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Doğan ÇS, Taner S, Tiryaki BD, Alaygut D, Özkayın N, Kara A, Gençler A, Pınarbaşı AS, Nalçacıoğlu H, Yüksel S, Akacı O, Yılmaz EK, Yavuz S, Doğan K, Gülşan RYÇ, Aksoy GK, Çiçek N, Aksu B, Küçük N, Altugan FŞ, Selçuk ŞZ, Baştuğ F, Erfidan G, Atmış B, Gökçeoğlu AU, Önder ENA, Elmacı AM, Cengiz N, Gülleroğlu K, Yılmaz EB, Tayfur AÇ, Yılmaz GG, Yel Sİ, Pehlivanoğlu C, Akgün C, Kara MA, Kılıç BD, Şimşek ÖÖ, Yucal M, Ağar BE, Gürgöze MK, Yağmur İ, Madsar Ö, Karalı DT, Girişgen İ, Bodur ED, Çomak E, Gökçe İ, Kaya M, Tabel Y, Günay N, Gülmez R, Çalışkan S. Characteristics and predictors of chronic kidney disease in children with myelomeningocele: a nationwide cohort study. Pediatr Nephrol 2024; 39:1509-1519. [PMID: 38040872 DOI: 10.1007/s00467-023-06212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Myelomeningocele (MMC) is highly prevalent in developing countries, and MMC-related neurogenic bladder is an important cause of childhood chronic kidney disease (CKD). This nationwide study aimed to evaluate demographic and clinical features of pediatric patients with MMC in Turkey and risk factors associated with CKD stage 5. METHODS Data from children aged 0-19 years old, living with MMC in 2022, were retrospectively collected from 27 pediatric nephrology centers. Patients > 1 year of age without pre-existing kidney abnormalities were divided into five groups according to eGFR; CKD stages 1-5. Patients on dialysis, kidney transplant recipients, and those with eGFR < 15 ml/min/1.73 m2 but not on kidney replacement therapy at time of study constituted the CKD stage 5 group. RESULTS A total of 911 (57.8% female) patients were enrolled, most of whom were expectantly managed. Stages 1-4 CKD were found in 34.3%, 4.2%, 4.1%, and 2.4%, respectively. CKD stage 5 was observed in 5.3% of patients at median 13 years old (range 2-18 years). Current age, age at first abnormal DMSA scan, moderate-to-severe trabeculated bladder on US and/or VCUG, and VUR history were independent risk factors for development of CKD stage 5 (OR 0.752; 95%; CI 0.658-0.859; p < 0.001; OR 1.187; 95% CI 1.031-1.367; p = 0.017; OR 10.031; 95% CI 2.210-45.544; p = 0.003; OR 2.722; 95% CI 1.215-6.102; p = 0.015, respectively). Only eight CKD stage 5 patients underwent surgery related to a hostile bladder between 1 and 15 years old. CONCLUSION MMC-related CKD is common in childhood in Turkey. A proactive approach to neurogenic bladder management and early protective surgery in selected cases where conservative treatment has failed should be implemented to prevent progressive kidney failure in the pediatric MMC population in our country.
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Affiliation(s)
- Çağla Serpil Doğan
- Division of Pediatric Nephrology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey.
