![\"Vlasov](\"https:\/\/treime.md\/wp-content\/uploads\/2016\/07\/Vlasov-Lilia.jpg\")
<\/a>Boala cronic\u0103 de rinichi are anumite particularit\u0103\u0163i evolutive la v\u00e2rstnici, determinate mai ales de prezen\u0163a crescut\u0103 a comorbidit\u0103\u0163ilor, \u00een special cardiovasculare. Bolile cerebrovasculare, alterarea statusului func\u0163ional, diabetul, denutri\u0163ia proteic\u0103 determin\u0103 o evolu\u021bie mai drastic\u0103 a IRA la v\u00e2rstnici.<\/p>\nPacien\u0163ii v\u00e2rstnici sunt de 34 de ori mai frecvent expu\u0219i la IRA dec\u00e2t adul\u0163ii tineri. Etiologia IRA este adesea multifactorial\u0103, frecvent cu o cauz\u0103 iatrogen\u0103.<\/p>\n
Prevalen\u0163a IRA la v\u00e2rstnici este diferit\u0103 de cea \u00eenregistrat\u0103 \u00een popula\u0163ia general\u0103 \u0219i de v\u00e2rst\u0103 frage-d\u0103. Mai frecvent apare dup\u0103 interven\u0163ii chirurgicale, deshidratare, \u0219oc, sepsis, obstruc\u0163ie urinar\u0103, embolie cu colesterol, administrarea de medicamente anti-inflamatoare nesteroidiene, inhibitori ai enzimei de conversie, exces de diuretice, tratament pe termen lung cu aminoglicozide (necroz\u0103 tubular\u0103 acut\u0103). Utilizarea de AINS la pacien\u0163ii cu insuficien\u0163\u0103 cardiac\u0103 congestiv\u0103 \u0219i utilizarea inhibitorilor enzimei de conversie la b\u0103tr\u00e2ni cu stenoz\u0103 aterosclerotic\u0103 a arterelor renale favorizeaz\u0103 instalarea rapid\u0103 a IRA.<\/p>\n
Insuficien\u021ba renal\u0103 acut\u0103 este definit\u0103 ca prerenal\u0103, intrinsec\u0103 \u0219i postrenal\u0103. IRA prerenal\u0103 este a doua cauz\u0103 cea mai comun\u0103 de IRA la v\u00e2rstnici, constituind aproape o treime din toate cazurile spitalizate.<\/p>\n
Principalele cauze prerenale de insuficien\u0163\u0103 renal\u0103 acut\u0103 la v\u00e2rstnici<\/p>\n
- \n
- Hipovolemia:<\/li>\n<\/ul>\n
— Hemoragia<\/p>\n
— Deple\u0163ia volemic\u0103 (de exemplu, v\u0103rs\u0103turi, diaree, diurez\u0103 necorespunz\u0103toare, arsuri)<\/p>\n
- \n
- Hipoperfuzia renal\u0103:<\/li>\n<\/ul>\n
— Antiinflamatoarele nesteroidiene\/inhibitorii selec-tivi de ciclo-oxigenaz\u0103 2<\/p>\n
— Inhibitorii enzimei de conversie a angiotensinei\/ antagoni\u0219tii receptorilor de angiotensin\u0103 II<\/p>\n
— Anevrismul aortic abdominal<\/p>\n
— Stenoza\/ocluzia arterei renale<\/p>\n
— Sindromul hepatorenal<\/p>\n
- \n
- Hipotensiunea:<\/li>\n<\/ul>\n
— \u0218ocul cardiogen<\/p>\n
— \u0218ocul distributiv (de exemplu, sepsis, anafilaxie)<\/p>\n
- \n
- St\u0103rile edematoase:<\/li>\n<\/ul>\n
— Insuficien\u0163a cardiac\u0103<\/p>\n
— Ciroza hepatic\u0103<\/p>\n
— Sindromul nefrotic<\/p>\n
Cauze comune ale IRA prerenale la v\u00e2rstnici pot fi: deple\u0163ia de volum ingerat (de exemplu, a sc\u0103zut consumul de lichide), sc\u0103derea volumului sangvin eficient (de exemplu, vasodilata\u0163ie sistemic\u0103) \u0219i hemodinamice.<\/p>\n
Necroza tubular\u0103 acut\u0103 (NTA) este cea mai frecvent\u0103 cauz\u0103 de IRA intrinsec\u0103 (peste 50% din IRA la pacien\u0163ii v\u00e2rstnici spitaliza\u0163i \u00een unit\u0103\u0163i de terapie intensiv\u0103). NTA apare, de obicei, dup\u0103 un eveniment acut ischemic sau toxic. Patogeneza NTA implic\u0103 o interac\u0163iune de procese, care includ disfunc\u0163ia en-dotelial\u0103, hipoxia tubular\u0103, disfunc\u0163ie \u0219i apoptoz\u0103, obstruc\u0163ia tubular\u0103.<\/p>\n
