Kronik böbrek hastalığı olan çocuklarda eritrosit uyarıcı ajan kullanımının ortalama trombosit hacmi, nötrofil/lenfosit oranı ve trombosit/lenfosit oranına etkisi

Amaç: Kronik böbrek hastalığı anemi, azalmış trombosit üretimi, trombosit disfonksiyonu ve trombositoz gibi bazı hematolojik değişikliklerle ilişkilidir. İnflamatuar belirteçler kronik böbrek hastalığı sürecinde artmaktadır. Ortalama trombosit hacmi, nötrofil sayısının lenfosit sayısına oranı ve trombosit sayısının lenfosit sayısına oranı enflamasyonun göstergesidir. Eritrosit uyarıcı maddeler trombosit sayısını ve trombotik olayları arttırabilir. Bu çalışmada Kronik böbrek hastalığı olan çocuklarda eritrosit uyarıcı ajan tedavisi sonrası ortalama trombosit hacmi, nötrofil/lenfosit oranı ve trombosit/lenfosit oranı kullanımı arasındaki ilişkiyi incelemeyi amaçladık. Gereç ve Yöntem: Kronik böbrek hastalığı’ tanısı alan ve 2013-2018 yılları arasında eritrosit uyarıcı ajan ile tedavi edilen 30 hastanın dosyaları retrospektif olarak incelendi. Bulgular: Çalışmamıza 16 erkek ve 14 kız hasta dahil edildi. Hastaların ortalama yaşı 10,6±5,4 yıl idi (ortanca 12; 1-17 yaş). Hastaların 12’si diyaliz öncesi, 9’u hemodiyaliz ve 9’u periton diyalizi grubundaydı. Hastaların ortalama eritrosit uyarıcı ajan kullanım süresi ortanca 12,5 ay (aralık 1-127 ay) idi. Kronik böbrek hastalığı tanılı hastalarda eritrosit uyarıcı ajan ile tedavi sonrası ortalama trombosit hacmi değerleri tüm gruplarda anlamlı olarak daha yüksek saptandı. Eritrosit uyarıcı ajan ile tedavi sonrası trombosit/lenfosit oranlarında anlamlı olarak farklılık gözlenmedi. Trombosit/lenfosit oranı, ortalama trombosit hacmi, beyaz hücre sayısı ve monosit sayıları ile anlamlı ancak ters bir korelasyona sahipti. Ortalama trombosit hacmi ve nötrofil/lenfosit oranı ölçümleri diyaliz modalitesinden etkilenirken trombosit/lenfosit oranının etkilenmediği saptandı. Sonuçlar: Bu çalışmada, sonuçlarımızdaki nedensellik ve etki ilişkilerini raporlayamadık. Bununla birlikte, bu basit, ucuz, evrensel yöntemler nefrologlar tarafından hastaların değerlendirilmesinde ilk adım olarak kullanılabilir.

Anahtar Kelimeler:

Kronik böbrek hastalığı, ortalama eritrosit hacmi, nötrofil/lenfosit oranı trombosit/lenfosit oranı, eritrosit uyarıcı ajan

The effect of erythrocyte stimulating agents on mean platelet volume, the platelet/lymphocyte ratio and the neutrophil/lymphocyte ratio in children with chronic kidney disease

Aim: Chronic kidney disease is associated with some hematologic changes such as decreased platelet production, platelet dysfunction and thrombocytosis. The inflammatory markers increase in chronic kidney disease. Mean platelet volume, the ratio of neutrophil count to lymphocyte count, and the ratio of platelet count to lymphocyte count are indicative of inflammation. Erythrocyte stimulating agents can increase platelet count and thrombotic events. We aimed to determine the relationship between the use of erythrocyte stimulating agents and mean platelet volume, the neutrophil/lymphocyte ratio and the platelet/lymphocyte ratio in children with chronic kidney disease in this study. Material and Method: The files of 30 patients diagnosed with chronic kidney disease and treated with erythrocyte stimulating agents between 2013 and 2018 were reviewed retrospectively. Results: The mean age of the patients (16 boys and 14 girls) was 10.6 ± 5.4 years (median 12; 1-17 years). Twelve of them were in pre-dialysis, 9 in hemodialysis and 9 in peritoneal dialysis group. The mean duration of use of erythrocyte stimulating agents was 29.2 ± 34.8 months (median 12.5; 1-127 months). Mean platelet volume values after treatment with erythrocyte stimulating agents in chronic kidney disease patients were significantly higher in all groups. The platelet/lymphocyte ratio values after treatment with erythrocyte stimulating agents were not significant different in all groups. The platelet/lymphocyte ratio had a significant but opposite correlation with mean platelet volume, white cell count and monocyte counts. Mean platelet volume and the neutrophil/lymphocyte ratio measurements were affected by dialysis modality. However the platelet/lymphocyte ratio was not affected. Conclusions: In this small retrospective study, we could not report causality and effect associations in our results. Nevertheless, these simple, cheap, universal methods may be used as the first step in the evaluation of patients by nephrologists.

Keywords:

Children chronic kidney disease, mean platelet volume, platelet/lymphocyte ratio, neutrophil/lymphocyte ratio,

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