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Acile Başvuran Böbrek Nakilli Hastaların Değerlendirilmesi: Tek Merkez Deneyimi

Year 2019, , 20 - 24, 01.01.2019
https://doi.org/10.30934/kusbed.456136

Abstract

Amaç: Son dönem böbrek yetmezlikli hastalarda böbrek nakli ve diyaliz tedavi seçenekleridir. Böbrek nakli, bu hastalar için en iyi tedavi seçeneğidir. Fakat immunsüpresif rejimler ve ek hastalıklar nedeniyle böbrek nakilli hastalar enfeksiyon ve kardiyovasküler hastalıklara duyarlı hale gelirler. Bu retrospektif çalışmada, acile başvuran böbrek nakilli hastaların demografik yapıları, klinik bulguları, laboratuar bulguları ve hasta sonuçları incelenmiştir.

Yöntem: Acile başvurmuş olup, hastanemizde böbrek nakli yapılan hastaların demografik yapıları, klinik bulguları, laboratuar bulguları, tanıları, hastanede kalış süreleri ve hasta sonuçları tıbbi kayıtlardan incelenmiştir. Bu hastalardan bir önceki hastane protokol numarasına sahip böbrek nakil hastaları ise kontrol grubu olarak alınmıştır.

Bulgular: Çalışmaya 218 hasta dahil edildi. Hastalar genel olarak canlı böbrek vericisi olan genç kadın bireylerdi. Hastaların ortalama yaşları 39,4±13,2 idi. Nedeni bilinmeyen böbrek yetmezliğini dışladıktan sonra kronik glomerulonefrit her iki grupta da en sık böbrek yetmezliği nedeniydi. En sık saptanan semptomlar ateş ve idrar yaparken yanma idi. İdrar yolu enfeksiyonu en sık konulan tanıydı. Hastaların ortalama yatış süresi 11,7±9,2 gündü. Takipler sırasında 35 hastanın (%16) böbrek fonksiyonu bozuldu ve 15 hastaya hemodiyaliz tedavisi başlandı. Hastaların 5’i (%2,2) (üçü sepsis, ikisi ensefalit nedeniyle) ise kaybedildi.

Sonuç: Acil serviste çalışan klinisyenler organ nakilli hasta başvuralarında enfeksiyonlar açısından çok dikkatli olmalıdır.


