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Yalın SF, Eren N, Sinangil A, Yilmaz VT, Tatar E, Ucar AR, Sevinc M, Can Ö, Gurkan A, Arik N, Alisir Ecder S, Uyar M, Yasar M, Gulcicek S, Mese M, Dheir H, Cakir U, Köksal Cevher Ş, Turkmen K, Guven B, Guven Taymez D, Erkalma Senates B, Ecder T, Kocak H, Uslu A, Demir E, Basturk T, Ogutmen MB, Kinalp C, Dursun B, Bicik Bahcebasi Z, Sipahi S, Dede F, Oruc M, Caliskan Y, Genc A, Yelken B, Altıparmak MR, Turkmen A, Seyahi N. Fabry Disease Prevalence in Renal Replacement Therapy in Turkey. Nephron Clin Pract 2019; 142:26-33. [PMID: 30739116 DOI: 10.1159/000496620] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 09/30/2018] [Accepted: 12/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fabry disease (FD) is an X-linked lysosomal storage disorder resulting from lack of alpha-galactosidase A (AGALA) activity in lysosomes. OBJECTIVE In this multicenter study, we aimed to evaluate the prevalence of FD in renal transplant (Tx) recipients in Turkey. We also screened dialysis patients as a control group. METHODS All Tx and dialysis patients were screened regardless of the presence of a primary disease. We measured the AGALA activity in all male patients as initial analysis. Mutation analysis was performed in male patients with decreased AGALA activity and in female patients as the initial diagnostic assay. RESULTS We screened 5,657 patients. A total of 17 mutations were identified. No significant difference was observed between the groups regarding the prevalence of patients with mutation. We found FD even in patients with presumed primary kidney diseases. Seventy-one relatives were analyzed and mutation was detected in 43 of them. We detected a patient with a new, unknown mutation (p.Cys223) in the GLA gene. CONCLUSIONS There are important implications of the screening. First, detection of the undiagnosed patients leads to starting appropriate therapies for these patients. Second, the transmission of the disease to future generations may be prevented by prenatal screening after appropriate genetic counseling. In conclusion, we suggest screening of kidney Tx candidates for FD, regardless of etiologies of chronic kidney disease.
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Affiliation(s)
- Serkan Feyyaz Yalın
- Department of Nephrology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Necmi Eren
- Department of Nephrology, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Ayse Sinangil
- Department of Nephrology, Bilim University Medical Faculty Medical, Istanbul, Turkey
| | - Vural Taner Yilmaz
- Division of Nephrology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Erhan Tatar
- Department of Nephrology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Ali Riza Ucar
- Division of Nephrology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Sevinc
- Department of Nephrology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Özgür Can
- Department of Nephrology, Haydarpasa Training and Research Hospital, Istanbul, Turkey
| | - Alp Gurkan
- Department of Nephrology, Medicana, Istanbul, Turkey
| | - Nurol Arik
- Department of Nephrology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | - Sabahat Alisir Ecder
- Division of Nephrology, Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Murathan Uyar
- Department of Nephrology, Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Murat Yasar
- Department of Nephrology, Pamukkale University Medical Faculty, Denizli, Turkey
| | - Sibel Gulcicek
- Department of Nephrology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Meral Mese
- Department of Nephrology, Dr. Lufti Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Hamad Dheir
- Department of Nephrology, Sakarya University Tip Medical Faculty, Sakarya, Turkey
| | - Ulkem Cakir
- Department of Nephrology, Acibadem University Medical Faculty, Istanbul, Turkey
| | - Şimal Köksal Cevher
- Department of Nephrology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Kultigin Turkmen
- Division of Nephrology, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | - Bahtisen Guven
- Department of Nephrology, Bahcesehir University Medical Faculty, Istanbul, Turkey
| | | | - Banu Erkalma Senates
- Department of Nephrology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Tevfik Ecder
- Department of Nephrology, Bilim University Medical Faculty Medical, Istanbul, Turkey
| | - Huseyin Kocak
- Division of Nephrology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Adam Uslu
- Department of Nephrology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Erol Demir
- Division of Nephrology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Taner Basturk
- Department of Nephrology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Melike Betul Ogutmen
- Department of Nephrology, Haydarpasa Training and Research Hospital, Istanbul, Turkey
| | - Can Kinalp
- Department of Nephrology, Medicana, Istanbul, Turkey
| | - Belda Dursun
- Department of Nephrology, Pamukkale University Medical Faculty, Denizli, Turkey
| | - Zerrin Bicik Bahcebasi
- Department of Nephrology, Dr. Lufti Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Savas Sipahi
- Department of Nephrology, Sakarya University Tip Medical Faculty, Sakarya, Turkey
