Turkiye Klinikleri Journal of Pediatrics

.: REVIEW
Böbrek Hastalıklarının Tanısında Kullanılan Laboratuvar Yöntemleri
Laboratory Methods Used in Diagnosis of Renal Diseases
Meral TORUN BAYRAMa, Gizem YILDIZa
aDokuz Eylül Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları ABD, İzmir, TÜRKİYE
Turkiye Klinikleri J Pediatr. 2021;30(1):69-79
doi: 10.5336/pediatr.2020-76181
Article Language: TR
Full Text
ÖZET
Böbrekler, sıvı-elektrolit ve asit-baz dengesinde, sistemik kan basıncının düzenlenmesinde, kemik mineral metabolizmasında ve eritropoezde merkezi rol oynar. Böbreğin bu fonksiyonlarının değerlendirilmesinde laboratuvar tetkikleri önemli bir yer alır. Bu tetkikler, böbreğin glomerüler ve tübüler fonksiyonlarını değerlendiren testler olarak 2'ye ayrılır. Çocuklarda glomerüler fonksiyonları değerlendirmek için çok sayıda yöntem kullanılmıştır. Bununla birlikte, glomerüler filtrasyon hızı (GFH), hâlen glomerüler fonksiyonunun en iyi göstergesidir. GFH'yi belirlemede en yaygın yöntem ekzojen ve endojen ajanların kullanıldığı klirens ölçüm yöntemidir. Klirens ölçümü için kullanılacak olan ideal bir madde dolaşımda serbestçe bulunmalı, glomerüler bazal membrandan serbestçe filtre olmalı, nefron boyunca sekrete edilmemeli ve geri emilmemeli, sabit hızda endojen üretilmeli ve kolaylıkla ölçülebilir olmalıdır. Klinik uygulamada endojen ajanlar kullanılarak, çeşitli matematiksel yöntemler ile tahmini GFH hesaplamaları da bulunmaktadır. Tübüler fonksiyonların değerlendirilmesi, glomerüler fonksiyonun değerlendirmesinden daha karmaşıktır. İdrar dansitesi, ozmolalitesi ve pH değeri tübüler fonksiyonlar hakkında fikir veren ve rutin olarak kullanılan başlıca laboratuvar parametreleridir. Tübüler fonksiyonların ayrıntılı incelemesi rutin olarak yapılmaz. Renal fosfat kaybı, idrar asidifikasyon defekti veya idrar konsantrasyon yeteneğinde azalma olan durumlarda renal tübüler fonksiyonlar ayrıntılı olarak araştırılır. İlgili tübülün farklı segmentlerine göre farklı fonksiyonlar etkilenebilir. Tübüler fonksiyonların değerlendirilmesi glukoz, fosfat, bikarbonat ve amino asitlerin geri emilimini, solütlerin fraksiyonel atılımını, konsantrasyon ve dilüsyon kapasitesini değerlendiren testleri içerir.

Anahtar Kelimeler: Böbrek hastalıkları; laboratuvar; glomerüler fonksiyonlar; tübüler fonksiyonlar
ABSTRACT
The kidneys play a central role in the maintenance fluid-electrolyte and acid-base balance, systemic blood pressure, bone and mineral metabolism and erythropoiesis. Laboratory tests are important in evaluating these functions of the kidney. Laboratory tests can be categorized into tests for glomerular and tubular functions. Broad sets of evaluation tools have been used to judge glomerular function in children. Glomerular filtration rate (GFR) is still the best indicator of renal function. The most common measurement method of GFR is clearance methodology, using exogenous and endogenous markers. The ideal substance for the measurement of clearance should be free in the circulation, freely filterable from through the glomerular basement membrane, not secreted and not reabsorbed along the nephron, generated endogenously at a steady rate and easily measurable. An estimation of GFR from endogenous biomarkers by various mathematical equations is also available for clinical use. Assessment of tubular function is more complicated than the measurement of glomerular function. Urine specific gravity, osmolality and pH are main laboratory parameters that are routinely used for evaluation of tubular functions. Detailed evaluation of tubular functions is not routinely performed. Tubular functions are assessed in detail in case of renal phosphate wasting, urine acidification defect or decrease concentration ability. Different functions may be affected with respect to the different segments of tubule involved. Evaluation of tubular functions include tests evaluating reabsorption of glucose, phosphate, bicarbonate and amino acids, fractional excretion of solutes, concentrating and diluting capacity.

