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İmmünoglobülin A Nefropatisinde Yaşam Süresi ve Yaşam Süresini Etkileyen Faktörler

Survival and the Factors Affecting It in Immunoglobulin A Nephropathy

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2008

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
IgA nephropathy is one of the most widely seen glomerulonephritides. It is one of the major causes of end stage renal disease. The aim of this study was to determine the clinical, biochemical, properties, treatment modalities, renal survival and factors affecting survival of patients with IgA nephropathy followed up in our center. Seventy-five patients (F:M=20:55, mean age=31.9±10.5) who were biopsied in our center between 1990 and 2003 were recruited into the study. The histopathological properties, arterial blood pressures, biochemical values, urinalysis for hematuria and poteinuria and levels of daily proteinuria determined both at the time of biopsy and during last 3 controls were evaluated. The treatments given were recorded. The differences between treated and not treated patients with respect to each type of the therapy were assesed by using Mann-Whitney-U test. The renal survival was calculated by using Kaplan-Meier and the affecting factors by using Cox regression methods. The 5- and 10-year renal survivals were calculated as 78% and 60% respectively when the final end-point was assumed to be doubling of serum creatinine with respect to initial value and/or development of ESRD. The patients who had used omega-3 fatty acids had better renal survivals. The factors affecting the renal survival significantly were initial serum creatinine, interstitial fibrosis and glomerulosclerosis, initial diastolic and final systolic blood pressures. In conclusion some histopathologic findings, biochemical values, arterial blood pressure levels are determined to affect the renal survival. However the natural history of the disease that shows variabilities among individual patients is thought to be one of the major factors affecting the renal survival.
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Abstract (Original Language): 
immünoglobülin A (IgA) nefropatisi dünyada en sık görülen primer glomerülonefritlerden biridir. IgA nefropatisinin son dönem böbrek yetmezliğinin (SDBY) majör etmenlerinden biri olduğu kabul edilmektedir. Son dönemlerde tedavisi açısından yapılan çalışmalarda artış olmasına rağmen kesin kabul görmüş bir tedavi protokolü yoktur. Bu çalışmanın amacı kliniğimizde böbrek biyopsiyle IgA nefropatisi tanısı almış hastaların klinik ve labaratuvar bulgularını, böbrek yaşam süresi ve yaşam süresini etkileyen faktörleri ortaya koymaktır. Kliniğimizde 1990 ve 2003 yılları arasında böbrek biyopsisiyle tanı konulmuş ve izlenmiş 75 hasta (K:E=20:55, ortalama yaş=31.9±10.5 yıl) çalışmaya alındı. Hastaların biyopsi sırasında ve son 3 kontrolde histopatolojik özellikleri, arteryel kan basınçları, biyokimyasal değerleri, proteinüri, hematüri varlığı, 24 saatlik idrarda protein düzeyleri ve izlem süresince aldıkları tedaviler kaydedildi. Hastaların bir tedavi alıp almamalarına göre aralarındaki farklar Mann-Whitney-U testine, böbrek yaşam süreleri Kaplan-Meier yöntemine, yaşam süresine etki eden faktörler ise Cox regresyon modeline göre belirlendi. Serum kreatinin düzeyinin başlangıcın iki katına çıkması ve/veya SDBY gelişmesi son nokta kabul edildiğinde 5 ve 10 yıllık böbrek yaşam süreleri sırasıyla %78 ve %60 olarak hesaplandı. Omega-3 yağ asitlerini kullanan hastaların kullanmayanlara göre böbrek yaşam süresinin anlamlı olarak daha uzun olduğu görüldü. Böbrek yaşam süresini anlamlı olarak etkileyen faktörler başlangıç serum kreatinini, interstisyel fibroz ve glomerüloskleroz varlığı, başlangıçtaki diyastolik kan basıncı ve izlemdeki sistolik kan basıncıydı. Sonuç olarak bazı histopatolojik ve biyokimyasal bulguların, arteryel kan basıncı kontrolünün ve bazı ilaçların böbrek yaşam süresini etkilediği görülmüştür. Hastalığın doğal seyrinin kişiye göre değişiklik göstermesinin de böbrek yaşam süresini etkileyen önemli faktörlerden biri olduğu düşünülmüştür.
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REFERENCES

References: 

