Buradasınız

Yoğun Bakım Ünitelerinde Akut Böbrek Yetmezliği

Acute Renal Failure in Intensive Care Patients

Journal Name:

Publication Year:

Author NameUniversity of AuthorFaculty of Author
Abstract (Original Language): 
Akut böbrek yetmezliği (ABY), böbreğin atık maddeleri süzmek, idrarı yoğunlaştırmak, elektrolitleri korumak ve sıvı dengesini sağlamak gibi son derece önemli işlevlerini birdenbire kaybetmesi sonucunda ortaya çıkan bir durum olup, yoğun bakım hastalarında sıklıkla rastlanan bir komplikasyondur. Çeşitli çalışmalarda yoğun bakıma alınan hastaların %15-20'sinde ABY geliştiği dikkati çekmiştir (1,2). Bunların çoğunluğu akut tübüler nekrozdur (ATN) (%75.6). ATN'nin de en sık nedeni olarak, sepsis %35.4, diğer medikal nedenler %35.4, nefrotoksik nedenler %31.6 olarak bildirilmiştir (3). ABY yoğun bakıma gerek duyulan durumlar dışında genellikle tamamı ile geri dönebilen iyi klinik gidişli bir tablodur. Son yıllarda yoğun bakım ve yapay böbrek tedavi olanaklarının çok gelişmesine rağmen, yoğun bakım hastalarında diğer organ yetmezlikleri ile bir¬likte görüldüğünde ölüm oranının %50-70'leri bulduğu bildirilmiştir (4). ABY'de kendisini oluşturan ne¬dene ve birlikte bulunan diğer hastalıkların ciddiye¬tine bağlı olarak ölüm riski farklılık gösterir. Örneğin, nefrotoksik ilaçların neden olduğu ABY'de bu oran %30 iken, olay solunum, karaciğer yetmezliği ve di¬ğer organ yetmezlikleri ile birlikte gelişmişse ölüm riski %90'ları bulur.
65-73

REFERENCES

References: 

