Meryem ONAY, Sema ŞANAL BAŞ, Gizem KURADA, Ata ÖZEN, Ebru KARAKOÇ, Birgül YELKEN

Nefrektomide Perioperatif Böbrek Fonksiyonunu Etkileyen Faktörler

Nefrektomi operasyonu geçiren hastalar genellikle öncesinde renal disfonksiyona sahip veya cerrahi sırasında meydana gelen doku kaybı nedeniyle renal yetmezlik açısından risk grubunda yer almaktadır. Bu çalışmada nefrektomi operasyonlarında genel anestezisi altında böbrek fonksiyonlarını etkileyen faktörleri değerlendirmeyi amaçladık. Kliniğimizde nefrektomi operasyonu geçiren hastaların demografik verileri, vaka türü (basit, parsiyel, radikal), laparotomi/laparoskopik, intraoperatif laktat düzeyi, anestezi süresi ve postoperatif komplikasyonlar kayıtları incelendi. Böbrek fonksiyonları preoperatif ve postoperatif dönemde (2. günde) üre, kreatinin ve tahmini glomeruler filtrasyon hızı (GFR) sonuçları ile karşılaştırıldı. Hastaların ortalama yaş 58.2 ± 13.02 iken, anestezi süresi 166.24 ± 53.01/dk, preoperatif eGFR 84.71 (67.69-90.0), postoperatif eGFR 65.09 (47.91-87.44) idi. Hastalar preoperatif ve postoperatif böbrek fonksiyon testleri kıyaslandığında; istatiksel olarak üre (p:0.01), kreatinin (p:0.01) ve GFR (p:0.01). GFR düşüşünü etkileyen faktörler, yaş (p:0.01) ve vaka türü. (p:0.01). Preoperatif döneme göre postoperatif dönemde laktat düzeylerindeki artış istatistiksel olarak anlamlıydı (p: 0.01). Laktat düzeyindeki artış komplikasyonlar (p: 0.001), vaka türü (p:0.01) ve cerrahi türü (p: 0.01) ile ilişkiliydi. Nefrektomi operasyonlarında özellikle radikal olanlarda kronik böbrek yetmezliği görülme sıklığı artmaktadır. Yaş ve vaka tipi de dikkate alınması gereken önemli parametrelerdir.

Anahtar Kelimeler:

Nefrektomi, Böbrek fonksiyonu, glomerular filtrasyon hızı

Factors Affecting Perioperative Period Renal Function in Nephrectomies

Patients who have had a nephrectomy usually have a history of renal dysfunction or are at risk for kidney failure due to tissue loss during surgery. In this study, our aim was to evaluate the factors affecting acute renal function in nephrectomy surgeries under general anesthesia. Demographic data of patients, case type, surgery type, duration of anesthesia, intraoperative lactate level, and postoperative complications of patients who underwent nephrectomy in our clinic were reviewed. Renal function was compared with urea, creatinine and estimated glomerular filtration rate (eGFR) levels in the preoperative (2 days before surgery) and postoperative period (day 2). The mean age of the patient was 58.2 ± 13.02 years, duration of anesthesia 166.24 ± 53.01/min, pre-operative eGFR 84.71 (67.69-90.0) mL/min/1.73 m2, and postoperative eGFR 65.09 (47.91-87.44) mL/min/1.73 m2 were respectively. When the pre- and postoperative renal functions of the patients were compared, the statistically significant results were those of urea (p: 0.01), creatinine (p:0.01), and GFR (p:0.01). The factors affecting GFR decrease were age (p:0.01) and case type (p:0.01). Increase in lactate levels in the postoperative period compared to the preoperative levels was statistically significant (p: 0.01). The increase in lactate levels was associated with complications (p: 0.001), case type (p:0.01) and surgery type (p: 0.01). Conclusions: The incidence of acute renal failure is increasing in nephrectomy surgeries, especially in radical ones. Age and case type are also the most important parameters to be consider.

Keywords:

Nephrectomy, Renal function, Glomeruler filtration rate,

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