Buradasınız

Yenidoğan Bebeklerde Akut Böbrek Yetersizliği

Acute Renal Failure in Neonatal Period

Journal Name:

Publication Year:

Keywords (Original Language):

Abstract (2. Language): 
Aim: Acute renal failure (ARF) is an important clinical problem in the neonatal period and usually related with a primary disease. Unless diagnosed early and treated properly, it may cause significant mortality and morbidity. In this study, we reviewed the clinical characteristics and prognostic risk factors of ARF patients followed up in our Neonatal Intensive Care Unit. Patients and Methods: One thousand and ninety four patients were followed up in the Neonatal Intensive Care Unit between January 2000 and January 2005. Thirtytwo of these patients (3%) were diagnosed as ARF with the criteria of doubling serum creatinine level or serum creatinine level expan¬ ding 1.5 mg/dL. Birth weight, gestational age, age at diagnosis of ARF, causes of ARF, presence of perinatal risk factors, serum creatinine levels, course of ARF, need for inotropic agents, need for dialysis and other organ involvement were noted. Results: Twenty-four of the babies were preterm babies (75%) and 13 were very low birth weight babies. The mean birth weight and gestational age of the babies were 1924 ± 927 g and 32.9 ± 4.9 weeks, respectively. Causes of ARF were prerenal in 28 cases (87%), renal in 3 cases (10%) and postrenal in 1 case (3%). Perinatal risk factors were present in 17 of the patients (53%). The median age of diagnosis and the median serum creatinine concentration were 5 days and 1.5 mg/dL, respectively. The clinical course of ARF was nonoliguric in 21 cases. Five patients needed dialysis therapy. Ten patients died with a mortality rate of 31%. The comparison of survivors and nonsurvivors showed that prematurity, very low birth weight, need for inotropic treatment, mechanical ventilation, the need for dialysis and other organ invol¬ vement were significantly important prognostic risk factors. Conc¬ lusion: Neonatal ARF is usually prerenal in origin. Perinatal risk factors are present in half of the cases. Mortality is high (31%). Prematurity, very low birth weight, hemodynamic instability, need for dialysis and other organ involvement are prognostic risk factors
Abstract (Original Language): 
Amaç: Akut böbrek yetersizliği (ABY) yenidoğan bebeklerde yüksek mortalite ve morbidite ile seyreden önemli bir klinik problemdir. Çalışmamızda A B Y tanısı ile izlenen yenidoğan bebeklerin klinik özelliklerinin belirlenmesi ve mortalite açısından risk faktörlerinin değerlendirilmesi amaçlanmıştır. Hastalar ve Yöntem: Ocak 2000 ile Ocak 2005 arasında yenidoğan yoğun bakım ünitesinde izlenen ve A B Y tanısı alan bebekler çalışmaya alındı. Bu bebekler doğum tartısı, gestasyon yaşı, A B Y tanısı aldığı dönemdeki yaşı, A B Y etiyolojileri, perinatal risk faktörlerinin varlığı, serum kreatinin düzeyleri, A B Y seyri, inotropik tedavi, diyaliz gereksinimi ve diğer organ tutulumları açısından değerlendirildi. Bulgular: Çalışma süresince yenidoğan yoğun bakım ünitesinde izlenen 1094 bebekten 32'si (%3) A B Y tanısı aldı. Olguların 24'ü (%75) preterm, 13'ü çok düşük doğum ağırlıklı bebeklerdi. Bebeklerin ortalama tartıları 1924 ± 927 g, ortalama gestasyon yaşları 32.9 ± 4.9 hafta idi. Çalışma grubunun ortanca tanı yaşı 5 gün, ortanca serum kreatinin düzeyi 1.5 mg/dL bulundu. A B Y etiyolojileri 28 olguda prerenal (%87), 3 olguda renal (%10), 1 olguda postrenal (%3) idi. A B Y 21 olguda oligürik olmayan seyir gösterdi. Olguların %53'ünde perinatal risk faktörleri vardı. Beş olguya periton diyalizi uygulandı; 10 bebek kaybedildi. Yaşayan ve kaybedilen bebekler karşılaştırıldığında prematürite, çok düşük doğum ağırlığı, inotropik ilaç gereksinimi, mekanik ventilasyon, diyaliz uygulanmış olması, diğer organ tutulumu olmasının mortalite açısından önemli göstergeler olduğu belirlendi. Tartışma: Sonuç olarak, yenidoğan A B Y ' n i n sıklıkla prerenal kaynaklı olduğu, yük¬ sek mortalite ile seyrettiği, preterm doğum, çok düşük doğum ağırlığı, hemodinamik instabilite, diyaliz gereksinimi, diğer organ tutulumu parametrelerinin mortalite açısından önemli olduğu vurgulandı.
FULL TEXT (PDF): 