1. Lins RL, Chew SL, Daelemans R. Epidemiology of acute renal failure; in R Bellamo, C Ronco (eds). Acute Renal Failure in Critically 1ll. Berlin, Springer, 1995, pp 147-159.
2. Feest TG , Round A , Hamad S. Incidence of severe acute renal failure in adults: results of a community based study. BMJ 1993 Feb 20;306(6876):481-3.
3. Liano F, Junco E, Pascual J, et al. The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group.
Kidney Int 1998, 53(suppl 66):S16-S24.
4. Mehta R L. Acute renal failure in the intensive care unit: which outcomes should we measure? Am J Kidney Dis 1996;
28(suppl 3):74-80.
5. Esson ML, Schrier RW. Diagnosis and treatment of acute tubu¬lar necrosis. Ann Intern Med 2002;137:744-752.
6. Bone RC. Immunologic Dissonance: A continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndro¬me (MODS). Ann Intern Med 1996;125;680-687.
7. Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP. The natural history of the systemic inflammatory response syndrome (SIRS) JAMA 1995;273;2:117-123.
8. Bone R G. The pathogenesis of sepsis. Ann Intern Med 1991;
115:457-469.
9. Knaus WA, Drapper EA, Wagner DP, Zimmerman JE. APAC¬HE II: A severity of disease classification system. Crit Care Med 1985;13:818-829.
10. Knaus WA, Drapper EA, Wagner DP, Zimmerman JE. Progno¬sis in Acute Organ Failure. Ann Surg 1985;202(6):685-693.
11. Lins RL, Elseviers M, Daelemans R, Zachee P, Gheuens E, Lens S, De Broe ME. Pognostic value of a new scoring system for hospital mortality in acute renal failure. Clin Nephrol 2000;
53:1;10-17.
12. Lins RL, Elseviers M, Daelemans R, Arnouts P, Billiouw J-M, Couttenye M, Gheuens E, Rogiers P, Rutsaert R, Van der Ni-epen P, De Broe ME. Re-evaluation and modification of the Stuivenberg Hospital Acute Renal Failure (SHARF) scoring system for the prognosis of acute ranal failure: an indepen¬dent multycenter, prospective study. Nephrol Dial Transplant 2004;19(9):2282-8.
13. VincentJ-L, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Sutter PM, Thijs LG. The SOFA (Sep¬sis related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med 1996;22:707-710.
14. Ferreira FL, Bota DP, Bross A, Melot C, Vincent J-L. Serial eva¬luation of the SOFA score to predict outcome in critically ill. JAMA 2001;268:1754-1758.
15. Borton IK, Hilton PJ, Taub NA, et al. Acute renal failure tre¬ated by hemofiltration: factors affectin outcome. Q J Med
1993;86:81-90.
16. Cioffi WG, Ashikaga T, Gamelli RL. Probability of surviving postoperative acute renal failure. Ann Surg 1984;200:205-211.
17. Liano F, Gallego A, Pascual J, Garcia-Martin F, Teruel JL, Mar-cen R, Orofino L, Orte L, Rivera M, Gallego N, Quereda C, Or-tuno J. Prognosis of acute tubular necrosis: An extended prospectively contrasted study. Nephron 1993;63:21-31.
18. Lohr JW, Pascual MJ, Garcia-Martin F, et al. A clinical index to predict survivel in acute renal patients requiring dialysis. Am J Kidney Dis 1988;11:254-259.
19. Paganini EP, Halstenberg WK, Goormastic M. Risk modelling in acute renal failure requiring dialysis: the introduction of a
new model. Clin Nephrol 1996;46;3:206-211.
20. Rasmussen M, Pitt EA, Ibels LS, McNeil DR. Prediction of out¬come in acute renal failure by discriminat analysis of clinical variables. Arch Intern Med 145:2015-2018.
21. Schaefer JH, Jochimsen F, Keller K, Wegscheider K, Distler A. Outcome prediction of acute renal failure in medical intensi¬ve care. Int Care Med 17:19-24.
22. Douma CE, Redekop WK, Van Der Meulen J, Van Olden RW,
Haeck J, Stuijk DG and Krediet RT. Predicting mortality in In¬tensive Care patient with acute renal failure treated with di¬alysis. J Am Soc Nephrol 1997;8:111-117.
23. Lameire N, Van Biesen W, Vanholder R, Colardyn F. The pla¬ce of intermittent hemodialysis in the treatment of acute renal failure in the ICU patient. Kidney Int 1998, 53,Suppl.66:S-110-S-119.
24. Conger JD. Interventions in clinical acute renal failure: what
are the data? Am J Kidney Dis 1995;26:565-76.
25. Bellomo R, Ronco C. Acute renal failure in the Intensive Care unit: Adequecy of dialysis and the case for continuous thera¬pies. Nephrol Dial Transplant 1996;11:424-428.
26. Clark WR, Mueller BA, Kraus MA, Macias WL. Extracorporeal therapy requirements for patients with acute renal failure. J
Am Soc Nephrol 1997;8:804-812.
27. Frankenfield DC, Reynolds HN, Wiles CE, Badellino MM, Si-
egel JN. Urea removal during continuous hemofiltration of conventional dialytic therapy and acute continuous hemodi-afiltration in the management of acute renal failure in critically
