Kanser hastalarında kontrastlı bilgisayarlı tomografi çekimi sonrası kontrast madde nefropatisi gelişme riski ve prediktif faktörler
Yükleniyor...
Dosyalar
Tarih
2011
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızın amacı hastanede yatırılarak tedavi edilen kanserli hastalarda kontrast madde nefropatisi sıklığının ve olası prediktif faktörlerinin araştırılmasıdır. Çalışmaya Tıbbi Onkoloji servisinde tetkik, kanser tedavisi, tedavi ya da hastalık komplikasyonları nedeniyle yatırılan ve kontrastlı bilgisayarlı tomografi çekilen 18 yaş ve üstü kanserli hastalar dahil edildi. Glomerüler filtrasyon hızı 60 ml/dk altında olan hastalar çalışma dışı bırakıldı. Çeşitli nedenlerle Tıbbi Onkoloji servisine yatırılan kanserli hastalarda kontrastlı bilgisayarlı tomografi çekilmesinden sonra hastaların %21.7'sinde kontrast madde nefropatisi gelişmiştir. Tüm hastaların %1.7'sinde, kontrast madde nefropatisi gelişen hastaların %7.7'sinde akut böbrek yetmezliği gelişmiştir. Kontrast madde nefropatisi riski kemoterapi alan hastalarda daha yüksek saptanmıştır (p=0.054). Bu hastalarda kontrast madde nefropatisi sıklığı %30, akut böbrek yetmezliği sıklığı %3 saptanmıştır. Kontrast madde nefropatisi gelişmesi; kanser bölgesi (p=0.62), kanser evresi (p=0.24), aktif kanser varlığı ya da yokluğu (p=0.6), son kemoterapi ile kontrast madde uygulamasına kadar geçen süre(p=0.44), uygulanan kemoterapi ilaçları ve birden fazla kemoterapi seçimi uygulanması (p=0.36) ile ilişkili bulunmadı. Kontrast madde nefropatisi gelişmesi; yaş (p>0.84), cinsiyet (p>0.46), boy ve kilo ile ilişkili bulunmadı. Diyabetes mellitus ve hipertansiyon, kontrast madde nefropatisi gelişimi ile ilişkili bulunmadı (p=0.19). Kontrast madde miktarı ile kontrast madde nefropatisi gelişmesi arasında ilişki bulunmadı (p=0.97). Anemi varlığı, kontrast madde nefropatisi gelişimi ile ilişkili olma eğiliminde idi. Bu anlamlı olmaya eğilimli ilişki kemoterapi alan hastalarda anlamını kaybederken (p=0.22) kemoterapi almayan hastalarda daha belirgindi (p=0.057). Serum sodyum, potasyum ve laktat dehidrogenaz enzim düzeyleri kontrast madde nefropatisi ile ilişkili bulunmadı (sırasıyla p=0.46, p=0.89, p=0.76). Çalışmamızda herhangi bir nedenle hastanede yatırılarak tedavi edilen ve kontrastlı bilgisayarlı tomografi çekilen özellikle kemoterapi alan ya da almış olan kanserli hastalarda kontrast madde nefropatisi sıklığının %30 kadar yüksek olabileceği ve bu hastalarda %3 oranında akut böbrek yetmezliği gelişebileceği ortaya konmuştur. Kanserli hastalarda anemi ve kemoterapinin uygulanmış olması dışında diğer klinik ve laboratuar faktörlerinin kontrast madde nefropatisi gelişiminde etkili olmadığı gözlenmiştir.