| | - Sevgin Taner
- Division of Pediatric Nephrology, Adana City Hospital, Adana, Turkey
| | - Betül Durucu Tiryaki
- Division of Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Demet Alaygut
- Division of Pediatric Nephrology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Neşe Özkayın
- Division of Pediatric Nephrology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Aslıhan Kara
- Division of Pediatric Nephrology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Aylin Gençler
- Division of Pediatric Nephrology, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
| | - Ayşe Seda Pınarbaşı
- Division of Pediatric Nephrology, Diyarbakır Children's Hospital, Diyarbakır, Turkey
| | - Hülya Nalçacıoğlu
- Division of Pediatric Nephrology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Selçuk Yüksel
- Division of Pediatric Nephrology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Okan Akacı
- Division of Pediatric Nephrology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Esra Karabağ Yılmaz
- Division of Pediatric Nephrology, Cerrahpaşa Medical Faculty, İstanbul University - Cerrahpaşa, İstanbul, Turkey
| | - Sevgi Yavuz
- Division of Pediatric Nephrology, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Kenan Doğan
- Division of Pediatric Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Rumeysa Yasemin Çiçek Gülşan
- Division of Pediatric Nephrology, University of Health Sciences, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Gülşah Kaya Aksoy
- Division of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Neslihan Çiçek
- Division of Pediatric Nephrology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Bağdagül Aksu
- Division of Pediatric Nephrology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Nuran Küçük
- Division of Pediatric Nephrology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Fatma Şemsa Altugan
- Division of Pediatric Nephrology, University of Health Sciences, Bilkent City Hospital, Ankara, Turkey
| | - Şenay Zırhlı Selçuk
- Division of Pediatric Nephrology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Funda Baştuğ
- Division of Pediatric Nephrology, Kayseri City Hospital, Kayseri, Turkey
| | - Gökçen Erfidan
- Division of Pediatric Nephrology, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| | - Bahriye Atmış
- Division of Pediatric Nephrology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Arife Uslu Gökçeoğlu
- Division of Pediatric Nephrology, Faculty of Medicine, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | | | - Ahmet Mithat Elmacı
- Division of Pediatric Nephrology, Faculty of Medicine, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Nurcan Cengiz
- Division of Pediatric Nephrology, Faculty of Medicine, Sıtkı Koçman University, Muğla, Turkey
| | - Kaan Gülleroğlu
- Division of Pediatric Nephrology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Ebru Bekiroğlu Yılmaz
- Division of Pediatric Nephrology, University of Health Sciencies, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Aslı Çelebi Tayfur
- Division of Pediatric Nephrology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | | | - Sİbel Yel
- Division of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Cemile Pehlivanoğlu
- Division of Pediatric Nephrology, Faculty of Medicine, Koç University, İstanbul, Turkey
| | - Cihangir Akgün
- Division of Pediatric Nephrology, Faculty of Medicine, İstanbul Medipol University, İstanbul, Turkey
| | - Mehtap Akbalık Kara
- Division of Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | | | - Özgür Özdemir Şimşek
- Division of Pediatric Nephrology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Melike Yucal
- Division of Pediatric Nephrology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Buket Esen Ağar
- Division of Pediatric Nephrology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Metin Kaya Gürgöze
- Division of Pediatric Nephrology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - İsmail Yağmur
- Division of Pediatric Urology, Faculty of Medicine, Harran University, Urfa, Turkey
| | - Ömer Madsar
- Department of Urology, Faculty of Medicine, Harran University, Urfa, Turkey
| | - Demet Tekcan Karalı
- Division of Pediatric Nephrology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - İlknur Girişgen
- Division of Pediatric Nephrology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ece Demirci Bodur
- Division of Pediatric Nephrology, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Elif Çomak
- Division of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - İbrahim Gökçe
- Division of Pediatric Nephrology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Mehtap Kaya
- Division of Pediatric Nephrology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Yılmaz Tabel
- Division of Pediatric Nephrology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Neslihan Günay
- Division of Pediatric Nephrology, Kayseri City Hospital, Kayseri, Turkey
| | - Rüveyda Gülmez
- Division of Pediatric Nephrology, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| | - Salim Çalışkan
- Division of Pediatric Nephrology, Cerrahpaşa Medical Faculty, İstanbul University - Cerrahpaşa, İstanbul, Turkey
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Zırhlı Selçuk Ş, Taner Elmas A, Tabel Y. Crush Syndrome of Children in Kahramanmaraş Earthquake: A Single Center Experience in Malatya. Turk Arch Pediatr 2024; 59:200-204. [PMID: 38454230 DOI: 10.5152/turkarchpediatr.2024.23276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Natural disasters cause enormous environmental, economic, and human losses. Children are the most vulnerable group and face severe consequences. While the primary cause of post-traumatic death is direct injury, the secondary cause is crush syndrome (CS). In this study, we aimed to share our experience in the management of children with CS during disasters by evaluating the clinical and laboratory outcomes of a group of 26 paediatric patients. MATERIALS AND METHODS Age, weight, length of time under rubble, laboratory results, and characteristics of crush injuries were assessed in 26 paediatric patients admitted to the emergency department after the earthquake. Diagnostic criteria for CS were established and the need for dialysis, hyperbaric oxygen or amputation and its determinants were assessed. RESULTS Crush syndrome was observed in 10 of the 26 patients. Significant differences in creatinine, aspartate aminotransferase, alanine aminotransferase, creatine kinase, hematocrit, pH, HCO3, and myoglobin levels were observed between patients with and without CS. None of the individuals rescued from the rubble within the first 6 hours had symptoms associated with CS. These 10 patients who developed CS were rescued within the first 48 hours of the earthquake, while 2 siblings were rescued after 81 hours and did not develop CS. CONCLUSION The fact that the children were rescued from the rubble after 81 hours without developing CS shows the importance of patience in rescue operations. In addition, the very cold weather conditions during this earthquake may have prevented the development of dehydration and acute kidney injury and reduced the possibility of CS.
