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Yilmaz K, Saygili S, Canpolat N, Akgun-Dogan O, Yuruk Yildirim ZN, Cicek-Oksuz RY, Oner HA, Aksu B, Akyel NG, Oguzhan-Hamis O, Dursun H, Yavuz S, Cicek N, Akinci N, Karabag Yilmaz E, Agbas A, Nayir AN, Konukoglu D, Kurugoglu S, Sever L, Caliskan S. Magnetic resonance imaging based kidney volume assessment for risk stratification in pediatric autosomal dominant polycystic kidney disease. Front Pediatr 2024; 12:1357365. [PMID: 38464892 PMCID: PMC10920221 DOI: 10.3389/fped.2024.1357365] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction In the pediatric context, most children with autosomal dominant polycystic kidney disease (ADPKD) maintain a normal glomerular filtration rate (GFR) despite underlying structural kidney damage, highlighting the critical need for early intervention and predictive markers. Due to the inverse relationship between kidney volume and kidney function, risk assessments have been presented on the basis of kidney volume. The aim of this study was to use magnetic resonance imaging (MRI)-based kidney volume assessment for risk stratification in pediatric ADPKD and to investigate clinical and genetic differences among risk groups. Methods This multicenter, cross-sectional, and case-control study included 75 genetically confirmed pediatric ADPKD patients (5-18 years) and 27 controls. Kidney function was assessed by eGFR calculated from serum creatinine and cystatin C using the CKiD-U25 equation. Blood pressure was assessed by both office and 24-hour ambulatory measurements. Kidney volume was calculated from MRI using the stereological method. Total kidney volume was adjusted for the height (htTKV). Patients were stratified from A to E classes according to the Leuven Imaging Classification (LIC) using MRI-derived htTKV. Results Median (Q1-Q3) age of the patients was 6.0 (2.0-10.0) years, 56% were male. There were no differences in sex, age, height-SDS, or GFR between the patient and control groups. Of the patients, 89% had PKD1 and 11% had PKD2 mutations. Non-missense mutations were 73% in PKD1 and 75% in PKD2. Twenty patients (27%) had hypertension based on ABPM. Median htTKV of the patients was significantly higher than controls (141 vs. 117 ml/m, p = 0.0003). LIC stratification revealed Classes A (38.7%), B (28%), C (24%), and D + E (9.3%). All children in class D + E and 94% in class C had PKD1 variants. Class D + E patients had significantly higher blood pressure values and hypertension compared to other classes (p > 0.05 for all). Discussion This study distinguishes itself by using MRI-based measurements of kidney volume to stratify pediatric ADPKD patients into specific risk groups. It is important to note that PKD1 mutation and elevated blood pressure were higher in the high-risk groups stratified by age and kidney volume. Our results need to be confirmed in further studies.
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Affiliation(s)
- Kubra Yilmaz
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Seha Saygili
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Nur Canpolat
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Ozlem Akgun-Dogan
- Division of Pediatric Genetics, Department of Pediatrics, Acıbadem University School of Medicine, Istanbul, Türkiye
| | | | | | - Huseyin Adil Oner
- Department of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Bagdagul Aksu
- Department of Pediatric Basic Sciences, Istanbul University, Institute of Child Health, Istanbul, Türkiye
| | - Nazli Gulsum Akyel
- Department of Pediatric Radiology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Ozge Oguzhan-Hamis
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Hasan Dursun
- Department of Pediatric Nephrology, Istanbul Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
| | - Sevgi Yavuz
- Department of Pediatric Nephrology, University of Health Sciences, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye
| | - Neslihan Cicek
- Department of Pediatric Nephrology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Nurver Akinci
- Department of Pediatric Nephrology, Bezmialem Vakif University Hospital, Istanbul, Türkiye
| | - Esra Karabag Yilmaz
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Ayse Agbas
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Ahmet Nevzat Nayir
- Department of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Dildar Konukoglu
- Department of Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Sebuh Kurugoglu
- Department of Pediatric Radiology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Lale Sever
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Salim Caliskan
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
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Genc DB, Akinci N, Yildirmak ZY, Vural S. Renal Ultrasonographic Abnormalities at Initial Presentation of Children Diagnosed with Acute Lymphoblastic Leukemia and Long-Term Renal Functions and Prognosis in Survivors. Sisli Etfal Hastan Tip Bul 2022; 56:421-426. [PMID: 36304210 PMCID: PMC9580970 DOI: 10.14744/semb.2022.89646] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/15/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The kidney is a vulnerable organ for acute lymphoblastic leukemia (ALL), by the disease, and various associated clinical pictures. This retrospective study aims to document renal ultrasound abnormalities in children with newly diagnosed ALL as well as to investigate the correlation between renal findings and clinical/laboratory/survival data. METHODS All children (age <18 years) with ALL were included in the study. An increase in size/nephromegaly (NM) or hyperechogenicity (HE) of the kidneys at first admission was accepted as a pathological renal abnormality. The clinical/laboratory findings, survival, and long-term renal functions were compared between patients with and without NM/HE. RESULTS The incidence of NM±HE was 12% in 163 patients. Enlargement of spleen, liver, or both and, hypercreatininemia was independently correlated with the presence of NM/HE. After the induction therapy, ultrasound findings were resolved in all patients, and NM/HE did not influence ALL prognosis. All survivors had normal renal functions in long term. CONCLUSION The renal ultrasound abnormalities are not uncommon in children with leukemia at admission, without a negative impact on leukemia prognosis and on long-term renal functions.