| | - Fatih Dede
- Department of Nephrology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Meric Oruc
- Department of Nephrology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Yasar Caliskan
- Division of Nephrology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Ahmed Genc
- Department of Nephrology, Sakarya University Tip Medical Faculty, Sakarya, Turkey
| | - Berna Yelken
- Department of Nephrology, Memorial Hospital, Istanbul, Turkey
| | - Mehmet Rıza Altıparmak
- Department of Nephrology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey,
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Sonmez A, Yilmaz MI, Saglam M, Kilic S, Eyileten T, Uckaya G, Caglar K, Oguz Y, Vural A, Yenicesu M, Kutlu M, Kinalp C, Zoccali C. The relationship between hemoglobin levels and endothelial functions in diabetes mellitus. Clin J Am Soc Nephrol 2009; 5:45-50. [PMID: 19833907 DOI: 10.2215/cjn.05080709] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Hemoglobin (Hb) is the main carrier and buffer of nitric oxide. Evidence has been produced that Hb concentration is inversely related with endothelial function in human diseases. Testing whether this association exists also in diabetic patients stage 1 to 2 chronic kidney disease (CKD) is important because anemia in these patients starts at an earlier stage than in other renal diseases. The relationship was investigated between Hb and flow-mediated dilation (FMD) levels of the patients with diabetic nephropathy in a cross-sectional design. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Eighty-nine diabetics with mild to moderate proteinuria and normal to mildly reduced GFR who were normotensive, nondyslipidemic, and cardiovascular-events free were enrolled. None of the patients was taking metformin or renin-angiotensin system blockers. RESULTS FMD was inversely related with Hb levels. Furthermore, there was an inverse link between proteinuria and FMD. However, further analysis of this association showed that the FMD-proteinuria link was confined to patients with proteinuria exceeding 150 mg/d, while no such association existed in patients with proteinuria <150 mg/d. Adjustment of the Hb-FMD relationship for pertinent Framingham risk factors, proteinuria, homeostasis model assessment (HOMA) index, and GFR levels had a modest influence on this association, which remained significant. CONCLUSIONS Endothelial function is inversely associated with Hb levels in diabetic patients with stage 1 to 2 CKD, and proteinuria is an effect modifier of this association. Overall, the observations of this study generate the hypothesis that proteinuria exposes a situation wherein Hb may limit the endothelium-mediated vasoregulation in diabetes.
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Affiliation(s)
- Alper Sonmez
- Department of Nephrology, Gülhane School of Medicine, 06018 Etlik, Ankara, Turkey
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Caglar K, Kinalp C, Arpaci F, Turan M, Saglam K, Ozturk B, Komurcu S, Yavuz I, Yenicesu M, Ozet A, Vural A. Cumulative prior dose of cisplatin as a cause of the nephrotoxicity of high-dose chemotherapy followed by autologous stem-cell transplantation. Nephrol Dial Transplant 2002; 17:1931-5. [PMID: 12401849 DOI: 10.1093/ndt/17.11.1931] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nephrotoxicity is one of the most frequent dose-limiting factors of high-dose chemotherapy to create tolerance of autologous peripheral blood stem-cell transplantation (PBSCT) for the treatment of malignant diseases. The relative importance of factors that may be responsible for the development of nephrotoxicity varied in different trials. METHODS The factors affecting nephrotoxicity in the early period of high-dose ifosfamide, carboplatin and etoposide treatment (ICE) followed by autologous PBSCT was investigated in 47 patients. ICE was given as a conditioning regimen for 6 days. Nephrotoxicity was defined as an increase in the serum creatinine concentration of 0.5 mg/dl or more over individual baseline levels. RESULTS Eleven patients developed nephrotoxicity (23.4%). There was no significant difference in baseline renal function between patients with nephrotoxicity and those without. No differences were found between the two groups in terms of average total doses of ICE, infections and antibiotic use. The age of patients was higher in those with nephrotoxicity (37+/-3.7 vs 26+/-1.7 years, P=0.019). The cumulative cisplatin dose administered prior to this regimen was higher in the group that developed nephrotoxicity (470 vs 227 mg/m(2), P=0.02). The overall mortality rate was 17%, but the transplant-related deaths were higher in the presence of nephrotoxicity (54.5 vs 5.5%, P=0.001). CONCLUSIONS The cumulative dose of cisplatin is a strong risk factor for the development of nephrotoxicity in patients who receive high doses of ICE followed by PBSCT. Nephrotoxicity may occur with much lower doses than the currently recommended maximum doses.
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Affiliation(s)
- Kayser Caglar
- Division of Nephrology, Department of Medicine and. Division of Medical Oncology, Gülhane Medical School, Etlik, Ankara, Turkey.