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Affiliation(s)
| | - Ahmet Taner Elmas
- Department of Pediatric Nephrology, University of İnönü, Malatya, Turkey
| | - Yılmaz Tabel
- Department of Pediatric Nephrology, University of İnönü, Malatya, Turkey
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Bakkaloğlu SA, Delibaş A, Sürmeli Döven S, Taner S, Yavuz S, Erfidan G, Danacı Vatansever E, Aynacı F, Yilmaz K, Taşdemir M, Akacı O, Akıncı N, Güven S, Çiçek N, Dursun I, Keleşoğlu E, Sancaktar M, Alaygut D, Saygılı S, Yavaşcan Ö, Yılmaz A, Gülleroğlu K, Ertan P, Demir BK, Poyrazoğlu H, Pınarbaşı S, Gençler A, Baştuğ F, Günay N, Çeleğen K, Noyan A, Parmaksız G, Avcı B, Çaycı FŞ, Bayrakçı U, Özlü SG, Aksoy ÖY, Yel S, İnal GA, Köse S, Bayazıt AK, Atmış B, Sarıbaş E, Çağlı Ç, Tabel Y, Elmas AT, Zırhlı Selçuk Ş, Demircioğlu Kılıç B, Akbalık Kara M, Büyükçelik M, Balat A, Durucu Tiryaki B, Erdoğdu B, Aksu B, Mahmudova G, Dursun H, Candan C, Göknar N, Mutlubaş F, Çamlar SA, Başaran C, Akbulut BB, Düzova A, Gülhan B, Oruç Ç, Peru H, Alpay H, Türkkan ÖN, Gülmez R, Çelakıl M, Doğan K, Bilge I, Pehlivanoğlu C, Büyükkaragöz B, Leventoğlu E, Alpman N, Zeybek C, Tülpar S, Çiçek Gülşan RY, Kara A, Gürgöze MK, Önder Akyol EN, Özdemir Atikel Y, Pul S, Sönmez F, Yıldız G, Akman S, Elmacı M, Küçük N, Yüksel S, Kavaz A, Nalçacıoğlu H, Alparslan C, Dinçel N, Elhan AH, Sever L. Pediatric kidney care experience after the 2023 Turkey/Syria earthquake. Nephrol Dial Transplant 2024:gfae033. [PMID: 38327222 DOI: 10.1093/ndt/gfae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND/AIMS Two earthquakes on February 6th, 2023 destroyed ten cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related-acute kidney injury (Crush-AKI) and death. METHOD A web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were asked. RESULTS 903 injured children (median age: 11.62 years) were evaluated. Mean TUR was 13 h (Interquartile range-IQR: 32.5), max 240 h). 31 of 32 patients with a TUR of >120 h survived. The patient who rescued after ten days survived.Two-thirds of the patients were given 50 mEq/L sodium-bicarbonate in 0.45% sodium-chloride solution on admission day. 58% of patients were given intravenous fluid (IVF) at a volume of 2000-3000 mL/m2 body surface area (BSA), 40% of 3000-4000 mL/m2 BSA, and only 2% of >4000 mL/m2 BSA. 425 patients had surgeries, 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively.Crush-AKI developed in 314 patients (36% of all patients). 189 patients were dialyzed. Age > 15 years, creatine phosphokinase (CK)≥20 950 U/L, TUR≥10 h, and the first-day IVF volume < 3000-4000 mL/m2 BSA were associated with Crush-AKI development. 22 deaths were recorded, 20 of 22 occurred in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived. CONCLUSIONS This is the most extensive pediatric kidney disaster data after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of >20 950 U/L, but not with death. Adolescent age and initial IVF of less than 3000-4000 mL/m2 BSA were also asscoiated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days.