Keywords: Kidney diseases; laboratory; glomerular functions; tubular functions
REFERENCES:
  1. Fogazzi GB, Verdesca S, Garigali G. Urinalysis: core curriculum 2008. Am J Kidney Dis. 2008;51(6):1052-67.[Crossref] [PubMed] 
  2. Edelmann CM Jr, Barnett HL, Stark H, Boichis H, Soriano JR. A standarized test of renal concentrating capacity in children. Am J Dis Child. 1967;114(6):639-44.[Crossref] [PubMed] 
  3. Nephrotic syndrome in children: prediction of histopathology from clinical and laboratory characteristics at time of diagnosis. A report of the International Study of Kidney Disease in Children. Kidney Int. 1978;13(2):159-65.[Crossref] [PubMed] 
  4. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.[PubMed] 
  5. Ginsberg JM, Chang BS, Matarese RA, Garella S. Use of single voided urine samples to estimate quantitative proteinuria. N Engl J Med. 1983;309(25):1543-6.[Crossref] [PubMed] 
  6. Houser M. Assessment of proteinuria using random urine samples. J Pediatr. 1984;104(6):845-8.[Crossref] [PubMed] 
  7. Abitbol C, Zilleruelo G, Freundlich M, Strauss J. Quantitation of proteinuria with urinary protein/creatinine ratios and random testing with dipsticks in nephrotic children. J Pediatr. 1990;116(2):243-7.[Crossref] [PubMed] 
  8. Assadi FK. Quantitation of microalbuminuria using random urine samples. Pediatr Nephrol. 2002;17(2):107-10.[Crossref] [PubMed] 
  9. Fogazzi GB, Edefonti A, Garigali G, Giani M, Zolin A, Raimondi S, et al. Urine erythrocyte morphology in patients with microscopic haematuria caused by a glomerulopathy. Pediatr Nephrol. 2008;23(7):1093-100.[Crossref] [PubMed] 
  10. Rosner MH, Bolton WK. Renal function testing. Am J Kidney Dis. 2006;47(1):174-83.[Crossref] [PubMed] 
  11. Roald AB, Aukland K, Tenstad O. Tubular absorption of filtered cystatin-C in the rat kidney. Exp Physiol. 2004;89(6):701-7.[Crossref] [PubMed] 
  12. Knight EL, Verhave JC, Spiegelman D, Hillege HL, de Zeeuw D, Curhan GC, et al. Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int. 2004;65(4):1416-21.[Crossref] [PubMed] 
  13. Levey AS, Greene T, Schluchter MD, Cleary PA, Teschan PE, Lorenz RA, et al. Glomerular filtration rate measurements in clinical trials. Modification of diet in renal disease study group and the diabetes control and complications trial research group. J Am Soc Nephrol. 1993;4(5):1159-71.[PubMed] [PMC] 
  14. Watt G, Omar F, Brink A, McCulloch M. Laboratory Investigation of the Child with Suspected Renal Disease. In: Avner ED, Harmon WE, Niaudet P, Yoshikawa N, Emma F, Goldstein SL, eds. Pediatric Nephrology. 7th ed. Heidelberg: Springer; 2016. p.613-36.[Crossref] 
  15. Nilsson-Ehle P, Grubb A. New markers for the determination of GFR: iohexol clearance and cystatin C serum concentration. Kidney Int Suppl. 1994;47:S17-9.[PubMed] 
  16. Schwartz GJ, Mu-oz A, Schneider MF, Mak RH, Kaskel F, Warady BA, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009;20(3):629-37.[Crossref] [PubMed] [PMC] 
  17. Gaspari F, Perico N, Ruggenenti P, Mosconi L, Amuchastegui CS, Guerini E, et al. Plasma clearance of nonradioactive iohexol as a measure of glomerular filtration rate. J Am Soc Nephrol. 1995;6(2):257-63.[PubMed] 
  18. Durand E, Prigent A. The basics of renal imaging and function studies. Q J Nucl Med. 2002;46(4):249-67.[PubMed] 
  19. Odlind B, Hällgren R, Sohtell M, Lindström B. Is 125I iothalamate an ideal marker for glomerular filtration? Kidney Int. 1985;27(1):9-16.[Crossref] [PubMed] 
  20. Guignard JP, Torrado A, Da Cunha O, Gautier E. Glomerular filtration rate in the first three weeks of life. J Pediatr. 1975;87(2):268-72.[Crossref] [PubMed] 
  21. Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, et al; CKD-EPI Investigators. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012;367(1):20-9. Erratum in: N Engl J Med. 2012;367(7):681. Erratum in: N Engl J Med. 2012;367(21):2060.[Crossref] [PubMed] [PMC] 
  22. Bagga A, Bajpai A, Menon S. Approach to renal tubular disorders. Indian J Pediatr. 2005;72(9):771-6.[Crossref] [PubMed] 
  23. Delaney MP, Price CP, Lamb EJ. Kidney disease. In: Burtis CA, Ashwood ER, Bruns DE, eds. Tietz textbook of clinical chemistry and molecular diagnostics. 5th ed. London: Elsevier/Saunders; 2012. p.1523-607.[Crossref] 
