YENİDOĞANLARDA AKUT BÖBREK HASARI MORBİDİTE VE MORTALİTESİNİ ETKİLEYEN FAKTÖRLER

Year 2024, , 510 - 518, 21.10.2024

Songül Tomar Güneysu , Ayşegül Zenciroğlu , Mehmet Bülbül

https://doi.org/10.18229/kocatepetip.1414458

Abstract

AMAÇ: Akut böbrek hasarı, yenidoğan yoğun bakım ünitelerinin ciddi sorunlarından biridir. Çalışmamızda yenidoğan yoğun bakım ünitelerinde akut böbrek hasarının sıklığı, risk faktörleri, primer tanıları, tedavileri ile erken dönem prognozları ve mortalitesinin değerlendirilmesi amaçlandı.
GEREÇ VE YÖNTEM: Çalışmamıza 1 Ocak 2013 - 31 Aralık 2016 tarihleri arasında hastanemiz yenidoğan yoğun bakım ünitesinde yatan ve akut böbrek hasarı geliştiği belirlenen yenidoğanlar akut böbrek hasarı grubu, her hasta için, aynı zamanda yatmış, akut böbrek hasarı tanısı almamış ikişer hasta kontrol grubu olarak alındı. Akut böbrek hasarı tanısı serum kreatinin >1,5mg/dl ve/veya ölçümleri arasında iki kat artışı ile konuldu.
BULGULAR: Çalışma süresince yenidoğan yoğun bakım ünitesinde yatan 7418 hastadan 201’inde (%2,7) akut böbrek hasarı saptandı. Bunların %42,3’ü preterm, %57,7’ü termdi. Hastaların %92,5’inde (186) prerenal akut böbrek hasarı saptandı. Akut böbrek hasarı olan hastaların %57,5’i oligo-anürikti ve 109 (%54,2) hasta kaybedildi. Renal replasman tedavisi 49’unda (%24,5) gerekti. Kritik konjenital kalp hastalığı (65; %32,3), hipoksik iskemik ensefalopati (36; %17,9), prematürite (23; %11,4), sepsis (21; %10,4), dehidratasyon (17; %8,5) en sık primer akut böbrek hasarı nedenleriydi. Akut böbrek hasarı gelişmesinde karaciğer fonksiyon testi bozukluğu, amfoterisin-B, vankomisin, aminoglikozid kullanımı, nöbet geçirme, proteinüri varlığı ve prematürite; akut böbrek hasarı mortalitesinde ise dopamin kullanımı ve renal replasman tedavi alması bağımsız risk faktörleri olarak belirlendi.
SONUÇ: Yenidoğanlarda akut böbrek hasarı çoğunlukla prerenal nedenliydi. İlk üç nedeni Kritik konjenital kalp hastalığı, hipoksik iskemik ensefalopati ve prematüriteydi. Yoğun bakım gerektiren yenidoğanların izleminde akut böbrek hasarı gelişebileceği unutulmamalı, riskler dikkatle değerlendirilmeli, yakından izlenmeli, nefrotoksik ilaçlar dikkatli kullanılmalı, akut böbrek hasarı belirlendiğinde uygun tedavi gecikmeden başlanmalıdır.

Keywords

Bebek, Yenidoğan, Akut böbrek hasarı, Risk faktörleri, Prognoz.

Ethical Statement

Yapılan çalışmada, araştırma ve yayın etiğine uyulmuştur.

Supporting Institution

Yazarlar bu çalışma için finansal destek almadıklarını beyan etmişlerdir.

FACTORS AFFECTING MORBIDITY AND MORTALITY OF ACUTE KIDNEY INJURY IN NEWBORNS

Abstract

OBJECTIVE: Acute kidney injury is one of the serious problems in Neonatal Intensive Care Units. Our study was aimed to evaluate the incidence, risk factors, primary diagnoses, treatments with early prognosis, and mortality of acute kidney injury in the neonatal intensive care units.
MATERIAL AND METHODS: Hospitalized newborns who had been diagnosed with acute kidney injury in neonatal intensive care units between January 1, 2013, and December 31, 2016, were included in the study as the acute kidney injury group. Two hospitalized newborns without acute kidney injury for each acute kidney injury patient were included in the study as a control group. The diagnosis of acute kidney injury was made with serum creatinine >1.5mg/dl and/or a two-fold increase between measurements.
RESULTS: Acute kidney injury was detected in 201 (2.7%) of 7418 patients hospitalized in the neonatal intensive care units during the study. Of these, 42.3% were preterm. Prerenal acute kidney injury was detected in 92.5% (186). Of these, 57.5% were oligo-anuric, and 109 (54.2%) patients died. Renal replacement therapy was required in 49 (24.5%) patients. Critical congenital heart disease (65;32.3%), hypoxic ischemic encephalopathy (36;17.9%), prematurity (23;11.4%), sepsis (21;10.4%) and dehydration (17;8.5%) were the most common causes of acute kidney injury. Liver function test abnormality, amphotericin-B, vancomycin, aminoglycoside use, seizures, presence of proteinuria, and prematurity were the independent risk factors in the development of acute kidney injury. Dopamine use and renal replacement therapy were determined as independent risk factors in acute kidney injury mortality.
CONCLUSIONS: Acute kidney injury in newborns was mostly prerenal. It should not be forgotten that acute kidney injury may develop during the follow-up of newborns requiring intensive care, and the risks should be carefully evaluated, closely monitored, nephrotoxic drugs should be used carefully, and when acute kidney injury is detected, appropriate treatment should be started without delay.

Keywords

Infant, Newborn, Acute kidney injury, Risk factors, Prognosis.

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