Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona
Autor(a) principal: | |
---|---|
Data de Publicação: | 2007 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFRN |
Texto Completo: | https://repositorio.ufrn.br/jspui/handle/123456789/13131 |
Resumo: | Objective: To determine the clinical maternal and neonatal outcomes in HELLP syndrome patients treated with dexamethasone who either developed renal injury or renal insufficiency and to identify predictive values of urea and creatinine for the identification of subjects with HELLP syndrome at risk of developing renal insufficiency. Methods: Non-radomized intervention study of dexamethasone use in HELLP syndrome. A total of 62 patients were enrolled at Maternidade Escola Januário Cicco (MEJC). Patients received a total of 30 mg of dexamethasone IV, in three doses of 10 mg every 12 hours. A clinical and laboratory follow up were performed at 24, 48 and 72 hours. Patients were followed up to 6 months after delivery. Patients were grouped in accordance to renal function, i.e, normal and some type of renal lesion. Renal lesion was considered when creatinine was equal or greater than 1.3 mg/dl and diuresis less than 100 ml in 4 hours period and renal insufficiency was defined when dialysis was needed. Results: A total of 1230 patients with preeclampsia were admitted at MEJC. Of those 62 (5%) developed HELLP syndrome. There was no statistical difference in the groups with renal involvement or normal renal function with respect to the demographics, type of anesthesia used and delivery, and weight of the newborn. An improvement in the AST, ALT, LDH, haptoglobine, antithrombine, fibrinogenen and platelets was observed within 72 hours after dexamethosone use. There was a significant increase in the diuresis within the interval of 6 hours before the delivery and 24 hours after it. Of the 62 patients, 46 (74. 2%) had normal renal function and 16 (25.8%) evolved with renal lesion, with 5 (8.1%) needing dialysis. These 5 patients who received dialysis recovered the xi renal function. The delay in administering dexamethasone increased in 4.6% the risk of development of renal insufficiency. Patients with renal insufficiency had received significantly more blood products than subjects without renal lesion (p=0.03). Diuresis, leukocytes, uric acid, urea, creatinine were significantly different between the groups with normal renal function, renal lesion and renal insufficiency. The levels of creatinine 1.2mg/dl and uric acid 51mg/dl, at admission are predictive of subjects who will evolve with renal lesion (p<0.001). Maternal mortality was 3.2%. None of the subjects with renal insufficiency evolved with chronic renal disease. Conclusions: Dexamethasone in patients with HELLP syndrome seems to reduce significantly the hepatic microthrombosis and normalize hemostasis as seen by improvement of liver function. Renal injury can be considered, in HELLP syndrome, when creatinine levels are greater than 1.3 mg/dl and diuresis less than 100 ml/h in interval of 4 hours. The level of creatinine greater than 1.2 mg/dl and urea greater than 51mg/dl are predictive of subjects with HELLP syndrome who will develop renal injury. Patients who receive more red cell packs develop renal insufficiency. Finally, the delay in administering dexamethasone increases the risk of developing renal insufficiency |
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Leão, Marcos Diashttp://lattes.cnpq.br/6752075987179306http://lattes.cnpq.br/7207146627442417Jerônimo, Selma Maria Bezerrahttp://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4785584A3&dataRevisao=nullFreitas Júnior, Reginaldo Antônio de OliveiraMauad Filho, Franciscohttp://lattes.cnpq.br/8866145289279854Araújo, Aderson da Silvahttp://lattes.cnpq.br/9615780257704881Araújo, Ana Cristina Pinheiro Fernandes de2014-12-17T14:13:24Z2009-02-202014-12-17T14:13:24Z2007-11-28LEÃO, Marcos Dias. Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona. 2007. 125 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal do Rio Grande do Norte, Natal, 2007.https://repositorio.ufrn.br/jspui/handle/123456789/13131Objective: To determine the clinical maternal and neonatal outcomes in HELLP syndrome patients treated with dexamethasone who either developed renal injury or renal insufficiency and to identify predictive values of urea and creatinine for the identification of subjects with HELLP syndrome at risk of developing renal insufficiency. Methods: Non-radomized intervention study of dexamethasone use in HELLP syndrome. A total of 62 patients were enrolled at Maternidade Escola Januário Cicco (MEJC). Patients received a total of 30 mg of dexamethasone IV, in three doses of 10 mg every 12 hours. A clinical and laboratory follow up were performed at 