Kalp Damar Cerrahisine Bağlı Akut Böbrek Yaralanması

Year 2019, , 211 - 217, 25.12.2019

Mahmut Padak , Reşat Dikme , Ömer Göç

https://doi.org/10.33715/inonusaglik.622822

Abstract

Kardiyopulmoner baypas (KPB), bir ekstrakorporeal dolaşım modeli olup esas olarak bir pompa, rezervuar ve oksijeneratörden oluşur. KPB’ın başlangıcında kan hastadan bu endotelyal yüzey içermeyen ekstrakorporeal dolaşıma katılarak hastanın genotipi, peroperatif parametreler ve patolojinin kompleksitesine göre kalp cerrahisi sonrasında değişik derecelerde gelişen ve kanın hücresel, hücre dışı veya humoral bileşenleri tarafından yönetilen inflamatuvar süreci başlatır. Kalp ameliyatı geçiren hastalar arasında akut böbrek hasarı oluşumu kötü prognoz ve mortalite artışı ile ilişkili görünmektedir. Akut böbrek hasarı (ABH), yoğun bakım hastalarında sık karşılaşılan mortalite ve morbiditeyi arttırarak klinik seyri olumsuz yönde etkileyen bir tablodur.

Keywords

cardiopulmonary bypass, acute kidney injury, dialysis

ACUTE KIDNEY INJURY DUE TO CARDIOVASCULAR SURGERY

Abstract

Cardiopulmonary bypass (CPB) is an extracorporeal circulatory model consisting essentially of a pump, reservoir and oxygenator. At the beginning of CPB, blood of the patient flows into the extracorporeal circulation, which does not contain the endothelial surface, from the patient and initiates the inflammatory process, that is developed by the cellular, extracellular or humoral components of the blood and this process varies according to the patient's genotype, peroperative parameters and complexity of the pathology. Acute renal injury among patients undergoing cardiac surgery appears to be associated with poor prognosis and increased mortality. Acute kidney injury (AKI) is a condition that increases the common mortality and morbidity in intensive care unit (ICU) patients and adversely affects the clinical course.

Keywords

Kardiyopulmoner baypas, akut böbrek hasarı

References

• 1.National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) Report: Adding Insult to Injury. 2009.2. Hsu CY, Chertow GM, McCulloch CE, Fan D, Ordonez JD, Go AS. Nonrecovery of kidney function and death after acute on chronic renal failure. Clin J Am Soc Nephrol. 2009;4(5):891–8. https://doi.org/10.2215/CJN. 05571008 Epub 2009 Apr 30.3. Kerr M. The economic impact of acute kidney disease [NHS Kidney Care report.]; 2011.4. Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004;15(6):1597–605.5. Thiele RH, Isbell JM, Rosner MH. AKI associated with cardiac surgery. Clin J Am Soc Nephrol (2015); 10(3):500–14. https://doi.org/10.2215/CJN.07830814 PMID: 253767636. Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol (2006); 1(1):19–32. https://doi.org/10.2215/CJN.00240605 PMID: 176991877. Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med. 2006; 34: 1913–1917. https://doi.org/10.1097/01. CCM.0000224227.70642.4F PMID: 167150388. Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: A systematic review. Kidney Int. 2008; 73: 538–546. https://doi.org/10.1038/sj.ki.5002743 PMID: 181609619. Hsu RK, McCulloch CE, Dudley RA, Lo LJ, Hsu CY. Temporal changes in incidence of dialysis-requiring AKI. J Am Soc Nephrol. 2013; 24: 37–42. https://doi.org/10.1681/ASN.2012080800 PMID: 2322212410. Awad S, Allison SP, Lobo DN. The history of 0.9 % saline. Clin Nutr. 2008;27:179–88.11. Reid F, Lobo DN, Williams RN, Rowlands BJ, Allison SP. (Ab)normal saline and physiological Hartmann's solution: a randomized double-blind crossover study. Clin Sci. 2003;104:17–24.12. McCluskey SA, Karkouti K, Wijeysundera D, Minkovich L, Tait G, Beattie WS. Hyperchloremia after noncardiac surgery is independently associated with increased morbidity and mortality: a propensity-matched cohort study. Anesth Analg. 2013;117:412–21.13.Base EM, Standl T, Lassnigg A, Skhirtladze K, Jungheinrich C, Gayko D, et al. Efficacy and safety of hydroxyethyl starch 6 % 130/0.4 in a balanced electrolyte solution (Volulyte) during cardiac surgery. J Cardiothorac Vasc Anesth. 2011;25:407–14.14. Chowdhury AH, Cox EF, Francis ST, Lobo DN. A randomized, controlled, double-blind crossover study on the effects of 1-L infusions of 6 % hydroxyethyl starch suspended in 0.9 % saline (Voluven) and a balanced solution (Plasma Volume Redibag) on blood volume, renal blood flow velocity, and renal cortical tissue perfusion in healthy volunteers. Ann Surg. 2014;259:881–7.15. Coppolino G, Presta P, Saturno L, Fuiano G. Acute kidney injury in patients undergoing cardiac surgery. J Nephrol. 2013;26(1):32-40.16. Perez-Valdivieso JR, Monedero P, Vives M, Garcia-Fernandez N, Bes- Rastrollo M; GEDRCC (Grupo Espanol de Disfuncion Renal en Cirugia Cardiaca). Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study. BMC Nephrol. 2009;10(1):27.17. Freeland K, Jahromi AH, Duvall LM, Mancini MC. Postoperative blood transfusion is an independent predictor of acute kidney injury in cardiac surgery patients. J Nephropathol. 2015;4(4):121-6.18. Ried M, Puehler T, Haneya A, Schmid C, Diez C. Acute kidney injury in septua- and octogenarians after cardiac surgery. BMC Cardiovasc Disord. 2011;11(1):52.19. Hu Y, Li Z, Chen J, Shen C, Song Y, Zhong Q. The effect of the time interval between coronary angiography and on-pump cardiac surgery on risk of postoperative acute kidney injury: a meta-analysis. J Cardiothorac Surg. 2013;8(1):178.20. Binbin Wu, Jianghua Chen, Yi Yang. Biomarkers of Acute Kidney Injury after Cardiac Surgery: A Narrative Review: Biomed Res Int. 2019 Jun 27. doi: 10.1155/2019/7298635, PMCID: PMC6620851 PMID: 3134652321. Coppolino G, Presta P, Saturno L, Fuiano G. Acute kidney injury in patients undergoing cardiac surgery. J Nephrol. 2013;26(1):32-40.22. Holzmann MJ, Ryden L, Sartipy U. Acute kidney injury and longterm risk of stroke after coronary artery bypass surgery. Int J Cardiol. 2013;168(6):5405-10.23. McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2008;51(15):1419-28.