Hepatorenal Sendrom Tanısı Olan Bireylerde Hemşirelik Bakımı/ Nursing Care in Individuals with Hepatorenal Syndrome

Öz

Hepatorenal sendrom, karaciğer yetmezliği olan hastalarda görülen en yaygın komplikasyonlardan biridir. Azotemi, oligüri, glomerüler
filtrasyon hızının azalması ve inatçı assitin artmasıyla ortaya çıkan böbrek yetmezliği tablosudur. Böbreklerde yapısal bir sorun yoktur. Hepatorenal
sendrom oluşumuna portal hipertansiyon, splenik arteriyel vazodilatasyon sebep olur. Sonuç olarak, renal hipoperfüzyona neden olan renal vazokonstrüksiyon
gelişir. Karaciğer transplantasyonu gerçekleşen hastalarda ameliyat sırasındaki yetersiz perfüzyona bağlı gelişen akut tübüler nekroz,
ameliyat sonrası hipovolemi ve ilaçlara bağlı gelişen nefrotoksisite, karaciğer nakli sonrası böbrek yetmezliğinin diğer önemli nedenlerindendir.
Tedavide amaç, splenik ve sistemik vazokonstrüksiyonun düzeltilmesi, böbreklerin vazodilatasyonunun sağlanması ve sodyum dengesi ile
birlikte normovoleminin sağlanmasıdır. Hemşirelik bakımında; klinikte hastanın hemodinamisinin stabil olması sağlanmalı, laboratuvar bulguları
izlenmeli ve hastanın durumu sıklıkla değerlendirilmelidir. Ayrıca hasta sıvı-elektrolit dengesizlikleri yönünden izlenmelidir. Hepatorenal sendroma
bağlı olarak hastanın saatlik diürez miktarı, ortalama arter basıncı, kreatinin klirensi ve serum kreatin gibi kritik değerlerindeki ani değişimler,
su ve tuz tutulumuna bağlı olarak ortaya çıkan ödem hastanın hemodinamisinin olumsuz etkilenmesine neden olur. Özellikle yoğun
bakım ünitelerinde hastaların izlemi önem taşımaktadır.

Anahtar Kelimeler

• Hepatorenal sendrom
• Böbrek yetmezliği
• Hemşirelik bakımı

Nursing Care in Individuals with Hepatorenal Syndrome

Öz

Hepatorenal syndrome is one of the most common complications seen in patients with liver failure. Azotemia,
oliguria, decreased glomerular filtration rate, and renal failure manifested by increased persistent acidity. There
is no structural problem in the kidneys. Portal hypertension and splenic arterial vasodilation cause the formation
of hepatorenal syndrome. As a result, renal vasoconstriction causes of renal hypoperfusion. Acute tubular
necrosis due to inadequate perfusion during surgery, postoperative hypovolemia, and drug-induced
nephrotoxicity in patients with liver transplantation are other important causes of renal failure after liver
transplantation. To correct splenic and systemic vasoconstriction, to provide vasodilatation of the kidneys, and to
provide normovolemia with sodium balance are the treatment aims. In nursing care; In the clinic, the patient's
hemodynamics should be stabilized, laboratory findings should be monitored and the patient's condition should
be evaluated frequently. Also, the patient should be monitored in terms of fluid-electrolyte imbalances. Sudden
changes in critical values such as the patient's urine output, mean arterial pressure, creatinine clearance and
serum creatinine due to hepatorenal syndrome, edema due to water and salt retention cause the patient's
hemodynamics to be negatively affected. Monitoring of patients is important, especially in intensive care units.

