Turkiye Klinikleri Journal of Veterinary Sciences

.: REVIEW
Köpek ve Kedilerde Kronik Böbrek Hastalığının Komplikasyonlarına Genel Bakış: Geleneksel Derleme
An Overview to Complications of Chronic Kidney Disease in Dogs and Cats: Traditional Review
Mehmet MADENa, Merve Cansu KILIÇKAYAa, Süleyman Serhat İYİGÜNa
aSelçuk Üniversitesi Veteriner Fakültesi Klinik Bilimler Bölümü, İç Hastalıkları ABD, Konya, Türkiye
Turkiye Klinikleri J Vet Sci. 2022;13(2):72-80
doi: 10.5336/vetsci.2022-87948
Article Language: TR
Full Text
ÖZET
 Kronik böbrek hastalığı (KBH); böbreklerde önemli nefron kayıpları ile seyreden, geri dönüşümsüz (irreversibl) ve tipik olarak ilerleyici (progressive), yapısal ve/veya işlevsel bozukluk olarak tanımlanmaktadır. Başta orta ve ileri yaşlı kedi ve köpekler olmak üzere, her yaştaki evcil hayvanlarda görülen böbrek hastalıklarının en yaygın türüdür. KBH insidansı, köpek ve kedilerde sırasıyla %0,5-1,5 ve %1-3 arasında görülmektedir. Geriatrik kedilerde KBH prevalansının, geriatrik köpeklerden daha yüksek olduğu ve %35-81 gibi yüksek oranlarda seyrettiği bildirilmektedir. Tubulointerstisyel yangı ve fibrozis ile karakterize olan KBH; genetik, çevresel ve bireysel faktörlerin etkin olduğu karmaşık ve ilerleyici bir hastalık tablosu ile seyreder. Böbrek hasarına cevap olarak; hemodinamik adaptasyonlar, sistemik hipertansiyon, renin-anjiyotensin aldosteron sisteminin aktivasyonu, proteinüri, hiperfosfatemi, hipoksi ve oksidatif stres gelişir. Başlangıç nedeni ne olursa olsun, yangı ve fibrozise ilerleyen, yavaş seyirli böbrek hasarı oluşur. Hastalığın ilerlemesi ile ilişkili faktörlerin anlaşılması, hastalığın ilerlemesini yavaşlatabilen terapötik müdahale potansiyeli sağlar. Bu çerçevede böbrek fonksiyonu, homeostatik adaptasyonlar ve böbrek hasarının sonuçlarının değerlendirilmesi, komplikasyonların belirlenmesi ve yönetimi, KBH tedavisinin en önemli unsurlarını oluşturmaktadır. KBH olgularında böbrek fonksiyon kaybına paralel olarak; anemi, sistemik hipertansiyon, kardiyovasküler ve gastrointestinal bozukluklar, asit-baz dengesi ve elektrolit bozuklukları, hormonal değişiklikler, lipid metabolizması bozuklukları ve üremik ensefalopati gibi komplikasyonlar gelişmektedir. KBH'li hastaların böbrek fonksiyonlarının korunması ve yaşam kalitesinin iyileştirilmesinde bu komplikasyonların bilinmesi, destekleyici ve semptomatik tedavi uygulamalarıyla iyi yönetilebilmesi önemlidir. Bu anlamda KBH yönetimi, bir komplikasyon yönetimi olarak değerlendirilmelidir. Bu derlemede, KBH olgularında gelişen anemi, sistemik hipertansiyon, kardiyovasküler ve gastrointestinal bozukluklar, asit-baz dengesi, elektrolitler ve hormonlarla ilgili değişiklikler, lipid metabolizması bozuklukları ve nörolojik komplikasyonlar özetlenmiştir.