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Affiliation(s)
- Dildar Bahar Genc
- Department of Pediatric Hematology and Oncology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Nurver Akinci
- Department of Pediatric Nephrology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Zeynep Yildiz Yildirmak
- Department of Pediatric Hematology and Oncology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Sema Vural
- Department of Pediatric Hematology and Oncology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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Ajiri R, Burgmaier K, Akinci N, Broekaert I, Büscher A, Dursun I, Duzova A, Eid LA, Fila M, Gessner M, Gokce I, Massella L, Mastrangelo A, Miklaszewska M, Prikhodina L, Ranchin B, Ranguelov N, Rus R, Sever L, Thumfart J, Weber LT, Wühl E, Yilmaz A, Dötsch J, Schaefer F, Liebau MC. Phenotypic Variability in Siblings with Autosomal Recessive Polycystic Kidney Disease. Kidney Int Rep 2022; 7:1643-1652. [PMID: 35812281 PMCID: PMC9263410 DOI: 10.1016/j.ekir.2022.04.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Autosomal recessive polycystic kidney disease (ARPKD) is a rare monogenic disorder characterized by early onset fibrocystic hepatorenal changes. Previous reports have documented pronounced phenotypic variability even among siblings in terms of patient survival. The underlying causes for this clinical variability are incompletely understood. Methods We present the longitudinal clinical courses of 35 sibling pairs included in the ARPKD registry study ARegPKD, encompassing data on primary manifestation, prenatal and perinatal findings, genetic testing, and family history, including kidney function, liver involvement, and radiological findings. Results We identified 70 siblings from 35 families with a median age of 0.7 (interquartile range 0.1–6.0) years at initial diagnosis and a median follow-up time of 3.5 (0.2–6.2) years. Data on PKHD1 variants were available for 37 patients from 21 families. There were 8 patients from 7 families who required kidney replacement therapy (KRT) during follow-up. For 44 patients from 26 families, antihypertensive therapy was documented. Furthermore, 37 patients from 24 families had signs of portal hypertension with 9 patients from 6 families having substantial hepatic complications. Interestingly, pronounced variability in the clinical course of functional kidney disease was documented in only 3 sibling pairs. In 17 of 20 families of our cohort of neonatal survivors, siblings had only minor differences of kidney function at a comparable age. Conclusion In patients surviving the neonatal period, our longitudinal follow-up of 70 ARPKD siblings from 35 families revealed comparable clinical courses of kidney and liver diseases in most families. The data suggest a strong impact of the underlying genotype.
