Evaluation of patients with upper gastrointestinal bleeding in chronic renal failure

Abstract

Objectives: Incidence of gastrointestinal complications especially gastric bleeding increased in patients with chronic renal failure (CRF). The aim of this study was to comparatively investigate upper gastrointestinal bleeding (UGB) in patients with non-hemodialysis CRF and the patients without CRF. Materials and methods: Seventy-six patients (55 men and 21 women) with and without CRF and UGB was included. The first group who had CRF consisted of 23 patients and the control group 53. All patients were evaluated in the view point of age, gender, smoking status, other illnesses, medicine usage, laboratory parameters, endoscopic evidence and endoscopic intervention (scleroteraphy). Results: Calcium levels of patients with a history of previous UGB was significantly lower compared with those bleeding for the first time (p

Keywords

• Renal insufficiency, chronic, gastrointestinal hemorrhage, risk assessment

Üst gastrointestinal kanama geçiren kronik böbrek yetmezlikli hastaların incelenmesi

Öz

Amaç: Kronik böbrek yetmezliği (KBY) olan hastalarda özellikle mide kanaması olmak üzere gastrointestinal komplikasyonların insidansı artmıştır. Bu çalışmanın amacı KBY'li non-hemodiyaliz hastalar ile KBY olmayan üst gastrointestinal kanama (ÜGK) geçiren hastaları karşılaştırmalı olarak incelemektir. Gereç ve yöntem: Kronik böbrek yetmezliği olan ve böbrek yetmezliği olmayan ÜGK geçiren 76 hasta çalışmaya alındı. Çalışmaya alınan hastaların 55'i erkek, 21'i kadın idi. Kronik böbrek yetmezliği olan grup 23 hasta, kontrol grubu ise 53 hastadan oluşuyordu. Çalışmaya alınan tüm hastalar; yaş, cinsiyet, sigara kullanımı, ek hastalık varlığı, ilaç kullanımı, laboratuvar parametreleri, endoskopik bulgular ve endoskopik girişim (skleroterapi) açısından değerlendirildi. Bulgular: Geçirilmiş ÜGK öyküsü olan hastaların kalsiyum düzeyleri, ilk kez kanama geçiren hastalara göre daha düşük bulundu (p

Anahtar Kelimeler

• Böbrek yetmezliği, gastrointestinal kanama, risk değerlendirmesi

Kaynakça

1. Tanrıverdi MH, Karadağ A, Hatipoğlu EŞ. Kronik böbrek yetmezliği. Konuralp Tıp Dergisi 2010; 2(2): 27-32.
2. Alkan R, Uz E, Balcık OS, Uz B, Bayram Y. Is end-stage renal disease always symptomatic? Klinik Deneysel Araş- tırmalar Dergisi 2010; 1(3): 216-8.
3. Yılmaz ME, Sarı Y, Kara İH, Düzen S, Colpan L, Isıkoglu B. Diyaliz programında bulunan kronik böbrek yetmezlikli hasta-larda ve sağlıklı bireylerde nitrik oksit düzeylerinin incelenmesi. Dicle Tıp Dergisi 2000; 27(1): 157-65
4. Andriulli A, Malfi B, Recchia S, et al. Patients with chronic renal failure are not at a risk of developing chronic peptic ulcers. Clin Nephrol 1985; 23(5): 245-8.
5. Milito G, Taccone-Gallucci M, Brancaleone C, et al. As- sessment of the upper gastrointestinal tract in hemodialysis patients awaiting renal transplantation. Am J Gastroenterol 1983; 78(6): 328-31.
6. Wee A, Kang JY, Ho MS, et al. Gastroduodenal mucosa in uraemia: endoscopic and histological correlation and prev- alence of helicobacter-like organisms. Gut 1990; 31(10): 1093-6.
7. Gheissari A, Rajyaguru V, Kumashiro R, Matsumoto T. Gas- trointestinal hemorrhage in end stage renal disease patients. Int Surg 1990; 75(2): 93-5.
8. Zavada J, Sulkova S, Lukas M. Gastrointestinal hemorrhage and endoscopic findings in patients with chronic kidney failure. Vnitr Lek 2002; 48(11):1011-6.

