Acil Servis’e Kalp Yetmezliği Semptomları ile Başvuran Hastalara Uygulanan Diüretik Tedavi Neticesinde Karşılaşılabilecek Akut Böbrek Yetmezliği Tablosunu Önceden Belirlemede; Tımp-2 ve Igfbp7’nin Rolü

Abstract

Gorgulu S, Early Determination of Acute Kidney Failure as a Result of Diuretic Treatment Administered to Patients Presenting to the Emergency Department with Cardiac Failure Symptoms; the Role of TIMP-2 and IGFBP7, Hacettepe University Medical Faculty, Emergency of Medicine, Specialty Thesis. Ankara, 2020. While the level of serum creatinine is often used to determine acute kidney injure, it is considered to be a delayed biomarker. The aim of this study was to test TIMP-2 and IGFBP7 levels in the blood samples of patients in order to determine acute renal injury early, which may develop in patients treated with intravenous furosemide for stage III-IV heart failure in the emergency department. This prospective and observational study planned to study patients, with no known kidney disease, between 10 June 2019 and 31 January 2020 in Hacettepe University Emergency Department who were being treated with intravenous furosemide due to stage III-IV heart failure. Blood samples were taken three times; before treatment and six and twelve hours after the initiation of treatment. 84 patients were included in this study. An increase in the creatinine above normal and a decrease in the glomerular filtration rate below 60 ml/minute based on the hospital’s laboratory’s parameters according to age and sex, were the primary outcomes of this study. The results of IGFBP-7 at the 0th, 6th and 12th hour were found to be statistically significant in patients with and without an increase in their creatinine levels (p=0,036, p=0,042, p=0,006 <0,05). It was found that those with increased creatinine value in all three hours had higher IGFBP-7 value than those who did not. However, it was found that this increase did not increase depending on time. In the ROC curve for IGFBP7; it was found that the specific cut-off value was 118.71 (sensitivity= 0.80 and specificity=0.69). The value of the area under the curve was 71.4% and the 95% confidence interval for this area was 58.2% and 84.5%. It has been detected that basal (zero hour) value in serum sample of IGFBP7 can be effective in predicting acute kidney injury. However, this did not indicate the degree of renal injury.