Yoğun bakım ünitesinde akut böbrek yetmezliğinin patogenezi, prognozu ve tedavisi

Akut böbrek yetmezliği böbreklerin ekskresyon, idrar konsantrasyonu, elektrolit tutulumu ve sıvı dengesini sağlama fonksiyonlarında ani kayıp ile karakterizedir. Akut böbrek yetmezliğinin prognozunu etkileyen pek çok faktör bulunmaktadır. Renal replasman tekniklerinde son yıllarda görülen gelişmelere rağmen yoğun bakım ünite-sinde akut böbrek yetmezliğine bağlı hastalarda morbidite ve mortalite hala çok yüksektir. Yoğun bakım hastaları içinde en kritik grubu temsil eden bu hastalarda diyalizin zamanlaması, uygulanacak diyaliz şekli ve dozu ile ilgili günümüzde hazırlanmış kılavuzlar bulunmamaktadır. Bu derlemede yoğun bakım ünitesinde gelişen akut böbrek yetmezliğinin patogenezi, seyri ve prognozu özetlenmekte ve mevcut renal replasman seçenekleri anlatılmaktadır

The course, prognosis and treatment of acute renal failure in intensive care unit

Acute renal failure is characterized by an abrupt loss of the excretion, urine concentration, electrolyte and volume regulation functions of the kidneys. The prognosis of acute renal failure is influenced by a variety of factors. Despite the improvements in renal replacement techniques in the recent years, the morbiditiy and mortality of acute renal failure in intensive care unit stil remains high. There is a lack of guidelines concerning the timing, type and dose of dialysis therapy in this very critical subgroup of intensive care unit patients. This review summarizes the pathogenesis, course and prognosis of acute renal failure in the intensive care unit setting and discloses the available renal replacement therapy alternatives.

PDF

___

1. Schrier RW, Wang W, Poole B, Mitra A. Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Invest 2004;114: 5-14.
2. Bernieh B, Al Hakim M, Boobes Y, Siemkovics E, El Jack H. Outcome and predictive factors of acute renal failure in the intensive care unit. Transplant Proc 2004;36: 1784-17.
3. Koreny M, Karth GD, Geppert A, Neunteufl T, Priglinger U, Heinz G, et al. Prognosis of patients who develop acute renal failure during the first 24 hours of cardiogenic shock after myocardial infarction. Am J Med 2002;112: 115-9.
4. Clarkson MR, Friedewald JJ, Eustace JA, Rabb H. Acute kidney injury. In: Brenner BM, ed. 8th ed. Brenner & Rector’s The Kidney. Philadelphia:Saunders; 2008; p: 951.
5. Mehta RL. Outcomes research in acute renal failure. Semin Nephrol 2003;23: 283-94.
6. Mehta RL, McDonald B, Gabbai F, Pahl M, Farkas A, Pascual MT, et al. Nephrology consultation in acute renal failure: does timing matter? Am J Med 2002;113: 456-1.
7. Oudemans-van Straaten HM, Bosman RJ, van der Spoel JI, Zandstra DF. Outcome of critically ill patients treated with intermittent high-volume haemofiltration: a prospective cohort analysis. Intensive Care Med 1999;25: 814-21.
8. Schwilk B, Wiedeck H, Stein B, Reinelt H, Treiber H, Bothner U. Epidemiology of acute renal failure and outcome of haemodiafiltration in intensive care. Intensive Care Med 1997;23: 1204-11.
9. Arabi Y, Ahmed QA, Haddad S, Aljumah A, Al-Shimemeri A. Outcome predictors of cirrhosis patients admitted to the intensive care unit. Eur J Gastroenterol Hepatol 2004;16: 333-9.
10. Wan L, Bellomo R, Di Giantomasso D, Ronco C. The pathogenesis of septic acute renal failure. Curr Opin Crit Care 2003;9: 496-502.
11. Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet 2005;365: 417-30.
12. Hoste EA, Blot SI, Lameire NH, Vanholder RC, De Bacquer D, Colardyn FA, et al. Effect of nosocomial bloodstream infection on the outcome of critically ill patients with acute renal failure treated with renal replacement therapy. J Am Soc Nephrol 2004;15: 454-62.
13. Liu KD. Molecular mechanisms of recovery from acute renal failure. Crit Care Med 2003;31: 572-81.
14. Uchino S, Bellomo R, Ronco C. Intermittent versus continuous renal replacement therapy in the ICU: impact on electrolyte and acid-base balance. Intensive Care Med 2001;27: 1037-43.
15. Schortgen F, Soubrier N, Delclaux C, Thuong M, Girou E, Brun- Buisson C, et al. Hemodynamic tolerance of intermittent hemodialysis in critically ill patients: usefulness of practice guidelines. Am J Respir Crit Care Med 2000;162: 197-202.
16. Van Biesen W, Vanholder R, Lameire N. Dialysis strategies in critically ill acute renal failure patients. Curr Opin Crit Care 2003;9: 491-5.
17. Marshall MR, Ma T, Galler D, Rankin AP, Williams AB. Sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring renal replacement therapy: towards an adequate therapy. Nephrol Dial Transplant 2004;19: 877-84.