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Affiliation(s)
- Ramona Ajiri
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Kathrin Burgmaier
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Nurver Akinci
- Department of Pediatric Nephrology, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Ilse Broekaert
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Anja Büscher
- Department of Pediatrics II, University Hospital Essen, Essen, Germany
| | - Ismail Dursun
- Department of Pediatric Nephrology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Ali Duzova
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Loai Akram Eid
- Department of Pediatric Nephrology, Dubai Kidney Center of Excellence, Dubai Hospital, Dubai, United Arab Emirates
| | - Marc Fila
- Pediatric Nephrology Unit, CHU Arnaud de Villeneuve-Université de Montpellier, Montpellier, France
| | - Michaela Gessner
- Department of General Pediatrics and Hematology/Oncology, Children’s University Hospital Tuebingen, Tuebingen, Germany
| | - Ibrahim Gokce
- Division of Pediatric Nephrology, Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Laura Massella
- Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children’s Hospital—IRCCS, Rome, Italy
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Monika Miklaszewska
- Department of Pediatric Nephrology and Hypertension, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Larisa Prikhodina
- Department of Inherited and Acquired Kidney Diseases, Veltishev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow, Russia
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Centre de référence maladies rénales rares, Bron, France
| | - Nadejda Ranguelov
- Department of Pediatrics, Saint-Luc Academic Hospital, Université Catholique de Louvain Medical School, Brussels, Belgium
| | - Rina Rus
- Division of Nephrology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia
| | - Lale Sever
- Department of Pediatric Nephrology, Cerrahpaşa School of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Julia Thumfart
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Lutz Thorsten Weber
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Alev Yilmaz
- Pediatric Nephrology Department, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Jörg Dötsch
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Max Christoph Liebau
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
- Correspondence: Max Christoph Liebau, Department of Pediatrics, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
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Yuruk Yildirim ZN, Usta Akgul S, Alpay H, Aksu B, Savran Oguz F, Kiyak A, Akinci N, Yavuz S, Ozcelik G, Gedikbasi A, Gokce I, Ozkayin N, Yildiz N, Pehlivanoglu C, Goknar N, Saygili S, Tulpar S, Kucuk N, Bilge I, Tasdemir M, Agbas A, Dirican A, Emre S, Nayir A, Yilmaz A. PROGRESS STUDY: Progression of chronic kidney disease in children and heat shock proteins. Cell Stress Chaperones 2021; 26:973-987. [PMID: 34671941 PMCID: PMC8578260 DOI: 10.1007/s12192-021-01239-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022] Open
Abstract
Various molecular and cellular processes are involved in renal fibrosis, such as oxidative stress, inflammation, endothelial cell injury, and apoptosis. Heat shock proteins (HSPs) are implicated in the progression of chronic kidney disease (CKD). Our aim was to evaluate changes in urine and serum HSP levels over time and their relationships with the clinical parameters of CKD in children. In total, 117 children with CKD and 56 healthy children were examined. The CKD group was followed up prospectively for 24 months. Serum and urine HSP27, HSP40, HSP47, HSP60, HSP70, HSP72, and HSP90 levels and serum anti-HSP60 and anti-HSP70 levels were measured by ELISA at baseline, 12 months, and 24 months. The urine levels of all HSPs and the serum levels of HSP40, HSP47, HSP60, HSP70, anti-HSP60, and anti-HSP70 were higher at baseline in the CKD group than in the control group. Over the months, serum HSP47 and HSP60 levels steadily decreased, whereas HSP90 and anti-HSP60 levels steadily increased. Urine HSP levels were elevated in children with CKD; however, with the exception of HSP90, they decreased over time. In conclusion, our study demonstrates that CKD progression is a complicated process that involves HSPs, but they do not predict CKD progression. The protective role of HSPs against CKD may weaken over time, and HSP90 may have a detrimental effect on the disease course.
