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Author: TUĞLULAR, ZÜBEYDE SERHAN ×

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    Sepsiste serum laktat yüksekliği-sidemi ilişkisinin böbrek fonksiyonları penceresinden incelenmesi
    (2022-12-08) TUĞCU, MURAT; AŞICIOĞLU, EBRU; ARIKAN, İZZET HAKKI; BARUTÇU ATAŞ, DİLEK; TUĞLULAR, ZÜBEYDE SERHAN; VELİOĞLU, ARZU; Karadağ H., Berke Menteşe İ., Barutçu Ataş D., Tuğcu M., Aşıcıoğlu E., Velioğlu A., Tuğlular Z. S. , Arıkan İ. H.
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    Kronik hemodiyaliz hastalarında bnt162b2 ve coronavac’a karşı hümoral yanıt: çok merkezli prospektif kohort çalışması
    (2022-11-09) TUĞLULAR, ZÜBEYDE SERHAN; TUĞCU, MURAT; Mirioğlu Ş., Kazancıoğlu R., Cebeci E., Eren N., Sakacı T., Alagöz S., Tuğcu M., Tuğlular Z. S., Sümbül B., Seyahi N., et al.
    Giriş: Kronik hemodiyaliz (HD) hastalarında SARS-CoV-2 için geliştirilmiş olan inaktif aşılara dair veriler hala sınırlıdır. Bu çalışmada, kronik HD hastalarında CoronaVac’ın uyardığı hümoral yanıtları BNT162b2 ile kıyaslayarak araştırmayı amaçladık. Yöntemler: COVID-19 geçirmemiş ve BNT162b2 veya CoronaVac ile aşılanmayı planlayan erişkin kronik HD hastaları bu çok merkezli prospektif kohorta dahil edildi. Katılımcılardan aşılanmadan önce ve 2 doz aşıdan 1 ile 3 ay sonra serum örnekleri alındı. Virüsün reseptör bağlayıcı bölgesine karşı gelişen anti-SARS-CoV-2 IgG antikorları ölçüldü ve ≥50 AU/ml pozitif kabul edildi. Aşılanmaya rağmen yaşanan COVID-19 enfeksiyonları ve aşıdan sonra gelişen advers olaylar kaydedildi. Bulgular: Doksan iki hasta çalışmaya dahil edildi ve 68’i (% 73.9) başlangıçta seronegatifti. BNT162b2 ve CoronaVac sırasıyla 38 (% 55.9) ve 30 (% 44.1) hastaya uygulandı, bu iki grubun başlangıçtaki özellikleri genel olarak benzerdi (Tablo 1). Birinci ayda seropozitiflik oranı BNT162b2 grubunda % 93.1 iken CoronaVac grubunda % 88’di (p=0.519), antikor seviyeleri ise BNT162b2 grubunda daha yüksekti (p<0.001). Üçüncü ayda seropozitiflik oranı (% 96.4 ile % 78.3, p=0.045) ve antikor seviyeleri (p=0.001) BNT162b2 grubunda CoronaVac’a kıyasla daha yüksek bulundu (Tablo 2). Beş hasta (% 7.4) aşılanmaya rağmen COVID-19 yaşadı ancak hepsi sekelsiz iyileşti. Advers olaylar BNT162b2 ile daha sık görüldü, fakat tamamı hafif seyirliydi. Çoklu lineer regresyon modeli sadece aşı seçiminin (BNT162b2) hümoral yanıtla ilişkili olduğunu gösterdi (β=0.272, p=0.038). Başlangıçta seropozitif olan hastalar (n=24) tüm ölçüm noktalarında daha yüksek antikor seviyelerine sahipti. Sonuç: BNT162b2 ve CoronaVac naif kronik HD hastalarında hümoral yanıtları uyarmaktadır, ancak bu yanıtlar BNT162b2 ile daha güçlü ve uzun ömürlüdür. Her iki aşı da başlangıçta seropozitif olan hastalarda yüksek antikor seviyelerini sağlamaktadır (Bu çalışma Bezmialem Vakıf Üniversitesi Bilimsel Araştırma Projeleri Koordinasyon Birimi tarafından desteklenmiştir. Proje numarası: 20210613)
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    Böbrek Nakli Dirençli Akut Rejeksiyon Tedavisinde Ekulizumab Deneyimi
    (2022-12-08) TUĞCU, MURAT; BARUTÇU ATAŞ, DİLEK; TUĞLULAR, ZÜBEYDE SERHAN; VELİOĞLU, ARZU; Berke Menteşe İ., Barutçu Ataş D., Tuğcu M., Tuğlular Z. S. , Velioğlu A.
