Bazal Ürik Asid Düzeyi, Sepsiste Akut Böbrek Hasarının Önceden Belirlenmesi İçin Bir Kılavuz Olabilir

Year 2021, Volume: 31 Issue: 4, 391 - 395, 15.12.2021

Hakki Yilmaz

https://doi.org/10.54005/geneltip.970853

Abstract

Amaç: Sepsis, yoğun bakım ünitesinde (YBÜ), akut böbrek hasarının (ABH) en önemli nedeni olup %15-20’sinde renal replasman tedavisi ihtiyacı olmaktadır. Ürik asit, hipertansiyon, dislipidemi, yağlı karaciğer, böbrek hastalıkları ve kardiyovasüler hastalıklarla ilişkilidir. Ürik asit seviyelerinin ABH riskinin artması ile bağlantılı olduğu gösterilmiştir. Biz de artmış ürik asit düzeyinin ABH'yı önceden belirlemede rolü olup olmadığını incelemeyi amaçladık.
Gereç ve Yöntem: Bu retrospektif çalışmada, Eylül 2015-Aralık 2017 arasında sepsis nedeni ile YBÜ kabul edilen 105 ardışık hastayı dahil ettik. Kabul esnasındaki klinik laboratuvar testleri ve basitleştirilmiş akut fizyoloji skoru (SAPSII) kaydedildi ve 7 gün boyunca böbrek fonksiyonlarının izlemi yapıldı.
Bulgular: 7 gün içindeki ABH oluşum oranı %47.6 idi. Bazal ürik asit düzeyi ABH gelişen grupta ABH gelişmeyen gruba göre daha yüksekti. Multivariate lojistik regresyon analizinde, serum ürik acid, albumin ve SAPSII; ABH ile bağımsız olarak bağlantılıydı. Serum ürik asit 6.85 mg/dl eşik noktasında sepsis hastalarında ABH'yı belirlemede oldukça etkiliydi ve %72 duyarlılık ve %85.5 özgüllüğe sahipti. Sonuç: Artmış ürik asit düzeyi sepsiste ABH'nın önceden belirlenmesinde yardımcı olabilir.

Keywords

Ürik asit, Akut böbrek hasarı, Sepsis.