24, 48 and 72 hours. Patients were followed up to 6 months after delivery. Patients were grouped in accordance to renal function, i.e, normal and some type of renal lesion. Renal lesion was considered when creatinine was equal or greater than 1.3 mg/dl and diuresis less than 100 ml in 4 hours period and renal insufficiency was defined when dialysis was needed. Results: A total of 1230 patients with preeclampsia were admitted at MEJC. Of those 62 (5%) developed HELLP syndrome. There was no statistical difference in the groups with renal involvement or normal renal function with respect to the demographics, type of anesthesia used and delivery, and weight of the newborn. An improvement in the AST, ALT, LDH, haptoglobine, antithrombine, fibrinogenen and platelets was observed within 72 hours after dexamethosone use. There was a significant increase in the diuresis within the interval of 6 hours before the delivery and 24 hours after it. Of the 62 patients, 46 (74. 2%) had normal renal function and 16 (25.8%) evolved with renal lesion, with 5 (8.1%) needing dialysis. These 5 patients who received dialysis recovered the xi renal function. The delay in administering dexamethasone increased in 4.6% the risk of development of renal insufficiency. Patients with renal insufficiency had received significantly more blood products than subjects without renal lesion (p=0.03). Diuresis, leukocytes, uric acid, urea, creatinine were significantly different between the groups with normal renal function, renal lesion and renal insufficiency. The levels of creatinine 1.2mg/dl and uric acid 51mg/dl, at admission are predictive of subjects who will evolve with renal lesion (p<0.001). Maternal mortality was 3.2%. None of the subjects with renal insufficiency evolved with chronic renal disease. Conclusions: Dexamethasone in patients with HELLP syndrome seems to reduce significantly the hepatic microthrombosis and normalize hemostasis as seen by improvement of liver function. Renal injury can be considered, in HELLP syndrome, when creatinine levels are greater than 1.3 mg/dl and diuresis less than 100 ml/h in interval of 4 hours. The level of creatinine greater than 1.2 mg/dl and urea greater than 51mg/dl are predictive of subjects with HELLP syndrome who will develop renal injury. Patients who receive more red cell packs develop renal insufficiency. Finally, the delay in administering dexamethasone increases the risk of developing renal insufficiencyObjetivo: Determinar os perfis clínicos, maternos e fetais das pacientes com síndrome HELLP completa, que desenvolveram injúria renal ou insuficiência renal, submetidas ao uso da dexametasona em altas doses e identificar valores preditivos de uréia ou creatinina que, identificariam as pacientes que com injúria renal, evoluiriam para insuficiência renal. Métodos: Estudo prospectivo de intervenção terapêutica, não randomizado, no qual foram arroladas 62 pacientes com síndrome HELLP completa, internadas na Maternidade Escola Januário Cicco (MEJC). As pacientes foram submetidas ao uso de dexametasona endovenosa, num total de 30 mg, divididas em três doses de 10 mg a cada 12 horas. Foi realizado seguimento clínico e laboratorial, a partir do diagnóstico, e, após 24, 48 e 72 horas, sendo mantido o seguimento clínico até seis meses após o parto. Foram divididas em três grupos: sem lesão renal, com injúria renal e com insuficiência renal. A injúria renal foi definida, quando os níveis de creatinina eram maiores ou iguais a 1.3 mg/dl e a diurese era inferior a 100 ml no período de 04 horas. Considerou-se insuficiência renal, quando houve necessidade de diálise. Resultados: No período avaliado, 1230 pacientes apresentaram pré-eclâmpsia e destas 62 (5%) evoluíram para síndrome HELLP completa. Não houve diferença estatísticas dos grupos avaliados quanto aos parâmetros demográficos, tipo de anestesia, parto e pesos dos recém-nascidos. Observouse melhora nos níveis de AST, ALT, LDH, haptoglobina, anti-trombina III, fibrinogênio e plaquetas, quando avaliados no período de 72 horas. O aumento do volume da diurese foi significativo no intervalo de 06 horas antes do parto e 24 horas após o parto. Das 62 pacientes, 46 (25,8%) não apresentaram ix comprometimento renal, 16 (74,2%) evoluíram com lesão renal, e, destas, apenas 05 (8,1%) necessitaram de diálise, sem evolução para doença crônica. Após o parto, cada hora de atraso, na administração da dexametasona, aumentou em 4,6% o risco de desenvolvimento de insuficiência renal. As pacientes com insuficiência renal receberam anteriormente uma maior quantidade de transfusão sanguínea (p=0,03). A diurese, leucometria, ácido úrico, uréia, creatinina foram significativamente diferentes entre os grupos sem lesão renal, injúria renal isolada e as com insuficiência