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Affiliation(s)
| | - Sebahat Usta Akgul
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, 34390 Istanbul, Turkey
| | - Harika Alpay
- Division of Pediatric Nephrology, Medical Faculty, Marmara University, Istanbul, Turkey
| | - Bagdagul Aksu
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390 Istanbul, Turkey
- Institute of Child Health, Istanbul University, Istanbul, Turkey
| | - Fatma Savran Oguz
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, 34390 Istanbul, Turkey
| | - Aysel Kiyak
- Division of Pediatric Nephrology, Kanuni Sultan Suleyman Education and Research Hospital, Istanbul, Turkey
| | - Nurver Akinci
- Division of Pediatric Nephrology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Sevgi Yavuz
- Division of Pediatric Nephrology, Kanuni Sultan Suleyman Education and Research Hospital, Istanbul, Turkey
| | - Gul Ozcelik
- Division of Pediatric Nephrology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Asuman Gedikbasi
- Institute of Child Health, Istanbul University, Istanbul, Turkey
- Division of Pediatric Nutrition and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ibrahim Gokce
- Division of Pediatric Nephrology, Medical Faculty, Marmara University, Istanbul, Turkey
| | - Nese Ozkayin
- Division of Pediatric Nephrology, School of Medicine, Trakya University, Edirne, Turkey
| | - Nurdan Yildiz
- Division of Pediatric Nephrology, Medical Faculty, Marmara University, Istanbul, Turkey
| | - Cemile Pehlivanoglu
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390 Istanbul, Turkey
| | - Nilufer Goknar
- Division of Pediatric Nephrology, Bagcilar Education and Research Hospital, Istanbul, Turkey
| | - Seha Saygili
- Division of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sebahat Tulpar
- Division of Pediatric Nephrology, Bakirkoy Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Nuran Kucuk
- Division of Pediatric Nephrology, Kartal Education and Research Hospital, Istanbul, Turkey
| | - Ilmay Bilge
- Division of Pediatric Nephrology, School of Medicine, Koc University, Istanbul, Turkey
| | - Mehmet Tasdemir
- Division of Pediatric Nephrology, School of Medicine, Koc University, Istanbul, Turkey
| | - Ayse Agbas
- Division of Pediatric Nephrology, Haseki Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Dirican
- Department of Biostatistics, Istanbul Faculty of Medicine, Istanbul University, 34390 Capa, Istanbul, Turkey
| | - Sevinc Emre
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390 Istanbul, Turkey
| | - Ahmet Nayir
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390 Istanbul, Turkey
| | - Alev Yilmaz
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390 Istanbul, Turkey
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Yesilbas O, Yozgat CY, Akinci N, Sonmez S, Tekin E, Talebazadeh F, Jafarov U, Temur HO, Yozgat Y. Acute Myocarditis and Eculizumab Caused Severe Cholestasis in a 17-Month-Old Child Who Has Hemolytic Uremic Syndrome Associated with Shiga Toxin-Producing Escherichia coli. J Pediatr Intensive Care 2020; 10:216-220. [PMID: 34395040 DOI: 10.1055/s-0040-1713111] [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: 02/14/2020] [Accepted: 05/02/2020] [Indexed: 10/23/2022] Open
Abstract
Cardiovascular involvement is uncommon in pediatric patients with hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC-HUS). In this case report we presented a case of 17-month-old toddler who had a sporadic type of STEC-HUS complicated by acute myocarditis. The patient was successfully treated by a single dose of eculizumab after six doses of therapeutic plasma exchange (TPE) were inefficient to prevent the cardiac complication. Hepatotoxicity was observed after a single dose of eculizumab. Hepatic and cholestatic enzyme levels slowly returned to normal within 6 months. To the best of our knowledge, this is the first case of myocarditis/cardiomyopathy treated with eculizumab in STEC-HUS. This case illustrates the need for vigilance regarding myocardial involvement and eculizumab-induced hepatotoxicity in STEC-HUS.
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Affiliation(s)
- Osman Yesilbas
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Nurver Akinci
- Department of Pediatric Nephrology, Bezmialem Vakif University, Istanbul, Turkey
| | - Sirin Sonmez
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Eser Tekin
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Faraz Talebazadeh
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Uzeyir Jafarov
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Hafize Otcu Temur
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
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Yesilbas O, Yozgat CY, Akinci N, Talebazadeh F, Jafarov U, Guney AZ, Temur HO, Yozgat Y. Sudden Cardiac Arrest and Malignant Ventricular Tachycardia in an 8-Year-Old Pediatric Patient Who Has Hemolytic Uremic Syndrome Associated with Shiga Toxin-Producing Escherichia coli. J Pediatr Intensive Care 2020; 9:290-294. [PMID: 33133747 DOI: 10.1055/s-0040-1708553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/15/2019] [Accepted: 02/16/2020] [Indexed: 10/24/2022] Open
Abstract
Gastrointestinal, neurological, pancreatic, hepatic, and cardiac dysfunction are extrarenal manifestations of hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC-HUS). The most frequent cause of death for STEC-HUS is related to the central nervous system and cardiovascular system. Cardiac-origin deaths are predominantly related to thrombotic microangiopathy-induced ischemia and the immediate development of circulatory collapse. STEC-HUS cardiac related deaths in children are rare with only sporadic cases reported. In our literature search, we did not come across any pediatric case report about STEC-HUS causing sudden cardiac arrest and malignant ventricular tachycardia (VT). Herein, we report the case of an 8-year-old female child with a typical clinical manifestation of STEC-HUS. On the seventh day of pediatric intensive care unit admission, the patient had a sudden cardiac arrest, requiring resuscitation for 10 minutes. The patient had return of spontaneous circulation with severe monomorphic pulsed malignant VT. Intravenous treatment with lidocaine, amiodarone and magnesium sulfate were promptly initiated, and we administered multiple synchronized cardioversions, but VT persisted. Furthermore, we were not able to ameliorate her refractory circulation insufficiency by advanced cardiopulmonary resuscitation. Thus, inevitably, the patient lost her life. This case illustrates the need for aggressive management and the dilemma that pediatric critical care specialists, cardiologists, and nephrologists have to face when dealing with STEC-HUS that is worsened by a sudden cardiac arrest accompanied with VT.
