Böbrek tutulumu olan sistemik lupus eritematozus tanılı hastaların retrospektif olarak incelenmesi
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Date
2022
Authors
Duran, Yasemin Deniz
Journal Title
Journal ISSN
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Sistemik Lupus Eritamatozus (SLE) kronik, otoimmun, böbrek tutulumu ciddi seyreden bir hastalıktır. Böbrek tutulumu hastaların yaklaşık yarısında görülmektedir. Tedavisinde son yıllarda ciddi gelişmeler olmakla birlikte yaklaşık hastaların %10-20’sinde son dönem böbrek yetmezliği gelişmektedir. Çalışmamızda lupus nefriti tanısı ile takip edilen hastaların tedavi rejimlerinin değerlendirilmesi, remisyon oranları ve remisyon ile ilişkili faktörlerinin incelenerek literatürle karşılaştırılması amaçlanmıştır. Çalışmamıza 2009-2021 yılları arasında Bursa Uludağ Üniversitesi Tıp Fakültesi Hastanesi nefroloji bölümünde böbrek biyopsisi yapılıp lupus nefriti tanısı almış 42 hasta dahil edilmiştir. Hastaların demografik özellikleri, tanı anı bulguları, biyopsi patoloji sonuçları, 6. ay ve 12. ay remisyon oranları retrospektif olarak incelenmiştir. 6. ayın sonunda hastaların %37,8'i tam remisyondayken, birinci yılın sonunda %40’ı tam remisyondaydı. Hastalar 6. ve 12. ayda tam remisyonda olan ve olmayan olarak iki gruba ayrıldı. Altıncı ayda tanı anı proteinüri miktarı ve tanı anı hemoglobin değeri açısından gruplar arasında anlamlı fark bulunmuştur (sırasıyla p=0,022, p=0,006). Tam remisyona girmeyen grupta medyan proteinüri miktarı 2945 mg/gün iken, tam remisyona giren grupta medyan proteinüri 1835 mg/gün olarak saptanmıştır. Hemoglobin değeri ise remisyonda olmayan grupta daha yüksek bulunmuştur. 12. ayda ise tam remisyonda olan grupta lupus tanı yaşı daha yüksek bulunmuştur (p=0,014). Tam remisyona giren grupta ortalama lupus tanı yaşı 35,8±2,8 iken tam remisyona girmeyen grupta 27,1±1,9'dur. Sonuç olarak, lupus nefriti SLE'nin ciddi ve sık görülen organ tutulumlarındandır. Farklı tedavilere rağmen 1. yılda tam remisyon oranı %50 civarındadır. Remisyon ile ilişkili faktörlerin belirlenmesi prognozu tahmin etmek için önem arz etmektedir. Çalışmamızda tanı anı proteinüri düzeyi, hemoglobin seviyesi ve lupus tanı yaşı ile remisyon arasında ilişki bulunmuştur.
Systemic Lupus Erythematosus (SLE) is a chronic, autoimmune disease with severe renal involvement. Renal involvement is observed in approximately half of the patients. Although significant developments have been made in the treatment in recent years, approximately 10-20% of patients develop end-stage renal disease. Our study's objectives were to assess the treatment regimens of lupus nephritis patients, to examine remission rates and the factors associated with remission, and to compare the results with existing literature. Our study included 42 patients diagnosed with lupus nephritis after a kidney biopsy in the nephrology department of Bursa Uludag University Medical Faculty Hospital between 2009 and 2021. Demographic characteristics of the patients, findings at the time of diagnosis, biopsy pathology results, and remission rates at the 6th and 12th months were retrospectively analyzed. 40% of the patients were in complete remission at the end of the first year, compared to 37.8% at the end of the sixth month. At 6 and 12 months, patients were divided into two groups: those who had achieved complete remission and those who had not. There was a significant difference between the groups at the sixth-month evaluation regarding the amount of proteinuria and haemoglobin levels at the time of diagnosis (p=0.022, p=0.006, respectively). While the median proteinuria in the group that did not achieve complete remission was 2945 mg/day, the median proteinuria in the group that achieved complete remission was 1835 mg/day. The non-remission group had significantly higher haemoglobin levels. Age at lupus diagnosis was greater in the group who achieved complete remission at 12 months (p=0.014). While the mean age at diagnosis of lupus was 35.8±2.8 in the group in complete remission, it was 27.1±1.9 in the group that did not achieve complete remission. In conclusion, lupus nephritis is a serious and common organ involvement of SLE. Despite different treatments, the complete remission rate at one year is around 50%. Determining the factors associated with remission is important to predict the prognosis. Our study found a correlation between the proteinuria level at the time of diagnosis, the haemoglobin level, and the age at diagnosis of lupus and remission.
Systemic Lupus Erythematosus (SLE) is a chronic, autoimmune disease with severe renal involvement. Renal involvement is observed in approximately half of the patients. Although significant developments have been made in the treatment in recent years, approximately 10-20% of patients develop end-stage renal disease. Our study's objectives were to assess the treatment regimens of lupus nephritis patients, to examine remission rates and the factors associated with remission, and to compare the results with existing literature. Our study included 42 patients diagnosed with lupus nephritis after a kidney biopsy in the nephrology department of Bursa Uludag University Medical Faculty Hospital between 2009 and 2021. Demographic characteristics of the patients, findings at the time of diagnosis, biopsy pathology results, and remission rates at the 6th and 12th months were retrospectively analyzed. 40% of the patients were in complete remission at the end of the first year, compared to 37.8% at the end of the sixth month. At 6 and 12 months, patients were divided into two groups: those who had achieved complete remission and those who had not. There was a significant difference between the groups at the sixth-month evaluation regarding the amount of proteinuria and haemoglobin levels at the time of diagnosis (p=0.022, p=0.006, respectively). While the median proteinuria in the group that did not achieve complete remission was 2945 mg/day, the median proteinuria in the group that achieved complete remission was 1835 mg/day. The non-remission group had significantly higher haemoglobin levels. Age at lupus diagnosis was greater in the group who achieved complete remission at 12 months (p=0.014). While the mean age at diagnosis of lupus was 35.8±2.8 in the group in complete remission, it was 27.1±1.9 in the group that did not achieve complete remission. In conclusion, lupus nephritis is a serious and common organ involvement of SLE. Despite different treatments, the complete remission rate at one year is around 50%. Determining the factors associated with remission is important to predict the prognosis. Our study found a correlation between the proteinuria level at the time of diagnosis, the haemoglobin level, and the age at diagnosis of lupus and remission.
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Keywords
Sistemik lupus eritematozus, Lupus nefriti, Remisyon, Proteinüri, Systemic lupus erythematosus, Lupus nephritis, Remission, Proteinuri
Citation
Duran, Y. D. (2022). Böbrek tutulumu olan sistemik lupus eritematozus tanılı hastaların retrospektif olarak incelenmesi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.