Probabilitatea IRA postrenale cre\u0219te odat\u0103 cu v\u00e2rsta. Afec\u0163iunile maligne, hipertrofia benign\u0103 de prostat\u0103, carcinomul de prostat\u0103 \u0219i pelvian sunt toate cauze importante. Identificarea din timp a IRA secundare obstruc\u0163iei, cu efectuarea imagisticii renale este esen\u0163ial\u0103.<\/p>\n
\u00cen ciuda progreselor din medicina de \u00eengrijire critic\u0103 \u0219i terapie de substitu\u0163ie renal\u0103, mortalitatea atinge 75% la cei v\u00e2rstnici. Diagnosticul timpuriu al cauzelor care stau la baza IRA la b\u0103tr\u00e2ni este esen\u0163ial pentru managementul corect \u0219i prognosticul favorabil al acestora.<\/p>\n
Materiale \u0219i metode<\/p>\n
A fost efectuat un studiu retrospectiv \u00een Spitalul Clinic Municipal Sf\u00e2nta Treime din Chi\u0219in\u0103u, sec\u0163ia de nefrologie \u0219i unitatea de terapie intensiv\u0103. Datele clinice \u0219i rezultatele investiga\u021biilor au fost selectate din fi\u0219ele medicale a 330 de pacien\u0163i (b\u0103rba\u021bi \/ femei: 215\/115), cu v\u00e2rsta \u00eentre 68 \u0219i 80 de ani, spitaliza\u0163i cu IRA de pe 1 ianuarie 2013 p\u00e2n\u0103 pe 31 decembrie 2014. S-a folosit sistemul informa\u021bional al spitalului.<\/p>\n
Leziunea renal\u0103 acut\u0103 a fost definit\u0103 ca o cre\u0219tere cu 50% a creatininei serice \u00een 48 de ore, indiferent de debitul urinar. Leziunea renal\u0103 acut\u0103 s-a diagnosticat printr-un declin rapid (ore, zile) al ratei de filtrare glomerular\u0103 la un pacient v\u00e2rstnic cu func\u021bie renal\u0103 anterior normal\u0103 sau la un pacient cunoscut cu boal\u0103 cronic\u0103 de rinichi. S-a standardi-zat defini\u021bia IRA \u00een func\u021bie de criteriile RIFLE, bazat\u0103 pe cre\u0219terea creatininei \u0219i pe sc\u0103derea debitului urinar, care include trei nivele de afectare a func\u021biei renale: risc de disfunc\u021bie renal\u0103, leziune renal\u0103 \u0219i insuficien\u021b\u0103 renal\u0103 (tabelul 1). Defini\u0163ia IRA, criteriile RIFLE (dup\u0103 Brenner \u0219i Rector\u2019s K., edi\u0163ia 2008)<\/p>\n
Tabelul 1<\/em><\/p>\n
\n\n
\n Element clinic<\/em><\/td>\n Criterii \u00een func<\/em>\u021b<\/em>ie de<\/em><\/td>\n Criterii \u00een func<\/em>\u021b<\/em>ie<\/em><\/td>\n<\/tr>\n \n definit<\/em><\/td>\n rata filtr<\/em>\u0103<\/em>rii glomerulare<\/em><\/td>\n de debitul urinar<\/em><\/td>\n<\/tr>\n \n Risk (risc de<\/td>\n Cre\u015fterea creatininei x<\/td>\n Debit urinar <0.5<\/td>\n<\/tr>\n \n IRA)<\/td>\n 1.5 sau sc\u0103derea RFG<\/td>\n ml\/kg\/or\u0103 \u00d7 6 ore<\/td>\n<\/tr>\n \n <\/td>\n >25%<\/td>\n <\/td>\n<\/tr>\n \n Injury (lezare<\/td>\n Cre\u015fterea creatininei<\/td>\n Debit urinar <0.5<\/td>\n<\/tr>\n \n renal\u0103)<\/td>\n \u00d72 sau sc\u0103derea RFG<\/td>\n ml\/kg\/or\u0103 \u00d7 12 ore<\/td>\n<\/tr>\n \n <\/td>\n >50%<\/td>\n <\/td>\n<\/tr>\n \n Failure (insufi-<\/td>\n Cre\u015fterea creatininei \u00d73<\/td>\n Debit urinar <0.3<\/td>\n<\/tr>\n \n cien\u0163\u0103 renal\u0103)<\/td>\n cu sc\u0103derea RFG >75%<\/td>\n ml\/kg\/or\u0103 \u00d7 24<\/td>\n<\/tr>\n \n <\/td>\n sau creatinina \u2265 4 mg\/<\/td>\n ore sau anurie x<\/td>\n<\/tr>\n \n <\/td>\n dl (cu o cre\u015ftere acut\u0103 ><\/td>\n 12 ore<\/td>\n<\/tr>\n \n <\/td>\n 0.5 mg\/dl)<\/td>\n <\/td>\n<\/tr>\n \n Loos (pierde-<\/td>\n Pierderea complet\u0103 a<\/td>\n <\/td>\n<\/tr>\n \n rea func\u0163iei<\/td>\n func\u0163iei renale > 4 s\u0103pt.