ill. Renal Failure 1993;15:595-602.
28. Paganini E P, Tapolyai M, Goormastic M, Halstenberg W, Koz-lowski L, Leblan CM, Moreno L, Sakai K. Establishing a dialy¬sis therapy/patient outcome link in intensive care unit acute dialysis with acute renal failure. Am J Kidney Dis 1996;(28
suppl 3):S81-S89.
29. Evanson JH, Hakim RM, Wingard RL, Knights S, Schulman G,
Ikizler TA, Himmelfarb J. Assessment of dose of dialysis in acute renal failure patients. J Am Soc Nephrol (Abstract) 1996;
7:1512.
30. Schiffle H, Lang SM, Fischer R. Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 2002;346;5:305-
310.
31. Rowell KK, Kraning IL, Thomas O, Ewans J, Ward Kennedy J, Blackmon JR, Kusumi F. Splanchnic removal of lactate and pyruvate during prolonged exercise in man. J Appl Physiol
1966;21:1773-1783.
32. Levraut J, Ciebiera JP, Jambou P, Ichai C, Labib Y, Grimaud D. Effect of continuous venobenous hemofiltration with dialy¬sis on lactate clearance in critically ill patients. Crit Care Med
1997;25:58-62.
33. Conger J. Hemodynamic factors in acute renal failure. Adv Re¬nal Raplac Ther 1997;4(suppl):25-37.
34. Conger JD, Schultz MF, Miller F, Robinette JB. Responses to hemorrhagic arterial pressure reduction in different ischemic renal failure models. Kidney Int 1994;46:318-326.
35. Yeh BP, Tomki DJ, Stacy WK, Bear ES, Haden HT, Falls WF.
Factors influencing sodium and water excretion in uremic
man. Kidney Int 1975;7:103-110.
36. Siegler MH, Manns M, Teehan BP. Effects of intermittent he-modialysis on residual renal function in critically ill patients
72
Türk Nefroloji Diyaliz ve Transplantasyon Dergisi /Official Journal of the Turkish Society of Nephrology
Yoğun Bakım Ünitelerinde Akut Böbrek Yetmezliği £
with acute renal failure (abst). J Am Soc Nephrol 1994;5:
477A.
37. Manns M, Sigler MH, Teehan BP. Renal function changes du¬ring intermittent hemodialysis vs continuous hemodialysis in
acute renal failure (abst). ASAIO 1996;42:78.
38. Kuijk WH, Hillion D, Savoiu C, Leunissen KM. Critical role of the extracorporeal blood temperature in the heodynamic res¬ponse during hemofiltration. J Am Soc Nephrol 1997;8:949-
955.
39. Misset T, Timsit J F, Renaud B, Tamion F, Carlet J. Compari¬son of hemodynamic tolerance of sequential hemodialysis and contiuous hemofiltration during acute renal failure in ICU patients: A randomised crossover study. Intensive Care Med
1996;22:742-746.
40. Schulman G, Fogo A, Gung G, Badr K, Hakim R. Complement activation retards resolution of acute ischemic acute renal fa¬ilure in the rat. Kidney Int 1991;40:1069-1074.
41. Hakim RM, Wingard RL, Parker RA. Effect of the dialysis membrane in the treatment of patients with acute renal failu¬re. N Engl J Med 1994;331:1338-1342.
42. Schiffle H, Lang SM, Konig A, Stasser T, Haider MC, Held E.
Biocompatible membranes in acute renal failure: Prospective case-controlled study. Lancet 1994;344:570-572.
43. Himmelfarb J, Tolkoff Rubin N, Chandran P, Parker RA, Win-
gard RL, Hakim R. A multicenter comparison of dialysis
membranes in the treatment of acute renal failure requiring dialysis. J Am Soc Nephrol 1998;9:257-66.
44. Kurtal H, Von Herrath D, Schaefer K. Is the choice of memb¬rane important for patients with acute renal failure requiring hemodialysis? Artif Organs 1995;19:391-4.
45. Jones CH, Newstead CG, Goutcher E, Will EJ, Dean SG, Da-
vison AM. Continuous dialysis for ARF in the ICU: choice of membrane does not influence survival [Abstract]. J Am Soc Nephrol 1997;8:126-A.
46. Jörres A, Gahl GM, Dobis C, Polenakovic MH, Cakalaroski K, Rutkowski B, et al. Haemodialysis-membrane biocompatibi-lity and mortality of patients with dialysis-dependent acute re¬nal failure: a prospective randomised multicentre trial. Inter¬national Multicentre Study Group. Lancet 1999;354:1337-41.
47. Kopple JD. The nutrition management of the patient with acute renal failure. JPEN J Parenter Enteral Nutr 1996;20:3-12.
48. Bellomo R, Seacombe J, Daskalakis M, Farmer M, Wright C, Parkin, et al. A prospective comparative study of moderate versus high protein intake for critically ill patients with acute renal failure. Ren Fail 1997;19:111-20.
49. Lohr J W, Schwab SJ. Minimizing hemorrhagic complications in dialysis patients. J Am Soc Nephrol 1991;2:961-975.
50. Caruana RJ, Raja RM, Bush JV, Kramer MS, Goldstein SJ.
Heparin free dialysis: Comparative data and results in high risk patients. Kidney Int 1987;31:1351-1355.

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