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    Early Effects of Renal Replacement Therapy on Cardiovascular Comorbidity in Children With End-Stage Kidney Disease: Findings From the 4C-T Study
    (Lippincott Williams & Wilkins, 2018) Schmidt, Bernhard M. W.; Sugianto, Rizky Indrameikha; Thurn, Daniela; Azukaitis, Karolis; Bayazit, Aysun K.; Canpolat, Nur; Eroglu, Ayse Guler
    Background The early impact of renal transplantation on subclinical cardiovascular measures in pediatric patients has not been widely investigated. This analysis is performed for pediatric patients participating in the prospective cardiovascular comorbidity in children with chronic kidney disease study and focuses on the early effects of renal replacement therapy (RRT) modality on cardiovascular comorbidity in patients receiving a preemptive transplant or started on dialysis. Methods We compared measures indicating subclinical cardiovascular organ damage (aortal pulse wave velocity, carotid intima media thickness, left ventricular mass index) and evaluated cardiovascular risk factors in 166 pediatric patients before and 6 to 18 months after start of RRT (n = 76 transplantation, n = 90 dialysis). Results RRT modality had a significant impact on the change in arterial structure and function: compared to dialysis treatment, transplantation was independently associated with decreases in pulse wave velocity (ss = -0.67; P < 0.001) and intima media thickness (ss = -0.40; P = 0.008). Independent of RRT modality, an increase in pulse wave velocity was associated with an increase in diastolic blood pressure (ss = 0.31; P < 0.001). Increasing intima media thickness was associated with a larger increase in body mass index (ss = 0.26; P = 0.003) and the use of antihypertensive agents after RRT (ss = 0.41; P = 0.007). Changes in left ventricular mass index were associated with changes in systolic blood pressure (ss = 1.47; P = 0.01). Conclusions In comparison with initiating dialysis, preemptive transplantation prevented further deterioration of the subclinical vascular organ damage early after transplantation. Classic cardiovascular risk factors, such as hypertension and obesity are of major importance for the development of cardiovascular organ damage after renal transplantation.
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    RITUXIMAB TREATMENT FOR DIFFICULT-TO-TREAT NEPHROTIC SYNDROME IN CHILDREN: A MULTICENTER STUDY
    (Springer, 2018) TaSdemir, Mehmet; Canpolat, Nur; Yildiz, Nurdan; Ozcelik, Gul; Benzer, Meryem; Saygili, Seha Kamil; Ozkayin, Nese
    [Abstract Not Available]
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    Rituximab treatment for difficult-to-treat nephrotic syndrome in children: a multicenter, retrospective study
    (Tubitak Scientific & Technological Research Council Turkey, 2021) TasdemIr, Mehmet; Canpolat, Nur; Yildiz, Nurdan; OzcelIk, Gul; Benzer, Meryem; Saygili, Seha Kamil; Ozkayin, Emine Nese
    Background/aim: This study aimed to evaluate the efficacy of rituximab in children with difficult-to-treat nephrotic syndrome, considering the type of disease (steroid-sensitive or -resistant) and the dosing regimen. Materials and methods: This multicenter retrospective study enrolled children with difficult-to-treat nephrotic syndrome on rituximab treatment from 13 centers. The patients were classified based on low (single dose of 375 mg/m(2)) or high (2-4 doses of 375 mg/m(2)) initial dose of rituximab and the steroid response. Clinical outcomes were compared. Results: Data from 42 children [20 steroid-sensitive (frequent relapsing / steroid-dependent) and 22 steroid-resistant nephrotic syndrome, aged 1.9-17.3 years] were analyzed. Eleven patients with steroid-sensitive nephrotic syndrome (55%) had a relapse following initial rituximab therapy, with the mean time to first relapse of 8.4 +/- 5.2 months. Complete remission was achieved in 41% and 36% of steroid-resistant patients, with the median remission time of 3.65 months. At Year 2, eight patients in steroid-sensitive group (40%) and four in steroid-resistant group (18%) were drug-free. Total cumulative doses of rituximab were higher in steroid-resistant group (p = 001). Relapse rates and time to first relapse in steroid-sensitive group or remission rates in steroid-resistant group did not differ between the low and high initial dose groups. Conclusion: The current study reveals that rituximab therapy may provide a lower relapse rate and prolonged relapse-free survival in the steroid-sensitive group, increased remission rates in the steroid-resistant group, and a significant number of drug-free patients in both groups. The optimal regimen for initial treatment and maintenance needs to be determined.