Pediatrik Kalp Cerrahisi Sonrası Gelişen Akut Böbrek Hasarının “Pediatrik Rıfle Kriterleri” Kullanılarak Değerlendirilmesi

Year 2019, Volume: 22 Issue: 1, 48 - 53, 11.04.2019

Mehmet Dedemoğlu Fatih Öztürk Deniz Günay Muharrem Dağlı Ekin Can Çelik Murat Sezgin Emre Selçuk Davut Çekmecelioğlu Hakan Ceyran

Abstract

Giriş: Pediatrik kalp cerrahisi uygulanan hastalarda, postoperatif akut böbrek hasarının belirlenmesi ve
mevcut hasarın derecesinin evrelenmesi için pRIFLE sınıflaması kullanılması ile bu hasta grubu ve böbrek
hasarı olmayan hasta grupları arasında postoperatif sonuçların karşılaştırılması amaçlanmıştır.

Hastalar ve Yöntem: Nisan 2012 ile Nisan 2013 tarihleri arasında kliniğimizde konjenital kalp hastalığı
nedeniyle ameliyat edilen tüm hastalar geriye dönük olarak incelendi. Akut böbrek hasarının belirlenmesi
ve evrelenmesi için pRIFLE kriterleri kullanıldı. Primer olarak önem verilen sonuçlar, postoperatif dönemde
akut böbrek hasarı gelişen olguların pRIFLE kriterleri ile belirlenmesi, hasar derecesinin pRIFLE evreleri
ile gösterilmesi, böbrek hasarı olguları ile böbrek hasarı olmayan olgular arasında operatif verilerin ve
postoperatif sonuçların karşılaştırılması idi.

Bulgular: Çalışmaya ardışık 105 hasta dahil edildi. Akut böbrek hasarı tespit edilen 45 (%42.9) hasta grup
1 olarak, diğerleri grup 2 olarak tanımlandı. Preoperatif verilerden ortalama yaş grup 1’de anlamlı olarak
düşüktü (p= 0.001). Operatif verilerden kardiyopulmoner baypas süresi grup 1’de anlamlı olarak yüksekti
(p= 0.04) ve hipotermi anlamlı olarak düşüktü (p= 0.001). Postoperatif dönemde, mortalite açısından gruplar
arasında istatistiksel anlamlı fark gözlenmedi (p= 0.65). Hastaların mekanik ventilasyon ve yoğun bakım kalış
süreleri, grup 1’de anlamlı olarak yüksek (sırasıyla p= 0.004 ve 0.04) iken, hastane kalış süreleri açısından
gruplar arasında fark yoktu (p= 0.53).

Sonuç: Pediatrik kalp cerrahisi uygulanan hastalarda postoperatif dönemde akut böbrek hasarı gelişme riski
yüksektir ve bu durum postoperatif sonuçları etkilemektedir. Bu nedenle perioperatif dönemde bu hasardan
korunma ve erken dönemde müdahale yönetiminin gerçekleştirilmesi için hasarın öngörüsünün yapılması
amacıyla neredeyse maliyetsiz, kolay ve hızlı sonuç alınan pRIFLE kriterlerinin kullanılmasını önermekteyiz.

Keywords

Akut böbrek hasarı, konjenital kalp hastalıkları, pRIFLE kriterleri

The Evaluation of Acute Kidney Injury After Pediatric Heart Surgery By Using “Pediatric RIFLE Criteria”

Abstract

Introduction: The aim of this study was to use pRIFLE classification for the determination and staging of
postoperative acute kidney injury in patients undergoing pediatric cardiac surgery and to compare of postoperative results between patients with and without kidney injury.

Patients and Methods: Between April 2012 and 2013, all patients undergoing congenital heart surgery were
retrospectively reviewed. pRIFLE criteria were used for the determination and staging of acute kidney injury.
Primary outcome of interest was the determination and staging of acute kidney injury in the postoperative
period by pRIFLE criteria and the comparison of postoperative results between patients with and without
kidney injury.

Results: Hundred and five consecutive patients were included in this study. Forty-five (42.9%) patients with
acute kidney injury were defined as group 1 and others as group 2. Mean age was significantly lower in group
1 (p= 0.001). According to the operative data, the mean cardiopulmonary bypass time was significantly higher
(p= 0.04) and the hypothermia was significantly lower in group 1 (p= 0.001). No statistically significant difference was observed between the groups in terms of mortality (p= 0.65). The mean duration of mechanical ventilation and intensive care unit stay was significantly higher in group 1 (p= 0.004 and p= 0.04, respectively),
but there was no difference between the groups in terms of hospital stay (p= 0.53).

Conclusion: There is a high risk of developing acute kidney injury in patients undergoing congenital cardiac surgery and it may affect postoperative outcomes. For this reason, we recommend the use of pRIFLE criteria which are almost costless, easy, and fast, to predict the renal damage for early detection
and intervention in acute kidney injury.

Keywords

Acute kidney injury, congenital heart diseases, pRIFLE criteria

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