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    PublicationOpen Access
    A case of alport syndrome with pregnancy-related atypical hemolytic uremic syndrome, andcrescentic glomerulonephritis
    (2021-05-01) BERKE MENTEŞE, İLAY; TUĞCU, MURAT; VELİOĞLU, ARZU; TUĞLULAR, ZÜBEYDE SERHAN; BERKE MENTEŞE İ., TUĞCU M., VELİOĞLU A., Nazlı İ., TUĞLULAR Z. S.
    BACKGROUND: Thrombotic microangiopathy (TMA) is one of the most important complications in pregnant patients with chronic kidney disease (CKD) causing clinical deterioration. However, little is known about the pregnancy course in women with Alport syndrome (AS). CASE: A 28-week pregnant, 22-year-old woman was admitted to our clinic because of widespread edema. Her medical history was notable only for hearing impairment. On examination, vital signs were normal except for the blood pressure (150/90 mmHg). There were diffuse crackles at the lung bases, and 3þ pitting edema in both legs. Lab results revealed heavy proteinuria with 11 gr/day and isomorphic erythrocytes with granular casts in microscopic urine examination. An emergency c-section was performed due to severe preeclampsia at 30 weeks’ gestation. After delivery, her edema did not improve, serum creatinine and lactate dehydrogenase levels elevated, anemia and thrombocytopenia developed (Table 1). Additional tests revealed negative Coombs test, schistocytes on peripheral smear and normal ADAMTS13 level. There was no pathology in serological studies. She received four sessions of plasmapheresis therapy, and with the diagnosis of aHUS, eculizumab therapy was started. Despite improving thrombocytopenia and anemia, serum creatinine levels continued to rise and her urine output decreased. A kidney biopsy was performed (Figure 1). In the light microscopy, 11 of 15 glomeruli had circumferential cellular crescents and 4 had partial cellular crescents. The sample had no findings consistent with TMA. No staining was seen with IgG, IgA, IgM, C3, C1q, j and k in immunofluorescence.
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    Primr FSGS ve ikinci FSGShastalarında karaciğer yağlanmasının karşılaştırılması
    (2019-10-16) ARIKAN, İZZET HAKKI; AKÇAY, SEÇKİN; TUĞCU, MURAT; VELİOĞLU, ARZU; KOÇ, MEHMET; TUĞLULAR, ZÜBEYDE SERHAN; AŞICIOĞLU, EBRU; Erbatur N. H., ARIKAN İ. H., AKÇAY S., TUĞCU M., VELİOĞLU A., AŞICIOĞLU E., KOÇ M., TUĞLULAR Z. S., ÖZENER İ. Ç.
