Perkutan Koroner Girişim Sonrası Kontrast Nefropati Gelişimi ve Yönetimi
Özet
Bu vaka sunumunda, acil servise tipik göğüs ağrısı ile başvuran ve ST yükselmesi olmayan miyokard infarktüsü (NON-STEMI) ön tanısıyla yatırılan 74 yaşında bir kadın hasta ele alınmaktadır. Yapılan koroner anjiyografi sonucunda sağ koroner arter (RCA) distalinde iskemiye neden olan lezyon saptanmış ve başarılı bir perkütan koroner girişimle stent takılarak tam açıklık sağlanmıştır. Ancak işlem sonrasında hastanın takibinde idrar çıkışının azalmasıyla birlikte serum kreatinin değerleri 48 saat içinde belirgin şekilde yükselerek kontrast madde nefropatisi (KMN) gelişmiştir. Nefroloji konsültasyonu doğrultusunda hastaya düşük doz izotonik serum ve furosemid infüzyonu başlanmış, renal ultrasonografi ve yakın hidrasyon takibi yapılmıştır. Nefroloji kliniği tarafından geçici hemodiyaliz katateri takılması önerilmesine rağmen, hastanın yaşlı olması ve hemodiyalizi tolere edemeyebileceği düşünülerek katater açılmamış ve tıbbi sıvı tedavisine devam edilmiştir. Takiplerde hastanın idrar çıkışının kademeli olarak arttığı, kreatinin düzeylerinin gerileyerek normal seviyeye indiği gözlenmiş ve hasta şifayla taburcu edilmiştir. Sonuç olarak, bu vaka diyalize gerek kalmadan da KMN tablosunun uygun medikal yönetimle geri döndürülebileceğini göstermektedir.
This case report presents a 74-year-old female patient who admitted to the emergency department with typical chest pain and was hospitalized with a pre-diagnosis of non-ST-elevation myocardial infarction (NON-STEMI). Coronary angiography revealed an ischemia-causing lesion in the distal right coronary artery (RCA), and complete patency was achieved via successful percutaneous coronary intervention with stent implantation. However, during follow-up, the patient developed contrast-induced nephropathy (CIN), as evidenced by a significant increase in serum creatinine levels and a decrease in urine output within 48 hours post-procedure. Following nephrology consultation, low-dose isotonic saline and furosemide infusion were initiated, along with renal ultrasonography and close hydration monitoring. Although temporary hemodialysis catheter placement was suggested by the nephrology department, the catheter was not inserted due to concerns that the elderly patient might not tolerate hemodialysis, and medical fluid therapy was maintained. In subsequent follow-ups, the patient's urine output gradually increased, creatinine values regressed to normal ranges, and she was successfully discharged. Consequently, this case demonstrates that CIN can be reversed with appropriate medical management without the mandatory initiation of dialysis.
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