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Affiliation(s)
- Sevcan A Bakkaloğlu
- Gazi University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Ali Delibaş
- Mersin University, Faculty of Medicine, Department of Pediatric Nephrology, Mersin, Türkiye
| | - Serra Sürmeli Döven
- Mersin University, Faculty of Medicine, Department of Pediatric Nephrology, Mersin, Türkiye
| | - Sevgin Taner
- Adana City Hospital, Pediatric Nephrology Unit, Adana, Türkiye
| | - Sevgi Yavuz
- Başakşehir Çam ve Sakura City Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Gökçen Erfidan
- Diyarbakır Gazi Yaşargil Hospital, Pediatric Nephrology Unit, Diyarbakır, Türkiye
| | | | - Fatma Aynacı
- Mersin City Hospital, Pediatric Nephrology Unit, Mersin, Türkiye
| | - Kenan Yilmaz
- Şanlıurfa Training Hospital, Pediatric Nephrology Unit, Şanlıurfa, Türkiye
| | - Mehmet Taşdemir
- İstinye University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Okan Akacı
- Bursa Yüksek İhtisas Hospital, Pediatric Nephrology Unit, Bursa, Türkiye
| | | | - Serçin Güven
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Neslihan Çiçek
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Ismail Dursun
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Emre Keleşoğlu
- İstanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | | | - Demet Alaygut
- SBÜ İzmir Tepecik Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Seha Saygılı
- İstanbul University - Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Önder Yavaşcan
- İstanbul Medipol University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Alev Yılmaz
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Kaan Gülleroğlu
- Başkent University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Pelin Ertan
- Manisa Celal Bayar University, Faculty of Medicine, Department of Pediatric Nephrology, Manisa, Türkiye
| | - Belde Kasap Demir
- İzmir Katip Çelebi University, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Hakan Poyrazoğlu
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Seda Pınarbaşı
- Diyarbakır Children's Hospital, Pediatric Nephrology Unit, Diyarbakır, Türkiye
| | - Aylin Gençler
- Harran University, Faculty of Medicine, Department of Pediatric Nephrology, Şanlıurfa, Türkiye
| | - Funda Baştuğ
- Kayseri City Hospital, Pediatric Nephrology Unit, Kayseri, Türkiye
| | - Neslihan Günay
- Kayseri City Hospital, Pediatric Nephrology Unit, Kayseri, Türkiye
| | - Kübra Çeleğen
- Kayseri City Hospital, Pediatric Nephrology Unit, Kayseri, Türkiye
| | - Aytül Noyan
- Başkent University, Adana Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | - Gönül Parmaksız
- Başkent University, Adana Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | - Begüm Avcı
- Başkent University, Adana Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | | | - Umut Bayrakçı
- Bilkent City Hospital, Pediatric Nephrology Unit, Ankara, Türkiye
| | - Sare Gülfem Özlü
- Bilkent City Hospital, Pediatric Nephrology Unit, Ankara, Türkiye
| | | | - Sibel Yel
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Güldane Aylin İnal
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Seçil Köse
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Aysun Karabay Bayazıt
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Bahriye Atmış
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Emel Sarıbaş
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Çağla Çağlı
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Yılmaz Tabel
- İnönü University, Faculty of Medicine, Department of Pediatric Nephrology, Malatya, Türkiye
| | - Ahmet Taner Elmas
- İnönü University, Faculty of Medicine, Department of Pediatric Nephrology, Malatya, Türkiye
| | - Şenay Zırhlı Selçuk
- İnönü University, Faculty of Medicine, Department of Pediatric Nephrology, Malatya, Türkiye
| | | | - Mehtap Akbalık Kara
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Mithat Büyükçelik
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Ayşe Balat
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Betül Durucu Tiryaki
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Bilge Erdoğdu
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Bağdagül Aksu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Günay Mahmudova
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Hasan Dursun
- SBÜ Prof. Dr Cemil Taşçıoğlu City Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Cengiz Candan
- İstanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Nilüfer Göknar
- İstanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Fatma Mutlubaş
