TY - JOUR T1 - Romatoid Artrit\'li hastalarda böbreğin histopatolojik ve fonksiyonel durumu TT - Histofunctional status of kidney in patients with rheumatoid arthritis AU - Aggarwal, Hari Krishan AU - Singh, Harpreet AU - Jain, Deepak AU - Bansal, Teena AU - Jain, Promil AU - Duhan, Joginder PY - 2011 DA - December DO - 10.5798/diclemedj.0921.2011.04.0053 JF - Dicle Medical Journal JO - diclemedj PB - Dicle University WT - DergiPark SN - 1300-2945 SP - 375 EP - 381 VL - 38 IS - 4 LA - tr AB - Amaç: Bu çalışmanın amacı romatoid artritte romatoid artritli (RA) hastalarda hastalık şiddeti ve süresinin böb­rek fonksiyonları ve histopatoloji üzerine etkilerini gözle­mektir. Gereç ve yöntem: Çalışmaya her biri 25\'er hasta içeren iki gruptan oluşan toplam 50 hasta alındı. Hastalık şiddeti sakatlık aktivite skoru (SAS) ile değerlendirildi. Tam id­rar tetkiki, serum üre ve kretinini ve kreatinin klirensi gibi böbrek değişkenleri hastaneye ilk başvuruda kaydedildi. Aktif idrar sediment bulunan, hematuria ve/veya 300 mg/gün\'den fazla proteinürisi bulunan ve serum kreatinini 1.5 mg/dl üzerinde olan hastalara perkutan böbrek biyopsisi uygulandı. Bulgular: Grup I hastalarda hastalık süresi 2-5 yıl ara­sında, Grup II\'de 5 yıldan uzun süreli idi. Romatoid artritli hastaların %28\'inde idrar anormallikleri saptandı, bunla­rın %12\'sinde izole hematüri, %10\'unda izole proteinüri, %6\'sında ise hematüri ve proteinüri birlikte görüldü. Has­taların %14\'ünde yüksek serum kreatinin değeri (>1.5 mg/dl) saptandı. Hastaların %20\'sine böbrek biyopsisi uygulandı ve biyopsi sonucunda histopatolojik olarak mezanjiyal glomerülonefrit, memebranöz glomerülonefrit, sekonder amiloidoz ve interstisyel nefrit bulundu. Grup II\'de ağır SAS bulunan hastaların %63\'ünde idrar anor­mallikleri saptanırken, %83\'ünde artmış serum kreatinin ve %60\'ında ağır histopatolojik anormallikler saptandı. Bu durum ileri düzeyde SAS ve uzamış hastalık süresinin böbrek histofonksiyonel durumu üzerinde önemli etkilerle birlikteliğini göstermekteydi. Sonuç: Romatoid artritte hastalık süresi ve ağırlığına pa­ralel olarak renal fonksiyon bozukluğunda bir artış olduğu gözlendi. KW - Romatoid artrit KW - böbrek fonksiyonları KW - hematüri KW - proteinüri N2 - Objectives: The aim of this study was to observe the ef­fects of duration and severity of disease on renal func­tions and histopathology in patients with rheumatoid ar­thritis (RA). Material and methods: The study included 50 patients of RA, who were divided into two groups of 25 patients each. Disease severity was assessed by Disability Activi­ty Score (DAS). The renal parameters i.e., urine complete examination, blood urea, serum creatinine and creatinine clearance were estimated at enrolment. Percutaneous renal biopsy was performed in patients having active uri­nary sediment, haematuria and/or proteinuria more than 300 mg/day and serum creatinine more than 1.5 mg/ml. Results: Group I patients had duration of disease be­tween 2-5 years and in Group II the duration was more than 5 years. Urine abnormalities were documented in 28% RA patients and 12% patients had isolated hema­turia, 10% patients presented with isolated proteinurea and combined haematuria and proteinurea was present in 6% patients.14% patients presented with raised crea­tinine( >1.5mg/ml). Renal biopsy was performed in 20% of patients which showed mesangial glomerulonephritis, membranous glomerulonephritis, secondary amyloidosis and interstitial nephritis. In group I severe DAS score was present in 17% of the patient having urinary abnormality, however 20% patients showed histopathological findings. In group II 63% of patients with severe DAS score had urinary abnormality, 83% showed raised