Department of Nephrology
At Başkent University Medical Faculty, Adana Dr. Turgut Noyan Practice and Research Hospital, the Department of Nephrology offers specialized care for adult patients aged 18 and over, focusing on the diagnosis and treatment of hypertension, kidney diseases, and dialysis (peritoneal or hemodialysis), as well as organ transplantation methods for patients with renal failure. These services are provided by our faculty members, along with expert health personnel.
In our nephrology outpatient clinic located in the Kışla campus, we provide detailed outpatient examination services to approximately 550 patients monthly. The patients' results are evaluated on the same day, and necessary treatments are organized. For patients requiring inpatient examination and treatment, our Yüreğir hospital offers services in this field with a 35-bed capacity ward.
Hemodialysis: In the Kışla dialysis center, hemodialysis treatment is provided to 450 patients six days a week. Patients are treated in separate rooms based on their hepatitis B and C status, under the responsibility of a nephrology specialist and a team of physicians and nurses with dialysis certification. At our Urfa center, affiliated with our unit, hemodialysis services are provided to 158 patients with 36 machines. Medical support for our patients is continuously maintained, with periodic medical checks at our institution. All our dialysis patients are monitored with monthly blood counts, biochemical tests, lung X-rays, ECGs, and echocardiograms. Laboratory and imaging services with the latest technological equipment are provided for patients requiring advanced examination. Outpatient peritoneal dialysis is performed on 40 patients under the responsibility of our center.
Kidney Transplantation: As part of Turkey's most advanced organ transplant team, our Adana hospital has performed 342 kidney transplants from deceased and living donors since 2010. Preoperative preparations and postoperative follow-ups for patients are meticulously carried out by specialists.
Diseases of Interest in the Field of Nephrology
- Hypertension
- Diabetic kidney disease (Diabetic Nephropathy)
- Glomerulonephritis
- Kidney infections (pyelonephritis)
- Acute kidney failure
- Chronic kidney failure
Hypertension
High blood pressure is defined as hypertension. The accepted normal blood pressure value in a resting adult is 120/80 mmHg. A diagnosis of hypertension is made if blood pressure consistently exceeds 140/90 mmHg in repeated measurements. Untreated and uncontrolled high blood pressure increases the risk of heart attack, heart failure, renal failure, cerebral hemorrhage, vascular obstruction, and death. If diagnosed and treated promptly, elevated blood pressure can be lowered, and the risk of organ damage and death can be reduced.
Classification of Hypertension
1. Primary (Essential) Hypertension
Primary (essential) hypertension is identified in 90% of hypertension cases. Factors such as stress, dietary habits, excessive salt intake, overweight, and genetic factors may play a role in this type of hypertension.
2. Causes of Secondary Hypertension
- Kidney disease (disorders of kidney tissue and vessels)
- Various diseases of the adrenal glands
- Some medications (birth control pills; cortisone, cold medicines, painkillers, etc.)
- Pregnancy
- Brain tumors or increased intracranial pressure
Risk Groups
- Heredity: Familial predisposition
- Gender: More common in men, but frequency increases in women after menopause
- Age: Usually occurs after age 35
- Obesity
- Alcohol
- Smoking
- Diabetes
- Poor nutrition and salty diets
- Sedentary lifestyle
- Users of birth control pills
- Stress
Symptoms of Hypertension: Hypertension can manifest silently or with symptoms such as pulsating headaches, especially at the base of the skull, nausea, vomiting, nosebleeds, numbness, fatigue, anxiety, tinnitus, blurred vision or darkening of the eyes, and frequent urination. These symptoms should not be ignored and should be investigated for hypertension.
Dangers of Hypertension to the Body
- Atherosclerosis (hardening of the arteries)
- Brain hemorrhage and stroke
- Heart attack and failure
- Vision loss in the eyes
- Kidney damage
Prevention and Protection from Hypertension
Initially, non-pharmacological treatments such as the following lifestyle changes will be beneficial:
- Restricting salt intake (maximum 1 teaspoon of table salt per day)
- Maintaining ideal weight
- Avoiding smoking
- Avoiding alcohol
- Regular exercise
- Stress management techniques
If hypertension cannot be reduced to the desired level with non-pharmacological methods, the doctor will choose the most suitable among various antihypertensive drugs. Regular monitoring can prevent cardiovascular, renal, and vascular diseases associated with hypertension.
