Kontrast madde nefropatisinde bir risk faktörü olarak metabolik sendrom

Abstract

AMAÇ: Kontrast maddenin artan miktarda kullanımı, kontrast madde nefropatisini Akut Böbrek Yetmezliğinin giderek sık rastlanan bir nedeni haline getirmiştir. Kontrast madde nefropatisi için, önceden var olan böbrek yetmezliği, diyabet, hipovolemi, ileri yaş, kalp yetmezliği, fazla kontrast madde kullanımı, nefrotoksik ilaçlar risk faktörlerini oluşturmaktadır. Metabolik Sendromun kontrast madde nefropatisi için risk faktörü olup olmadığı ile ilgili literatürde az sayıda çalışma yapılmış ve risk faktörü olduğu belirlenmiştir. Çalışmamızda, metabolik sendrom ve insülin direnci ile kontrast madde nefropatisi arasındaki ilişki incelenmiştir. MATERYAL VE METOD: Bu çalışmaya Dicle Üniversitesi Tıp Fakültesi dahili bilimler kliniklerinde yatan ve herhangi bir nedenle kontrastlı bilgisayarlı tomografi çekilen 94 hasta dahil edildi. Çalışmaya kreatinin seviyesi 1.0 ve üzerindeki hastalar alındı. Hastaların tomografi öncesi ve tomografiden 48 saat sonraki kreatinin değerlerine bakılarak kontrast madde nefropatisi gelişen hastalar tespit edildi. Tüm hastalar metabolik sendrom yönünden IDF kriterleri kullanılarak değerlendirildi. HOMA-IR değerleri hesaplandı. BULGULAR: Çalışmaya 73 erkek, 21 kadın hasta alındı. Toplam 94 hastanın 10’unda kontrast madde nefropatisi gelişti. Kontrast madde nefropatisi gelişen grubun %60’ ında, gelişmeyen grubun %38,1’inde metabolik sendrom saptandı. İnsülin direnci kontrast madde nefropatisi gelişen grupta %30, gelişmeyen grupta %17,9 oranında görüldü. Hasta sayısının azlığından dolayı aradaki bu fark istatistiksel anlamlılığa ulaşmadı. Hastaların değerlendirilen albümin, üre, kreatinin, ürik asit, CRP, hemoglobin değerleri arasında kontrast madde nefropatisi gelişen ve gelişmeyen gruplar arasında anlamlı fark saptandı. İki grup arasında bazal kreatinin klirensleri ve kreatinin ≥1.3 olanlarda belirgin fark saptandı. Renal fonksiyon bozukluğunun kontrast madde nefropatisiyle ilişkili olduğu görüldü. SONUÇ: Kontrast madde nefropatisi görüntüleme tekniklerinin gelişmesiyle birlikte daha sık görülmeye başlandı. Son yıllarda metabolik sendrom da kontrast madde nefropatisi risk faktörü olarak suçlanmaktadır. Sonuç olarak, bu çalışmada kontrast madde nefropatisi gelişen grupta daha yüksek oranda metabolik sendromlu hasta saptanmasına rağmen bu fark istatistiki anlamlılığa ulaşmamıştır. Ancak yine de oranın yüksek olması nedeniyle metabolik sendromlu hastalara kontrast madde verilirken dikkatli olunmalıdır.

Keywords

• Kontrast Madde Nefropatisi
• Metabolik Sendrom
• İnsülin Direnci

Metabolic syndrome as a risk factor in contrast-induced nephropathy

Abstract

Aims: The expanding use of contrast media has made contrast-induced acute kidney injury (CI-AKI) a cause of acute renal failure. This study investigated the relationship between metabolic syndrome (MS), insulin resistance, and contrast-induced acute kidney injury. Methods: This study encompassed 94 hospitalized patients (73 male) with creatinine levels of 1.0 and above who underwent contrast-enhanced computed tomography for various reasons in the internal medicine clinics of Dicle University Faculty of Medicine. Patients whose creatinine levels were routinely measured before and 48 hours after tomography and whose anamnesis information was sufficient for the International Diabetes Federation metabolic syndrome criteria were retrospectively included in the study. HOMA-IR values ​​were calculated. Results: CI-AKI developed in 10 (10.6%) patients out of 94. MS was identified in 60% of the group that developed CI-AKI and 38.1% that did not. Insulin resistance was observed in 30% of the group that developed CI-AKI and 17.9% that did not. Despite the observed difference, it did not achieve statistical significance. Considerable differences were found between the two groups regarding albumin, urea, creatinine, uric acid, C-reactive protein, and hemoglobin levels. CI-AKI was significantly more common in individuals with low creatinine clearance and in those with creatinine ≥1.3 mg/dl. Conclusion: Our study showed that a higher rate of patients with MS was detected in the group with CI-AKI. MS has been accused of being a risk factor for CI-AKI. Therefore, caution should be exercised when administering contrast to patients with MS.

Keywords

• Contrast-induced acute kidney injury
• insulin resistance
• metabolic syndrome

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