Erhan ADALI, Mehmet Ası OKTAN, Cihan HEYBELİ, Mehtat ÜNLÜ, Serkan YILDIZ, Ali ÇELİK, Sülen SARIOĞLU, Caner ÇAVDAR

Nefroloji kliniğimizde takip edilen birincil membranöz glomerülonefritli hastalarda klasik prognoz kriterlerinin retrospektif olarak değerlendirilmesi

Amaç: Kliniğimizde takip edilen birincil membranöz glomerülonefritli hastalarda klasik prognoz kriterlerinin retrospektif olarak değerlendirilmesidir. Gereç ve Yöntem: Kliniğimizce takipli birincil membranöz glomerülonefrit tanılı 54 hastanın retrospektif olarak arşiv kayıtları incelenmiştir. Üç hasta ikincil membranöz glomerülonefrit tanılı, 12 hasta dış merkez biyopsi tanılı, 2 hastanın yetersiz glomerül sayısı ve 7 hastanın da yetersiz laboratuvar verisi olması sebebiyle toplam 24 hasta çalışma kapsamı dışında bırakılarak kalan 30 hastanın demografik-klinik ve laboratuvar verileri not edilmiştir. Böbrek histopatolojik bulgularından yararlanılarak toplam böbrek kronisite indeksi hesaplanmıştır. Klinik prognostik faktörlerinin yanında böbrek kronisite indeksinin hastalık remisyonuna etkisi incelenmiştir. Bulgular: Tanı yaşının (>50), erkek cinsiyetin, hipertansiyon varlığının (≥140/90mmHg), tanı anındaki proteinüri miktarının (≥8 g/gün) ve yüksek böbrek kronisite skorunun (2-3) hastalık prognozuna olumsuz etkisi gözlenmiştir. Çalışmamızda günlük idrar protein kaçağı 8 gramdan fazla olan ve böbrek kronisite skoru 2-3 olan olguların tedaviye dirençli olduğu, daha az remisyon elde edildiği ve daha sık relapslarla seyrettiği görülmüştür. Sonuç: İleri evre histopatolojik hasarlanma bulgularının varlığının hastalık remisyonuna olumsuz etkisi gözlenmiştir. Proteinüri miktarı ve histopatolojik özellikler; risk sınıfını, remisyon ve relaps durumunu değerlendirmede ve seçilecek tedavide belirleyici olacaktır.

Anahtar Kelimeler:

membranöz nefropati, proteinüri, son dönem böbrek yetmezliği, hipertansiyon

RETROSPECTIVE EVALUATION OF THE CLASSICAL CRITERIA OF PROGNOSIS IN PATIENTS WITH PRIMARY MEMBRANOUS GLOMERULONEPHRITIS IN OUR NEPHROLOGY CLINIC

Objective: The aim of the study is retrospective evaluation of the classic criteria for prognosis in primary membranous glomerulonephritis patients in our clinic. Materials and Methods: The records of 54 patients with primary membranous glomerulonephritis who were followed-up by our clinic were retrospectively reviewed. A total of 24 patients were excluded from the study due to the fact that 3 patients had a secondary membranous glomerulonephritis, 12 patients had an external center biopsy, 2 patients had an inadequate glomerular material and 7 patients had inadequate laboratory data. Total renal chronicity index was calculated by using renal histopathological findings. Besides the clinical prognostic factors, the effect of renal chronicity index on disease remission was investigated. Results: The age (>50) of diagnosis, male sex, presence of hypertension (≥140/90 mmHg), proteinuria at the time of diagnosis and high renal chronicity score (2-3) had a negative effect on the prognosis of the disease. In our study, the patients with daily urine protein leakage more than 8 grams and renal chronicity score 2-3, were found to be resistant to treatment, had less remission and more frequent relapses. Conclusion: The presence of signs of advanced histopathological damage had a negative effect on disease remission. Amount of proteinuria and histopathological features will be decisive in the evaluation of the risk class, remission and relapse status and selection of the treatment.

