Yaşar YILDIRIM, ZÜLFÜKAR YILMAZ, Müslüm GÜNEŞ, Ali Veysel KARA, Ali Kemal KADİROĞLU, MEHMET EMİN YILMAZ

Diyabetik Nefropati Progresyonunda Nt-Pro BNP ve Volüm Yükü Arasındaki İlişki

Amaç: Kronik böbrek hastalığında (KBH) volüm yükünün erken tanısı çok önemlidir. NT- Pro BNP bunu gösteren değerli bir biyomarkırdır. Çalışmamızda diyabetik nefropati zemininde KBH gelişen evre 3-4 hastalarda NT-Pro BNP'nin sol ventrikül hipertrofisi, kan basıncı, glomerüler filtrasyon hızı ve proteinüri ile ilişkisini değerlendirmeyi amaçladık. Yöntemler: Diyabetik nefropati zemininde kronik böbrek hastalığı gelişen evre 3, 80 hasta ile evre 4, 80 hasta çalışmaya dahil edildi. NT-Pro BNP serumda, proteinüri 24 saatlik idrarda çalışıldı. Hastaların M-Mode ekokardiyografi ile sol ventrikül hipertrofisi belirlendi. KBH evrelerine göre iki gruba ayrılan hastaların T Pro BNP değerleri, sol ventrikül hipertrofisi, hipertansiyon ve proteinüri ile karşılaştırıldı. Bulgular: Diyabetik nefropatide hastalığın progresyonu ile birlikte NT- Pro BNP anlamlı olarak artmaktaydı. Ancak NT Pro BNP, sol ventrikül hipertrofisi, yüksek kan basıncı 1gram/gün üzerinde proteinürisi olanlarda daha yüksekti. Bununla beraber NT- Pro BNP ile sol ventrikül duvar kalınlığı arasında da pozitif korelasyon vardı. Bağımsız değişken olarak proteinüri, sistolik ve diyatolik kan basıncı NT- Pro BNP artışı ile ilişkilidir. Sonuç: Kronik böbrek hastalığının progresyonu ile NT Pro BNP artmaktadır. Bu artışa en büyük katkıyı proteinüri yapmaktadır.

The Relationship Between Nt-ProBNP and Volume Overload in Diabetic Nephropathy Progression

Objectives: The early diagnosis of volume overload in chronic kidney disease (CKD) is very important. N-terminal probrain natriuretic peptide (NT-proBNP) is a valuable biomarker for this purpose. Our study aimed to detect the relationship between NT-proBNP and left ventricular hypertrophy (LVH), hypertension (HT), GFR, and proteinuria among diabetic patients with stage 3-4 CKD. Methods: 160 diabetic patients with stage 3-4 CKD [80 patients in stage 3 CKD (group 1) and 80 patients in stage 4 CKD (group 2)] were enrolled. NT-proBNP levels were evaluated in serum, and proteinuria was determined from 24-hour collected urine. Left ventricular hypertrophy was evaluated by M-mode echocardiography. NT-proBNP levels were compared according to their left ventricular hypertrophy, hypertension, and proteinuria levels. Results: NT-proBNP levels was significantly higher, and GFR was lower in group 2 compared to group1 (p < 0.05). NTproBNP was higher in patients with LVH (+) HT (+) and proteinuria >= 1gr/d than patients with LVH (-), HT (-), and proteinuria < 1g/d (p < 0.05). We found a significant correlation between NT-proBNP levels and left ventricular posterior wall thickness, diastole (LVPWTd), proteinuria, SBP, and DBP. Proteinuria was the major contributor to increased NTproBNP levels among the independent variables. Conclusion: We detected that NT-proBNP levels are increased during the progression of CKD, and proteinuria is the major cause of increased NT-proBNP levels among the independent variables.

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