    Giriş: Fokal segmental glomerüloskleroz (FSGS) çeşitli etiyolojiler sonrasında oluşan, podosit hasarı ve renal kitlede azalmadan kaynaklanan, glomerüllerin bir kısmında (fokal) ve etkilenen glomerülün bir bölümünde (segmental) skleroz ile karakterize histolojik bir lezyondur. FSGS genel olarak primer ve ikincil alt gruplarına ayrılır. Bu alt grupların bazı ortak klinik ve patolojik özellikleri olsa da tedavileri ve prognozları farklıdır ve bu nedenle ayrımları önemlidir. Bu ayrımda en önemli basamak olan elektron mikroskopunun ülkemizde rutin olarak uygulanmaması nedeni ile primer ve ikincil FSGS ayrımı güç olabilmektedir. Non-alkolik yağlı karaciğer hastalığı (NAFLD) ve kronik böbrek hastalığı (KBH) ilişkisi de göz önüne alındığında NAFLD’in ikincil FSGS etiyolojisinde rol oynayabileceği hipotezi kurulmuştur. Bizim çalışmamızın amacı primer ve ikincil FSGS ayrımın zor olduğu durumlarda ve hemodinamik FSGS’nin bilinen nedenlerinin (obezite, uyku apnesi) gösterilemediği durumlarda, tanıya yönlendirme amacı ile ikincil FSGS ile NAFLD arasındaki ilişkiyi araştırmaktır. Yöntem: Çalışmaya Marmara Üniversitesi Eğitim Araştırma Hastanesi’nde 2004 ile 2018 yılları arasında nefroloji bölümünden takipli ve böbrek biyopsisi ile FSGS tanısı alan 73 hasta dahil edildi. 18 yaş altı, ailesel/genetik FSGS, Fabry hastalığı, Virüs ilişkili FSGS, ilaç ilişkili FSGS tanılı hastalar çalışmaya dahil edilmedi. Hastane arşivinden ve elektronik veri sisteminden hastaların demografik özellikleri ve laboratuvar verileri retrospektif olarak toplandı. Nefrotik sendromun tüm komponentlerinin olduğu ve bilinen ikincil bir neden olmayan hastalar primer FSGS, hipoalbüminemi ve ödemi olmayan diğer hastalar ikincil FSGS kabul edildi. Primer ve ikincil FSGS tanılı hastalar demografik, klinik, laboratuvar ve ultrason (USG) ile tanımlanan karaciğer yağlanması açısından karşılaştırıldı. Bulgular: Hastaların 46’sı (%63) erkek, 27’si (%37) kadındı. Hastaların 29’u (%39,7) primer FSGS, 44’ü (%60,3) ikincil FSGS olarak değerlendirildi. Primer FSGS tanılı 2 (%6,9) hastada hepatosteatoz saptandı, 27 hastada (%93,1) ise hepatosteatoz yoktu, ikincil FSGS tanılı 26 (%59,1) hastada hepatosteatoz saptandı, 18 hastada (%40,9) ise hepatosteatoz yoktu. İkincil FSGS tanılı hastalarda hepatosteatoz primer FSGS hastalarına göre daha sık olup anlamlı fark bulunmaktadır. (P<0,001) Sonuç: Çalışmamızda ikincil FSGS tanılı hastalarda karaciğer yağlanmasının, primer FSGS hastalarına göre daha sık görüldüğü bulunmuştur. Bu sonuç NAFLD KBH arasındaki ilişki de göze alındığında NAFLD’ın ikincil FSGS ile ilişkili olabileceğini desteklemektedir. Primer ve ikincil FSGS ayrımı hem elektron mikroskopuna ulaşım güçlüğü hem de bilinen bir biyomarker olmaması nedeni ile zorluğunu korumaktadır. Primer ve ikincil FSGS ayrımın zor olduğu durumlarda ve hemodinamik FSGS’nin bilinen nedenlerinin (obezite, uyku apnesi) gösterileme
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    PublicationOpen Access
    Humoral response to BNT162b2 and coronaVac in patients undergoing maintenance hemodialysis: A multicenter prospective cohort study
    (2023-01-01) TUĞCU, MURAT; TUĞLULAR, ZÜBEYDE SERHAN; MİRİOĞLU Ş., KAZANCIOĞLU R., Cebeci E., EREN N., Sakaci T., Alagoz S., Tugcu M., TUĞLULAR Z. S., SÜMBÜL B., Seyahi N., et al.
