LUPUS NEFRİTLİ HASTALARIN KLİNİK VE PATOLOJİK BULGULARININ DEĞERLENDİRİLMESİ VE TEDAVİ SONUÇLARI: TEK MERKEZ DENEYİMİ

Öz

Amaç: Sistemik lupus eritematozusun (SLE) böbrek tutulumu olarak bilinen lupus nefriti (LN), böbrek tutulumu olmayan SLE’ye göre daha kötü bir prognoza yol açar. Gereç ve Yöntem: Ocak 2012 ile Ocak 2021 arasında tanı konulan biyopsiyle kanıtlanmış LN hastaları incelendi. Tam remisyon (TR), idrar protein-kreatinin oranının (PKO) 0,50 g/g’nin altına düşmesi olarak tanımlandı. Kısmi yanıt, 24 saatlik idrar protein atılımının günde 3 g/günün altına düşmesi ve proteinüride en az %50 azalma olarak tanımlandı. Birincil etkili renal yanıt ise 0,7 g/g'dan düşük PKO ve tedavi başarısızlığı için herhangi bir kurtarma tedavisinin olmamasıdır. Bulgular: Tanı anında tüm hastalarda proteinüri mevcut olup, en yaygın form %36,4 ile sınıf IV LN idi ve hastaların %65.9’unda proliferatif LN vardı. Oniki ayda, 16 hastada (%37,2) TR elde edil di ve tanı anında sistolik ve diyastolik kan basıncı ile eGFR’de anlamlı farklar vardı (sırasıyla, p=0,01, p=0,02 ve p=0,016). Pro liferatif LN (p=0,024) ve interstisyel inflamasyonu olan hastalarda 12 aylık TR oranları daha düşük bulundu (p=0,04). Ayrıca, ste roid ve siklofosfamid ile tedavi edilen PLN hastaları ile steroid ve mikofenolat mofetil (MMF) ile tedavi edilenler arasında 6 ve 12 aylık TR oranlarında anlamlı fark bulunmadı (p>0,05). Bununla birlikte, mikofenolat mofetil grubunda TR elde etme süresi daha kısaydı (p=0,048). Sonuç: LN, SLE hastalarında morbidite ve mortalitenin önemli bir kaynağı olmaya devam etmekte olup erken tanı ve tedavi böbrek ve hasta sağkalımı için kritik öneme sahiptir.

Anahtar Kelimeler

• Böbrek sağkalımı
• lupus nefriti
• son dönem böbrek hastalığı
• remisyon
• indüksiyon tedavisi

EVALUATION OF CLINICAL AND PATHOLOGICAL FINDINGS AND TREATMENT OUTCOMES OF PATIENTS WITH LUPUS NEPHRITIS: A SINGLE CENTRE EXPERIENCE

Öz

Objective: Renal involvement in systemic lupus erythematosus (SLE), also known as lupus nephritis (LN), leads to a worse prognosis than SLE without kidney involvement. Material and Methods: Biopsy-proven LN patients diagnosed between January 2012 and January 2021 were reviewed. Complete remission (CR) was defined as a reduction in the urinary protein-to-creatinine ratio (UPCR) below 0.50 g/g. Partial response is characterised by a 24-h urine protein excretion reduction to below 3 g/day with at least a 50% decrease in proteinuria. Primary effective renal response was defined as PCR of less than 0.7 g/g and the absence of any rescue therapy for treatment failure. Result: All patients exhibited proteinuria at diagnosis, with class IV LN being the most common (36.4%) form, and 65.9% had prolif erative LN. At 12 months, CR was achieved in 16 patients (37.2%) with significant differences in systolic and diastolic blood pressure and eGFR at diagnosis (p=0.01, p=0.02, and p=0.016, respective ly). CR rates were lower at 12 months in patients with proliferative LN (p=0.024) and interstitial inflammation (p=0.04). Besides, no significant difference was found in CR rates at 6 and 12 months between PLN patients treated initially with steroids and cyclo phosphamide and those treated with steroids and mycopheno late mofetil (p>0.05). However, the median time to achieve CR was shorter in the mycophenolate mofetil group (p=0.048). Conclusion: LN remains a significant source of morbidity and mortality in patients with SLE; therefore, early diagnosis and prompt initiation of the treatment are crucial for renal and patient survival.

Anahtar Kelimeler

• Renal survival
• lupus nephritis
• end-stage renal dis ease
• remission
• induction therapy

Kaynakça

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