Person: TUĞLULAR, ZÜBEYDE SERHAN
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TUĞLULAR
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ZÜBEYDE SERHAN
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Publication Open Access A severe case of systemic lupus erythematosus with increased pressure communicating hydrocephalus(AVES, 2015-06-04) TUNCER, EMİNE NEŞE; Ozen, Gulsen; Yilmaz-Oner, Sibel; Tuncer, Nese; Akbas, Turkay; Tuglular, Serhan; Direskeneli, HanerNormal/increased pressure hydrocephaly is an unusual manifestation of systemic lupus erythematosus (SLE), and the pathogenesis is still unclear. We report the case of an 18-year-old white female with severe refractory renal and pulmonary involvement who developed stupor during intensive immunosuppressive treatment. Enlarged ventricles on imaging and increased intracranial pressure with the exclusion of infectious and hemorrhagic/thrombotic processes suggested increased pressure communicating hydrocephalus associated with SLE. Few case reports are reviewed, and potential pathophysiologic mechanisms are discussed.Publication Open Access The blockade of the renin-angiotensin system reverses tacrolimus related cardiovascular toxicity at the histopathological level(J R A A S LTD, 2007-06) TUĞLULAR, ZÜBEYDE SERHAN; Agirbasli, Mehmet; Papila-Topal, Nurdan; Ogutmen, Betul; Deniz, Hicran; Cakalagaoglu, Fulya; Tuglular, Serhan; Akoglu, EmelIntroduction. In this study, we investigate the toxic effects of tacrolimus (FK506) on the cardiovascular system at the histopathological level in a rat model and whether these effects can be reversed by the blockade of the renin-angiotensin system (RAS) by either an angiotensin-converting enzyme inhibitor (ACE-inhibitors) or an angiotensin receptor antagonist (ARB). Methods and results. Thirty-one Wistar rats were divided into four groups. FK506 group was treated with FK506 intraperitoneally (i.p.), FK506+ACE-inhibitors and FK506+ARB groups were treated with either quinapril or valsartan orally in addition to FK506. Control group was treated with saline i.p. Histological and immunohistochemical staining of cardiovascular tissue in the FK506 group showed increased vacuolar degeneration (11.2 vs. 5.8, p=0.008), arterial hyalinosis (10.7 vs. 6.3, p=0.036), transforming growth factor-beta (TGF-P) (12.2 vs. 4.8, p=0.001) and vascular endothelial growth factor expression (VEGF) (10.7 vs. 6.3, p=0.036), elastic van Gieson (11.5 vs. 5.5, p=0.004), and periodic acid Schiff stain scores (12.5 vs. 4.5, p < 0.001) compared to the control group. Immunoihistochemical scores showed that expression of TGF-P is up-regulated, and bone morphogenic protein (BMP-7) is down-regulated with FK506 toxicity.Adding RAS blockade with either an ACE-inhibitor or an ARB could reverse FK506 induced changes. Both FK506+ACE-inhibitors and FK506+ARB groups demonstrated decrease in arterial hyalinosis (22.1 vs. 14.4 (FK5o6+ACE-inhibitor) and 13.6 (FK506+ARB), p=0.09) and vacuolar degeneration (23.1 vs. 16.1 (FK506+ACEinhibitor) and 12.4 (FK506+ARB), p=0.006) scores compared to the FK506 group. Conclusion. Blockade of RAS could reverse the histopathological signs of FK506 induced cardiac toxicity in a rat model.Publication Open Access Acute Renal Failure due to Bladder Injury after Cesarean Section: Case Report and Review of the Literature(TURK NEFROLOJI DIYALIZ TRANSPLANTASYON DERGISI, 2019-11-05) AŞICIOĞLU, EBRU; Atas, Dilek Barutcu; Asicioglu, Ebru; Durgay, Meryem; Arikan, Hakki; Koc, Mehmet; Tuglular, Serhan; Ozener, CetinA 31-year-old woman who had an uncomplicated cesarean section five days prior to admission presented with abdominal distention. Evaluation revealed acute renal failure and abdominal ascites. Diagnostic paracentesis showed urinary ascites, which confirmed a bladder injury. The patient was conservatively treated by placement of a Foley catheter that resulted in complete resolution of the renal failure.Publication Open Access Low bone density, vertebral fracture and FRAX score in kidney transplant recipients: A cross-sectional cohort study(PUBLIC LIBRARY SCIENCE, 2021-04-30) VELİOĞLU, ARZU; Velioglu, Arzu; Kaya, Burcu; Aykent, Basar; Ozkan, Bige; Karapinar, Melis Sevil; Arikan, Hakki; Asicioglu, Ebru; Bugdayci, Onur; Yavuz, Dilek Gogas; Tuglular, SerhanBackground Kidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients. Patients-method Patients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD. Results One hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,511,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024-1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015-0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (>= 20% risk of fracture), and 23.5% had high hip fracture probability (>= 3% risk of hip fracture) according to FRAX. Conclusion Exploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population.Publication Open Access C-reactive protein to albumin ratio is associated with disease activity in anti-neutrophil cytoplasmic antibody associated vasculitis(2023-01-01) ALİBAZ ÖNER, FATMA; DİRESKENELİ, RAFİ HANER; TUĞLULAR, ZÜBEYDE SERHAN; AŞICIOĞLU, EBRU; Atas D. B., Sahin G. K., ŞENGÜL Ş., KAYA B., PAYDAŞ S., ALİBAZ ÖNER F., DİRESKENELİ R. H., TUĞLULAR Z. S., AŞICIOĞLU E.Objective/Aim: C-reactive protein to albumin ratio (CAR) has recently been recognized as an independent prognostic marker for vasculitides. This study aims to investigate CAR and its relationship with disease activity and damage in prevalent ANCA associated vasculitis (AAV) patients. Methods: Fifty-one patients with AAV and 42 age-sex-matched healthy controls were enrolled in this crosssectional study. Birmingham vasculitis score (BVAS) was used to assess vasculitis activity and vasculitis damage index (VDI) to provide information on disease damage. Results: The median (25th-75th) age of the patients were 55 (48-61) years. CAR was significantly higher in AAV patients than controls (1.9±2.7 vs 0.7±0.4; p=0.006). The 75th percentile of BVAS was defined as high BVAS (BVAS≥5) and ROC curve analysis showed that CAR≥0.98 predicted BVAS≥5 with 70.0% sensitivity and 68.0% specificity (AUC:0.660, CI: 0.482-0.837, p=0.049). When patients with CAR≥0.98 were compared to those without, BVAS [5.0 (3.5-8.0) vs. 2.0 (0-3.25), p<0.001], BVAS≥5 [16 (64.0%) vs 4 (15.4%) patients, p:0.001], VDI [4.0 (2.0-4.0) vs. 2.0 (1.0-3.0), p=0.006], and CAR [1.32 (1.07-3.78) vs. 0.75 (0.60-0.83), p<0.001] were higher whereas albumin [3.8 (3.1-4.3) vs. 4.1 (3.9-4.4) g/dL, p=0.025] and haemoglobin [12.1 (10.4-13.4) vs. 13.0 (12.5-14.2) g/dL, p=0.008] were lower. Multivariate analysis revealed that BVAS [OR(95% CI):1.313 (1.003-1.719), p=0.047] was an independent factor associated with CAR≥0.98 in patients with AAV. Furthermore, correlation analysis showed that CAR significantly correlated with BVAS (r: 0.466, p=0.001). Conclusion: In this study, we observed that CAR was significantly associated with disease activity in AAV patients and can be used to monitor disease activityPublication Open Access Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: A multicenter study by the Turkish society of nephrology(PUBLIC LIBRARY SCIENCE, 2021-08-10) ARIKAN, İZZET HAKKI; Arikan, Hakki; Ozturk, Savas; Tokgoz, Bulent; Dursun, Belda; Seyahi, Nurhan; Trabulus, Sinan; Islam, Mahmud; Ayar, Yavuz; Gorgulu, Numan; Karadag, Serhat; Gok, Mahmut; Akcali, Esra; Bora, Feyza; Aydin, Zeki; Altun, Eda; Ahbap, Elbis; Polat, Mehmet; Soypacaci, Zeki; Oguz, Ebru Gok; Koyuncu, Sumeyra; Colak, Hulya; Sahin, Idris; Dolarslan, Murside Esra; Helvaci, Ozant; Kurultak, Ilhan; Eren, Zehra; Dheir, Hamad; Ogutmen, Melike Betul; Taymez, Dilek Guven; Genek, Dilek Gibyeli; Ozkurt, Sultan; Bakir, Elif Ari; Yuksel, Enver; Sahutoglu, Tuncay; Oto, Ozgur Akin; Boz, Gulsah; Sengul, Erkan; Kara, Ekrem; Tuglular, SerhanBackground Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI. Methods In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients. Results The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0-1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04-2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06-2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08-3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05-2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25-3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44-3.51], p = 0.0001) were independent predictors of in-hospital mortality. Conclusions Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.Publication Open Access Favipiravir Use in Kidney Transplant Recipients with COVID-19: A Single-Center Experience(2022-02) TİGEN, ELİF; Kaya, Burcu; Barutcu Atas, Dilek; Tukenmez Tigen, Elif; Asicioglu, Ebru; Arikan, Hakki; Tuglular, Serhan; Velioglu, ArzuPublication Open Access Does colchicine also induce a clearance of the established amyloid deposits?