Melahat ÇOBAN, Ayça İNCİ, Üstün YILMAZ, Metin SARIKYA, Bekir EROL, Yıldız KILAR, Esin EREN, Emre ASİLTÜRK

OTOZOMAL DOMİNANT POLİKİSTİK BÖBREK HASTALIĞI HASTALARINDA RENAL VE KARDİYOVASKÜLER OLAYLARIN İLİŞKİSİ

Giriş: Otozomal dominant polikistik böbrek hastalığı (ODPBH) bilateral böbreklerdeki çok sayıdaki kistlerin gelişimi ile karekterize genetik bir hastalıktır. Mortalite ve morbiditenin en sık nedeni kardiyovasküler olaylardır. Çalışmamızın amacı; sol ventrikül (SV) sistolik fonksiyonu korunmuş prediyaliz farklı kronik böbrek hastalığı (KBH) evrelerindeki erişkin ODPBH hastalarında; renal yapı ve renal fonksiyon ile SV hipertrofisi (SVH) ve ateroskleroz gelişimi arasındaki ilişkiyi incelemektir. Gereç ve Yöntem: Bu kesitsel çalışmaya 86 (36(%41.9) erkek) ODBPH hastası alındı. Hastalar yaş ve cinsiyet benzer 47 sağlıklı gönüllü kontrol grubu ile karşılaştırıldı. Toplam böbrek hacmi (TBH) ve toplam kist hacmi (TKH) ölçümleri kontrastsız üst batın manyetik rezonans görüntüleme (MRG) ile belirlendi. Böbrek fonksiyonları; serum kreatinin, tahmini glomerüler filtrasyon hızı (eGFH), spot idrar protein/kreatinin oranı (SPKO) ile belirlendi. Ekokardiyografi (EKO) ile sol ventrikül ejeksiyon fraksiyonu (SVEF), sol atrium çapı (SAÇ), SV end-diyastolik çapı (SVEDÇ), SV end-sistolik çapı (SVESÇ) hesaplandı. Ateroskleroz varlığı karotis arter intima-media kalınlığı (KA- IMK) ölçümü ile belirlendi. Bulgular: Kronik böbrek hastalığı (KBH) evresine göre hastaların 46(%53.5)’sı evre 1-2, 32(%37.2)’si evre 3-4 ve 8(%9.3)’i prediyaliz evre 5 ‘teydi. 56(%65.1) hasta hipertansifti. 36(%41.9) hastada SVH gelişimi saptandı. Evre 1-2 hastalarda, prediyaliz evre 5 hastalara göre eGFH daha yüksek; kreatinin, TBH, SPKO, SVKİ, KA-IMK daha düşüktü. TBH>1302mm 3 olanlarda, TBH ≤1302mm 3 olanlara göre; kreatinin (p=0.004), SVKİ (p=0.001), SVH (p=0.009), KA-IMK (p=0.022) yüksek, eGFH (p=0.006) düşüktü. Sonuç:ODPBH hastalarında artan TBH değerleri ve azalan böbrek fonksiyon testleri ile SVH ve ateroskleroz gelişimi arasında ilişki vardır.

THE RELATIONSHIP BETWEEN RENAL AND CARDIOVASCULAR EVENTS IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Introduction:Autosomal dominant polycystic kidney disease (ODPBH) is a genetic disorder characterized by the development of multiple cysts in the bilateral kidneys. Cardiovascular events are the most common cause of mortality and morbidity. The aim of our study is to examine the relation between renal structure and renal function, and the development of LV hypertrophy (LVH) and atherosclerosis in adult ADPKD patients with predialysis chronic renal failure (CKD) and preserved left ventricular (LV) systolic function. Material and Methods:86 (36(41,9%) male) ADPKD patients were included in this cross-sectional study. The patients were compared to 47 healthy volunteer control group with similar age and gender distribution. Total kidney volume (TKV) and total cyst volume measurements were determined by non-contrast abdominal magnetic resonance imaging (MRI). With echocardiography, SV ejection fraction (LVEF), left atrial diameter (LAD), LV end- diastolic diameter (LVEDD), LV end-systolic diameter (LVESD) were calculated. Development of atherosclerosis was assessed with carotid artery intima-media thickness (CA-IMT) measurement. Results: According to the stage of CKD, 46 (53.5%) patients had stage 1-2 disease, 32 (37.2%) had stage 3-4 disease and 8 (9.3%) had predialysis stage 5 disease.56 patients (65.1%) were hypertensive. LVH was detected in 36 (41.9%) patients. In comparison to patients with predialysis stage 5 CKD, patients with stage 1-2 disease had higher eGFR and lower creatinine, TKV, UPCR, LVMI, and CA-IMT values.Patients with TKV>1302mm 3 showed higher values of creatinine (p=0.004), LVMİ (p=0.001), LVH (p=0.009) and CA-IMT (p=0.022), and lower values of eGFR (p=0.006) in compared to the patients with TKV ≤1302 mm 3 . Conclusion:In ADPKD patients, the increased TKV values and reduced renal function tests are associated with LVH and atherosclerosis development.

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