Evaluacija dijagnostičkih kriterija za endemsku nefropatiju

Dika, Živka (2012) Evaluacija dijagnostičkih kriterija za endemsku nefropatiju. PhD thesis, Sveučilište u Zagrebu.

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Abstract

EN is a chronic aristolochic acid nephropathy whose prevalence has not been changed significantly in the last 3 decades. In EN villages there has been a shift towards an older age in diagnosing EN. We do not expect the development of EN in persons in the WHO subgroups of others and those at risk because at their age (45-50 yrs) 30 years ago there were persons in WHO subgroup of the diseased, but in this study the persons in the subgroups of others and those at risk do not have the signs of kidney disease. The aforementioned data rise the question of the exposure to etiological agent 30 years ago as well as the question of plausible disappearance of EN. Anemia, a characteristic of a chronic kidney disease, has not shown to be a good marker in differentiating WHO subgruops and therefore should not be used as a diagnostic criterion for EN. Furthermore, there was no difference in blood in urinary dipstick test between EN and control villages as well as among the study subgroups, Therefore, this test is not a good screening tool in detecting those with urothelial tumor among farmers in EN villages. Although the early phase of EN is characterized by the proximal tubule damage, the proximal tubule enzyme LAP has not shown to be a good marker in differentiating the study subgroups. Moreover, the progression of EN, especially in the advance stage of the disease is characterized by interstital renal fibrosis and TGF beta in renal fibrosis plays a central role (99). Several studies have shown no correlation between urinary TGF beta and histological findings of renal fibrosis (153, 171). In our study urinary TGF beta has not shown to be a good marker in differentiating the study subgroups. In our study the assesment of kidney function by MDRD formula as well as both kidney lenght and parenchima thickness, have shown to be good markers in differentiating the study subgroups and therefore should be implemented into the diagnostic criteria for EN. Also, alpha 1mCR has shown to be a great marker in screening and diagnosing EN in the study, Based on our results the cut off value of alpha 1mCR for screening should be 23,5 mg/g creatinine instead of 15 mg/g creatinine in the present criteria, while for making a diagnosis of EN 31,5 mg/g creatinine. Positive family history for EN increases 5,8 times the risk for developing EN compared to a negative one. Therefore, positive family history for EN is an important criterion for screening and diagnosing EN. Taken together, persons with positive family history for EN, i.e. WHO subgrup of those at risk as well as those with alpha 1mCR greater than 23,5 mg/g creatinine who in our study partly represent persons in the WHO subgroup of suspected of having EN, are persons with greater risk for developing EN and therefore should be regularly followed up by their GPs.

Abstract in Croatian

EN je kronična nefropatija aristolohične kiseline čija se učestalost nije bitnije mijenjala posljednjih tri desetljeća. U EN selima bilježi se pomak u postavljanju dijagnoze EN prema starijoj dobi. Ostali i rizični u EN selima vjerojatno neće razviti nefropatiju budući da su prije tri desetljeća u dobi u kojoj se sada nalaze spomenute SZO podskupine (45-50 godina) bili oboljeli od EN, a rizični i ostali sada nemaju znakove bubrežne bolesti što otvara pitanje ranije izloženosti spomenutih podskupina etiološkom čimbeniku kao i pitanje mogućeg nestanka EN. Anemija koja je inače obilježje kronične bubrežne bolesti nije se pokazala dobrim biljegom u razlikovanju pojednih SZO podskupina pa više ne treba biti uključena u dijagostičke kriterije. Osim toga, nije bilo razlike između kontrolnih i EN sela kao niti između pojednih SZO podskupina test trakom za eritocituriju, pa time taj test nije dobar test probira za tumor prijelaznog epitela mokraćnog sustava. Iako ranu fazu EN karakterizira oštećenje proksimalnog tubula određivanje LAP se nije pokazalo korisno u razlikovanju pojednih SZO podskupina kao niti EN sela od kontrolnih sela. Osim toga, progresijom nefropatije naročito u uznapredovaloj fazi prisutna je intersticijska fibroza a TGFbeta je ključni čimbenik u procesu bubrežne fibroze (99). Prema nekim istraživanjima koncentracija TGF beta u mokraći ne pokazuje povezanost sa stupnjem bubrežne fibroze (153; 171). U našem istraživanju TGF beta u mokraći nije se pokazao korisnim kako u razlikovanju pojednih SZO podskupina tako i u dijagnosticiranju EN. Procjena bubrežne funkcije prema MDRD jednadžbi kao i uzdužni promjeri i debljina parenhima bubrega su se pokazali kao značajni pokazatelji u razlikovanju pojednih SZO podskupina u ovom istraživanju te bi ih trebalo uključiti u dijagnostičke kriterije za EN. Također jedan od značajnih biljega u probiru i dijagnosticiranju EN u istraživanju bio je i alfa 1mCR. Na temelju naših rezulatata granična vrijednost za probir populacije u EN selima bi trebala biti 23,5 mg/g kreatinina, a ne dosadašnjih 15 mg/g, dok za postavljanje dijagnoze EN 31,5 mg/g kreatinina. Pozitivna obiteljska anamneza za EN za 5,8 puta povećava vjerojatnost oboljenja od EN u odnosu na one bez pozitivne anamneze pa je bitan kriterij u probiru populacije u EN selima ali i u dijagnosticiranju EN. Ukupno gledajući, osobe s pozitivnom obiteljskom anamnezom za EN što odgovara podskupini rizičnih prema SZO kriterijima kao i onih s alfa 1mCR iznad 23,5 mg/g kreatinina koji u ovom istraživanju obuhvaćaju dio podskupine sumnjivih prema SZO kriterijima čine posebno ugrožene skupine za razvoj EN te zahtjevaju redovito medicinsko praćenje.

Item Type: Thesis (PhD)
Mentors:
Mentor
Jelaković, Bojan
Departments: Izvan medicinskog fakulteta
Depositing User: Marijan Šember
University: Sveučilište u Zagrebu
Institution: Medicinski fakultet
Number of Pages: 114
Status: Unpublished
Creators:
CreatorsEmail
Dika, ŽivkaUNSPECIFIED
Date: 21 September 2012
Date Deposited: 25 Oct 2012 11:10
Last Modified: 25 Oct 2012 11:10
Subjects: /
Related URLs:
    URI: http://medlib.mef.hr/id/eprint/1641

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