Anahtar Kelimeler

• Hepatorenal syndrome
• Kidney failure
• Nursing care

Kaynakça

1. 1. Croghan A. Liver, Pancreas, and Biliary Tract Problems. Lewis S, Dirksen S, Heitkemper M, Bucher L, Harding M, eds. Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 9th ed. Mosby Elsevier Inc; 2014. p.1006-1026.
2. 2. Low G, Alexander GJM, Lomas DJ. Hepatorenal syndrome: aetiology, diagnosis, and treatment. Gastroenterology Research and Practice 2015;2015:1-11.
3. 3. Baraldi O, Valentini C, Donati G, Comai G, Cuna V, et al. Hepatorenal syndrome: update on diagnosis and treatment. World Journal of Nephrology 2015;4(5):511.
4. 4. Piano S, Rosi S, Maresio G, Fasolato S, Cavallin M, et al. Evaluation of the Acute Kidney Injury Network criteria in hospitalized patients with cirrhosis and ascites. Journal of Hepatology 2013;59(3): 482-489.
5. 5. Altınbaş Y. Karaciğer Nakli ve Hemşirelik Bakımı. Çevik C, Özyürek P, eds. Organ Nakli Hemşireliği. 1. Baskı. İstanbul: Nobel Tıp Kitabevi; 2017. s. 149-162.
6. 6. Rey RM, Delgado AF, De Zubiria A, Pinto R, De la Hoz-Valle JA, et al. Prevalence and short-term outcome of hepatorenal syndrome: A 9-year experience in a high-complexity hospital in Colombia. PLoS One 2020;15(10):e0239834. doi: 10.1371/journal.pone.0239834.
7. 7. Xiong J, Pu L, Xiong H, Xiang P, Zhang M, et al. Evaluation of the criteria of hepatorenal syndrome type of acute kidney injury in patients with cirrhosis admitted to ICU. Scand J Gastroenterol 2018;53(12):1590-1596. doi: 10.1080/00365521.2018.1545423.
8. 8. Zhang S, He LL, Wang XH, Dang ZB, Liu XL, et al. A novel scoring model for predicting mortality risk in patients with cirrhosis and hepatorenal syndrome. Eur J Gastroenterol Hepatol 2018;30(8):938-943. doi: 10.1097/ MEG.0000000000001127.

