Title Bubrežne parenhimske bolesti uzrokovane hematološkim neoplazmama Title (english) Renal parenchymal diseases caused by hematologic neoplasms Author Lana Turk Mentor Ivica Horvatić (mentor)Committee member Zdravko Mitrović (predsjednik povjerenstva)Committee member Ivana Vuković Brinar (član povjerenstva)Committee member Ivica Horvatić (član povjerenstva)Granter University of Zagreb Defense date and country 2023-07-13, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Bubreg, parni organ, mase otprilike 150 grama u zdrava odrasla čovjeka, anatomski je smješten uz kralježnicu u retroperitonealnom prostoru. Zbog složene fiziološke uloge u regulaciji volumena i sastava odjeljaka tjelesnih tekućina, protok krvi kroz oba bubrega iznosi 20-25% srčanog minutnog volumena. S tim u vezi, često je oštećen ciljni organ u pacijenata oboljelih od hematoloških neoplazmi. Postoji široki spektar bubrežnih manifestacija hematoloških neoplazmi kao i patofizioloških mehanizama nastanka istih. Povezanost između raznih entiteta zajedničkog naziva hematološke neoplazme i bubrežnog oštećenja je složena i dvosmjerna. Uz to što određeni klinički sindromi i patohistološke promjene bubrežnog parenhima mogu biti uzrokovani malignom bolešću odnosno nefrotoksičnošću kemoterapije i druge specifične onkološke terapije, također postoji povezanost obolijevanja od malignoma u osoba sa oštećenom bubrežnom funkcijom. Nadalje, prva, a u nekim slučajevima i jedina prezentacija hematološke neoplazme može biti neki stupanj bubrežnog oštećenja, koje pak može biti klinički manifestno ili se dokazuje laboratorijski, odnosno patohistološki. Upravo ta spoznaja o kompleksnoj povezanosti bubrežne funkcije i osnovne bolesti (hematološke neoplazme) iznjedrila je novu subspecijalističku granu, onkonefrologiju, sa ciljem što boljeg i sveobuhvatnog zbrinjavanja ovih pacijenata. Nužno je naglasiti, da svaki korak u pristupu, počevši od dijagnostike, a zatim i liječenja i praćenja ishoda liječenja valja biti multidisciplinaran. U ovome su radu opisani osnovni patofiziološki mehanizmi bubrežnog oštećenja povezani sa pojedinim hematološkim neoplazmama, klinički sindromi kojima se ta oštećenja mogu prezentirati, dijagnostičko-terapijski pristup pacijentima te bubrežna funkcija nakon primjene specifičnih modaliteta onkološkog liječenja. Na koncu, stavljen je naglasak na važnost očuvanja bubrežne funkcije tijekom čitavog dijagnostičko-terapijskog procesa budući da je ona usko vezana uz tijek i sam ishod liječenja, kao i dugoročnu prognozu i kvalitetu života ovih bolesnika.
Abstract (english) The kidney is a paired organ that weighs approximately 150 grams in a healthy adult and is anatomically located next to the spine in the retroperitoneal space. Due to its complex physiological role in regulating volume and composition of the body´s fluid compartments, blood flow through both kidneys account for 20-25% of total cardiac output. In this regard, this target organ is often damaged in patients with hematological neoplasms. There is a wide range of renal manifestations of hematological neoplasms as well as pathophysiological mechanisms of their occurrence. The connection between various entities under the common name of hematological neoplasms and kidney damage is complex and bidirectional. In addition to the fact that certain clinical syndromes and pathohistological changes of the renal parenchyma can be caused by the malignant disease or nephrotoxicity of chemotherapy and other specific oncological therapies, there is also a correlation between the risk of malignancies in people with impaired renal function. Furthermore, the first and in some cases the only presentation of a hematological neoplasm can be some degree of kidney damage, which can in turn be clinically apparent or can be proven by laboratory testing and/or pathohistological sampling. It was this knowledge about the complex relationship between kidney function and the underlying disease (hematological neoplasm) that gave rise to a new branch in medicine, subspeciality, onco-nephrology, with the aim of providing the best possible and comprehensive care for these patients. It is necessary to emphasize that every step in the approach, starting with diagnostics, and than treatment, as well as monitoring of treatment outcomes, ought to be multidisciplinary. This paper describes the basic pathophysiological mechanisms of kidney damage associated with certain hematological neoplasms, clinical syndromes in which these damages can be presented, the diagnostic and therapeutic approach to patients, and kidney function after the application of specific modalities of oncological treatment. Finally, emphasis is placed on the importance of preserving renal function during the entire diagnostic and therapeutic process, since it is closely related to the course and outcomes of oncological treatment, as well as the long-term prognosis and quality of life of these patients.
Keywords
hematološke neoplazme
bubrežno oštećenje
multidisciplinarni pristup
paraproteinemija/disproteinemija
onkonefrologija
Keywords (english)
hematological neoplasms
kidney damage
multidisciplinary approach
paraproteinemia/dysproteinemia
onconephrology
Language croatian URN:NBN urn:nbn:hr:105:570750 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2023-11-02 11:09:24
