Acil Servise Başvuran Hastalarda Tanı Amaçlı Çekilen Bilgisayarlı Tomografi Sonrası Kontrast Madde Nefropatisi

Yıl 2016, Cilt: 8 Sayı: 2, 61 - 67, 24.07.2016

Gulhan Kurtoglu Celik

Öz

Amaç: Kontrast madde nefropatisi hastanede gelişen akut böbrek hasarı sebeplerinin 3. sıklıkta görülenidir. Hastaneye yatış, hastanede kalış süresinde artış ve de yüksek mortalite oranları ile ilişkilidir. Çalışmamızın amacı acil serviste tanı amaçlı kontrastlı bilgisayarlı tomografi (BT) çekilen hastalarda kontrast madde nefropatisi (KMN) oluşum sıklığını ve risk faktörlerini araştırmaktır.
Materyal ve Metot: Mart 2013 - Mart 2014 tarihleri arasında Eğitim ve Araştırma Hastanesi Acil servisine başvuran, travmatik ve non-travmatik sebeplerle KMN önleyici tedavi almaksızın kontrastlı BT çekilen hastalar çalışmaya alınmıştır. Bu hastaların demografik özellikleri, kontrast madde nefropatisi görülme sıklığı ve risk faktörleri araştırılmıştır.Çalışmamız için etik kurul onayı alınmıştır.

Bulgular: Bazal kreatinin değeri normal (<1,2 mg/dl) ve bazal kreatinin değeri yüksek (>1,2 mg/dl) olan toplam 283 hasta çalışmaya dahil edilmiştir. Bu hastaların %64’ünü erkek, %36’sını kadın hastalar oluşturmuştur. Hastaların %11.7’sinde KMN gelişmiştir. KMN gelişen hastaların %13.1’si bazal kreatinin değeri normal (<1,2 mg/dl) olan hasta grubunda, %86.9’u ise bazal kreatinin değeri yüksek (>1,2 mg/dl) olan hasta grubundaydı. 18-30 arasındaki hastalarda KMN görülme oranı %3, 80 yaş ve üstü hasta grubunda ise bu oran %23.8 olarak bulunmuştur. Hastalarımızın %51.9 (147)’unda glomeruler filtrasyon hızı (GFH) < 60 ml/dak iken, %48.1 (136)’inde GFH > 60 ml/dak olarak bulunmuştur. Bazal GFH < 60 ml/dak olan hastaların %18.4’sinde, bazal GFH > 60 ml/dak olan hastaların %4.4’ünde KMN gelişmiştir. Çalışmaya dahil edilen hastalar arasında en sık görülen ek hastalık hipertansiyon (HT) idi. Kronik böbrek hastalığı (KBH) kontrast madde verilmesinden sonra kreatin yüksekliği ve diğer komorbiditelerle en yakından ilşkili hastalıktı. Hastalarımızın %92,9’una 100 mİ, kalan %7.1’ine de 200 mİ kontrast madde (KM) verilmiştir. Yüz mİ KM verilen hastaların %10.3 (27)’ünde, 200 mİ KM verilen hastaların %18.2’sinde KM gelişmiştir.

Sonuç: KBH, HT, koroner arter hastalığı (KAH), konjestif kalp yetmezliği (KKY) hikayesi olan ve GFH < 60 ml/dk olan hasta grubunda kontrast nefropati gelişme riskinin arttığını belirledik. Bu nedenle kontrast nefropati gelişme riski olan hastalar acil serviste daha dikkatli değerlendirilmelidir.

Anahtar Kelimeler

Kontrasta bağlı nefropati, risk faktörleri, acil servis

Contrast Induced Nephropathy Due To Diagnostic Computerized Tomography In Emergency Department

Öz

Objectives: Contrast induced nephropathy is the third most frequent cause of hospital-acquired acute kidney injury. It is associated with prolonged hospitalization, higher rates of complications and increased mortality. The aim of this study is to evaluate the frequency of diagnostic contrast enhanced computed tomography induced contrast nephropathy in patients in the emergency department and to investigate the risk factors.

Materials and Methods: The demographic characteristics, incidence of contrast induced nephropathy and risk factors of the patients who were admitted to Ankara Atatürk Training and Research Hospital Emergency Department (ED) between 1 March 2013-1 March 2014 were studied. These patients were admitted to ED because of both traumatic and non-traumatic diseases, contrast enhanced computed tomographies were performed but no prevention techniques for contrast induced nephropathy were applied.

Results: A total of 283 adult patients who had normal (<1,2 mg/dL ) or high (>1,2 mg/dL) basal creatinin levels were included in our study; 64% of these patients were male and 36% were female. Contrast induced nephropathy developed in 11.7% of patients. In patients who had contrast induced nephrophathy, 13.1% had normal (<1,2 mg/dl) creatinin level in the beginning, whereas 86.9% of them had high (>1,2 mg/dl) basal creatinin level. In patients, the incidence of contrast induced nephropathy was 3% 23.8% respectively in patients between 18-30 years and >80 years old. GFR was < 60 ml/min in 51.9% (147) and GFR was > 60 ml/min in 48.1% (136) of our patients. The incidence of contrast induced nephropathy in the patients was 18.4% and 4.4%, respectively in patients whose GFR <60 ml/min and > 60 ml/min. The most frequent comorbid disease was hypertension and chronic renal disease was the most strongly associated disease with regard to the increase of creatinin levels after contrast media administration and other comorbidities. During computerized tomography, 92.9 % of our patients received 100 ml, 7.1% received 200 ml contrast media. Contrast induced nephropathy developed in 10.3% of the patients who received 100 ml and 18.2% of the patients who received 200 ml contrast media.

Conclusion: We found that; the risk of contrast nephropathy significantly increased in patients with chronic renal disease, hypertension, coronary artery disease, congestive heart failure and in those whose GFR <60 ml / min. Therefore, the patients with the risk of developing contrast-induced nephropathy should be evaluated more carefully in the ED.

Anahtar Kelimeler

Contrast-induced nephropathy, risk factors, emergency department

Kaynakça

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