Procena aktivnosti i remisije tokom lečenja idiopatske retroperitonealne fibroze
Assessment of disease activity and remission of idiopathic retroperitoneal fibrosis
Author
Obrenčević, KatarinaMentor
Petrović, DejanCommittee members
Živančević-Simonović, Snežana
Jovanović, Dragan
Stanković, Vesna
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Show full item recordAbstract
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 наукаDate:
29-01-2019Projects:
- 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)