Böbrek fonksiyon bozukluğu olan hastalarda endoskopik üreter taşı cerrahisinin glomerüler filtrasyon hızı üzerine etkisi

Amaç: Ameliyat öncesi tahmini glomerüler filtrasyon oranları (eGFR) düzeyi 60 ml/dk’nın altında olan bir hasta grubunda üst üreter taşlarında üreterorenoskopi (URS) ya da fleksible üreterorenoskopi (fURS) öncesi ve sonrası eGFR değişimini ve buna etki eden faktörleri değerlendirmeyi amaçladık. Yöntem: Üst üreter taşı nedeniyle ameliyat planlanan ve kısa MDRD formülü ile hesaplanan ameliyat öncesi eGFR 60 ml/dk’nın altında olan 32 hasta çalışmaya dahil edildi. Hastaların ameliyat öncesi ve sonrası eGFR değişimlerine etki eden faktörler çoklu lineer regresyon analizi ile karşılaştırıldı. Bulgular: Düşük renal rezervli hastalar da tedavi sonrasında renal fonksiyonlar açısından iyi düzeyde bir iyileşme gösterdiler. Yaş, beden kitle indeksi (BKİ) ve preoperatif eGFR anlamlı düzeyde postoperatif eGFR’yi etkiliyordu (p<0.05). Postoperatif eGFR’nin preoperatif eGFR ile doğru, diğer iki parametre ile ise ters orantılı olduğu görüldü. Sonuç: Bu çalışma ile literatürde ilk defa renal rezervi düşük hasta popülasyonunda genç yaş, yüksek preoperatif eGFR değerleri ve düşük BKİ’nin postoperatif eGFR yükselmesi açısından iyi prognoz parametreleri olduğu gösterildi.

Anahtar Kelimeler:

Endoskopik üreter taşı tedavisi, Üreterorenoskopi, Retrograd intrarenal cerrahi, Glomerüler filtrasyon hızı, Düşük renal rezerv, Kronik böbrek yetmezliği

Effect of endoscopic ureteral stone surgery on glomerular filtration rate in patients with renal impairment

Objective: We aimed to evaluate the estimated glomerular filtration rates (eGFR) change in upper ureteral stones before and after ureterorenoscopy (URS) or flexible ureterorenoscopy (fURS) in a patient group with preoperative eGFR level below 60 ml / min and the factors affecting it. Methods: Thirty-two patients who were scheduled for surgery due to upper ureteral stones and whose preoperative eGFR that calculated with the short MDRD formula, below 60 mL / min were included in the study. Factors that affect preoperative and postoperative eGFR changes of the patients were investigated by multiple linear regression analysis. Results: Patients with low renal reserve also showed a good improvement in renal function after treatment. Age, body mass index (BMI) and preoperative eGFR significantly affected postoperative eGFR (p <0.05). It was observed that postoperative eGFR was directly proportional to preoperative eGFR and inversely proportional to the other two parameters. Conclusion: With this study, it was shown for the first time in the literature that young age, high preoperative eGFR values and low BMI are good prognosis parameters in terms of postoperative eGFR increase in the patient population with low renal reserve.

Keywords:

Endoscopic ureteral stone treatment, Ureterorenoscopy, Retrograde intrarenal surgery, Glomerular filtration rate, Low renal reserve, Chronic renal failure,

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