Morfometrijska analiza glomerula, klinički tok i ishod bolesti kod gojaznih i negojaznih bolesnika sa fokalno segmentnom glomerulosklerozom

  • Elena Angel Jordanova Department of nephrology, Clinic for Internal Medicine, Clinical Hospital Center Zemun, Belgrade
  • Radmila Janković University of Belgrade, Faculty of Medicine, Institute of Pathology, Belgrade, Serbia
  • Radomir Naumović Clinic of Nephrology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade
  • Dejan Ćelić Clinical Center of Vojvodina,Clinic of Nephrology and Clinical Immunology, Novi Sad, Serbia
  • Bojana Ljubičić Clinical Center of Vojvodina, Clinic of Nephrology and Clinical Immunology, Novi Sad, Serbia
  • Sanja Simić Ogrizović Medigroup Hospital, Belgrade, Serbia
  • Gordana Basta Jovanović University of Belgrade, Faculty of Medicine, Institute of Pathology, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP190204033J
Ključne reči: biopsija;, glomerulska filtracija, brzina;, glomeruloskleroza, fokalna, segmentna;, bubreg, glomerul;, gojaznost;, rizik, procena;, lečenje, ishod

Sažetak


Uvod/Cilj. U poslednje tri decenije fokalno segmentna glomeruloskleroza (FSGS) je predstavljena kao oblik glomerulopatije uslovljene gojaznošću (GUG), poseban entitet karakterisan proteinurijom, glomerulomegalijom, progresivnom glomerulosklerozom i smanjenjem bubrežne funkcije. Cilj ove studije bio je odrediti morfometriju glomerula, klinički tok i ishod nakon dve godine praćenja gojaznih i negojaznih FSGS bolesnika. Metode. Studija je obuhvatila 35 FSGS bolesnika (23 muškaraca, starosti od 46,5 ± 15,2 godina), podeljenih u dve grupe: gojazni [body mass index (BMI) – indeks telesne mase ≥ 27 kg/m2 – 18 bolesnika, starosti od

 

 47,2 ± 15,5 godina] i negojazni [BMI < 27 kg/m2 (17 bolesnika, starosti od 45,7 ± 15,2 godina)]. Merena je serumska koncentracija proteina, albumina, holesterola, triglicerida i kreatinina u momentu biopsije, kao i 6, 12 i 24 meseca nakon biopsije. Jačina glomerulske filtracije (JGF) procenjena je pomoću formula Cockcroft-Gault (BMI < 27 kg/m2) i Cockcroft-GaultLBW (BMI ≥ 27 kg/m2). Između dve grupe morfometrijski su poređeni poluprečnik glomerula (PG), volumen glomerula (VG) i gustina glomerula (GG) Rezultati. U vreme biopsije i nakon 6 meseci, gojazni su imali značajno nižu JGF u poređenju sa negojaznim. Nakon 24 meseca praćenja, nije bilo razlike između grupa. Gojazni su imali statistički značajno viši PG (109,44 ± 6,03 μm vs. 98,53 ± 14,38 μm) i VG (3,13 ± 0,49 x 106 μm3 vs. 2,26 ± 0,83 x 106 μm3), ali nižu GG bez značajne razlike u poređenju sa negojaznim (1,91 ± 0,39/mm2 vs. 1,95 ± 0,61/mm2). Pronađena je značajna, pozitivna korelacija između VG i BMI (r = 0,439). Nakon 12 meseci praćenja, značajno viši procenat negojaznih bolesnika ušlo je u kompletnu remisiju u poređenju sa gojaznim (71,4% vs. 37,5%; p = 0,041), ali, nakon 24 meseca nije bilo značajne razlike između grupa. Zaključak. Gojazni bolesnici su u vreme biopsije bubrega i nakon 6 meseci praćenja imali značajno nižu JGF u poređenju sa negojaznim bolesnicima. Međutim, nakon 12 i 24 meseca, ova statistički značajna razlika se izgubila. Takođe, posle 24 meseca praćenja nije bilo značajne razlike između dve grupe u procentu bolesnika sa kompletnom remisijom nefrotskog sindroma.

Biografija autora

Elena Angel Jordanova, Department of nephrology, Clinic for Internal Medicine, Clinical Hospital Center Zemun, Belgrade

Specialist of internal medicine,

Nephrologist

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Objavljeno
2021/02/11
Broj časopisa
Vol. 78 Br. 1 (2021): Vojnosanitetski Pregled
Rubrika
Originalni članak