Hepatit B Virus Enfeksiyonlu Hastalarda Renal Fonksiyonların Sintigrafik Değerlendirilmesi

Abstract

Aim: Chronic hepatitis B virus (HBV) infection can induce nephropathy and major HBV antigens (HBcAg, HBeAg, HBsAg) and immune complexes responsible for its pathogenesis. The purpose of our study was to assess the renal function of patients with HBV infection by means of technetium diethylenetriamine pentaacetic acid (Tc99m DTPA) scintigraphy, in order to detect any early renal dysfunction, which might be related to nephropathy associated with HBV infection. Methods: Nineteen patients (10 male and 9 female with a mean age of 37.11±11.34 years, age range 25−62 years) with the diagnosis of HBV infections, and 16 healthy controls (8 male and 8 female with a mean age of 33.50±11.56 years, age range 24-55 years) were enrolled into the study. All subjects had no history of renal disease and treatment of HBV infection including interferon-alfa, pegylated interferon-alfa, lamivudine and adefovir. Blood urea nitrogen (BUN), urea and creatinine were analyzed. The renal perfusion, concentration and excretion were evaluated by Tc99m DTPA scintigraphy. The time to peak (TTP), peak activity (counts/second) (PA), clearance half time (T1/2) and percent contribution of each kidney to total function (differential function) were calculated. The glomerular filtration rate (GFR) was determined simultaneously by 3 methods; gamma camera uptake method (Gates, GFR), predicted creatinine clearance method (Cockcroft-Gault, CG-GFR), and Modification of Diet in Renal Disease (MDRD). The variables were compared between groups. Results: The mean values of patients’ parameters were as follows; right TTP:5.73±3.14 min, left TTP:5.52±2.09 min, right PA:884.78±214.85 cts/sec, left PA:889.52±252.68 cts/sec and right T1/2:17.84±6.89 min, left T1/2:14.51±8.59 min. Differential functions were 50.27±3.39% on the right side and 49.72±3.39% on the left side. In study group, Gates GFR value was 125.63±25.84 ml/min, CG-GFR:124.05±24.32 ml/min, MDRDGFR:113.15±24.70 ml/min/1.73 m2, BUN:14.57±5.05 mg/dl, urea: 27.37±10.24 mg/dl, and creatinine:0.73±0.18 mg/dl. The mean values of control group were as follows; right TTP:4.05±1.87 min, left TTP:2.93±1.14 min, right PA:819.25±260.48 cts/sec, left PA:796.75±176.94 cts/sec, and right T1/2:12.25±3.19 min, left T1/2:12.25±5.49 min. In control group, Gates GFR value was 109.75±39.03 ml/min, CG-GFR:104.62±39.67 ml/min, MDRD-GFR:89.68±34.15 ml/min/1.73 m2, BUN:11.37±4.47 mg/dl, urea:24.75±5.54 mg/dl, and creatinine:0.78±0.17 mg/dl. There were a statistical difference between patients and controls groups at right TTP value and left TTP value (p

Keywords

• Hepatitis B virus,Tc99m DTPA scintigraphy,renal function

Hepatit B Virus Enfeksiyonlu Hastalarda Renal Fonksiyonların Sintigrafik Değerlendirilmesi