References

  • Medin C, Elinder CG, Hylander B, Blom B, Wilczek H. Survival of patients who have been on a waiting list for renal transplantation. Nephrol Dial Transplant. 2000;15:701‐704. doi: 10.1093/ndt/15.5.701
  • Suthanthiran M, Strom TB. Renal transplantation. N Engl J Med. 1994;331:365. doi:10.1056/NEJM199408113310606
  • Briggs JD. Causes of death after renal transplantation. Nephrol Dial Transplant. 2001;16:1545. doi:10.1093/ndt/16.8.1545
  • The AST Infectious Disease Community of Practice, American Society of Transplantation, Infectious Disease Guidelines for Transplantation. Am J Transpl. 2009; 9(Suppl 4):S1. Screening of donor and recipient prior to solid organ transplantation. Am J Transplant 2004;4(10):10.
  • Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357:2601. doi:10.1056/NEJMra064928
  • Green M. Introduction: Infections in solid organ transplantation. Am J Transplant. 2013;13(4):3. doi:10.1111/ajt.12093
  • Alangaden GJ, Thyagarajan R, Gruber SA, et al. Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant. 2006;20:401.doi:10.1111/j.1399-0012.2006.00519.x
  • Pellé G, Vimont S, Levy PP, et al. Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Transplant. 2007;7:899. doi:10.1111/j.1600-6143.2006.01700.x.
  • Lee JR, Bang H, Dadhania D, et al. Independent risk factors for urinary tract infection and for subsequent bacteremia or acute cellular rejection: a single-center report of 1166 kidney allograft recipients. Transplantation. 2013;96:732. doi:10.1097/TP.0b013e3182a04997.
  • Abbott KC, Swanson SJ, Richter ER, et al. Late urinary tract infection after renal transplantation in the United States. Am J Kidney Dis. 2004;44:353. doi:0.1053/j.ajkd.2004.04.040
  • Chuang P, Parikh CR, Langone A. Urinary tract infections after renal transplantation: a retrospective review at two US transplant centers. Clin Transplant. 2005;19:230. doi:10.1111/j.1399-0012.2005.00327.x
  • Ariza-Heredia EJ, Beam EN, Lesnick TG, Cosio FG, Kremers WK, Razonable RR. Impact of urinary tract infection on allograft function after kidney transplantation. Clin Transplant. 2014;28:683. doi:10.1111/ctr.12366
  • Muñoz P. Management of urinary tract infections and lymphocele in renal transplant recipients. Clin Infect Dis. 2001;33(1):53. doi:10.1086/320905
  • Trzeciak S, Sharer R, Piper D, et al. Infections and severe sepsis in solid-organ transplant patients admitted from a university-based ED. Am J Emerg Med. 2004;22(7):530-3. doi:10.1016/j.ajem.2004.09.010
  • Schold JD, Elfadawy N, Buccini LD, et al. Emergency Department Visits after Kidney Transplantation. Clin J Am SocNephrol. 2016;11(4):674-83. doi:10.2215/CJN.07950715.
  • Venkat KK, Venkat A. Care of the renal transplant recipient in the emergency department. Ann Emerg Med. 2004;44:330-341. doi:10.1016/S0196064404005670
  • Bodro M, Linares L, Chiang D, Moreno A, Cervera C. Managing recurrent urinary tract infections in kidney transplant patients. Expert Rev Anti Infect Ther. 2018:1-10. doi:10.1080/14787210.2018.1509708
  • Esezobor CI, Nourse P, Gajjar P. Urinary tract infection following kidney transplantation: frequency, risk factors and graft function. Pediatr Nephrol. 2012;27(4):651-7. doi:10.1007/s00467-011-2044-1
  • Wojciechowski D, Chandran S. Effect of ciprofloxacin combined with sulfamethoxazole-trimethoprim prophylaxis on the incidence of urinary tract infections after kidney transplantation. Transplantation. 2013;96(4):400-5. doi:10.1097/TP.0b013e3182962cab
  • Kartal M, Göksu R, Eray O, Güngör F. Acil servise başvuran renal transplant hastalarının hastaneye yatışını etkileyen faktörler. Turk J Emerg Med.2009;9(4):159-162.
  • Miles AMV, Sumrani N, Horowitz R et al. Diabetes mellitus after renal transplantation: as deleterious as non-transplant-associated diabetes? Transplantation. 1998;65:380.
  • Markell M. Clinical impact of posttransplant diabetes mellitus. Transplant Proc. 2001;33:19-22. doi:10.1016/S0041-1345(01)02230-8

Evaluating Emergency Department Admissions Among Renal Transplant Recipients: One Center Experience

Year 2019, , 20 - 24, 01.01.2019
https://doi.org/10.30934/kusbed.456136

Abstract

Objective: Renal Replacement therapy for end stage renal disease (ESRD) patients includes transplantation and dialysis. Kidney transplantation is the treatment of choice for ESRD. However, transplant patients are susceptible to infection and cardiovascular disease due to immunosuppressive regimens and existing multiple comorbidities. In this retrospective study, we aimed to investigate the demographic characteristics, clinical manifestations, laboratory findings and outcomes of transplant patients who were admitted to the emergency department.

Methods: Transplant patients who were subsequently admitted to the emergency department were retrospectively evaluated. The patients’ demographic, clinical and laboratory findings, symptoms, diagnoses, duration of hospitalization and outcomes were obtained from medical records. Transplant patients with previous hospital protocol numbers of each patient were enrolled into study as control group.

