Geri̇atri̇k Onkonefroloji̇
Ergün Parmaksız, Serap YadigarYaş ilerledikçe hastalarda nefrolojik problemlerin sıklığı arttığı bilinmekte olup, aynı zamanda geriatrik onkoloji hasta grubunda da yıllar içinde istikrarlı bir artış göz önüne alındığında bu hastaların nefrolojik takibi ayrı bir yer tutmaktadır. Geriatrik nefro-onkoloji (GNO) hastalarında nefrolojinin rolü, malignitenin kendisinin veya tedavi yönetiminde ortaya çıkabilecek nefrolojik problemlerin ivedi bir şekilde çözülmesini sağlayıp hastanın ek bir problem ile karşılaşmasını önlemektir. GNO hastalarda böbrek fonksiyon testlerinin takibinde kreatinin, yaş, cinsiyet, nütrisyonel durum, kas kitlesinde değişikliklerden ötürü ve böbrek hasarı meydana geldikten 24 ile 72 saat sonra kreatinin değişikliği olduğundan tek başına kullanılmamalıdır1 . Cystatin C böbrek fonksiyonun değerlendirilmesinde kullanılmasına rağmen GNO hastalarda Cystatin C’nin maligniteden ve verilecek kemoterapötik ilaçlardan etkilenebileceğinden yeterince değerlendirme yapılmamıştır2 . Bu hastalarda glomerüler filtrasyon hızının (GFH) değerlendirilmesinde kreatinin klirensi ölçümü, tGFH ölçümleri, kanser spesifik denklemleri içerir. tGFH ölçümlerinde serum kreatinin ve cystatin C gibi endojen filtrasyon belirteçleri kullanılır. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) denklemi ile GFH ölçülmesinde ırk, yaş, cinsiyet, kreatinin değişiklerini kullanılır ve kanser hastalarında CKD-EPI kullanımı kohort çalışmalarda onaylanmıştır ve CKD-EPI diğer metodlara göre kanser hastalarında daha üstün olduğu gösterilmiştir3 . Bir istisna olarak carboplatin alacak hastalarda Calvert formülü kullanılmaktadır4 .
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