COVİD-19 geçiren çocuklarda böbrek hasarının değerlendirilmesi
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Tarih
2022
Yazarlar
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmaya ocak ve mart 2022 tarihleri arasında, Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi çocuk acil veya diğer çocuk hastalıkları servislerindeki, Şiddetli akut solunum sendromu Koronavirüs 2 (SARS-CoV-2) polimeraz zincir reaksiyonu (PCR) testi pozitif saptanan 130 hasta ile çocuklarda multisistem inflamatuar sendromu (MIS-C) tanısı ile takip edilen beş hasta dâhil edildi. Akut böbrek hasarı (ABH) tanısı için KDIGO ve pRIFFLE kriterleri kullanıldı. İstatistiksel analizler için SPSS 22.0 programı kullanıldı ve p<0,05 olması anlamlı kabul edildi.
Her iki kritere göre de 2019 Koronavirüs hastalığı (COVID-19) hastalarının %31,5’inde ABH tespit edildi. ABH olanlarda hasta yaşının 24,8 ay (min:1 max:211) olduğu ve anlamlı olarak daha küçük olduğu belirlendi (p= 0,005). Hastalardan beslenmede azalma şikâyeti ve muayenesinde dehidratasyon, mukoza kuruluğu, cilt kuruluğu olanlarda ABH sıklığının anlamlı olarak arttığı tespit edildi (sırasıyla p= 0,041, p= 0,001, p= 0,001, p= 0,035). Yoğun bakımda takip edilen hastalarda da ABH sıklığı artmış bulundu (p= 0,038). Kronik hastalıklarla ya da ilaç kullanımıyla ABH sıklığının değişmediği tespit edildi. ABH olan hastalarda serum fibrinojen düzeyinin anlamlı olarak daha düşük, D-dimer düzeyinin anlamlı olarak daha yüksek olduğu tespit edildi (sırasıyla p= 0,047, p= 0,035). COVID-19 hastalarının %24’ünde idrar albümin/kreatinin oranı, %48,8’inde idrar protein/kreatinin oranı yüksek tespit edildi. ABH olan hastalarda idrar albümin, idrar sodyum ve idrarda fraksiyonel sodyum atılımı anlamlı olarak daha yüksek tespit edildi (sırasıyla p= 0,038, p= 0,044, p= 0,038). COVID-19 hastalarının %44,4’ünde metabolik asidoz tespit edildi. Serum bikarbonat düzeyi ile glomerüler filtrasyon hızı arasında anlamlı pozitif korelasyon tespit edildi (p= 0,006). COVID-19 hastalarının %21’inde hipofosfatemi, %17,8’inde hiponatremi, %2,4’ünde hipoalbüminemi tespit edildi. ABH olan hastalarda hiponatremi ve hipofosfatemi anlamlı olarak daha sık tespit
v
edildi (sırasıyla p= 0,022, p= 0,028). ABH olan hastaların serum albümin düzeyi, olmayanlara göre anlamlı olarak daha düşüktü (p= 0,043). COVID-19 hastalarının üç aylık takibinde hastaların bir kısmında ABH’nin ve elektrolit bozukluğunun devam ettiği tespit edildi.
MIS-C hastalarının %40’ında da her iki kritere göre ABH tespit edildi. ABH olan hastaların serum interlökin-6, prokalsitonin, C-reaktif protein, D-dimer düzeyi ABH olmayanlara göre daha yüksek olsa da istatistiksel olarak anlamlı düzeyde yükseklik tespit edilmedi. Hastaların hepsinde hiponatremi görülürken, %80’inde hipokalsemi, %60’ında hipokalemi, %60’ında hipokloremi, %60’ında hipofosfatemi tespit edildi. Hastaların hepsinin idrar sodyum düzeyi 40 mmol/l’nin üzerinde, %60’ının fraksiyonel sodyum atılımı birin altında bulundu. Hastaların %40’ının idrar protein/kreatinin oranı yüksek tespit edildi. Hastaların üç aylık takibinde ABH’nin devam etmediği tespit edildi. Takipleri sırasında hastaların idrar protein/kreatinin oranı normale gerilediği tespit edildi. İlk başvuruda tespit edilen serum elektrolit bozuklukları ikinci ve üçüncü ayda düzeldiği tespit edildi. Sadece bir hastanın üçüncü ay kontrolünde hiperfosfatemi tespit edildi.