    Introduction: Data regarding inactivated vaccines for SARS-CoV-2 in patients undergoing maintenance hemodialysis (MHD) are limited. We aimed to investigate humoral responses induced by CoronaVac compared to BNT162b2 in this population. Methods: In this multicenter prospective cohort study, adult patients undergoing MHD who lacked a history of COVID-19 and decided to get vaccinated with BNT162b2 or CoronaVac were enrolled. Participants provided serum samples before, 1 and 3 months after 2 doses. Anti-SARS-CoV-2 IgG antibodies against receptor-binding domain of the virus were measured, and levels >= 50 AU/mL were considered as positive. Breakthrough infections and adverse events were recorded. Results: Ninety-two patients were included, 68 (73.9%) of whom were seronegative at baseline. BNT162b2 and CoronaVac were administered in 38 (55.9%) and 30 (44.1%) patients. At 1 month, seropositivity was 93.1% in BNT162b2 and 88% in CoronaVac groups (p = 0.519). Quantitative antibody levels were significantly higher in BNT162b2 (p < 0.001). At 3 months, both seropositivity (96.4% and 78.3%, p = 0.045) and antibody levels (p = 0.001) remained higher in BNT162b2 compared to CoronaVac. Five patients (7.4%) experienced breakthrough COVID-19. Adverse events were more frequent with BNT162b2, although all of them were mild. Multiple linear regression model showed that only vaccine choice (BNT162b2) was related to the humoral response (beta = 0.272, p = 0.038). Seropositive patients at baseline (n = 24) had higher antibody levels at any time point. Conclusions: BNT162b2 and CoronaVac induced humoral responses in naive patients undergoing MHD, which were more robust and durable for 3 months after BNT162b2. Both vaccines created high antibody levels in patients who were seropositive at baseline.
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    Kronik böbrek hastalığı olan yaşlı hastalarda mortalite belirteci: Prognostik beslenme indeksi
    (2021-09-22) TUĞCU, MURAT; VELİOĞLU, ARZU; ARIKAN, İZZET HAKKI; KOÇ, MEHMET; BARUTÇU ATAŞ, DİLEK; TUĞLULAR, ZÜBEYDE SERHAN; AŞICIOĞLU, EBRU; BARUTÇU ATAŞ D., TUĞCU M., AŞICIOĞLU E., VELİOĞLU A., ARIKAN İ. H., KOÇ M., TUĞLULAR Z. S.
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    The relationship between perceived stress with anxiety, depression, sleep quality, insomnia and drug adherence in patients with systemic lupus erythematosus during the covid-19 pandemic
    (2022-05-01) DİRESKENELİ, RAFİ HANER; BARUTÇU ATAŞ, DİLEK; ARIKAN, İZZET HAKKI; GÖKMEN YILDIRIM, KARDELEN; VELİOĞLU, ARZU; ALİBAZ ÖNER, FATMA; TUĞLULAR, ZÜBEYDE SERHAN; AŞICIOĞLU, EBRU; TUĞCU, MURAT; GÖKMEN YILDIRIM K., BARUTÇU ATAŞ D., TUĞCU M., VELİOĞLU A., ARIKAN İ. H., ALİBAZ ÖNER F., DİRESKENELİ R. H., TUĞLULAR Z. S., AŞICIOĞLU E.