renal. Níveis de creatinina, acima de 1.2mg/dl e uréia de 51mg/dl, são níveis preditivos de evolução para injúria renal (p<0,001). A mortalidade materna, no grupo estudado, foi de 3,2%. Não houve evolução para insuficiência renal crônica. Conclusões: A utilização da dexametasona, provavelmente, reduz, de forma significativa, a microtrombose hepática e estabiliza a hemostasia, pela avaliação dos marcadores hepáticos. A injúria renal pode ser definida, na síndrome HELLP completa, como valores de creatinina superior a 1,3mg/dl e diurese inferior a 100ml/h em intervalo maior que 4h. Os valores de creatinina superior a 1,2mg/dl e uréia maior que 51mg/dl, na admissão da paciente, são preditivos de injúria renal. Pacientes que foram submetidas à transfusão de concentrado de hemácias desenvolvem insuficiência renal com maior freqüência e o retardo na administração do corticóide é um fator de risco na necessidade de diálise nas pacientes com injúria renalapplication/pdfporUniversidade Federal do Rio Grande do NortePrograma de Pós-Graduação em Ciências da SaúdeUFRNBRCiências da SaúdeSíndrome de Helppdexametasonainjúria renalinsuficiência renalmorbidadeCNPQ::CIENCIAS DA SAUDERedução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasonainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFRNinstname:Universidade Federal do Rio Grande do Norte (UFRN)instacron:UFRNTEXTMarcosDL.pdf.txtMarcosDL.pdf.txtExtracted texttext/plain209884https://repositorio.ufrn.br/bitstream/123456789/13131/6/MarcosDL.pdf.txtee55375221be01ec6a82e6fdb3e8695eMD56ReducaoMorbi-mortalidadeSíndrome_Leão_2007.pdf.txtReducaoMorbi-mortalidadeSíndrome_Leão_2007.pdf.txtExtracted texttext/plain209245https://repositorio.ufrn.br/bitstream/123456789/13131/8/ReducaoMorbi-mortalidadeS%c3%adndrome_Le%c3%a3o_2007.pdf.txt2fd8bffa2690e8bc540b6f993a6fa4f0MD58THUMBNAILMarcosDL.pdf.jpgMarcosDL.pdf.jpgIM Thumbnailimage/jpeg3785https://repositorio.ufrn.br/bitstream/123456789/13131/7/MarcosDL.pdf.jpg47d2b5efb4615843aa04ef5b677b115cMD57ReducaoMorbi-mortalidadeSíndrome_Leão_2007.pdf.jpgReducaoMorbi-mortalidadeSíndrome_Leão_2007.pdf.jpgGenerated Thumbnailimage/jpeg1458https://repositorio.ufrn.br/bitstream/123456789/13131/9/ReducaoMorbi-mortalidadeS%c3%adndrome_Le%c3%a3o_2007.pdf.jpg5668a946a32cea5ad6b5ddae1f69d3a9MD59ORIGINALReducaoMorbi-mortalidadeSíndrome_Leão_2007.pdfapplication/pdf394769https://repositorio.ufrn.br/bitstream/123456789/13131/1/ReducaoMorbi-mortalidadeS%c3%adndrome_Le%c3%a3o_2007.pdf9d488c1ed88a3702407b23c55a28b19bMD51123456789/131312019-05-26 03:13:01.418oai:https://repositorio.ufrn.br:123456789/13131Repositório de PublicaçõesPUBhttp://repositorio.ufrn.br/oai/opendoar:2019-05-26T06:13:01Repositório Institucional da UFRN - Universidade Federal do Rio Grande do Norte (UFRN)false |
dc.title.por.fl_str_mv |
Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona |
title |
Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona |
spellingShingle |
Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona Leão, Marcos Dias Síndrome de Helpp dexametasona injúria renal insuficiência renal morbidade CNPQ::CIENCIAS DA SAUDE |
title_short |
Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona |
title_full |
Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona |
title_fullStr |
Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona |
title_full_unstemmed |
Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona |
title_sort |
Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona |
author |
Leão, Marcos Dias |
author_facet |
Leão, Marcos Dias |
author_role |
author |
dc.contributor.authorID.por.fl_str_mv |
|
dc.contributor.authorLattes.por.fl_str_mv |
http://lattes.cnpq.br/6752075987179306 |
dc.contributor.advisorID.por.fl_str_mv |
|
dc.contributor.advisorLattes.por.fl_str_mv |
http://lattes.cnpq.br/7207146627442417 |
dc.contributor.referees1.pt_BR.fl_str_mv |
Jerônimo, Selma Maria Bezerra |
dc.contributor.referees1ID.por.fl_str_mv |
|
dc.contributor.referees1Lattes.por.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4785584A3&dataRevisao=null |
dc.contributor.referees2.pt_BR.fl_str_mv |
Freitas Júnior, Reginaldo Antônio de Oliveira |
dc.contributor.referees2ID.por.fl_str_mv |
|
dc.contributor.referees3.pt_BR.fl_str_mv |
Mauad Filho, Francisco |
dc.contributor.referees3ID.por.fl_str_mv |
|
dc.contributor.referees3Lattes.por.fl_str_mv |
http://lattes.cnpq.br/8866145289279854 |
dc.contributor.referees4.pt_BR.fl_str_mv |
Araújo, Aderson da Silva |
dc.contributor.referees4ID.por.fl_str_mv |
|
dc.contributor.referees4Lattes.por.fl_str_mv |
http://lattes.cnpq.br/9615780257704881 |
dc.contributor.author.fl_str_mv |
Leão, Marcos Dias |
dc.contributor.advisor1.fl_str_mv |
Araújo, Ana Cristina Pinheiro Fernandes de |
contributor_str_mv |
