Bubrežna funkcija u bolesnika s upalnim bolestima crijeva

master's thesis

• Title (english): Renal function in patients with inflammatory bowel diseases
• Author: Jakob Vrus
• Mentor: Nikolina Bašić Jukić (mentor)
• Committee member: Željko Kaštelan (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Nikolina Bašić Jukić (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

Pojavnost upalnih bolesti crijeva (UBC, od engl. IBD – Inflammatory Bowel Diseases) posljednjih je nekoliko godina u stalnom porastu, pa tako raste i pojavnost njihovih ekstraintestinalnih očitovanja i sistemskih komplikacija. Bubrežna očitovanja UBC-a, iako rijetka, mogu dovesti do razvoja završnog stadija kronične bubrežne bolesti i posljedične potrebe za nadomještanjem bubrežne funkcije hemodijalizom i/ili transplantacijom bubrega. To su prije svega bubrežni kamenci čija je pojavnost i do pet puta češća nego u zdravih pojedinaca, ali i parenhimske bolesti poput IgA nefropatije, tubulointersticijskog nefritisa i sekundarne amiloidoze. S obzirom na nefrotoksičnost ciklosporina i mogućnost razvoja akutnog tubulointersticijskog nefritsa uz mesalazin, pri njihovoj uporabi preporučuje se redovita kontrola bubrežne funkcije. Uvode se i novi lijekovi radi sekundarne ili tercijarne prevencije oksalatnih kamenaca (probiotici s Oxalobacter formigenes) i glomerularnih IgA depozita (baminercept), kojima se nastoji očuvati bubrežna homeostaza. Dosadašnji rezultati pokazuju da infliksimab može usporiti napredovanje amiloidoze bubrega. Lijek se pokazao sigurnim u bolesnika na hemodijalizi, naročito ako je potrebno brzo djelovati na upalu crijeva. Ishodi liječenja i prognoza su bolji kod primatelja transplantiranog bubrega nego u iste skupine UBC bolesnika s transplantiranom jetrom. Smatra se kako je to posljedica snažnije imunosupresivne terapije u bubrežnih primatelja.

Abstract (english)

The incidence of inflammatory bowel diseases (IBD) has rapidly increased over the last few years, as have increased their extraintestinal mannifestations and systemic complications. Renal manifestations of IBD, although rare, can lead to chronic renal failure and the need for renal replacement therapy with either dialysis or renal transplantation. Renal manifestations are primarily renal calculi, which have a tendency of appearing up to five times more frequently in IBD patients than in the general population, but also parenchymal diseases as IgA nephropathy, tubulointerstitial nephritis and secondary amyloidosis. Due to the nephrotoxicity of cyclosporine and possible development of acute tubulointerstitial nephritis as a consequence of mesalazin treatment, regular renal function monitoring is mandatory. New therapeutic options are being introduced for secondary and tertiary prevention of oxalate stones (probiotics featuring Oxalobacter formigenes) and glomerular IgA deposits (baminercept), with the intent of preserving renal homeostasis. Infliximab can prevent further renal deterioration in kidneys affected by amyloidosis. Furthermore, its use in patients on hemodialysis has been proven to be safe and necessary if rapid supression of intestinal inflammation is required. Patients with IBD having undegone renal transplantation tend to have better outcomes compared to liver transplant recipients. This is postulated to be the effect of more intensive imunosupressive therapy in kidney recipients.

• Keywords: upalna bolest crijeva; ulcerozni kolitis; Crohnova bolest; bubrežne komplikacije; transplantacija bubrega; hemodijaliza
• Keywords (english): inflammatory bowel disease; ulcerative colitis; Crohn's disease; renal complications; kidney transplatation; hemodialysis
• Language: croatian
• URN:NBN: urn:nbn:hr:105:723250
• 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: 2022-05-19 09:07:16