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Previous issue date: 2007-11-28 / 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 Janu?rio
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 / Objetivo: Determinar os perfis cl?nicos, maternos e fetais das pacientes com s?ndrome HELLP completa, que desenvolveram inj?ria renal ou insufici?ncia renal, submetidas ao uso da dexametasona em altas doses e identificar valores preditivos de ur?ia ou creatinina que, identificariam as pacientes que com inj?ria renal, evoluiriam para insufici?ncia renal. M?todos: Estudo prospectivo de interven??o terap?utica, n?o randomizado, no qual foram arroladas 62 pacientes com s?ndrome HELLP completa, internadas na Maternidade Escola Janu?rio Cicco (MEJC). As pacientes foram submetidas ao uso de dexametasona endovenosa, num total de 30 mg, divididas em tr?s doses de 10 mg a cada 12 horas. Foi realizado seguimento cl?nico e laboratorial, a partir do diagn?stico, e, ap?s 24, 48 e 72 horas, sendo mantido o seguimento cl?nico at? seis meses ap?s o parto. Foram divididas em tr?s grupos: sem les?o renal, com inj?ria renal e com insufici?ncia renal. A inj?ria
renal foi definida, quando os n?veis de creatinina eram maiores ou iguais a 1.3 mg/dl e a diurese era inferior a 100 ml no per?odo de 04 horas. Considerou-se
insufici?ncia renal, quando houve necessidade de di?lise.
Resultados: No per?odo avaliado, 1230 pacientes apresentaram pr?-ecl?mpsia e destas 62 (5%) evolu?ram para s?ndrome HELLP completa. N?o houve diferen?a estat?sticas dos grupos avaliados quanto aos par?metros
demogr?ficos, tipo de anestesia, parto e pesos dos rec?m-nascidos. Observouse melhora nos n?veis de AST, ALT, LDH, haptoglobina, anti-trombina III, fibrinog?nio e plaquetas, quando avaliados no per?odo de 72 horas. O aumento do volume da diurese foi significativo no intervalo de 06 horas antes do parto e 24 horas ap?s o parto. Das 62 pacientes, 46 (25,8%) n?o apresentaram
ix comprometimento renal, 16 (74,2%) evolu?ram com les?o renal, e, destas, apenas 05 (8,1%) necessitaram de di?lise, sem evolu??o para doen?a cr?nica. Ap?s o parto, cada hora de atraso, na administra??o da dexametasona,
aumentou em 4,6% o risco de desenvolvimento de insufici?ncia renal. As pacientes com insufici?ncia renal receberam anteriormente uma maior quantidade de transfus?o sangu?nea (p=0,03). A diurese, leucometria, ?cido ?rico, ur?ia, creatinina foram significativamente diferentes entre os grupos sem les?o renal, inj?ria renal isolada e as com insufici?ncia renal. N?veis de creatinina, acima de 1.2mg/dl e ur?ia de 51mg/dl, s?o n?veis preditivos de evolu??o para inj?ria renal (p<0,001). A mortalidade materna, no grupo estudado, foi de 3,2%. N?o houve evolu??o para insufici?ncia renal cr?nica.
Conclus?es: A utiliza??o da dexametasona, provavelmente, reduz, de forma significativa, a microtrombose hep?tica e estabiliza a hemostasia, pela
avalia??o dos marcadores hep?ticos. A inj?ria renal pode ser definida, na s?ndrome 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 ur?ia maior que 51mg/dl, na admiss?o da paciente, s?o preditivos de inj?ria renal. Pacientes que foram submetidas ? transfus?o de
concentrado de hem?cias desenvolvem insufici?ncia renal com maior freq??ncia e o retardo na administra??o do cortic?ide ? um fator de risco na necessidade de di?lise nas pacientes com inj?ria renal
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/13131 |
| Date | 28 November 2007 |
| Creators | Le?o, Marcos Dias |
| Contributors | CPF:70410798487, http://lattes.cnpq.br/7207146627442417, Jer?nimo, Selma Maria Bezerra, CPF:15603016434, http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4785584A3&dataRevisao=null, Freitas J?nior, Reginaldo Ant?nio de Oliveira, CPF:03027472496, Mauad Filho, Francisco, CPF:15575152804, http://lattes.cnpq.br/8866145289279854, Ara?jo, Aderson da Silva, CPF:64073904000, http://lattes.cnpq.br/9615780257704881, Ara?jo, Ana Cristina Pinheiro Fernandes de |
| Publisher | Universidade Federal do Rio Grande do Norte, Programa de P?s-Gradua??o em Ci?ncias da Sa?de, UFRN, BR, Ci?ncias da Sa?de |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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