Zelal Adibelli

Renal Behçet's Disease: An Update

OBJECTIVE The aims of this study are (1) to report 33 patients with Behçets disease (BD) having various renal manifestations, and (2) to update current data using our patients and published papers about BD and renal manifestations. METHODS The PubMed database was searched using the terms BD or Behçets syndrome. We found reports of 94 patients (including ours) with BD and specific renal diseases (amyloidosis, 39; glomerulonephritis [GN], 37; renal vascular disease, 19; interstitial nephritis, 1). RESULTS The presentation of renal disease was edema/nephrotic syndrome in 12 patients (36%). Renal disease was incidentally diagnosed by routine urine analysis and measurement of serum creatinine level in 20 patients (61%). Renal failure was present in 23 patients (70%) and 5 of them have had cyclosporine treatment. The frequency of renal disease among BD patients has been reported to vary from less than 1 to 29%. CONCLUSIONS The clinical spectrum of renal BD shows a wide variation. Amyloidosis (AA type), GN, and macroscopic/microscopic vascular disease are the main causes of renal BD. Patients with vascular involvement have a high risk of amyloidosis and amyloidosis is the most common cause of renal failure in BD. Several types of glomerular lesions are seen in BD. Current treatment options for renal BD are not evidence based. Radiological vascular intervention combined with immunosuppressive drugs can be useful in selected cases. Routine urine analysis and measurement of serum creatinine level are needed for early diagnosis of renal BD.

Lemon juice as an alternative therapy in hypertension in Turkey

We aimed to learn the frequency of lemon juice usage among the hypertensive patients in a local region of northern Turkey. One hundred fifty six (72.5%) of hypertensive patients were using alternative therapy and eighty six patients (40%) were drinking lemon juice. We think that to gain success in the treatment of hypertension educating the society is important and there should be clinical studies about the effect of lemon juice on blood pressure, which is one of the most common alternative therapies in our country.

Transplantation tourism: high risk for the recipients.

Yakupoglu YK, Ozden E, Dilek M, Demirbas A, Adibelli Z, Sarikaya S, Akpolat T. Transplantation tourism: high risk for the recipients. 
Clin Transplant 2010: 24: 835–838.

Home sphygmomanometers: validation versus accuracy.

ObjectiveThe validation and accuracy of sphygmomanometers are important issues in the home sphygmomanometer market and in clinical practice. The aims of this study are to assess the frequency of validated home sphygmomanometers and to evaluate the relationship between the validation and accuracy of the devices. MethodsEight hundred and ninety-six home sphygmomanometers were brought by individuals to the University Hospital Hypertension Clinic for this study, and 870 (97%) of the devices were in adequate working condition and suitable for analysis. The relationship between accuracy and validation was investigated only in automated sphygmomanometers (n = 554). ResultsBoth the manufacturer and model were known in 500 devices (90%), and these devices were eligible for evaluation of validation. We found 74 devices listed in the dabl Educational Trust website. Twenty-two of the 74 (30%) devices were validated. Four hundred (72%) of the 554 automated sphygmomanometers were inaccurate. The frequency of accuracy was higher among validated devices compared with nonvalidated devices (68 vs. 15%) (P<0.01). ConclusionOur study showed that the frequency of accurate devices was higher among validated sphygmomanometers compared with nonvalidated sphygmomanometers. To our knowledge, our study is the first to demonstrate the relationship between accuracy and validation of home sphygmomanometers. The frequency of device-related errors can be decreased by training patients and supervising the blood pressure device market. Nonprofit organizations can help patients to overcome some of the problems in the blood pressure device market.

Self-measurement of blood pressure at home: is it reliable?

