Acile Başvuran Böbrek Nakilli Hastaların Değerlendirilmesi: Tek Merkez Deneyimi

Amaç: Son dönem böbrek yetmezlikli hastalarda böbrek nakli ve diyaliz tedavi seçenekleridir. Böbrek nakli, bu hastalar için en iyi tedavi seçeneğidir. Fakat immunsüpresif rejimler ve ek hastalıklar nedeniyle böbrek nakilli hastalar enfeksiyon ve kardiyovasküler hastalıklara duyarlı hale gelirler. Bu retrospektif çalışmada, acile başvuran böbrek nakilli hastaların demografik yapıları, klinik bulguları, laboratuar bulguları ve hasta sonuçları incelenmiştir.Yöntem: Acile başvurmuş olup, hastanemizde böbrek nakli yapılan hastaların demografik yapıları, klinik bulguları, laboratuar bulguları, tanıları, hastanede kalış süreleri ve hasta sonuçları tıbbi kayıtlardan incelenmiştir. Bu hastalardan bir önceki hastane protokol numarasına sahip böbrek nakil hastaları ise kontrol grubu olarak alınmıştır.Bulgular: Çalışmaya 218 hasta dahil edildi. Hastalar genel olarak canlı böbrek vericisi olan genç kadın bireylerdi. Hastaların ortalama yaşları 39,4±13,2 idi. Nedeni bilinmeyen böbrek yetmezliğini dışladıktan sonra kronik glomerulonefrit her iki grupta da en sık böbrek yetmezliği nedeniydi. En sık saptanan semptomlar ateş ve idrar yaparken yanma idi. İdrar yolu enfeksiyonu en sık konulan tanıydı. Hastaların ortalama yatış süresi 11,7±9,2 gündü. Takipler sırasında 35 hastanın (%16) böbrek fonksiyonu bozuldu ve 15 hastaya hemodiyaliz tedavisi başlandı. Hastaların 5’i (%2,2) (üçü sepsis, ikisi ensefalit nedeniyle) ise kaybedildi.Sonuç: Acil serviste çalışan klinisyenler organ nakilli hasta başvuralarında enfeksiyonlar açısından çok dikkatli olmalıdır.

Anahtar Kelimeler:

Kronik böbrek hastalığı, Böbrek nakli, İmmünsüpresyon

Evaluating Emergency Department Admissions Among Renal Transplant Recipients: One Center Experience

Objective: Renal Replacement therapy for end stage renal disease (ESRD) patients includes transplantation and dialysis. Kidney transplantation is the treatment of choice for ESRD. However, transplant patients are susceptible to infection and cardiovascular disease due to immunosuppressive regimens and existing multiple comorbidities. In this retrospective study, we aimed to investigate the demographic characteristics, clinical manifestations, laboratory findings and outcomes of transplant patients who were admitted to the emergency department.Methods: Transplant patients who were subsequently admitted to the emergency department were retrospectively evaluated. The patients’ demographic, clinical and laboratory findings, symptoms, diagnoses, duration of hospitalization and outcomes were obtained from medical records. Transplant patients with previous hospital protocol numbers of each patient were enrolled into study as control group.Results: 218 patients were enrolled into study. More than half of the patients in each group were young women with live kidney donors. The mean (±SD) age of the patients was 39.4±13.2. Chronic glomerulonephritis was the leading etiology of kidney failure among both groups in those where the etiology was identified. The most common symptoms were fever and dysuria. Urinary tract infection was the most frequently diagnosed complication. Mean (±SD) duration of hospitalization was 11.7±9.2 day. Kidney function worsened in 35 patients (16%) and hemodialysis was initiated in 15 of them. Five patients (2.2%) died (sepsis in three, encephalitis in 2).Conclusion: Physicians should have a high index of suspicion for infection during evaluation of organ transplant recipients in the emergency department.

Keywords:

Chronic kidney disease, Renal transplantation, Immunosuppression,

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