- SBÜ İzmir Tepecik Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Seçil Arslansoyu Çamlar
- SBÜ İzmir Tepecik Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Cemaliye Başaran
- İzmir Tepecik Hospital, Pediatric Nephrology Unit, İzmir, Türkiye
| | - Burcu Bulum Akbulut
- Acıbadem University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Ali Düzova
- Hacettepe University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Bora Gülhan
- Hacettepe University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Çiğdem Oruç
- Hacettepe University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Harun Peru
- Selçuk University, Faculty of Medicine, Department of Pediatric Nephrology, Konya, Türkiye
| | - Harika Alpay
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Özde Nisa Türkkan
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Rüveyda Gülmez
- İstanbul University - Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Mehtap Çelakıl
- Sakarya University, Faculty of Medicine, Department of Pediatric Nephrology, Sakarya, Türkiye
| | - Kenan Doğan
- Kocaeli University, Faculty of Medicine, Department of Pediatric Nephrology, Kocaeli, Türkiye
| | - Ilmay Bilge
- Koç University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Cemile Pehlivanoğlu
- Koç University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Bahar Büyükkaragöz
- Gazi University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Emre Leventoğlu
- Gazi University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Nuray Alpman
- Gülhane Hospital, Pediatric Nephrology Unit, Ankara, Türkiye
| | - Cengiz Zeybek
- SBÜ Gülhane Hospital, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Sebahat Tülpar
- Bakırköy Dr Sadi Konuk Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | | | - Aslıhan Kara
- Fırat University, Faculty of Medicine, Department of Pediatric Nephrology, Elazığ, Türkiye
| | - Metin Kaya Gürgöze
- Fırat University, Faculty of Medicine, Department of Pediatric Nephrology, Elazığ, Türkiye
| | | | | | - Serim Pul
- Ümraniye Training and Research Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Ferah Sönmez
- Bezm-i Alem University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Gizem Yıldız
- Dokuz Eylül University, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Sema Akman
- Akdeniz University, Faculty of Medicine, Department of Pediatric Nephrology, Antalya, Türkiye
| | - Midhat Elmacı
- Karamanoğlu Mehmetbey University, Faculty of Medicine, Department of Pediatric Nephrology, Karaman, Türkiye
| | - Nuran Küçük
- Kartal Dr Lütfi Kırdar City Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Selçuk Yüksel
- Çanakkale Onsekiz Mart University, Faculty of Medicine, Department of Pediatric Nephrology, Çanakkale, Türkiye
| | - Aslı Kavaz
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Nephrology, Eskişehir, Türkiye
| | - Hülya Nalçacıoğlu
- Ondokuz Mayıs University, Faculty of Medicine, Department of Pediatric Nephrology, Samsun, Türkiye
| | - Caner Alparslan
- İzmir Demokrasi University, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Nida Dinçel
- SBÜ İzmir Dr Behçet Uz Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Atilla H Elhan
- Ankara University, School of Medicine Department of Biostatistics, Ankara, Turkey
| | - Lale Sever
- İstanbul University - Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
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4
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Kısaarslan AP, Çiçek SÖ, Batu ED, Şahin S, Gürgöze MK, Çetinkaya SB, Ekinci MK, Atmış B, Barut K, Adrovic A, Ağar BE, Şahin N, Demir F, Bağlan E, Kara MA, Selçuk ŞZ, Özdel S, Çomak E, Akkoyunlu B, Yener GO, Yıldırım DG, Öztürk K, Yıldız M, Haşlak F, Şener S, Kısaoğlu H, Baba Ö, Kızıldağ Z, İşgüder R, Çağlayan Ş, Bilgin RBG, Aytaç G, Yücel BB, Tanatar A, Sönmez HE, Çakan M, Kara A, Elmas AT, Kılıç BD, Ayaz NA, Kasap B, Acar BÇ, Ozkaya O, Yüksel S, Bakkaloğlu S, Aydoğ Ö, Aksu G, Akman S, Dönmez O, Bülbül M, Büyükçelik M, Tabel Y, Sözeri B, Kalyoncu M, Bilginer Y, Poyrazoğlu MH, Ünsal E, Kasapçopur Ö, Özen S, Düşünsel R. Neuropsychiatric involvement in juvenile-onset systemic lupus erythematosus: A multicenter study. Joint Bone Spine 2023; 90:105559. [PMID: 36858168 DOI: 10.1016/j.jbspin.2023.105559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Neuropsychiatric (NP) involvement is a restricted area in juvenile-onset systemic lupus erythematosus (jSLE). AIM To investigate the prevalence, demographic and clinical features, and outcomes of the neurological involvement in the Turkish jSLE population. METHODS This study was based upon 24 referral centers' SLE cohorts, multicenter and multidisciplinary network in Turkey. Patient data were collected by a case report form which was standardized for NP definitions according to American Collage of Rheumatology (ACR). Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) neuropsychiatric part was used to determine NP damage. Variables were evaluated Ward's hierarchical clustering analyses, univariate, and multivariate logistic regression analyses. RESULTS A hundred forty-nine of 1107 jSLE patients had NP involvement (13.5%). The most common NPSLE findings were headache (50.3%), seizure (38.3%), and acute confusional state (33.6%). Five clusters were identified with all clinical and laboratory findings. The first two clusters involved neuropathies, demyelinating diseases, aseptic meningitis, and movement disorder. Cluster 3 involved headache, activity markers and other SLE involvements. Idiopathic intracranial hypertension, cerebrovascular disease, cognitive dysfunction, psychiatric disorders and SLE antibodies were in the fourth, and acute confusional state was in the fifth cluster. In multivariate analysis, APA positivity; OR: 2.820, (%95CI: 1.002-7.939), P: 0,050, plasmapheresis; OR: 13.804 (%95CI: 2.785-68.432), P: 0,001, SLEDAI scores; OR: 1.115 (%95CI: (1.049-1.186), P: 0,001 were associated with increased risk for neurologic sequelae. CONCLUSION We detected the prevalence of juvenile NPSLE manifestations in Turkey. We have identified five clusters that may shed light pathogenesis, treatment and prognosis of NP involvements. We also determined risk factors of neurological sequelae. Our study showed that new definitions NP involvements and sequelae for childhood period are needed.
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Affiliation(s)
| | | | - Ezgi D Batu
- Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sezgin Şahin
- Pediatric Rheumatology, Cerrahpasa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Metin K Gürgöze
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Fırat University, Elazıg, Turkey
| | | | | | - Bahriye Atmış
- Pediatric Nephrology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Kenan Barut
- Pediatric Rheumatology, Cerrahpasa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Amra Adrovic
- Pediatric Rheumatology, Cerrahpasa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Buket Esen Ağar
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Fırat University, Elazıg, Turkey
| | - Nihal Şahin
- Pediatric Rheumatology, Derince Educational and Research Hospital, Kocaeli, Turkey
| | - Ferhat Demir
- Pediatric Rheumatology, Acıbadem Hospital, Istanbul, Turkey
| | - Esra Bağlan
- Pediatric Rheumatology, Doctor Sami-Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Turkey
| | - Mehtap Akbalık Kara
- Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Şenay Zırhlı Selçuk
- Pediatric Nephrology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Semanur Özdel
- Pediatric Rheumatology, Doctor Sami-Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Turkey
| | - Elif Çomak
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Betül Akkoyunlu
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Gülçin Otar Yener
- Pediatric Rheumatology, Şanlıurfa Research and Training Hospital, Şanlıurfa, Turkey
| | | | - Kübra Öztürk
- Pediatric Rheumatology, Istanbul Medeniyet University, Göztepe Professor Doctor Süleyman-Yalçın City Hospital, İstanbul, Turkey
| | - Mehmet Yıldız
- Pediatric Rheumatology, Cerrahpasa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Fatih Haşlak
- Pediatric Rheumatology, Cerrahpasa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Seher Şener
- Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hakan Kısaoğlu
- Pediatric Rheumatology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Özge Baba
- Pediatric Rheumatology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Zehra Kızıldağ
- Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Rana İşgüder
- Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Şengül Çağlayan
- Pediatric Rheumatology, Ümraniye Research and Training Hospital, İstanbul, Turkey
| | | | - Gülçin Aytaç
- Pediatric Rheumatology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Burcu Bozkaya Yücel
- Pediatric Rheumatology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ayşe Tanatar
- Pediatric Rheumatology, Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Hafize E Sönmez
- Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Mustafa Çakan
