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ABY KBY VE DİALİZ Hakan OĞUZTÜRK

Tanıma geçmeden önce... ,[object Object],[object Object],[object Object],[object Object],[object Object]

AKUT BÖBREK YETMEZLİĞİ ,[object Object],[object Object]

Patogenez ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

FONKSİYONEL NEDENLER ,[object Object],[object Object],[object Object],[object Object]

PRERENAL BÖBREK YETMEZLİĞİ ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PRERENAL BÖBREK YETMEZLİĞİNİN SIVI SEKESTRASYONU

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PRERENAL BÖBREK YETMEZLİĞİ AZALMIŞ KARDİYAK OUTPUT

[object Object],[object Object],[object Object],[object Object],RENAL BÖBREK YETMEZLİĞİ

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],RENAL BÖBREK YETMEZLİĞİ

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],RENAL BÖBREK YETMEZLİĞİ

POSTRENAL BÖBREK YETMEZLİĞİ İNFANTLAR ve ÇOCUKLAR Retrokaval üreter Retroperitoneal tümör Pıhtı Vezikoüreteral reflü (K) Üreterovezikal bileşke obst. Üreterosel Megaüreter- Prune-Belly send. Üreter Ant. ve post. üretral valvler (E) Taşlar Nörojenik mesane Pıhtı Üretral atrezi Fimozis Üreterosel Meatal stenoz Üretra ve mesane çıkışı

OBSTRÜKTİF BÖBREK YETMEZLİĞİNİN AYIRICI TANISI - ERİŞKİNLER Travma Papiller nekroz: Sickle cell, DM, piyelonefrit Enflamatuar barsak hastalığı Gebe uterus Üreter, uterus, prostat, mesane, kolon, rektum karsinomları Retroperitoneal lenfoma Kaza ile cerrahi ligasyon Vezikoüreteral reflü (K) Ürat kristalleri Taş Aort anevrizması Retroperitoneal fibrozis: idiyopatik, tümörler ( serviks, uterus, prostat, kolon), tbc, sarc, propanolol Striktür: Tbc, NSAID, radyasyon,schistosomiasis Uterin leiomiyoma Üreter Taş Benign prostat hipertrofisi Nörojenik mesane: DM, spinal kord hastalığı, multiple sklerosis, Parkinson hastalığı,  -bloker Fimozis Yapısal (E)- STD Prostat, mesane kanseri Serviks, kolon kanseri Travma Pıhtı Üretra ve mesane çıkışı

BÖBREK FONKSİYONLARI BOZULURSA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PATOFİZYOLOJİ- Sebep ne olursa olsun.. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PATOFİZYOLOJİ- devam ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PATOFİZYOLOJİ- devam

ABY’DE MORTALİTE/ MORBİDİTE ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ÖYKÜDE... ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ÖYKÜDE...

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ÖYKÜDE...

FİZİK MUAYENE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],FİZİK MUAYENE

TANI ,[object Object],Akut interstitiel nefrit, akut GN, parsiyel obstrüktif üropati, nefrotoksik- iskemik ATN, radyokontrast-induced ABY, rabdomiyoliz Non-oligüri >400 ml Prerenal yetmezlik, hepatorenal sendrom Oligüri <400 ml İdrar yolu obst., renal arter obst., RPGN, bilat. Diffüz renal kortikal nekroz Anüri <100 ml Ayırıcı tanı 24 h’te idrar çıkışı

TANI ,[object Object],Renal taş, acyclovir, etilen glikol, sülfonamid, methotrexate, kontrast madde Kristalüri Akut allerjik interst nefrit, ateroembolizm Eozinofilüri Akut int nefrit, piyelonefrit Lökosit silendirler ATN, GN, interstitiel nefrit Granüler silendirler Glomerülonefrit, malign hipertansiyon Albümin Glomerülonefrit, malign hipertansiyon Eritrosit silendirler Rabdomiyoliz, masif hemoliz Hemoglobin Postrenal, prerenal yetm, HÜS, TTP,preglomerüler vaskülit ateroembolizm, Normal Etyoloji İdrar sedimenti

[object Object],[object Object],[object Object],[object Object],[object Object],TANI

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],TANIDA... devam

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],TANIDA... devam

[object Object],TANIDA > %1 < %1 FeNa Una/ Pna  Ucrea/ Pcrea < 20 > 40 İdrar/ plazma crea (mg/dl) < 10- 15 > 20 Plazma BUN/ crea (mg/dl) > 40 < 20 İdrar Na (mEq/ L) < 500 >500 İdrar osm (mosm/ kgH2O) <1012 >1018 İdrar dansitesi ATN Prerenal Test

TANI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

KISACA: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

TEDAVİ ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],TEDAVİ

KRONİK BÖBREK YETMEZLİĞİ ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

HEMODİYALİZLE İLGİLİ ACİLK SORUNLAR ,[object Object],[object Object],[object Object],[object Object],[object Object]

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