and midarm. Biochemical tests were performed only in Peritoneal Dialysis (PD) group. SPSS for Windows ver. 15.0 was used for statistics. Results: The mean age of patients was 49.3±14.4, and mean age of control group was 43.8±10.6 (p=0.075). In PD group dominant hand dynamometer test 1,2 and 3 results were 19.3±9.3 kg, 25.3±10.8 kg, 25.5± 10.6 kg and; 34.2±10.3 kg, 34.4±9.8 kg, 34.6±10.0 kg for control group (p< 0,001). Right key pinch results were 6.7±1.9 kg for patients; 13.5±4.5 kg for control group (p<0.001). Left key pinch results were 6.8±1.9 kg for patients; 13.2±4.4 kg for control group (p<0.001). There was not any significant relationship concerning handgrip or key pinch tests with biochemical parameters. Conclusion: Handgrip Strength Test and key pinch may be reliable, cheap and easily performed tests for the diagnosis of Protein Energy Wasting in patients on Peritoneal Dialysis.Publication Open Access Volume status in patients on peritoneal dialysis: the role of apelin and bio-impedance spectroscopy(2012-01-01T00:00:00Z) Kazancioglu, RÜMEYZA; Gursu, MELTEM; KARADAG, S; TATLI, E; AYDIN, Z; UZUN, S; SUMNU, A; CEBECI, E; OZTURK, S; KAZANCIOĞLU, RÜMEYZA; GÜRSU, MELTEMOne of the main factors determining the survival of peritoneal dialysis (PD) patients is volume status. We aimed to investigate hydration status of PD patients by bio-impedance spectroscopy (BIS) and echocardiography and to study the relation of them with apelin, which has effects related with volume status like vasodilation, positive inotropism, and inhibition of ADH release and RAS antagonism. Chronic PD patients without active cardiac disease or clinically prominent hypervolemia were included. Besides the demographic, clinical, and laboratory data, BIS and echocardiographic findings together with apelin levels were recorded. The study included 21 patients. Of them, eight patients were euvolemic, one patient was hypovolemic, and others have some degree of overhydration (1.1-6.8 L) with BIS, although all were euvolemic clinically. Mean apelin level was 1.49 +/- 0.49 ng/mL. Apelin level was positively correlated with ejection fraction and negatively with total body water (TBW), intracellular and extracellular water, lean tissue mass, and left atrium diameter. On linear regression model, TBW was the major determinant of apelin. Although apelin is expected to increase in hypervolemic patients, the negative correlation with body water in this study may be related with yet unknown role of apelin in dialyzed patients. They may have important roles in volume status in future.Publication Open Access A Case of Primary Hypoparathyroidism Presenting with Acute Kidney Injury Secondary to Rhabdomyolysis.(2016-01-01) SUMNU, A; AYDIN, Z; GURSU, MELTEM; UZUN, S; KARADAG, S; CEBECI, E; OZTURK, S; Kazancioglu, RÜMEYZA; GÜRSU, MELTEM; KAZANCIOĞLU, RÜMEYZASymmetric calcification of the basal ganglia identified radiographically occurs in a variety of familial and nonfamilial conditions. Primary Familial Brain Calcifications (PFBC), which were known by many names previously, including Fahr disease and striopallidodentate calcinosis, are a genetic disease characterized by various mutations in four separate genes and autosomal dominant inheritance [1–4]. PFBC may present with various psychiatric and neurological symptoms [5]. On the other hand, many secondary causes, either infectious, toxic, or metabolic, have been described to cause symmetrical basal ganglion calcifications and so are in the differential diagnosis of PFBC [6]. Parathyroid diseases such as hypoparathyroidism, pseudohypoparathyroidism, and pseudo-pseudohypoparathyroidism are in the forefront among the metabolic causes. Idiopathic or postsurgical hypoparathyroidism is the most common cause of symmetric calcification of the basal ganglia [7–9]. Herein, a case of primary hypoparathyroidism with severe tetany, rhabdomyolysis, and acute kidney injury (AKI) is presented.Publication Open Access Hemodialysis Experience of a Large Group of Syrian Refugees in Turkey: All Patients Deserve Effective Treatment(2019-01-01) Gursu, MELTEM; ARICI, MUSTAFA; Ates, Kenan; Kazancioglu, RÜMEYZA; Yavas, Pinar Guneser; Öztürk, Murat; ALTUN, BÜLENT; Arinsoy, Turgay; GÜRSU, MELTEM; KAZANCIOĞLU, RÜMEYZABackground/Aims: Refugee dialysis is a worldwide growing dilemma with limited experience. This report presents the largest hemodialysis (HD) patient registry data of Syrian refugees in Turkey. Methods: Demographic, clinical, laboratory, and dialysis practice data of 345 Syrian HD patients during one year were collected and analyzed. Results: There were 345 prevalent Syrian HD patients at the end of 2016. Majority of the patients were placed in the Southeast Anatolian Region. The majority of the patients (74.8%) are in the