KRONİK BÖBREK YETMEZLİKLİ OLGUDA ABDOMİNAL AORTA ANEVRİZMASI RÜPTÜRÜ VE NEFROLİTİAZİS BİRLİKTELİĞİ

Abstract

Sıklıkla asemptomatik seyreden nefrolitiazis nadiren karın ağrısı yakınmasına neden olur. Abdominal aorta anevrizma (AAA) rüptürü şiddetli karın ağrısı yakınmasına neden olabilen ölümcül bir tablodur. Her iki hastalığın tanısında bilgisayarlı tomografinin tanısal değeri yüksek olup AAA’da kontrast madde kullanılarak bilgisayarlı tomografik (BT) anjiyografi uygulanılmaktadır. Böbrek fonksiyon bozukluğu olan hastalarda kontrast madde kullanımı nefropatiye neden olabileceğinden tanısal amaçlı BT anjiyografi kullanılacaksa kontrast nefropati koruyucu önlemler alınarak işlem uygulanmalıdır. Bu yazımızda son dönem böbrek yetmezliği tanılı, karın ağrısı yakınması ile gelen aynı anda nefrolitiazis ve 4 cm’nin altında olan AAA rüptürü tespit edilen olgunun tanı ve tedavi yaklaşımını sunacağız.

Keywords

• Son dönem böbrek yetmezliği,abdominal aorta anevrizması rüptürü,nefrolitiazis,kontrast nefropati.

A CASE OF ABDOMINAL AORTIC ANEURYSM RUPTURE WITH CONCURRENT NEPHROLITHIASIS IN A PATIENT WITH CHRONIC RENAL FAILURE

Abstract

Nephrolithiasis while usually asymptomatic may sometimes present with mild abdominal pain. Aortic abdominal aneurysm (AAA) rupture however presents with intense abdominal pain and is a fatal condition. In both conditions computed tomography (CT) is highly diagnostic and contrast CT angiography is used to diagnose abdominal aortic aneurysms. In renal dysfunction extra measures need to be taken in order to use contrast agents. We present a case of a patient with end stage renal failure with nephrolithiasis and an AAA rupture fewer than 4 cm and highlight our diagnostic and treatment methods.

Keywords

• End stage renal disease,abdominal aortic aneurysm,nephrolithiasis,contrast nephropathy.

References

1. 1. Johnston KW, Rutherford RB, Tilson MD, et al. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg 1991;13(3):452-8.
2. 2. Paraskevas KI, Mikhailidis DP, Veith FJ. The rationale for lowering the size threshold in elective endovascular repair of abdominal aortic aneurysm. J Endovasc Ther 2011;18(3):308-313
3. 3. Hollingsworth JM, Rogers MA, Kaufman SR, et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet 2006;368(9542):1171-9.
4. 4. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002;39(5):930-6.
5. 5. GÜLEL, Okan. "Kontrast Nefropatisi ve Önlenmesi." Turkiye Klinikleri J Cardiovasc Sci 2009;21(3):450-9.
6. 6. Stacul F, Adam A, Becker CR, et al. Strategies to reduce the risk of contrast-induced nephropathy. Am J Cardiol 2006;98(6):59-77.
7. 7. Wanhainen A, Bergqvist D, Bjorck M. Measuring the abdominal aorta with ultrasonography and computed tomography - difference and variability. Eur J Vasc Endovasc Surg 2002;24(5):428-434
8. 8. Chaikof EL, Brewster DC, Dalman RL, et al. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 2009;50(4):2-49

9. 9. Brewster DC, Cronenwett JL, Hallett JW, Jr., et al. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg 2003;37(5):1106-1117
10. 10. Greenhalgh RM, Brown LC, Kwong GP, et al. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 2004;364(9437):843-8