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Procena aktivnosti i remisije tokom lečenja idiopatske retroperitonealne fibroze

Assessment of disease activity and remission of idiopathic retroperitoneal fibrosis

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Disertacija.pdf (5.890Mb)
Katarina_Obrencevic_Medicina.pdf (1.574Mb)
Author
Obrenčević, Katarina
Mentor
Petrović, Dejan
Committee members
Živančević-Simonović, Snežana
Jovanović, Dragan
Stanković, Vesna
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Abstract
Uvod/Cilj rada: Idiopatska retroperitonealna fibroza je retko oboljenje, koje se karakteriše fibroinflamatornim tkivom i zahvatanjem uretera, dovodeći do opstruktivne nefropatije i bubrežne insuficijencije. Bolest je najverovatnije autoimunske prirode. Terapija uključuje imunosupresive, ali optimalni pristup do sada nije definisan. Sedimentacija (SE) i C-reaktivni protein (CRP) predstavljaju markere aktivne inflamacije u početnoj fazi bolesti i stoga bi mogli predstavljati senzitivne prediktore odgovora na terapiju imunosupresivnim lekovima. Metode: Retrospektivna klinička opservaciona studija tipa serije slučajeva obuhvatila je pacijente sa idiopatskom retroperitonealnom fibrozom kod kojih su primenjena dva različita terapijska protokola: kortikosteroidi u kombinaciji sa mikofenolat mofetilom i kortikosteroidi u kombinaciji sa azatioprinom. Ukupno je uključeno 28 pacijenata (13 u prvoj, 15 u drugoj grupi) koji su lečeni u Klinici za nefrologiju Vojnomedicinske akademije. ...Rezultati: 92,3% pacijenata je inicijalno imalo povišene vrednosti SE i CRP-a, a 67,8% akutnu bubrežnu insuficijenciju. Kod svih pacijenata se gube opšti simptomi nakon 4 nedelje terapija. Bubrežna funkcija se u obe grupe značajno poboljšava, već posle prvih mesec dana, s tim da je kreatinin na kraju bio viši u u grupi sa mikofenolatom, kao posledica relapsa kod 23,1% pacijenata u ovoj grupi. Redukcija fibroznog tkiva je je bila brža pod terapijom mikofenolatom nakon 6 meseci, a 100% redukcije na kraju postiže 53,8% pacijenata u prvoj i 33,3% u drugoj grupi. Vrednost SE i CRP-a posle mesec dana u grupi sa azatioprinom značajno korelira sa smanjenjem debljine fibroznog tkiva posle 6 meseci i posle godinu dana terapije. U grupi sa mikofenolatom jedino vrednost CRP-a nakon mesec dana značajno korelira sa redukcijom fibroznog tkiva nakon godinu dana. Zaključak: Mikofenolat mofetil ima brži i potpuniji efekat na povlačenje hidronefroze i kompletnu redukciju fibroznog tkiva, u odnosu na azatioprin, koji deluje sporije, i ne postiže kompletnu redukciju. CRP se pokazao kao dobar parametar koji u oba terapijska protokola korelira sa postizanjem remisije bolesti.

Background/Aim: Idiopathic retroperitoneal fibrosis (IRF) is a rare disease characterized by fibroinflammatory periaortic tissue that affects the ureters, causing obstructive nephropathy and impairment of renal function. Findings strongly suggest an autoimmune etiology. Medical treatment includes immunosuppressive drugs, but the optimal treatment has not been established. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) represent markers of active inflammation in the early phase of the disease, and hence could be sensitive predictors of the treatment response. Methods: This retrospective case series study includes patients with IRF treated with two different protocols: corticosteroids in combination with mycophenolate mofetil (MMF) and corticosteroids combined with azathioprine (AZA). The total number of 28 patients (13 in the first group and 15 in the second group) were treated and followed in the Clinic of nephrology in Military Medical Academy. Results: ...At presentation 92.3% of patients had elevated levels of ESR and CRP, and 67.8% of them had acute renal insufficiency. Systemic symptoms resolved after four weeks in all patients. The kidney function improved significantly in both groups after first moth of treatment, although the creatinine level was higher in the MMF group because of the disease recurrence in 23% of the patients. In MMF group was observed faster reduction in the periaortic mass after six months and 53.8% of patients achieve 100% of the mass reduction at the end of the treatment while 33.3% in AZA group. The levels of ESR and CRP after one month of treatment in AZA group correlated with the fibrotic mass reduction after six months and after one year. In MMF group, only the CRP level after one month correlated with the fibrotic mass reduction achieved after one year. Conclusion. MMF had more rapid and complete effect in hydrnephrosis withdrawal and total reduction of the fibrotic tissue, comparing with AZA whose effect was slower and without complete mass reduction. CRP strongly correlated with the remission of the disease in both therapeutic protocols.

Faculty:
Универзитет у Крагујевцу, Факултет медицинских наука
Date:
29-01-2019
Projects:
  • Medical costs structure and budget impact analysis regarding most prevalent and/or most expensive diseases and cost/effectiveness/utility coefficient determination of common medical interventions (RS-175014)
  • Genetic polymorphisms of CYP genes in Serbian population (RS-175093)
Keywords:
Idiopatska retroperitonealna fibroza / Idiopathic retroperitoneal fibrosis / sedimentacija eritrocita / Creaktivni protein / kortikosteroidi / mikofenolat mofetil / azatioprin / Erythrocyte sedimentation rate / C-reactive protein / Corticosteroids / Mycophenolate mofetil / Azathioprine
[ Google Scholar ]
Handle
https://hdl.handle.net/21.15107/rcub_nardus_11133
URI
https://nardus.mpn.gov.rs/handle/123456789/11133
http://eteze.kg.ac.rs/application/showtheses?thesesId=6680
https://fedorakg.kg.ac.rs/fedora/get/o:1109/bdef:Content/download

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