Anahtar Kelimeler: Kronik böbrek hastalığı; komplikasyon; köpek; kedi
ABSTRACT
 Chronic kidney disease (CKD); It is defined as an irreversible and typically progressive structural and/or functional disorder with significant loss of nephrons in the kidneys. It is the most common type of kidney disease seen in pets of all ages, especially middle and older cats and dogs. The incidence of CKD is seen between 0.5-1.5% and 1-3% in dogs and cats, respectively. It has been reported that the prevalence of CKD in geriatric cats is higher than that of geriatric dogs, with a high rate of 35-81%. CKD characterized by tubulointerstitial inflammation and fibrosis; It progresses with a complex and progressive disease in which genetic, environmental and individual factors are effective. In response to kidney damage; hemodynamic adaptations, systemic hypertension, activation of the renin-angiotensin aldosterone system, proteinuria, hyperphosphatemia, hypoxia and oxidative stress develop. Regardless of the initial cause, slowly progressing kidney damage occurs that progresses to inflammation and fibrosis. Understanding the factors associated with disease progression provides the potential for therapeutic intervention that can slow disease progression. In this context, evaluation of kidney function, homeostatic adaptations and consequences of kidney damage, determination and management of complications constitute the most important elements of CKD treatment. Parallel to the loss of kidney function in CKD cases; some complications develop. It is important to be aware of these complications and to manage them well with supportive and symptomatic treatment practices in protecting the kidney functions and improving the quality of life of patients with CKD. In this sense, CKD management should be considered as a complication management. In this review, anemia, systemic hypertension, cardiovascular and gastrointestinal disorders, acid-base balance, changes in electrolytes and hormones, lipid metabolism disorders and neurological complications in CKD patients are summarized.

Keywords: Chronic kidney disease; complication; dog; cat
REFERENCES:
  1. Polzin DJ. Chronic kidney disease in small animals. Vet Clin North Am Small Anim Pract. 2011;41(1):15-30. [Crossref]  [PubMed] 
  2. Grauer GF. Acute renal failure and chronic kidney disease. In: Small Animal Internal Medicine. 4th ed. St. Louis, Missouri: Mosby-Elsevier; 2009. p.645-59.
  3. Bartges JW. Chronic kidney disease in dogs and cats. Vet Clin North Am Small Anim Pract. 2012;42(4):669-92, vi. [Crossref]  [PubMed] 
  4. Schaer M, Gaschen F, eds. Altuğ N, çeviri editörü. Köpek ve Kedilerin Klinik Hekimliği. 3. Baskı. Ankara: Ayrıntı Basım ve Matbaacalık; 2016. p.460.
  5. Sparkes AH, Caney S, Chalhoub S, Elliott J, Finch N, Gajanayake I, et al. ISFM consensus guidelines on the diagnosis and management of feline chronic kidney disease. J Feline Med Surg. 2016;18(3):219-39. [Crossref]  [PubMed] 
  6. Mayer-Roenne B, Goldstein RE, Erb HN. Urinary tract infections in cats with hyperthyroidism, diabetes mellitus and chronic kidney disease. J Feline Med Surg. 2007;9(2):124-32. [Crossref]  [PubMed] 
  7. DeBowes LJ, Mosier D, Logan E, Harvey CE, Lowry S, Richardson DC. Association of periodontal disease and histologic lesions in multiple organs from 45 dogs. J Vet Dent. 1996;13(2):57-60. [Crossref]  [PubMed] 
  8. Nabi SU, Wani AR, Shah OS, Dey S. Association of periodontitis and chronic kidney disease in dogs. VeterinaryWorld. 2014;7(6):403-7. [Crossref] 
  9. Kralova S, Leva L, Toman M. Changes in lymphocyte function and subsets in dogs with naturally occurring chronic renal failure. Can J Vet Res. 2010;74(2):124-9. [PubMed]  [PMC] 
  10. Kralova-Kovarikova S, Leva L, Knotek Z, Toman M. Changes in lymphocyte function and subset counts in cats with spontaneous chronic kidney disease. Veterinarni Medicina. 2016;61(10):553-9. [Crossref] 
  11. Polzin DJ, Osborne CA. Update-conservative medical management of chronic renal failure. In: Kirk RW, ed. Current Veterinary Therapy IX. 9th ed. WB Saunders; Philadelphia, PA; 1986. p.1167-73.