References

• 1. Edwards NL. The role of hyperuricemia and gout in kidney and cardiovascular disease. Cleve Clin J Med. 2008;75(Suppl 5):13-6.
• 2. Johnson RJ, Segal MS, Srinivas T, et al. Essential hypertension, progressive renal disease, and uric acid: a pathogenetic link? J Am Soc Nephrol. 2005;16(7):1909-19.
• 3. Jee SH, Lee SY, Kim MT. Serum uric acid and risk of death from cancer, cardiovascular disease or all causes in men. Eur J Cardiovasc Prev Rehabil. 2004;11(3):185-91.
• 4. Lytvyn Y, Perkins BA, Cherney DZ. Uric acid as a biomarker and a therapeutic target in diabetes. Can J Diabetes. 2015;39(3):239-46.
• 5. Bos MJ, Koudstaal PJ, Hofman A, Witteman JC, Breteler MM. Uric acid is a risk factor for myocardial infarction and stroke: the Rotterdam study. Stroke. 2006;37(6):1503-7.
• 6. Madero M, Sarnak MJ, Wang X, et al: Uric acid and long-term outcomes in CKD. Am J Kidney Dis. 2009;53:796-803.
• 7. Fang Y, Ding X, Zhong Y, et al. Acute kidney injury in a Chinese hospitalized population. Blood Purif. 2010;30(2):120-6.
• 8. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39(5):930-6.
• 9. Uchino S. The epidemiology of acute renal failure in the world. Curr Opin Crit Care. 2006;12(6):538-43.
• 10. Lapsia V, Johnson RJ, Dass B, et al. Elevated uric acid increases the risk for acute kidney injury. Am J Med. 2012;125(3):302.e9-17.
• 11. Otomo K, Horino T, Miki T, et al. Serum uric acid level as a risk factor for acute kidney injury in hospitalized patients: a retrospective database analysis using the integrated medical information system at Kochi Medical School hospital. Clin Exp Nephrol. 2016;20(2):235-43.
• 12. Dellinger RP, Levy MM, Rhodes A, et al; Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580-637.
• 13. The Kidney Disease Improving Global Outcomes (KDIGO) Working Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(Suppl 1):1-138.
• 14. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957–63.
• 15. ADA. Standards of medical care in diabetes—2009. Diabetes Care. 2009;32(Suppl 1):13–61.
• 16. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289(19):2560–72.
• 17. Youden, WJ. Index for rating diagnostic tests. Cancer. 1950;3(1):32–5.
• 18. Doi K. Role of kidney injury in sepsis. J Intensive Care. 2016;4:17. doi: 10.1186/s40560-016-0146-3.
• 19. Meneshian A, Bulkley GB. The physiology of endothelial xanthine oxidase: from urate catabolism to reperfusion injury to inflammatory signal transduction. Microcirculation. 2002;9(3):161-75.
• 20. Terada LS, Guidot DM, Leff JA, et al. Hypoxia injures endothelial cells by increasing endogenous xanthine oxidase activity. Proc Natl Acad Sci USA. 1992;89(8):3362-6.
• 21. Khosla UM, Zharikov S, Finch JL, et al. Hyperuricemia induces endothelial dysfunction. Kidney Int. 2005;67(5):1739-42.
• 22. Cai W, Duan XM, Liu Y, et al. Uric acid ınduces endothelial dysfunction by activating the HMGB1/RAGE signaling pathway. Biomed Res Int. 2017;2017:4391920. doi: 10.1155/2017/4391920.
• 23. Hahn K, Kanbay M, Lanaspa MA, Johnson RJ, Ejaz AA. Serum uric acid and acute kidney injury: A mini review. J Adv Res. 2017;8(5):529-36.
• 24. Kaushik M, Choo JC. Serum uric acid and AKI: is it time? Clin Kidney J. 2016;9(1):48-50.
• 25. Sánchez-Lozada LG, Tapia E, Santamaría J, et al. Mild hyperuricemia induces vasoconstriction and maintains glomerular hypertension in normal and remnant kidney rats. Kidney Int. 2005;67(1) 237-47.
• 26. Roncal CA, Mu W, Croker B, et al. Effect of elevated serum uric acid on cisplatin-induced acute renal failure. Am J Physiol Renal Physiol. 2007;292(1):F116-22.
• 27. Mazzali M, Hughes J, Kim YG, et al. Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism. Hypertension. 2001;38(5):1101-6.
• 28. Akbar SR, Long DM, Hussain K, et al. Hyperuricemia: an early marker for severity of illness in sepsis. Int J Nephrol. 2015;2015:301021. doi: 10.1155/2015/301021.
• 29. MacKinnon KL, Molnar Z, Lowe D, Watson ID, Shearer E. Measures of total free radical activity in critically ill patients. Clin Biochem. 1999;32(4):263-8.
• 30. Tsai K, Hsu T, Kong C, Lin K, Lu F. Is the endogenous peroxyl-radical scavenging capacity of plasma protective in systemic inflammatory disorders in humans? Free Radic Biol Med. 2000;28(6):926-33.
• 31. Gaipov A, Solak Y, Turkmen K, Toker A, Baysal AN, Cicekler H. Serum uric acid may predict development of progressive acute kidney injury after open heart surgery. Ren Fail. 2015;37(1):96–102.
• 32. Ejaz AA, Beaver TM, Shimada M, Sood P, Lingegowda V, Schold JD. Uric acid: a novel risk factor for acute kidney injury in high-risk cardiac surgery patients? Am J Nephrol. 2009;30(5):425–29.
• 33. Mendi MA, Afsar B, Oksuz F, Turak O, Yayla C, Ozcan F. Uric acid is a useful tool to predict contrast-induced nephropathy. Angiology. 2017;68(7):627–32.
• 34. Park SH, Shin WY, Lee EY, Gil HW, Lee SW, Lee SJ. The impact of hyperuricemia on in-hospital mortality and incidence of acute kidney injury in patients undergoing percutaneous coronary intervention. Circ J. 2011;75(3):692–97.