Results: 218 patients  were enrolled into study.  More than half of the patients in each group were young women with live kidney donors. The mean (±SD) age of the patients was 39.4±13.2. Chronic glomerulonephritis was the leading etiology of kidney failure among both groups in those where the etiology was identified. The most common symptoms were fever and dysuria. Urinary tract infection was the most frequently diagnosed complication. Mean (±SD) duration of hospitalization was 11.7±9.2 day. Kidney function worsened in 35 patients (16%) and hemodialysis was initiated in 15 of them. Five patients (2.2%) died (sepsis in three, encephalitis in 2).

Conclusion: Physicians should have a high index of suspicion for infection during evaluation of organ transplant recipients in the emergency department.


References

  • Medin C, Elinder CG, Hylander B, Blom B, Wilczek H. Survival of patients who have been on a waiting list for renal transplantation. Nephrol Dial Transplant. 2000;15:701‐704. doi: 10.1093/ndt/15.5.701
  • Suthanthiran M, Strom TB. Renal transplantation. N Engl J Med. 1994;331:365. doi:10.1056/NEJM199408113310606
  • Briggs JD. Causes of death after renal transplantation. Nephrol Dial Transplant. 2001;16:1545. doi:10.1093/ndt/16.8.1545
  • The AST Infectious Disease Community of Practice, American Society of Transplantation, Infectious Disease Guidelines for Transplantation. Am J Transpl. 2009; 9(Suppl 4):S1. Screening of donor and recipient prior to solid organ transplantation. Am J Transplant 2004;4(10):10.
  • Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357:2601. doi:10.1056/NEJMra064928
  • Green M. Introduction: Infections in solid organ transplantation. Am J Transplant. 2013;13(4):3. doi:10.1111/ajt.12093
  • Alangaden GJ, Thyagarajan R, Gruber SA, et al. Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant. 2006;20:401.doi:10.1111/j.1399-0012.2006.00519.x
  • Pellé G, Vimont S, Levy PP, et al. Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Transplant. 2007;7:899. doi:10.1111/j.1600-6143.2006.01700.x.
  • Lee JR, Bang H, Dadhania D, et al. Independent risk factors for urinary tract infection and for subsequent bacteremia or acute cellular rejection: a single-center report of 1166 kidney allograft recipients. Transplantation. 2013;96:732. doi:10.1097/TP.0b013e3182a04997.
  • Abbott KC, Swanson SJ, Richter ER, et al. Late urinary tract infection after renal transplantation in the United States. Am J Kidney Dis. 2004;44:353. doi:0.1053/j.ajkd.2004.04.040
  • Chuang P, Parikh CR, Langone A. Urinary tract infections after renal transplantation: a retrospective review at two US transplant centers. Clin Transplant. 2005;19:230. doi:10.1111/j.1399-0012.2005.00327.x
  • Ariza-Heredia EJ, Beam EN, Lesnick TG, Cosio FG, Kremers WK, Razonable RR. Impact of urinary tract infection on allograft function after kidney transplantation. Clin Transplant. 2014;28:683. doi:10.1111/ctr.12366
  • Muñoz P. Management of urinary tract infections and lymphocele in renal transplant recipients. Clin Infect Dis. 2001;33(1):53. doi:10.1086/320905
  • Trzeciak S, Sharer R, Piper D, et al. Infections and severe sepsis in solid-organ transplant patients admitted from a university-based ED. Am J Emerg Med. 2004;22(7):530-3. doi:10.1016/j.ajem.2004.09.010
  • Schold JD, Elfadawy N, Buccini LD, et al. Emergency Department Visits after Kidney Transplantation. Clin J Am SocNephrol. 2016;11(4):674-83. doi:10.2215/CJN.07950715.
  • Venkat KK, Venkat A. Care of the renal transplant recipient in the emergency department. Ann Emerg Med. 2004;44:330-341. doi:10.1016/S0196064404005670
  • Bodro M, Linares L, Chiang D, Moreno A, Cervera C. Managing recurrent urinary tract infections in kidney transplant patients. Expert Rev Anti Infect Ther. 2018:1-10. doi:10.1080/14787210.2018.1509708
  • Esezobor CI, Nourse P, Gajjar P. Urinary tract infection following kidney transplantation: frequency, risk factors and graft function. Pediatr Nephrol. 2012;27(4):651-7. doi:10.1007/s00467-011-2044-1
  • Wojciechowski D, Chandran S. Effect of ciprofloxacin combined with sulfamethoxazole-trimethoprim prophylaxis on the incidence of urinary tract infections after kidney transplantation. Transplantation. 2013;96(4):400-5. doi:10.1097/TP.0b013e3182962cab
  • Kartal M, Göksu R, Eray O, Güngör F. Acil servise başvuran renal transplant hastalarının hastaneye yatışını etkileyen faktörler. Turk J Emerg Med.2009;9(4):159-162.
  • Miles AMV, Sumrani N, Horowitz R et al. Diabetes mellitus after renal transplantation: as deleterious as non-transplant-associated diabetes? Transplantation. 1998;65:380.
  • Markell M. Clinical impact of posttransplant diabetes mellitus. Transplant Proc. 2001;33:19-22. doi:10.1016/S0041-1345(01)02230-8
There are 22 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article | Clinical Medical Sciences
Authors