  12. Lulich JP, Osborne CA, O'brien TD, Polzin DJ. Feline renal failure: questions, answers, questions. The Compendium on continuing education for the practicing veterinarian (USA). 1992;14(2):127-53.
  13. Boyd LM, Langston C, Thompson K, Zivin K, Imanishi M. Survival in cats with naturally occurring chronic kidney disease (2000-2002). J Vet Intern Med. 2008;22(5):1111-7. [Crossref]  [PubMed] 
  14. Syme HM, Markwell PJ, Pfeiffer D, Elliott J. Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria. J Vet Intern Med. 2006;20(3):528-35. [Crossref]  [PubMed] 
  15. O'Neill DG, Elliott J, Church DB, McGreevy PD, Thomson PC, Brodbelt DC. Chronic kidney disease in dogs in UK veterinary practices: prevalence, risk factors, and survival. J Vet Intern Med. 2013;27(4):814-21. [Crossref]  [PubMed] 
  16. Jepson RE. Current understanding of the pathogenesis of progressive chronic kidney disease in cats. Vet Clin North Am Small Anim Pract. 2016;46(6):1015-48. [Crossref]  [PubMed] 
  17. Macdougall IC. Anaemia of chronic kidney disease. Medicine. 2007;35(8):457-60. [Crossref] 
  18. King LG, Giger U, Diserens D, Nagode LA. Anemia of chronic renal failure in dogs. J Vet Intern Med. 1992;6(5):264-70. [Crossref]  [PubMed] 
  19. Elliott J, Barber PJ. Feline chronic renal failure: clinical findings in 80 cases diagnosed between 1992 and 1995. J Small Anim Pract. 1998;39(2):78-85. [Crossref]  [PubMed] 
  20. Chalhoub S, Langston C, Eatroff A. Anemia of renal disease: what it is, what to do and what's new. J Feline Med Surg. 2011;13(9):629-40. [Crossref]  [PubMed] 
  21. Javard R, Grimes C, Bau-Gaudreault L, Dunn M. Acute-phase proteins and ıron status in cats with chronic kidney disease. J Vet Intern Med. 2017;31(2):457-64. [Crossref]  [PubMed]  [PMC] 
  22. Coleman AE, Brown SA. Hypertension and the kidney. In: Elliot J, Grauer GF, Westropp JL, eds. BSAVA Manuel of Canine and Feline Nephrology and Urology. 3rd ed. Gloucester: British Small Animal Veterinary Association; 2017. p.216-23. [Crossref] 
  23. Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: core curriculum 2019. Am J Kidney Dis. 2019;74(1):120-31. [Crossref]  [PubMed] 
  24. Syme H. Hypertension in small animal kidney disease. Vet Clin North Am Small Anim Pract. 2011;41(1):63-89. [Crossref]  [PubMed] 
  25. Reynolds BS, Lefebvre HP. Feline CKD: Pathophysiology and risk factors--what do we know? J Feline Med Surg. 2013;15 Suppl 1:3-14. [Crossref]  [PubMed] 
  26. Syme HM, Barber PJ, Markwell PJ, Elliott J. Prevalence of systolic hypertension in cats with chronic renal failure at initial evaluation. J Am Vet Med Assoc. 2002;220(12):1799-804. [Crossref]  [PubMed] 
  27. Kobayashi DL, Peterson ME, Graves TK, Lesser M, Nichols CE. Hypertension in cats with chronic renal failure or hyperthyroidism. J Vet Intern Med. 1990;4(2):58-62. [Crossref]  [PubMed] 
  28. Novellas R, Ruiz de Gopegui R, Espada Y. Assessment of renal vascular resistance and blood pressure in dogs and cats with renal disease. Vet Rec. 2010;166(20):618-23. [Crossref]  [PubMed] 
