Title Akutna bubrežna insuficijencija tijekom perioperacijskog razdoblja
Title (english) Perioperative acute renal injury
Author Dina Bajraktarević
Mentor Daniela Bandić Pavlović (mentor)
Committee member Mladen Perić (predsjednik povjerenstva)
Committee member DINKO TONKOVIĆ (član povjerenstva)
Committee member Daniela Bandić Pavlović (član povjerenstva)
Granter University of Zagreb School of Medicine (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities) Zagreb
Defense date and country 2016-07-15, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Anesthesiology and Reanimatology
Abstract Akutna bubrežna insuficijencija (ABI) je klinički sindrom koji je česta i ozbiljna komplikacija nakon velikih operativnih zahvata, te u velikoj mjeri doprinosi povećanju stope morbiditeta i mortaliteta, produljenom boravku pacijenata u bolnici, te višim troškovima liječenja. Podloga oštećenja bubrega je multifaktorska, te uključuje brojne preoperativne, intraoperativne i postoperativne faktore. Važan rizični faktor predstavljaju hitni operativni zahvati i opsežne operacije u kritičnih pacijenata s posebnim naglaskom na kardiokirurške operacije i transplantaciju organa. Široka uporaba nefrotoksičnih lijekova, kontrasta i diuretika u perioperacijskom periodu su odgovorni za značajan broj bolničkih ABI. Poznavanje mogućih uzroka insuficijencije, kao i razumijevanje njene patofiziologije olakšava nam ranu identifikaciju oštećenja bubrežne funkcije, pravovremenu primjenu terapije, te sprječavanje pojave komplikacija i daljnje progresije bolesti. Mehanizam s kojim ABI pridonosi povećanom mortalitetu još nije u potpunosti jasan, ali moguća objašnjenja su volumno preopterećenje, abnormalnosti u koagulaciji, povećana incidencija sepse s multiorganskim zatajenjem, te disfukcija vitalnih organa posredovana citokinima ili imunološkim sustavom. Kvalitetna preoperativna priprema, prepoznavanje i modifikacija rizičnih faktora od velike su važnosti za poboljšavanje ishoda pacijenata. Najbitniji čimbenici za uspješnu prevenciju oštećenja bubrega su pravilna nadoknada tekućine, održavanje euvolemije, sprječavanje prolongirane ishemije, te izbjegavanje hipotenzije i nefrotoksičnih lijekova tijekom cijelog perioperacijskog razdoblja. Unatoč napretku medicine na području intenzivne skrbi, dijalize i kirurških tehnika liječenje ABI je uglavnom suportivno, stoga je težište stavljeno na prevenciju bubrežnog oštećenja u rizičnih pacijenata. Novije studije uglavnom analiziraju patofiziologiju, preoperativne rizične faktore i rane biomarkere, te strategije perioperacijskog očuvanja bubrežne funkcije.
Abstract (english) Acute renal injury (ARI) is a clinical syndrome which is a common and serious complication after major surgeries and is largely associated with increased patient morbidity, mortality, prolonged hospital stays and greater healthcare costs. The etiology of renal damage is multifactorial and includes many preoperative, intraoperative and postoperative factors. Important risk factors represent emergency surgery and major surgery in the critically ill patients with special attention on cardiac and transplantation surgeries. Common use of nephrotoxic drugs, contrast dye and diuretics in the perioperative period are responsible for a significant amount of in-hospital ARI. The knowledge of possible causes of insuficiency, as well as comprehension of her underlying pathophysiology facilitates early identification of renal damage, prompt treatment and also prevention of complications and further progression of disease. The mechanism by which ARI itself contributes to increased mortality remains not completely understood, but possible explanations are volume overload, an increased incidence of sepsis with multiorgan failure, abnormalities in coagulation and cytokine or immunemediated major organ dysfunction. Adequate preoperative preparation, recognition and modification of risk factors have great importance for improving patients outcome. The key factors for succesful prevention of renal damage are correct fluid management, the maintenance of euvolemia, prevention of prolonged ischemia and also avoidance of hypotension and nephrotoxic drugs during the entire perioperative period. Despite a growing body of literature on area of intensive care, dialysis and surgical techniques, the treatment of ARI remains mainly supportive, so the aim of management is prevention of renal damage in patients at risk of developing ARI. New studies mostly analyze the pathophysiology, preoperative risk factors, early biomarkers and the strategies employed for perioperative renal protection.
Keywords
akutna bubrežna insuficijencija
perioperacijsko zbrinjavanje
kirurško liječenje
Keywords (english)
acute renal injury
perioperative management
surgical treatment
Language croatian
URN:NBN urn:nbn:hr:105:739615
Study programme Title: Medicine Study programme type: university Study level: integrated undergraduate and graduate Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resource Text
File origin Born digital
Access conditions Open access
Terms of use
Created on 2017-08-11 07:22:47