9. 9. Jamil K, Huang X, Lovelace B, Pham AT, Lodaya K, et al. The burden of illness of hepatorenal syndrome (HRS) in the United States: a retrospective analysis of electronic health records. J Med Econ 2019;22(5):421-429. doi: 10.1080/13696998.2019.1580201.
10. 10. Lata J. Hepatorenal syndrome. World Journal of Gastroenterology 2012; 18(36): 4978.
11. 11. Nowicki LV. Nursing Care of Patients With Liver, Pancreatic and Gallbladder Disorders. Williams LS, Hopper PD, eds. Understanding Medical Surgical Nursing. 5th Edition. Philadelphia: Davis Company; 2015. s. 780-809.
12. 12. Angeli P, Ginès P, Wong F, Bernardi M, Boyer TD, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Journal of Hepatology 2015;62(4):968-974.
13. 13. Fisher EM, Brown DK. Hepatorenal syndrome. AACN Advanced Critical Care 2010;21(2):165-184.
14. 14. Li G, Grant C. Hepatorenal syndrome: a nurse’s guide to identification, management and advocacy. Gastrointestinal Nursing 2016;5(11):12-18.
15. 15. Weil D, Levesque E, McPhail M, Cavallazzi R, Theocharidou E, et al. Prognosis of cirrhotic patients admitted to intensive care unit: a meta-analysis. Annals of Intensive Care 2017;7(33):1-14.
16. 16. Utako P, Emyoo T, Anothaisintawee T, Yamashiki N, Thakkinstian A, et al. Clinical outcomes after liver transplantation for hepatorenal syndrome: a systematic review and meta-analysis. BioMed Research International 2018;2018:1-8.
17. 17. Tan HK, Marquez M, Wong F, Renner EL. Pretransplant Type 2 Hepatorenal Syndrome is associated with persistently impaired renal function after liver transplantation. Transplantation 2015;99(7):1441-6. doi: 10.1097/ TP.0000000000000557.
18. 18. Davenport A, Sheikh MF, Lamb E, Agarwal B, Jalan R. Acute kidney injury in acute-on-chronic liver failure: where does hepatorenal syndrome fit? Kidney International 2017;92(5): 1058-1070.
19. 19. Acevedo JG, Cramp ME. Hepatorenal syndrome: update on diagnosis and therapy. World Journal of Hepatology 2017;9(6): 293.
20. 20. Ginès P, Schrier RW. Renal failure in cirrhosis. New England Journal of Medicine 2009;361(13):1279-1290.
21. 21. European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology 2018;69(2):406-460. Doi: 10.1016/j.jhep.2018.03.024.
22. 22. Solé C, Solà E, Huelin P, Carol M, Moreira R, et al. Characterization of inflammatory response in hepatorenal syndrome: Relationship with kidney outcome and survival. Liver International 2019;39(7):1246-1255. Doi: 10.1111/liv.14037.
23. 23. Angeli P, Garcia-Tsao G, Nadim MK, Parikh CR. News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document. Journal of Hepatology 2019;71(4):811-822. Doi: 10.1016/j.jhep.2019.07.002.
24. 24. Simonetto DA, Gines P, Kamath PS. Hepatorenal syndrome: pathophysiology, diagnosis, and management. BMJ 2020;370:2687. doi: 10.1136/bmj.m2687.
25. 25. Zeyneloğlu P. Hepatorenal sendrom. Türk Yoğun Bakım Derneği Dergisi 2012;10(1):37-44.
26. 26. Colle I, Laterre PF. Hepatorenal syndrome: the clinical impact of vasoactive therapy. Expert Review of Gastroenterology & Hepatology 2017;12(2):173-188.
27. 27. Rossle M, Gerbes AL. TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update. Gut BMJ 2010;59(7):988–1000.
28. 28. Song T, Rössle M, He F, Liu F, Guo X, et al. Transjugular intrahepatic portosystemic shunt for hepatorenal syndrome: A systematic review and meta-analysis. Digestive and Liver Disease 2018;50(4):323-330. Doi: 10.1016/j.dld.2018.01.123.
29. 29. Kasper J, Bettinelli M. Care of the critically ill patient experiencing alcohol withdrawal and/or liver failure. Perrin Ouimet K, Macleod Edgerly C, eds. Understanding the Essentials of Critical Care Nursing. Third Edition. New York: Pearson; 2017.
30. 30. Katarey D, Jalan R. Update on extracorporeal liver support. Current Opinion in Critical Care 2020;26(2):180-185. doi: 10.1097/MCC.0000000000000708.
31. 31. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol 2016;64(2):433-485. doi: 10.1016/ j.jhep.2015.10.006.
32. 32. Ayar Y, Ersoy A, Soyak H. Cirrhosis and renal dysfunction. Turkish Nephrology Dialysis Transplantation 2016;16:25.
33. 33. Fitzpatrick E. Assessment and Management of Patients With Hepatic Disorders. Smeltzer SC, Bare BG. Brunner & Suddarth’s Textbook Of Medical Surgical Nursing. 2.nd ed. Philadelphia: North American Edition, Lippincott Williams& Wilkins; 2010. p. 1116-1168.
34. 34. Nowicki L. Nursing Care of Patients With Liver, Pancreatic, and Gallbladder Disorders. Williams L, Hopper P, eds. Understanding Medical Surgical Nursing. 5th ed. Philadelphia: F.A. Davis Company; 2015. p. 779- 808.
35. 35. Kanan N. Sıvı-Elektrolit ve Asit-Baz Dengesizlikleri. Aksoy G, Akyolcu N, Kanan N, eds. Cerrahi Hemşireliği I. 1. Baskı. İstanbul: Nobel Tıp Kitabevi; 2017. s. 49-77.
36. 36. Krag A, Bendtsen F, Henriksen JH, Moller S. Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites. Gut BMJ 2009;59(01):105-110.
37. 37. Metcalfe H. Assessment and Management of Patients With Hepatic Disorders. Farrell M, eds. Textbook of Medical Surgical Nursing. Fourth Australian and New Zealand Edition. Sydney: Lippincott Williams&Wilkins Wolters Kluwers Health; 2017.
38. 38. Tok Özen A, Enç N. The role of nurses for changes in fluid-electrolyte balance in critical diseases. Journal of Cardiovascular Nursing 2013;4(1):9-13.
39. 39. Olgun N, Aslan FE, Fındık ÜY. Karaciğer Hastalıkları. Karadakovan A, Aslan FE, eds. Dahili ve Cerrahi Hastalıklarda Bakım. 4. Baskı. Ankara: Akademisyen Kitabevi; 2017. s.709-741.
40. 40. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. Journal of Hepatology 2010;53(3):397-417. doi: 10.1016/j.jhep.2010.05.004.
41. 41. Wadei HM, Mai ML, Ahsan N, Gonwa TA. Hepatorenal syndrome: pathophysiology and management. Clinical Journal of the American Society of Nephrology 2006;1(5):1066-1079.
42. 42. Soyer Ö. Böbrek Nakli ve Hemşirelik Bakımı. Çevik C, Özyürek P, eds. Organ Nakli Hemşireliği. 1. Baskı. İstanbul: Nobel Tıp Kitabevi; 2017. s. 149-162.
43. 43. Karadakovan A, Kaymakçı Ş. Üriner Sistem Hastalıkları. Karadakovan A, Aslan FE, eds. Dahili ve Cerrahi Hastalıklarda Bakım. 4. Baskı. Ankara: Akademisyen Kitabevi; 2017. s. 857-915.
44. 44. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: quick reference guide. Washington DC: National Pressure Ulcer Advisory Panel; 2009
45. 45. Hupcey JE. Feeling safe: the psychosocial needs of ICU patients. Journal of Nursing Scholarship 2000;32(4):361-367.