Covid-19 ve Akut Böbrek Hasarı
Özet
COVID-19 hastalığı sıklıkla akciğer tutulumuyla seyretse de, hastanede yatan hastalarda akut böbrek hasarı (ABH) önemli ve mortaliteyi artıran bir komplikasyon olarak öne çıkmaktadır. Enfeksiyonun seyri sırasında yoğun bakım ihtiyacı olan hastalarda ABH insidansı %30-50 seviyelerine ulaşmakta, entübasyon gerektiren durumlarda ise bu oran %78'e kadar yükselmektedir. Patofizyolojide bölgesel ve sistemik inflamatuvar yanıtlar, vasküler endotel hasarı, mikrotrombüs oluşumu ve virüsün ACE2 reseptörlerine bağlanarak renin-anjiotensin-aldosteron sistemini (RAAS) bozması kritik roller oynamaktadır. Bu durum anjiotensin 2 birikimine yol açarak proinflamatuvar ve vazokonstriktör süreçleri tetiklemektedir. Tedavide spesifik bir ilaç bulunmamakla birlikte; hemodinamik destek, nefrotoksik ajanlardan kaçınma, sıvı yönetimi ve seçilmiş vakalarda sürekli renal replasman tedavisi uygulanmaktadır.
Although COVID-19 primarily manifests as a pulmonary infection, acute kidney injury (AKI) is a significant complication that increases mortality, particularly in hospitalized individuals. The incidence of AKI reaches 30-50% among patients requiring intensive care, escalating up to 78% in intubated cases. The underlying pathophysiology involves localized and systemic immune responses, endothelial damage, microthrombosis, and the disruption of the renin-angiotensin-aldosterone system (RAAS) via viral binding to ACE2 receptors. This viral interaction leads to angiotensin 2 accumulation, triggering pro-inflammatory and vasoconstrictive mechanisms. Management relies on supportive interventions, avoiding nephrotoxic agents, fluid balancing, and utilizing continuous renal replacement therapy in severe cases.
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