<\/td>\n <\/td>\n<\/tr>\n \n renale)<\/td>\n = IRA persistent\u0103<\/td>\n <\/td>\n<\/tr>\n \n ESRD (insu-<\/td>\n Pierderea complet\u0103 a<\/td>\n <\/td>\n<\/tr>\n \n ficien\u0163\u0103 renal\u0103<\/td>\n func\u0163iei renale >3 luni<\/td>\n <\/td>\n<\/tr>\n \n terminal\u0103)<\/td>\n <\/td>\n <\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n Not\u0103: Clasificarea se bazeaz\u0103 fie pe agravarea filtratului glomerular, fie pe reducerea diurezei.<\/p>\n
Analizele biochimice de s\u00e2nge au inclus clea-rance-ul creatininei serice, ureea, acidul uric, biliru-bina, creatinina, electroli\u021bii (inclusiv Na, Ca \u0219i fosfat) serici \u0219i testele patognomonice specifice, \u00een func\u0163ie de circumstan\u0163e. Testele urinare au cuprins analiza microscopic\u0103 a sedimentului, microscopia sedimen-tului, uroculturile.<\/p>\n
Evaluarea pacientului s-a bazat pe determi-narea tipului de IRA. Prezen\u0163a comorbidit\u0103\u0163ilor, factorii de risc, tratamentul efectuat au fost luate \u00een considera\u0163ie.<\/p>\n
Rezultate ob\u0163inute:<\/p>\n
La cei 330 de pacien\u0163i v\u00e2rstnici cu IRA s-a constatat sc\u0103derea valorilor HB, albuminei serice, protrombinei, natriului seric \u0219i cre\u0219terea evident\u0103 a concentra\u021biei de potasiu \u0219i a azotemiei, cre\u0219terea VSH (tabelul 2).<\/p>\n
Tabelul 2<\/em><\/p>\n
Spectrul investiga\u0163iilor paraclinice la pacien\u0163ii v\u00e2rstnici cu IRA<\/em><\/p>\n
<\/p>\n
\n\n
\n Indicii serici<\/em><\/td>\n Pacien<\/em>\u021b<\/em>i cu<\/em><\/td>\n Pacien<\/em>\u021b<\/em>i<\/em><\/td>\n p<\/sup><\/em>1,2<\/em><\/td>\n <\/td>\n<\/tr>\n \n IRA<\/em><\/td>\n f<\/em>\u0103<\/em>r<\/em>\u0103<\/em> IRA<\/em><\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Diureza<\/td>\n 418,7\u00b142,33<\/td>\n 1080\u00b124,8<\/td>\n ***<\/td>\n <\/td>\n<\/tr>\n \n (ml \/ 24 ore)<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Proteinuria (g\/l)<\/td>\n 0,10\u00b10,028<\/td>\n 0,03\u00b10,008<\/td>\n *<\/td>\n <\/td>\n<\/tr>\n \n Densitatea urinar\u0103 (un)<\/td>\n 1015\u00b11,37<\/td>\n 1017\u00b11,09<\/td>\n *<\/td>\n <\/td>\n<\/tr>\n \n Clearance creat. (ml\/min)<\/td>\n 38\u00b13,63<\/td>\n 101\u00b13,92<\/td>\n **<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Sodiul (mmol\/l)<\/td>\n 128\u00b11,00<\/td>\n 140\u00b10,55<\/td>\n **<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Potasiul (mmol\/l)<\/td>\n 5,83\u00b10,21<\/td>\n 4,66\u00b10,12<\/td>\n **<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Creatinina (mmol\/l)<\/td>\n 0,21 \u00b10,022<\/td>\n 0,07\u00b10,003<\/td>\n ***<\/td>\n <\/td>\n<\/tr>\n \n Ureea (mmol\/l)<\/td>\n 15,66\u00b10,87<\/td>\n 5,9\u00b10,44<\/td>\n ***<\/td>\n <\/td>\n<\/tr>\n \n Albumina (g\/l)<\/td>\n 30,9\u00b11,84<\/td>\n 45,8\u00b11,54<\/td>\n **<\/td>\n <\/td>\n<\/tr>\n \n Protrombina (%)<\/td>\n 62,7\u00b12,66<\/td>\n 79,9\u00b11,94<\/td>\n **<\/td>\n <\/td>\n<\/tr>\n \n Hb (g\/l)<\/td>\n 96,0\u00b13,80<\/td>\n 119\u00b13,03<\/td>\n *<\/td>\n <\/td>\n<\/tr>\n \n VSH (mm\/or\u0103)<\/td>\n 40\u00b14,70<\/td>\n 19,2\u00b12,53<\/td>\n ***<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n Not\u0103: * \u2013 p>0,05; ** \u2013 p<0,05; *** \u2013 p<0,0.<\/em><\/p>\n