age range of 20-64 years. Dialysis vintage in Turkey is less than 12 months in 20.8% and less than one month in 29.3% of patients. The vascular access was arteriovenous fistula in the majority of patients (72.5%). Kt/V is over 1.7 in 57%, serum albumin is above 35 g/L in 65.8% and hemoglobin level is more than 100 g/L in %65.2 of the patients. The ratio of patients with serum phosphorus level of 1.13-1.77 mmol/L was 56.2%. Twenty Syrian HD patients (14 male, 6 female) died within the year 2016 and annual mortality rate was 5.7%. Conclusion: This study with the largest number of Syrian refugees undergoing maintenance hemodialysis showed good dialysis practices, acceptable values for dialysis adequacy and biochemical parameters along with lower mortality compared to native HD population of Turkey. Longer follow up will enrich the knowledge related to care of refugee population in all over the world.Publication Open Access Skin disorders in peritoneal dialysis patients: An underdiagnosed subject.(2016-07-06) Gursu, MELTEM; UZUN, S; TOPCUOĞLU, D; Koc, LK; Yucel, L; SUMNU, A; CEBECI, E; OZKAN, O; BEHLUL, A; Koc, L; OZTURK, S; KAZANCIOGLU, RÜMEYZA; GÜRSU, MELTEM; KAZANCIOĞLU, RÜMEYZAAIM: To examine all skin changes in peritoneal dialysis (PD) patients followed up in our unit. METHODS: Patients on PD program for at least three months without any known chronic skin disease were included in the study. Patients with already diagnosed skin disease, those who have systemic diseases that may cause skin lesions, patients with malignancies and those who did not give informed consent were excluded from the study. All patients were examined by the same predetermined dermatologist with all findings recorded. The demographic, clinical and laboratory data including measures of dialysis adequacy of patients were recorded also. Statistical Package for Social Sciences (SPSS) for Windows 16.0 standard version was used for statistical analysis. RESULTS: Among the patients followed up in our PD unit, those without exclusion criteria who gave informed consent, 38 patients were included in the study with male/female ratio and mean age of 26/12 and 50.3 ± 13.7 years, respectively. The duration of CKD was 7.86 ± 4.16 years and the mean PD duration was 47.1 ± 29.6 mo. Primary kidney disease was diabetic nephropathy in 11, nephrosclerosis in six, uropathologies in four, chronic glomerulonephritis in three, chronic pyelonephritis in three, autosomal dominant polycystic kidney disease in three patients while cause was unknown in eight patients. All patients except for one patient had at least one skin lesion. Loss of lunula, onychomycosis and tinea pedis are the most frequent skin disorders recorded in the study group. Diabetic patients had tinea pedis more frequently (P = 0.045). No relationship of skin findings was detected with primary renal diseases, comorbidities and medications that the patients were using. CONCLUSION: Skin abnormalities are common in in PD patients. The most frequent skin pathologies are onychomycosis and tinea pedis which must not be overlooked.Publication Open Access Soluble TNF-Like Weak Inducer of Apoptosis as a New Marker in Preeclampsia: A Pilot Clinical Study.(2016-01-01) YILDIRIM, ZEYNEP BEYZA; SUMNU, A; BADEMLER, N; KILIC, ERDEM; SUMNU, G; KARADAG, S; GURSU, MELTEM; OZEL, A; BATMAZ, G; ATES, SEDA; Dane, B; OZTURK, S; YILDIRIM, ZEYNEP BEYZA; KILIÇ, ERDEM; GÜRSU, MELTEM; ATEŞ, SEDA; KILIÇOĞLU DANE, PAKİZER BANUntroduction: All findings of preeclampsia appear as the clinical consequences of diffuse endothelial dysfunction. Soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) was recently introduced as a TNF related cytokine in various inflammatory and noninflammatory disorders. sTWEAK was found to be related to endothelial dysfunction in patients with chronic kidney disease. In our study we aimed to compare sTWEAK levels in women with preeclampsia to corresponding levels in a healthy pregnant control group. Materials and methods: The study was undertaken with 33 patients with preeclampsia and 33 normal pregnant women. The concentration of sTWEAK in serum was calculated with an enzyme linked immunosorbent assay (ELISA) kit. Results: Serum creatinine, uric acid, LDH levels, and uPCR were significantly higher in the patient group compared to the control group. sTWEAK levels were significantly lower in preeclamptic patients (332 ± 144 pg/mL) than in control subjects (412 ± 166 pg/mL) (p = 0.04). Discussion: Our study demonstrates that sTWEAK is decreased in patients with preeclampsia compared to healthy pregnant women. There is a need for further studies to identify the role of sTWEAK in the pathogenesis of preeclampsia and to determine whether it can be regarded as a predictor of the development of preeclampsia.