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    Liver-Spleen Ratio: Can It Be Used for the Prediction of Coronary Artery Disease?
    (Aves, 2022) Poyraz, Necdet; Ozer, Hakan; Baloglu, Ismail; Kadiyoran, Cengiz; Yilmaz, Pinar Diydem; Sertdemir, Ahmet Lutfu; Turkmen, Kultigin
    Background: Considering that ectopic fat accumulation in various organs, especially the heart and liver, is a cardiometabolic risk factor, the need for easily accessible markers of ectopic fat accumulation is inevitable. The main starting point of the study is based on the hypothesis of predicting cardiovascular disease risk through the link that can be established between the liver-spleen ratio, which is one of the strong indicators of hepatosteatosis, and epicardial adipose tissue volume. Methods: This was a retrospective study. The records of 283 consecutive patients who underwent coronary computed tomography angiography in our Radiology Department were reviewed retrospectively from our hospital's system. All patients' epicardial adipose tissue volume and liver-spleen ratio were calculated using appropriate criteria on non-contrast computed tomography images. Additionally, the Coronary Artery Disease-Reporting and Data System was calculated on contrast computed tomography images. The participating patients were divided into groups according to the liver-spleen ratio and Coronary Artery Disease-Reporting and Data System score. Results: We found that while there was a negative correlation between the liver-spleen ratio and epicardial adipose tissue volume in the hepatosteatosis group, this relationship was not observed in the non-steatosis group. In addition, we observed that the family history of cardiovascular disease and the frequency of cardiovascular disease were higher in the hepatosteatosis group than in the other group, and there was a correlation between cardiovascular disease and the liver-spleen ratio. Also, we found that age and liver- spleen ratio values were found to be independent predictors of coronary artery disease. Conclusion: In our study, we found that the frequency of cardiovascular disease was lower in patients with a high liver-spleen ratio. We also demonstrated in the study that the liver-spleen ratio, which indicates a low level of epicardial adipose tissue volume accumulation, is an independent predictor of cardiovascular disease. In addition, the use of liver-spleen ratio, which is more valuable than liver attenuation in predicting hepatic steatosis, may be more useful in evaluating the risk of hepatosteatosis-related cardiovascular disease.
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    Membranous Nephropathy: Current Understanding in The Light of New Advances
    (Aves, 2023) Ozer, Hakan; Baloglu, Ismail; Fervenza, Fernando C.; Turkmen, Kultigin
    Membranous nephropathy is the most common cause of primary nephrotic syndrome in adults. The most important mech-anism in its pathogenesis is loss of immune tolerance. New developments in membranous nephropathy are mostly related to the diagnosis and treatment of the disease, and until recently, the gold standard method in diagnosis was a kidney biopsy. In recent years, many membranous nephropathy-associated antigens and antibodies have been identified. The increased availability of these biomarkers is beneficial in predicting the treatment response, determining the treatment plan, and eliminating the necessity of kidney biopsy in the diagnosis of membranous nephropathy. Because of both the difference in treatment responses and the treatment-related side effects, membranous nephropathy treatment should be individualized. In addition, it is recommended to make a treatment plan by calculating the risk of progressive kidney fail-ure of the disease. Parallel to the changes in diagnosis and follow-up, treatment plans in membranous nephropathy have undergone severe changes in recent years. As the autoimmunity targets in the pathogenesis of the disease become clearer, treatment has turned to more specific therapies that are more selective in targeting antibody-producing cells, such as rituximab. This article described the new developments in the pathogenesis, diagnosis, and treatment of membranous nephropathy.
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    Monocyte-HDL Ratio: Can It Be Included in the Follow-Up of Diabetes Mellitus and Diagnosis of Diabetic Nephropathy?
    (2023) Ozer, Hakan; Aydoğan, Kader Zeybek; Ozturk, Yasin; Yonet, Fethi; Baloglu, Ismail
    Background and Aim: Diabetic nephropathy is the most common cause of end-stage renal disease and albuminuria is the earliest manifestation of diabetic nephropathy.Oxidative stress and inflammation caused by advanced glyco-oxidation end products contribute to micro and macrovascular complications of diabetes. Monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) is an essential indicator of inflammation and oxidative stress. In this study, we aimed to reveal the relationship between diabetes regulation and complications and MHR. Material and Method: A total of 182 subjects, including 152 patients with diabetes mellitus (DM) and 30 healthy controls, were included in this study. All data of the subjects were scanned retrospectively. The DM group was divided into two groups nephropathy (n=68) and non-nephropathy (n=84), with a limit of 30 mg/day for albuminuria. MHR was calculated by dividing the monocyte count by the HDL cholesterol count. Results: When patients with DM were divided into nephropathy and non-nephropathy, patients with nephropathy had higher MHR levels than the other group. We showed that MHR correlated with albuminuria, creatinine, and HbA1c in patients with diabetic nephropathy. In addition, in the regression analysis, albuminuria and MHR were predictors of DN, while MHR, age, and creatinine were found to be independent predictors of albuminuria. Conclusion: MHR, which is an easily calculated marker with simple laboratory tests, which is frequently requested in routine practice in the follow-up of diabetes patients, can help predict the regulation of diabetes and its kidney complications.
