İntravenöz immünglobulin tedavisi sonrası gelişen akut böbrek hasarının değerlendirilmesi ve nötrofil jelatinaz ilişkili lipokalinin tedavi sonrası ilk 24 saatteki hasarı belirlemedeki rolü
Küçük Resim Yok
Tarih
2022
Yazarlar
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Cilt Başlığı
Yayıncı
T.C. Maltepe Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: İntravenöz İmmünglobulin G (IVIG) , Kawasaki, kronik inflamatuar demiyelinizan nöropati, B hücreli lenfositik lösemi gibi hastalıkların tedavisinde kullanılmaktadır. Ticari IVIG preparatlarının polimerleşmesini önlemek amacıyla stabilizan maddeler kullanılmaktadır. Sükroz bunlardan biridir ve osmotik nefrozise yol açarak akut böbrek hasarı oluşturabilmektedir . Bu calışma; ilk 24 saatteki Nötrofil Jelatinaz İlişkili Lipokalin’in (NGAL) düzeyinin IVIG tedavisi esnasında gelişebilecek ABH’ni öngörmek konusunda yararlı olup olmadığını ortaya koymak amacı ile planlanmıştır. Gereç ve Yöntem: Ocak 2022- Eylül 2022 tarihleri arasında Maltepe Üniversitesi Hastanesi İç hastalıkları ve Nöroloji Kliniğinde yatarak IVIG tedavisi altındaki 25 gönüllü hasta ve 10 tedavi uygulanmayan, benzer özellikli gönüllü kontrol grubu olarak çalışmaya dahil edilmiştir. Vaka grubunun IVIG tedavisi öncesi(0.gün) ve sonrası(1.gün ) kan bun, kreatinin, sodyum, potasyum, kalsiyum, magnezyum, fosfor, ürik asit ve idrar NGAL, mikroalbümin/ kreatinin ölçümleri yapılmıştır. Tedavisi devam eden hastaların 5.gün kan biyokimyasal tetkikleri tekrarlanmıştır. Kontrol grubunun ise kan bun, kreatinin, sodyum, potasyum, kalsiyum, magnezyum, fosfor, ürik asit ve idrar NGAL, mikroalbümin/ kreatinin ölçümleri yapılmıştır. Hastaların ve kontrol grubunun komorbitleri , kullandıkları ilaçları sorgulanarak izlem formuna kaydedilmiştir. Kan ve idrar laboratuar ölçümleri Maltepe Üniversitesi Hastanesi laboratuarında yapılmıştır. İstatistiksel Analiz: Çalışmada elde edilen bulgular değerlendirilirken, istatistiksel analizler için IBM SPSS Statistics 26 (IBM SPSS, Türkiye) programı kullanıldı. Anlamlılık p< p0.05 düzeyinde değerlendirilmiştir. Bulgular: Çalışmaya 25’i IVIG alan hasta, 10’u kontrol grubunda olmak üzere toplam 35 kişi dahil edilmiştir. Genel olarak çalışmaya katılan kadın hastaların oranı %60,0, erkek hastaların oranı %40,0’dır.Kadın ve erkek oranı kontrol ve vaka grubunda benzerdir. Tüm katılımcıların yaş ortalaması ise 64,71 ±14,53 olarak hesaplanmıştır. Vaka grubunun NGAL sonucu ortalaması 28,3±49,50 ng/ml olarak hesaplanmıştır. Kontrol grubunun NGAL sonuç ortalaması ise 23,15± 26,43 ng/ml olarak hesaplanmıştır p: 0,75 olup iki grup arasında istatistiksel farklılık yoktur. IVIG tedavisi alan 25 vaka grubundaki hastaların tedavi öncesi idrar NGAL değer ortalaması 28,36±49,52ng/ml olup vaka grubunun IVIG tedavi sonrası 1.gün değer ortalaması ise 44,5±79,78 ng/ml dir. P değeri 0,178 olup fark istatistik olarak anlamlı değildir. Çalışmadaki septik 2 hastanın IVIG öncesi ve sonrası idrar NGAL değerleri sınır değer olan 131,7 ng/ml üzerinde olup devamında iki hastada da akut böbrek yetmezliği gelişmiştir. İdrar NGAL ve idrar mikroalbümin/kreatinin korelasyon analizinde p 0,03 olarak saptanmıştır. Tartışma ve Sonuç: Sükroz içermeyen IVIG preparatları ile tedavi gören hastalarda IVIG e bağlı bir akut böbrek hasarı gelişmemiştir. IVIG tedavi sonrası idrar NGAL ölçümleri daha yüksek saptanmış olup tedavi öncesi NGAL ölçümü ile kıyaslandığında anlamlı bir istatistiksel farklılık izlenmemiştir. Tedavideki 2 septik hastanın tedavi öncesi ve sonrası idrar NGAL ölçümleri yüksek seyretmiş olup, ABH 72 saat sonra gelişmiştir. İdrar NGAL düzeyi ve idrar mikroalbümin/kreatinin düzeyinin birbiri ile bağlantılı bulunması uygulamanın böbrekte bir miktar hasara yol açmış olduğunun kanıtı olarak yorumlanabilir.