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Affiliation(s)
- Osman Yesilbas
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Nurver Akinci
- Department of Pediatric Nephrology, Bezmialem Vakif University, Istanbul, Turkey
| | - Faraz Talebazadeh
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Uzeyir Jafarov
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Hafize Otcu Temur
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
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7
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Vural S, Karaman S, Yilmaz S, Ozcelik GS, Akinci N. Chemotherapy-induced rhabdomyolysis in chidren with leukemia: a case report. Leuk Res 2019. [DOI: 10.1016/s0145-2126(19)30415-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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8
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Sevinc M, Hasbal NB, Ozcelik G, Akinci N, Basturk T, Koc Y, Kirecci SL, Demir M, Dokucu AI, Unsal A. Kidney Transplantation Outcomes in Temporarily Protected Syrian Patients With End-Stage Renal Failure in Turkey. Transplant Proc 2019; 51:2279-2282. [PMID: 31358455 DOI: 10.1016/j.transproceed.2019.01.194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Approximately 6.3 million Syrian people migrated to other countries due to war since 2011. There are more than 3.5 million Syrian people living in Turkey under temporary protection. Syrian people receive free health care in Turkey, including kidney transplantation. Our institution started a kidney transplantation program about 3 years ago. It is the first institution performing living, related kidney transplantation for Syrian patients with end-stage renal failure. METHODS All living, related kidney transplantations to Turkish and Syrian patients from the beginning of our transplantation program until September 2018 were enrolled in this study. Donor and recipient characteristics, induction and maintenance immunosuppression, length of hospital stay, creatinine values at first week and first month, treatment incompatibility, and graft survival were evaluated. RESULTS Of the 25 living, related kidney transplantations 20% were Syrian. Three of 5 Syrian recipients were in the pediatric age group. None of the Syrian transplantations were preemptive, while half of the Turkish transplantations were preemptive (P = .005). Immunosuppression protocols, creatinine values, length of hospital stay, and graft survival rates were similar between groups. None of the Syrian recipients had treatment incompatibility (0%), unlike the Turkish recipients (15%). CONCLUSION Outcomes of kidney transplantation for Syrian recipients are similar to those of Turkish recipients. Having this no-cost facility is great for Syrian kidney failure patients. The number of transplantations for Syrian patients under temporary protection in Turkey is expected to increase in the future, with these favorable results and easy to access, free health care facilities.