Abstract

Amaç: Kronik hepatit B virus (HBV) enfeksiyonu nefropatiyi indüklemektedir ve patogenezinden major HBV antijenleri (HBcAg, HBeAg, HBsAg) ile immun kompleksler sorumlu tutulmaktadır. Çalışmamızın amacı, HBV enfeksiyonu ile ilişkili olabilecek herhangi bir böbrek fonksiyon bozukluğunu erken tespit etmek için, teknesyum dietilentriamin pentaasetik asid (Tc99m DTPA) sintigrafisi ile HBV enfeksiyonlu hastaların renal fonksiyonlarını değerlendirmekti. Metod: Çalışmamıza, HBV enfeksiyon tanılı 19 hasta (10 erkek, 9 kadın, yaş ortalaması: 37.11±11.34 yıl, yaş aralığı:25−62 yıl) ve 16 sağlıklı kontrol grubu (8 erkek, 8 kadın, yaş ortalaması: 33.50±11.56 yıl, yaş aralığı:24−55 yıl) dahil edildi. Tüm deneklerde böbrek hastalığı ve interferon-alfa, pegylated interferon-alfa, lamivudine ve adefovir içeren HBV enfeksiyon tedavisi öyküsü yoktu. Kan üre nitrojeni (BUN), ure ve kreatinin analiz edildi. Böbrek perfüzyonu, konsantrasyonu ve ekskresyonu Tc99m DTPA sintigrafisi ile değerlendirildi. Pik zamanı (TTP), pik aktivite (kaunt/saniye) (PA), Yarılanma zamanı (T1/2) ve diferansiyel böbrek fonksiyonları hesap edildi. Glomeruler filtrasyon oranı (GFR) eş zamanlı olarak 3 metod ile belirlendi; gamma kamera uptake metodu (Gates, GFR), Kreatinin klerens metodu (Cockcroft-Gault, CG-GFR) ve böbrek hastalığında modifiye diyet metodu (MDRD). Değişkenler gruplar arasında karşılaştırıldı. Bulgular: Hastalara ait parametrelerin ortalama değerleri; sağ TTP:5.73±3.14 dak, sol TTP:5.52±2.09 dak, sağ PA:884.78±214.85 kts/sn, sol PA:889.52±252.68 kts/sn ve sağ T1/2:17.84±6.89 dak, sol T1/2:14.51±8.59 dak. Diferansiyel funksiyonlar sağda % 50.27±3.39 ve solda %49.72±3.39 idi. Çalışma grubunda, Gates GFR:125.63±25.84 ml/dak, CG-GFR:124.05±24.32 ml/dak, MDRD-GFR:113.15±24.70 ml/dak/1.73 m2, BUN:14.57±5.05 mg/dl, urea: 27.37±10.24 mg/dl ve kreatinin:0.73±0.18 mg/dl idi. Kontrol grubuna ait parametrelerin ortalama değerleri; sağ TTP:4.05±1.87 dak, sol TTP:2.93±1.14 dak, sağ PA:819.25±260.48 kts/sn, sol PA:796.75±176.94 kts/sn ve sağ T1/2:12.25±3.19 dak, sol T1/2:12.25±5.49 dak. Kontrol grubunda, Gates GFR:109.75±39.03 ml/dak, CG-GFR:104.62±39.67 ml/dak, MDRD-GFR:89.68±34.15 ml/dak/1.73 m2, BUN:11.37±4.47 mg/dl, urea:24.75±5.54 mg/dl ve kreatinin:0.78±0.17 mg/dl idi. Sağ TTP ve sol TTP değerlerinde hasta ve kontrol grupları arasında istatistiksel farklılık vardı (sırasıyla, p

Keywords

• Hepatit B virus,Tc99m DTPA sintigrafi,böbrek fonksiyonu

References

1. Norder H, Courouce AM, Magnius LO. Complete genomes, phylogenetic relatedness and structural proteins of six strains of the hepatitis B virus, four of which represent two new genotypes. Virology, 198: 489–603, 1994
2. Naicker S, Fabian J, Naidoo S, Wadee S, Paget G, Goetsch S. Infection and glomerulonephritis. Semin Immunopathol, 29: 397–414, 2007
3. Connor FL, Rosenberg AR, Kennedy SE, Bohane TD. HBV associated nephrotic syndrome: resolution with oral lamivudine. Arch Dis Child, 88; 446–449, 2003
4. Bhimma R, Coovadia HM. Hepatitis B Virus-Associated Nephropathy. Am J Nephrol, 24: 198–211, 2004 Lai KN, Li PKT, Lui SF, et al. Membranous nephropathy related to hepatitis B virus in adults. N Engl J Med, 324: 1457–1463, 1991
5. Agodoa L, Eknoyan G, Ingelfinger J, et al. Assessment of structure and function in progressive renal disease. Kidney Int, 63: 144–150, 1997
6. Sarkar SD, Singhal PC. Basis of renal scintigraphy. In: Elgazzar AH (ed) The pathophysiologic basis of nuclear medicine. Springer-Verlag, Berlin Heidelberg, 154– 168, 2001
7. Gunasekera RD, Allison DJ, Peters AM. Glomerular filtration rate in relation to extracellular fluid volume: similarity between 99mTc-DTPA and inulin. Eur J Nucl Med, 23: 49–54, 1996
8. Petersen LJ, Petersen JR, Talleruphuus U, et al. Glomerular filtration rate estimated from the uptake phase of 99mTc-DTPA renography in chronic renal failure. Nephrol Dial Transplant, 14: 1673–1678, 1999

9. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron, 16: 31–41. 1976
10. Levey AS, Greene T, Kusek J, Beck GJ
11. Group MS. A simplified equation to predict glomerular filtration rate from serum creatinine [Abstract]. J Am Soc Nephrol, 11: A0828, 2000
12. Han SH. Extrahepatic manifestations of chronic hepatitis B. Clin Liver Dis, 8: 403– 418, 2004
13. de Man RA, Schalm SW, van der Heijden AJ, ten Kate FW, Wolff ED, Heijtink RA. Improvement of hepatitis B-associated glomerulonephritis after antiviral combination therapy. J Hepatol, 8: 367–372, 1989 10