BÖBREK BİYOPSİLERİNDE AKUT İNTERSTİSYEL NEFRİT ORANLARININ DEĞERLENDİRİLDİĞİ (TEK MERKEZ ÇALIŞMASI)

Amaç:Böbrek biyopsisi yaptığımız hastalardaki, akut interstisyel nefrit prevalansını ve klinikopatolojik özelliklerini değerlendirmeyi amaçladık. Materyal ve Metot:İzmir Kâtip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma Hastanesi Nefroloji kliniğinde 2010-2018 yılları arasında böbrek biyopsisi yapılmış 1048 natif böbrek biyopsileri geriye dönük olarak incelendi. Böbrek biyopsi sonucunda histopatolojik olarak akut interstisyel nefrit tanısı almış 42 hastanın dosyaları tarandı. Bu hastaların dosya taramalarından akut interstisyel nefrite yol açacak tıbbi hikayeleri, klinik, laboratuvar ve patolojik bulguları, aldıkları tüm tedavileri ve sonuçlarıkaydedildi. Bulgular:Merkezimizde 2010-2018 yılları arasında yapılmış tüm böbrek biyopsilerindeki akut interstisyel nefrit prevalansını %4 bulduk. Çalışmamızda akut interstisyel nefritin en sık nedeni non- steroid antiinflamatuvar ilaç kullanımı (17 hastada %40.5) olduğunu tespit ettik. 30 hasta (%71.4) steroid verildi. Steroid tedavisi alan 17 hastada (%56) ve steroid tedavisi almayan yedi hastada (%58) böbrek fonksiyonlarında tam iyileşme görüldü. Steroid tedavisi alan ve almayan gruplar arasında böbrek fonksiyonlarının tam olarak düzelmesi açısından anlamlı farklılık tespit edilmedi (p=0.651). Hastaneye kabul sırasında 12 hasta (%28.6) akut hemodiyaliz ihtiyacı gösterdi ve bu hastaların hepsi steroid tedavisi aldı. Akut hemodiyaliz ihtiyacı olan hastalardan sekiz hastamız (%19.0) kronik hemodiyaliz programında kaldı. Akut interstisyel nefrit tanısı konulduktan 3 ay içerisinde iki, sonraki sekiz yıllık takip süresinde de altı olmak üzere, toplam sekiz hastamız (%19) eksitusoldu. Sonuç:Çalışmamızdaki akut interstisyel nefrit prevalansı diğer çalışmalar ile benzer bulundu. Çalışmamızda en sık etiyolojik sebep ilaçlardı. Özellikle de non-steroid antiinflamatuvar ilaçlar ilk sırada yer aldı. Bu nedenle tüm hastalarda özellikle ilaç anamnezi iyi sorgulanmalıdır. Öncelikle, akut interstisyel nefritin altında yatan etiyolojik nedendüzeltilmelidir.

Evaluating Acute Interstitial Nephritis Rates in Renal Biopsies (Single Center Study)

Aim:We aimed to evaluate the prevalence and clinicopathological features of acute interstitial nephritis in patients undergoing renal biopsy. Materials and Methods:A total of 1048 native kidney biopsies performed between 2010 and 2018 in the Nephrology Clinic of Katip Celebi University Atatürk Training and Research Hospital were reviewed retrospectively. The records of 42 patients with histopathological diagnosis of acute interstitial nephritis were screened. Medical history, clinical, laboratory and pathological findings, all treatments and results of all patients with acute interstitial nephritis wererecorded. Results:The prevalence of acute interstitial nephritis in all renal biopsies was found 4%. We found that the most common cause of acute interstitial nephritis was non-steroid anti-inflammatory drugs (40.5% in 17 patients). Thirty patients (71.4%) received steroid treatment, among them renal function improved in 17 patients (56%). There was no significant difference between the groups receiving end not receiving steroid therapy in terms of complete recovery of renal function (p>0.05). During admission, 12 patients (28.6%) required acute hemodialysis and all of these patients received steroid treatment. A total of eight patients (19.0%) remained in the chronic hemodialysis program. Overall eight patients (19%) died due to acute interstitial nephritis during the follow-up. Conclusion:The prevalence and the most common etiologic factors of acute interstitial nephritis were found similar to literature. In particular, non-steroidal anti-inflammatory drugs took the first place. Therefore, the history of the drug should be questioned well in all patients. Firstly, the underlying etiologic cause of acute interstitial nephritis should be corrected.

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