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Affiliation(s)
- Mustafa Sevinc
- Nephrology Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
| | | | - Gul Ozcelik
- Pediatric Nephrology Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Nurver Akinci
- Pediatric Nephrology Department, Bezmi Alem Vakif University Hospital, Istanbul, Turkey
| | - Taner Basturk
- Nephrology Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Yener Koc
- Nephrology Department, Istanbul Bilim University, Istanbul, Turkey
| | - Sinan Levent Kirecci
- Urology Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mesut Demir
- Pediatric Surgery Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ali Ihsan Dokucu
- Pediatric Surgery Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Abdulkadir Unsal
- Nephrology Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Topaloglu R, Gulhan B, İnözü M, Canpolat N, Yilmaz A, Noyan A, Dursun İ, Gökçe İ, Gürgöze MK, Akinci N, Baskin E, Serdaroğlu E, Demircioğlu Kiliç B, Yüksel S, Övünç Hacihamdioğlu D, Korkmaz E, Hayran M, Ozaltin F. The Clinical and Mutational Spectrum of Turkish Patients with Cystinosis. Clin J Am Soc Nephrol 2017; 12:1634-1641. [PMID: 28793998 PMCID: PMC5628704 DOI: 10.2215/cjn.00180117] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 01/06/2017] [Accepted: 06/26/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Infantile nephropathic cystinosis is a severe disease that occurs due to mutations in the cystinosis gene, and it is characterized by progressive dysfunction of multiple organs; >100 cystinosis gene mutations have been identified in multiple populations. Our study aimed to identify the clinical characteristics and spectrum of cystinosis gene mutations in Turkish pediatric patients with cystinosis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We identified the clinical characteristics and spectrum of cystinosis gene mutations in Turkish patients with cystinosis in a multicenter registry that was established for data collection. The data were extracted from this registry and analyzed. RESULTS In total, 136 patients (75 men and 61 women) were enrolled in the study. The most common clinical findings were growth retardation, polyuria, and loss of appetite. None of the patients had the 57-kb deletion, but seven novel mutations were identified. The most common mutations identified were c.681G>A (p.Glu227Glu; 31%), c.1015G>A (p.Gly339Arg; 22%), and c.18_21 del (p.Thr7Phefs*7; 14%). These mutations were associated with earlier age of disease onset than the other mutations. To understand the effects of these allelic variants on clinical progression, the mutations were categorized into two major groups (missense versus deletion/duplication/splice site). Although patients with missense mutations had a better eGFR at the last follow-up visit, the difference was not significant. Patients in whom treatment began at age <2 years old had later onset of ESRD (P=0.02). Time to ESRD did not differ between the patients with group 1 and group 2 mutations. CONCLUSIONS The most common cystinosis gene mutations identified in Turkey were c.681G>A (p.Glu227Glu), c.1015G>A (p.Gly339Arg), and c.18_21 del (p.Thr7Phefs*7). Patients with less severe cystinosis gene mutations tend to have better kidney outcome.
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Affiliation(s)
- Rezan Topaloglu
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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10
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Isiyel E, Ezgu SAB, Caliskan S, Akman S, Akil I, Tabel Y, Akinci N, Ozdogan EB, Ozel A, Eroglu FK, Ezgu FS. Molecular analysis of the AGXT gene in patients suspected with hyperoxaluria type 1 and three novel mutations from Turkey. Mol Genet Metab 2016; 119:311-316. [PMID: 27915025 DOI: 10.1016/j.ymgme.2016.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 09/13/2016] [Revised: 10/30/2016] [Accepted: 10/31/2016] [Indexed: 12/22/2022]
Abstract
Primary hyperoxaluria type 1 (PH1) is a rare, autosomal recessive disease, caused by the defect of AGXT gene encoding hepatic peroxisomal alanine glyoxylateaminotransferase (AGT). This enzyme is responsible for the conversion of glyoxylate to glycine. The diagnosis of PH1 should be suspected in infants and children with nephrocalcinosis or nephrolithiasis. Early diagnosis and treatment is crucial in preventing disease progression to end stage kidney disease (ESKD). In this study, AGXT gene sequence analyses were performed in 82 patients who were clinically suspected (hyperoxaluria and nephrolithiasis or nephrocalcinosis with or without renal impairment) to have PH1. Disease causing mutations have been found in fifteen patients from thirteen families (18%). Novel mutations have been found (c.458T>A (p.L153X), c.733_734delAA (p.Lys245Valfs*11), c.52 C>T (p.L18F)) in three of 13 families. There were 3-year lag time between initial symptoms and the time of PH1 is suspected; additionally, 5.5-year lag time between initial symptoms and definitive diagnosis. Consanguinity was detected in 77% of the patients with mutation. After genetic diagnosis, one patient received combined kidney and liver transplantation. AGXT gene sequencing is now the choice of diagnosis of PH1 due to its non-invasive nature compared to liver enzyme assay. Early diagnosis and accurate treatment in PH1 is important for better patient outcomes.
