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Öğe A new recommendation for febrile urinary tract infection in children aged 2-24 months: Tepecik UTI Guideline-2(NLM (Medline), 2023) Koyun Cezayir, Begüm; Yavaşcan, Önder; Alaygut, Demet; Kasap Demir, Belde; Mutlubaş, Fatma; Arslansoyu Çamlar, Seçil; Alparslan, Caner; Soyaltın, Eren; Özgür, SuAIM: Urinary tract infections (UTIs) represent a common febrile illness in infancy. The study compared two UTI guidelines in terms of number of imaging studies, presence of parenchymal damage and radiation exposure in patients with the first febrile UTI between 2 and 24?months of age. METHOD: The results of Tepecik UTI Guideline-1 used until 2012 (Group 1, n?=?105) were retrospectively compared with Tepecik UTI Guideline-2 (Group 2) used after 2013. In Group 1, urinary tract ultrasonography (US), dimercaptosuccinic acid (DMSA) and voiding cystourethrography (VCUG) were made in all patients. In Group 2, if the US result was abnormal, patients were evaluated with VCUG and DMSA. If the US was normal, only DMSA was performed. If the DMSA was abnormal, the VCUG was undergone (n: 43, 40.9%). RESULTS: The abnormal VCUG detection rate was 69.2% in Group 1 and 30.8% in Group 2 (p?=?0.09). Sensitivity and specificity of US in the diagnosis of vesicoureteral reflux (VUR) was 15.9% and 96.7% in Group 1 and 61.5% and 70.5% in Group 2, respectively. Abnormal DMSA findings were observed among 33.3% (Groups 1) and 66.7% (Groups 2) subjects, respectively (p?>?0.05). The median radiation exposure (500?mrem) of patients in Group 1 was statistically significantly higher than those in Group 2 (200?mrem) (p?Öğe A partial response to abatacept in a patient with steroid resistant focal segmental glomerulosclerosis(Turkish Journal of Pediatrics, 2020) Soyaltın, Eren; Kasap Demir, Belde; Alparslan, Caner; Arslansoyu Çamlar, Seçil; Alaygut, Demet; Yavaşcan, Önder; Mutlubaş, FatmaBackground. Herein we present our experience with abatacept in a patient diagnosed with primary focal segmental glomerulosclerosis (FSGS) and resistant to steroid and other immunosuppressives. Case. A 17-year-old girl was diagnosed with idiopathic nephrotic syndrome (NS) at the age of 8 years. Kidney biopsy was performed when she did not respond to 6-weeks of steroid (2mg/kg) therapy followed by three doses of pulse methylprednisolone (PMP) and considered as steroid resistant NS. The biopsy revealed focal segmental glomerulosclerosis (FSGS) and cyclophosphamide was added to the steroid treatment but the patient had no response. The genetic analysis revealed G34G/A318A compound homozygous synonym aminoacid variation in NPHS2 gene, thus all immunosuppressive regimes were stopped and she was put on supportive treatment. Throughout this period, she had nephrotic range of proteinuria, however serum albumin levels were >3g/dl. At the end of two years, the patient had NS with severe edema and hypoalbuminemia. When the genetic analysis was interpreted again, it was found to be consistent with a polymorphism rather than a mutation. Following 3 doses of PMP, oral steroid treatment was resumed and cyclosporine (CsA) was added to the treatment at the fifth year of follow up. However, she was unresponsive to CsA at the end of the first year as well as mycophenolate mofetil used for 12 months and rituximab used for 6 months, respectively. Then abatacept was instituted and proteinuria decreased below 1 gr/day and serum albumin levels increased to 3 g/dl at the end of 6 doses. Serum albumin levels remained stable in the following 7 months. Conclusion. Partial remission including the decrease in proteinuria and increase in albumin levels achieved in our patient encourages the usage of abatacept in patients who do not respond to multiple immunosuppressive therapies.