Pojavnost i rizični čimbenici za urolitijazu u bolesnika s hemofilijom

doctoral thesis

• Title (english): Incidence and risk factors for urolithiasis in patients with hemophilia
• Author: Marijo Vodanović
• Mentor: Silva Zupančić-Šalek (mentor)
• Committee member: Igor Aurer (predsjednik povjerenstva)
• Committee member: Ivan Krhen (član povjerenstva)
• Committee member: Željko Kaštelan (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2021-03-18, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Universal decimal classification (UDC): 616 - Pathology. Clinical medicine

Abstract

Uvod i svrha rada: Neke studije sugeriraju da bolesnici s hemofilijom (BSH) imaju veću prevalenciju urolitijaze u usporedbi s općom muškom populacijom iste dobne skupine.
Kod odraslih BSH nedostaje spoznaja o čimbenicima rizika za urolitijazu. Svrha je rada istražiti prevalenciju/pojavnost urolitijaze kod odraslih BSH te pridružene čimbenike rizika.-----
Metode: U ovo presječno istraživanje uključena su 92 odrasla BSH liječena u jednom centru, KBC-u Zagreb. Ultrazvuk urotrakta bila je metoda izbora za dokazivanje urolitijaze, dok se svim ispitanicima uzimala anamneza te uzorci za laboratorijske pretrage krvi i urina.-----
Rezultati: Prevalencija urolitijaze znatno je viša kod BSH nego u hrvatskoj populaciji (10,9 % vs. 5,9 %; P = 0,042). Također je vjerojatnost doživljenja/pojave urolitijaze tijekom života znatno viša nego u općoj populaciji (25 % vs. 12 %; P = 0,001).
Trenutačna prisutnost urolitijaze i ranija anamneza urolitijaze nisu bile statistički značajno povezane s tipom hemofilije ili težinom hemofilije kao niti s načinom liječenja ili vrstom lijeka (plazmatski ili rekombinatni faktori) (P > 0,05). U multivarijatnoj analizi neovisni prediktori trenutačne prisutnosti urolitijaze (P < 0,05) bili su arterijska hipertenzija, prisutnost inhibitora, hiperkalciurija, povišen serumski bilirubin (P < 0,05), dok su hematurija (P = 0,051) i ranije infekcije mokraćnog sustava (P = 0,059) prepoznati kao relevantni čimbenici. Slično su arterijska hipertenzija, prisutnost inhibitora i pozitivna anamneza hematurije u anamnezi prepoznati kao nezavisni prediktori u anamnezi urolitijaze (P < 0,05), dok je ranije liječenje HCV bilo na granici statističke značajnosti (P = 0,085). -----
Zaključak: Odrasli BSH imaju češću urolitijazu koja se može smatrati još jednom bolešću povezanom s hemofilijom. Čimbenici rizika ukazuju na neimunološko i imunološko oštećenje bubrega te hiperkalciuriju kao glavne etiološke mehanizme nastanka bubrežnih kamenaca u ovih bolesnika.

Abstract (english)

Introduction and aim: Patients with haemophilia (PWH) could have higher prevalence of urolithiasis according to some studies compared with age-matched males. There is a lack of data regarding risk factors for urolithiasis in adult PWH patients. The aim of this work is to investigate the prevalence of urolithiasis in adult PWH and associated risk factors. -----
Methods: We cross-sectionally evaluated 92 adult PWH, from one centre, UHC Zagreb. Presence of urolithiasis was assessed by ultrasound, while all patients had a medical history and samples were taken for blood and urine laboratory tests.-----
Results: Prevalence of urolithiasis was significantly higher among PWH than reported prevalence in Croatian population (10,9 % vs. 5,9 %; P = 0,042). Similarly, occurrence of urolithiasis during course of disease was significantly higher than estimated lifetime cumulative incidence of urolithiasis in Croatian population (25 % vs 12 %; P = 0,001).
Neither current presence of urolithiasis, nor urolithiasis previously recorded during course of the disease showed statistically significant associations with type of hemophilia, severity of hemophilia, use of plasma derived factors or recombinant factors (P > 0,05 for all associations). In multivariate analyses, arterial hypertension, presence of inhibitors, hypercalciuria and serum bilirubin were identified as independent predictors of current urolithiasis (P < 0,05), whereas haematuria (P = 0,051) and prior urinary infections (P = 0,059) were also recognized as relevant factors. Similarly, arterial hypertension, presence of inhibitors and history of macrohematuria were recognized as independent predictors of history of urolithiasis (P < 0,05). -----
Conclusion: Adult PWH have more frequent urolithiasis which can be considered as haemophilia-related disease. Risk factors indicate non-immunological and immunological kidney damage and hypercalciuria as the main etiological mechanisms of urolithiasis in these patients.

• Keywords: Hemofilija A; Hematurija; Hiperkalciurija; Ultrasonografija; Urolitijaza; Hipertenzija; Bubreg
• Keywords (english): Hemophilia A; Hematuria; Hypercalciuria; Ultrasonography; Urolithiasis; Hypertension; Kidney
• Language: croatian
• URN:NBN: urn:nbn:hr:105:627874
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
• Type of resource: Text
• Extent: 99 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-06-25 08:53:01