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Affiliation(s)
- Emel Isiyel
- Department of Pediatric Nephrology, Gazi University Medical Faculty, Turkey.
| | | | - Salim Caliskan
- Department of Pediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty, Turkey
| | - Sema Akman
- Department of Pediatric Nephrology, Akdeniz University Medical Faculty, Turkey
| | - Ipek Akil
- Department of Pediatric Nephrology, Celal Bayar University Medical Faculty, Turkey
| | - Yilmaz Tabel
- Department of Pediatric Nephrology, Inonu University Medical Faculty, Turkey
| | - Nurver Akinci
- Department of Pediatric Nephrology, Sisli Etfal Training and Research Hospital, Turkey
| | - Elif Bahat Ozdogan
- Department of Pediatric Nephrology, Karadeniz Technical University Medical Faculty, Turkey
| | - Ahmet Ozel
- Department of Pediatric Nephrology, Konya Training and Research Hospital, Turkey
| | - Fehime Kara Eroglu
- Department of Pediatric Nephrology, Hacettepe University Medical Faculty, Turkey
| | - Fatih S Ezgu
- Department of Pediatric Metabolic Disorders and Pediatric Genetics, Gazi University Medical Faculty, Turkey
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Yesilkaya S, Acikel C, Fidanci BE, Polat A, Sozeri B, Ayaz NA, Makay BB, Simsek D, Akinci N, Özçelik G, Kavukçu S, Emre S, Donmez O, Delibas A, Yüksel S, Berdeli A, Poyrazoglu H, Saldir M, Fidanci K, Çakar N, Peru H, Bakkaloglu S, Tabel Y, Sari O, Aydogan U, Ozenc S, Basbozkurt G, Unsal E, Kasapcopur Ö, Gok F, Ozen S, Demirkaya E. Development of a medication adherence scale for familial Mediterranean fever (MASIF) in a cohort of Turkish children. Clin Exp Rheumatol 2015; 33:S156-62. [PMID: 26393894 DOI: pmid/26393894] [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] [Received: 09/08/2014] [Accepted: 06/05/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To develop and assess the validity and reliability of an adherence scale concerning medical treatment in paediatric FMF patients. METHODS The Medication Adherence Scale in FMF Patients (MASIF) is a 18-item questionnaire that evaluates adherence to medication in four domains. Validation of the instrument was accomplished in paediatric FMF patients (aged 2-18 years) under medication at least for 6 months. The first step was to build up the scale through qualitative approach (with interviews using semi-structured questions). Validation analyses included assessment of feasibility, face and content validity; construct validity, internal consistency and test-retest reliability. RESULTS One hundred and fifty patients with FMF were enrolled in the study. The mean age of the patients was 11.11±4.02 years and 48.7% of them were male. The MASIF was found to be feasible and valid for both face and content. It correlated with the Morisky Medication Adherence Scale as a gold standard thereby demonstrating good construct validity (r=0.515, p<0.001). Assessment of content validity identified four subscales. The internal consistency, Cronbach's alpha was 0.728. There was a positive and significant correlation between test and retest scores (r=0.843; p<0.001). Also, a significant correlation between parents' and children's reports (r=0.781, p<0.001). CONCLUSIONS Based on these results, the use of this scale to assess and follow up the adherence to treatment in paediatric FMF patients under medical treatment is recommended.