Araújo, Ana Cristina Pinheiro Fernandes de |
dc.subject.por.fl_str_mv |
Síndrome de Helpp dexametasona injúria renal insuficiência renal morbidade |
topic |
Síndrome de Helpp dexametasona injúria renal insuficiência renal morbidade CNPQ::CIENCIAS DA SAUDE |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE |
description |
Objective: To determine the clinical maternal and neonatal outcomes in HELLP syndrome patients treated with dexamethasone who either developed renal injury or renal insufficiency and to identify predictive values of urea and creatinine for the identification of subjects with HELLP syndrome at risk of developing renal insufficiency. Methods: Non-radomized intervention study of dexamethasone use in HELLP syndrome. A total of 62 patients were enrolled at Maternidade Escola Januário Cicco (MEJC). Patients received a total of 30 mg of dexamethasone IV, in three doses of 10 mg every 12 hours. A clinical and laboratory follow up were performed at 24, 48 and 72 hours. Patients were followed up to 6 months after delivery. Patients were grouped in accordance to renal function, i.e, normal and some type of renal lesion. Renal lesion was considered when creatinine was equal or greater than 1.3 mg/dl and diuresis less than 100 ml in 4 hours period and renal insufficiency was defined when dialysis was needed. Results: A total of 1230 patients with preeclampsia were admitted at MEJC. Of those 62 (5%) developed HELLP syndrome. There was no statistical difference in the groups with renal involvement or normal renal function with respect to the demographics, type of anesthesia used and delivery, and weight of the newborn. An improvement in the AST, ALT, LDH, haptoglobine, antithrombine, fibrinogenen and platelets was observed within 72 hours after dexamethosone use. There was a significant increase in the diuresis within the interval of 6 hours before the delivery and 24 hours after it. Of the 62 patients, 46 (74. 2%) had normal renal function and 16 (25.8%) evolved with renal lesion, with 5 (8.1%) needing dialysis. These 5 patients who received dialysis recovered the xi renal function. The delay in administering dexamethasone increased in 4.6% the risk of development of renal insufficiency. Patients with renal insufficiency had received significantly more blood products than subjects without renal lesion (p=0.03). Diuresis, leukocytes, uric acid, urea, creatinine were significantly different between the groups with normal renal function, renal lesion and renal insufficiency. The levels of creatinine 1.2mg/dl and uric acid 51mg/dl, at admission are predictive of subjects who will evolve with renal lesion (p<0.001). Maternal mortality was 3.2%. None of the subjects with renal insufficiency evolved with chronic renal disease. Conclusions: Dexamethasone in patients with HELLP syndrome seems to reduce significantly the hepatic microthrombosis and normalize hemostasis as seen by improvement of liver function. Renal injury can be considered, in HELLP syndrome, when creatinine levels are greater than 1.3 mg/dl and diuresis less than 100 ml/h in interval of 4 hours. The level of creatinine greater than 1.2 mg/dl and urea greater than 51mg/dl are predictive of subjects with HELLP syndrome who will develop renal injury. Patients who receive more red cell packs develop renal insufficiency. Finally, the delay in administering dexamethasone increases the risk of developing renal insufficiency |
publishDate |
2007 |
dc.date.issued.fl_str_mv |
2007-11-28 |
dc.date.available.fl_str_mv |
2009-02-20 2014-12-17T14:13:24Z |
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2014-12-17T14:13:24Z |
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doctoralThesis |
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publishedVersion |
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LEÃO, Marcos Dias. Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona. 2007. 125 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal do Rio Grande do Norte, Natal, 2007. |
dc.identifier.uri.fl_str_mv |
https://repositorio.ufrn.br/jspui/handle/123456789/13131 |
identifier_str_mv |
LEÃO, Marcos Dias. Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona. 2007. 125 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal do Rio Grande do Norte, Natal, 2007. |
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https://repositorio.ufrn.br/jspui/handle/123456789/13131 |
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Universidade Federal do Rio Grande do Norte |
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UFRN |
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Ciências da Saúde |
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Universidade Federal do Rio Grande do Norte |
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