Primer ve sekonder glomerulonefritlerde protein elektroforezi
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Date
2018
Authors
Şahin, Ahmet Bilgehan
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Glomerüler hastalıklar etiyolojilerine (primer veya sekonder), patogenezlerine ve klinik özelliklerine göre sınıflandırılabilir. En iyi tedavi yanıtının alınması ve en uygun hastalık takibinin planlanması için glomerülonefritlerin primer-sekonder ayrımının yapılması çok önemlidir. Bu ayrımda klinik prezentasyon, çeşitli laboratuvar belirteçleri, böbrek biyopsisinin histopatolojik bulguları yardımcı olmaktadır. Fakat klinik pratikte birçok vakada primer-sekonder ayrımında zorluklar yaşanmaktadır. Protein elektroforezi, plazmadaki proteinleri fiziksel özelliklerine göre ayırma yöntemidir. Protein elektroforezi birçok kronik inflamatuar sistemik hastalığın tanı ve takibinde kullanılmaktadır. Birçok biyokimyasal ve serolojik testlere göre çok daha ucuz ve pratik bir tanı yöntemidir. Çalışmamızda bu yöntemin glomerülonefritlerin etiyolojilerinin aydınlatılmasında yardımcı olup olamayacağının belirlenmesi amaçlandı. Çalışmamızda 2008-2016 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Nefroloji Kliniğinde proteinüri, hematuri, böbrek yetmezliği gibi çeşitli nedenler ile yapılan böbrek biyopsileri tarandı. Tanı anında protein elektroforezi olan ve primer veya sekonder glomerülonefrit tanısı kesinleştirilen hastalar çalışmaya dâhil edildi. Yapılan biyopsilerin 258'inde (%59,7) primer glomerülonefrit tanısı kondu. En sık membranöz glomerülonefrit saptanırken (%32,2). Sekonder glomerülonefritler hastaların %40,3'ünde saptandı. En sık sekonder glomerülonefrit nedeni amiloidoz olarak bulundu (%28,1). Serum protein elektroforezi bandları primer ve sekonder glomerülonefritlerde karşılaştırıldığında albümin fraksiyonunun primer glomerülonefritlerde; α2 ve gama fraksiyonlarının sekonder glomerülonefritlerde dah yüksek olduğu saptandı. Eritrosit sedimentasyon hızı ve C-reaktif protein düzeyleri sekonder glomerülonefritlerde daha yüksekti. Primer ve sekonder glomerülonefritlerin ayrımında çeşitli zorluklar yaşanmaktadır. Yeni bulunan moleküllerin ve genetik testlerin daha zamana ihityaçları vardır. Serum protein elektroforezi ucuz, basit ve ulaşımı çok daha kolay bir test olması hasebiyle; özellikle gama bandının hastanın diğer laboratuar ve klinik özellikleri ile birlikte yorumlanması klinisyene primer sekonder glomerülonefrit ayrımında yardımcı olabilir. Sekonder glomerülonefrit için kabul görecek gama yüzdesi eşik değeri çalışmamızı destekleyen yayınlar ile mümkün olabilir.
Glomerular diseases can be classified according to etiology (primary or secondary), pathogenesis and clinical features. It is very important to distinguish the primary-secondary glomerulonephritis for the best treatment response and to plan the most appropriate follow-up. Clinical presentation, various laboratory markers, histopathological findings of kidney biopsy are helpful in this distinction. However, there are difficulties in distinction between primary and secondary in many cases in clinical practice, Protein electrophoresis is a method of separating proteins in the plasma according to their physical properties. Protein electrophoresis is used in the diagnosis and follow-up of many chronic inflammatory systemic diseases. It is a much cheaper and more practical diagnostic method than many biochemical and serological tests. In our study, it was aimed to determine whether this method could be helpful in elucidating the etiology of glomerulonephritis. In the present study, kidney biopsies which were performed in Nephrology Clinic, Uludag University Medical Faculty between the years 2008-2016 for various reasons such as proteinuria, hematuria, renal failure etc, were evaluated. Patients who had protein electrophoresis at the time of diagnosis and who had absolute diagnosis with primary or secondary glomerulonephritis were included in the study. Primer glomerulonephritis was diagnosed in 258 of the biopsies (59.7%). The most common glomerulonephritis was membranous glomerulonephritis (32.2%). Secondary glomerulonephritis was observed in 40.3% of patients. The most common secondary cause of glomerulonephritis was found as amyloidosis (28.1%). When the serum protein electrophoresis bands were compared in primary and secondary glomerulonephritis, the albumin fraction was higher in primary glomerulonephrites; α2 and gamma fractions were higher in the secondary glomerulonephrites. Erythrocyte sedimentation rate and C-reactive protein levels were higher in secondary glomerulonephritis. There are various difficulties in distinguishing primary and secondary glomerulonephritis. Newly found molecules and genetic tests require more time to ube used in clinical practice. Due to the fact that serum protein electrophoresis is cheap, simple and much easier to access; interpretation of the gamma band in conjunction with other laboratory and clinical features of the patient may help to distinguish primary secondary glomerulonephritis. The threshold value of the percentage for secondary glomerulonephritis may be possible with publications supporting our study.
Glomerular diseases can be classified according to etiology (primary or secondary), pathogenesis and clinical features. It is very important to distinguish the primary-secondary glomerulonephritis for the best treatment response and to plan the most appropriate follow-up. Clinical presentation, various laboratory markers, histopathological findings of kidney biopsy are helpful in this distinction. However, there are difficulties in distinction between primary and secondary in many cases in clinical practice, Protein electrophoresis is a method of separating proteins in the plasma according to their physical properties. Protein electrophoresis is used in the diagnosis and follow-up of many chronic inflammatory systemic diseases. It is a much cheaper and more practical diagnostic method than many biochemical and serological tests. In our study, it was aimed to determine whether this method could be helpful in elucidating the etiology of glomerulonephritis. In the present study, kidney biopsies which were performed in Nephrology Clinic, Uludag University Medical Faculty between the years 2008-2016 for various reasons such as proteinuria, hematuria, renal failure etc, were evaluated. Patients who had protein electrophoresis at the time of diagnosis and who had absolute diagnosis with primary or secondary glomerulonephritis were included in the study. Primer glomerulonephritis was diagnosed in 258 of the biopsies (59.7%). The most common glomerulonephritis was membranous glomerulonephritis (32.2%). Secondary glomerulonephritis was observed in 40.3% of patients. The most common secondary cause of glomerulonephritis was found as amyloidosis (28.1%). When the serum protein electrophoresis bands were compared in primary and secondary glomerulonephritis, the albumin fraction was higher in primary glomerulonephrites; α2 and gamma fractions were higher in the secondary glomerulonephrites. Erythrocyte sedimentation rate and C-reactive protein levels were higher in secondary glomerulonephritis. There are various difficulties in distinguishing primary and secondary glomerulonephritis. Newly found molecules and genetic tests require more time to ube used in clinical practice. Due to the fact that serum protein electrophoresis is cheap, simple and much easier to access; interpretation of the gamma band in conjunction with other laboratory and clinical features of the patient may help to distinguish primary secondary glomerulonephritis. The threshold value of the percentage for secondary glomerulonephritis may be possible with publications supporting our study.
Description
Keywords
Primer glomerülonefrit, Sekonder glomerülonefrit, Protein elektroforezi, Poliklonal gamopati, Primary glomerulonephritis, Secondary glomerulonephritis, Protein electrophoresis, Polyclonal gammopathy
Citation
Şahin, A. B. (2018). Primer ve sekonder glomerulonefritlerde protein elektroforezi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.