Diabetic Kidney Disease (Diabetic Nephropathy)
High blood sugar causes an increase in the filtering function of the kidneys, followed by narrowing of the vessels, resulting in widespread dysfunction in the kidneys. Kidney damage caused by diabetes is known as "diabetic kidney disease." It is one of the most important complications of diabetes and is currently the most common cause of end-stage renal disease (ESRD). In patients with diabetes, kidney damage can be investigated by looking for protein in the urine, and if present, by the amount and blood tests. Normally, no protein is found in urine. The condition where the amount of protein detected in the urine exceeds a certain value, but is not very high, is known as "microalbuminuria." Screening for "microalbuminuria" in urine generally begins 5 years after diagnosis in Type 1 diabetics and immediately in Type 2 diabetics. Diabetic kidney damage is progressive. If the same person also has high blood pressure (hypertension) or high blood lipids (hyperlipidemia), the progression of kidney damage accelerates. Therefore, not only diabetes but also accompanying diseases must be controlled.
Prevention and Treatment
1. Maintaining blood sugar control
2. Keeping blood pressure under control, treating hypertension if present (Blood pressure should be 130/80 mmHg)
3. Timely treatment of urinary tract infections
4. Dietary regulation, reducing protein intake (0.8-1.0 g/kg/day)
5. Hyperlipidemia treatment: Keeping blood lipids within normal limits, following a diet low in cholesterol and fat
6. Regular exercise and weight loss
Glomerulonephritis
An inflammatory disease in the inner structure of the kidneys. Symptoms and findings vary depending on the type of glomerulonephritis. Diagnosing glomerulonephritis is usually straightforward with a physical examination, blood urea and creatinine tests, and a simple urine analysis. Swelling in the hands, feet, and eyelids, darkening of the urine color (urine can take on the color of tea), and high blood pressure are findings of glomerulonephritis during examination. Hematuria (blood in the urine) and proteinuria (protein loss) in urine analysis are indicative of glomerulonephritis. The main difficulty in diagnosing glomerulonephritis is identifying the disease causing it. To understand the type of glomerulonephritis, a kidney biopsy should be performed, meaning a microscopic sample should be taken from the kidney.
Problems Caused by Glomerulonephritis
Practically, glomerulonephritis presents itself in 5 ways. The patient may have no symptoms at all, or there may be advanced kidney failure.
1. Abnormalities in urine analysis: The patient has no symptoms or findings. Blood or protein loss is detected in a urine analysis conducted for another reason.
2. Nephrotic syndrome: There is a loss of more than 3-3.5 grams of protein per day in the urine. The patient has indentable swellings in the hands, feet, face, and other areas. In addition, blood albumin levels decrease, and cholesterol levels increase.
3. Acute onset glomerulonephritis: The main problems in these patients are blood in the urine, high blood pressure, and fluid accumulation in the body. Most nephritis that develops following streptococcal infections in children fall into this category.
4. Chronic (prolonged) glomerulonephritis: These patients have blood and protein loss in the urine, high blood pressure, swelling, and the disease is long-term.
5. Rapidly progressing nephritis: Kidney failure develops quickly, and the patient requires dialysis treatment.
Treatment
Varies for each patient. Treatment is planned according to the results of the kidney biopsy and the problems present in the patient. Glomerulonephritis treatment must be under the supervision of a specialist physician, preferably a nephrology specialist. Failure in treatment can lead to permanent kidney failure, and the patient may require continuous dialysis treatment.
Kidney Infections (Pyelonephritis)
Develops as a result of microorganisms entering the body, reaching the kidneys, and causing inflammation. It can be acute or chronic. Kidney infection is a serious illness. If untreated, it can lead to chronic kidney failure. Additionally, the infectious agent can enter the bloodstream, causing blood poisoning and death.
Signs and Symptoms
Continuous pain starting in the back and radiating towards the groin, chills with sudden fever, sudden urge to urinate even with an empty bladder, frequent urination, difficulty urinating, painful urination, cloudy or bloody urine, severe nausea, and vomiting.
Risk Factors
1. Kidney stones
2. Congenital kidney diseases
3. Enlargement of the prostate gland (benign prostatic hyperplasia)
4. Pregnancy
5. Catheterization
Diagnostic Tests
Urinalysis, urine culture, complete blood count, comprehensive blood biochemistry, intravenous pyelography, ultrasonography, computed tomography, cystoscopy.