9. Chalasani N, Cotsonis G, Wilcox CM. Upper gastrointestinal bleeding in patients with chronic renal failure: role of vas- cular ectasia. Am J Gastroenterol 1996; 91(11): 2329-32.
10. Zuckerman GR, Cornette GL, Clouse RE, Harter HR. Up- per gastrointestinal bleeding in patients with chronic renal failure. Ann Intern Med 1985; 102(5): 588-92.
11. Wasse H, Gillen DL, Ball AM, et al. Risk factors for upper gastrointestinal bleeding among end-stage renal disease pa- tients. Kidney Int 2003; 64(4): 1455-61.
12. Posner GL, Fink SM, Huded FV, et al. Endoscopic findings in chronic hemodialysis patients with upper gastrointestinal bleeding. Am J Gastroenterology 1983; 78(11): 720-1.
13. Cryer B, Kliewer D, Sie H, McAllister L, Feldman M. Ef- fects of cutaneous aspirin on the human stomach and duo- denum. Proc Assoc Am Physicians 1999; 111(5): 448-56.
14. Reimer ME, Johnston SA, Leib MS, et al. The gastroduo- denal effects of buffered aspirin, carprofen, and etodolac in healthy dogs. J Vet Intern Med 1999; 13(5): 472-7.
15. Wallace JL, Vergnolle N, Muscará MN, et al. Enhanced anti-inflammatory effects of a nitric oxide-releasing deriva- tive of mesalamine in rats. Gastroenterology 1999; 117(3): 557-66.
16. Genta RM. The sad NSAID colon. Adv Anat Pathol 1999; 6(4): 213-7.
17. Hernandez-Diaz S, Rodriguez LA. Association between nonsteroidal anti-inflammatory drugs and upper gastroin- testinal tract bleeding/perforation: an overview of epide- miologic studies published in the 1990s. Arch Intern Med 2000; 160(14): 2093-9.
18. Gaspari F, Vigano G, Orisio S, et al. Aspirin prolongs bleed- ing time in uremia by a mechanism distinct from platelet cyclooxygenase inhibition. J Clin Invest 1987; 79(6): 1788- 97.
19. Livio M, Benigni A, Remuzzi G. Coagulation abnormalities in uremia. Semin Nephrol 1985; 5(2): 82-90.
20. Oliveira C, Frazão JM, Pires C, Silva JG, Carrera F. [Sig- nificance of digestive hemorrhage in patients with chronic renal in-sufficiency in hemodialysis]. Acta Med Port 1992; 5(2): 71-4.
21. Boyle JM, Johnston B. Acute upper gastrointestinal hem- orrhage in patients with chronic renal disease. Am J Med 1983; 75(3): 409-12.
22. Sanchez Perales MC, Vazquez E, García Cortés MJ, et al. Platelet antiaggregation and hemorrhagic risk in hemodi- alysis. Nefrologia 2002; 22(5): 456-62.
23. Galeazzi F, Blennerhassett PA, Qiu B, O’Byrne PM, Col- lins SM. Cigarette smoke aggravates experimental colitis in rats. Gastroenterology 1999; 117(4): 877-83.
24. Ma L, Wang HY, Chow JY, Cho CH. Cigarette smoke in- creases apoptosis in the gastric mucosa: role of epidermal growth factor. Digestion 1999; 60(5): 461-8.
25. Ma L, Chow JY, Cho CH. Cigarette smoking delays ulcer healing: role of constitutive nitric oxide synthase in rat stomach. Am J Physiol 1999; 276(1 pt 1): G238-48.
26. Muto S, Asano Y, Hosoda S, Miyata M. Hypochlorhydria and hypergastrinemia and their association with gastroin- testinal bleeding in undialyzed and hemodialyzed patients. Nephron 1988; 50(1): 10-3.
27. Saha H, Pietilä K, Mustonen J, et al. Acute effects of calcium carbonate and citrate on secondary hyperparathyroidism in chronic renal failure. Am J Nephrol 1991; 11(6): 465-9.
28. Kes P. Serum gastrin concentration in chronic renal failure. Acta Med Croatica 1992; 46(1): 47-58.
29. Tung CF, Chow WK, Chang CS, Peng YC, Hu WH. The prevalence and significance of hypoalbuminemia in non- variceal upper gastrointestinal bleeding. Hepatogastroen- terology 2007; 54(76): 1153-6.