Introduction and Aim: Intravenous Immunoglobulin G (IVIG) is used in the treatment of diseases such as Kawasaki, chronic inflammatory demyelinating neuropathy, B-cell lymphocytic leukemia. Stabilizing agents are used to prevent the polymerization of commercial IVIG preparations. Stabilizing substances such as sucrose may cause acute kidney injury by causing osmotic nephrosis. In this study ; It was planned to reveal whether the Neutrophil Gelatinase-Associated Lipocalin (NGAL) level in the first 24 hours is useful in predicting AKI that may develop during IVIG treatment. Materials and Methods: Between January 2022 and September 2022, 25 voluntarily patients under IVIG treatment and 10 voluntarily control group at Maltepe University Hospital Internal Medicine and Neurology Clinic were included in the study. Blood bun, creatinine, sodium, potassium, calcium, magnesium, phosphorus, uric acid and urine NGAL, microalbumin/creatinine measurements were made before(0 day) and after(1 day) IVIG treatment of the case group. Blood biochemical tests were repeated on the 5th day of the patients whose treatment continued. In the control group, blood bun, creatinine, sodium, potassium, calcium, magnesium, phosphorus, uric acid and urine NGAL, microalbumin/creatinine measurements were made. The comorbidities of the patients and the control group were recorded in the follow-up form by questioning the drugs they used. Blood and urine laboratory measurements were made in the laboratory of Maltepe University Hospital. Results: A total of 35 people, 25 of whom received IVIG, and 10 of whom were in the control group, were included in the study. In general, the rate of female patients participating in the study is 60.0%, and the rate of male patients is 40.0%. The ratio of female and male patients is similar in the control and case groups. The mean age of all participants was calculated as 64.71 ± 14.53. The mean NGAL result of the case group was calculated as 28.3±49.50 ng/ml. The mean NGAL result of the control group was calculated as 23.15±26.43 ng/ml, p: 0.75, and there was no statistical difference between the two groups. The mean urinary NGAL value of the patients in the 25 case group who received IVIG treatment was 28.36±49.52ng/ml before the treatment, and the mean value on the 1st day after IVIG treatment in the case group was 44.5±79.78 ng/ml. The P value is 0.178 and the difference is not statistically significant. Urine NGAL values before and after IVIG in the 2 septic patients in the study were above the cut-off value of 131.7 ng/ml, and acute renal failure developed in both patients. In the correlation analysis of urine NGAL and urine microalbumin/creatinine, p was determined as 0.03 Discussion and Conclusion: Acute kidney injury due to IVIG did not develop in patients treated with IVIG preparations that do not contain sucrose. Urine NGAL measurements were found to be higher after IVIG treatment, and no statistically significant difference was observed when compared to pre-treatment NGAL measurement. Urine NGAL measurements were high before and after treatment in 2 septic patients in treatment, and acute renal failure developed after 72 hours. The correlation of urinary NGAL level and urinary microalbumin/creatinine level can be interpreted as evidence that the application caused some damage to the kidney.
