Kontrast madde nefropatisinin önlenmesinde dopamin kullanımı
Küçük Resim Yok
Tarih
2004
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç : Kontrast madde nefropatisinin (KMN) literatürde çok çeşitli tanımı mevcuttur. En sık kabul gören tanımı, kontrast madde alımından 48-72 saat sonra serum kreatinin değerinde yükselme olarak kabul edilmektedir. Kontrast nefropatisi, tanısal veya girişimsel amaçlı kontrast madde kullanımı sonucu özellikle diyabetes mellitus, hipertansiyon, hipovolemi gibi risk taşıyan kişilerde görülmektedir. Çalışmamızda dopaminin. KMN proflaksisi için kullanılabilirliğini incelemeyi amaçladık. Yöntem ve gereçler : Çalışmaya Radyoloji Ünitesine başvuran kontrast kullanan 60 hasta dahil edildi. Olguların üçü uyumsuzluk nedeni ile çalışma dışı bırakıldı. Olgular iki gruba ayrıldı. Birinci gruba %5 Dext-roz solüsyonu içinde 0.2 mgr/kg/dk hızında dopamin infüzyonu yapıldı, ikinci gruba dopamin olmaksızın sadece %5 Dextroz solüsyonu aynı dozda verildi. Her iki gruba da kontrast kullanımını takiben 6 saat süre içinde verildi. Olgulardan BUN, kreatinin, ürik asit tayini için 6. ve 72. saatte kan örnekleri alındı. Bulgular: Her iki grubun sonuçları karşılaştırıldı. Ayrıca riskli olan ve olmayan gruplar da kendi arasında karşılaştırıldı. Plasma kreatinin düzeyi birinci grupta belirgin olarak yükseldi (p=0.04). Diyabetes mellitus, hipertansiyon, piyelonefrit, ürolitiyazis, konjestif kalp yetmezliği, nefrotoksik ajan kullanımı risk faktörü olarak kabul edildi. Rsik faktörleri hastaların öykülerinden belirlendi. Diyabetli, piyelonefritli ve konjestif kalp yetmezliği olan hasta sayısı subgrup analizi için yeterli sayıda değildi. Dopamin almayan hipertansif hasta grubunda serum kreatinin düzeyleri dopamin alanlara göre istatistiksel olarak anlamlı olmaya yakın derecede artmıştı (p=0.07). Nefrotoksik ilaç alım öyküsü olan ve dopamin almayan olgularda serum kreatinin düzeyi dopamin alanlara göre anlamlı derecede yüksek saptandı (p=0.02). Kontrast maddenin ürolitiyazis üzerinde etkisi görülmedi. Sonuçlar : Dopamin, KMN proflaksisinde, özellikle riskli hastalarda kullanılabilecek bir ajandır. Ancak kesin bir sonuca varabilmek için geniş serili özellikle riskli hastaları içeren çalışmalara ihtiyaç vardır.
A variety of definition of radiocontrast medium induced nephropathy (RCIN) have been employed in the literature. A proportional or absolute rise in serum creatinine within a reference time (48-72 hours) is the most accepted definition. Diagnostic and interventional procedures using radiocontrast media causes nephropathy, especially person with risk, for example diabetes mellitus, hypertension, volum depletion, etc... In the current study, we aimed if dopamine can be used for prophylaxis of RCIN. Sixty patients who had admitted to radiology department for radiocontrast diagnostic procedure, were included study. Three of them were withdrawn because of their noncompliance. Patients seperated two groups. The first group was given 0.2mgr/kg/min dopamine in %5 dextrose solution. The second group was given same quantity of %5 dextrose solution without dopamine during six hours after radiocontrast infusion. Blood samples were taken for analysis of BUN, creatinine and uric acid before contrast media infusion and following sixth and seventysecond hours. The results were compared within two groups and subgroups who had risk factors or not. Plasma creatinine levels significantly more rised than those of first group (p=0.04). As a risk factor, diabetes mellitus, hypertension, pyelonepritis, urolithiasis, congestive heart failure and nephrotoxic drug intake were detected in history. There were not enough number of diabetics, congestive heart failure and pyelonephritis.Creatinine levels of the patients who were hypertensive and had not received dopamine were rised more than hypertensive and dopamine received goup and it was seemed nearly significant (p=0.07). Ceatinine levels of the patient with drug intake history and had not received dopamine were rised significantly than dopamine received group (p=0.02). It was seemed that kontrast medium did not influence the patients with urolithiasis. In conclusion dopamine can be considered as a valid prophlactic agent for RCIN, especially on patients with risk factor. But we believed that we need more studies including as high as number of patients with all risk factors.
A variety of definition of radiocontrast medium induced nephropathy (RCIN) have been employed in the literature. A proportional or absolute rise in serum creatinine within a reference time (48-72 hours) is the most accepted definition. Diagnostic and interventional procedures using radiocontrast media causes nephropathy, especially person with risk, for example diabetes mellitus, hypertension, volum depletion, etc... In the current study, we aimed if dopamine can be used for prophylaxis of RCIN. Sixty patients who had admitted to radiology department for radiocontrast diagnostic procedure, were included study. Three of them were withdrawn because of their noncompliance. Patients seperated two groups. The first group was given 0.2mgr/kg/min dopamine in %5 dextrose solution. The second group was given same quantity of %5 dextrose solution without dopamine during six hours after radiocontrast infusion. Blood samples were taken for analysis of BUN, creatinine and uric acid before contrast media infusion and following sixth and seventysecond hours. The results were compared within two groups and subgroups who had risk factors or not. Plasma creatinine levels significantly more rised than those of first group (p=0.04). As a risk factor, diabetes mellitus, hypertension, pyelonepritis, urolithiasis, congestive heart failure and nephrotoxic drug intake were detected in history. There were not enough number of diabetics, congestive heart failure and pyelonephritis.Creatinine levels of the patients who were hypertensive and had not received dopamine were rised more than hypertensive and dopamine received goup and it was seemed nearly significant (p=0.07). Ceatinine levels of the patient with drug intake history and had not received dopamine were rised significantly than dopamine received group (p=0.02). It was seemed that kontrast medium did not influence the patients with urolithiasis. In conclusion dopamine can be considered as a valid prophlactic agent for RCIN, especially on patients with risk factor. But we believed that we need more studies including as high as number of patients with all risk factors.
Açıklama
Anahtar Kelimeler
Kontrast Nefropatisi, Causes Nephropathy, Dopamin, Dopamine, KMN Proflaksisi
Kaynak
Haydarpaşa Numune Eğitim ve Araştırma Hastanesi Tıp Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
44
Sayı
4