  29. Hori Y, Heishima Y, Yamashita Y, Isayama N, Kanno N, Nakamura K, et al. Relationship between indirect blood pressure and various stages of chronic kidney disease in cats. J Vet Med Sci. 2018;80(3):447-52. [Crossref]  [PubMed]  [PMC] 
  30. Brown S. Systemic arterial hypertension. Chronic kidney disease. In: Bartges J, Polzin DJ, eds. Nephrology and Urology of Small Animals. 1st ed. USA: Blackwell Publishing Ltd; 2011. p.675-83. [Crossref] 
  31. Sansom J, Barnett KC, Dunn KA, Smith KC, Dennis R. Ocular disease associated with hypertension in 16 cats. Journal of Small Animal Practice. 1994;35(12):604-11. [Crossref] 
  32. Brown CA, Munday JS, Mathur S, Brown SA. Hypertensive encephalopathy in cats with reduced renal function. Vet Pathol. 2005;42(5):642-9. [Crossref]  [PubMed] 
  33. Church ME, Turek BJ, Durham AC. Neuropathology of spontaneous hypertensive encephalopathy in cats. Vet Pathol. 2019;56(5):778-82. [Crossref]  [PubMed] 
  34. O'Neill J, Kent M, Glass EN, Platt SR. Clinicopathologic and MRI characteristics of presumptive hypertensive encephalopathy in two cats and two dogs. J Am Anim Hosp Assoc. 2013;49(6):412-20. [Crossref]  [PubMed] 
  35. Ronco C, Bellasi A, Di Lullo L. Cardiorenal syndrome: an overview. Adv Chronic Kidney Dis. 2018;25(5):382-90. [Crossref]  [PubMed] 
  36. Orvalho JS, Cowgill LD. Cardiorenal syndrome: diagnosis and management. Vet Clin North Am Small Anim Pract. 2017;47(5):1083-102. [Crossref]  [PubMed] 
  37. London GM. Cardiovascular disease in chronic renal failure: pathophysiologic aspects. Semin Dial. 2003;16(2):85-94. [Crossref]  [PubMed] 
  38. Peters RM, Goldstein RE, Erb HN, Njaa BL. Histopathologic features of canine uremic gastropathy: a retrospective study. J Vet Intern Med. 2005;19(3):315-20. [Crossref]  [PubMed] 
  39. McLeland SM, Lunn KF, Duncan CG, Refsal KR, Quimby JM. Relationship among serum creatinine, serum gastrin, calcium-phosphorus product, and uremic gastropathy in cats with chronic kidney disease. J Vet Intern Med. 2014;28(3):827-37. [Crossref]  [PubMed]  [PMC] 
  40. Polzin DJ. Chronic kidney disease. In: Bartges J, Polzin DJ, eds. Nephrology and Urology of Small Animals. 1st ed. USA: Blackwell Publishing Ltd; 2011. p.431-71. [Crossref] 
  41. Polzin DJ. Evidence-based step-wise approach to managing chronic kidney disease in dogs and cats. J Vet Emerg Crit Care (San Antonio). 2013;23(2):205-15. [Crossref]  [PubMed] 
  42. Pusoonthornthum R, Vimuktanandana O, Pusoonthornthum P, Rungsipipat A, Krishnamra N. Calcium-phosphorus homeostasis in cats with spontaneous chronic kidney disease and metabolic acidosis. Comparative Clinical Pathology. 2012;21(5):985-91. [Crossref] 
  43. Lazaretti P, Kogika MM, Hagiwara MK, Lustoza MD, Mirandola RMS. Serum concentration of intact parathormone in dogs with chronic renal failure. Arq Bras Med Vet Zoot. 2006;58(4):489-94. [Crossref] 
