Nefroloji kliniğimizde takip edilen birincil membranöz glomerülonefritli hastalarda klasik prognoz kriterlerinin retrospektif olarak değerlendirilmesi

Yıl 2019, , 213 - 223, 06.02.2020

Erhan Adalı Mehmet Oktan Cihan Haybeli Mehtat Ünlü Serkan Yıldız Ali Çelik Sülen Sarıoğlu , Caner Çavdar

https://doi.org/10.5505/deutfd.2019.93446

Öz

Amaç: Kliniğimizde takip edilen birincil membranöz glomerülonefritli hastalarda klasik prognoz kriterlerinin retrospektif olarak değerlendirilmesidir.
Gereç ve Yöntem: Kliniğimizce takipli birincil membranöz glomerülonefrit tanılı 54 hastanın retrospektif olarak arşiv kayıtları incelenmiştir. Üç hasta ikincil membranöz glomerülonefrit tanılı, 12 hasta dış merkez biyopsi tanılı, 2 hastanın yetersiz glomerül sayısı ve 7 hastanın da yetersiz laboratuvar verisi olması sebebiyle toplam 24 hasta çalışma kapsamı dışında bırakılarak kalan 30 hastanın demografik-klinik ve laboratuvar verileri not edilmiştir. Böbrek histopatolojik bulgularından yararlanılarak toplam böbrek kronisite indeksi hesaplanmıştır. Klinik prognostik faktörlerinin yanında böbrek kronisite indeksinin hastalık remisyonuna etkisi incelenmiştir.
Bulgular: Tanı yaşının (>50), erkek cinsiyetin, hipertansiyon varlığının (≥140/90mmHg), tanı anındaki proteinüri miktarının (≥8 g/gün) ve yüksek böbrek kronisite skorunun (2-3) hastalık prognozuna olumsuz etkisi gözlenmiştir. Çalışmamızda günlük idrar protein kaçağı 8 gramdan fazla olan ve böbrek kronisite skoru 2-3 olan olguların tedaviye dirençli olduğu, daha az remisyon elde edildiği ve daha sık relapslarla seyrettiği görülmüştür.
Sonuç: İleri evre histopatolojik hasarlanma bulgularının varlığının hastalık remisyonuna olumsuz etkisi gözlenmiştir. Proteinüri miktarı ve histopatolojik özellikler; risk sınıfını, remisyon ve relaps durumunu değerlendirmede ve seçilecek tedavide belirleyici olacaktır.

Anahtar Kelimeler

membranöz nefropati, proteinüri, son dönem böbrek yetmezliği, hipertansiyon

RETROSPECTIVE EVALUATION OF THE CLASSICAL CRITERIA OF PROGNOSIS IN PATIENTS WITH PRIMARY MEMBRANOUS GLOMERULONEPHRITIS IN OUR NEPHROLOGY CLINIC

Öz

Objective: The aim of the study is retrospective evaluation of the classic criteria for prognosis in primary membranous glomerulonephritis patients in our clinic.
Materials and Methods: The records of 54 patients with primary membranous glomerulonephritis who were followed-up by our clinic were retrospectively reviewed. A total of 24 patients were excluded from the study due to the fact that 3 patients had a secondary membranous glomerulonephritis, 12 patients had an external center biopsy, 2 patients had an inadequate glomerular material and 7 patients had inadequate laboratory data. Total renal chronicity index was calculated by using renal histopathological findings. Besides the clinical prognostic factors, the effect of renal chronicity index on disease remission was investigated.
Results: The age (>50) of diagnosis, male sex, presence of hypertension (≥140/90 mmHg), proteinuria at the time of diagnosis and high renal chronicity score (2-3) had a negative effect on the prognosis of the disease. In our study, the patients with daily urine protein leakage more than 8 grams and renal chronicity score 2-3, were found to be resistant to treatment, had less remission and more frequent relapses.
Conclusion: The presence of signs of advanced histopathological damage had a negative effect on disease remission. Amount of proteinuria and histopathological features will be decisive in the evaluation of the risk class, remission and relapse status and selection of the treatment.

Anahtar Kelimeler

membranous nephropathy, proteinuria, end stage kidney disease, hypertension

Kaynakça

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