    AIMS: Sleep disorders, depression and anxiety are commonly reported in patients with systemic lupus erythematosus (SLE). Public health emergencies such as pandemics can also increase these psychosocial distresses. Early diagnosis and treatment of these disorders will substantially affect patients' quality of life and medication adherence. The aim of this study was to evaluate both medication non-adherence and the incidence of perceived stress, anxiety, depression, sleep quality and insomnia during the COVID pandemic in patients with SLE. METHOD: This was a cross-sectional, descriptive survey study. A total of 211 participants, including 160 SLE patients aged 18 years and older and 51 healthy volunteers who were similar in age and gender, were included. A questionnaire of socio-demographics and COVID-19 status, Medication Compliance Reporting Scale (MARS-5), Perceived Stress Scale (PSS), Hospital Anxiety and Depression Scale (HADA and HAD-D), Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) scales was assessed. The participants were interviewed face to face, and the answers were recorded by the researcher. RESULTS: The mean age of the patients was 41.85 ± 12.97 years and 142 (88.7%) of the patients were female. There was no significant difference between the patient and control groups in terms of the history of COVID-19 infection, symptoms and hospitalization. Fifty-nine (36.9%) patients had high perceived stress, 16 (10.0%) had anxiety, 45 (28.1%) had depression, 77 (48.1%) had poor sleep quality and 62 (38.8%) patients had insomnia. PSS (23.64 ± 7.86 versus 19.73 ± 4.80, P = .001), HAD-D (5.60 ± 3.40 versus 4.08 ± 2.21, P = .003), PSQI (6.31 ± 3.62 versus 4.43 ± 2.20, P = .001) and ISI (6.81 ± 4.98 versus 4.53 ± 2.83, P = .002) scores were significantly higher in the patient group than controls. Patients with PSS score ≥ 25 were categorized as patients with a high PSS score. Presence of anxiety, depression, poor sleep quality and insomnia were significantly higher in patients with a high PSS score. Medication non-adherence was detected in 79 (49.4%) of the patients. Interestingly, there was no difference in MARS-5 scores between high and low PSS groups. Comparison of baseline characteristics and clinical data of the patients according to PSS score is shown in Table 1. The high PSS score was positively correlated with HAD-A, HAD-D, PSQI and ISI scores. Regression analysis revealed that high perceived stress is an independent predictor of depression [Exp(β) 95% CI 1.488 (1.245-1.779), P < .001], and anxiety [Exp(β) 95% CI 1.235 (1.026-1.487), P = .026]. CONCLUSION: SLE patients demonstrated increased levels of perceived stress, depression, poor sleep quality and insomnia compared to the healthy population during the COVID-19 pandemic. SLE patients with high perceived stress had more depression, anxiety, poor sleep quality and insomnia than those without. It needs to be determined whether these findings will have an impact on patient outcomes during long-term follow-up. Palavras-chave adult; anxiety; conference abstract; controlled study; coronavirus disease 2019; depression; female; follow up; gender; Hospital Anxiety and Depression Scale; hospitalization; human; incidence; insomnia; Insomnia Severity Index; major clinical study; male; medication compliance; outcome assessment; pandemic; Perceived Stress Scale; physiological stress; Pittsburgh Sleep Quality Index; questionnaire; sleep quality; sociodemographics; systemic lupus erythematosus; young adult
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    PublicationOpen Access
    Resilience and challenges of peritoneal dialysis survivors in the aftermath of the 2023 Kahramanmaraş earthquake
    (2024-01-01) TUĞCU, MURAT; TUĞLULAR, ZÜBEYDE SERHAN; Sahutoglu T., Danis R., Pembegul I., Ozturk I., Huzmeli C., Tugcu M., Oguz E. G., BORA F., Islam M., Ayar Y., et al.
    Introduction: Peritoneal dialysis (PD) remains understudied in disaster nephrology. This retrospective multicenter study explores the experiences of PD survivors following the February 6, 2023, Kahramanmaraş Earthquake. Methods: Adult PD patients from 11 affected cities were analyzed to assess challenges faced during and postearthquake, alongside clinical outcomes. Results: Among 101 participants (median age: 45 years, median PD duration: 24 months), 57 were female, with 79 on continuous ambulatory PD. Challenges included power outages and water shortages, with primary shelter in kin\"s houses (33%) and homes (28%). Twelve patients experienced PD program delays, and three lacked assistance postdisaster. Sixteen patients changed PD modalities, with seven experiencing postearthquake peritonitis. Clinical parameters remained stable, except for a slight decrease in hemoglobin levels. Conclusion: Despite challenges, PD survivors exhibited resilience, highlighting the importance of addressing peritonitis and unusual pathogens in disaster preparedness initiatives.
