Ostojic Predrag, Stojanovski Natasa
Institute of Rheumatology, Belgrade, Serbia.
School of Medicine, University of Belgrade, Belgrade, Serbia.
Rheumatol Int. 2017 Mar;37(3):363-368. doi: 10.1007/s00296-016-3632-y. Epub 2016 Dec 22.
The aim of this study was to estimate prevalence and severity of renal insufficiency in systemic sclerosis (SSc) and to assess risk factors associated with reduced glomerular filtration rate (GFR) in SSc patients. Seventy-three consecutive patients with SSc (67 women and 6 men), mean age 56.2 years, mean disease duration 6.7 years, were included in this cross-sectional study. GFR was measured by creatinine clearance (CCr) in all patients, as well as 24-h proteinuria. We assessed frequency and severity of renal insufficiency in our patients with SSc and estimated the association of renal insufficiency with age, disease duration, subtype of the disease, earlier diagnosed arterial hypertension, and medications for which we assumed to affect renal function-cytostatics, nonsteroidal anti-inflammatory drugs, glucocorticoids, ACE inhibitors, diuretics, and calcium channel blockers (CCB). Fifty-six out of 73 patients with SSc (76.7%) had reduced GFR (CCr lower than 90 ml/min), compared to 17/73 (23.3%) of patients with normal renal function. Mild renal insufficiency was noticed in 28/73 (38.4%), moderate in 21/73 (28.8%) and severe renal insufficiency in 5/73 (6.8%). End-stage renal disease (CCr < 15 ml/min) was found in 2/73 (2.7%) of patients. Using the univariate general linear statistical model, we have found that previously diagnosed arterial hypertension and treatment with glucocorticoids are independent risk factors for reduced GFR. On the other hand, age, disease duration, disease form, as well as antibodies (anticentromere antibodies-ACA and anti-topoisomerase I antibodies-ATA) were excluded as independent risk factors. Patients with SSc and arterial hypertension treated with CCB had significantly higher mean CCr than patients treated with diuretics (90.4 vs 53.5 ml/min, p = 0.03), or patients treated with ACE inhibitors (90.4 vs 41.7 ml/min, p = 0.001). Decreased GFR is common in SSc. Most of patients have mild or moderate renal insufficiency. Previously diagnosed arterial hypertension, especially when treated with ACE inhibitors or diuretics, and glucocorticoids are independent risk factors associated with reduced GFR in SSc. These medications should be therefore used with caution in SSc patients.
本研究的目的是评估系统性硬化症（SSc）患者肾功能不全的患病率和严重程度，并评估与SSc患者肾小球滤过率（GFR）降低相关的危险因素。本横断面研究纳入了73例连续的SSc患者（67例女性和6例男性），平均年龄56.2岁，平均病程6.7年。所有患者均通过肌酐清除率（CCr）测量GFR，并检测24小时蛋白尿。我们评估了SSc患者肾功能不全的频率和严重程度，并估计了肾功能不全与年龄、病程、疾病亚型、既往诊断的动脉高血压以及我们认为会影响肾功能的药物（细胞毒性药物、非甾体抗炎药、糖皮质激素、ACE抑制剂、利尿剂和钙通道阻滞剂[CCB]）之间的关联。73例SSc患者中有56例（76.7%）GFR降低（CCr低于90 ml/min），而肾功能正常的患者为17/73（23.3%）。73例患者中28例（38.4%）有轻度肾功能不全，21例（28.8%）为中度，5例（6.8%）为重度肾功能不全。2/73（2.7%）的患者出现终末期肾病（CCr < 15 ml/min）。使用单变量一般线性统计模型，我们发现既往诊断的动脉高血压和糖皮质激素治疗是GFR降低的独立危险因素。另一方面，年龄、病程、疾病形式以及抗体（抗着丝点抗体-ACA和抗拓扑异构酶I抗体-ATA）被排除为独立危险因素。接受CCB治疗的SSc合并动脉高血压患者的平均CCr显著高于接受利尿剂治疗的患者（90.4 vs 53.5 ml/min，p = 0.03），或接受ACE抑制剂治疗的患者（90.4 vs 41.7 ml/min，p = 0.001）。GFR降低在SSc中很常见。大多数患者有轻度或中度肾功能不全。既往诊断的动脉高血压，尤其是接受ACE抑制剂或利尿剂治疗时，以及糖皮质激素是与SSc患者GFR降低相关的独立危险因素。因此，这些药物在SSc患者中应谨慎使用。
