Histofunctional status of kidney in patients with rheumatoid arthritis

Abstract

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.

Keywords

• Rheumatoid arthritis, renal functions, histo­pathology, haematuria, proteinuria

Romatoid Artrit\'li hastalarda böbreğin histopatolojik ve fonksiyonel durumu

Abstract

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.

Keywords

• Romatoid artrit, böbrek fonksiyonları, hematüri, proteinüri

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