IRA la v\u00e2rstnici a fost provocat\u0103 de cauze multi-factoriale. Principalele cauze au fost infec\u0163iie (sepsis), bolile cardiovasculare (\u0219oc cardiogen), hipovolemia \u0219i medicamentele administrate cu efect nefrotoxic (tabelul 3).<\/p>\n
Tabelul 3<\/p>\n
Cauzele IRA la pacien\u0163ii v\u00e2rstnici lua\u021bi \u00een studiu<\/p>\n
\n\n
\n Cauzele IRA la pacien\u0163ii v\u00e2rstnici lua\u021bi \u00een studiu<\/em><\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Factorii etiologici ai IRA<\/em><\/td>\n Cazuri<\/em><\/td>\n <\/td>\n %<\/em><\/td>\n<\/tr>\n \n Hipovolemie<\/td>\n <\/td>\n 44<\/td>\n <\/td>\n 13,3<\/td>\n<\/tr>\n \n Infec\u0163ii<\/td>\n <\/td>\n 65<\/td>\n <\/td>\n 19,6<\/td>\n<\/tr>\n \n Medicamente<\/td>\n <\/td>\n 49<\/td>\n <\/td>\n 14,8<\/td>\n<\/tr>\n \n Boli cardiovasculare<\/td>\n <\/td>\n 57<\/td>\n <\/td>\n 17,2<\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Sindrom hepatorenal<\/td>\n <\/td>\n 29<\/td>\n <\/td>\n 8,7<\/td>\n<\/tr>\n \n Tumori maligne<\/td>\n <\/td>\n 14<\/td>\n <\/td>\n 4,2<\/td>\n<\/tr>\n \n Acutizarea maladiilor renale<\/td>\n 23<\/td>\n <\/td>\n 6,9<\/td>\n<\/tr>\n \n preexistente<\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Accident vascular acut<\/td>\n <\/td>\n 4<\/td>\n <\/td>\n 1,2<\/td>\n<\/tr>\n \n Obstruc\u0163ii urinare<\/td>\n <\/td>\n 32<\/td>\n <\/td>\n 9,6<\/td>\n<\/tr>\n \n Necroz\u0103 tubulointersti ial\u0103<\/td>\n 13<\/td>\n <\/td>\n 3,9<\/td>\n<\/tr>\n \n acut\u0103<\/td>\n \u0163<\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n La 49 pacien\u021bi v\u00e2rstnici, IRA a fost provocat\u0103 de medicamente, tratamentul antibacterial \u00een doze neajustate fiind cel mai comun factor de insuficien\u021b\u0103 renal\u0103 acut\u0103, urmat de administrarea de lung\u0103 durat\u0103 a AINS, a diureticelor \u00een doze mari \u0219i a substan\u0163elor de contrast (tabelul 4).<\/p>\n
Tabelul 4<\/p>\n
Inciden\u021ba medicamentelor nefrotoxice \u00een IRA la v\u00e2rstnici<\/p>\n
\n\n
\n Medica<\/em>\u0163<\/em>ia nefrotoxic<\/em>\u0103<\/em><\/td>\n Cazuri<\/em><\/td>\n %<\/em><\/td>\n<\/tr>\n \n Blocan i ai canalelor de calciu<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n (dehidroperidinici)\u0163<\/sup><\/td>\n 4<\/td>\n 8,1<\/td>\n<\/tr>\n \n Antibiotice<\/td>\n 24<\/td>\n 48,9<\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Antiinflamatoare nesteroidene<\/td>\n 12<\/td>\n 24,8<\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Diuretice<\/td>\n 7<\/td>\n 14,2<\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Substan\u0163e de contrast<\/td>\n 2<\/td>\n 4<\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Inhibitori ai enzimei de conversie<\/td>\n 4<\/td>\n 8,1<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n Din num\u0103rul total de 330 de v\u00e2rstnici, 110 pacien\u021bi (33,3%) au avut anterior boal\u0103 cronic\u0103 renal\u0103 gr. II, potrivit Funda\u021biei Na\u021bionale a bolilor renale (K \/ DOQI); afectarea renal\u0103 a fost interpretat\u0103 ca IRA suprapus\u0103 pe BCR.<\/p>\n
Schimb\u0103rile structurale \u0219i func\u021bionale ale rini-chilor \u00een procesul de \u00eemb\u0103tr\u00e2nire reprezint\u0103 un factor de risc independent pentru apari\u0163ia IRA.<\/p>\n