Mahmoud El Sawan This is me 0000-0001-5093-2680

Serkan Feyyaz Yalın 0000-0002-8146-6966

Publication Date January 1, 2019
Submission Date September 3, 2018
Acceptance Date November 4, 2018
Published in Issue Year 2019

Cite

APA El Sawan, M., & Yalın, S. F. (2019). Evaluating Emergency Department Admissions Among Renal Transplant Recipients: One Center Experience. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, 5(1), 20-24. https://doi.org/10.30934/kusbed.456136
AMA El Sawan M, Yalın SF. Evaluating Emergency Department Admissions Among Renal Transplant Recipients: One Center Experience. KOU Sag Bil Derg. January 2019;5(1):20-24. doi:10.30934/kusbed.456136
Chicago El Sawan, Mahmoud, and Serkan Feyyaz Yalın. “Evaluating Emergency Department Admissions Among Renal Transplant Recipients: One Center Experience”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 5, no. 1 (January 2019): 20-24. https://doi.org/10.30934/kusbed.456136.
EndNote El Sawan M, Yalın SF (January 1, 2019) Evaluating Emergency Department Admissions Among Renal Transplant Recipients: One Center Experience. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 5 1 20–24.
IEEE M. El Sawan and S. F. Yalın, “Evaluating Emergency Department Admissions Among Renal Transplant Recipients: One Center Experience”, KOU Sag Bil Derg, vol. 5, no. 1, pp. 20–24, 2019, doi: 10.30934/kusbed.456136.
ISNAD El Sawan, Mahmoud - Yalın, Serkan Feyyaz. “Evaluating Emergency Department Admissions Among Renal Transplant Recipients: One Center Experience”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 5/1 (January 2019), 20-24. https://doi.org/10.30934/kusbed.456136.
JAMA El Sawan M, Yalın SF. Evaluating Emergency Department Admissions Among Renal Transplant Recipients: One Center Experience. KOU Sag Bil Derg. 2019;5:20–24.
MLA El Sawan, Mahmoud and Serkan Feyyaz Yalın. “Evaluating Emergency Department Admissions Among Renal Transplant Recipients: One Center Experience”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, vol. 5, no. 1, 2019, pp. 20-24, doi:10.30934/kusbed.456136.
Vancouver El Sawan M, Yalın SF. Evaluating Emergency Department Admissions Among Renal Transplant Recipients: One Center Experience. KOU Sag Bil Derg. 2019;5(1):20-4.