  44. Kogika MM, Lustoza MD, Notomi MK, Wirthl VA, Mirandola RM, Hagiwara MK. Serum ionized calcium in dogs with chronic renal failure and metabolic acidosis. Vet Clin Pathol. 2006;35(4):441-5. [Crossref]  [PubMed] 
  45. de Brito Galvao JF, Nagode LA, Schenck PA, Chew DJ. Calcitriol, calcidiol, parathyroid hormone, and fibroblast growth factor-23 interactions in chronic kidney disease. J Vet Emerg Crit Care (San Antonio). 2013;23(2):134-62. [Crossref]  [PubMed]  [PMC] 
  46. Craver L, Marco MP, Martínez I, Rue M, Borràs M, Martín ML, et al. Mineral metabolism parameters throughout chronic kidney disease stages 1-5--achievement of K/DOQI target ranges. Nephrol Dial Transplant. 2007;22(4):1171-6. [Crossref]  [PubMed] 
  47. Cortadellas O, Fernández del Palacio MJ, Talavera J, Bayón A. Calcium and phosphorus homeostasis in dogs with spontaneous chronic kidney disease at different stages of severity. J Vet Intern Med. 2010;24(1):73-9. [Crossref]  [PubMed] 
  48. King JN, Tasker S, Gunn-Moore DA, Strehlau G; BENRIC (benazepril in renal insufficiency in cats) Study Group. Prognostic factors in cats with chronic kidney disease. J Vet Intern Med. 2007 Sep;21(5):906-16. [Crossref]  [PubMed] 
  49. Moe S, Drüeke T, Cunningham J, Goodman W, Martin K, Olgaard K, et al; Kidney Disease: Improving Global Outcomes (KDIGO). Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2006;69(11):1945-53. [Crossref]  [PubMed] 
  50. Gutierrez O, Isakova T, Rhee E, Shah A, Holmes J, Collerone G, et al. Fibroblast growth factor-23 mitigates hyperphosphatemia but accentuates calcitriol deficiency in chronic kidney disease. J Am Soc Nephrol. 2005;16(7):2205-15. [Crossref]  [PubMed] 
  51. Barber PJ, Elliott J. Feline chronic renal failure: calcium homeostasis in 80 cases diagnosed between 1992 and 1995. J Small Anim Pract. 1998;39(3):108-16. [Crossref]  [PubMed] 
  52. Gnudi G, Bertoni G, Luppi A, Cantoni AM. Unusual hyperparathyroidism in a cat. Vet Radiol Ultrasound. 2001;42(3):250-3. [Crossref]  [PubMed] 
  53. Rusenov A. A clinical case of secondary renal hyperparathyroidism in a four-month-old Pug puppy. Revue Med Vet. 2010;161:570-3. [Link] 
  54. Behling-Kelly E. Serum lipoprotein changes in dogs with renal disease. J Vet Intern Med. 2014;28(6):1692-8. [Crossref]  [PubMed]  [PMC] 
  55. Martino-Costa AL, Malhão F, Lopes C, Dias-Pereira P. Renal interstitial lipid accumulation in cats with chronic kidney disease. J Comp Pathol. 2017;157(2-3):75-9. [Crossref]  [PubMed] 
  56. Adagra C, Foster DJ. Hyperammonaemia in four cats with renal azotaemia. J Feline Med Surg. 2015;17(2):168-72. [Crossref]  [PubMed] 
  57. Machado M, Wilson TM, Sousa DER, Gonçalves AAB, Martins CS, Castro MB. Uraemic encephalopathy in a persian cat with chronic kidney disease. J Comp Pathol. 2020;180:100-4. [Crossref]  [PubMed] 
  58. Pellegrino FC. Renal-associated encephalopathy: bibliographic review. Anales de Veterinaria de Murcia. Murcia: Facultad de Veterinaria, Universidad de Murcia; 2009. p.47-57. [Crossref] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

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