Akut Böbrek Hasarı: Sınıflandırılması ve Prognoz

Yıl 2018, Cilt: 12 Sayı: 3, 180 - 185, 01.12.2018

Zeynep Savaş Şen Nilgün Çakar

Öz

Amaç: Çalışma ile çocuk hastalarda Akut Böbrek Hasarının (ABH) etiyolojisi, klinik özellikleri, prognoz üzerinde etkili faktörleri ve sonuçları tanımlamak için Acute Kidney Injury Network tarafından öne sürülen sınıflandırma kriterlerinin kullanılması ve ABH sınıflandırılmasında pediatrik-modifiye RIFLE (pRIFLE) kriterlerinin rutine geçirilmesi amaçlanmıştır.Gereç ve Yöntemler: Mayıs 2008-Temmuz 2010 arasında ABH tanısı ile yatırılan ya da hastanede izlemi sırasında ABH gelişen %25’i yenidoğan 72 hasta (42 erkek, 30 kız) ileri doğru olarak incelendi.Bulgular: Hastaların ortanca yaşı 9.11 ay (minimum 0, maksimum 216.56 ay)’dı. ABH nedeni olarak dehidratasyon, %30.6 oranı ile en sık etiyolojik faktör olarak saptandı. Bunu sırasıyla hipoksi (%19.4), sepsis (%16.7), ilaç (%12.5) ve hemolitik üremik sendroma (%9.7) bağlı ABH izledi. Hastaların %15.3’ü risk, %25’i hasar, %59.7’si ise yetmezlik olarak sınıflandırıldı. Mortalite oranı %26.4’dü. Erkek cinsiyet, mekanik ventilasyon, nefrotoksik ilaç, ABH gelişimi sırasında hastanede yatıyor olmak, oligüri/anüri ve nefroloji konsültasyonunun gecikmesi mortalite ile ilişkili bulundu (p<0.05). Mortalite oranı risk grubunda %10.7, hasar grubunda %31.5 ve yetmezlik grubunda %57.8’di.Sonuç: Diyaliz gereksinimini ve hastane mortalitesini önceden tahmin etmede pRIFLE sınıflamasının etkin bir yöntem olduğu görüldü.

Anahtar Kelimeler

Akut böbrek hasarlanması, Prognoz, Sınıflandırma

Acute Kidney Injury: Classification and Prognosis

Öz

Objective: The aim of this study was to use the classification criteria suggested by the Acute Kidney Injury Network in order to define the etiology, clinical features, prognostic factors and results of Acute Kidney Injury (AKI) in pediatric patients and to support the routine application of pediatric-modified RIFLE (pRIFLE) criteria for the classification of AKI.Material and Methods: The patient group comprised 72 patients (42 males, 30 females) of whom 25% were newborns and 75% were children aged >1 month, who were either hospitalized due to a diagnosis of AKI or in whom AKI had developed during hospitalization between May 2008 and July 2010. Results: The median age at the time of AKI was 9.11 months (minimum 0, maximum 216.56 months). The etiology of AKI was dehydration in 30.6%, hypoxia in 19.4%, sepsis in 16.7%, drug-induced in 12.5% and hemolytic uremic syndrome in 9.7%. AKI patients were classified according to the staging system as follows: 15.3% of the patients were in the risk, 25% in the injury, and 59.7% in the failure category. The mortality rate was 26.4%. Male sex, mechanical ventilation, nephrotoxic drugs, hospitalization before the development of AKI, oliguria/anuria and delay in nephrology consultation were found to be associated with increased mortality (p<0.05). Mortality rate was 10.7% for the risk, 31.5% for the injury and 57.8 % for the failure categories. Conclusion: The pRIFLE classification was an effective method in predicting the need for dialysis and hospital mortality

Anahtar Kelimeler

Acute kidney injury, Prognosis, Classification

Kaynakça

• Andreoli SP. Acute kidney injury in children. Pediatr Nephrol 2009; 24:253-63.
• Mak RH. Acute kidney injury in children: The dawn of a new era. Pediatr Nephrol 2008;23:2147-9.
• Anochie IC, Eke FU. Acute renal failure in Nigerian children: Port Harcourt experience. Pediatr Nephrol 2005;20:1610-4.
• Vachvanichsanong P, Dissaneewate P, Lim A, McNeil E. Childhood acute renal failure. 22-year experience in a university hospital in southern Thailand. Pediatrics 2006;118:786-91.
• Assounga AG, Assambo-Kieli C, Mafouna A, Moyen G, Nzingoula S. Etiology and outcome of acute renal failure in children in Congo- Brazzaville. Saudi J Kidney Dis Transpl 2000;11:40-3.
• Otukesh H, Hoseini R, Hooman N, Chalian M, Chalian H, Tabarroki A. Prognosis of acute renal failure in children. Pediatr Nephrol 2006; 21:1873-8.
• The Turkish Society for Pediatric Nephrology Acute Kidney Injury Study Group. Etiology and outcome of acute kidney injury in children. Pediatr Nephrol 2010;25:1453-61.
• Hui-Stickle S, Brewer ED, Goldstein SL. Pediatric ARF epidemiology at a tertiary care center from 1999 to 2001. Am J Kidney Dis 2005;45:96-101.
• Akcan-Arikan A, Zapitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 2007;71:1028-35.
• Andreoli SP. Clinical evaluation of acute kidney injury in children. In: Avner ED, Harmon WE, Niaudet P, Yoshikawa N (eds). Pediatric Nephrology, 6th ed. Berlinn: Springer, 2009:1603-18.
• Whyte DA, Fine RN. Acute renal failure in children. Pediatr Rev 2008;29:299-306.
• Sutherland SM, Ji J, Sheikhi FH, Widen E, Tian L, Alexander SR, Ling XB. AKI in hospitalized children: Epidemiology and clinical associations in a National cohort. Clin J Am Soc Nephrol 2013;8: 1661-9.
• Cao Y, Yi ZW, Zhang H, Dang XQ, Wu XC, Huang AW. Etiology and outcomes of acute kidney injury in Chinese children: A prospective multicentre investigation. BMC Urol 2013;13: 41.
• Olowu WA. Acute kidney injury in children in Nigeria. Clin Nephrol 2015;83:70-4.
• Tresa V, Yaseen A, Lanewala AA, Hashimi S, Khatri S, Ali I, Mubarak M. Etiology, clinical profile and short-term outcome of acute kidney injury in children at a tertiary care pediatric nephrology center in Pakistan. Ren Fail 2017;39:26-31.