Med J Bakirkoy. 2021; 17(1): 85-93 | DOI: 10.5222/BMJ.2021.25338

Monitorization of NGAL, Creatinine and Renal Blood Flow in the Follow-up of Acute Kidney Injury in Intensive Care

Mehmet Süleyman Sabaz¹, Halil Çetingök², Gokhan Sertcakacilar³, Yusuf Ziya Yener³, Erdal Atiç³, Aysun Erbahceci Salik⁴, Evrim Kucur Tulubas³, Gulsum Oya Hergunsel^3
1Department of Anesthesiology and Reanimation, Division of Intensive Care, Marmara University Pendik Training And Research Hospital, Istanbul, Turkey
²Department of Anesthesiology and Reanimation, Division of Algology, Istanbul University Istanbul Faculty Of Medicine, Istanbul, Turkey
³Department of Anesthesiology and Reanimation, Health Sciences University Bakýrköy Dr Sadi Konuk Training And Research Hospital
⁴Department of radiology, Health Sciences University Bakýrköy Dr Sadi Konuk Training And Research Hospital, Istanbul, Turkey

Objectýve: Acute Kidney Injury (AKI) and subsequent renal failure are the leading causes of morbidity and mortality in the intensive care unit (ICU). In this study, it was planned to compare Neutrophil Gelatinase-associated Lipocalin (NGAL) and creatinine values in patients diagnosed with AKI and to determine the effect of renal dose dopamine use on renal blood flow, development of chronic renal failure (CRF) and mortality.
Materýals and methods: This prospective study was planned with 35 patients developed AKI in the ICU of Bakýrköy Dr. Sadi Konuk Training and Research Hospital. The patients were randomized into 2 groups as 18 patients who received dopamine treatment with the recommendation of the cardiology clinic and 17 patients who did not receive dopamine treatment. Urea, creatinine and NGAL plasma levels were compared between groups.
Results: There was no difference between the groups in terms of age, gender and AKI stage. The 0th, 24th hour results and 24-hour changes of urea, creatinine and NGAL values of dopamine patient, who took dopamine, were found to be similar to those of patients who did not take dopamine. A significant positive correlation was found between the 24-hour change in creatinine value and the 24-hour change in NGAL (r=0.374; p<0.05). There was no significant change in the diameter and flow of renal arteries between measurements in patients who received dopamine. The rates of patients who regain normal kidney functions, develop CRF or develop mortality between the two groups were found to be similar.
Conclusýon: Treatment results of AKI developing in ICU are not satisfactory. Low-dose dopamine treatment has no effect on patient outcomes in these patients. NGAL is a biomarker that has the ability to show renal damage at an early stage. Serial measurement of NGAL concentration during ICU stay may benefit the clinician in early diagnosis and follow-up of AKI.

Keywords: Acute Kidney Injury, NGAL, Creatinine, Renal Doppler Ultrasonography, Intensive Care Unit

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Yoðun Bakýmda Akut Böbrek Hasarý Takibinde NGAL, Kreatinin ve Renal Kan Akýmýnýn Monitörizasyonu

Mehmet Süleyman Sabaz¹, Halil Çetingök², Gokhan Sertcakacilar³, Yusuf Ziya Yener³, Erdal Atiç³, Aysun Erbahceci Salik⁴, Evrim Kucur Tulubas³, Gulsum Oya Hergunsel^3
1Anesteziyoloji ve Reanimasyon Bölümü, Yoðun Bakým Ünitesi, Marmara Üniversitesi Pendik Eðitim Ve Araþtýrma Hastanesi, Ýstanbul, Türkiye
²Anesteziyoloji ve Reanimasyon Ana Bilim Dalý, Algoloji Bilim Dalý, Istanbul Üniversitesi Istanbul Týp Fakültesi, Ýstanbul, Türkiye
³Anesteziyoloji ve Reanimasyon Bölümü, Saðlýk Bilimleri Üniversitesi Bakýrköy Dr Sadi Konuk Eðitim Ve Araþtýrma Hastanesi, Ýstanbul, Türkiye
⁴Radyoloji Bölümü, Saðlýk Bilimleri Üniversitesi Bakýrköy Dr Sadi Konuk Eðitim Ve Araþtýrma Hastanesi, Ýstanbul, Türkiye

Amaç: Akut böbrek hasarý (AcuteKidneyInjury: AKI) ve sonrasýnda geliþen böbrek yetmezliði YBÜ’nde morbidite ve mortalite nedenlerinin baþýnda yer alýr. Bu çalýþmada AKI tanýsý alan hastalarda Nötrofil jelatinaz-iliþkili lipokalin (NGAL) ve kreatinin deðerlerini karþýlaþtýrmak, renal doz dopamin kullanýmýnýn, böbrek kan akýmý, kronik böbrek yetmezliði (KBY) geliþimi ve mortalite üzerindeki etkisini belirlemek planlanmýþtýr.
Gereç ve yöntem: Bu prospektif araþtýrma Bakýrköy Dr.Sadi Konuk Eðitim ve Araþtýrma Hastanesi YBÜ’nde, AKI geliþen toplam 35 hasta ile planlandý. Hastalar, kardiyoloji kliniðinin önerisi ile dopamin tedavisi alan 18 hasta ve dopamin tedavisi almayan 17 hasta olacak þekilde 2 gruba randomize edildi. Hastalarýn 0. ve 24. saatte üre, kreatinin ve NGAL plazma seviyeleri gruplar arasýnda karþýlaþtýrýldý.
Bulgular: Gruplar arasýnda yaþ, cinsiyet ve AKI evresi açýsýndan fark yoktu. Dopamin alan hastalarýn üre, kreatinin ve NGAL deðerlerinin 0., 24. saat sonuçlarý ve 24 saatlik deðiþimleri dopamin almayan hastalarla benzer bulundu. Kreatinin deðerindeki 24 saatlik deðiþim ile NGAL deðerindeki 24 saatlik deðiþim miktarý arasýnda anlamlý pozitif korelasyon olduðu belirlendi (r=0.374; p <0,05). Dopamin alan hastalarda renal arterlerin çap ve akýmýnda ölçümler arasýnda anlamlý deðiþiklik saptanmadý. Ýki grup arasýnda normal böbrek fonksiyonlarýný geri kazanan, KBY geliþen veya mortalite geliþen hastalarýn oranlarý benzer bulundu.
Sonuç: Yoðun bakýmda geliþen AKI’nin tedavi sonuçlarý tatmin edici deðildir. Bu hastalarda düþük doz dopamin tedavisinin hasta sonuçlarýna bir etkisi yoktur. NGAL, renal hasarý erken dönemde gösterme becerisine sahip bir biyobelirteçtir. YBÜ'nde kalýþ süresi boyunca NGAL konsantrasyonunun seri ölçümü AKI nin erken tanýnmasý ve takibinde klinisyene fayda saðlayabilir.

Anahtar Kelimeler: Akut Böbrek Hasarý, NGAL, Kreatinin, Renal Doppler Ultrasonografi, Yoðun Bakým Ünitesi

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