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    PublicationOpen Access
    Sarcopenia predicts mortality in renal transplant candidates
    (2022-05-01) BARUTÇU ATAŞ, DİLEK; ARIKAN, İZZET HAKKI; ÇOBAN, HARUN; AŞICIOĞLU, EBRU; ÇİMŞİT, CANAN; VELİOĞLU, ARZU; TUĞCU, MURAT; TUĞLULAR, ZÜBEYDE SERHAN; KURŞUN, MELTEM; ÇOBAN H., BARUTÇU ATAŞ D., KURŞUN M., TUĞCU M., AŞICIOĞLU E., ARIKAN İ. H., Cimsit C., TUĞLULAR Z. S., VELİOĞLU A.
    BACKGROUND AND AIMS: Sarcopenia is common in chronic kidney disease (CKD) and is associated with increased mortality and morbidity. Sarcopenia in CKD can be defined as a decreased muscle mass, mainly due to the catabolic state caused by the uremic environment. Malnutrition and inflammation are also common in sarcopenic patients. In this study, we aimed to investigate the prevalence of sarcopenia defined as low muscle mass determined by Psoas Muscle Index (PMI) in waitlisted end-stage renal disease (ESRD) patients and its association between ‘Prognostic Nutritional Index (PNI)’, ‘C-reactive protein (CRP) to Albumin Ratio (CAR)’ and mortality. METHOD: ESRD patients registered to national kidney transplant waiting list and had abdomen CT at admission were included in the study. Kidney donor candidates were constituted as healthy controls. PMI (cm2/m2) were calculated by proportioning the psoas muscle area detected in the abdomen CT with the square of the height. The PMI of the controls at the fifth percentile according to gender was accepted as the limit value for sarcopenia. PNI and CAR were calculated using albumin, CRP and absolute lymphocyte count. The associations between PMI, PNI, CAR and all-cause mortality were investigated. RESULTS: A total of 162 ESRD patients and 87 age matched healthy controls were included in the study. The mean age of the patients was 44.7 ± 14.2 years and followup time was 3.37 (0.35–9.60) years. The mean PMI were similar between the groups (5.24 ± 1.71 versus 5.48 ± 1.87 cm2/m2, P = 0.302). While prevalence of sarcopenia (16.7% versus 3.4%, P = 0.002) and CAR [1.47 (0.12–37.10) versus 0.74 (0.21–10.20), P < 0.001] was higher; PNI [40 (20.4–52.2) versus 44 (36.1–53.0), P < 0.001] was lower in ESRD patients than controls. When ESRD patients compared according to sarcopenia PMI [3.45 ± 0.9 versus 5.59 ± 1.6, P < 0.001] and PNI [39 (20.4–51) versus 41 (23–52.2), P = 0.005] was significantly lower and CAR [2.03 (0.28–34.65) versus 1.28 (0.12–37.1), P = 0.041] was higher in sarcopenic ESRD group than nonsarcopenic ESRD group (Table 1). In the correlation analysis, PMI was positively correlated with PNI (r = 0.246, P = 0.002), no correlated with CAR (r = −0.061, P = 0.445). In the follow-up, 67 waitlisted patients had been transplanted. In the five-year survival analysis, the non-sarcopenic transplant group [95% CI: 4.612–5.123 versus 95% CI: 2.721–5.413, P = 0.001] had better survival than sarcopenic transplant group (Figure 1). Mortality rates were similar in both sarcopenic transplant group and non-sarcopenic-non-transplant group. Multivariate regression analysis showed that sarcopenia (HR: 10.277, 95% CI: 3.912–27.000, P < 0.001), not having a transplant (HR: 3.949, 95% CI: 1.301–11.993, P = 0.015), low PNI (HR: 3.532, 95% CI: 1.303– 9.574, P = 0.013) and duration of renal replacement therapy (HR: 1.009, 95% CI: 1.002–1.015, P = 0.008) were independent risk factors for mortality in all ESRD group. CONCLUSION: In this study we observed that sarcopenia, as defined by low muscle mass, is almost seen five times more frequent in ESRD patients than controls and positively correlated wit