Modaliteti liječenja hemodijalizom kod akutnog bubrežnog zatajenja

master's thesis

• Title (english): Hemodialysis modalities in acute kidney injury
• Author: Barbara Borojević
• Mentor: Tonko Gulin (mentor)
• Committee member: Sandra Karanović Štambuk (predsjednik povjerenstva)
• Committee member: Ivana Vuković Brinar (član povjerenstva)
• Committee member: Tonko Gulin (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Bubreg je ključni organ u održavanju homeostaze vode i elektrolita u tijelu te izlučivanju razgradnih produkata (urea, kreatinin) iz organizma. Naglo slabljenje ili gubitak bubrežne funkcije dovodi do nastanka akutnog bubrežnog zatajenja (ABZ). Uzroci ABZ-a mogu biti prerenalni (smanjena perfuzija bubrega), renalni (oštećenje unutar bubrega) ili postrenalni (opstrukcija). Glavni parametri za postavljanje dijagnoze i određivanje stadija ABZ-a su promjene u koncentraciji serumskog kreatinina i volumena diureze. Ako se konzervativnim metodama liječenja ne postigne oporavak bubrežne funkcije, potrebno je, na temelju individualne procjene bolesnika, započeti bubrežnu nadomjesnu terapiju (BNT). BNT uključuje peritonealnu dijalizu, hemodijalizu, hemofiltraciju i transplantaciju bubrega. Hemodijaliza se može primjeniti u raznim modalitetima, kao intermitentna hemodijaliza (IHD) ili kontinuirana bubrežna nadomjesna terapija (KBNT). IHD se primjenjuje u hemodinamski stabilnih pacijenata s potrebom za brzo uklanjanje toksičnih tvari, dok se KBNT koristi u hemodinamski nestabilnih pacijenata s potrebama za većim uklanjanjem tekućine i otopljenih tvari. Stopa mortaliteta je visoka u ABZ-u, pogotovo kod bolesnika koji zahtijevaju neki oblik BNT-a i zbrinjavanje u jedinicama intenzivne skrbi. Visoki mortalitet je uzrokovan većinom samom težinom bolesti (sepsa, multiorgansko zatajenje), no postoji i niz komplikacija hemodijalize koje mogu nepovoljno djelovati na bolesnikovo stanje. Komplikacije koje se mogu javiti uključuju hipotenziju, hemoragiju, infekciju, sindrom disekvilibrija, reakciju na dijalizator te disbalans elektrolita i acidobazne ravnoteže.

Abstract (english)

The kidney is a key organ in maintaining water and electrolytes homeostasis in the body and excreting waste products (urea, creatinine). A sudden decrease or loss of kidney function leads to acute kidney failure (AKF). The causes of AKF can be pre-renal (reduced kidney perfusion), renal (damage inside the kidney) or post-renal (obstruction). The main criterias for diagnosing and determining the stage of AKF are changes in serum creatinine concentration and urine output. If treatment with conservative methods does not lead to recovery of kidney function, it might be necessary, based on the individual assessment of the patient, to start renal replacement therapy (RRT). RRT includes peritoneal dialysis, hemodialysis, hemofiltration and kidney transplantation. Hemodialysis can be applied in various modalities, such as intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT). IHD is used in hemodynamically stable patients with a need for rapid removal of toxic substances, while CCRT is used in hemodynamically unstable patients with a need for greater removal of fluid and solutes. The mortality rate is high in AKF, especially in patients who require some form of RRT and treatment in intensive care unit. High mortality is mostly caused by the severity of the illness (sepsis, multiorgan failure), but there are also several hemodialysis complications that can have an adverse effect on the patient's condition. Complications that may occur include hypotension, hemorrhage, infection, disequilibrium syndrome, dialyzer reaction, electrolytes and acid-base imbalance.

• Keywords: akutno bubrežno zatajenje; akutno bubrežno oštećenje; hemodijaliza; intermitentna hemodijaliza; kontinuirana bubrežna nadomjesna terapija
• Keywords (english): acute kidney failure; acute kidney injury; hemodialysis; intermittent hemodialysis; continuous renal replacement therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:825363
• 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
• Created on: 2023-10-23 10:54:40