Yoğun bakım ünitesinde akut böbrek yetmezliği ve tedavi yöntemleri

Amaç: Bu derlemenin amacı, böbrek fonksiyonlarında ani azalma ile karekterize, dahiliye pratiğinde sıkça karşılaşılan bir durum olan akut böbrek yetmezliğinin (ABY) sadece genel klinik anlamında değil aynı zamanda yoğun bakım ünitelerindeki (YBÜ) önemini de vurgulamaktır. Ana Bulgular: Ana bulgulara bakıldığında, YBÜ’nde ABY’nin yüksek oranda gözlemlendiği birçok çalışma ile ortaya konulmuştur. ABY vakalarının çoğunlukla multifaktöryal olduğu belirlenmiştir. Multiorgan disfonksiyonuyla giden sepsisin, YBÜ’de gözlemlenen ABY etyolojisinde önemli bir yer tuttuğu ortaya konmuştur. YBÜ’de gözlemlenen ABY’nin izole organ yetmezliği gibi düşünülmemesi gerekliliği belirlenmiştir. Etiyolojisinden tedavisine kadar kompleks bir yapı gösteren ABY için en önemli yaklaşım korunmadır. Korunma amacına hizmet eden öneriler arasında, intravenöz izotonik hidrasyon, yeterli ortalama arterial basıncının sağlanması ve nefrotoksik ajan maruziyetinin en aza indirilmesi sayılabilir. Sonuç: Sonuç olarak, YBÜ’ndeki ABY’nin mortalitesi ve morbiditesi yüksek düzeylerde seyretmektedir. Renal mortaliteyi etkileyen faktörler arasında mekanik ventilasyon gereksinimi, inotrop desteği, oligüri, multiorgan disfonksiyonu (MODS), kormorbidite (konjestif kalp yetmezliği, kronik böbrek yetmezliği, diabetes mellitus, karaciğer yetmezliği gibi) olarak sayılabilir.

Acute renal failure in intensive care units and therapy methods

Objective: The aim of this review is to underline the importance of acute renal failure that is significant with acute deterioration in renal functions and besides a frequent case that is occurring not only in routine internal medicine clinics but also in intensive care units. Main Findings: The main findings indicate that acute renal failure is a significant event to be seen very common in critically ill patients. Acute renal failure is reported to be multifactorial. Multiorgan dysfunction (MODS) with sepsis is an important etiologic factor for critically ill patients with acute renal failure. Acute renal failure is not only an organ failure, but also a complex syndrome occurring in intensive care units. Due to the complex structure of the illness of concern it can be underlined that prevention is the first action to be taken into account. Some precautions should be taken like intravenous isotonic hydration, maintaining adequate mean arterial pressure and minimizing nephrotoxin exposure. Conclusion: To end with, acute renal failure happening in intensive care units has reported to have high mortality and morbidity rates. The factors that affect renal mortality can be summarized as the requirement of mechanic ventilation, use of inotropic agents, olyguria, multiorgan dysfunction (MODS) and comorbidity.

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