  24. Fahimi D, Mohajeri S, Hajizadeh N, Madani A, Esfahani ST, Ataei Net al. Comparison between fractional excretions of urea and sodium in children with acute kidney injury. Pediatr Nephrol. 2009;24(12):2409-12.[Crossref] [PubMed] 
  25. Srivastava T, Schwaderer A. Diagnosis and management of hypercalciuria in children. Curr Opin Pediatr. 2009;21(2):214-9.[Crossref] [PubMed] 
  26. Alconcher LF, Castro C, Quintana D, Abt N, Moran L, Gonzalez L, et al. Urinary calcium excretion in healthy school children. Pediatr Nephrol. 1997;11(2):186-8.[Crossref] [PubMed] 
  27. Foley KF, Boccuzzi L. Urine calcium: laboratory measurement and clinical utility. Lab Med. 2010;41(11):683-6.[Crossref] 
  28. Cole DE, Quamme GA. Inherited disorders of renal magnesium handling. J Am Soc Nephrol. 2000;11(10):1937-47.[PubMed] 
  29. Bangert SK, Lapsley M. Renal tubular disorders and renal stone disease. In: Marshall W, Bangert SK, eds. Clinical biochemistry-metabolic and clinical aspects. 2nd ed. London: Churchill/Livingston; 2008. p.174-85.
  30. Singh J, Moghal N, Pearce SH, Cheetham T. The investigation of hypocalcaemia and rickets. Arch Dis Child. 2003;88(5):403-7.[Crossref] [PubMed] [PMC] 
  31. Shaw NJ, Wheeldon J, Brocklebank JT. Indices of intact serum parathyroid hormone and renal excretion of calcium, phosphate, and magnesium. Arch Dis Child. 1990;65(11):1208-11.[Crossref] [PubMed] [PMC] 
  32. Bökenkamp A, Ludwig M. Disorders of the renal proximal tubule. Nephron Physiol. 2011;118(1):p1-6.[Crossref] [PubMed] 
  33. Santer R, Calado J. Familial renal glucosuria and SGLT2: from a mendelian trait to a therapeutic target. Clin J Am Soc Nephrol. 2010;5(1):133-41.[Crossref] [PubMed] 
  34. Duran N. Amino acids. In: Blau N, Duran M, Gibson KM, eds. Laboratory guide to the methods in biochemical genetics. 1st ed. Berlin: Springer; 2008. p.53-89.[Crossref] [PubMed] 
  35. Choi MJ, Ziyadeh FN. The utility of the transtubular potassium gradient in the evaluation of hyperkalemia. J Am Soc Nephrol. 2008;19(3):424-6.[Crossref] [PubMed] 
  36. Haque SK, Ariceta G, Batlle D. Proximal renal tubular acidosis: a not so rare disorder of multiple etiologies. Nephrol Dial Transplant. 2012;27(12):4273-87.[Crossref] [PubMed] [PMC] 
  37. Escobar L, Mejía N, Gil H, Santos F. Distal renal tubular acidosis: a hereditary disease with an inadequate urinary H⁺ excretion. Nefrologia. 2013;33(3):289-96. English, Spanish.[PubMed] 
  38. Kim GH, Han JS, Kim YS, Joo KW, Kim S, Lee JS. Evaluation of urine acidification by urine anion gap and urine osmolal gap in chronic metabolic acidosis. Am J Kidney Dis. 1996;27(1):42-7.[Crossref] [PubMed] 
  39. Halperin ML, Kamel KS, Goldstein MB. Tools to use to diagnose acid-base disorders. In: Halperin ML, Goldstein MB, Kamel KS, eds. Fluid, Electrolyte, and Acid-Base Physiology-a Problem-Based Approach. 4th ed. Philadelphia: Saunders; 2010. p.39-59.[Crossref] 
  40. Stiburkova B, Bleyer AJ. Changes in serum urate and urate excretion with age. Adv Chronic Kidney Dis. 2012;19(6):372-6.[Crossref] [PubMed] 
  41. Stapleton FB, Linshaw MA, Hassanein K, Gruskin AB. Uric acid excretion in normal children. J Pediatr. 1978;92(6):911-4.[Crossref] [PubMed] 
  42. De Santo NG, Di Iorio B, Capasso G, Paduano C, Stamler R, Langman CB, et al. Population based data on urinary excretion of calcium, magnesium, oxalate, phosphate and uric acid in children from Cimitile (southern Italy). Pediatr Nephrol. 1992;6(2):149-57.[Crossref] [PubMed] 
  43. Norman ME, Feldman NI, Cohn RM, Roth KS, McCurdy DK. Urinary citrate excretion in the diagnosis of distal renal tubular acidosis. J Pediatr. 1978;92(3):394-400.[Crossref] [PubMed] 
  44. Saborio P, Tipton GA, Chan JC. Diabetes insipidus. Pediatr Rev. 2000;21(4):122-9; quiz 129.[Crossref] [PubMed] 
  45. Mishra G, Chandrashekhar SR. Management of diabetes insipidus in children. Indian J Endocrinol Metab. 2011;15 Suppl 3(Suppl3):S180-7.[Crossref] [PubMed] [PMC] 
  46. Endre ZH, Pickering JW, Walker RJ. Clearance and beyond: the complementary roles of GFR measurement and injury biomarkers in acute kidney injury (AKI). Am J Physiol Renal Physiol. 2011;301(4):F697-707.[Crossref] [PubMed] 
  47. Vaidya VS, Ferguson MA, Bonventre JV. Biomarkers of acute kidney injury. Annu Rev Pharmacol Toxicol. 2008;48:463-93.[Crossref] [PubMed] [PMC] 

.: Up To Date

.: Process List

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com