\u00cen studiul retrospectiv efectuat, hipovolemia, infec\u0163iile bacteriene, bolile cardiovasculare, inclusiv sindromul coronarian acut cu insuficien\u021b\u0103 cardiac\u0103 acut\u0103, medicamentele nefrotoxice au fost cauzele mai frecvente ale IRA. Am identificat un grup de pacien\u0163i cu IRA suprapus\u0103 pe boal\u0103 cronic\u0103 de rinichi (BCR) \u00eentr-o propor\u021bie mare (33, 0.3%), ceea ce este un factor deosebit de vulnerabil \u00een instalarea IRA la v\u00e2rstnici.<\/p>\n
Metodele de investigare a insuficien\u021bei renale acute la v\u00e2rstnici ar trebui s\u0103 fie complexe \u0219i multi-disciplinare (tabelul 5).<\/p>\n
Tabelul 5<\/p>\n
Metode de investigare a insuficien\u021bei renale acute<\/p>\n
\n\n
\n Examin<\/em>\u0103<\/em>ri<\/em><\/td>\n Interpretare<\/em><\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Explor<\/strong>\u0103<\/strong>ri urinare:<\/strong><\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Sumar de urin\u0103 pentru<\/td>\n Sugereaz\u0103 un proces inflamator<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n decelarea hematiilor,<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n renal.<\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n proteinelor sau a ambelor<\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Examen microscopic pentru<\/td>\n Cilindrii eritrocitari,<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n identificarea de celule,<\/td>\n granulo\u015fi sunt caracteristici<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n cilindri, cristale<\/td>\n glomerulonefritei.<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Explor<\/strong>\u0103<\/strong>ri biochimice:<\/strong><\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Uree, creatinin\u0103, electroli\u0163i<\/td>\n Aten ie la hiperpotasemie,<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Analiza gazelor sangvine,<\/td>\n hiperfosfatemie,\u0163<\/sup><\/td>\n acidoz\u0103<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n bicarbonatului seric<\/td>\n metabolic\u0103, hipocalcemie.<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Creatinkinaza,<\/td>\n Cre\u015fterea semnificativ\u0103<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n a creatinkinazei \u015fi a<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n mioglobinuria<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n mioglobinuriei \u2013 rabdomioliz\u0103.<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Proteina C reactiv\u0103<\/td>\n Marker de infec\u0163ie sau<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n inflama\u0163ie.<\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Imunoglobuline serice,<\/td>\n Bolile de sistem,<\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n electroforeza proteinelor<\/td>\n glomerulopatiile, proteinuria<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n serice, proteine urinare<\/td>\n Bence Jones sugereaz\u0103 mielom<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Bence Jones<\/td>\n multiplu.<\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Hematologie:<\/strong><\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n Eozinofilia poate ap\u0103rea \u00een<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n nefrita intersti\u0163ial\u0103 acut\u0103 \u00een<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n emboli colesterolici sau \u00een<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Hemoleucograma complet\u0103<\/td>\n vasculit\u0103.