Böbrek biyopsisi yapılmış diyabetik hastaların biyopsi bulguları ile böbrek sağ kalımına etkilerinin retrospektif değerlendirilmesi
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Dosyalar
Tarih
2024
Kurum Yazarları
Teymur, Ahmet
Süreli Yayın başlığı
Süreli Yayın ISSN
Cilt Başlığı
Yayınevi
Bursa Uludağ Üniversitesi
Özet
Diyabet hastalarında gelişen böbrek patolojilerinin diyabetik nefropati (DNP) veya non-diyabetik böbrek hastalıkları (NDBH) nedenli olduğunun ayrıcı tanısı için sıklıkla böbrek biyopsisi gerekmektedir. Çalışmamızda diyabetik hastalarda yapılan biyopsi bulgularını ve bulguların renal sağ kalıma etkilerini inceleyerek, hastalardaki böbrek patolojilerinin erken tanınması, uygun tedavi ve takibinin belirlenmesi, ayrıcı tanı için biyopsi gereken hastaların ayırt edilmesi için yol gösterici belirteçleri saptamayı hedefledik. Çalışmaya Ocak 2005-Mayıs 2023 tarihleri arasında Bursa Uludağ Üniversitesi Tıp Fakültesi Hastanesi Nefroloji Polikliniği'ne başvuran, diyabet tanısı olan ve böbrek biyopsisi yapılan 132 hasta seçildi. Çalışmamız retrospektif kohort çalışmasıdır. Hastaların demografik, klinik, patolojik ve laboratuvar verileri, tanı ve ölüm tarihleri kayıt edilerek analiz edildi. Hastalar DNP, NDBH ve DNP+NDBH olarak üç gruba ayrıldı. Çalışmamızda DNP sıklığı %43,2, NDBH sıklığı %47,2, DNP+NDBH sıklığı %9,6 saptandı. Çalışmamızda yüksek HbA1c düzeyi, 5 yıldan uzun diyabet varlığı, insülin ihtiyacının olması, diyabetik retinopati varlığı ve biyopside arteryal hiyalinizasyon bulgusu DNP ile ilişkili saptanırken (p<0,05); akut böbrek hasarı, retinopati yokluğu ve 5 yıldan kısa diyabet varlığı NDBH ile ilişkili saptandı (p<0,05). Çalışmamızda renal sağ kalım açısından DNP, NDBH ve DNP+NDBH tanı grupları arasında anlamlı farklılık saptandı (p=0,048). Renal sonlanıma ulaşmayan hastaların oranı DNP grubunda %56, NDBH grubunda %75, DNP+NDBH grubunda %83 olarak saptandı. Renal sağ kalım süreleri gruplar arasında anlamlı farklılık göstermiş olup; NDBH grubunda 69,12 ay, DNP grubunda 48,52 ay saptandı (p=0,011). DNP prognozunun NDBH grubundan daha kötü seyrettiği gösterilmiştir. Diyabet hastalarında spesifik hastalık düşündürür bulgu varlığında böbrek biyopsisinin yapılarak NDBH erken saptanması uzun renal sağkalım ile ilişkili saptanmıştır.