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Abstract
Previous studies have demonstrated that elevated plasma leptin concentrations are associated with essential hypertension. It has also recently been shown that leptin plays a promoting role in angiogenesis, and the vascular endothelium expresses the long form of leptin receptor. Those data led us to hypothesize that leptin might contribute to end-organ damage in hypertension. Thus, in the present study we evaluated the relationship between plasma leptin concentrations and hypertensive retinopathy (HR). One hundred and eleven patients newly diagnosed with essential hypertension [EHT; mean age, 43.5 +/-10.7 yr; body mass index (BMI), 28.1 +/- 4.4 kg/m2; male/female ratio, 71/40] and 79 healthy normotensive control subjects (NT; mean age, 43.6 +/- 9.2 yr; BMI, 28.2 +/- 3.3 kg/m2; male/female ratio, 50/29) were enrolled in the study. For the assessment of retinopathy according to the Keith-Wagener classification, direct and indirect ophthalmoscopy were performed in all subjects after dilatation of the pupils. Plasma leptin levels were significantly higher in EHT (11.8 +/- 11.1 ng/mL) than in NT (7.2 +/- 5.1 ng/mL) (P = 0.003). Plasma leptin concentrations were strongly correlated with BMI in both EHT (r = 0.45; P = 0.001) and NT (r = 0.38; P = 0.001) groups. Plasma leptin in patients with grade 2 HR (24.8 +/- 15.8 ng/mL; n = 22) was significantly higher than that in patients with grade 1 HR (16.1 +/- 4.9 ng/mL; n = 29; P = 0.001), grade 0 HR (5.1 +/- 3.1 ng/mL; n = 60; P = 0.001), and NT (P = 0.001). Plasma leptin in patients with grade 1 HR was also significantly higher than that in patients without retinopathy (P = 0.001) or in NT (P = 0.001). The estimated threshold of plasma leptin concentration for HR was 10.2 ng/mL. This critical leptin level served largely to separate patients with retinopathy from those without retinopathy. In summary, our results show that plasma leptin concentrations increase progressively with higher grades of hypertensive retinopathy even after correction for BMI, suggesting that a critical leptin level is needed for the development of retinopathy. Elevated concentrations of plasma leptin might be secondary to release of leptin by the vascular endothelium damaged by high blood pressure, as an epiphenomenon. However, a pathogenic role for leptin in hypertensive retinopathy cannot be excluded.
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Affiliation(s)
- G Uckaya
- Department of Endocrinology and Metabolism, Gulhane School of Medicine, Etlik-Ankara, Turkey
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Uçkaya G, Ozata M, Sonmez A, Kinalp C, Eyileten T, Bingol N, Koc B, Kocabalkan F, Ozdemir IC. Plasma leptin levels strongly correlate with plasma renin activity in patients with essential hypertension. Horm Metab Res 1999; 31:435-8. [PMID: 10450836 DOI: 10.1055/s-2007-978769] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Previous studies demonstrated elevated plasma leptin and angiotensinogen (PRA) levels in essential hypertension. However, a few studies investigated the relationship between leptin and angiotensinogen levels in both lean and overweight/ obese hypertensives. The aim of the present study was therefore to examine the relationship between blood pressure, leptin and plasma renin activity in normotensives and in both lean and overweight/obese patients with essential hypertension. Two groups of subjects who were carefully matched for age, gender, waist:hip ratio and body mass index (BMI) were studied: 28 normotensives (NT) (age: 40.1+/-9.1 years old, BMI: 28.1+/-3.6 kg/m2, male/female: 18/10) and 33 newly diagnosed mild to moderate essential hypertensives (EHT) (age: 38.9+/-10 years old, BMI: 27.9+/-4.8 kg/m2, male/female: 22/11). No significant differences in age, gender, waist:hip ratio, fasting blood glucose and BMI were detected between EHT and NT groups. However, systolic and diastolic pressures, mean arterial blood pressures, plasma leptin levels and PRA were significantly higher in EHT group than in NT group (P = 0.001). Plasma leptin levels were strongly correlated with BMI in EHT (r=0.67, P = 0.001) and NT groups (r=0.44, P = 0.001). Plasma leptin levels were correlated with plasma PRA levels in both EHT and NT groups (r = 0.66 and r = 0.44; both P < 0.05, respectively). There was no correlation between leptin or PRA and systolic, diastolic pressures, or mean arterial blood pressures. Furthermore, the patients were divided as lean (n=16) and overweight/obese (n = 17) and compared with BMI-matched controls. In both subgroups, plasma leptin and PRA levels were also higher than those of controls. Our results showed that elevated plasma leptin and PRA are associated with hypertension in both lean and overweight/obese hypertensives. Moreover, plasma leptin was significantly correlated with plasma angiotensinogen levels. These findings suggest that adipose mass is an important determinant of blood pressure, although the mechanism is not clear.
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Affiliation(s)
- G Uçkaya
- Department of Internal Medicine, Gulhane School of Medicine, Etlik-Ankara, Turkey
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