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Yenidoğan ve Erken Süt Çocukluğu Döneminde Kronik Böbrek Yetersizliği

Chronic Renal Failure in Newborn and Early Infancy Period

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Abstract (2. Language): 
Chronic renal failure (CRF) is defined as a serum creatinine above 1mg/dl in the 1st year of life, which corresponds to creatinine clearances below 30ml/min per 1.73m². CRF is rarely seen in the newborn period. According to data from the British Association for Pediatric Nephrology, the incidence of CRF in children under 2 years of life is 0.31/million annually. CRF presenting in the newborn period is usually due to congenital or inherited conditions and acquired causes are less common. Renal hypodysplasia, usually associated with obstructive uropathy or bilateral gross vesicoureteral reflux, is the most common cause of congenital CRF. The usual presentation is failure to thrive in the newborn period, with the typical biochemical changes of renal failure suchas increased creatinine levels, hyperpotassemia, hyperuricemia, hyperphosphatemia, hypocalcaemia, and decreased bicarbonate levels together with metabolic acidosis. Renal replacement therapy should be provided to treat children of any age unless they have overwhelmingly serious additional diagnoses. The biggest single problem in most babies with CRF is achieving an adequate energy intake. Peritoneal dialysis is the preferred option for dialysis in early life. Hemodialysis is technically possible, but morbidity and mortality are high.
Abstract (Original Language): 
Yaşamın ilk yılında serum kreatinin değerinin sürekli 1 mg/ dl’nin üzerinde veya kreatinin klirensinin 30 ml/dk/1.73 m²’nin altında olması kronik böbrek yetersizliği (KBY) olarak tanımlanır. Yenidoğan döneminde KBY nadir bir durumdur. British Association for Pediatric Nephrology verilerine göre yaşamın ilk 2 yılında KBY görülme sıklığı yılda milyonda 0.31 vakadır. Yenidoğan döneminde KBY genellikle konjenital nedenlere bağlıdır, edinsel nedenler daha az sıklıkta görülür. En sık nedeni böbrek hipoplazi/displazisidir. Böbrek hipodisplazisi sıklıkla posterior üretral valv (PUV) ve bilateral vezikoüreteral reflü (VUR) gibi konjenital üropatilere ikincil gelişir. Yenidoğan döneminde genellikle tartı alamama ve kreatinin yüksekliği, hiperpotasemi, hiperürisemi, hiperfosfatemi, hipokalsemi ve bikarbonat düşüklüğü ile birlikte metabolik asidoz gibi böbrek yetersizliğinin tipik biyokimyasal değişiklikleri görülür. Bebeğin yaşı ne olursa olsun kontrindikasyon yoksa Renal Replasman Tedavisi (RRT) verilmelidir. Son dönem böbrek yetersizliği olan yenidoğan ve süt çocuklarında en büyük problem yeterli kalori alımının sağlanamamasıdır. RRT verilecek bebeklerde periton diyalizi ilk tedavi seçeneğidir. Hemodiyaliz teknik olarak mümkün olmasına karşın mortalite ve morbiditesi yüksektir.

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