- Pediatric Rheumatology, University of Health Sciences, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, İstanbul, Turkey
| | - Aslıhan Kara
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Fırat University, Elazıg, Turkey
| | - Ahmet T Elmas
- Pediatric Nephrology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | | | - Nuray Aktay Ayaz
- Pediatric Rheumatology, Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Belde Kasap
- Pediatric Nephrology, Katip-Çelebi University, İzmir, Turkey
| | - Banu Çelikel Acar
- Pediatric Nephrology and Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Ozan Ozkaya
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, İstinye University, İstanbul, Turkey
| | - Selçuk Yüksel
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Sevcan Bakkaloğlu
- Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Özlem Aydoğ
- Pediatric Rheumatology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Güzide Aksu
- Pediatric Rheumatology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Sema Akman
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Osman Dönmez
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Mehmet Bülbül
- Pediatric Rheumatology, Doctor Sami-Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Turkey
| | - Mithat Büyükçelik
- Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Yılmaz Tabel
- Pediatric Nephrology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Betül Sözeri
- Pediatric Rheumatology, Ümraniye Research and Training Hospital, İstanbul, Turkey
| | - Mukaddes Kalyoncu
- Pediatric Rheumatology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Yelda Bilginer
- Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Muammer H Poyrazoğlu
- Pediatric Rheumatology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Erbil Ünsal
- Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Özgür Kasapçopur
- Pediatric Rheumatology, Cerrahpasa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Seza Özen
- Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ruhan Düşünsel
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
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5
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Leventoğlu E, Atikel YÖ, Nalçacıoğlu H, Dursun İ, Dursun H, Yıldırım ZNY, Yıldız N, Aksoy GK, Taşdemir M, Çelakıl M, Kılıç BD, Selçuk ŞZ, Canpolat N, Çakıcı EK, Özlü SG, Tülpar S, Yüksel S, Atmış B, Döven SS, Taner S, Ertan P, Tufan AK, Bayram MT, Kalyoncu M, Gülleroğlu KS, Kabasakal SC, Demir BK, Gülşan RYÇ, Bilge I, Dönmez O, Kara A, Yavaşcan Ö, Özçelik G, Yıldırım DG, Güler MA, Sönmez F, Poyrazoğlu MH, Akman S, Topaloğlu R, Alpay H, Ezgü SAB. COVID-19 in pediatric nephrology centers in Turkey. Turk J Med Sci 2022; 52:1762-1770. [PMID: 36945974 PMCID: PMC10390129 DOI: 10.55730/1300-0144.5521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 07/24/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is limited data on COVID-19 disease in children with kidney disease. We aimed to investigate the characteristics and prognosis of COVID-19 in pediatric nephrology patients in Turkey. METHODS This was a national, multicenter, retrospective cohort study based on an online survey evaluating the data between 11th March 2020 and 11th March 2021 as an initial step of a detailed pediatric nephrology COVID-19 registry. RESULTS Two hundred and three patients (89 girls and 114 boys) were diagnosed with COVID-19. One-third of these patients (36.9%) were between 10-15 years old. Half of the patients were on kidney replacement therapy: kidney transplant (KTx) recipients (n = 56, 27.5%), patients receiving chronic hemodialysis (n = 33, 16.3%) and those on peritoneal dialysis (PD) (n = 18, 8.9%). Fifty-four (26.6%) children were asymptomatic. Eighty-two (40.3%) patients were hospitalized and 23 (28%) needed intensive care unit admission. Fifty-five percent of the patients were not treated, while the remaining was given favipiravir (20.7%), steroid (16.3%), and hydroxychloroquine (11.3%). Acute kidney injury developed in 19.5% of hospitalized patients. Five (2.4%) had MIS-C. Eighty-three percent of the patients were discharged without any apparent sequelae, while 7 (3.4%) died. One hundred and eight health care staff were infected during the study period. DISCUSSION COVID-19 was most commonly seen in patients who underwent KTx and received HD. The combined immunosuppressive therapy and frequent exposure to the hospital setting may increase these patients' susceptibility. Staff infections before vaccination era were alarming, various precautions should be taken for infection control, particularly optimal vaccination coverage.