Çalışma verilerimiz göstermiştir ki; COVID-19 ve MIS-C hastalığı olan çocuklarda sıklıkla ABH gelişmektedir. ABH yoğun bakım ihtiyacı olan COVID-19 hastalarında artmakla birlikte herhangi bir kronik hastalığı olmayan ve ayaktan takip edilen hastalarda da sıklıkla görülmektedir. Hasarın beslenme azlığı ve dehidratasyon görülen hastalarda artmış olması prerenal ABH’yi düşündürmektedir. Ancak hastalarda sıklıkla proteinüri ve serum elektrolit bozukluğu gibi tubuler hasar göstergelerinin bozulmuş olması, böbrek hasarının renal düzeyde de meydana geldiğini göstermektedir.
Sonuç olarak hastalarımızda gerek başvuru anında, gerekse üç aylık takiplerinde ABH’nin gelişmesi ve/veya devam etmesi, çocukluk çağı COVID-19 hastalarının da böbrek hasarı yönünden incelenmesi ve uzun dönem takip edilmesi gerektiğini düşündürmektedir.
In this study, cases in Necmettin Erbakan University Meram Medical Faculty pediatric emergency or other pediatric services between January and March 2022 were examined. The study included 130 patients with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test and five patients followed up with the diagnosis of multisystem inflammatory syndrome in children (MIS-C). KDIGO and pRIFFLE criteria were used for the diagnosis of acute kidney injury (AKI). The IBM SPSS 22.0 software was used to analyse collected data and the result was considered as significant p<0.05. According to the obtained results, it was found that AKI occurred in 31.5% of COVID-19 patients. The patient's age (24.8 months, min:1 max:211) was determined in those with AKI and it was considered statistically significant. (p= 0.005). In addition, it was determined that the frequency of AKI was significantly increased in patients with complaints of decreased nutrition and dehydration, dry mucous membranes, and dry skin in the examination (respectively p= 0,041, p= 0,001, p= 0,001, p= 0,035). The frequency of AKI was also found to be increased in patients followed in the intensive care unit (p= 0,038). The frequency of AKI did not change in the patients having chronic diseases or drug use. In addition, patients with AKI had significantly lower serum fibrinogen levels but significantly higher D-dimer levels (respectively p= 0,047, p= 0,035). It was found that 24% of patients had higher urinary albumin/ creatinine ratio and 48.8% of patients had higher urinary protein creatinine levels. It was found that patients with AKI had significantly higher urinary albumin, sodium levels and urinary fractional sodium excretion (respectively p= 0,038, p= 0,044, and p= 0,038). Additionally, metabolic acidosis was detected in 44.4% of COVID-19 patients, and a significant positive correlation was found between serum bicarbonate level and estimated glomerular filtration rate (p= 0,006). Our study showed that 21% hypophosphatemia, 17.8% hyponatremia, and 2.4% hypoalbuminemia were detected in COVID-19 patients. While hyponatremia and vii hypophosphatemia were detected more frequently in patients with AKI (respectively p= 0,022, p= 0,028), serum albumin levels were significantly lower in patients with AKI (p= 0,043). In the three-month follow-up of COVID-19 patients, it was determined that AKI and electrolyte disturbances continued in some of the patients. It was determined that 40% of MIS-C patients had AKI according to both criteria. Although serum interleukin-6, procalcitonin, C-reactive protein, and D-dimer levels of the patients with AKI were higher than those without AKI, it was not considered statistically significant. Hyponatremia was detected in all of the patients, hypocalcemia 80%, hypokalemia 60%, hypochloremia 60%, and hypophosphatemia 60%. The urinary sodium level of all the patients was >40 mmol/L, and the fractional sodium excretion was <1 in 60% of the patients. The urinary protein/creatinine ratio was higher in 40% of the patients. However, after a three-month follow-up, AKI has not detected. During the follow-ups, the urine protein/creatinine ratio of the patients regressed to be normal. It was determined that serum electrolyte disorders detected in the first diagnosis improved in the second and third months. Hyperphosphatemia was detected in only one patient at the third-month follow-up. The findings showed that; AKI often causes in children with COVID-19 and MIS-C disease. Although AKI is increasing in COVID-19 patients who need intensive care, it is also frequently seen in outpatients without any chronic disease. The damage is increased in patients with undernutrition and dehydration that suggesting the possibility of prerenal AKI. However, primarily tubular damage indicators such as proteinuria and serum electrolyte disturbances are frequently impaired in patients indicating that kidney damage is also present at the renal level. As a result, the progression and/or persistence of AKI in participating patients, both at first diagnosis and three-month follow-up, is strongly suggested that childhood COVID-19 patients should be examined in terms of kidney damage in the long term.