serum creatinine and 60% had histopathological abnormalities indicating severe DAS score and increased duration of disease was associated with significant effects on histofunctional sta­tus of kidney. Conclusion: There was a significant increase in renal dysfunction with duration and severity of disease in rheu­matoid arthritis. CR - Adu D, Amery P. The patient with rheumatoid arthritis, mixed connective tissue disease, or polymyosis: Oxford Textbook of clinical nephrology, 2nd ed. Oxford University Press: Davison AM, Camison S, Grunfeld JP, Ponticelli C, Litz E. Wincarls CG,1998; II: 975-85 CR - Wolfe F, Mitchell DM, Sibley JT, Fries JF, Block DA, Wil- liams CA, et al. The mortality of rheumatoid arthritis. Ar- thritis Rheum 1994; 4(3): 481-94 CR - Murtru O, Laasko M, Isomaki H, Koota K.Ten year mortality and cause of death in patients with rheumatoid arthritis. Br Med J 1985; 290(11): 1797-9 CR - Arnett FC. The American rheumatism association 1987 re- vised criteria for the classification of RA. Arthritis Rheum 1988; 31(3): 315-20. CR - Cockeroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16(1):31-41. CR - Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activ- ity scores that include twenty-eight-joint counts. Devel- opment and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995;38(1):44–8. CR - Cohen AS. Amyloidosis in arthritis and allied conditions: Ar- thritis and allied conditions, Philadelphia: DJ, Carty Mc, 1989: 1275-93. CR - Boers M, Croonen AM, Dijkonans BA, Breedveld FC. Re- nal findings in rheumatoid arthritis: clinical aspects of 132 necropsies. Ann Rheum Dis 1987; 46(4): 658-63. CR - Yoshida K, Morozumi K, Sunganuma T, Aoki J. Clinico- pathological study of nephropathy in patients with rheuma- toid arthritis. Rheumatoid 1991; 31(1): 14-21. CR - Braun A, Zeier M. Rheumatoid arthritis and the kidney. Un- easy companions. Nephron Clic Prac 2004; 96(1): 105-6 CR - Boers M. Renal disorders in rheumatoid arthritis. Semin Ar- thritis Rhem 1990; 20(1): 57-68. CR - Dutchie JJ, Brown PE, Truclove LH, Baragar FD, Lawrie AJ. Course and prognosis in rheumatoid arthritis. A further report. Ann Rheum Dis 1964; 23(2): 193-204. CR - Jacobsson LTH, Knowler WC, Pillemer S. Rheumatoid ar- thritis and mortality. Arthritis Rheum 1993; 36(9): 1045- 53. CR - Nadkar MY, Londhey VA. Investigating kidney. Involve- ment in rheumatoid arthritis. JAPI 2004; 52(3): 447-8. CR - Karstila K, Harmoinen A, Lentimaki T, Korpela M, Mus- tonen T, Saha H. Measurement of kidney function in pa- tients with rheumatoid arthritis: Plasma cystatin C versus Cr-EDTA clearance. Nephron Clin Prac 2008:25(1): 13-8. CR - Pederson LM, Nordin H, Svensson B, Biddla H. Microal- buminuria in patients with rheumatoid arthritis. Ann Rheu- matic Dis 1995; 54(2): 189-92. CR - Sihvonen S, Korpela M, Mustonen J, Laippala P, Paster- nack A. Renal disease as a predictor of increased mortal- ity among patients with rheumatoid arthritis. Nephron Clin Pract 2004; 96(1): 107-14. CR - Karstila K, Korpela M, Shivonen S, Muslonen J. Prognosis of clinical renal disease and incidence of new renal findings in patients with rheumatoid arthritis; follow up of a popula- tion based study. Clin rhematoi 2007; 26: 2089-95. CR - Koseki Y, Terai C, Moriguchi M, Uesato M, Kamatani N. A prospective study of renal disease in patients with early rheumatoid arthritis. Ann Rheum Dis 2001; 60(2): 327-31. CR - Korpela M, Mustonen J, Teppo AM, Helin H, Pasternack A. Mesangial glomerulonephritis as an extra-articular mani- festation of rheumatoid arthritis. Br J Rheumatology 1997; 36(12): 1189-95. UR - https://doi.org/10.5798/diclemedj.0921.2011.04.0053 L1 - https://dergipark.org.tr/en/download/article-file/54133 ER -