Engin Melek, Sercan Aynacı, Bahriye Atmış, Sevcan Erdem, Nazan Özbarlas, Aysun BAYAZIT

Çocuklarda kronik böbrek hastalığının ihmal edilen bir nedeni: tip 2 kardiyorenal sendrom

Kardiyorenal sendrom hem kalp hem de böbreklerin etkilendiği bir hastalıktır ve bu organlardan birinde olan akut ya da kronik fonksiyon bozukluğunun diğer organda akut yada kronik fonksiyon bozukluğuna yol açması olarak tanımlanmaktadır. Son dönem böbrek yetmezliği olan hastaların en önemli ölüm nedeninin kardiyovasküler olaylar olduğu ve akut kalp yetmezliği olan hastalarda böbrek fonksiyonlarında azalmanın yaygın bir komplikasyon olduğu çok iyi bilinmektedir. Buna karşın, kronik kalp hastalığı olan bir hastada kardiyovasküler hastalık semptom ve bulguları belirgin değilse, kronik böbrek hastalığı etiyolojisinde kardiyovasküler hastalıklar hemen akla gelmemektedir. Bundan dolayı biz bu raporda hem çocuk hem de çocuk nefroloji hekimlerinin bu sendroma farkındalıklarını artırmak amacıyla daha önce bir dış merkezde 6 ay boyunca kronik böbrek hastalığı tanısı ile izlenen; böbrek biyopsisi yapılmak üzere hastanemize sevk edilen ve tip 2 kardiyorenal sendrom tanısı koyulan 11 yaşında kız hasta sunulmuştur.

Anahtar Kelimeler:

Çocuk, kronik böbrek hastalığı, kardiyorenal sendrom

An ignored cause of chronic kidney disease in children: type 2 cardiorenal syndrome

Cardiorenal syndrome is a disorder of the heart and kidneys in which acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other organ. It is well known that the main cause of mortality among patients with end-stage renal disease is due to cardiovascular events and a common complication in patients in acute heart failure is a decrease in renal function. However, when there are no signs and/or symptoms of chronic cardiovascular disease, cardiovascular causes in the etiology of chronic kidney disease is not the first differential considered. We present an 11 year-old girl patient, diagnosed with type 2-chronic cardiorenal syndrome who had previously been followed in another center with the diagnosis of chronic kidney disease for six months and referred to our hospital for kidney biopsy. We present this case to increase awareness of pediatrician and nephrologist about this syndrome.

PDF

___

Braam B, Joles JA, Danishwar AH, Gaillard CA. Cardiorenal syndrome-current understanding and future perspectives. Nat Rev Nephrol. 2014;10:48-55.
Ronco C, McCullough P, Anker SD, Anand I, Aspromonte N, Bagshaw SM et al. Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative. Eur Heart J. 2010;31:703-11.
Weinfeld MS, Chertow GM, Stevenson LW. Aggravated renal dysfunction during intensive therapy for advanced chronic heart failure. Am Heart J. 1999;138:285-90.
Labban B, Arora N, Restaino S, Markowitz G, Valeri A, Radhakrishnan J. The role of kidney biopsy in heart transplant candidates with kidney disease. Transplantation. 2010;89:887-93.
Dries DL., Exner DV, Domanski MJ, Greenberg B, Stevenson LW. The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol. 2000;35:681-9.
U.S. Renal Data System. USRDS 2007 Annual Data Report: Atlas of Chronic Kidney Disease and End- Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. 2007.
Lee SR, Jeong KH. Novel Biomarkers for Cardio- renal Syndrome. Electrolyte Blood Press. 2012;10:12- 7.
Adams KF Jr, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005;149:209-16.
Shlipak MG, Massie BM. The clinical challenge of cardiorenal syndrome. Circulation. 2004;110:1514-17.
Olowu WA. Epidemiology, pathophysiology, clinical characteristics and management of childhood cardiorenal syndrome. World J Nephrol. 2012;1:16- 24.