In this study, cases in Necmettin Erbakan University Meram Medical Faculty pediatric emergency or other pediatric services between January and March 2022 were examined. The study included 130 patients with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test and five patients followed up with the diagnosis of multisystem inflammatory syndrome in children (MIS-C). KDIGO and pRIFFLE criteria were used for the diagnosis of acute kidney injury (AKI). The IBM SPSS 22.0 software was used to analyse collected data and the result was considered as significant p<0.05. According to the obtained results, it was found that AKI occurred in 31.5% of COVID-19 patients. The patient's age (24.8 months, min:1 max:211) was determined in those with AKI and it was considered statistically significant. (p= 0.005). In addition, it was determined that the frequency of AKI was significantly increased in patients with complaints of decreased nutrition and dehydration, dry mucous membranes, and dry skin in the examination (respectively p= 0,041, p= 0,001, p= 0,001, p= 0,035). The frequency of AKI was also found to be increased in patients followed in the intensive care unit (p= 0,038). The frequency of AKI did not change in the patients having chronic diseases or drug use. In addition, patients with AKI had significantly lower serum fibrinogen levels but significantly higher D-dimer levels (respectively p= 0,047, p= 0,035). It was found that 24% of patients had higher urinary albumin/ creatinine ratio and 48.8% of patients had higher urinary protein creatinine levels. It was found that patients with AKI had significantly higher urinary albumin, sodium levels and urinary fractional sodium excretion (respectively p= 0,038, p= 0,044, and p= 0,038). Additionally, metabolic acidosis was detected in 44.4% of COVID-19 patients, and a significant positive correlation was found between serum bicarbonate level and estimated glomerular filtration rate (p= 0,006). Our study showed that 21% hypophosphatemia, 17.8% hyponatremia, and 2.4% hypoalbuminemia were detected in COVID-19 patients. While hyponatremia and vii hypophosphatemia were detected more frequently in patients with AKI (respectively p= 0,022, p= 0,028), serum albumin levels were significantly lower in patients with AKI (p= 0,043). In the three-month follow-up of COVID-19 patients, it was determined that AKI and electrolyte disturbances continued in some of the patients. It was determined that 40% of MIS-C patients had AKI according to both criteria. Although serum interleukin-6, procalcitonin, C-reactive protein, and D-dimer levels of the patients with AKI were higher than those without AKI, it was not considered statistically significant. Hyponatremia was detected in all of the patients, hypocalcemia 80%, hypokalemia 60%, hypochloremia 60%, and hypophosphatemia 60%. The urinary sodium level of all the patients was >40 mmol/L, and the fractional sodium excretion was <1 in 60% of the patients. The urinary protein/creatinine ratio was higher in 40% of the patients. However, after a three-month follow-up, AKI has not detected. During the follow-ups, the urine protein/creatinine ratio of the patients regressed to be normal. It was determined that serum electrolyte disorders detected in the first diagnosis improved in the second and third months. Hyperphosphatemia was detected in only one patient at the third-month follow-up. The findings showed that; AKI often causes in children with COVID-19 and MIS-C disease. Although AKI is increasing in COVID-19 patients who need intensive care, it is also frequently seen in outpatients without any chronic disease. The damage is increased in patients with undernutrition and dehydration that suggesting the possibility of prerenal AKI. However, primarily tubular damage indicators such as proteinuria and serum electrolyte disturbances are frequently impaired in patients indicating that kidney damage is also present at the renal level. As a result, the progression and/or persistence of AKI in participating patients, both at first diagnosis and three-month follow-up, is strongly suggested that childhood COVID-19 patients should be examined in terms of kidney damage in the long term.
Açıklama
Anahtar Kelimeler
COVID-19, MIS-C, Akut böbrek hasarı, Çocuk, COVID-19, MIS-C, Acute kidney injury, Child
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Ünsaçar. M. Z. (2022). COVİD-19 geçiren çocuklarda böbrek hasarının değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