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    Retrospective Evaluation of Therapeutic Plasma Exchange in Nephrology Clinic: A Single-Center Experience
    (Aves, 2023) Serin, Hatice Ozge; Baloglu, Ismail; Tonbul, Halil Zeki; Turkmen, Kultigin; Selcuk, Nedim Yilmaz
    Objective: The indication for use of therapeutic plasma exchange has been increasing in recent years. It is a method that contributes significantly to the reduction of mortality and morbidity with immunosuppressive treatments in many life -threatening diseases. The aim of this study is to examine, research, and develop therapeutic plasmapheresis procedures performed in a nephrology department.Methods: In this study, we retrospectively reviewed the therapeutic plasma exchange procedures performed in our center. The demographic characteristics, clinical features, and laboratory results before and after the procedure of all patients were screened.Results: A total of 67 patients (36 females, 31 males; mean age, 45.73 +/- 15.89 years) and 398 apheresis sessions were analyzed. The most common nephrological indication of the therapeutic plasma exchange was acute humoral rejection (40.3%). When the laboratory values of the patients before and after the procedure were examined, it was observed that there was a statistically significant decrease in creatinine and platelet values after the procedure and a significant increase in bicarbonate values. When therapeutic plasma exchange was performed for hemolytic uremic syndrome, it was found that there was a decrease in lactate dehydrogenase level and an increase in platelet count. Complications were detected in 2 of the patients during the procedure.Conclusion: Therapeutic plasmapheresis exchange can be performed by many different indications in a nephrology department. Acute humoral rejection was the most common indication for plasmapheresis in our center. We think that the procedure performed with the right indications will contribute to better outcomes.
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    The relationship between FGF23 and anemia in HD and renal transplant patients
    (Springer, 2022) Baloglu, Ismail; Ozer, Hakan; Ozturk, Yasin; Erdur, Mehmet Fatih; Tonbul, Halil Zeki; Turkmen, Kultigin
    Purpose Recent studies claim that FGF23 is also associated with anemia and inflammation. In this study, the relationship between FGF23 and anemia in hemodialysis (HD) and renal transplantation patients (RTx patients) patients was investigated. Methods This was a cross-sectional study involving 40 RTx patients (13 females, 27 males; mean age, 45.93 +/- 12.49 years) who had transplantation at least 6 months before, 25 HD patients (12 females, 13 males; mean age, 54.72 +/- 15.5 years), and 20 healthy control subjects (13 females, 7 males; mean age, 36.7 +/- 9.38 years). FGF23 was studied using Elisa method. Parameters such as iron, ferritin, total iron binding capacity, and transferrin saturation were assessed. Results FGF23 level was significantly higher in HD patients when compared with the RTx patients and control groups. In the bivariate correlation analysis, hemoglobin was positively correlated with albumin (r = 0.681, p = 0.000), ferritin (r = 0.446, p = 0.043), and negatively correlated with CRP (r = - 0.476, p = 0.016) and FGF23 (r = 0.493, p = 0.043). FGF23 was found to be an independent predictor of decreased hemoglobin in HD patients. In addition, this association was observed to disappear after transplantation. Conclusion While FGF23 is closely related to hemoglobin levels in HD patients, we have shown that this relationship disappears after transplantation.
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    Two Different Presentation of C3 Glomerulonephritis Treated with Eculizumab: Two Cases and Brief Overview
    (Aves, 2023) Ozturk, Yasin; Ozer, Hakan; Baloglu, Ismail; Turkmen, Kultigin
    C3 glomerulopathy is a newly defined glomerular disease dominated by C3 complement storage and uncertain C1, C4, and immunoglobin accumulations. Hereditary mutations associated with Complement Factor H (CFH) causing hyperactivation of the alternative complement pathway were identified. Most mutations associated with C3 glomerulopathy are associated with the N-terminal end. Whether mutations are pathogenic or not will direct diagnosis and treatment. We present 2 cases, one 61-year-old and one 24-year-old attending our clinic at different times with hematuria, proteinuria, edema, and kidney failure. Both patients had C3 glomerulopathy diagnosed based on the results of kidney biopsy and were treated with eculizumab. Both cases had CFH-associated mutations.