Başkent Üniversitesi Yayınları

A renal artery aneurysm in a stenotic renal artery is a rare clinical entity with an incidence of 0.015% to 1% in patients with renovascular hypertension. Interventional stent placement is the first line of treatment for simple aneurysms of the proximal renal artery. However, renal autotransplantation has been used as an alternative treatment for complex lesions and for lesions originating from the distal renal artery. We present a patient with a renal artery aneurysm, renal artery stenosis of the segmental branches of the left kidney, and occlusion of the right renal artery. The surgical strategy included renal explantation, ex vivo renal preservation, ex vivo reconstruction of the 2 renal artery branches, and renal heterotopic autotransplantation. We conclude that renal autotransplantation is a safe and effective surgical procedure for patients with complex renal arterial disease.

Amaç: Hipertansiyon (HT) hemodiyaliz hastalarında sık görülen bir problemdir. Hastaların % 80’inde HT nedeni kuru ağırlığa ulaşılamamasıdır. Fakat, istenilen kuru ağırlığa ulaşılabilmesi de tüm hastalardaki HT problemini çözememektedir. Bu çalışmada, intradiyalitik periyod dışında normotensif seyreden bir grup hastada gözlenen HT nedenleri araştırıldı. Materyal ve Metod: Stabil seyreden, akut veya kronik bir infeksiyonu ya da kan basıncını etkileyebilecek kardiyak problemi bulunmayan 3 grup hasta seçildi. Grup 1 (n:9) sadece diyaliz esnasında HT gelişen hastalar, Grup 2 (n:9) HT’u bulunan hastalar ve Grup 3 (n:19) normotensif seyreden hastalardan oluşturuldu. Gruplar arasında plazma renin aktivitesi (PRA), aldosteron düzeyleri, gen polimorfizmleri (ACE, AGT, ATI, ATII ve ecNOS), kullanılan eritropoietin (EPO) doz/hafta, sigara öyküsü ve hemodiyaliz uyumu karşılaştırıldı. Sonuçlar: Çalışmaya ortalama yaşları 40.68±12.58 yıl olan 37 hasta (14 K, 23 E) alındı. Yaş, hemodiyaliz uyumu ve sigara öyküsü açısından gruplar arasında fark bulunamadı. Grup 3’le karşılaştırdığımızda Grup 1 ve 2 hastalarında interdiyalitik kilo alımı anlamlı olarak fazla bulundu (p=0.03 ve p=0.007). Fakat, Grup 1 ve 2 arasında anlamlı fark yoktu (p>0.05). Kullanılan haftalık EPO dozu Grup 1 hastalarında Grup 3’ten anlamlı olarak fazla bulundu (p=0.008). PRA ve aldosteron düzeyleri her 3 grupta da diyaliz başında, ortasında ve sonunda benzer bulundu (p>0.05). Gen polimorfizmleri açısından 3 grup arasında da anlamlı bir fark saptanamadı (p>0.05). Yorum: Sonuç olarak, kullanılan haftalık EPO dozu ve interdiyalitik kilo alımı hemodiyaliz esnasında gelişen HT’a neden olabilecek faktörler olarak saptandı. Reasons for Hypertension During Hemodialysis Sessions Objective: Hypertension (HT) is a common problem in hemodialysis (HD) patients. In approximately 80% of cases, HT occurs because target dry weight is not achieved. However, reaching the desired dry weight does not always resolve HT completely. To identify causes of HT during HD sessions, this study focused on findings in a group of HD patients who were normotensive at all times except during dialysis sessions. Materials and Methods: Thirty-seven HD patients (14 F, 23 M; mean age 40.68 ± 12.58 years) were selected for the study. All were stable, and none had acute or chronic infection, or any cardiac disease that could affect blood pressure. Group I patients (n: 9) only exhibited HT during HD sessions, Group II patients (n: 9) were hypertensive at all times, and Group III patients (n: 19) were normotensive. The groups were compared with respect to plasma renin activity (PRA), aldosterone levels, gene polymorphisms (ACE, AGT, ATI, ATII and ecNOS), erythropoietin (EPO) dose/week, smoking history, interdialytic weight gain, and HD compliance. Results: There were no significant differences among the three groups with respect to age, HD compliance, or smoking history. Groups I and II had a higher mean interdialytic weight gain values than Group III (p = 0.03and p = 0.007, respectively). Group I also had a higher EPO dose/week than Group III (p = 0.008), whereas there was no significant difference between Groups I and II with respect to EPO dose/week (p > 0.05). There were no differences among the groups with respect to PRA or aldosterone levels at the beginning, middle, or end of an HD session (p > 0.05 for all). There were also no significant differences among the groups with respect to frequencies of the gene polymorphisms investigated (p > 0.05 for all). Conclusion: The results suggest that EPO dose/week and interdialytic weight gain are factors responsible for hypertension during HD sessions. The analysis revealed no links between occurrence of HT during HD sessions and PRA, aldosterone level, or any gene polymorphisms known to be associated with HT.

Başkent Üniversitesi Yayınları

Browse

Filters

Settings

Sort By

Results per page

Search Results