Prediktori bubrežnog ishoda kod ANCA-udruženih glomerulonefritisa
Sažetak
Uvod/Cilj. Primarni anti-neutrofilna citoplazmatska antitela (ANCA)-udruženi vaskulitisi predstavljaju hronično multisistemsko autoimunsko oboljenje u koje se ubrajaju mikroskopski poliangiitis (MPA), granulomatoza sa poliangiitisom (WG), eozionofilna granulomatoza sa poliangiitsom (EPGA; Churg-Stranss sindrom – CSS), kao i lokalizovane forme bolesti. U našem ispitivanju, koristili smo kliničke i serološke parametre kod bolesnika kako bismo pronašli koji od njih bi bili najbolji prediktori bubrežnog ishoda kod ANCA-udruženih glomerulonefritisa. Metode. Analizirani su podaci 42 bolesnika sa dijagnozom MPA (9), WG (17), eozionofilna granulomatoza sa poliangiitsom (EPGA; CSS) (0), kao i idiopatski rapido-progresivni glomerulonefritis bez imunskih depozita (16). Cockcroft formula je upotrebljena za izračunavanje glomerulske filtracije u momentu prezentacije bolesti i nakon petogodišnjeg praćenja bolesnika. Ostali faktori koji su analizirani bili su: pol, starost, tip ANCA antitela, tip infekcija, stepen hronične bubrežne insuficijencije (HBI), potreba za hemodijalizom i mortalitet. Rezultati. Od ukupno 42 bolesnika, 17 (40,48%) su bili muškog pola. Prosečna starost bolesnika u vreme postavljanja dijagnoze bila je 57,8 ± 10,44 godina. Prisustvo pozitivnih anti-proteinaze 3 (anti-PR3) antitela potvrđeno je kod 18 bolesnika, a anti-MPO antitela kod 17 bolesnika. Pozitivnost anti-PR3 i anti-MPO antitela dokazana je kod tri bolesnika. Inicijalno, hemodijalizni tretman je
sproveden kod 12 bolesnika. Nakon sprovedene terapije kod 29 bolesnika postignuta je potpuna, a kod 13 bolesnika delimična remisija. Od ukupnog broja bolesnika, osam (19,04%) je razvilo terminalni stadijum slabosti bubrega i nastavilo lečenje hroničnim hemodijalizama. Tokom perioda praćenja od pet godina, 12 bolesnika (28,57%) je umrlo. Starost bolesnika bila je statistički značajan predictor brzine glomerularne filtracije (GFR-a) u momentu prezentacije bolesti (p = 0.011). GFR t = 0 pokazao se statistički značajnim (p = 0.000) za procenu ishoda bubrežne funkcije kod ANCA-udruženih glomerulonefritisa. Zaključak. Bubrežna funkcija u momentu prezentovanja bolesti, određena putem GFR t = 0, predstavlja jedini značajni faktor za procenu ishoda bubrežne funkcije kod ANCA-udruženih glomerulonefritisa, kao i mortaliteta kod ovih bolesnika.
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