Abstract
The aim of our study is to search the frequency of developing contrast induced nephropathy on patients being treated by hospitalizing and to serach its probable predictive factors. The patients being hospitalized with the reason of examination, cancer treatment, treatment of disease complications and whose contrast enhanced computerized tomography were taken at the age of above 18 were included to this study. The patients whose glomerular filtration rate is below 60 ml/min were excluded from this study. The contrast induced nephropathy has emerged at the 21% of the cancer patients who were admitted to medical oncology service for various reasons and performed contrast-enhanced computerized tomography. Acute renal failure emerged on the 1.7% of all patients and the 7.7% of the patients with CIN emergence. The risk of contrast induced nephropathy was detected much higher on patients receiving chemotherapy (p=0.054). The frequency of contrast induced nephropathy as 30% and the frequency of acute renal failure as 3% were detected on these patients. The cancer area (p=0.62), the stage of cancer (p=0.24), the presence of active cancer or the absence (p=0.6), the duration until the latest chemotherapy and contrast agent application (p=0.44), the chemotherapy medicine applied and the appliance of the choice of chemotherapy more than once (p=0.36), were not found in a relation with the emergence of contrast induced nephropathy. The emergence of contrast induced nephropathy was not found in a relation with age (p>0.84), gender (p>0.46), height and weight. Diabetes mellitus and hypertension were not found in a relation with the emergence of contrast induced nephropathy (p=0.19). The amount of the conrast agent was not found in a relation with the emergence of contrast induced nephropathy (p=0.97). The presence of anemia had a tendency to be in a relation with the emergence of contrast induced nephropathy. On one hand, while the relation, with a tendency to be significant, was losing its significance on patients applied chemotherapy (p=0.22); on the other hand, it was more evident on patients not applied chemotherapy (p=0.057). The blood levels of sodium, potassium and lactate dehydrogenase enzyme were not found in a relation with the emergence of contrast induced nephropathy (respectively p=0.46, p=0.89, p=0.76). In our study, the frequency of contrast induced nephropathy may be as high as %30 and the emergency of acute renal failure may be high as %3 was presented, on the patients with cancer whom were performed contrast enhanced computerized tomography and who is admitted to hospital, treated for any reason, especially were taking or took chemotherapy. In patients with cancer, other clinical and laboratory factors were not found effective on the emergence of contrast induced nephropathy, except anemia and chemotherapy applied.
Abstract
The aim of our study is to search the frequency of developing contrast induced nephropathy on patients being treated by hospitalizing and to serach its probable predictive factors. The patients being hospitalized with the reason of examination, cancer treatment, treatment of disease complications and whose contrast enhanced computerized tomography were taken at the age of above 18 were included to this study. The patients whose glomerular filtration rate is below 60 ml/min were excluded from this study. The contrast induced nephropathy has emerged at the 21% of the cancer patients who were admitted to medical oncology service for various reasons and performed contrast-enhanced computerized tomography. Acute renal failure emerged on the 1.7% of all patients and the 7.7% of the patients with CIN emergence. The risk of contrast induced nephropathy was detected much higher on patients receiving chemotherapy (p=0.054). The frequency of contrast induced nephropathy as 30% and the frequency of acute renal failure as 3% were detected on these patients. The cancer area (p=0.62), the stage of cancer (p=0.24), the presence of active cancer or the absence (p=0.6), the duration until the latest chemotherapy and contrast agent application (p=0.44), the chemotherapy medicine applied and the appliance of the choice of chemotherapy more than once (p=0.36), were not found in a relation with the emergence of contrast induced nephropathy. The emergence of contrast induced nephropathy was not found in a relation with age (p>0.84), gender (p>0.46), height and weight. Diabetes mellitus and hypertension were not found in a relation with the emergence of contrast induced nephropathy (p=0.19). The amount of the conrast agent was not found in a relation with the emergence of contrast induced nephropathy (p=0.97). The presence of anemia had a tendency to be in a relation with the emergence of contrast induced nephropathy. On one hand, while the relation, with a tendency to be significant, was losing its significance on patients applied chemotherapy (p=0.22); on the other hand, it was more evident on patients not applied chemotherapy (p=0.057). The blood levels of sodium, potassium and lactate dehydrogenase enzyme were not found in a relation with the emergence of contrast induced nephropathy (respectively p=0.46, p=0.89, p=0.76). In our study, the frequency of contrast induced nephropathy may be as high as %30 and the emergency of acute renal failure may be high as %3 was presented, on the patients with cancer whom were performed contrast enhanced computerized tomography and who is admitted to hospital, treated for any reason, especially were taking or took chemotherapy. In patients with cancer, other clinical and laboratory factors were not found effective on the emergence of contrast induced nephropathy, except anemia and chemotherapy applied.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Kontrast madde nefropatisi, Kanser, Kemoterapi, Contrast Induced Nephropathy, Cancer, Chemotherapy