Keywords:

membranous nephropathy, proteinuria, end stage kidney disease, hypertension,

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1. Couser WG. Primary membranous nephropathy. Clin J Am Soc Nephrol.2017; 12(6):983-97.
2. Zeng C, Chen H, Wang R, et al. Etiology and clinical characteristics of membranous nephropathy in Chinese patients. Am J Kidney Dis.2008; 52: 691-8.
3. Cahen R, Francois B, Trolliet P, et al.Etiology of membranous glomerulonephritis. Nephrol Dial Transplant.1989;4:172–80.
4. Glassock RJ. Diagnosis and natural course of membranous nephropathy. Semin Nephrol.2003; 23:324–32.
5. Cattran DC. Idiopathic membranous glomerulonephritis. Kidney Int. 2001;59:1983–94.
6. Cattran D. Management of membranous nephropathy: when and what for treatment. J Am Soc Nephrol.2005;16:1188–94.
7. Shiiki H, Saito T, Nishitani Y, et al. Prognosis and risk factors for idiopathic membranous nephropathy with nephrotic syndrome in Japan. Kidney Int. 2004;65:1400-7.
8. Cattran D, Reich H, Beanlands H, et al. The impact of sex in primary glomerulonephritis. Nephrol Dial Transplant. 2008;23:2247-53.
9. Du-Buf Vereijken P, Branten A, Wetzels J, et al. Idiopathic membranous nephropathy: Outline and rationale of treatment strategy. Am J Kidney Dis.2005;46:1012-29.
10. KDIGO Work Group KDIGO clinical practice guidelines for glomerulonephritis. Kidney Int.2012; 2 (2):1-174.
11. Reichert L J, Koene RA, Wetzels JF, et al. Prognostic factors in idiopathic membranous nephropathy. Am J Kidney Dis.1998;31 (1):1-11.
12. Koene RA, Wetzels JF, Reichert LJ, et al. Urinary Beta-2 microglobulin predicts renal out come with idiopathic in patients membranous nephropathy. J Am Soc Nephrol.1995; 6 (6): 1666-9.
13. Branten AJW, Du Buf-Vereijken PW, Klasen IS, et al. Urinary excretion of beta2-microglobulin and IgG predict prognosis in idiopathic membranous nephropathy: a validation study. J Am Soc Nephrol.2005;16:169-74.
14. Segal Paul E. Recent advances and prognosis in idiopathic membranous nephropathy. Adv Chronic Kidney Dis. 2012;19:114-9.
15. Sethi S, D'Agati VD, Nast CC, et al. A proposal for standardized grading of chronic changes in native kidney biopsy specimens. Kidney Int.2017;91: 787–9.
16. Pei Y, Cattran D, Greenwood C. Predicting chronic renal insufficiency in idiopathic membranousglomerulonephritis. Kidney Int. 1992;42:960–6.
17. Cattran DC, Pei Y, Greenwood CM, et al. Validation of a predictive model of idiopathic membranous nephropathy: its clinical and research implications. Kidney Int.1997;51: 901–7.
18. Fervenza FC, Sethi S, Specks U. Idiopathic membranous nephropathy: diagnosis and treatment. Clin J Am Soc Nephrol.2008;3:905–19.
19. Shiiki H, Saito T, Nishitani Y, et al. Prognosis and risk factors for idiopathic membranous nephropathy with nephrotic syndrome in Japan Kidney Int. 2004;65:1400-7
20. Schieppati A, Mosconi L, Perna A, et al. Prognosis of untreated patients with Idiopathic Membranous Nephropathy. N Engl J Med. 1993;329:85-9.
21. Csiky B, Kovacs T, Wagner L, et al. Ambulatory blood pressure monitoring and progression in patients with IgA nephropathy. Nephrol Dial Transplant. 1999;14:86–90.
22. Hogan SL, Muller KE, Jennette JC, et al. Review of the therapeutic studies of idiopathic membranous glomerulopathy. Am J Kidney Dis. 1995; 25:862.
23. Ponticelli C, Zucchelli P, Passerini P, et al. A 10-year follow-up of a randomized study with methylprednisolone and chlorambucil in membranous nephropathy. Kidney Int. 1995; 48:1600.
24. Hladunewich MA, Troyanov S, Calafati J, et al. The natural history of the non-nephrotic membranous nephropathy patient. Clin J Am Soc Nephrol. 2009;4:1417.
25. Zhang B, Cheng M,Yang M, et al. Analysis of the prognostic risk factors of idiopathic membranous nephropathy using a new surrogate end-point. Biomed Rep. 2016;4:147-52.