Deveci Burak, Kurtoglu Aysegul, Kurtoglu Erdal, Salim Ozan, Toptas Tayfur
Department of Hematology, Ali Osman Sönmez Oncology Hospital, Bursa, Turkey.
Department of Biochemistry, Antalya Training and Research Hospital, Antalya, Turkey.
Ann Hematol. 2016 Feb;95(3):375-81. doi: 10.1007/s00277-015-2561-2. Epub 2015 Nov 23.
Urinary albumin to creatinine (ACR) and beta2 microglobulin to creatinine ratios (BCR) are the surrogate and robust markers of renal glomerulopathy and tubulopathy, respectively. These markers predict short-term renal deterioration and mortality in various conditions. We aimed to assess the frequency and predictors of glomerular and tubular defects, renal impairment, and hyperfiltration in 96 adult patients with beta thalassemia intermedia and major. ACR > 300 mg/g creatinine and BCR > 300 μg/g creatinine were used to define the renal glomerular and tubular damages, respectively. Glomerular filtration rate (eGFRcreat) was estimated according to 2009 the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Decreased eGFRcreat was defined as less than 60 mL/min per 1.73 m(2). Renal glomerular and/or tubular defects were observed in about 68.8 % of all patients. Forty percent of patients had glomerular hyperfiltration. None of the patients had a decreased eGFRcreat. T2* value ≤20 msec on cardiac magnetic resonance (cMR) was the only independent predictor of glomerular damage (p = 0.013). Use of alendronate was associated with less renal tubular damage (p = 0.007). Female gender and previous history of splenectomy were the independent predictors of glomerular hyperfiltration in multivariate analysis (p < 0.001 and p = 0.040, respectively). Renal tubular and glomerular damage is frequent in adult patients with thalassemia intermedia and major. T2* value on cMR was the only independent predictor of glomerular damage. However, since we did not explore all the parameters of iron, it is not possible to draw a definite conclusion about the association of cMR and glomerular damage. There is no association with cardiac iron overload/accumulation and tubular damage or hyperfiltration.
尿白蛋白与肌酐比值（ACR）和β2微球蛋白与肌酐比值（BCR）分别是肾小球病和肾小管病的替代且可靠的标志物。这些标志物可预测多种情况下的短期肾脏恶化和死亡率。我们旨在评估96例中间型和重型β地中海贫血成年患者中肾小球和肾小管缺陷、肾功能损害及超滤的发生率和预测因素。分别采用ACR>300mg/g肌酐和BCR>300μg/g肌酐来定义肾小球和肾小管损伤。根据2009年慢性肾脏病流行病学协作组（CKD-EPI）方程估算肾小球滤过率（eGFRcreat）。eGFRcreat降低定义为每1.73m²小于60ml/min。约68.8%的患者存在肾小球和/或肾小管缺陷。40%的患者存在肾小球超滤。所有患者的eGFRcreat均未降低。心脏磁共振成像（cMR）上T2值≤20msec是肾小球损伤的唯一独立预测因素（p=0.013）。使用阿仑膦酸盐与较少的肾小管损伤相关（p=0.007）。多因素分析中，女性性别和既往脾切除史是肾小球超滤的独立预测因素（分别为p<0.001和p=0.040）。中间型和重型地中海贫血成年患者中肾小管和肾小球损伤很常见。cMR上的T2值是肾小球损伤的唯一独立预测因素。然而，由于我们未探究铁的所有参数，因此无法就cMR与肾小球损伤的关联得出明确结论。心脏铁过载/蓄积与肾小管损伤或超滤无关联。