(OXFORD UNIV PRESS, 1999-04-01) TUĞLULAR, ZÜBEYDE SERHAN; Tuglular, S; Bihorac, A; Ozener, IC; Akoglu, EPublication Open Access Distribution, preparedness and management of Ukrainian adult refugees on dialysis - an international survey by the Renal Disaster Relief Task Force of the European Renal Association(2023-10-01) TUĞLULAR, ZÜBEYDE SERHAN; Pawłowicz-Szlarska E., Vanholder R., Sever M. S., TUĞLULAR Z. S., Luyckx V., Eckardt K., Gallego D., Ivanov D., Nistor I., Shroff R., et al.Background: Due to the Russian-Ukrainian war, some of the about 10 000 adults requiring dialysis in Ukraine fled their country to continue dialysis abroad. To better understand the needs of conflict-affected dialysis patients, the Renal Disaster Relief Task Force of the European Renal Association conducted a survey on distribution, preparedness and management of adults requiring dialysis who were displaced due to the war. Methods: A cross-sectional online survey was sent via National Nephrology Societies across Europe and disseminated to their dialysis centers. Fresenius Medical Care shared a set of aggregated data. Results: Data were received on 602 patients dialyzed in 24 countries. Most patients were dialyzed in Poland (45.0%), followed by Slovakia (18.1%), Czech Republic (7.8%) and Romania (6.3%). The interval between last dialysis and the first in the reporting center was 3.1 ± 1.6 days, but was ≥4 days in 28.1% of patients. Mean age was 48.1 ± 13.4 years, 43.5% were females. Medical records were carried by 63.9% of patients, 63.3% carried a list of medications, 60.4% carried the medications themselves and 44.0% carried their dialysis prescription, with 26.1% carrying all of these items and 16.1% carrying none. Upon presentation outside Ukraine, 33.9% of patients needed hospitalization. Dialysis therapy was not continued in the reporting center by 28.2% of patients until the end of the observation period. Conclusions: We received information about approximately 6% of Ukrainian dialysis patients, who had fled their country by the end of August 2022. A substantial proportion were temporarily underdialyzed, carried incomplete medical information and needed hospitalization. The results of our survey may help to inform policies and targeted interventions to respond to the special needs of this vulnerable population during wars and other disasters in the future.Publication Open Access Recommendations for kidney patients in covid-19 era based on current evidence(2022-01-01) VELİOĞLU, ARZU; TUĞLULAR, ZÜBEYDE SERHAN; Ozturk S., VELİOĞLU A., TUĞLULAR Z. S.Patients with chronic kidney disease, patients on dialysis, and kidney transplant recipients are at high risk of mortality and morbidity due to coronavirus disease-19. Most patients with chronic kidney disease are elderly and have other comorbidities. In addition, some of these patients have been exposed to immunosuppressive drugs to treat their underlying primary disease or to prevent allograft rejection. This general profile of chronic kidney disease patients renders them susceptible to a more severe course of coronavirus disease-19 once they are infected with severe acute respiratory syndrome coronavirus 2. Many studies showed that impaired kidney function on admission is an independent risk factor for a more severe course of coronavirus disease-19 with significantly increased risk for hospital and intensive care unit admission, intubation, mechanical ventilation, and death. Coronavirus disease-19 vaccination is crucial to create immunity in the general community, but the evidence addressing this specific population is scarce. However, based on the current evidence, all patients with chronic kidney disease are strongly recommended to receive the available vaccine in their country against coronavirus disease-19, and booster doses will presumably prove necessary for this group of patients. Furthermore, vigilant use of protective measures is strongly recommended for this patient population. Current studies and recommendations from health authorities should be followed closely.