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Affiliation(s)
- Sirzat Yesilkaya
- Gulhane Military Medical Academy, Department of Family Medicine, Ankara, Turkey
| | - Cengizhan Acikel
- Gulhane Military Medical Faculty, Department of Biostatistics, Ankara, Turkey
| | - Berna Eren Fidanci
- Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey, Turkey
| | - Adem Polat
- Gulhane Military Medical Faculty, Department of Pediatrics, Ankara, Turkey
| | - Betül Sozeri
- Ege University Faculty of Medicine, Pediatric Rheumatology, Izmir, Turkey
| | - Nuray Aktay Ayaz
- Kanuni Sultan Suleyman Research and Training Hospital, Pediatric Nephrology-Rheumatology, Istanbul, Turkey
| | - Balahan Bora Makay
- Dokuz Eylul University Hospital, Department of Pediatrics, İzmir, Turkey
| | - Dogan Simsek
- Gulhane Military Medical Faculty, Department of Pediatrics, Ankara, Turkey
| | - Nurver Akinci
- Sisli Etfal Education and Research Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Gul Özçelik
- Sisli Etfal Education and Research Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Salih Kavukçu
- Dokuz Eylul University Hospital, Department of Pediatrics, İzmir, Turkey
| | - Sevinc Emre
- Istanbul University, Department of Pediatrics, Istanbul, Turkey
| | - Osman Donmez
- Uludag University Medical Faculty, Dept. of Pediatric Rheumatology, Bursa, Turkey
| | - Ali Delibas
- Akdeniz University, Department of Pediatrics, Mersin, Turkey
| | - Selcuk Yüksel
- Pamukkale University Medical Faculty, Dept. of Paediatrics, Denizli, Turkey
| | - Afig Berdeli
- Ege University Faculty of Medicine, Pediatric Rheumatology, Izmir, Turkey
| | - Hakan Poyrazoglu
- Erciyes University Medical Faculty, Department of Paediatrics, Kayseri, Turkey
| | - Mehmet Saldir
- Gulhane Military Medical Faculty, Department of Pediatrics, Ankara, Turkey
| | - Kursat Fidanci
- Gulhane Military Medical Faculty, Department of Pediatrics, Ankara, Turkey
| | - Nilgun Çakar
- Ministry of Health Dıskapı Children's Hospital, Paediatric Nephrology, Ankara, Turkey
| | - Harun Peru
- Selcuk University, Department of Paediatrics, Ankara, Turkey
| | | | - Yilmaz Tabel
- Inonu University, Paediatric Nephrology, Malatya, Turkey
| | - Oktay Sari
- Gulhane Military Medical Academy, Department of Family Medicine, Ankara, Turkey
| | - Umit Aydogan
- Gulhane Military Medical Academy, Department of Family Medicine, Ankara, Turkey
| | - Salim Ozenc
- Gulhane Military Medical Academy, Department of Family Medicine, Ankara, Turkey
| | - Gokalp Basbozkurt
- Gulhane Military Medical Faculty, Department of Pediatrics, Ankara, Turkey
| | - Erbil Unsal
- Dokuz Eylul University Hospital, Department of Pediatrics, İzmir, Turkey
| | | | - Faysal Gok
- Gulhane Military Medical Faculty, Paediatric Rheumatology Unit, Ankara, Turkey
| | - Seza Ozen
- Hacettepe University, Paediatric Nephrology and Rheumatology Unit, Ankara, Turkey
| | - Erkan Demirkaya
- Gulhane Military Medical Faculty, Paediatric Rheumatology Unit, Ankara; and Gulhane Military Medical Academy, FMF Arthritis Vasculitis and Orphan disease Research in Paediatric Rheumatology, Ankara, Turkey.
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Akin M, Erginel B, Tanik C, Akinci N, Yildiz A, Beker B, Karadag CA, Sever N, Turk S, Dokucu AI. The first laparoscopic resection of an aldosterone-secreting adrenocortical oncocytoma in a child. Journal of Pediatric Surgery Case Reports 2014. [DOI: 10.1016/j.epsc.2014.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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13
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Demirkaya E, Acikel C, Tufan A, Kucuk A, Berdeli A, Gul A, Onat AM, Delibas A, Duzova A, Dinc A, Yavascan O, Kasapcopur O, Makay B, Goker B, Sozeri B, Kisacik B, Comak E, Unsal E, Erken E, Gunal E, Baskin E, Yalcinkaya F, Yildiz F, Gok F, Basbozkurt G, Ozcelik G, Demircin G, Poyrazoglu H, Erdem H, Direskeneli H, Ozer H, Ozdogan H, Simsek I, Dursun I, Gokce I, Tunca M, Gurgoze M, Cakar N, Akinci N, Ayaz N, Donmez O, Ozkaya O, Topaloglu R, Kavukcu S, Yuksel S, Akar S, Bakkaloglu S, Emre S, Senel S, Erten S, Yavuz S, Kalman S, Kasifoglu T, Kalyoncu U, Tabel Y, Ekinci Z, Ozen S. PW01-025 – Definition of colchicine resistance in FMF. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952434 DOI: 10.1186/1546-0096-11-s1-a78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Geylani Gulec S, Urganci N, Yuksek K, Akinci N, Hatipoglu N. A Rare Cause Of Acid: Galactosemia. Istanbul Tip Derg 2012. [DOI: 10.5505/1304.8503.2012.38257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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