İLERİ YAŞLI PRİMER MEMBRANÖZ NEFROPATİLİ HASTALARDA GLOMERÜLER C3 BİRİKİMİNİN ÖNEMİ

Öz

Amaç: Bu çalışmada, primer membranöz nefropatili (PMN) yaşlı (>60 yaş) hastalarda glomerüler C3 birikim yoğunluğunun klinik, histopatolojik özellikler ve hastalığın seyri üzerindeki etkilerini araştırmayı amaçladık. Gereç ve Yöntem: Bu retrospektif gözlemsel çalışmaya dahil ettiğimiz PMN’li 105 hastayı böbrek biyopsi örneklerinde C3 birikiminin yoğunluğuna göre düşük yoğunluklu (C3 1+; LI) ve yüksek yoğunluklu (C3 2+ veya C3 3+; HI) olmak üzere iki grupta inceledik. Birincil sonlanım noktası son evre böbrek hastalığı, ikincil sonlanım noktaları ise tam (CR) veya kısmi remisyon (PR) idi. Bulgular: İzlem sonunda (ortanca 30,6 ay), HI grubunda LI grubuna kıyasla daha fazla hasta birincil noktaya ulaşırken daha az hasta ikincil son noktalara erişti (sırasıyla p=0,015 ve p=0,016). Ayrıca HI grubunda LI grubuna göre glomerüler filtrasyon hızı (eGFR) daha düşük (p<0,001), proteinüri ise daha fazlaydı (p=0,018). Kaplan-Meier analizlerinde böbrek sağ kalımının (p=0,031) HI grubunda LI grubundan daha düşük olduğu saptandı. Çok değişkenli lojistik regresyon analizlerinde, son noktalar öngördürücü bir parametre saptanamadı. Sonuç: Yoğun glomerüler C3 birikimi, PMN’li yaşlı hastalarda olumsuz klinik sonuçlarla ilişkilidir. 

Anahtar Kelimeler

• Kompleman sistemi
• C3
• ileri yaş
• membranöz nefropati

THE IMPORTANCE OF GLOMERULAR C3 ACCUMULATION IN ELDERLY PATIENTS WITH PRIMARY MEMBRANOUS NEPHROPATHY

Öz

ABSTRACT Objective: The purpose of this study was to investigate the impact of glomerular C3 accumulation density on clinical, histopathological parameters and outcomes in elderly (>60 years) individuals with primary membranous nephropathy (PMN). Material and Methods: In this study, we examined the patients (n=105) in two groups according to the C3 staining density in kidney biopsy samples as low intensity (C3: 1+; LI group) and high intensity (C3: 2+ or C3: 3+; HI group). The primary endpoint of our study was the end-stage renal disease, and the secondary endpoints were the development of partial remission (PR) or complete remission (CR). Results: At the end of the follow-up (mean 30.6 months), more patients achieved the primary endpoint, and fewer patients achieved the secondary endpoints in the HI group compared to the LI group. (p=0.015 and p=0.016, respectively). Moreover, the glomerular filtration rate (eGFR) was lower (p<0.001), and proteinuria was higher in the HI group (p=0.018). Kaplan-Meier survival analysis revealed that renal survival (p=0.031) was lower in the HI group compared to the LI group. In the multivariate logistic regression analyses, no predictive parameters could be detected for the endpoints. Conclusion: Intense glomerular C3 deposition in elderly (>60 years) patients with PMN may be related to poor clinical outcomes. 

Anahtar Kelimeler

• Complementary system
• C3
• older age
• membranous nephropathy

Kaynakça

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