Öğe Blood pressure parameters affecting ventricular repolarization in obese children(Springer Science and Business Media Deutschland GmbH, 2023) Kasap Demir, Belde; Soyaltın, Eren; Alparslan, Caner; Demircan, Tülay; Arslansoyu Çamlar, Seçil; Alaygut, Demet; Mutlubaş, Fatma; Öncel, Elif Perihan; Yavaşcan, Önder; Dündar, Bumin Nuri; Karadeniz, CemBackground Ventricular repolarization (VR) increases the risk of sudden cardiac death due to ventricular arrhythmia. We aimed to evaluate the blood pressure (BP) parameters affecting VR in obese children.Methods Obese (BMI = 95p) and healthy children = 120 cm between January 2017 and June 2019 were included. Demographic and laboratory data, peripheral and central BPs evaluated by a device capable of ambulatory blood pressure monitoring (ABPM), and pulse wave analysis were assessed. Electrocardiographic ventricular repolarization indices, left ventricular mass index (LVMI), and relative wall thickness (RWT) were calculated.Results A total of 52 obese and 41 control patients were included. Uric acid, triglyceride, total cholesterol, LDL, and ALT values, systolic and diastolic office BPs, 24-h, daytime and nighttime systolic and mean arterial BPs, daytime diastolic BP SDS levels, daytime and nighttime systolic loads, daytime diastolic load, 24-h, daytime and nighttime central systolic and diastolic BPs, and pulse wave velocity values were significantly higher, whereas 24-h, daytime and nighttime AIx@75 were similar between the groups. fT4 levels of obese cases were significantly lower. QTcd and Tp-ed were higher in obese patients. Although RWT was higher in obese cases, LVMI values and cardiac geometry classifications were similar. The independent factors affecting VR in obese cases were younger age and higher diastolic load at night (B = - 2.83, p = 0.010; B = 0.257, p = 0.007, respectively).Conclusion Obese patients have higher peripheral and central BP, arterial stiffness, and higher VR indices that develop before an increase in LVMI. It would be useful to prevent obesity from an early age and follow up nighttime diastolic load to control VR associated sudden cardiac death in obese children.Öğe Can we use copeptin as a biomarker for masked hypertension or metabolic syndrome in obese children and adolescents?(Walter de Gruyter GMBH, 2020) Deligözoğlu, Duygu; Kasap Demir, Belde; Alparslan, Caner; Erbak, Huriye; Çatlı, Gönül; Mutlubaş, Fatma; Alaygut, Demet; Soyaltın, Eren; Arslansoyu Çamlar, Seçil; Yavaşcan, ÖnderObjectives: Copeptin, the C-terminal part of arginine-vasopressin, is increased in hypertensive adolescents and closely associated with metabolic syndrome (MS). We aimed to investigate whether serum copeptin can be used to differentiate masked hypertension (MHT) and MS, and the role of sodium intake, natriuretic peptide response and renin-angiotensin-aldosterone system in MHT and MS in obese youth.Methods: Obese children aged 10-18 years with normal office blood pressure measurements were included. Patients with MHT and normotension and those with MS and non-MS were evaluated separately. Biochemical parameters, copeptin, brain natriuretic peptide (BNP), aldosterone, renin, urine sodium, and protein were evaluated. Echocardiography, fundoscopic examination, and ambulatory blood pressure monitoring were performed.Results: There were 80 (M/F=39/41) obese patients with a mean age of 13.78 +/- 1.93 years. The cases with MHT, MS, and concomitant MHT and MS were 53,24, and 13%, respectively. Copeptin levels were similar among patients with and without MHT or MS (p>0.05). However, multivariate analysis revealed that copeptin significantly increased the probability of MHT (OR 1.01, 95% CI=1.001-1.018, p=0.033). Copeptin was positively correlated with daytime systolic and diastolic load, aldosterone, BNP, and urine microalbumin/creatinine levels (p<0.05). Linear regression analyses revealed that copeptin was significantly correlated with BNP regardless of having MHT or MS in obese youth. In the MHT group, 24-h sodium excretion was not significantly correlated with BNP.Conclusion: Copeptin may be a beneficial biomarker to discriminate MHT, but not MS in obese children and adolescents. An insufficient BNP response to sodium intake might be one of the underlying causes of MHT in obese cases.