Renalna funkcija posle nefrektomije: donorska nefrektomija vs. radikalna nefrektomija
Sažetak
Uvod/Cilj. Posle donorske nefrektomije (DN) ili radikalne nefrektomije (RN) zbog tumora bubrega, praćenje bubrežne funkcije je od suštinskog značaja. Cilj rada bio je da se uporedi preoperativna i postoperativna bubrežna funkcija posle DN, u odnosu na bolesnike koji su bili podvrgnuti RN zbog maligniteta bubrega. Metode. Retrospektivnom studijom slučaj-kontrole obuhvaćeno je 199 ispitanika podeljenih u dve grupe: I grupa (n = 105) bili su ispitanici kojima je urađena DN zbog transplantacije bubrega živog srodnog/nesrodnog donora, dok je II grupa (n = 94) bila kontrolna grupa i obuhvatala je bolesnike kojima je urađena RN zbog svetloćelijskog karcinoma bubrežnih ćelija u kliničkom stadijumu T1bNoM0, gde je ta hirurška procedura bila i konačni vid lečenja. Rezultati. Preoperativno, procenjena stopa brzine glomerulske filtracije [estimated glomerular filtration rate (eGFR) prema jednačini Chronic Kidney Disease−Epidemiology Collaboration (EGFR EPI)] u grupi bolesnika sa DN iznosila je 94,95 mL/min/1,73 m2, a kod bolesnika sa RN 71,00 mL/min/1,73 m2. Bolesnici koji su bili podvrgnuti RN imali su tendenciju da eGFR EPI nakon deset godina praćenja ostane ispod 60 mL/min/1,73 m2, u poređenju sa osobama koje su bile podvrgnute DN. Kod ispitanika I grupe (DN) prosečna eGFR EPI iznosila je 80,40 mL/min/1,73 m2, a kod ispitanika II grupe (RN) 56,00 mL/min/1,73 m2. Primećena je i veća učestalost pojave dijabetesa melitusa (DM) i arterijske hipertenzije (AH) u grupi posle DN u odnosu na grupu posle RN (AH: 44,3% vs. 21,3%; DM: 22,6% vs. 9,6%). Zaključak. Uporednim praćenjem obe grupe, može se primetiti da se, poznatim adaptivnim mehanizmima, kod njih ostvaruje oporavak bubrežne rezerve posle prve godine od nefrektomije. Bez obzira na to što se kod transplantacije bubrega živog davaoca kod davaoca bubrega smanjuje inicijalna bubrežna rezerva (zbog nefrektomije, trajnog gubitka renalne mase), davaocima bubrega se, zahvaljujući adaptivnim mehanizmima, funkcija bubrega oporavlja unutar prve godine od hirurške intervencije.
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