Özgür Akın OTO, Safak MIRIOGLU, Ahmet Burak DİRİM, Seda ŞAFAK, Nurana GÜLLER, Erol DEMİR, Ayşe Serra ARTAN, Yasemin ÖZLÜK, Ali Rıza UÇAR, Lala SOLTANOVA, Kanan NURİYEV, Halil YAZICI, Yasar CALISKAN

İLERİ YAŞLI PRİMER MEMBRANÖZ NEFROPATİLİ HASTALARDA GLOMERÜLER C3 BİRİKİMİNİN ÖNEMİ

Amaç: Bu çalışmada, primer membranöz nefropatili (PMN) yaşlı (>60 yaş) hastalarda glomerüler C3 birikim yoğunluğunun klinik, histopatolojik özellikler ve hastalığın seyri üzerindeki etkilerini araştırmayı amaçladık. Gereç ve Yöntem: Bu retrospektif gözlemsel çalışmaya dahil ettiğimiz PMN’li 105 hastayı böbrek biyopsi örneklerinde C3 birikiminin yoğunluğuna göre düşük yoğunluklu (C3 1+; LI) ve yüksek yoğunluklu (C3 2+ veya C3 3+; HI) olmak üzere iki grupta inceledik. Birincil sonlanım noktası son evre böbrek hastalığı, ikincil sonlanım noktaları ise tam (CR) veya kısmi remisyon (PR) idi. Bulgular: İzlem sonunda (ortanca 30,6 ay), HI grubunda LI grubuna kıyasla daha fazla hasta birincil noktaya ulaşırken daha az hasta ikincil son noktalara erişti (sırasıyla p=0,015 ve p=0,016). Ayrıca HI grubunda LI grubuna göre glomerüler filtrasyon hızı (eGFR) daha düşük (p<0,001), proteinüri ise daha fazlaydı (p=0,018). Kaplan-Meier analizlerinde böbrek sağ kalımının (p=0,031) HI grubunda LI grubundan daha düşük olduğu saptandı. Çok değişkenli lojistik regresyon analizlerinde, son noktalar öngördürücü bir parametre saptanamadı. Sonuç: Yoğun glomerüler C3 birikimi, PMN’li yaşlı hastalarda olumsuz klinik sonuçlarla ilişkilidir.

Anahtar Kelimeler:

Kompleman sistemi, C3, ileri yaş, membranöz nefropati

THE IMPORTANCE OF GLOMERULAR C3 ACCUMULATION IN ELDERLY PATIENTS WITH PRIMARY MEMBRANOUS NEPHROPATHY

ABSTRACT Objective: The purpose of this study was to investigate the impact of glomerular C3 accumulation density on clinical, histopathological parameters and outcomes in elderly (>60 years) individuals with primary membranous nephropathy (PMN). Material and Methods: In this study, we examined the patients (n=105) in two groups according to the C3 staining density in kidney biopsy samples as low intensity (C3: 1+; LI group) and high intensity (C3: 2+ or C3: 3+; HI group). The primary endpoint of our study was the end-stage renal disease, and the secondary endpoints were the development of partial remission (PR) or complete remission (CR). Results: At the end of the follow-up (mean 30.6 months), more patients achieved the primary endpoint, and fewer patients achieved the secondary endpoints in the HI group compared to the LI group. (p=0.015 and p=0.016, respectively). Moreover, the glomerular filtration rate (eGFR) was lower (p<0.001), and proteinuria was higher in the HI group (p=0.018). Kaplan-Meier survival analysis revealed that renal survival (p=0.031) was lower in the HI group compared to the LI group. In the multivariate logistic regression analyses, no predictive parameters could be detected for the endpoints. Conclusion: Intense glomerular C3 deposition in elderly (>60 years) patients with PMN may be related to poor clinical outcomes.

Keywords:

Complementary system, C3, older age, membranous nephropathy,

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