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    Does enalapril prevent peritoneal fibrosis induced by hypertonic (3.86%) peritoneal dialysis solution?
    (Multimed Inc, 2001) Duman, S; Gunal, AI; Sen, S; Asci, G; Ozkahya, M; Terzioglu, E; Akcicek, F; Atabay, G
    Objective: Peritoneal fibrosis (PF) is one of the most serious causes of failure in continuous ambulatory peritoneal dialysis (PD). Although the underlying mechanism responsible for the genesis of PF is still unknown, transforming growth factor beta (TGF beta (1)) has been shown to be associated with PF. Angiotensin converting enzyme inhibitors have been shown to prevent the stimulating effect of growth factors. The aim of the present study was to investigate the effect of enalapril on peritoneal function and morphology in a rat model of experimental PF. Methods: Twenty-one albino Wistar rats were divided into three groups: (1) the control group (C) received 10 mt isotonic saline Intraperitoneally (IP), (2) the dextrose (Dx) group 10 mt 3.86% dextrose PD solution IF, and (3) the enalapril-treated group (ENA) 10 cc 3.86% dextrose PD solution IP plus 100 mg/L enalapril in drinking water. After 4 weeks, a 1-hour peritoneal equilibration test was performed with 20 mt 2.27% dextrose PD solution. Dialysate-to-plasma urea ratio (D/P urea), glucose reabsorption (D-1/D-0 glucose), ultrafiltration (UF) volume, and levels of dialysate protein, TGF beta (1), and cancer antigen 125 (CA125) were determined. The parietal peritoneum was evaluated histologically by light microscopy. Results: Administration of enalapril resulted in preserved UF (-0.2 +/- 0.7 mt vs 1.7 +/- 0.3 mt, p<0.05), protein loss (2.3 +/- 0.5 g/L vs 1.6 +/- 0.2 g/L, p < 0.05), and peritoneal thickness (77 +/- 7 mu vs 38 +/- 5 mu, p < 0.001). D/P urea increased significantly in the Dr group (p < 0.05). Both higher levels of TGF beta (1) (undetectable vs 298 +/- 43 pg/mL, p< 0.001) and lower levels of CA125 in dialysate effluent (0.94 +/- 0.5 U/L vs 0.11 +/- 0.1 U/L, p > 0.05) were determined in the Dx group. Conclusion:These findings show that peritoneal morphology and function tests were dramatically deranged in the Dr group. The same properties were partially preserved in the ENA group. The production of TGF beta (1) was significantly reduced but peritoneal thickness was not completely inhibited. In conclusion, by inhibiting the production of TGF beta (1), enalapril can preserve peritoneal histology, peritoneal function, and remodeling of mesothelial cells.
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    Effectiveness of pulse cyclophosphamide plus oral steroid therapy in idiopathic membranoproliferative glomerulonephritis
    (Oxford Univ Press, 1997) Toz, H; Ok, E; Unsal, A; Asci, G; Basdemir, G; Basci, A
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    Excellent control of blood pressure ambulatory measured for 48-hours in hemodialysis patients
    (Oxford Univ Press, 2005) Toz, H; Ozkahya, M; Asci, G; Duman, S; Ok, E; Basci, A
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    How can we standardize peritoneal thickness measurements in experimental studies in rats?
