Akut Böbrek Yetmezliği Tanısıyla Kliniğimize Yatan Olguların Analizi

Year 2015, Volume: 16 Issue: 1, 17 - 24, 08.05.2015

Ahmet Ahsen Memnune Sena Ulu Şeref Yüksel Kasım Demir Mükremin Uysal , Gürsel Acartürk

Abstract

Objective: Acute renal failure, which is characterized by a speedy decrease in renal function, is an important clinical syndrome with a high mortality rate. In spite of advanced intensive care and renal replacement therapies in recent years, Acute renal failure mortality continues to remaining high . In this study, we evaluated patients hospitalized with ARF. Material and Methods: We reviewed 145 patients with a diagnosis of Acute renal failure between January 2011 and December 2012 in our hospital, retrospectively. From the records of the patients, age, Acute renal failure type, application form, application of the basic findings, etiology, concomitant diseases, treatment, and laboratory values were recorded.Results: The most common causes of Acute renal failure etiology in our hospital were prerenal azotemia (38.6%) and nephrotoxic agents (30.3%) . The 72.6%of patients were nonoliguric, while 27.4%were oliguric. Medical treatment was applied to 65.5%of patients and medical management together with hemodialysis therapy was administered to the rest of the patients. The improvement rate of patients was 869% while 13.1%of the patients were lost. The 63.2%of dying patients were treated with hemodialysis treatment in addition to medical treatment, while 36.8%had ment and 78.1%of them received only medical treatment. Conclusion: According to the etiology of Acute renal failure, medical reasons come to the forefront compared with 40 years ago. It is also observed that the need for dialysis in Acute renal failure patients with oligoanuria increased and the patients who require dialysis have worse prognosis. Therefore, these patients should be monitored more closely

Keywords

Acute renal failure, Oliguria, Hemodialysis

Akut Böbrek Yetmezliği Tanısıyla Kliniğimize Yatan Olguların Analizi

Abstract

Amaç: Akut böbrek yetmezliği, böbrek fonksiyonlarında hızlı bir azalmayla karakterize ve yüksek mortalite oranına sahip önemli bir klinik sendromdur. Akut böbrek yetmezliğinde mortalite, son yıllardaki yoğun bakım ve renal replasman tedavilerindeki gelişmeye rağmen yüksek kalmaya devam etmektedir. Bu çalışmada kliniğimizde ABY tanısıyla yatan hastaları değerlendirdik.Gereç ve Yöntem: Ocak 2011 ve Aralık 2012 arasında hastanemize Akut böbrek yetmezliği tanısıyla başvuran 145 hastayı retrospektif olarak inceledik. Hastaların kayıtlarından yaşı, Akut böbrek yetmezliği tipi, başvuru şekli, başvurudaki temel bulguları, etyolojisi, zeminde eşlik eden hastalıklar, uygulanan tedavi ve laboratuvar değerleri kaydedildi.Bulgular: Olguların etiyolojisi incelendiğinde en sık nedenler prerenal azotemi (%38,6) ve nefrotoksik ajan kullanımıydı (%30,3). Hastaların %72,6’sı nonoligürik %27,4’ü oligürik idi. Olguların %65,5’ine medikal tedavi uygulanırken %34,5’ine medikal tedaviye ek olarak hemodiyaliz tedavisi uygulandı. Hastaların %86,9’u tedavi sonucu iyileşirken, %13,1’i kaybedildi. Ölen hastaların %63,2’si medikal tedaviye ek olarak hemodiyaliz tedavisi alırken %36,8’i sadece medikal tedavi almıştı. Oligürik hastaların %67,5’i medikal tedavi ve hemodiyaliz, %32,5’i sadece medikal tedavi alırken nonoligürik hastaların %21,9’u medikal tedavi ve hemodiyaliz, %78,1’i sadece medikal tedavi aldı.Sonuç: Akut böbrek yetmezliği etiyolojisinde 40 yıl öncesine göre medikal nedenler ön plana çıkmaktadır. Ayrıca oligoa