REFERENCES

References: 

1. Seri I, Evans J, Tulassay T. Renal insufficiency and acute renal failure. In: Taeusch HW, Ballard RA (Eds), 1998 Avery's Diseases of the Newborn, 7th edition. WB Saunders Company, 1158-1164.
2. Gouyon JB, Guignard JP. Management of acute renal failu¬re in newborns. Pediatr Nephrol 2000;14:1037-44.
3. Hentschel R, Lödige B, Bulla M. Renal insufficiency in the neonatal period. Clin Nephrol 1996;46(1):54-8.
4. Medina VA, Lopez-Herce CJ, Lopez FY, et al. Acute renal fa¬ilure in critically-ill children. A preliminary study. An Pedi-
atr (Barc) 2004;61(6):509-14.
5. Kavvadia V, Greenough A, Dimitriou G, Hooper R. Rando¬mised trial of fluid restriction in ventilated very low birth weight infants. Arch Dis Child Fetal Neonatal Ed
2000;83:F91-F96.
6. Toth-Heyn P, Drukker A, Guignard JP. The stressed neona¬tal kidney: from pathophysiology to clinical management of neonatal vasomotor nephropathy. Pediatr Nephrol
2000;14:227-239.
7. Guignard JP, Gouyon JB, John EG. Vasoactive factors in the immature kidney. Pediatr Nephrol 1991;5:443-6.
8. Vasarhelyi B, Toth-Heyn P, Treszl A, Tulassay T. Genetic polymorphisms and risk for acute renal failure in preterm
neonates. Pediatr Nephrol 2005;20:132-5.
9. Drukker A. International Perinatal Nephrology Symposium 20-21 June 2001, Lausanne, Switzerland. Pediatr Nephrol
2002;17:133-8.
10. Agras PI, Tarcan A, Baskin E, Cengiz N, Gurakan B, Saatci U. Acute renal failure in the neonatal period. Ren Fail
2004;26(3): 305-9.
11. Guilllery EN, Nuyt AM, Robillard JE. Functional develop¬ment of the kidney in utero. In: Polin RA, Fox WW (Eds), 1998, Fetal and neonatal physiology, 2nd ed. Philadelphia: Saunders, pp 1560-72.
12. Manalich R, Reyes L, Herrera M, Melendi C, Fundora I. Re¬lationship between weight at birth and the number and si¬ze of renal glomeruli in humans: a histomorphometric
study. Kidney Int 2000;58:770-3.
13. Akima S, Kent A, Reynolds GJ, Gallagher M, Falk MC. Indo-
methacin and renal impairment in neonates. Pediatr Neph-
rol 2004; 19:490-3.
14. Andreoli SP. Acute renal failure in the newborn. Semin Pe-
rinatol 2004;28(2):112-23.
15. Rodriguez MM, Gomez AH, Abitbol CL, Chandar JJ, Duara S, Zilleruelo GE. Histomorphometric analysis of postnatal glomerulogenesis in extremely preterm infants. Pediatr Dev
Pathol 2004; 7(1):17-25.
35
0 Acute Renal Failure in Neonatal Period
16. Rodriguez-Soriano J, Aguirre M, Oliveros R, Vallo A. Long-term renal follow-up of extremely low birth weight infants.
Pediatr Nephrol 2005;20:579-584.
17. Tulassay T, Vasarhelyi B. Birth weight and renal function.
Curr Opin Nephrol Hypertens 2002; 11(3): 347-52.
18. Can G. Perinatoloji.
Pediatr
i adlı kitapta, editör Neyzi O, Er-tuğrul T, 2002, Nobel Tıp Kitabevleri, 3. baskı, s 295-305.
19. Grylack L, Medani C, Hultzen C, et al. Nonoliguric acute re¬nal failure in the newborn. Am J Dis Child 1982; 13: 518-20.
20. Chevalier RL, Campbell F, NFNP R, Brenbridge ANAG.
Prognostic factors in neonatal acute renal failure. Pediatrics
1984; 2: 265-272.
21. Coulthard MG, Vernon B. Managing acute renal failure in very low birthweight infants. Arch Dis Child 1995; 73: F187-
F192.
22. Karlowicz MG, Adelman RD. Acute renal failure in the ne-onate. Clin Perinatol 1992; 19(1): 139-58.
23. Stapleton FB, Jones DB, Green RS. Acute renal failure in ne-onates: Incidence, etiology and outcome. Pediatr Nephrol
1987; 1: 314.
24. Chevalier RL, Campbell F, Brenbridge AG. Prognostic factors in neonatal acute renal failure. Pediatrics 1984; 74: 265-72.

Thank you for copying data from http://www.arastirmax.com