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Original scientific paper

https://doi.org/10.20471/acc.2021.60.s1.22

Ishod starijih bolesnika s ANCA glomerulonefritisom liječenih imunosupresivnom terapijom

Karlo Kurtov ; Department of Emergency Medicine Sisak-Moslavina County
Mario Laganović ; Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Croatia; School of Medicine, University of Zagreb
Sandra Karanović ; Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Croatia; School of Medicine, University of Zagreb
Živka Dika ; Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Croatia; School of Medicine, University of Zagreb
Ema Ivandić ; Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Croatia
Marijana Živko ; Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Croatia
Jelena Kos ; Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Croatia
Margareta Fištrek ; Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Croatia
Bojan Jelaković ; Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Croatia; School of Medicine, University of Zagreb
Ivana Vuković Brinar ; Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Croatia; School of Medicine, University of Zagreb


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Abstract

Najčešći uzrok brzoprogresivnog glomerulonefritisa u starijih je glomerulonefritis s antineutrofilnim citoplazmatskim
protutijelima (ANCA-GN, od eng. antineutrophil cytoplasmic antibody related glomerulonephritis), a s obzirom na komorbiditete
predstavlja izazov u odluci oko primjene imunosupresivne terapije (IS). Cilj ovog istraživanja je usporediti razlike u
ishodu dvije dobne skupine bolesnika.
Istraživanje je obuhvatilo slučajeve ANCA-GN ograničenih na bubrege, liječene od 1990. do 2018. godine, njih 38
(18 muških), od kojih 11 ima 65 ili više godina (medijan 70, min.-max. 66 - 79 godina) a 27 mlađih (medijan 55, min. - max.
23 - 64 godina). Svi bolesnici su liječeni monoterapijom ili kombinacijom IS-a.
Najčešće primjenjena IS u starijoj populaciji bila je kombinacija intravenskog ciklofosfamida i kortikosteroida (KS) (u 9
(81,8%)), u mlađoj kombinacija KS s ciklofosfamidom ili rituksimabom (59,2%). Stariji pacijenti imali su sličnu učestalost
smrtnosti (3, 14,8% vs 4, 27,3%; P = 0.369), zloćudnih bolesti (1, 3,7% vs 1, 9,1%; P = 0.5) i infektivnih komplikacija (10,
46,7% vs 7, 63,6%); P = 0.388). Deset bolesnika je na kraju praćenja bila ovisno o nadomještanju bubrežne funkcije (NBF)
bez razlike u dobnoj skupini (6, 22,2% vs 4, 36,4%; P = 0.369). Međutim, od inicijalne potrebe NBF-om se uz IS oporavila
polovica starijih i mlađih bolesnika.
Naši rezultati su u skladu trenutačnim stajalištima koja podupiru primjenu IS terapije kod starijih bolesnika sa
ANCA-GN zbog usporedivih ishoda i rizika komplikacija kao u mlađih bolesnika.

Keywords

Antineutrofilna citoplazmatska antitijela; glomerulonefritis; stariji; imunosupresija; mortalitet; kronično bubrežno zatajenje

Hrčak ID:

260436

URI

https://hrcak.srce.hr/260436

Publication date:

1.1.2021.

Article data in other languages: english

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