Lipokalin udružen sa neutrofilnom gelatinazom kao prediktor ishoda lečenja primarnog glomerulonefritisa

  • Gordana Stražmešter Majstorović University Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, Serbia
  • Igor Mitić University Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, Serbia
  • Vladimir Djurović University Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, Serbia; †University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
  • Sonja Golubović University Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, Serbia; †University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
  • Lada Petrović University Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, Serbia; †University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
  • Violeta Knežević University Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, Serbia; †University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
DOI: https://doi.org/10.2298/VSP251026020S
Ključne reči: biomarkeri;, glomerulonefritis;, bubreg, hronična insuficijencija;, lipokalini;, lečenje, ishod.

Sažetak


Uvod/Cilj. Biomarkeri za predviđanje toka bolesti mogli bi da olakšaju izbor terapije primarnog glomerulonefritisa (PGN). Podaci o ulozi lipokalina udruženog sa neutrofilnom gelatinazom (neutrophil gelatinase-associated lipocalin – NGAL) u PGN su oskudni. Cilj rada bio je da se proceni značaj NGAL u predviđanju ishoda lečenja PGN. Metode. Istraživanjem je obuhvaćeno ukupno 60 obolelih od PGN, praćenih od 2012. do 2024. godine. Pri postavljanju dijagnoze određivani su serumski NGAL (sNGAL) i urinarni NGAL (uNGAL). Parametri bubrežne funkcije (serumski kreatinin, proteinurija) i ishod bolesti–razvoj terminalnog stadijuma bubrežne slabosti (end-stage renal disease – ESRD)–procenjivani su na početku praćenja, posle 5 godina i posle kompletnog perioda praćenja. Povezanost NGAL-a i kliničkih ishoda analizirana je korišćenjem odgovarajućih statističkih testova. Rezultati. Na početku, medijane nivoa za sNGAL i uNGAL iznosile su 154,71 ng/mL i 13,94 ng/mL, redom. Tokom medijane praćenja od 112 meseci, 8,33% bolesnika je izgubljeno iz praćenja, a 20% je razvilo ESRD. Bolesnici koji su razvili ESRD imali su više nivoe sNGAL (p = 0,027). Korišćenjem sNGAL, razvoj ESRD bio je solidno predvidljiv (AUC = 0,709; p = 0,036), a sNGAL je bio značajno povezan sa vremenskim periodom do razvoja ESRD (Kaplan-Meier analiza, p < 0,001). U grupi sa najvišim sNGAL petogodišnje preživljavanje bubrega bilo je najniže. Bolesnici sa stabilnom ili poboljšanom procenjenom stopom glomerularne filtracije (estimated glomerular filtration rate – eGFR) imali su više vrednosti odnosa uNGAL/kreatinin (p = 0,049). Promene u vrednostima proteinurije bile su u negativnoj korelaciji sa koncentracijama sNGAL (p < 0,001) i uNGAL (p = 0,005). Zaključak. Kod obolelih od PGN, sNGAL može biti prediktor razvoja ESRD, potencijalno odražavajući njegovu profibroznu aktivnost. Nasuprot tome, korelacija između nivoa NGAL i promene vrednosti proteinurije, kao i povezanost između viših vrednosti odnosa uNGAL/kreatinin i poboljšane eGFR, ukazuju na složenu i potencijalno protektivnu ulogu NGAL u progresiji bolesti.

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Objavljeno
2026/04/27
Broj časopisa
Vol. 83 Br. 04 (2026): Vojnosanitetski pregled
Rubrika
Originalni članak