Nghiên cứu giá trị chẩn đoán của tiêu chuẩn KDIGO, RIFLE, AKIN, cystatin C huyết thanh và các yếu tố nguy cơ dự báo tổn thương thận cấp sau mổ tim mở (TT ANH)

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INTRODUCTION Acute kidney injury (AKI) is a syndrome characterized by the rapid decline of renal function which leads to homeostatic imba lance. In the past, the common term of this syndrome was acute renal failure, and since 2004 it has been replaced by acute k idney injury, and accompanied with some new diagnostic criter ia such as KDIGO, RIFLE and AKIN. AKI can occur in many different kinds of patients , such as infection, trauma , toxicit y, surgery… w ith the inc idence ranging from 1 to 80% according to the subjects and definit ions applied. Especially, in cardiac surgery, the AKI rate can be as high as 40% with t he mortalit y up t o 60% in pat ients requir ing rena l replacement therapy (RRT), compared with 2-8% in general cardiac surgery. Therefore, early predict ing and d iagnosing is e ssentia l for effe ctive prevention of AKI. To accomplish it , we need first t o identif y the r isk factors, and then, use predict ion scores to calculate the poss ibilit y of AKI occurrence after surgery. Beside that, us ing so me new b iological markers such as cystatin C, NGAL…which have been init ially reported of having ability to early diagnose AKI is a lso reasonable approach. In Vietnam, there are only a few research on these issues. Therefore, we carried out this study for 2 a ims : 1. To evaluate the role of KDIGO, RIFLE, AKIN criteria, serum cystatin C in diagnosing of AKI in the early period af ter open-heart surgery 2. To determine the risk f actors and the value of Cleveland Clinic, AKICS and ACEF scores to predict AKI in the early period af ter openheart surgery M INISTRY OF EDUCATION & TRAINING M INISTRY OF DEFENCE 108 INS TITUTE OF CLIN ICAL MED ICAL AND PHARMACEUTICAL S CIENC ES NGO DINH TRUNG STUDY ON THE DIAGNOSTIC VALUE OF KDIGO, RIFLE, AKIN CRITERIA, SERUM CYSTATIN C AND RISK FACTORS FOR CARDIAC SURGERYASSOCIATED ACUTE KIDNEY INJURY Specialty: Anesthes ia and Critical Care Code: 62720122 SUMMARY OF MEDICAL DOCTORAL THESIS Hanoi – 2020 This study is completed in 108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES Supervisor: Assoc Prof PhD Tran Duy Anh Reviewer 1: ……………………………………………… Reviewer 2: ……………………………………………… Reviewer 3: ……………………………………………… The thesis will be presented at Institute Council of 108 Institute of Clinical Medical and Pharmaceutical Sciences at hour day month year The thesis can be found at: National library Library of the Clinical Medicine Research Institute 108 INTRODUCTION Acute kidney injury (AKI) is a syndrome characterized by the rapid decline of renal function which leads to homeostatic imbalance In the past, the common term of this syndrome was acute renal failure, and since 2004 it has been replaced by acute kidney injury, and accompanied with some new diagnostic criteria such as KDIGO, RIFLE and AKIN AKI can occur in many different kinds of patients, such as infection, trauma, toxicity, surgery… with the incidence ranging from to 80% according to the subjects and definitions applied Especially, in cardiac surgery, the AKI rate can be as high as 40% with the mortality up to 60% in patients requiring renal replacement therapy (RRT), compared with 2-8% in general cardiac surgery Therefore, early predicting and diagnosing is essential for effective prevention of AKI To accomplish it, we need first to identify the risk factors, and then, use prediction scores to calculate the possibility of AKI occurrence after surgery Beside that, using some new biological markers such as cystatin C, NGAL…which have been initially reported of having ability to early diagnose AKI is also reasonable approach In Vietnam, there are only a few research on these issues Therefore, we carried out this study for aims: To evaluate the role of KDIGO, RIFLE, AKIN criteria, serum cystatin C in diagnosing of AKI in the early period after open-heart surgery To determine the risk factors and the value of Cleveland Clinic, AKICS and ACEF scores to predict AKI in the early period after openheart surgery Practical significance and new contributions In Vietnam and also in the world, cardiac surgery using cardiopulmonary bypass is very popular The advances in skills, techniques and equipments have helped to improve the overall outcomes However, there have still been some complications, one of them is AKI, which could lead to higher morbidity and mortality of these patients Therefore, early detect and prevent this complication is very important New contributions of the thesis: Applying new criteria, including KDIGO, RIFLE, AKIN, in diagnosing AKI after cardiac surgery, and giving comparisons and recommendations for using these criteria in clinica l practice Determining the value of serum cystatin C in diagnosing cardiac surgery-associated acute kidney injury, and the possibility of application in clinical practice Determining the risk factors and the value of some risk scores (Cleveland Clinic, AKICS and ACEF) in predicting AKI after cardiac surgery, which could help to early predict, diagnose and so prevent this complication Structure of the thesis The dissertation has 122 pages, including pages of Introduction, 35 pages of Overview, 21 pages of Subjects and Methods, 31 pages of Results, 32 pages of Discussion, pages of Conclusion, and page of Recommendation There are 34 tables, 16 figures, pictures with 155 references, including in Vietnamese and 149 in English The published works related to the thesis, studying protocol and list of participating subjects are also included Chapter OVERVIEW 1.1 Anatomical and functional features of kidney The structural and functional unit of kidney is nephron, which is composed of a renal corpuscle and a renal tubule The main function of nephron is to filter out wastes and toxins from the blood, and return needed molecules The renal function is represented by Glomerular filtration rate (GFR) In clinica l practice, creatinine clearance rate (Ccr) is commonly used to evaluate the GFR 1.2 Diagnostic criteria for acute kidney injury For many years, acute renal failure used to be the term indicating the rapid decline in renal function; however, there was no consensus definition for this condition Therefore, since 2004, the term acute kidney injury has been proposed to replace “acute renal failure”, accompanied with some newly developed definitions for AKI such as RIFLE (2004), AKIN (2007) and KDIGO (2012) According to the RIFLE criteria, AKI is defined as an increase of serum creatinine (Scr) with 50%, corresponding to a decrease in GFR, relative to baseline, of >25% or a urine output (UO) of 6h The RIFLE classification considers three severity classes of AKI (Risk, Injury and Failure), according to the variations in serum creatinine and/or urine output, and two outcome classes (loss of kidney function and end-stage kidney disease) The AKIN classification is a later version of RIFLE: it only relies on SCr and not on GFR changes; AKI is defined by the sudden decrease (in 48 h) of renal function, defined by an increase in absolute SCr of at least 26.5 μmol/L (0.3 mg/dl) or by a percentage increase in SCr ≥50% (1.5× baseline value), or by a decrease in the UO (documented oliguria
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