Öğe COVID-19 in pediatric nephrology centers in Turkey(Springer, 2021) Bakkaloğlu, Sevcan Azime; Özdemir Atikel, Yeşim; Leventoğlu, Emre; Nalcacıoğlu, Hülya; Dursun, İsmail; Poyrazoğlu, Hakan; Dursun, Hasan; Yürük Yıldırım, Zeynep; Yıldız, Nurdan; Kaya Aksoy, Gülşah; Akman, Sema; Taşdemir, Mehmet; Bilge, Ilmay; Çelakıl, Mehtap; Demircioğlu Kılıç, Beltinge; Zırhlı Selçuk, Şenay; Canpolat, Nur; Kargın Çakıcı, Evrim; Özlü, Sare Gülfem; Tülpar, Sebahat; Yüksel, Selçuk; Atmış, Bahriye; Sürmeli Döven, Serra; Taner, Sevgin; Ertan, Pelin; Kavaz, Aslı; Torun Bayram, Meral; Kalyoncu, Mukaddes; Gülleroğlu, Kaan; Kabasakal, Caner; Kasap Demir, Belde; Çiçek, Rümeysa Yasemin; Dönmez, Osman; Kara, Aslıhan; Yavaşcan, Önder; Özçelik, Gül; Gezgin Yıldırım, Deniz; Güler, Muhammet Akif; Sönmez, Ferah; Topaloğlu, Rezan; Alpay, Harika[Abstract Not Available]Öğe COVID-19 in pediatric nephrology centers in Turkey(Turkiye Klinikleri, 2022) Leventoğlu, Emre; Özdemir Atikel, Yeşim; Nalçacıoğlu, Hülya; Dursun, İsmail; Dursun, Hasan; Yürük Yıldırım, Zeynep; Yıldız, Nurdan; Kaya Aksoy, Gülşah; Taşdemir, Mehmet; Çelakil, Mehtap; Demircioğlu Kılıç, Beltinge; Zırhlı Selçuk, Şena; Canpolat, Nur; Kargın Çakıcı, Evrim; Özlü, Sare Gülfem; Tülpar, Sebahat; Yüksel, Selçuk; Atmış, Bahriye; Sürmeli Döven, Serra; Taner, Sevgin; Ertan, Pelin; Kavaz, Aslı; Torun Bayram, Meral; Kalyoncu, Mukaddes; Gülleroğlu, Kaan; Kabasakal, Caner; Kasap Demir, Belde; Çiçek, Rümeysa Yasemin; Bilge, İlmay; Dönmez, Osman; Kara, Aslıhan; Yavaşcan, Önder; Özçelik, Gül; Gezgin Yıldırım, Deniz; Güler, Muhammet Akif; Sönmez, Ferah; Poyrazoğlu, Hakan; Akman, Sema; Topaloğlu, Rezan; Alpay, Harika; Bakkaloğlu, Sevcan AzimeBackground/aim: There is limited data on COVID-19 disease in children with kidney disease. We aimed to investigate the characteristics and prognosis of COVID-19 in pediatric nephrology patients in Turkey. Materials and methods: This was a national, multicenter, retrospective cohort study based on an online survey evaluating the data between 11th March 2020 and 11th March 2021 as an initial step of a detailed pediatric nephrology COVID-19 registry. Results: Two hundred and three patients (89 girls and 114 boys) were diagnosed with COVID-19. One-third of these patients (36.9%) were between 10–15 years old. Half of the patients were on kidney replacement therapy: kidney transplant (KTx) recipients (n = 56, 27.5%), patients receiving chronic hemodialysis (n = 33, 16.3%) and those on peritoneal dialysis (PD) (n = 18, 8.9%). Fifty-four (26.6%) children were asymptomatic. Eighty-two (40.3%) patients were hospitalized and 23 (28%) needed intensive care unit admission. Fifty-five percent of the patients were not treated, while the remaining was given favipiravir (20.7%), steroid (16.3%), and hydroxychloroquine (11.3%). Acute kidney injury developed in 19.5% of hospitalized patients. Five (2.4%) had MIS-C. Eighty-three percent of the patients were discharged without any apparent sequelae, while 7 (3.4%) died. One hundred and eight health care staff were infected during the study period. Conclusion: COVID-19 was most commonly seen in patients who underwent KTx and received HD. The combined immunosuppressive therapy and frequent exposure to the hospital setting may increase these patients’ susceptibility. Staff infections before vaccination era were alarming, various precautions should be taken for infection control, particularly optimal vaccination coverage.