<\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n \u015fi trombocitele<\/td>\n Trombocitopenia \u015fi fragmentele<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n de eritrocite sugereaz\u0103<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n microangiopatia trombotic\u0103,<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n sindromul hepatorenal.<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Teste de coagulare<\/td>\n Coagulare intravascular\u0103<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n diseminat\u0103, asociat\u0103 cu sepsis.<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Teste imunologice:<\/strong><\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Anticorpi anti-nucleari<\/td>\n ANA pozitivi \u00een LES \u015fi \u00een alte<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n (ANA)<\/td>\n boli autoimune.<\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n Anticorpi anti-ADN dublu<\/td>\n Anticorpii anti-ADNdc mai<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n catenar (dc)<\/td>\n specifici pentru LES.<\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n Anticorpi citoplasmatici<\/td>\n Asocia\u0163i cu vasculita sistemic\u0103;<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n anti-neutrofilici (ANCA)<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n anticorpii c-ANCA \u015fi anti-PR3<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n Anticorpi anti-proteinaza 3<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n asocia\u0163i cu granulomatoza<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n (PR3)<\/td>\n Wegener;<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n anticorpii p-ANCA \u015fi anti-<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n Anticorpi anti-<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n MPO prezen\u0163i \u00een poliangeita<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n mieloperoxidaz\u0103 (MPO)<\/td>\n microscopic\u0103.<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n Concentra\u0163ia<\/td>\n Sc\u0103zut\u0103 \u00een LES,<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n glomerulonefrita postinfec\u0163ioas\u0103<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n complementului<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n acut\u0103, c rioglobulinemie.<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n Anticorpi anti-membran\u0103<\/td>\n Prezen\u0163i \u00een boala Goodpasture,<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n bazal\u0103 glomerular\u0103<\/td>\n glomerulonefrite.<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n Titrul anti-streptolizinei O \u015fi<\/td>\n Crescut dup\u0103 infec\u0163ia<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n anti-ADNse B<\/td>\n streptococic\u0103.<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n Teste virusologice:<\/strong><\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n Hepatita B \u015fi C; HIV<\/td>\n Controlul infec\u0163iei virale \u00een<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n zona de dializ\u0103.