بررسی اتیولوژی و توزیع فراوانی گلومرولونفریت کرسنتیک در بیوپسی‌های کلیه

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دانشجوی پزشکی، دانشکده‌ی پزشکی و کمیته‌ی تحقیقات دانشجویی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشیار، گروه آمار زیستی، و اپیدمیولوژی، دانشکده‌ی بهداشت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 پژوهشگر، انستیتو پژوهشی نیکان، اصفهان، ایران

4 استاد، گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: گلومرولونفریت کرسنتیک، وضعیتی پاتولوژیک است که به صورت درگیری وسیع گلومرول‌ها بیش از 50 درصد همراه با کرسنت مشخص می‌شود که به سه دسته‌ی کلی Anti-Glomerular basement membrane (Anti-GBM)، ایمیون کمپلکس و واسکولیت‌های ANCA associated (Antineutrophil cytoplasmic antibody) تقسیم می‌شود و استاندارد طلایی تشخیص آن بیوپسی کلیه می‌باشد.روش‌ها: این مطالعه، یک مطالعه‌ی توصیفی- تحلیلی- مقطعی بود که روی بیوپسی کلیه‌ی بیماران مراجعه کننده به یک مرکز از سال 1390 تا شهریور 1394 انجام شد. از میان 1108 نمونه‌ی بیوپسی، 87 بیمار کرسنتیک وارد مطالعه شدند. بیماران در 6 گروه کلی نفریت لوپوسی، نفروپاتی Immunoglobulin A (IgA) و هنوخ شوئن لاین (Henoch shoen line)، واسکولیت‌های ANCA associated و وگنر، گودپاسچر، کرایوگلوبولینمی و Post streptococcal glomerulonephritis (PSGN) دسته‌بندی شدند.یافته‌ها: متوسط سن بیماران در این بررسی، به طور کلی در تمام گروه‌ها 17 ± 36 سال (با کمینه‌ی 3، بیشینه‌ی 81 و متوسط 32 سال) بود. 54 بیمار (1/62 درصد) مرد بودند. از نظر توزیع فراوانی در میان گروه‌ها 36 بیمار (3/41 درصد) IgA نفروپاتی وهنوخ شوئن لاین، 32 بیمار (7/36 درصد) نفریت لوپوسی، 14 بیمار (0/16 درصد) ANCA associated vasculitis، 2 بیمار گودپاسچر، 2 بیمار کرایوگلوبولینمی و 1 بیمار PSGN بودند. در بررسی حاضر، میانگین کراتینین سرم و پروتئین ادرار 24 ساعته در بیماران به ترتیب 1 ± 2 میلی‌گرم بر دسی‌لیتر (متوسط 1 میلی‌گرم) و 830 ± 1930 میلی‌گرم روزانه (متوسط 2000 میلی‌گرم روزانه) بود. در این مطالعه، میان سن و تعداد کرسنت رابطه‌ی مثبت وجود داشت (001/0 > P). همچنین، میان تعداد کرسنت و کراتینین سرم نیز رابطه‌ی واضح و مثبتی وجود داشت (007/0 = P)، اما میان تعداد کرسنت و پروتئین ادرار 24 ساعته، ارتباط معنی‌دار وجود نداشت.نتیجه‌گیری: این مطالعه، اهمیت ارتباط کرسنت با کراتینین سرم و سن رانشان داد. بنا بر این، تعداد کرسنت‌ها و نوع آن‌ها می‌تواند در پیش‌آگهی بیماران دخیل باشد. این مطالعه، نشان داد که IgA نفروپاتی، شایع‌ترین علت کرسنتیک گلومرولونفریت در میان گروه‌ها بوده است؛ به طور کلی، کرسنتیک گلومرولونفریت در تمام گروه‌ها به جز لوپوس در آقایان بیشتر بود. مطالعه‌ی حاضر، در یک مرکز انجام شد؛ پیشنهاد می‌شود که این مطالعه به صورت چند مرکزی انجام شود. همچنین، این مطالعه نقش انجام بیوپسی کلیه برای تشخیص زودهنگام کرسنت را نشان می‌دهد؛ چرا که کرسنت‌، ارتباط مثبتی با میزان کراتینین سرم داشت.

کلیدواژه‌ها

عنوان مقاله [English]

Etiology and Frequency Distribution of Crescentic Glomerulonephritis in Renal Biopsy

نویسندگان [English]

  • Hamid Nasri 4
  • Seyed Mohsen Hosseini 2
  • Zohreh Zamani 1
  • Samaneh Khodadadi 3
  • Mitra Moradi 3
1 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
3 Researcher, Nickan Research Institute, Isfahan, Iran
4 Professor, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Crescentic glomerulonephritis results from proliferating cells in Bowman's capsule and formation of crescents. It is classified in three major groups: Anti-Glomerular basement membrane (anti GBM) antibody mediated, Immune-complex mediated, and antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis.Methods: This is a cross-sectional study of 87 biopsy-proven cases of crescentic glomerulonephritis during 2011-2015 in a single center. They were classified into six groups: Lupus nephritis, Immunoglobulin A (IgA) nephropathy, ANCA-associated glomerulonephritis (containing of cANCA and pANCA vasculitis), Goodpasture syndrome, Cryoglobulinemia, and Poststreptococcal glomerulonephritis (PSGN).Findings: Of 87 renal biopsy, 62% were males. The mean age in all patients groups was 36 ± 17 years. Frequency distribution of the groups in our study were as follow: IgA nephropathy (41.3%), Lupus nephritis (36.7%), ANCA-associated glomerulonephritis (16%), Goodpasture syndrome (2.2%), Cryoglobulinemia (2.2%), and PSGN (1.1%). Mean and median of serum creatinine and proteinuria were 2 ± 1 mg/dl (Median = 1mg/dl) and 1930 ± 830 mg/day (Median = 2000mg/day). In this study, we found a significant positive correlation between the number of crescents and age (P < 0.001), additionally we found a positive association between the proportion of crescents and serum creatinine (P = 0.007), however, there were no significant correlation between the proportion of crescents and proteinuria (P > 0.050).Conclusion: This study reveals the importance of relationship between the proportion of crescents and serum creatinine .Therefore the proportion of crescents may influence the prognosis of the disease. This research approved most prevalence reason for crescentic glomerulonephritis was IgA nephropathy. This study shows the role of renal biopsy in early diagnosis of crescentic glomerulonephritis while this study showed the positive correlation between crescents and serum creatinine.

کلیدواژه‌ها [English]

  • Crescents
  • Glomerulonephritis
  • Lupus nephritis
  • IgA nephropathy
  • Vasculitis

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مجله دانشکده پزشکی اصفهان
دوره 34، شماره 387 - شماره پیاپی 387
مرداد و شهریور 1395
صفحه 692-700

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سابقه مقاله

  • تاریخ دریافت: 23 آبان 1394
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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