Öğe Risk assessment for arrhythmia in pediatric renal transplant recipients(Başkent University, 2023) Kasap Demir, Belde; Soyaltın, Eren; Alparslan, Caner; Arslansoyu Çamlar, Seçil; Demircan, Tülay; Yavaşcan, Önder; Mutlubaş, Fatma; Alaygut, Demet; Karadeniz, CemObjectives: Renal transplant recipients are at risk for ventricular arrhythmia and sudden death. To assess that risk, we compared the ventricular repolarization markers of pediatric renal transplant recipients with those of healthy children. Materials and Methods: We included 30 children and adolescents who were followed for at least 6 months after renal transplant; 30 age- and sex-matched children were included for the control group. Demographic features, medications, and laboratory findings were recorded. Blood pressure measurements, ventricular repolarization indexes including QT dispersion, corrected QT dispersion, T-wave peak-to-end interval dispersion, the T-wave peak-to-end interval/QT ratio, the T-wave peak-to-end interval/corrected QT ratio, left ventricular mass index, and relative wall thickness were compared between groups. In addition, the correlations of ventricular repolarization indexes with other variables were evaluated. Results: Blood pressure standard deviation scores, the mean heart rate, QT dispersion, corrected QT dispersion, the T-wave peak-to-end interval/QT ratio, the T-wave peak-to-end interval/corrected QT ratio, left ventricular mass index, and relative wall thickness values were significantly higher in renal transplant patients, whereas T-wave peak-to-end interval dispersion, ejection fraction, and fractional shortening were similar between groups. Although ventricular repolarization indexes were similar in patients with and without left ventricular hypertrophy, only corrected QT dispersion was significantly higher in patients with hypertension (P = .006). The only variable that significantly predicted prolonged corrected QT dispersion was the systolic blood pressure standard deviation score (P = .005, beta = .403). Conclusions: Ventricular repolarization anomalies, hypertension, left ventricular hypertrophy, and cardiac geometry irregularity may be observed after renal transplant in pediatric recipients despite acceptable allograft functions and normal serum electrolyte levels. Control of systolic blood pressure would decrease the risk of ventricular repolarization abnormalities, namely, the corrected QT dispersion. Follow-up of cardiovascular risks with noninvasive methods is recommended in all pediatric renal transplant recipients.Öğe The 6th of february earthquake and the Turkish society of pediatric nephrology-organizational aspects of pediatric kidney care(Oxford University Press, 2023) Bakkaloğlu, Sevcan Azime; Yavaşcan, Önder; Yılmaz, Alev; Gülleroğlu, Kaan; Kasap Demir, Belde; Ertan, Pelin; Poyrazoğlu, HakanThe 6 February 2023 earthquake that struck southern and central Turkey and northern and western Syria had unique drawbacks, such as the occurrence of two strong, destructive earthquakes nine hours apart in multiple and densely populated geographical areas, exposure to unforgiving winter conditions, and increased anxiety and fear due to multiple aftershocks [1, 2]. As of 26 March 2023, >50 000 people have been killed and many more have been injured in Turkey [3]. One recent editorial and a letter emphasized the vital importance of increased awareness of disaster preparedness and rapid action on organizational issues [4, 5]. Nongovernmental organizations including academic medical societies should take responsibility during disasters [6] and work together with other stakeholders. Since an earthquake should be considered a “kidney disaster” because of crush injuries and resultant acute kidney injury [7], the Turkish Society of Pediatric Nephrology (TSPN) took primary responsibility during the immediate and early phases of earthquake.