<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n Radiologie:<\/strong><\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n Dimensiunea, simetria<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n Ecografie renal\u0103, CT renal<\/td>\n rinichilor \u2013 dovezi ale<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n obstruc\u0163iei.<\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n \n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n Studiul a confirmat importan\u021ba identific\u0103rii \u0219i corect\u0103rii factorilor pre \u0219i postrenali, \u00eembun\u0103t\u0103\u0163irii func\u0163iei cardiace \u0219i perfuziei sangvine renale \u00een situa\u021biile critice men\u021bionate.<\/p>\n
S-a aten\u021bionat c\u0103 prezen\u0163a multiplelor comorbidit\u0103\u021bi oblig\u0103 pacien\u021bii la un tratament medicamentos impun\u0103tor, care poate provoca IRA. Verificarea medicamentelor consumate \u0219i \u00eencetarea administr\u0103rii agen\u0163ilor nefrotoxici, ajustarea dozele-lor \u0219i monitorizarea concentra\u0163iilor medicamentoase sunt obligatorii pentru pacien\u021bii v\u00e2rstnici, precum \u0219i monitorizarea corect\u0103 a echilibrului lichidian \u0219i evaluarea zilnic\u0103 a greut\u0103\u021bii corporale.<\/p>\n
De asemenea, trebuie de diagnosticat \u0219i de tratat agresiv orice proces infec\u0163ios.<\/p>\n
Concluzii:<\/em><\/p>\n
S-a constatat c\u0103 cele mai frecvente cauze ale IRA la pacien\u021bii \u00een v\u00e2rst\u0103 r\u0103m\u00e2n a fi septicemia \u0219i hipovolemia, cu perfuzia sangvin\u0103 renal\u0103 compromis\u0103. Au fost identifica\u0163i agen\u021bii medicamento\u0219i cu efect nefrotoxic prioritar \u2013 antibioticul \u0219i antiinflamatoarele nesteroidene.<\/p>\n
S-a aten\u0163ionat despre prezen\u021ba unui grup de pacien\u021bi cu IRA suprapus\u0103 pe BCR \u00eentr-o propor\u021bie mare (33, 0.3%), ceea ce necesit\u0103 o aten\u021bie sporit\u0103 fa\u021b\u0103 de maladiile renale preexistente \u0219i particularit\u0103\u0163ile rinichiului senil.<\/p>\n
Fiziopatologia IRA la v\u00e2rstnici nu este bine \u00een\u0163eleas\u0103, op\u0163iunile terapeutice sunt limitate, iar la un num\u0103r semnificativ de pacien\u0163i, maladia evolu-eaz\u0103 c\u0103tre insuficien\u0163\u0103 renal\u0103 cronic\u0103. Priorit\u0103\u0163ile managementului insuficien\u0163ei renale acute sunt: diagnosticarea timpurie, instituirea m\u0103surilor pre-ventive \u0219i optimizarea tratamentului, f\u0103r\u0103 \u00eenc\u0103rcare terapeutic\u0103 excesiv\u0103.<\/p>\n
<\/em><\/strong>Bibliografie<\/em><\/strong><\/p>\n
- \n
- Aldasoro M., Mauricio M.D. et al. Effects of aspirin, nimesulide, and SC-560 on vasopressin-induced contrac-tion of human gastroepiploic artery and saphenous vein. In: Crit. Care Med., 2008; nr. 36(1), p. 193-197. <\/em><\/li>\n
- Chertow G.M., Burdick E., Honour M., Bonventre J.V., Bates D.W. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. In: J. Am. Soc. Nephrol., 2005; nr. 16(11), p. 3365-3370. <\/em><\/li>\n
- Coca S.G. Acute kidney injury in elderly persons. In: Am. J. Kidney Dis., 2010; nr. 56(1), p. 122-131. <\/em><\/li>\n
- James M., Pannu N. Methodological considerations for observational studies of acute kidney injury using existing data sources. In: J. Nephrol., 2009; nr. 22(3), p. 295-305. <\/em><\/li>\n
- Hoste E.A., Kellum J.A., Katz N.M., Rosner M.H., Haase M., Ronco C. Epidemiology of acute kidney injury. In: Contrib. Nephrol., 2010; nr. 165, p. 1-8. <\/em><\/li>\n<\/ol>\n
