Henoch-schonlein purpuralı çocuk hastalarda organ tutulumları ve böbrek tutulumunu etkileyen faktörler
Organ involvement and factors affecting renal involvement in pediatric patients with henoch-schonlein purpura
Yazar: ŞAFAK DEMİRTAŞ
Danışman: PROF. DR. ZÜBEYDE GÜNDÜZ ; DOÇ. DR. İSMAİL DURSUN
Erciyes Üniversitesi / Tıp Fakültesi / Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2017
Konu: Çocuk Sağlığı ve Hastalıkları = Child Health and Diseases
Dizin: Böbrek = Kidney ; Böbrek hastalıkları = Kidney diseases ; Glomerülonefrit-İgA = Glomerulonephritis-IgA ; Nefrit = Nephritis ; Purpura-Schoenlein-Henoch = Purpura-Schoenlein-Henoch ; Vaskülit = Vasculitis ; Çocuk hastalıkları = Child diseases ; Çocuklar = Children ; İmmünoglobülin A = Immunoglobulin A

Özet:
GİRİŞ VE AMAÇ: IGA VASKÜLİTİ VÜCUTTA KÜCÜK DAMARLARI TUTAN ÇOCUKLUK ÇAĞININ EN YAYGIN VASKÜLİTİDİR. BÖBREK TUTULUMUNUN PROGNOZU BELİRLEDİĞİ HASTALIKTA HER ORGAN ETKİLENEBİLİR. BU ÇALIŞMANIN AMACI IGA VASKÜLİTİ TANISI ALMIŞ HASTALARIN GERİYE DOĞRU İNCELENMESİ ORGAN TUTULUMLARININ VE KLİNİKLERİNİN BELİRLENMESİ, BÖBREK TULUMUNU ARTIRAN RİSK FAKTÖRLERİNİN BELİRLENMESİ VE UZUN DÖNEM PROGNOZLARININ SAPTANMASIDIR.

MATERYAL VE METHOD: ÇALIŞMAYA ERCİYES ÜNİVERSİTESİ PEDİATRİK NEFROLOJİ VE ROMATOLOJİ BİLİM DALI'NDA 1990 VE 2016 YILLARI ARASINDA TAKİP EDİLEN 415 IGA VASKÜLİTİ HASTASI ALINDI. HASTALARIN DOSYALARI RETROSPEKTİF OLARAK TARANDI. HASTALARIN BAŞVURU BULGULARI, ORGAN TUTULUMLARI, KULLANDIKLARI TEDAVİLER VE UZUN DÖNEM PROGNOZLARI BELİRLENDİ. 

BULGULAR: ÇALIŞMAMIZDA IGA VASKÜLİTİ (HSP) TANISI ALAN 415 HASTA DEĞERLENDİRİLDİ. HASTALARIN 173'Ü (%41,7) KIZ, 242'Sİ(%58,3) ERKEKTİ. ORTALAMA BAŞVURU YAŞI 8,3±3,1 YIL İDİ. CİLT TUTULUMU %100, EKLEM TUTULUMU %77.1, GİS TUTLUMU %58.6, BÖBREK TUTULUMU %38.3, SKALP ÖDEMİ %10.1, SKROTAL TUTULUM %5.3 VE SANTRAL SİNİR SİSTEMİ TULUMU %1.6 OLARAK BULUNDU. BÖBREK TUTULUMU İÇİN RİSK FAKTÖRLERİ DEĞERLENDİRİLDİĞİNDE GASTROİNTESTİNAL TUTULUMUN NEFRİT OLANLARDA DAHA SIK GÖRÜLDÜĞÜ SAPTANDI (P=0.01). YAŞ, DİYASTOLİK KAN BASINCI VE GİS TUTULUMUNUN BÖBREK TUTULUMU İLE KORELASYON GÖSTERDİĞİ, GİS TUTULUMU VE DİYASTOLİK KAN BASINCININ BÖBREK TUTULUMUNU ETKİLEYEN RİSK FAKTÖRLERİ OLDUKLARI TESPİT EDİLDİ.  

SONUÇ: HASTALARIN TANI ANINDAKİ YAŞLARI, KAN BASINCI YÜKSEKLİĞİ VE GİS TUTULUMU HASTALARDA NEFRİT GELİŞMESİNİ TAHMİN ETMEDE ÖNEMLİ BULGULARDIR. ÖZELLİKLE GİS TUTULUMU OLAN HASTALAR BÖBREK TUTULUMU AÇISINDAN DİKKATLE TAKİP EDİLMELİDİR.

Abstract:
INTRODUCE AND AIM: IGA VASCULITIS IS THE MOST COMMON VASCULITIS SEEN IN CHILDHOOD. THOUGH KIDNEY INVOLVEMENT IS A MAJOR FACTOR AFFECTING PROGNOSIS, EVERY ORGAN ON BODY MIGHT BE AFFECTED.  THE AIM OF THIS STUDY IS TO DETERMINE THE ORGAN INVOLVEMENT AND CLINICS, TO IDENTIFY THE RISK FACTORS THAT INCREASE THE NEPHRITIS AND TO DETERMINE THE LONG-TERM PROGNOSIS OF PATIENTS WITH IGA VASCULITIS. 

MATERIALS AND METHODS: 415 IGA VASCULITIS PATIENTS WHO WERE FOLLOWED IN 1990 AND 2016 IN ERCIYES UNIVERSITY PEDIATRIC NEPHROLOGY AND RHEUMATOLOGY DEPARTMENT INCLUDED THE STUDY. PATIENTS' FILES WERE SCANNED RETROSPECTIVELY. THE PATIENTS' PRESENTING SEMPTOMS, ORGAN INVOLVEMENT, TREATMENT AND LONG-TERM PROGNOSIS WERE DETERMINED.

RESULTS: IN OUR STUDY, 415 PATIENTS DIAGNOSED WITH IGA VASCULITIS (HSP) WERE EVALUATED. OF THE PATIENTS, 173 (41.7%) WERE FEMALE AND 242 (58.3%) WERE MALE. THE MEAN REFERENCE AGE WAS 8.3 ± 3.1 YEARS. SKIN INVOLVEMENT WAS FOUND 100%, JOINT INVOLVEMENT WAS 77.1%, GIS INVOLVEMENT WAS 58.6%, RENAL INVOLVEMENT WAS 38.3%, SCALP EDEMA WAS 10.1%, SCROTAL INVOLVEMENT WAS 5.3% AND CENTRAL NERVOUS SYSTEM INVOLVEMENT WAS 1.6%. WHEN RISK FACTORS FOR NEPHIRITIS WERE ASSESSED, IT WAS FOUND THAT GASTROINTESTINAL INVOLVEMENT WAS MORE FREQUENT IN THOSE WITH NEPHRITIS (P=0.01). AGE, DIASTOLIC BLOOD PRESSURE AND GIS INVOLVEMENT WERE CORRELATED WITH RENAL INVOLVEMENT, AND GIS INVOLVEMENT AND DIASTOLIC BLOOD PRESSURE ARE FOUND TO BE RISK FACTORS FOR RENAL INVOLVEMENT.

CONCLUSION: AGE AT DIAGNOSIS, ELEVATED BLOOD PRESSURE AND GIS INVOLVEMENT ARE IMPORTANT FINDINGS IN PREDICTING THE DEVELOPMENT OF NEPHRITIS IN PATIENTS. PATIENTS WITH GIS INVOLVEMENT SHOULD BE CAREFULLY MONITORED FOR KIDNEY INVOLVEMENT.