    (Multimed Inc, 2001) Duman, S; Sen, S; Gunal, AI; Asci, G; Akcicek, F; Basci, A
    lozenge Objective: The various methods of measuring peritonea[ thickness in experimental studies in rats have yielded conflicting results. Also, no standard method exists to assess histologic findings in peritoneal morphology. We therefore undertook the present study to create a reproducible and standard method for assessing rat peritoneal histology in experimental studies. lozenge Methods: Parietal peritoneal samples from 61 Wistar albino rats were used in the study. Excepting the skin, the whole abdominal wall from each rat was cut two-dimensionally (longitudinally and horizontally), fixed in formalin, and processed routinely for light microscopy. Slides were divided into two groups according to the direction of the inner abdominal muscle fibers in the sections. Longitudinal and horizontal sections of abdominal muscle were evaluated. For every section, one histopathology image was captured from a light microscope to an IBM-compatible computer. Peritoneal thickness (mean of the maximum and the minimum) and submesothelial area (SMA) were drawn on the image. A computer program then automatically performed measurements. Two different measurement methods were compared, based on the same sections. lozenge Results:The mean peritoneal thickness was 91 +/- 8 mum in the longitudinal sections and 75 +/- 7 mum in the horizontal sections (p < 0.05). Measurements of the SMA were found to be 47,762 +/- 4,374 mum(2) for the longitudinal sections and 40,389 +/- 3,631 mum(2) for the horizontal sections (p < 0.05). In both types of sections, a positive correlation (96% for longitudinal and 90% for horizontal) was found between the SMA and the peritonea[ thickness (p < 0.01). The SMA measurements correlated significantly with functional properties [ratio of the dialysate concentration of glucose initially and after a 1-hour dwell (D-1/D-0 glucose), ultrafiltration, and protein loss; p < 0.01]. lozenge Conclusion: Peritoneal thickness can be measured as a mean of the minimum and maximum values. That measurement strongly correlates with submesothelial area. Both types of sections can be used, but the horizontal and longitudinal sections show systematic differences. All samples in a study should be taken using the same section pattern, either longitudinal or horizontal.
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    Intima media thickness as a predictor of atherosclerosis in renal transplantation
    (Elsevier Science Inc, 2004) Toz, H; Duman, S; Altunel, E; Sezis, M; Ozbek, S; Ozkahya, M; Asci, G; Ok, E; Basci, A
    It has been reported that an increase in carotid artery intima-media thickness (IMT), a sign of early atherosclerosis, has a predictive value for future cardiovascular (CV) events. There are limited data about IMT measurements in renal transplant patients who display a high rate of CV mortality. In this study carotid artery IMT was measured by high resolution B-mode ultrasonography in 102 randomly selected RT patients to assess the relationship between IMT and CV disease and risk factors. A positive correlation was found between IMT and age, triglyceride level, and hematocrit. IMT was significantly higher among patients who were diabetic (0.68 +/- 0.27 vs 0.50 +/- 0.2) or had CV disease (0.88 +/- 0.28 vs 0.53 +/- 0.21). An increased IMT was associated with a longer duration of ESRD, higher lipid level, lower serum albumin, and presence of previous CMV disease. CV disease was more frequent among patients with increased IMT. Considering its relation to CV risk factors, it is concluded that the measurement of carotid artery IMT is an easy, reliable and non-invasive method to be used to assess atherosclerotic disease in renal transplant patients.
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    Is "zero-hour" biopsy of the transplanted kidney risky?
    (Elsevier Science Inc, 2004) Duman, S; Ozbek, S; Sen, S; Tamsel, S; Toz, H; Asci, G; Ozkahya, M; Sezis, M; Ok, E; Hoscoskun, C
    Zero-hour renal allograft biopsy provides valuable diagnostic information for comparison to subsequent kidney material. However, the invasive nature of the biopsy procedure tends to limit its widespread use in many centers. We undertook this retrospective study to examine the rate and clinical importance of complications in our series of patients routinely undergoing zero-hour biopsies performed between 1994 and 2001. Two hundred thirty-six zero-hour biopsies included only one sample performed with a 14G needle from lower posterior part of kidney by using a manual tru-cut technique. Doppler ultrasonography was performed after first 5 days. An average of 34 +/- 19 glomeruli were obtained in the biopsies. The biopsy specimens were adequate for diagnosis in 77% of the procedures. Ten (4%) patients experienced complications of intraparenchymal arteriovenous fistula (n = 4), which regressed spontaneously; perirenal hematoma (n = 4); intraparenchymal hematoma (n = 2); and a minimal perirenal collection (n = 41). We conclude that zero-hour biopsy is a safe diagnostic method. The rate of complications is low, as well as generally mild and self-limiting.