Treatment
Appropriate antibiotics against the causative microorganism must be used. In cases of recurrent infections, urine culture and antibiogram should be conducted. The antibiotic selected according to the results should be used for 10-14 days. Urinalysis should be repeated 2 and 6 weeks after treatment. If bacteria are still present in the urine, antibiotic treatment should be repeated. Additionally, high fluid intake is encouraged to increase urine flow. The goal is to help expel microorganisms from the urinary tract. Tuberculosis should be investigated in cases resistant to antibiotic treatment.
Prevention
Most kidney infections start in the bladder, so it is important to keep bacteria away from the urinary tract. The following simple rules will be beneficial for this purpose. Pay attention to hygienic rules when using the toilet. Clean your anal area after every bowel movement. Women should clean from front to back to prevent bacteria from entering the urinary tract. Do not hold in your urine. Make sure you empty your bladder each time. Try to wear cotton underwear. Avoid wearing undergarments that trap heat and moisture in the area. High fluid intake will increase urine flow, thereby reducing the development of infection.
Acute Kidney Injury
Acute kidney injury (AKI) is defined as a rapid deterioration in kidney functions, accompanied by elevated levels of urea and creatinine in the blood and a reduction in urine output (less than 400 milliliters in 24 hours). There are many causes of acute kidney failure. It can develop due to a decrease in body water and consequently renal blood flow in situations such as heart failure, bleeding from any part of the body, burns, excessive diarrhea or vomiting, or taking excessive diuretics, as well as primary kidney diseases like glomerulonephritis and pyelonephritis, systemic diseases such as diabetes and systemic lupus erythematosus, intake of substances or drugs harmful to the kidneys, and obstruction of urine flow due to stones, tumors, or prostate hypertrophy.
Symptoms and Findings of Acute Kidney Injury
The clinical course of acute kidney failure includes stages of reduced urine output (oliguria) and increased urine output (diuresis). The symptoms and findings vary depending on the stage.
Oliguria Phase: Can last 1-2 weeks or longer. The most significant sign in this phase is reduced or absent urine output. Blood levels of potassium, creatinine, phosphorus, and urea rise. Symptoms associated with the accumulation of uremic toxins in the body include nausea, vomiting, loss of appetite, weight loss, anemia, itching, edema due to fluid accumulation, hypertension, and proteinuria and hematuria in urine tests.
Diuresis Phase: Urine output increases. Daily urine output can increase to 1-2 liters or even 3-4 liters, and elevated metabolic wastes and electrolytes in the blood return to normal. Recovery from the illness can take up to 3 months.
Treatment of Acute Kidney Injury
Treatment for acute kidney failure is planned according to the severity of the damage.
Treatment Goals:
The goals are to eliminate the possible cause of kidney damage, regulate fluid-electrolyte balance, prevent metabolic complications and infections, and sustain the patient's life until kidney functions recover. Fluid intake and output are carefully calculated, and no more fluid than what is excreted in urine (plus 500 ml for physiological loss) should be given to avoid pulmonary edema. As urine output increases, the amount of fluid given is also increased. A diet low or free in protein, restricted in salt and potassium, and high in carbohydrates (candies, sugary liquids, honey) is provided. Weight is monitored, as weight gain indicates excess fluid administration. If urine output does not increase adequately and blood levels (urea, creatinine, and potassium) reach life-threatening levels, dialysis treatment is initiated.
Chronic Kidney Failure
Chronic kidney failure is a disease characterized by the irreversible impairment of all kidney functions, leading to a condition of uremia. Uremia is a group of symptoms arising from elevated levels of urea in the blood. In our country, the most common causes of chronic kidney failure are diabetes mellitus and hypertension. Additionally, glomerulonephritis, kidney stones, infections, systemic diseases affecting the kidney (SLE, PAN, scleroderma), congenital anomalies of the kidney (polycystic kidney, hypoplastic kidney, multicystic kidney disease), nephrotoxins (certain antibiotics, excessive chronic use of painkillers, heavy metals like gold, lead, cadmium), tumors or structural abnormalities of the urinary tract, and vascular diseases of the kidney (narrowing in both renal arteries) can lead to kidney failure.
As kidney failure progresses, many problems emerge due to the deterioration of kidney functions:
1. Levels of harmful urea and creatinine increase in the body.
2. High blood pressure and body swelling (edema) develop due to water and sodium retention.
3. Anemia occurs.
4. Bone metabolism is disrupted.
5. Blood potassium levels rise, which can lead to cardiac rhythm disorders.
6. Cardiovascular diseases can develop.
