Uspešno lečenje idiopatske retroperitonealne fibroze kombinovanom imunosupresivnom terapijom
Sažetak
Apstrakt
Uvod/Cilj. Idiopatska retroperitonealna fibroza (IRF) karakteriše se periaortnim fibroinflamatornim tkivom koje zahvata uretere dovodeći do opstruktivne nefropatije i različitog stepena bubrežne insuficijencije. Oboljenje je najverovatnije autoimune etiologije. Optimalna terapija do sada nije definisana. Cilj rada bio je analiza dugoročne efikasnosti kombinovane imunosupresivne terapije kortikosteroidima i mikofenolat mofetilom u lečenju IRF. Metode. Retrospektivno je praćeno 13 bolesnika (8 muškaraca i 5 žena) sa IRF. Svi bolesnici su primili kortikosteroide i mikofenolat mofetil (MMF). Kod bolesnika sa izraženom bubrežnom insuficijencijom, prvo je učinjena dekompresija urinarnog trakta i potom započeta terapija peroralnim prednizonom 0,5 mg/kg sa brzim smanjivanjem doze. Bolesnici sa umerenom bubrežnom slabošću primili su inicijalno tri pulsne doze metilprednizolona intravenski, a potom je nastavljeno sa prednizonom. Doza MMF je bila 1000 mg dva puta dnevno. MMF je obustavljen nakon 18 meseci, a prednizon nakon 48 meseci. Rezultati. Kod svih bolesnika došlo je do povlačenja opštih simptoma bolesti. Vrednost sedimentacije eritrocita (SE) smanjena je sa prosečnih 67,6 na 26,3 mm/h, a C-reaktivnog proteina (CRP) sa prosečih 18,5 na 6,3 mg/L. Kod sedam od ukupno osam bolesnika, ureteralni stentovi su uspešno izvađeni nakon prosečno 13 nedelja. Sedam bolesnika imalo je 100% redukciju periaortnog tkiva, a prosečni stepen redukcije je bio 76,9%. Bubrežna funkcija je poboljšana, kod šest bolesnika je normalizovana, dok je kod četiri zaostala umerena hronična bubrežna slabost usled afunkcije jednog bubrega. Tri bolesnika sa prethodnom hroničnom bubrežnom insuficijencijom nisu pogoršala funkciju. Recidiv bolesti imala su tri bolesnika. Nisu registrovani neželjeni efekti terapije. Zaključak. Kombinovana primena kortikosteroida i MMF je potencijalno efikasna terapija u poboljšanju bubrežne funkcije i smanjenju debljine fibroznog tkiva kod bolesnika sa IRF. Ona bi mogla otkloniti potrebu za plasiranjem ureteralnih stentova i hirurškim lečenjem. Duže trajanje terapije moglo bi smanjiti mogućnost recidiva bolesti.
Reference
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