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    Progressive nature of carotid atherosclerosis in renal transplantation
    (Oxford Univ Press, 2005) Sipahi, S; Altunel, E; Asci, G; Toz, H; Duman, S; Ozbek, SS; Ok, E; Basci, A
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    Strict volume control normalizes hypertension in peritoneal dialysis patients
    (W B Saunders Co-Elsevier Inc, 2001) Gunal, AI; Duman, S; Ozkahya, M; Toz, H; Asci, G; Akcicek, F; Basci, A
    The aim of this study is to investigate whether normal blood pressure (BP) can be achieved in patients with hypertension on continuous ambulatory peritoneal dialysis (CAPD) therapy by strict volume control without the use of antihypertensive drugs. Of the 78 patients in our center, 47 persons had hypertension and/or were on antihypertensive drug therapy. After discontinuing these drugs, a strong dietary salt restriction was imposed by repeatedly explaining the need for it to patients and families. If this approach did not result in sufficient BP decrease, ultrafiltration (UF) was added by increased use of hypertonic (3.86% glucose) peritoneal dialysis solution. Cardiothoracic index (CTI) on the chest radiograph was also used as a measure of volume control. With salt restriction alone or combined with UF, body weight decreased by a mean of 2.8 +/- 0.5 kg, and BP decreased from a mean of 158.2 +/- 17.0/95.7 +/- 10.3 to 119.7 +/- 16.0/77.9 +/- 9.7 mm Hg in 37 patients, accompanied by a decrease in CTI from 48.0% +/- 5.6% to 42.9% +/- 4.5%. In 19 patients who had residual renal function, 24-hour urine volume decreased to 28% of the pretreatment volume, accompanied by a mean decrease in Kt/V urea from 2.06 +/- 0.5 to 1.85 +/- 0.4. In 7 of the remaining patients who did not respond to the applied treatment, BP decreased from 158.8 +/- 23.2/111.6 +/- 9.8 to 113.5 +/- 14.3/76.4 +/- 6.2 mm Hg after administration of an angiotensin-converting enzyme (ACE) inhibitor. Their CTI was 41.2% +/- 1.3%, indicating the absence of hypervolemia, in 3 patients, the desired results could not be reached because of noncompliance. Our findings show that normal BP can be achieved by severe salt restriction combined with increased UF in the majority of CAPD patients. This is accompanied by a decrease in CTI from upper limits into the normal range, but also by a decrease in residual renal function and Kt/V index. In most of the remaining patients, normal BP can be reached by the use of ACE inhibitors. (C) 2001 by the National Kidney Foundation, Inc.
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    Successful treatment of post-transplant Kaposi's sarcoma by reduction of immunosuppression
    (Oxford Univ Press, 2002) Duman, S; Toz, H; Asci, G; Alper, S; Ozkahya, M; Unal, I; Celik, A; Ok, E; Basci, A
    Background. The aim of this study was to investigate retrospectively the clinical presentation, the efficacy of reducing immunosuppression and the consequences of this therapeutic approach in Kaposi's sarcoma (KS) developing after renal transplantation. Methods. We reviewed the records of 502 patients who had been followed up at our transplantation unit between October 1, 1987 and December 30, 1998. Twelve patients (2.4%) with KS were included in the study. Results. The mean age of KS patients was 38+/-11 years (one female, 11 males). All were on prednisone, azathioprine (AZT) and cylcosporin treatment. KS was encountered at a mean of 18+/-0 months post-renal transplantation. Typical Kaposi's lesions were present in the skin of 11 out of 12 patients. In the only patient without skin involvement, who died from haemophagocytic histiocytic syndrome caused by septicaemia, KS was diagnosed post-mortem in a lymph node. In five patients only skin involvement was present, while the others also had visceral involvement (oropharynx in two patients, trachea and lung in three, lymph node in two, stomach and duodenum in two). Cyclosporin was stopped within 1 month after KS diagnosis, and AZT was stopped in three patients. Both cutaneous and visceral KS manifestations disappeared and no patient was lost due to KS. During a follow-up period 46 19 months, KS recurred in the lungs in one patient together with lung tuberculosis, while he was on prednisone and AZT. Two patients lost their graft due to chronic rejection. The remaining eight patients currently have a functioning graft with a mean creatinine level of 1.4+/-0.5 mg/dl. Conclusion. KS is the most frequent post-transplant neoplasia (80%) in our country. In the present study cohort, half of the patients had visceral involvement. Reduction or discontinuation of immunosuppression caused complete remission in all patients without surgical intervention, chemotherapy or radiotherapy.
