Akutno bubrežno oštećenje i metforminska laktacidoza kod COVID-19 infekcije – prikaz slučaja

professional thesis

• Author: Neven Bosanac
• Mentor: Krešimir Galešić (mentor)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2023-02-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Od početka izbijanja epidemije koronavirusa (SARS-COV-2) krajem 2019. godine, kasnije nazvanom infekcijom COVID-19, ona je doživljavana primarno kao respiratorna bolest. Međutim, vrlo brzo je otkriveno da praktično nema organskog sustava koji ova bolest ne zahvaća, pa tako i uzrokuje oštećenje bubrega. Akutno bubrežno oštećenje je učestala komplikacija kod hospitaliziranih pacijenta s COVID-19 infekcijom, osobito kod osoba s pridruženim komorbiditetima kao što su šećerna bolest tipa 2. Kako je metformin jedan od najčešće korištenih oralnih hipoglikemika; lijek prvog izbora i linije; kod tih pacijenata je i povećan rizik za razvoj metaboličke laktacidoze.
Laktacidoza uvjetovana uporabom metformina u terapiji je relativno rijetko zbivanje, no može uzrokovati teške komplikacije osobito kod osoba s bubrežnim oštećenjem. Zbog smanjenog izlučivanja putem urina dolazi do posljedične akumulacije metformina u organizmu te disbalansa u metabolizmu laktata te nastanka metaboličke acidoze. Kao dodatni čimbenik se izdvaja i dehidracija u sklopu ostalih simptoma kao što su proljev i povraćanje koji dodatno doprinose oštećenju bubrežne funkcije.
U ovom prikazu slučaja se opisuje pacijentica s akutnom bubrežnom ozljedom, šećernom bolesti, laktacidozom uvjetovanom primjenom metformina s COVID-19 infekcijom te enterokolitisom uzrokovanim Clostridium difficile. Iako je laktacidoza opisana kao rijetka komplikacija uporabe metformina, ista može biti i fatalnog ishoda. Prikazane su i moguće životno ugrožavajuće komplikacije COVID-19 infekcije (plućna embolija) u razdoblju poslije bolesti COVID-19.
Brzim pristupom nadomjesnom bubrežnom liječenju, bez odlaganja, unatoč tehničkim manjkavostima, dobrom organizacijom te požrtvovanošću medicinskog osoblja u izvanrednim uvjetima rada, mogu se postići uspješni rezultati liječenja kao i adekvatnog zbrinjavanja i liječenja mogućih komplikacija.

Abstract (english)

Since the beginning of the outbreak of the corona virus epidemic (SARS-COV-2) at the end of 2019, then called COVID-19 infection, it has been seen primarily as a respiratory disease.However, it was quickly discovered that there is practically no organ system that is not affected by this disease, and thus causes kidney damage. Acute renal impairment is a common
complication in hospitalized patients with COVID-19 infection, particularly in individuals with associated comorbidities such as type 2 diabetes. How metformin is one of the most commonly used oral hypoglycemics; drug of first choice and line; these patients also have an increased risk of developing metabolic lactic acidosis.
Lactic acidosis due to the use of metformin in therapy is relatively rare, but can cause severe complications, especially in people with renal impairment. Due to reduced urinary excretion, there is a consequent accumulation of metformin in the body and an imbalance in lactate metabolism and the development of metabolic acidosis. An additional factor is dehydration as part of other symptoms such as diarrhea and vomiting, which further contribute to impaired renal function.
This case report describes a patient with acute renal injury, diabetes, lactic acidosis due to metformin with COVID-19 infection, and enterocolitis caused by Clostridium difficile. Although lactic acidosis has been described as a rare complication of metformin use, it can be fatal. Possible life-threatening complications of COVID-19 infection (pulmonary embolism) in the post-covid period have also been presented.
With quick access to renal replacement therapy, without delay, despite technical shortcomings, good organization and dedication of medical staff in emergency conditions, successful treatment results can be achieved as well as adequate care and treatment of possible complications.

• Keywords: akutna bubrežna ozljeda; nadomjesno bubrežno liječenje; laktacidoza; metformin; šećerna bolest; infekcija COVID-19; plućna embolija; Clostridium difficile
• Keywords (english): acute renal injury; renal replacement therapy; lactic acidosis; metformin; diabetes; COVID-19 infection; pulmonary embolism; Clostridium difficile
• Language: croatian
• URN:NBN: urn:nbn:hr:105:160166
• Study programme: Title: Nephrology; Study programme type: university; Study level: postgraduate specialist; Academic / professional title: sveučilišni/a magistar/magistra nefrologije (sveučilišni/a magistar/magistra nefrologije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-12-19 12:30:15