Kahramanmaraş Depremleri ile Çocuklarda Oluşan Akut Böbrek Hasarı Risk Faktörlerinin Araştırılması: Retrospektif Bir Analiz

Abstract

Amaç: 6 Şubat 2023 tarihinde meydana gelen ve Türkiye ve Suriye'de büyük yıkıma neden olan ikiz Kahramanmaraş depremleri, yalnızca Türkiye'de 11 ilde 16 milyondan fazla insanı etkilemiştir. Depremzedelerde sık görülen bir durum olan ezilme (crush) sendromu, böbrek hipoperfüzyonuna bağlı akut böbrek hasarının (ABH) gelişimi için kayda değer bir risk etmenidir. Bu nedenle depremzedelerde böbrek fonksiyon bozukluğu ve buna bağlı komplikasyonların önlenmesi için zamanında müdahale çok önemlidir. Bu bağlamda bu çalışma, bu depremlerden sağ kurtulan çocuklarda ABH görülme sıklığını ve ezilme yaralanması başta olmak üzere ABH gelişimini öngörebilecek klinik ve laboratuvar parametrelerini belirlemek amacıyla yapılmıştır. Gereç ve Yöntemler: Bu retrospektif çok merkezli çalışmanın evrenini, Kahramanmaraş depremlerinden sağ kurtularak Türkiye'nin Şanlıurfa ilindeki iki üçüncü basamak sevk merkezine kabul edilen çocuklar oluşturmuştur. Çocukların demografik, klinik ve laboratuvar özellikleri elde edilerek, ABH gelişimini öngören faktörleri belirlemek için istatistiksel analizlere tabi tutulmuştur. Bulgular: Araştırmaya dahil edilen 40 depremzede çocuğun ortanca yaşı 9 yıl (1-17 yıl) idi. Bu çocukların 17(%42,5) 'sinde ABH gelişmiş (Grup-1), 23(%57,5) 'ünde gelişmemişti (Grup 2). Otuz iki (%80,0) çocukta ezilme yaralanması görülmüştü. Grup-1'in ortanca yaşı Grup-2'den istatistiksel olarak anlamlı derecede yüksek bulunmuştur (p=0,004). Enkazdan çıkarılma süresi de Grup-1'de Grup-2'ye göre istatistiksel olarak anlamlı derecede daha yüksek bulunmuştur (p=0,028). Ezilme yaralanması özelliklerinin ABH gelişimi ile ilişkili olmadığı belirlendi (p>0,05). Öte yandan, hastane öncesi intravenöz hidrasyonun daha düşük ABH insidansı ile anlamlı düzeyde ilişkili olduğu bulundu (p=0,014). ABH'lı çocukların 12 (%70,6)'sine hemodiyaliz uygulanmıştı. Çalışma grubundaki 40 çocuktan Grup-1'de yer alan iki (%5) çocuk ölmüştü. Sonuç: Çalışmamızın bulguları, depremzede çocuklarda ABH'nin önlenmesinde başta intravenöz hidrasyon olmak üzere gerekli müdahalelerin zamanında uygulanmasının önemini ortaya koymuştur. Ezilme yaralanması özellikleri ile AKI gelişimi arasında anlamlı bir ilişki bulamadık. Öte yandan, yaşı daha büyük olan ve deprem enkazı altında daha uzun süre kalan çocuklarda ABH gelişme olasılığının daha yüksek olduğunu tespit ettik.

Keywords

• Depremler
• ezilme yaralanması
• akut böbrek hasarı
• travma
• ekstremiteler
• kırıklar

Predictors of Acute Kidney Injury in Children Following the Kahramanmaraş Earthquakes: A Retrospective Analysis

Abstract

Aim: The twin Kahramanmaraş earthquakes that occurred on February 6th, 2023, caused massive destruction in Turkey and Syria, affecting more than 16 million people in 11 provinces in Turkey alone. Crush syndrome, a common condition in earthquake survivors, is a significant risk element for the emergence of acute kidney injury (AKI) due to renal hypoperfusion. Therefore, timely intervention is critical to prevent renal dysfunction and related complications in earthquake survivors. In this particular situation, the current research was conducted to determine the occurrence of AKI and clinical and laboratory parameters that may predict the development of AKI, particularly crush injury, in child survivors of these earthquakes. Material and Methods: The sample of this retrospective multi-center study comprised child survivors of the Kahramanmaraş earthquakes admitted to two tertiary referral centers in the Şanlıurfa province of Turkey. Children’s demographic, clinical, and laboratory characteristics were collected, and statistical tests were carried out to identify predictive factors for AKI development. Results: The results shows that the median age of the 40 earthquake victims, 22 (55%) female and 18 (45%) male, was 9 years (1-17years). Of these children, 17 (42.5%) developed AKI (Group-1), while 23 (57.5%) did not (Group-2). Crush injuries were observed in 32 (80.0%) children. The median age of Group-1 was found significantly higher than Group-2 (p=0.004). The time to extrication from the rubble was also found significantly higher in Group 1 comparing to in Group 2 (p=0.028). Crush injury characteristics were not found to be associated with the development of AKI (p>0.05). However, receiving intravenous hydration during the transfer to the hospital was found significantly linked to a lower incidence of AKI (p=0.014). Hemodialysis was performed in 12 (70.6%) children with AKI. Of the 40 children in the sample, two (5%) in Group1 had died. Conclusion: The findings of our study demonstrated the importance of timely implementation of necessary interventions, intravenous hydration in particular, in preventing AKI in child earthquake victims. This study did not find any significant correlation between crush injury characteristics and the development of AKI. On the other hand, we determined that children who were older and remained under earthquake rubble for longer were more likely to develop AKI.

Keywords

• Earthquakes
• crush injuries
• acute kidney injury
• trauma
• extremities
• fractures

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