Ciddi Akut Böbrek Hasarı Gelişen Multiple Skleroz Olgusu

Year 2022, , 299 - 301, 30.12.2022

Burcu Çilek Balimre , Ceren Erdoğan Eroğlu , Erkan Şengül , Zahide Yılmaz Güneş , Didem Yıldız Toksöz

https://doi.org/10.47572/muskutd.980830

Abstract

Multipl skleroz (MS), merkezi sinir sisteminin en sık görülen nöroinflamatuar hastalığıdır. Alt üriner sistem disfonksiyonu MS’li hastalarda sık ve önemli bir problemdir. Hastaların çoğu mesane aktivasyonunda artış ve detrüsör kas dissinerjisine bağlı mesane boşalmasındaki yetersizlik ile başvurur. Literatürde bu hastalarda ciddi akut böbrek hasarı nadir gelişen bir durumdur. Bu çalışmada, ciddi akut böbrek hasarı (ABH) gelişen 41 yaşında 15 yıl önce MS tanısı koyulan kadın hasta sunulmuştur. İdrar miktarında azalma, bacaklarda ödem, yürüme güçlüğü, çift görme şikayeti ile acil servise başvuran hastanın fizik muayenesinde glob vezikale, pretibial +3 ödem, sol alt ekstremitede güç kaybı, sol gözde nistagmus saptandı. Böbrek hastalığı öyküsü olmayan hastanın yapılan laboratuvar tetkiklerinde üre >268 mg/dl, kreatinin: 26.74 mg/dl saptandı. Akut böbrek hastalığı KDIGO (Kidney Disease Improving Global Outcomes) sınıflamasına göre evre 3 olarak kabul edildi. Bilgisayarlı tomografi ve üriner ultrasonografide bilateral hidronefroz dışında patolojiye rastlanılmadı. Mesane kateteriazasyonu sonrası rezidüel idrar volümü toplam 7000 mL olarak saptandı. Hastanın renal fonksiyonlarının iyileşmesi idrar kateterizasyonu ve destekleyici tedavi ile 10 gün içerisinde sağlandı. MS’li hastalarda alt üriner sistem disfonksiyonunun erken tesbiti mortalite ve morbiditeye neden olabileceği için önemlidir. Bu nedenle tüm MS’li hastalar nöroürolojik açıdan değerlendirilmelidir.

Keywords

akut böbrek hasarı, multipl skleroz, alt üriner sistem disfonksiyonu

A Case of Multiple Sclerosis with Severe Acute Kidney Injury

Abstract

Multiple sclerosis (MS) is the most frequent neuroinflammatory disease of the central nervous system. Lower urinary tract dysfunction is a common and important problem in patients with MS. Most patients present with bladder hyperreflexia and failure to empty the bladder secondary to detrusor-distal sphincter dyssynergia. Severe acute kidney injury is a rare case in these patients in the literature. In this study, a 41-year-old female patient with a severe acute kidney injury (AKI) who was diagnosed with MS 15 years ago is presented. The physical examination of the patient presented in the emergency department with complaints of decreased urine amount, edema in the legs, difficulty in walking, and diplopia revealed glob vesicale, pretibial +3 edema, loss of strength in the left lower extremity, nystagmus in the left eye. Urea >268 mg/dl, creatinine: 26.74 mg/dl were detected in the laboratory tests of the patient who had no history of kidney disease. It was accepted as stage 3 according to the acute kidney disease-KDIGO (Kidney Disease Improving Global Outcomes) classification. No pathology was found in the computerized tomography and urinary ultrasonography except for bilateral grade 2-3 hydronephrosis. After the urinary catheterization was performed, the residual urine was drained and recorded as 7000 mL in total. A recovery in the patient's renal functions was achieved within 10 days with urinary catheterization and supportive therapy. An early detection of lower urinary system dysfunction in patients with MS is important as it may cause mortality and morbidity. Therefore, all patients with MS should be evaluated from a neurourological perspective. 

Keywords

acute kidney injury, multiple sclerosis, lower urinary tract dysfunction

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