Siroz Hastalarında Böbrek Fonksiyonlarının Değerlendirilmesi

Öz

Amaç: Siroz hastalarında böbrek fonksiyonları sıklıkla bozulmaktadır. Bu çalışmada sirozlu hastalarda böbrek fonksiyonlarının değerlendirilmesi amaçlanmıştır. Materyal - Metod: Çalışmaya kesitsel olarak sirozu olan 321 hasta alınmıştır. Siroz tanısı klinik, laboratuvar ve görüntüleme yöntemleri ile konulmuştur. Glomerüler filtrasyon hızı (GFR) serum kreatinin temelli Modification of Diet in Renal Disaeses Study (MDRD) formülüyle hesaplanmıştır. Bulgular: Sirotik 321 hastanın, 189’u erkek (%58), yaş ortalaması 55.6 ± 15.1, yaş dağılımı 18-91 yaş idi. Hastaların 116’sı (%36) kompanse iken, 205’i (%64) dekompanse idi. Sirozun etyolojik nedenleri 134 (%42) hepatit B, 98 (%30) kriptojenik, 46 (%14) hepatit C, 10 Wilson (%3), 10 delta hepatiti (%3), 23 (%8) diğer nedenler (alkolik siroz, kardiyojenik siroz, Budd-Chiari, biliyer siroz vs) idi. Hastaların ortalama GFR’si 96.2 ± 27.8 ml/dk idi. GFR 205 hastada (%63) normal sınırlarda iken, 118 hastada (%37) normal sınırın altındaydı. GFR düşük olan hastalardan 87’si (%73) evre 1, 23’ü(%20) evre 2, 6’sı (%5) evre 3 ve 2’si (%2) son dönem böbrek yetmezliği sınırında idi. Sonuç: Sirozlu hastalarda bölgemizde en sık etyolojik neden hepatit B, ikinci sırada kriptojenik, üçüncü sırada hepatit C’dir. Hastaların üçte ikiye yakını dekompanse siroz olup, tüm sirotik hastaların en az üçte birinde böbrek hasarı vardı.

Anahtar Kelimeler

• siroz
• böbrek hasarı
• glomerüler filtrasyon hızı

Evaluation of Kidney Functions in Patients with Cirrhosis

Öz

Introduction: Renal functions are frequently impaired in patients with cirrhosis. In this study, it was aimed to evaluate kidney functions in patients with cirrhosis. Materials and Methods: The cross-sectional study were included 321 cirrhosis patients. Imaging, laboratory, and clinical approaches were used to diagnose cirrhosis. The Modification of Diet in Renal Diseases Study (MDRD) formula, which is based on serum creatinine, was used to calculate glomerular filtration rate (GFR). Results: Of 321 cirrhotic patients, 189 (58%) were male, mean age was 55.6 ± 15.1 years, age range was 18-91 years. While 116 (36%) of the patients were compensated, 205 (64%) were decompensated. Etiological causes of cirrhosis 134 (42%) hepatitis B, 98 (30%) cryptogenic, 46 (14%) hepatitis C, 10 Wilson (3%), 10 delta hepatitis (3%), 23 (8%) other causes (alcoholic cirrhosis, cardiogenic cirrhosis, Budd-Chiari, biliary cirrhosis etc.). The mean GFR of the patients was 96.2 ± 27.8 ml/min. While GFR was within the normal range in 205 patients (63%), it was below the normal range in 118 (37%) patients. Of the patients with low GFR, 87 (73%) were at stage 1, 23 (20%) were at stage 2, 6 (5%) were at stage 3 and 2 (2%) were at the limit of end-stage renal disease. Conclusion: The most common etiological cause in our region in patients with cirrhosis is hepatitis B, cryptogenic in the second place and hepatitis C in the third place. Nearly two-thirds of the patients had decompensated cirrhosis, and at least one-third of all cirrhotic patients had kidney injury.

Anahtar Kelimeler

• cirrhosis
• kidney injury
• glomerular filtration rate

Kaynakça

1. Lei L, Li L, Zhang H. Advances in the Diagnosis and Treatment of Acute Kidney Injury in Cirrhosis Patients. Biomed Res Int. 2017: 8523649. doi: 10.1155/2017/8523649.
2. Angeli P, Gines P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the international club of ascites. Gut 2015; 64:531–7.
3. MacDonald AJ, Nadim MK, Durand F, et al. Acute kidney injury in cirrhosis: implications for liver transplantation. 2019: 2(25), 171-178. doi: 10.1097/ MCC.0000000000000590.
4. Kumar U, Kumar R, Jha SK, et al. Shortterm mortality in patients with cirrhosis of the liver and acute kidney injury: A prospective observational study. Indian J Gastroenterol. 2020 Oct;39(5):457-464. doi: 10.1007/s12664-020-01086-z.
5. Shetty S, Nagaraju SP, Shenoy S, et al. Acute kidney injury in patients with cirrhosis of liver: Clinical profile and predictors of outcome. Indian J Gastroenterol. 2018 May;37(3):248-254. doi: 10. 1007/s12664- 018-0867-4.
6. Uyanıkoğlu A. Siroz. Pratik Gastroenteroloji, editör: Ahmet Uyanıkoğlu. US Akademi 2021: 97-116.
7. Allegretti AS, Ortiz G, Wenger J, et al. Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study. Int J Nephrol. 2015;2015:108139. doi: 10.1155/2015/108139.
8. Karagozian R, Bhardwaj G, Wakefield DB, et al. Acute kidney injury is associated with higher mortality and healthcare costs in hospitalized patients with cirrhosis. Ann Hepatol. 2019 Sep-Oct;18(5):730-735. doi: 10. 1016/j.aohep.2019.03.011.

9. Jagarlamudi N, Wong F. Acute kidney injury: prediction, prognostication and optimisation for liver transplant. Hepatol Int. 2020 Mar;14(2):167-179. doi: 10. 1007/ s12072-020-10018-0. 10) Nabil M, Abdalla A, Nashwa M, et al. Acute kidney injury in patients with liver cirrhosis. Tanta medical journal. 2017;45(4):192–197. doi: 10. 4103/tmj. tmj_6_17.
10. Jo SK, Yang J, Hwang SM, et al. Role of biomarkers as predictors of acute kidney injury and mortality in decompensated cirrhosis. Sci Rep. 2019 Oct 10;9(1):14508. doi: 10. 1038/ s41598-019-51053-8.
11. Thapa P, Kc S, Hamal AB, et al. Prevalence of Acute Kidney Injury in Patients with Liver Cirrhosis. JNMA; journal of the Nepal Medical Association (2020): 58(228), 554–559. https://doi.org/10. 31729/ jnma.5147.
12. Gomes CGO, de Andrade MVM, Resende Guedes L, et al. Clinical Aspects and Prognosis Evaluation of Cirrhotic Patients Hospitalized with Acute Kidney Injury. Can J Gastroenterol Hepatol. 2019 Mar 3; 2019:6567850. doi: 10.1155/2019/6567850.
13. Piano S, Rosi S, Maresio G, et al. Evaluation of the acute kidney injury network criteria in hospitalized patients with cirrhosis and ascites. J Hepatol 2013; 59: 482–489.