Primer Glomerülonefritlerde İmmünosüpresif Tedavilerin Yan Etkileri

Yıl 2024, Cilt: 38 Sayı: 3, 169 - 177, 27.12.2024

Tuba Yuce Inel , Halil Yazıcı , Özgür Akın Oto , Erol Demir , Fsdime Sevgi Saçlı , Ali Rıza Uçar , Ahmet Burak Dirim , Savaş Öztürk , Aydın Türkmen

https://doi.org/10.18614/deutip.1423356

Öz

Amaç: Glomerülonefrit (GN) tedavisinde yaygın olarak kullanılan immünosupresif (IS) ajanların yan etkileri açısından hastaların yakından izlenmesi gerekmektedir. Çalışmamız, özellikle IS'ye odaklanarak, primer GN'li hastalarda ilaca sekonder görülen yan etkileri araştırmayı amaçladı.
Yöntemler: Bu çalışmaya IS ajanlarla tedavi edilen 162 yetişkin GN hastası dahil edildi. Çalışmada hastaların demografik ve klinik özellikleri, laboratuvar bulguları ve IS ilaçlarla ilişkili yan etkiler incelendi. Hastalar; enfeksiyonların sıklığı ve natürü, muskuloskeletal ve gastrointestinal semptomlar, tromboembolizm, yeni başlayan diyabet, avasküler nekroz, nöropsikiyatrik yan etkiler ve premalign durumlar açısından da araştırıldı.
Bulgular: Hastaların %51,9'u erkekti ve yaş ortalaması 37,2±12,9 yıldı. Hastalar ortalama 69,6±40,1 ay süreyle klinik gözlem altında tutuldu ve tedavi sırasında %71'inde en az bir yan etki görüldü. Veriler incelendiğinde GN tipi ile yan etki varlığı arasında anlamlı bir korelasyon saptanmadı. Kortikosteroid (KS) alan hastaların, diğer IS tedavilere göre daha yüksek miyopati insidansı sergilediği gösterildi (p=0,001). Hipoalbüminemi (OR: 2,05; %95 GA: 1,82–2,28; p =0,001) ve steroid tedavisi (OR: 1,04; %95 GA: 1,01–1,06; p = 0,009), yan etki riskinin artmasıyla anlamlı şekilde ilişkili bulundu.
Sonuç: GN vakalarında, özellikle hipoalbüminemi ve KS maruziyetinin eşlik ettiği durumlarda, hastaların IS tedavisiyle ilişkili yan etkilerle karşılaşma olasılığı artabilir.
Ana noktalar:
• GN tanılı hastalar, IS ajanlardan kaynaklanabilecek olası yan etkileri tespit etmek için dikkatli bir şekilde izlenmelidir.
• Hipoalbuminemi ve kortikosteroide maruziyet, yan etki görülme olasılığını artırır.
• Bu çalışmada, GN tipi ile yan etkiler arasında anlamlı bir ilişki olmadığı görülmüştür.

Anahtar Kelimeler

Glomerülonefrit, yan etkiler, enfeksiyonlar, immünosupresif tedaviler

Proje Numarası

Tarih ve Sayı: 21.11.2023-2265277

Side Effects of Immunosuppressive Treatments in Primary Glomerulonephritis

Öz

Abstract
Background: It is imperative to closely monitor patients for adverse effects of immunosuppressive (IS) agents, widely used in treating glomerulonephritis (GN). Our study aimed to investigate the occurrence of any drug-related adverse events in patients with primary GN, explicitly focusing on IS.
Methods: The present study analyzed 162 adult GN patients treated with IS drugs. The study scrutinized the demographic and clinical profiles of the patients, laboratory findings, and any side effects associated with IS drugs. We further investigated the patients for frequency and nature of infections, musculoskeletal and gastrointestinal symptoms, thromboembolism, new-onset diabetes, avascular necrosis, neuropsychiatric side effects, and premalignant conditions.
Results: The study comprised a diverse group of patients with a male majority of 51.9% and a mean age of 37.2±12.9 years. The patients were under clinical observation for an average of 69.6±40.1 months, and during the treatment, 71% experienced at least one adverse effect. After evaluating the data, we did not find a significant correlation between the GN type and the presence of side effects. Research demonstrates that patients receiving corticosteroids (CS) exhibit a higher incidence of myopathy than those receiving other IS therapies (p=0.001). Hypoalbuminemia (OR: 2.05; 95% CI: 1.82–2.28; p =0.001) and steroid treatment (OR: 1.04; 95% CI: 1.01–1.06; p = 0.009) are significantly associated with increased risk of adverse outcomes.
Conclusion: In cases of GN, it is not unusual for patients to encounter adversities associated with IS treatment, primarily when there is a comorbidity of hypoalbuminemia and CS exposure. The probability of these side effects occurring may increase under such circumstances.

Main Points:
• Patients diagnosed with GN should undergo meticulous monitoring to detect any potential adverse effects that may arise from the administration of IS agents
• The probability of experiencing side effects is higher when hypoalbuminemia and CS exposure are present.
• The present study suggests no discernible correlation between the type of GN and side effects.

Anahtar Kelimeler

glomerulonephritis, side effects, immunosuppressive treatment, infections

Etik Beyan

Conflict of Interest Statement: The authors have no conflicts of interest to declare. Informed consent: All participants gave written informed consent to participate in the study

Destekleyen Kurum

Funding Sources: The authors did not receive any funding for this study

Proje Numarası

Tarih ve Sayı: 21.11.2023-2265277

Teşekkür

Acknowledgments: None declared

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