1. Levy M, Berger J. Worldwide perspective of IgA nephropathy. Am J Kidney Dis 1988;12:340-47.
2. Russel MW, Mestecky J, Julain BA, et al: IgA-associated renal diseases: Antibodies to environmental antigens in sera and deposition of immunoglobulins and antigens in glomeruli. J Clin Immunol. 1986 Jan;6(1):74-86.
3. Feehally J. IgA Nephropathy and Henoch-Schönlein Nephri¬tis. In Johnson RJ, Feehally J (eds) Comprehensive Clinical Nephrology second edition 2003;319-329. Harcourt Publis¬hers Limited 2003.
4. Feehally J. IgA Nephropathy and Henoch-Shönlein-Purpura. In Brady HR, Wilcox CS (eds), Therapy in Nephrology and Hypertension second edition 2003:165-176. Saunders 2003.
5. Kaplan EL, Meier P. Nonparametric estimation from incomp¬lete observations. J Am Stat Assoc. 1958;53:457-81.
6. Cox DR. Regression models and life tables. J R Stat Soc [B] 1972;34:187-220.
7. Giuseppe D'Amico. Natural History of Idiopathic IgA Nep-hropathy: Role of Clinical and Histological Prognostic Fac¬tors. Am J Kidney Dis. 2000;36:227-37.
8. Goumenos DS, Daviouros P, El-Nahas AM, Ahuja M, Short-
24
Türk Nefroloji Diyaliz ve Transplantasyon Dergisi /Official Journal of the Turkish Society of Nephrology
İmmünoglobülin A Nefropatisinde Yaşam Süresi ve Yaşam Süresini Etkileyen Faktörler £
land
JR
, Viachojannis JG, Brown CB. Prednisolone and Azat-hioprine in IgA Nephropathy. Nephron Clin Pract.
2003;93:58-68.
9.
Bögenschüt
z O, Bohle A, Batz C, et al. IgA Nephritis: On Im¬portance of Morphological and Clinical Parameters in the Long-Term Prognosis of 239 Patients. Am J Nephrol 1990;10:137-47.
10. Schena FP, Montenegro M, Scivittaro V. Meta-Analysis of Ran¬domized Controlled Trials in Patients with Primary IgA Nep-hropathy (Berger's Disease). Nephol Dial Transplant 1990;Suppl.1:47-52.
11. Pozzi C, Balosca P, Fogazzi G, et al. Corticosteroids in IgA nephropathy: a randomized controlled trial. The Lancet 1999;353:883-87.
12. Ballardie WF, Roberts ISD. Controlled Prospective Trial of Prednisolone and Cytotoxics in Progressive IgA Nephro-pathy. J Am Soc Nephrol. 2001;13:142-48.
13. Rasche FM, Christoph HK, David C, Karges W, Jehle PM, Mertz A, Keller F. Cyclophosphamide Pulse Therapy in Advanced Progressive IgA Nephropathy. Nephron Clin Pract
2003;93:131-36.
14. Praga M, Gutierrez E, Gonzalez E, Morales E, Hernandez E. Treatment of IgA Nephropaythy with ACE Inhibitors: A Rando¬mized and Controlled Trial. JaM Soc Nephrol; 2003: 1578-83.
15. Buemi M, Allehra A, Corica F, Aloisi C, Giacobbe M, Pettina-to G, Corconello A, Senatore M, Frisina N. Effect of fluvas-tatin on proteinuria in patients with immunoglobulin A nephropathy. Clin Pharmacol Ther. 2000;67:427-31.
16. Donadio JV, Bergstralh EJ, Kenneth P et al. For the Mayo Nephrology Colloborative Group. A Controlled Trial of Fish Oil in IgA Nephropathy. N Engl J Med. 1994;331:1194-99.
17. The GISEN group: Randomised placebo controlled trial of ef¬fect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nep-
hropathy. Lancet 1997;349:1857-63.
18. Bannister KM, Weaver A, Clarkson AR, Woodroffe AJ: Effect
of angiotensin converting enzyme and calcium channel inhi¬bition on progression og IgA nephropathy. Contrib Nephrol
1995;111:184-193.
19. Cheng IKP, Fang GX, Wong MC, Ji YL, Chan KW, Yeung HWD: A randomised prospective comparison of nadolol cap-topril with or without ticlopidineon disease progression of IgA nephropathy. Nephrology 1998;4:19-26.
20. Walker RG, Yu SH, Owen JE, et al: The treatment of mesan-gial IgA nephropathy with cyclophosphamide, dipyridamol and warfarin: a two-year prospective trial. Clin Nephrol 1990;34:103-107.
21. Lee GSI, Choong HL, Chang GSC, Woo KT. Three-year ran¬domised controlled trial of dipyrimadole and low-dose war¬farin in patients with IgA nephropathy and renal impairment.
Nephrology 1997;3;117-121.
22. Bennett WM, Walker RG, Kincaid-Smith P. Treatment of IgA
nephropathy with eicasopentaenoic acid (EPA). A two-year
prospective trial. Clin Nephrol 1989;31:128-129.
23. Nolin L, Courteau M. Management of IgA nephropathy: Evi¬dence-based recommendations. Kidney Int. 1999; 70; 56-62.
24. Katafuchi R, Oh Y, Hori k, Komota T, Yanase T et al. An im¬portant role of glomerular segmental lesions on progression og IgA nephropathy: A multivariate analysis. Clin Nephrol
1994;41:191-98.
25. Kobayashi Y, Kokubo T, Horii A, Hiki Y,Tateno S. Prognos¬tic prediction of long-term clinical course in individual IgA nephropathy patients. Nephrology 1997;3:35-40.
26. Packham DK, Yan HD, Hewitson TD, Nicholls KM, Fairley
KF, Kincaid-Smith P. The significance of focal and segmental hyalinosis and sclerosis and nephrotic range proteinuria in
IgA nephropathy. Clin Nephrol 199646:225-29.
27. Abbate M, Remuzzi G. Progression of Renal Insufficiency, part two: Mechanisms. In Massry SG, Glassock RJ (eds); Massry And Glassock's Textbook Of Nephrology (fourth ed)
2001;1210-1217. Lippincott Williams And Wilkins 2001.
28. D'Amico G, Minetti L, Ponticelli C, Fellin G, Ferrario F et al. Prognostic indicators in idiopathic IgA mesengial nephro-pathy. Q J Med 1986;59:363-378.
29. Droz D, Kramar A, Nawar T, Noel LH. Primary IgA nephro-pathy: Prognostic factors. Contrib Nephrol 1984;40202-207.

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