Self‐measurement of blood pressure (BP) at home is more common than 10 years ago and encouraged by current guidelines to increase patient adherence to treatment and reach the goal of target BP. The aims of this study are to evaluate the accuracy of home sphygmomanometers and to investigate behavior/knowledge of the sphygmomanometer owners. A campaign was planned to determine the accuracy of home sphygmomanometers in 2006. Seven hundred and twenty‐three home sphygmomanometers were brought by individuals to the University Hospital Hypertension Clinic within 1 year and 693 (96%) of the devices were in adequate working condition and suitable for analysis. Four hundred and thirty‐nine (63%) of the sphygmomanometers were automatic. Four hundred and eleven (59.3%) of the 693 sphygmomanometer were inaccurate. About 80% (256/320) of the wrist devices were inaccurate. Most studies evaluating the accuracy of sphygmomanometers are conducted in hospital or primary care settings; studies investigating home sphygmomanometers are rare. High frequency of inaccurate home devices is a major public health problem. In conclusion, inaccurate devices have been used in home BP measurements frequently and frequency of device‐related errors can be decreased by awareness and training of the patients. Physicians and healthcare providers should advise the patients to check the accuracy of their home sphygmomanometers regularly.

Is localized prostate cancer an obstacle for an immediate consideration for renal transplantation? A case report.

Currently, renal failure patients with a history of prostate cancer are recommended to have a 2 to 5-year disease-free interval prior to being allowed to receive a kidney transplant. This disease is now amenable to curative therapy if diagnosed at an early stage when the tumor is organ-confined. We report a patient undergoing immediate renal transplantation following a laparoscopic radical prostatectomy for the treatment of prostate cancer. Candidates for renal transplantation who are diagnosed with early stage, organ-confined prostate cancer may be immediately considered for transplantation following radical prostatectomy in view of the high likelihood of cure of their prostate cancer.

Neurological Complications after Renal Transplantation: A Retrospective Clinical Study

INTRODUCTION The aim of this study was to evaluate the incidence and types of neurological complications (NCs) and associated factors in renal transplantation (RT) patients. METHODS Three hundred and forty-four patients who had RT performed at our institution between January 2005 and July 2014 were retrospectively evaluated. RESULTS File records of the patients revealed 19 who experienced a total of 22 episodes of NCs, of whom three had more than one episode. The mean age of 19 patients included in the study, of whom eight were female, was 37.52±13.08 (range, 18-65) years. NCs were classified into central or peripheral depending on the location of involvement of the central nervous system (CNS). CNS involvement was found in 16 (84.2%) of the 19 patients. Tremor (36.8%) was the most common CNS complication in these patients. Encephalopathy, generalized tonic-clonic seizures, and status epilepticus were observed in two patients (10.5%). Delirium and dementia were observed in one patient (5.2%). Headache was experienced by one patient, and agitated depression was observed in one patient. Six patients (26.3%) had the peripheral nervous system involvement. One patient had the numbness of hands with normal electromyography findings, and four patients had polyneuropathy. In one patient, lumbar plexopathy was observed. Seventeen of the 22 NCs were considered to be caused by immunosuppressive agents. Each incidence of amyloidosis, infection, septic emboli, and hypoglycemia caused a neurological episode. The etiology of one episode was unknown. CONCLUSION Different neurological disorders can be seen after RT, and most of them are caused by immunosuppressive drugs. NCs seen after RT can be treated by decreasing the dose or changing the immunosuppressive drug.

First A2-to-O Renal Transplantation in the 21st Century: A Step in the Transplantation History of Turkey

Renal transplantation is the best treatment modality for patients with end-stage renal disease. Turkey is a country with limited cadaveric donor organ programs. Herein we have reported the first A2-to-O living donor kidney transplantation in Turkey. A 20-year-old female patient was admitted for a living related renal transplantation from her only potential donor her mother. She was blood group O and her mother was blood group A2. Three plasmapheresis sessions followed by intravenous immunoglobulin (IVIG) were performed every other day in the week prior to transplantation. Daclizumab was administered at the time of transplantation with an additional four doses every 2 weeks after the procedure. The immunsuppressive regimen included tacrolimus, mycophenolate mofetil, and prednisolone. Eight plasmapheresis sessions followed by IVIG were performed in the first 2 weeks posttransplant. Six months after transplantation, the serum creatinine was 1 mg/dL. Our experience showed that A2-to-O renal transplantation can be safely performed and may expand the pool of living kidney donors in Turkey.