DMSA Sintigrafisi ile Renal Skar Tespit Edilen Hastaların Uzun Dönem İzlemi

Abstract

This study aimed to determine possible complications during follow-up of patients with renal scar (RS), and to determine risk factors of these complications. This study enrolled 50 patients who had RS with a mean follow-up duration of 9,69 years and compared with 25 patients without RS. The patients underwent office blood pressure (BP) measurement and ambulatory blood pressure measurement (ABPM). Serum creatinine and blood urea nitrogen (BUN) levels, as well as 24-hour urinary protein, albumin, and creatinine levels were studied and creatinine clearance was calculated. ABPM was standardized by age, sex, and height, using the least median of squares (LMS) method. There was no significant difference between the glomerular filtration rates (GFR) values of the groups with and without RS. There was also no significant difference in GFR values between patients with mild, moderate, and severe RS. However, all 7 patients with albuminuria were in the group with RS. Patients with severe RS and bilateral RS had a greater albuminuria. ABPM detected hypertension (HT) in 20,4% of patients with RS, with %60 of these patients having nocturnal HT. The 24-hour, day time, night time BP standard deviation scores (SDS) and 24-hour, daytime, nighttime mean arterial pressure (MAP) SDS and whole day systolic and diastolic BP load, and night time systolic and diastolic BP load were significantly higher in patients with RS than those without (in all p<0,05). Although day time diastolic BP load was significantly higher in patients with severe RS compared to those with mild RS, other ABPM parameters were not significantly different between mild, moderate, and severe RS. Patients with RS and albuminuria had a higher 24-hour and night time diastolic BP SDS and a lower GFR compared to those with RS but no albuminuria. Patients with RS had a negative correlation between GFR and 24-hour diastolic BP SDS, night time diastolic BP SDS, whole day diastolic BP load, and night time diastolic BP load. In conclusion, although there was no significant difference between kidney function tests of patients with and without RS, the risk of developing HT and albuminuria was found to be increased in patients with RS than those without. As nocturnal HT was also pronounced in patients with HT, ABPM should be used for the follow up of patients with RS. Patients with albuminuria added on RS appeared as the most risky group, and these patients had higher BP readings and lower GFR. Monitoring albuminuria should be a part of routine follow-up among patients with RS: Patients with albuminuria should be closely monitored for HT and renal dysfunction.