Stručni rad

https://doi.org/10.33004/reumatizam-67-2-8

Kidney involvement in adults with IgA vasculitis: experiences from Clinical Hospital Dubrava, Zagreb

Ana Gudelj Gračanin ; Zavod za kliničku imunologiju, alergologiju i reumatologiju, Klinika za unutarnje bolesti Medicinskog fakulteta Sveučilišta u Zagrebu, Klinička bolnica Dubrava, Zagreb, Hrvatska
Tea Mikula ; Medicinski fakultet Sveučilišta u Zagrebu, Zagreb, Hrvatska
Ivica Horvatić ; Division of Nephrology and Dialysis, Department of Internal Medicine, School of Medicine University of Zagreb, Clinical Hospital Dubrava, Zagreb, Croatia
Luka Torić ; Division of Nephrology and Dialysis, Department of Internal Medicine, School of Medicine University of Zagreb, Clinical Hospital Dubrava, Zagreb, Croatia
Majda Golob ; Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, School of Medicine University of Zagreb, Clinical Hospital Dubrava, Zagreb, Croatia
Jasminka Dobša ; Faculty of Organization and Informatics, University of Zagreb, Varaždin, Croatia
Matea Liskij ; School of Medicine of the University of Zagreb, Zagreb, Croatia
Gabrijela Buljan ; School of Medicine of the University of Zagreb, Zagreb, Croatia
Karla Draženović ; School of Medicine, University of Zagreb, Zagreb, Croatia
Matej Nedić ; Polyclinic Nedić, Slatina, Croatia
Danica Galešić Ljubanović ; Department of Pathology, Clinical Hospital Dubrava, Zagreb, Croatia
Krešimir Galešić ; Division of Nephrology and Dialysis, Department of Internal Medicine, School of Medicine University of Zagreb, Clinical Hospital Dubrava, Zagreb, Croatia

Sažetak

Introduction: IgA vasculitis, formerly named Henoch-Schönlein purpura, is a systemic small-vessel vasculitis that occurs commonly in children, while in adults, the disease remains rare. It is characterised by non-thrombocytopenic palpable purpura, arthritis, arthralgia, kidney disease and gastrointestinal pain. This study aimed to determine clinical signs and symptoms, laboratory and pathohistological parameters and therapy of IgA vasculitis in adults with renal involvement, by conducting our research on a sample of patients of a tertiary referral hospital. Research subjects and methods: In this retrospective cohort study, patients treated at Clinical Hospital Dubrava from 2011 to 2019 were included, who were diagnosed with IgA vasculitis, based on clinical, laboratory and pathohistological criteria. Clinical and laboratory parameters, were determined through the use of methods commonly used in clinical practice. In patients with symptoms and signs of kidney involvement and after patients’ consent, kidney biopsy was performed, and analysed by light, immunofluorescence and electron microscopy. Results: twenty-two adults (12 M, 10 F), whose median age was 57, were included in our study. Palpable purpura and nephritis were present in all patients. Thirteen (59.1%) patients had arthralgia and five of them (22.5%) experienced
abdominal pain. Respiratory infection preceded vasculitis in six (27.3%) patients, six patients ((27.3%) were taking medications and got vaccinated prior to the occurrence of vasculitis, and in ten (45.4%) patients the predisposing factor was unknown. Asymptomatic hematuria was present in ten (47.6%), subnephrotic proteinuria in three (14.3%), nephrotic syndrome in nine (42.9%) and nephritic syndrome in three (14.3%) patients. According to the
findings of kidney biopsy, which was performed on 18 patients, eleven (61.6%) had mesangial proliferation, fourteen (77.8%) had endocapillary proliferation, and eleven (61.6%) had extracapillary (crescents) proliferation. After the diagnosis, renin-angiotensin inhibitors were used by eighteen (81.8%) patients, glucocorticoids by twenty-one (95.5%) and cyclophosphamide by five (22.7%) patients. Patient follow-up was performed for 23 to 84 months and, in the said period, all of them had improved or stagnant renal function, except for one patient who died. Conclusion: Renal manifestations of IgA vasculitis may change the commonly mild course of this disease and lead to an increase in morbidity as well as affect the type and duration of treatment. So, in everyday work, it is important to determine characteristics of renal changes in IgA vasculitis in order for an adequate therapeutic option to be applie.

Ključne riječi

Purpura, Schoenlein-Henoch – complications, diagnosis, drug therapy; Kidney diseases – diagnosis, drug therapy, etiology; Kidney – pathology; Biopsy; Glomerulonephritis, IgA – dijagnoza, farmakoterapija, patologija; Immunoglobulin A; Arthralgia – etiology; Abdominal pain – etiology; Glucocorticoids – therapeutic use; Angiotensin – converting enzyme inhibitors – therapeutic use; Angiotensin receptor antagonists – therapeutic use

Hrčak ID:

262173

URI

https://hrcak.srce.hr/262173

Datum izdavanja:

14.9.2021.

Podaci na drugim jezicima: hrvatski

Posjeta: 2.032 *