Keywords

Akut böbrek yetmezliği, Oligüri, Hemodiyaliz

References

• Liano F, Pascual J. Outcomes in acute renal failure. Sem Nephrol 1988;18:541.
• Dixon BS, Anderson RJ. Nonoliguric acute renal fai- lure. Am J Kidney Dis 1985;6:71-80.
• Abreo K, Moorthy AV, Osborne M. Changing pattern and outcome of acute renal failure requiring hemodi- alysis. Arch Intern Med 1986;146:1338-44.
• Beamen M, Turney JH, Rodger RSC, et al. Changing pattern of acute renal failure Q J Med 1987;62(237):15
• Utas C, Yalcindag C, Taskapan H, et al. Acute renal failure in central anatolia. Nephr Dial Transpl 2000; 15: 152
• Kadiroglu AK, Sit D, Atay AE, et al. The evaluation of effects of demographic features, biochemical para- meters, and cytokines on clinical outcomes in patients with acute renal failure. Renal failure 2007;29:503-8.
• Ympa YP, Sakr Y, Reinhart K, Vincent JL. Has morta- lity from acute renal failure decreased? A systematic review of the literature. Am J Med 2005;118(8):827
• Barretti P, Soares VA. Acute renal failure: Clinical out- come and causes of death. Ren Fail. 1997;19(2):253–7.
• Fliser D, Laville M, Covic A, et al. A European Renal Best Practice (ERBP) position statement on the Kid- ney Disease Improving Global Outcomes (KDIGO) cli- nical practice guidelines on acute kidney injury: part 1: definitions, conservative management and contrast-in- duced nephropathy. Nephrol Dial Transplant. 2012 ;27(12):4263-72.
• Turney JH, Marshall DH, Brownjohn AM, et al. The evolution of acute renal failure, 1956-1988. Q J Med 1990;74:83.
• Turfanda T, Kocak N, Kadiroglu A, ve ark. Ge- beliğe bağlı akut böbrek yetmezliği. Tıp Fak Mecm 1980;43:691-8.
• Beaman M, Turney JH, Rodger RSC, et al. Changing patterns and acute renal failure Q J Med 1987;62:15.
• Abreo K, Moorthy V, Osborne M. Changing patter- ns and outcomes of acute renal failure requiring he- modialysis. Arch Intern Med 1986;146:1338.
• Nissenson AR. Acute renal failure: definition and pathogenesis. Kidney Int 1988;66(suppl):7.
• San A, Selçuk Y, Tonbul Z, et al. Etiology and prog- nosis in 438 patients with acute renal failure. Renal failure 1996;18:593.
• Altıntepe L, Güney I, Tonbul Z, et al. Assessment of acute renal failure patients treated in our nephrology clinic bettween 1996 and2002. Transplant Proceeding 2005;36:3002-5.
• Öztürk S, Arpacı D, Yazıcı H, et al. Outcomes of acute renal failure patients requiring intermittent hemodialysis. Renal Failure 2007;29:992.
• Wang Y, Cui Z, Fan M. Retrospective analyzes on Chinese patients diagnosed with acute renal failu- re hospitalized during last decade. Am J Nephrol 2005;25:514-9.
• Kellum JA, leblanc M, Gibrey RT, Tumlin J, lieberthal W, Ronca C. Primary prevention of acute renal failure in critically ill patient. Curr Opin Crit Care 2005;11:537
• Erem C, Sönmez M, Kavgacı H, ve ark. Akut böbrek yetersizliğinde komplikasyonlar ve mortalite. Türk Nefr Diy Trans Der 1995;2:106-10.
• Kaufman J, Dhakal M, Patel B, Hamburger R. Com- munity-acquired acute renal failure. Am J Kidney Dis 1991;17(2):191-8.
• Thompson M. Use of essential amino acid/dextro- se solution in the nutritional management of patients with acute renal failure . Clin Pharm 1985;19:106-11.
• Finn WF. Diagnosis and management of acute tu- bular necrosis. Med Clin North Am 1990;74:873-91.