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    Treatment of hypertension in dialysis patients by ultrafiltration: Role of cardiac dilatation and time factor
    (W B Saunders Co, 1999) Ozkahya, M; Toz, H; Unsal, A; Ozerkan, F; Asci, G; Gurgun, C; Akcicek, F; Mees, EJD
    We retrospectively analyzed the blood pressure (BP) and cardiothoracic index (CTI) of 67 hemodialysis patients with hypertension who could be followed up for at least 8 months. A new treatment policy was adopted, aimed at strict volume control. Dietary salt restriction was strongly emphasized. Ultrafiltration (UF) was applied during regular dialysis sessions and sometimes in additional sessions, as long as BP and CTi remained at greater than normal values. All antihypertensive drugs were discontinued at the beginning of treatment. Average BP decreased from 173 +/- 17/102 +/- 9 to 139 +/- 18/86 +/- 11 mm Hg after 6 months and to 118 +/- 12/73 +/- 6 mm Hg after 36 months. Corresponding values for CTi were 52% +/- 4%, 47% +/- 3%, rind 42% +/- 4%, respectively. Conventional relatively short dialysis (three times weekly for at least 4 hours) can achieve normal BPs with prolonged effort in most patients, whereas improvement in heart condition facilitates this. (C) 1999 by the National Kidney Foundation, Inc.
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    Volume control associated with better cardiac function in long-term peritoneal dialysis patients
    (Multimed Inc, 2006) Asci, G; Ozkahya, M; Duman, S; Toz, H; Erten, S; Ok, E
    Background: This study was undertaken to investigate the effect of tong-term blood pressure (BP) reduction, achieved with salt restriction and strict volume control, on frequency and regression of left ventricular hypertrophy (LVH) in tong-term peritoneal dialysis (PD) patients. Methods: 56 patients who had been treated for more than 2 years under our care were enrolled. After echocardiographic (Echo) evaluation, 46 patients were included in the follow-up study. In our unit, we aim to keep patients' BP below 130/85 mmHg and cardiothoracic index below 0.50. To reach these targets, moderate salt restriction is advised, and if necessary, hypertonic PD solutions are used. Echo was performed at the beginning of the study (after a mean period of 36 months on PD) and at the end of the prospective follow-up period (24 months later). Results: At the time of the first Echo, LVH was detected in only 8 (21%) patients. Residual urine volume was significantly decreased compared to data taken when they first started PO (658 +/- 795 vs 236 +/- 307 mL/day). Mean Left ventricular mass index (LVMI) was 107 +/- 26.5 g/m(2). LVMI was significantly decreased at the end of the follow-up in patients who had LVH at baseline. No LVH developed in patients who had normal LVMI at baseline. Conclusion: Our results indicate that control of hypertension is possible when extracellular fluid volume is kept under control using hypertonic PD solutions in case of recruitment in addition to salt restriction in Long-term PD patients. Sustained normovolemia is associated with tow incidence and regression of LVH.