Introduction and Aim: Intravenous Immunoglobulin G (IVIG) is used in the treatment of diseases such as Kawasaki, chronic inflammatory demyelinating neuropathy, B-cell lymphocytic leukemia. Stabilizing agents are used to prevent the polymerization of commercial IVIG preparations. Stabilizing substances such as sucrose may cause acute kidney injury by causing osmotic nephrosis. In this study ; It was planned to reveal whether the Neutrophil Gelatinase-Associated Lipocalin (NGAL) level in the first 24 hours is useful in predicting AKI that may develop during IVIG treatment. Materials and Methods: Between January 2022 and September 2022, 25 voluntarily patients under IVIG treatment and 10 voluntarily control group at Maltepe University Hospital Internal Medicine and Neurology Clinic were included in the study. Blood bun, creatinine, sodium, potassium, calcium, magnesium, phosphorus, uric acid and urine NGAL, microalbumin/creatinine measurements were made before(0 day) and after(1 day) IVIG treatment of the case group. Blood biochemical tests were repeated on the 5th day of the patients whose treatment continued. In the control group, blood bun, creatinine, sodium, potassium, calcium, magnesium, phosphorus, uric acid and urine NGAL, microalbumin/creatinine measurements were made. The comorbidities of the patients and the control group were recorded in the follow-up form by questioning the drugs they used. Blood and urine laboratory measurements were made in the laboratory of Maltepe University Hospital. Results: A total of 35 people, 25 of whom received IVIG, and 10 of whom were in the control group, were included in the study. In general, the rate of female patients participating in the study is 60.0%, and the rate of male patients is 40.0%. The ratio of female and male patients is similar in the control and case groups. The mean age of all participants was calculated as 64.71 ± 14.53. The mean NGAL result of the case group was calculated as 28.3±49.50 ng/ml. The mean NGAL result of the control group was calculated as 23.15±26.43 ng/ml, p: 0.75, and there was no statistical difference between the two groups. The mean urinary NGAL value of the patients in the 25 case group who received IVIG treatment was 28.36±49.52ng/ml before the treatment, and the mean value on the 1st day after IVIG treatment in the case group was 44.5±79.78 ng/ml. The P value is 0.178 and the difference is not statistically significant. Urine NGAL values before and after IVIG in the 2 septic patients in the study were above the cut-off value of 131.7 ng/ml, and acute renal failure developed in both patients. In the correlation analysis of urine NGAL and urine microalbumin/creatinine, p was determined as 0.03 Discussion and Conclusion: Acute kidney injury due to IVIG did not develop in patients treated with IVIG preparations that do not contain sucrose. Urine NGAL measurements were found to be higher after IVIG treatment, and no statistically significant difference was observed when compared to pre-treatment NGAL measurement. Urine NGAL measurements were high before and after treatment in 2 septic patients in treatment, and acute renal failure developed after 72 hours. The correlation of urinary NGAL level and urinary microalbumin/creatinine level can be interpreted as evidence that the application caused some damage to the kidney.
Açıklama
Anahtar Kelimeler
İntravenöz immünglobulin G, Nötrofil jelatinaz İlişkili lipokalin, Akut böbrek hasarı(ABH), Biyobelirteç, Intravenous immunoglobulin G, Neutrophil gelatinase-associated lipocalin, Acute renal failure, Biomarker
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Karataş, H. K. (2002). İntravenöz immünglobulin tedavisi sonrası gelişen akut böbrek hasarının değerlendirilmesi ve nötrofil jelatinaz ilişkili lipokalinin tedavi sonrası ilk 24 saatteki hasarı belirlemedeki rolü / Evaluation of acute kidney injury after intravenous immunoglobulin therapy and the role of neutrophil gelatinase-associated lipocalin in determining the damage in the first 24 hours after treatment. (Yayımlanmamış Uzmanlık Tezi). Maltepe Üniversitesi, Tıp Fakültesi, İstanbul.
