COVID-19 Enfeksiyonunda Böbrek Hasarı ve Yönetimi
Özet
COVID-19 enfeksiyonunda akut böbrek hasarı (ABH), özellikle ağır seyreden vakalarda ve yoğun bakım hastalarında mortaliteyi önemli ölçüde artıran yaygın bir komplikasyondur. Bu hasarın gelişiminde hipovolemi, akut solunum sıkıntısı sendromu (ARDS) ile ilişkili hemodinamik değişiklikler ve yüksek PEEP uygulamaları, sitokin fırtınası sendromunun tetiklediği hiperinflamatuar süreçler ve virüsün ACE-2 reseptörü aracılığıyla böbrek tübüler epitel hücrelerine doğrudan viral invazyonu olmak üzere dört temel patofizyolojik mekanizma rol oynamaktadır. Hastalığın yönetiminde, idrar tahlili yoluyla hematüri ve proteinürinin erken dönemde taranması riskli hastaların tespiti açısından kritik bir öneme sahipken; tedavi sürecinde övoleminin sağlanması, izotonik salin yerine dengeli kristaloidlerin tercih edildiği kontrollü sıvı yönetimi ve endike durumlarda sürekli renal replasman tedavisinin (CRRT) zamanında başlatılması önerilmektedir. Genel popülasyona kıyasla daha yüksek ABH insidansı ve mortalite oranına sahip olan böbrek nakli alıcılarında ise erken hacim resüsitasyonunun yanı sıra immünosupresif tedavilerin hastanın klinik durumuna göre titizlikle yeniden düzenlenmesi hayati bir önem taşımaktadır.
In patients with COVID-19 infection, acute kidney injury (AKI) is a common complication that significantly increases mortality, particularly in severe cases and intensive care patients. Four primary pathophysiological mechanisms play a role in the development of this injury: hypovolemia, hemodynamic alterations and high PEEP applications associated with acute respiratory distress syndrome (ARDS), hyperinflammatory processes triggered by cytokine storm syndrome, and direct viral invasion of renal tubular epithelial cells by the virus via the ACE-2 receptor. In the management of the disease, early screening of hematuria and proteinuria through urinalysis is critical for identifying high-risk patients, while the treatment process recommends maintaining euvolemia, employing controlled fluid management with balanced crystalloids instead of isotonic saline, and initiating continuous renal replacement therapy (CRRT) timely when indicated. For kidney transplant recipients, who present with higher AKI incidence and mortality rates compared to the general population, prompt fluid resuscitation and the meticulous adjustment of immunosuppressive therapies according to the patient's clinical status are of vital importance.
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