Kontrast maddelerin böbrek fonksiyonları üzerindeki etkisi
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Dosyalar
Tarih
2016
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Böbrek fonksiyonlarının herhangi bir sebebe bağlı olarak saatler ya da günler içerisinde bozulması akut böbrek hasarı (ABH) olarak tanımlanır. ABH'nın önemli sebeplerinden birisi de kontrast madde nefropatisidir (KMN). Kontrast madde alımından 48-72 saat sonra bazal kreatinine göre kreatinin seviyesinde %25 oranında veya serum kreatininde 0.5 gr/dl'lik artış olması KMN olarak tanımlanır. KMN hastane kaynaklı ABH sebepleri arasında hipotansiyon ve cerrahi girişimden sonra en sık üçüncü sıradadır. Serum kreatinin seviyesinin nefrotoksisitenin erken safhalarında yükselmemesi, başka nedenle de değişmesi sebebi ile KMN'ni saptamak için yeni biyobelirteçler araştırılmıştır. Son zamanlarda Neutrophil Gelatinaze-Associated Lipocalin (NGAL), Sistatin C ve Kidney Injury Molecule (KIM-1) yeni nesil erken biyobelirteçlerden bazılarıdır. Bu moleküller henüz kreatinin artmadan serum ve idrarda artarak ABH'nın erken dönemde tanınmasını sağlarlar. Bu çalışmada, koroner anjiografi yapılan hastalarda bu moleküller ile erken dönemde ABH gelişiminin değerlendirilmesini amaçladık. Hastalar ve Metod: Stabil angına pektoris nedeni ile koroner anjiografi (KAG) yapılması planlanan toplam 80 hasta çalışma kapsamında değerlendirildi. İşlem öncesi başlangıç ve işlem sonrası 6. saatte serum ve idrarda NGAL ve Sistatin C, sadece idrarda KIM-1 ve belirtilen saatlere ek olarak 48. saatte serum kreatinin seviyesi bakılarak erken dönemde KMN araştırıldı. Bulgular: Hastalar KMN gelişen ve gelişmeyen olarak iki gruba ayrıldığında 10 hastada KMN saptandı. NGAL, Sistatin C ve KIM-1 açısından iki grup arasında anlamlı bir fark saptanmadı. Gruplar kendi içinde başlangıç ve 6. saat arasındaki fark olarak değerlendirildiğinde her iki gruptada üriner NGAL (üNGAL) değerinde 6. saatte anlamlı artış saptanırken KMN gelişmeyen grupta serum NGAL (sNGAL) değerinde anlamlı artış saptandı. Diğer biyobelirteçlerde anlamlı fark saptanmadı. Sonuç: KMN gelişimini erken dönemde tespit etmek için değerlendirilen biyobelirteçlerden sadece üNGAL anlamlı sonuçlar gösterirken, diğer belirteçlerin ise KMN gelişimini değerlendirmede yararlı olmadığı saptandı.
ABSTRACT Introduction and Aim: Acute kidney injury (AKI) is defined as loss of renal function depending on any cause over hours to days. One of the major causes of AKI is Contrast induced nephropathy (CIN). Greater than 25% increase of serum creatinine according to baseline creatinine or an absolute increse in serum creatinine of 0.5 g / dL after 48-72 hours from contrast agent uptake is defined as CIN. CIN is the third most common cause of hospital acquired AKI, after hypotension and surgery. New biomarkers was investigated for CIN due to level of serum creatinine is not to rise in the early stages of Nephrotoxicity and affects from other reasons. Neutrophil Gelatinase-Associated Lipocalin (NGAL), cystatin C and Kidney Injury Molecule (KIM-1) are recently new generation of early biomarkers. These molecules increase in serum and urine before an increase in serum creatinine and that provides recognition of AKI in the early stages. In this study, we aimed to evaluate early detection of the development of AKI with these molecules in patients who underwent coronary angiography. Materials and Methods: A total of 80 patients scheduled for coronary angiography (CAG) due to stable angina pectoris were evaluated. Before starting the processes and 6 hours after the procedure, levels of NGAL and Cystatin C in serum and urine, KIM-1 just in urine and additionally the level of the serum creatinine at 48 hours were investigated for early CIN. Results: Patients is divided into two groups: CIN-group and no-CIN group. CIN was observed in 10 patients. There was no significant difference in NGAL, KIM-1 and Cystatin C levels between the two groups. When the groups were assessed as the difference between its initial and 6. hours, the urinary NGAL (uNGAL) is significantly increased in both groups at 6. hours and serum NGAL (sNGAL) is significantly increased in no-CIN group. There were no significant differences in other biomarkers Conclusion: Only uNGAL showed significant results among the evulation of biomarkers that assess the development of CIN at an early stage while Other biomarkers not useful in evaluation the development of CIN.
ABSTRACT Introduction and Aim: Acute kidney injury (AKI) is defined as loss of renal function depending on any cause over hours to days. One of the major causes of AKI is Contrast induced nephropathy (CIN). Greater than 25% increase of serum creatinine according to baseline creatinine or an absolute increse in serum creatinine of 0.5 g / dL after 48-72 hours from contrast agent uptake is defined as CIN. CIN is the third most common cause of hospital acquired AKI, after hypotension and surgery. New biomarkers was investigated for CIN due to level of serum creatinine is not to rise in the early stages of Nephrotoxicity and affects from other reasons. Neutrophil Gelatinase-Associated Lipocalin (NGAL), cystatin C and Kidney Injury Molecule (KIM-1) are recently new generation of early biomarkers. These molecules increase in serum and urine before an increase in serum creatinine and that provides recognition of AKI in the early stages. In this study, we aimed to evaluate early detection of the development of AKI with these molecules in patients who underwent coronary angiography. Materials and Methods: A total of 80 patients scheduled for coronary angiography (CAG) due to stable angina pectoris were evaluated. Before starting the processes and 6 hours after the procedure, levels of NGAL and Cystatin C in serum and urine, KIM-1 just in urine and additionally the level of the serum creatinine at 48 hours were investigated for early CIN. Results: Patients is divided into two groups: CIN-group and no-CIN group. CIN was observed in 10 patients. There was no significant difference in NGAL, KIM-1 and Cystatin C levels between the two groups. When the groups were assessed as the difference between its initial and 6. hours, the urinary NGAL (uNGAL) is significantly increased in both groups at 6. hours and serum NGAL (sNGAL) is significantly increased in no-CIN group. There were no significant differences in other biomarkers Conclusion: Only uNGAL showed significant results among the evulation of biomarkers that assess the development of CIN at an early stage while Other biomarkers not useful in evaluation the development of CIN.
Açıklama
YÖK Tez No: 435507
Anahtar Kelimeler
Nefroloji, Nephrology, Böbrek, Kidney, Böbrek fonksiyon testleri, Kidney function tests, Böbrek hastalıkları, Kidney diseases, Böbrek yetmezliği-akut, Kidney failure-acute, KIM-1, KIM-1, Kontrast maddeler, Contrast media, NGAL, NGAL, Sistatinler, Cystatins, Kontrast Madde Nefropatisi, NGAL, Sistatin C, KIM-1, Contrast Induced Nephropathy, NGAL, Cystatin C, KIM-1 ?