Retrospective Evaluation Of The Biopsy Findings And Their Effects On Kidney Survival Of Diabetic Patients Who Had Renal Biopsy Kidney biopsy is often required for the differential diagnosis of kidney pathologies developing in diabetic patients due to diabetic nephropathy (DNP) or non-diabetic kidney diseases (NDKD). In our study, we aimed to identify guiding markers for early diagnosis of renal pathologies in patients, determination of appropriate treatment and follow-up, and discrimination of patients requiring biopsy for differential diagnosis by examining the biopsy findings in diabetic patients and the effects of the findings on renal survival. 132 patients who applied to Bursa Uludağ University Faculty of Medicine Hospital Nephrology Polyclinic between January 2005 and May 2023, were diagnosed with diabetes and underwent kidney biopsy were selected for the study. Our study is a retrospective cohort study. Demographic, clinical, pathological and laboratory data of the patients, diagnosis and death dates were recorded and analyzed. The patients were divided into three groups: DNP, NDKD and DNP+NDKD. In our study, the frequency of DNP was found to be 43.2%, the frequency of NDKD was 47.2%, and the frequency of DNP+NDKD was 9.6%. In our study, high HbA1c level, presence of diabetes for more than 5 years, need for insulin, presence of diabetic retinopathy and arterial hyalinization finding in biopsy were found to be associated with DNP (p<0.05); Acute kidney injury, absence of retinopathy, and presence of diabetes for less than 5 years were found to be associated with NDKD (p<0.05). In our study, a significant difference was found between the DNP, NDKD and DNP+NDKD diagnostic groups in terms of renal survival (p=0.048). The rate of patients who did not reach renal endpoint was 56% in the DNP group, 75% in the NDKD group, and 83% in the DNP+NDKD group. Renal survival times showed significant differences between groups; It was found to be 69.12 months in the NDKD group and 48.52 months in the DNP group (p = 0.011). It has been shown that the prognosis of DNP is worse than that of the NDKD group. In diabetic patients, early detection of NDKD by performing a kidney biopsy in the presence of findings suggestive of a specific disease has been found to be associated with longer renal survival.
Retrospective Evaluation Of The Biopsy Findings And Their Effects On Kidney Survival Of Diabetic Patients Who Had Renal Biopsy Kidney biopsy is often required for the differential diagnosis of kidney pathologies developing in diabetic patients due to diabetic nephropathy (DNP) or non-diabetic kidney diseases (NDKD). In our study, we aimed to identify guiding markers for early diagnosis of renal pathologies in patients, determination of appropriate treatment and follow-up, and discrimination of patients requiring biopsy for differential diagnosis by examining the biopsy findings in diabetic patients and the effects of the findings on renal survival. 132 patients who applied to Bursa Uludağ University Faculty of Medicine Hospital Nephrology Polyclinic between January 2005 and May 2023, were diagnosed with diabetes and underwent kidney biopsy were selected for the study. Our study is a retrospective cohort study. Demographic, clinical, pathological and laboratory data of the patients, diagnosis and death dates were recorded and analyzed. The patients were divided into three groups: DNP, NDKD and DNP+NDKD. In our study, the frequency of DNP was found to be 43.2%, the frequency of NDKD was 47.2%, and the frequency of DNP+NDKD was 9.6%. In our study, high HbA1c level, presence of diabetes for more than 5 years, need for insulin, presence of diabetic retinopathy and arterial hyalinization finding in biopsy were found to be associated with DNP (p<0.05); Acute kidney injury, absence of retinopathy, and presence of diabetes for less than 5 years were found to be associated with NDKD (p<0.05). In our study, a significant difference was found between the DNP, NDKD and DNP+NDKD diagnostic groups in terms of renal survival (p=0.048). The rate of patients who did not reach renal endpoint was 56% in the DNP group, 75% in the NDKD group, and 83% in the DNP+NDKD group. Renal survival times showed significant differences between groups; It was found to be 69.12 months in the NDKD group and 48.52 months in the DNP group (p = 0.011). It has been shown that the prognosis of DNP is worse than that of the NDKD group. In diabetic patients, early detection of NDKD by performing a kidney biopsy in the presence of findings suggestive of a specific disease has been found to be associated with longer renal survival.
Açıklama
Anahtar kelimeler
Diyabetik nefropati, Retinopati, Böbrek biyopsi, Diabetic nephropathy, Retinopathy, Kidney biopsy
Alıntı
Teymur, A. (2024). Böbrek biyopsisi yapılmış diyabetik hastaların biyopsi bulguları ile böbrek sağ kalımına etkilerinin retrospektif değerlendirilmesi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.