Značaj i određivanje vrijednosti visokoosjetljivih troponina I i T u bolesnika s kroničnom bubrežnom bolesti

master's thesis

• Title (english): Significance and determination of high-sensitivity troponins I and T in patients with chronic kidney disease
• Author: Branko Lozić
• Mentor: Ingrid Prkačin (mentor)
• Committee member: Nikolina Bašić Jukić (predsjednik povjerenstva)
• Committee member: Ivančica Delaš (član povjerenstva)
• Committee member: Ingrid Prkačin (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Kronična bubrežna bolest (KBB) obilježena je postupnim i progresivnim gubitkom svih bubrežnih funkcija. Jedna petina muškaraca i jedna četvrtina žena u dobi iznad 65 godina boluje od KBB-a. Uzimajući u obzir rastuću incidenciju dijabetesa i hipertenzije koji predstavljaju glavne uzroke kroničnog gubitka bubrežne funkcije, može se zaključiti da KBB postaje globalni javnozdravsteni problem. Vodeći uzrok smrti u oboljelih od KBB-a su kardiovaskularne bolesti i to ponajviše bolesti vezane uz srce poput ishemijske bolesti srca i srčanog zatajenja. Visokoosjetljivi srčani troponini (hs-cTnT, hs-cTnI) zlatni su standard u dijagnostici kardijalne patologije. Najčešće se koriste u detekciji akutnog koronarnog sindroma, ali povećane se vrijednosti mogu zabilježiti u nizu patoloških stanja. Poznato je da se povećane serumske vrijednosti troponina mogu zabilježiti u više od dvije trećine pacijenata s KBB-om na dijalizi, čak i u odsustvu kardiovaskularnih bolesti. Cilj ovog rada bio je napraviti pregled literature i ustanoviti zašto dolazi do povećanja koncentracije troponina u krvi kroničnih bubrežnih bolesnika te zaključiti postoji li veza između povećanja njihove koncentracije i mortalitetnih i morbiditetnih pokazatelja. Pretraživanjem literature ustanovljeno je da su pacijenti u terminalnim stadijima bubrežnog zatajenja pod značajno povećanim rizikom za razvoj kardiovaskularnih bolesti i smrtnoga ishoda. Studije su također ukazale na snažnu povezanost između koncentracije visokoosjetljivih troponina i kardiovaskularnog, odnosno all-cause mortaliteta u oboljelih. S druge strane, iako je funkcija troponina jako dobro poznata, malo se zna o načinu njihovog metaboliziranja i ekskrecije. Teorija prema kojoj se troponini izlučuju bubrezima postaje sve prihvaćenija unutar znanstvenih krugova. Pojedine studije, od kojih su neke i hrvatskih autora, dokazale su prisustvo troponina u urinu i ukazale na patološke vrijednosti u oboljelih od KBB-a i akutnog koronarnog sindroma. Daljnja su istraživanja potrebna kako bi se ustanovilo je li moguće koristiti troponine u urinu kao potencijalne biomarkere u prepoznavanju bubrežnih i kardiovaskularnih bolesti.

Abstract (english)

Chronic kidney disease (CKD) is characterized by gradual loss of all kidney functions over a period of time. One-fifth of men and one-quarter of women over the age of 65 suffer from CKD. Given the growing incidence of diabetes and hypertension, which are the main causes of this disease, CKD is becoming one of the major public health problems. The leading cause of death in people with CKD are cardiovascular diseases, primarily heart-related conditions such as ischemic heart disease and heart failure. High-sensitivity cardiac troponins (hs-cTnT, hs-cTnI) are crucial biomarkers used in the detection of cardiac pathology. They are mostly used in the detection of acute coronary syndrome, but elevated values can be also observed in several other conditions. Studies have shown that serum troponin levels are elevated in more than two-thirds of patients with CKD on dialysis, even in those without any cardiovascular pathology. The aim of this thesis was to review the literature and to determine the reason for the increase of troponin concentration in patients with CKD and to determine whether there is a connection between their increase and the mortality rate. Literature search revealed that patients with end-stage renal disease (ESRD) are at especially high risk of cardiovascular morbidity and mortality. Studies have also shown a strong association of high-sensitivity troponins with cardiovascular and all-cause-mortality in those patients. On the other hand, even though the function of troponins is very well known, little is known about their excretion from the body. The theory that troponins are excreted by the kidneys is becoming widely accepted in scientific circles. New studies, some of which were performed by Croatian authors, have proven the presence of troponins in urine and have determined pathological values in patients with CKD and acute coronary syndrome. Further research is needed to determine whether it is possible to use troponins in urine as potential biomarkers for cardiovascular and kidney disease.

• Keywords: kronična bubrežna bolest; biomarkeri; troponini; mortalitet; urin
• Keywords (english): chronic kidney disease; biomarkers; troponins; mortality; urine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:640958
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-03-09 12:19:09