Hari Krishan AGGARWAL, Harpreet SİNGH, Deepak JAİN, Teena BANSAL, Promil JAİN, Joginder DUHAN

Romatoid Artrit\'li hastalarda böbreğin histopatolojik ve fonksiyonel durumu

Amaç: Bu çalışmanın amacı romatoid artritte romatoid artritli (RA) hastalarda hastalık şiddeti ve süresinin böbrek fonksiyonları ve histopatoloji üzerine etkilerini gözlemektir. Gereç ve yöntem: Çalışmaya her biri 25\'er hasta içeren iki gruptan oluşan toplam 50 hasta alındı. Hastalık şiddeti sakatlık aktivite skoru (SAS) ile değerlendirildi. Tam idrar tetkiki, serum üre ve kretinini ve kreatinin klirensi gibi böbrek değişkenleri hastaneye ilk başvuruda kaydedildi. Aktif idrar sediment bulunan, hematuria ve/veya 300 mg/gün\'den fazla proteinürisi bulunan ve serum kreatinini 1.5 mg/dl üzerinde olan hastalara perkutan böbrek biyopsisi uygulandı. Bulgular: Grup I hastalarda hastalık süresi 2-5 yıl arasında, Grup II\'de 5 yıldan uzun süreli idi. Romatoid artritli hastaların %28\'inde idrar anormallikleri saptandı, bunların %12\'sinde izole hematüri, %10\'unda izole proteinüri, %6\'sında ise hematüri ve proteinüri birlikte görüldü. Hastaların %14\'ünde yüksek serum kreatinin değeri (>1.5 mg/dl) saptandı. Hastaların %20\'sine böbrek biyopsisi uygulandı ve biyopsi sonucunda histopatolojik olarak mezanjiyal glomerülonefrit, memebranöz glomerülonefrit, sekonder amiloidoz ve interstisyel nefrit bulundu. Grup II\'de ağır SAS bulunan hastaların %63\'ünde idrar anormallikleri saptanırken, %83\'ünde artmış serum kreatinin ve %60\'ında ağır histopatolojik anormallikler saptandı. Bu durum ileri düzeyde SAS ve uzamış hastalık süresinin böbrek histofonksiyonel durumu üzerinde önemli etkilerle birlikteliğini göstermekteydi. Sonuç: Romatoid artritte hastalık süresi ve ağırlığına paralel olarak renal fonksiyon bozukluğunda bir artış olduğu gözlendi.

Anahtar Kelimeler:

Romatoid artrit, böbrek fonksiyonları, hematüri, proteinüri

Histofunctional status of kidney in patients with rheumatoid arthritis

Objectives: The aim of this study was to observe the effects of duration and severity of disease on renal functions and histopathology in patients with rheumatoid arthritis (RA). Material and methods: The study included 50 patients of RA, who were divided into two groups of 25 patients each. Disease severity was assessed by Disability Activity Score (DAS). The renal parameters i.e., urine complete examination, blood urea, serum creatinine and creatinine clearance were estimated at enrolment. Percutaneous renal biopsy was performed in patients having active urinary sediment, haematuria and/or proteinuria more than 300 mg/day and serum creatinine more than 1.5 mg/ml. Results: Group I patients had duration of disease between 2-5 years and in Group II the duration was more than 5 years. Urine abnormalities were documented in 28% RA patients and 12% patients had isolated hematuria, 10% patients presented with isolated proteinurea and combined haematuria and proteinurea was present in 6% patients.14% patients presented with raised creatinine( >1.5mg/ml). Renal biopsy was performed in 20% of patients which showed mesangial glomerulonephritis, membranous glomerulonephritis, secondary amyloidosis and interstitial nephritis. In group I severe DAS score was present in 17% of the patient having urinary abnormality, however 20% patients showed histopathological findings. In group II 63% of patients with severe DAS score had urinary abnormality, 83% showed raised serum creatinine and 60% had histopathological abnormalities indicating severe DAS score and increased duration of disease was associated with significant effects on histofunctional status of kidney. Conclusion: There was a significant increase in renal dysfunction with duration and severity of disease in rheumatoid arthritis.

Keywords:

Rheumatoid arthritis renal functions, histopathology, haematuria, proteinuria,

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