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Affiliation(s)
- Emre Leventoğlu
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Yeşim Özdemir Atikel
- Department of Pediatric Nephrology, Eskişehir City Training and Research Hospital, Eskişehir, Turkey
| | - Hülya Nalçacıoğlu
- Department of Pediatric Nephrology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - İsmail Dursun
- Department of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Hasan Dursun
- Department of Pediatric Nephrology, Prof. Dr. Cemil Taşçıoğlu City Hospital, University of Health Sciences, İstanbul, Turkey
| | | | - Nurdan Yıldız
- Department of Pediatric Nephrology, İstanbul Pendik Education and Research Hospital, Marmara University, İstanbul, Turkey
| | - Gülşah Kaya Aksoy
- Department of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mehmet Taşdemir
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Koç University, İstanbul, Turkey
| | - Mehtap Çelakıl
- Department of Pediatric Nephrology, Hatay State Hospital, Hatay, Turkey
| | | | - Şenay Zırhlı Selçuk
- Department of Pediatric Nephrology, Turgut Özal Medical Center, İnönü University, Malatya, Turkey
| | - Nur Canpolat
- Department of Pediatric Nephrology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Evrim Kargın Çakıcı
- Department of Pediatric Nephrology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sare Gülfem Özlü
- Department of Pediatric Nephrology, Ankara City Training and Research Hospital, Ankara, Turkey
| | - Sebahat Tülpar
- Department of Pediatric Nephrology, İstanbul Bakırköy Dr. Sadi Konuk Research and Training Hospital, University of Health Sciences, İstanbul, Turkey
| | - Selçuk Yüksel
- Department of Pediatric Nephrology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Bahriye Atmış
- Department of Pediatric Nephrology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Serra Sürmeli Döven
- Department of Pediatric Nephrology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Sevgin Taner
- Department of Pediatric Nephrology, Adana City Training and Research Hospital, University of Health Sciences, Adana, Turkey
| | - Pelin Ertan
- Department of Pediatric Nephrology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Aslı Kavaz Tufan
- Department of Pediatric Nephrology, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Meral Torun Bayram
- Department of Pediatric Nephrology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Mukaddes Kalyoncu
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Kaan Savaş Gülleroğlu
- Department of Pediatric Nephrology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | | | - Belde Kasap Demir
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, İzmir Katip Çelebi University, İzmir, Turkey
| | | | - Ilmay Bilge
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Koç University, İstanbul, Turkey
| | - Osman Dönmez
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Aslıhan Kara
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Önder Yavaşcan
- Department of Pediatric Nephrology, Faculty of Medicine, Medipol University, İstanbul, Turkey
| | - Gül Özçelik
- Department of Pediatric Nephrology, Şisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Deniz Gezgin Yıldırım
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Muhammet Akif Güler
- Department of Pediatric Nephrology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Ferah Sönmez
- Department of Pediatric Nephrology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | | | - Sema Akman
- Department of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Rezan Topaloğlu
- Department of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Harika Alpay
- Department of Pediatric Nephrology, İstanbul Pendik Education and Research Hospital, Marmara University, İstanbul, Turkey
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