<\/em>Ricci Z., Cruz D.N., Ronco C. Classification and staging of acute kidney injury: beyond the RIFLE and AKIN criteria. In: Nat. Rev. Nephrol., 2011; nr. 7(4), p. 201-208.<\/em><\/p>\n
- \n
- Roghi A., Savonitto S., Cavallini C. et al. Atherosclerosis, Thrombosis and Vascular Biology Study Group and the Italian Society for Invasive Cardiology Investigators. Impact of acute renal failure following percutaneous coronary intervention on long-term mortality. In: J. Cardiovasc. Med., (Hagerstown), 2008; nr. 9(4), p. 375-381. <\/em><\/li>\n
- Ishani A., Xue J.L., Himmelfarb J. et al. Acute kidney injury increases risk of ESRD among elderly. In: J. Am. Soc. Nephrol., 2009; nr. 20(1), p. 223-228. <\/em><\/li>\n<\/ol>\n
<\/p>\n
Lilia Vlasov<\/strong>, d. \u0219. m., conf. univ., Departamentul Medicin\u0103 Intern\u0103,<\/p>\n
Clinica medical\u0103 nr. 1, Disciplina Sinteze Clinice, USMF Nicolae Testemi\u021banu[\/vc_column_text][vc_empty_space]
- Ishani A., Xue J.L., Himmelfarb J. et al. Acute kidney injury increases risk of ESRD among elderly. In: J. Am. Soc. Nephrol., 2009; nr. 20(1), p. 223-228. <\/em><\/li>\n<\/ol>\n
- Chertow G.M., Burdick E., Honour M., Bonventre J.V., Bates D.W. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. In: J. Am. Soc. Nephrol., 2005; nr. 16(11), p. 3365-3370. <\/em><\/li>\n
- Aldasoro M., Mauricio M.D. et al. Effects of aspirin, nimesulide, and SC-560 on vasopressin-induced contrac-tion of human gastroepiploic artery and saphenous vein. In: Crit. Care Med., 2008; nr. 36(1), p. 193-197. <\/em><\/li>\n
- St\u0103rile edematoase:<\/li>\n<\/ul>\n
- Hipotensiunea:<\/li>\n<\/ul>\n
- Hipoperfuzia renal\u0103:<\/li>\n<\/ul>\n
![<\/a>\n\t\t\t\t<\/li>\n\t\t\t<\/ul>\n\t\t<\/li><\/ul>[\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"[vc_row][vc_column][vc_images_carousel images=»5394,4829,4828″ img_size=»735×250″ autoplay=»yes»][vc_empty_space][vc_column_text]Actualmente, inciden\u0163a insuficien\u0163ei renale acute (IRA) este \u00een cre\u0219tere, \u00een special \u00een r\u00e2ndul pacien\u0163ilor spitaliza\u0163i, al celor v\u00e2rstnici sau al celor afla\u0163i \u00eentr-o stare critic\u0103 \u0219i se asociaz\u0103 cu o rat\u0103 ridicat\u0103 a mortalit\u0103\u0163ii. Pacien\u0163ii cu risc crescut sunt persoanele v\u00e2rstnice, cele cu diabet, hipertensivi \u0219i cei cu boli renale preexistente. S-a<\/p>\n","protected":false},"author":2,"featured_media":4829,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[53],"tags":[],"_links":{"self":[{"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/posts\/5393"}],"collection":[{"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/comments?post=5393"}],"version-history":[{"count":2,"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/posts\/5393\/revisions"}],"predecessor-version":[{"id":5397,"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/posts\/5393\/revisions\/5397"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/media\/4829"}],"wp:attachment":[{"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/media?parent=5393"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/categories?post=5393"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/tags?post=5393"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}](\"https:\/\/treime.md\/wp-content\/uploads\/2026\/04\/5_\u0441\u0430\u0439\u0442.jpg\"){kind=link}