Akutna bubrežna insuficijencija pacijenata u jedinici intenzivnog liječenja nakon kirurških zahvata

master's thesis

• Title (english): Acute kidney injury in postsurgical intensive care units
• Author: Barbara Mikuc
• Mentor: Dinko Tonković (mentor)
• Committee member: Slobodan Mihaljević (predsjednik povjerenstva)
• Committee member: Daniela Bandić Pavlović (član povjerenstva)
• Committee member: Dinko Tonković (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2023-09-19, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Akutna bubrežna insuficijencija u posljednjem je desetljeću preimenovana u pojam akutne bubrežne ozljede (ABO) koji je omogućio točniji i sveobuhvatniji opis ovog stanja, naglašavajući akutnost zbivanja i cijeli spektar bubrežne disfunkcije.

Postoperativna akutna bubrežna ozljeda je česta komplikacija koja se javlja u prosječno 25% pacijenata te je povezana sa većom učestalosti ranih i kasnih komplikacija, te povećanim mortalitetom. Čimbenici rizika za razvoj postoperativne ABO dijele se na preoperativne, intraoperativne i postoperativne. Oni uključuju stariju životnu dob, postojeću bubrežnu bolest i druge komorbiditete, te vrstu i trajanje operativnog zahvata. Uvođenje KDIGO dijagnostičkih kriterija olakšalo je rano postavljanje dijagnoze, omogućilo usporedbu epidemioloških podataka i provođenje istraživanja u ovom području. Prema KDIGO kriterijima dijagnoza se postavlja na osnovi razina serumskog kreatinina i diureze, a veliki napredak postignut je u razvoja novih specifičnijih biomarkera.

S obzirom da i dalje ne postoji istraživanjima potkrijepljeno učinkovito specifično liječenje ABO, najboljim postupkom liječenja smatra se prevencija. Važan alat u prevenciji su periodične usmjerene procjene zdravlja bubrega (engl. Kidney health assessment, KHA).

Održavanje optimalnog hemodinamskog statusa pacijenta kroz cijelo perioperativno razdoblje i izbjegavanje nefrotoksina temelj su renoprotektivnih mjera preporučenih od strane KDIGO organizacije. Njihovo pravodobno provođenje smanjuje incidenciju postoperativne ABO. Ukoliko ipak dođe do razvoja bubrežne ozljede, terapija je suportivna, a u težim je slučajevima potrebna i bubrežna nadomjesna terapija.

Abstract (english)

In the last decade, acute kidney insufficiency was renamed to the term acute kidney injury (AKI), which enabled a more accurate and comprehensive description of this condition, emphasizing the acuteness of the event and the entire spectrum of renal dysfunction.

Postoperative acute kidney injury is a common complication that occurs in an average of 25% of patients and is associated with a higher frequency of early and late complications, including increased mortality. Risk factors for the development of postoperative AKI are divided into preoperative, intraoperative, and postoperative. These include older age, existing kidney disease and other comorbidities, as well as the type and duration of the procedure. The introduction of the KDIGO diagnostic criteria facilitated early diagnosis, enabled the comparison of epidemiological data and the conducting of further research in this area. According to the KDIGO criteria, the diagnosis is made based on serum creatinine levels and diuresis, and great progress has been made in the development of new, more specific biomarkers of kidney injury.

Given that there is still no research-backed evidence on the effectiveness of any specific therapeutic procedure, the best treatment is prevention. An important tool in prevention are periodic targeted assessments of kidney health (Kidney health assessment, KHA).

Maintaining the patient's optimal hemodynamic status throughout the entire perioperative period and avoiding nephrotoxins are the basis of renoprotective measures recommended by the KDIGO organization. Their timely implementation reduces the incidence of postoperative ABO. If kidney injury does occur, the therapy is supportive, and in more severe cases, renal replacement therapy is required.

• Keywords: akutna bubrežna ozljeda; biomarkeri; postoperativno liječenje
• Keywords (english): acute kidney injury; biomarkers; postoperative care
• Language: croatian
• URN:NBN: urn:nbn:hr:105:336270
• 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: 2023-10-26 11:53:28