Uticaj gustine infiltrata u intersticijumu na prognozu primarnog glomerulonefritisa
Sažetak
Apstrakt
Uvod/Cilj. Razvoj inflamatornih promena i ožiljavanja i gubitak morfoloških struktura intersticijuma zauzimaju značajno mesto u patogenezi primarnih glomerulonefritisa, što utiče na nastanak, tok i prognozu ove bolesti. Cilj istraživanja bio je da se ispita uticaj promena u intersticijumu na prognozu primarnih glomerulonefitisa. Metode. Ispitivanjem je bilo obuhvaćeno 216 bolesnika sa različitim tipovima primarnih glomerulonefritisa lečenih na Klinici za nefrologiju i kliničku imunologiju Kliničkog centra Vojvodine koji su praćeni prosečno 77,5 meseci. Nakon utvrđivanja patohistološke dijagnoze tipa glomerulonefritisa, kvantifikovane su promene u intersticijumu bubrega. Određivana je numerička gustina u jedinici zapremine tkiva i struktura infiltrata korišćenjem Weibel-ovog sistema (M42) inkorporisanog u svetlosni mikroskop. Rutinske analize rađene su standardnom laboratorijskom procedurom. Rezultati: Tokom ispitivanog perioda najveća numerička gustina infiltrata verifikovana je kod esktrakapilarnog glomerulonefritisa (147 869 × mm-3), nešto manja kod membranoproliferativnog glomerulonefritisa (116 800 × mm-3) i fokalnosegmentne glomeruloskleroze (96 147 × mm-3), a najmanja kod glomerulonefritisa sa minimalnim promenama (11 416 × mm-3). Kod svih tipova glomerulonefritisa, osim glomerulonefritisa sa minimalnim promenama, ustanovljena je značajno (p < 0,0005) veća numerička gustina i zastupljenost ćelija infiltrata u odnosu na kontrolnu grupu. Upoređujući numeričku gustinu infiltrata svih ćelija sa parametrima bubrežne funkcije, utvrđena je značajna (p < 0,01) povezanost ovih pojava. Radi boljeg uvida u brzinu progresije bubrežne insuficijencije postavljenjem numeričke granice gustine infiltrata < 100 000 / > 100 000 ćelija/mm3 nezavisno od tipa glomerulonefritisa, ustanovljen je prognostički prediktor na osnovu kojeg su bolesnici sa manjom infiltracijom intersticijuma imali značajno (p < 0,005) sporiju progresiju bubrežne insuficijencije. Zaključak. Gustina infiltrata u intersticijumu kod primarnih glomerulonefritisa je važan, rani prognostički prediktor progresije bubrežne insuficijencije.
Reference
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