• Spiegel DM, Ullian ME, Zerbe GO, Berl T. Deter- minants survival and recovery in acute renal failure patients dialyzed in intensive care units. Am J Neph 1991;11:44-7.
• Liano F, Pascual J. Epidemiology of acute renal fa- ilure: A prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int 1996;50(3):811-18.
• Jayakumar M, Prabahar MR, Fernando EM. Epi- demiologic trend changes in acute renal failure-a tertiary center experience from South India. Ren Fail 2006;28(5):405–410.
• Parker RA, Himmelfarb J, Tolkoff-Rubin N, Chand- ran P, Wingard RL, Hakim RM. Prognosis of patients with acute renal failure requiring dialysis: Results of a multicenter study. Am J Kidney Dis 1998;32:432-43.
• Wang IK, Wang ST, Lin CL. Early prognostic factors in patients with acute renal failure requiring dialysis. Ren Fail 2006;28:43-9.
• Cantarovich F, Verho MT. A simple prognostic index for patients with acute renal failure requiring dialysis. French Multicentric Prospective Study on Furosemi- de in Acute Renal Failure Requiring Dialysis. Ren Fail 1996;18:585–92.
• Bullock ML, Umen AJ, Finkelstein M, Keane WF. The assessment of risk factors in 462 patients with acute renal failure. Am J Kidney Dis 1985;5:97-103.
• Gillum DM, Dixon BS, Yanover MJ, et al. The role of intensivedialysis in acute renal failure. Clin Nephrol 1986;25:249-55.
• Sezer MT, Demir M, Gungor G, Senol A . Predictors of mortality in patients with acute renal failure. Acta Medica 2006;49:183-8.
• Liangos O, Rao M, Balakrishnan VS. Relationship of urine output to dialysis initiation and mortality in acute renal failure. Nephron Clin Pract 2005;99(2):c56–c60.
• Lennon AM, Coleman PL, Brady HR. Management and outcome of acute renal failure. In: Johnson RJ, Fe- ehally J. Comphrensiva of clinical nephrology. Barcelo- na: Harcourt; 2000, p4.
• Cantarovich F, Bodin L, Functional acute renal fai- lure. In:Cantarovich F, Rangoonwala B, Verho M: prog- ress in acute renal failure. NJ: Hoechst Marion Roussel; 1998, p55.
• Abel RM. Nutritional support in the patients acute renal failure. J Am Col N 1983;2:33-44.
• Abel RM, Beck GH, Abbott WM, Ryan JA, Barnet GO, Fischer JE. Improved survival from acute renal fai- lure after treatment with intravenous essentional L-a- mino acids and glucose. N Eng J Med 1973;288:695-9.
• Min Baek S, Makaboli GG, Brayn-Brown LW, Kusek J, Shoemaker WL, The influence of parenteral nutrition on the course of acute renal failure. Surgery Gynecol Obstet 1975;141:405-8.
• Lima EQ, Dirce MT, Castro I, Yu L. Mortality risk factors and validation of severity scoring systems in critically ill patients with acute renal failure. Ren Fail 2005;27:547-56.
• Zang L,Wang M,Wang H. Acute renal failure in chro- nic kidney disease-clinical and pathological analysis of 104 cases. Clin Nephrol 2005;63:346-50.
• Jayakumar M, Prabahar MR, Fernando EM. Epide- miologic trend changes in acute renal failure—a tertiary center experience from South India. Ren Fail 2006;28(5):405-10.
• Obialo CI, Okonofua EC, Nzerue MC, Tayade AS, Riley LJ. Role of hypoalbuminemia and hypocholes- terolemia as copredictors of mortality in acute renal failure. Kidney Int 1999;56(3):1058-63.
• Chertow GM, Soroko SH, Paganini EP, et al. Mor- tality after acute renal failure: Models for prog- nostic stratificationand risk adjustment. Kidney Int 2006;70(6):1120-6.
• Chertow GM, Lazarus JM. Intensity of dialysis in re- nal failure. Semin Dial 1996;9:476-80.