{"id":7196,"date":"2020-09-29T10:25:00","date_gmt":"2020-09-29T09:25:00","guid":{"rendered":"https:\/\/euromedic.rs\/pregledi\/ct-enterografija-copy-copy\/"},"modified":"2020-10-07T10:38:15","modified_gmt":"2020-10-07T09:38:15","slug":"kontrastom-indukovana-nefropatija-cin","status":"publish","type":"post","link":"https:\/\/euromedic.rs\/pregledi\/dijagnostika\/multislajsni-skener-msct\/kontrastom-indukovana-nefropatija-cin\/","title":{"rendered":"Kontrastom indukovana nefropatija (CIN)"},"content":{"rendered":"

Zna\u010daj odre\u0111vanja vrednosti uree i kretinina u krvnom serumu kod pacijenata pre CT pregleda.<\/p>\n

Za obavljanje pregleda skenerom u najve\u0107em broju slu\u010dajeva i\u00a0 indikacija nepohodno je intravenski primeniti kontrastno sredstvo. Naj\u010de\u0107e se primenjuju niskoosmolarna ili izosmolarna jodna kontrrastna sredstva koja su najbezbedija i preporu\u010dena za ovakve vrste pregleda. U oko 2% svi pregleda nakon\u00a0 intravenske aplikacije kontrastnog sredstva javljaju se kontrastom indukovane nefropatije.<\/p>\n

Kontrastom indukovana nefropatija po definciji predstavlja pove\u0107anje nivoa serumskog kreatinina (kreatinina u krvi) za 56-60% u odnosu na osnovni rezultat u odsustvu alternativnog uzroka.<\/p>\n

Ko su rizi\u010dni pacijenti za nastanak kontrastom indukovane nefropatije?<\/p>\n

    \n
  1. Dijabeti\u010dari<\/li>\n
  2. Pacijenti sa smanjenom bubre\u017enom funkcijom kod kojih je vrednost\u00a0 <\/span>eGFR<45ml\/min.<\/li>\n<\/ol>\n

    Da li pacijent mo\u017ee biti bez simptoma a da ima smanjenu bubre\u017enu funkciju?\u00a0<\/span><\/b><\/p>\n

    Apsolutno DA!<\/p>\n

    Upravo to i jeste razlog insistiranja na dono\u0161enju sve\u017eih laboratorijskih vrednosti uree i kreatinina, na osnovu kojih se uz ostale parametre, bodi mass index, godine starosti, pol pacijenta odre\u0111uje vrednost eGFR.<\/p>\n

    Kako se mo\u017ee spre\u010diti nastanak kontrastom indukvane nefropatije i CT pregled<\/a> obaviti bezbedno?<\/b><\/p>\n

    Pre svega adekvatnom hidratacijom pacijenta pre CT pregleda, pravilnom ishranom nekoliko dana pre pregleda ( izbegavnje unosa proteina), adekvatnim tretmanom nakon pregleda, pojedini autori ve\u0107ih istra\u017eivanja savetuju i davanje odre\u0111enih lekova (acetli-cisteina) na dan pregleda i posle pregleda. Upravo navedene mere se mogu sprovesti samo onda kada i o\u010dekujemo da mo\u017ee do\u0107i do eventalnog o\u0161te\u0107enja bubre\u017ene funkcije, a o\u010dekujemo ih samo kod pacijenata kod kojih laboratorijske vrednosti uree i kreatinina nisu u referentnim vrednostima, \u0161to nas navodi na zaklju\u010dak da bez ovih laboratorijskih naza ne smemo dati kontrastno sredsvo, osim naravno kaada postoje vitalne indikacije odnosno kada je pacijent \u017eivotno ugro\u017een. Kod bolesnika s vrednostima serumskog kreatinina iznad 106 \u00b5mol\/l, rizik od nefrotoksi\u010dnosti raste eksponencijalno<\/p>\n

    METFORMIN I PRIMENA KONTRASTNOG SREDSTVA<\/b><\/p>\n

    Kod osoba koje su na terapiji metforminom (oralni antidijabetik), neophodno je tako\u0111e pre samog kontrastnog snimanja proveriti bubre\u017enu funkciju odre\u0111ivanjem vrednosti uree i kreatinina u serumu. U slu\u010daju kada je funkcija bubrega normalna, onda se prestaje sa davanjem metformina 48 sati pre snimanja i tek 48 sati posle kontrastnog snimanja, ako je bubre\u017ena funkcija normalna, mo\u017ee se opet nastaviti terapija. Ukoliko se desi da se javi kontrastom indukovana nefropatija\u00a0 onda se metformin zamenjuje drugim lekom.<\/p>\n

    Molimo Vas da pre svakog CT pregleda Va\u0161em radiologu dostavite najsve\u017eije laboratorijske analize uree i kreatinina.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Zna\u010daj odre\u0111vanja vrednosti uree i kretinina u krvnom serumu kod pacijenata pre CT pregleda. Za…<\/p>\n","protected":false},"author":1,"featured_media":7198,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[472],"tags":[465,466],"class_list":["post-7196","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-multislajsni-skener-msct","tag-ultrazvuuk","tag-uz"],"yoast_head":"\nKontrastom indukovana nefropatija - Dijagnostika i le\u010denje Euromedik<\/title>\n<meta name=\"description\" content=\"Zna\u010daj odre\u0111vanja vrednosti uree i kretinina u krvnom serumu kod pacijenata pre CT pregleda.Za obavljanje pregleda skenerom u najve\u0107em broju slu\u010dajeva i...\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/euromedic.rs\/pregledi\/dijagnostika\/multislajsni-skener-msct\/kontrastom-indukovana-nefropatija-cin\/\" \/>\n<meta property=\"og:locale\" content=\"sr_RS\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Kontrastom indukovana nefropatija - 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