Amiloidozis tanısında zorluklar: Böbrek iğne biopsisinden kaçınılabilir mi?
Küçük Resim Yok
Tarih
2002
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amiloidozis sistemik bir hastalık olup kesin tanı için dokuda amiloid birikiminin gösterilmesi gereklidir. Klinik kuşku olduğunda öncelikle yağ doku ve rektum biopsileri tercih edilir, birikim saptanmazsa böbrek ve/veya diğer organ biopsileri yapılmaktadır. Ancak birikimler az olduğunda ve uygun koşullarda değerlendirilmediğinde gözden kaçabilir. Bu çalışmada böbrek biopsisinde amiloid saptanan olguların diğer biopsileri tekrar değerlendirilerek amiloid birikimi açısından böbrek biopsisinin gerekliliği araştırıldı. Çalışmaya son üç yıl içinde böbrek biopsisi ile amiloidozis tanısı almış 55 olgu alındı. Bu olguların 15'inin diğer organlara ait 35 biopsisi yeniden değerlendirildi. Biopsilerin 7'si rektum, 6'sı kemik iliği, 6'sı mide, 3'ü karaciğer, 3'ü tükrük bezi, 2'si deri, 2'si cilt altı yağ dokusu olup mesane, kas, jejunum, dişeti, barsak ve böbrek'e ait birer biopsi incelendi. Olguların 14'ünün diğer biopsilerinde de birikim saptandı, bunların 10'nunda böbrek biopsisi yapılmadan da amiloidozis tanısı konabileceği belirlendi. Amiloid birikimleri 6 rektum, 6 mide, 3 tükrük bezi, 2 kemik iliği ve birer deri, mesane, jejunum, glomerül içermeyen böbrek biopsisinde saptandı. Üç olguda diğer biopsiler amiloid tipi ve etiolojiyi belirleme için yapılmıştı. Tanıda gecikmeye klinik verilerin eksikliği, teknik sorunlar ve biopsinin yetersizliğinin neden olduğu belirlendi. Amiloidozis kuşkusu duyulan olgularda böbrek biopsisi uygulanmadan önce olgunun varsa diğer biopsileri yeterli klinik bilgi ile tekrar değerlendirildiğinde amiloid tanısı konulabilir. Bu şekilde böbrek iğne biopsisinden kaçınmak mümkündür.
Amyloidosis is a systemic disease and amyloid deposition in tissue has to be shown to reach the exact diagnosis. If there is a clinical suspicion of amyloidosis, adipose tissue or rectum biopsy is preferred. If amyloid deposition can't be shown, renal and/or other organ biopsies are done. Minute depositions and those which are evaluated improperly, could be missed. In this study, we have investigated the necessity of renal biopsy for determination of amyloidosis, by evaluation of other biopsies of cases with renal amyloidosis. Fifty-five cases with a diagnosis of renal amyloidosis in the last three years were included in this study. Thirty-five biopsies from other organs of the fifteen cases were reevaluated. Of these 35 biopsies, seven were from rectum, six frombone marrow, six mm stomach, three from liver, three from salivary gland, two from skin, two from adipose tissue, and one from bladder, muscle, jejunum, gingiva, intestine and kidney. Amyloid deposition was detected in other organ biopsies of fourteen cases. In ten of them diagnosis could be made without renal biopsy. Amyloid deposition was found in 6 rectum, 6 stomach, 3 salivary gland, 2 bone marrow, one skin, bladder, jejunum and kidney (without glomeruli) biopsies. In three of the cases other biopsies were done for determination of amyloid subtype and the etiology. Incomplete data, technical problems and insufficient biopsy were the reasons that cause delay in diagnosis. Amyloidosis can be identified if the patients' other organ biopsies are reevaluated with sufficient clinical data before considering a renal biopsy. In this situation it is possible to spare the kidney from biopsy.
Amyloidosis is a systemic disease and amyloid deposition in tissue has to be shown to reach the exact diagnosis. If there is a clinical suspicion of amyloidosis, adipose tissue or rectum biopsy is preferred. If amyloid deposition can't be shown, renal and/or other organ biopsies are done. Minute depositions and those which are evaluated improperly, could be missed. In this study, we have investigated the necessity of renal biopsy for determination of amyloidosis, by evaluation of other biopsies of cases with renal amyloidosis. Fifty-five cases with a diagnosis of renal amyloidosis in the last three years were included in this study. Thirty-five biopsies from other organs of the fifteen cases were reevaluated. Of these 35 biopsies, seven were from rectum, six frombone marrow, six mm stomach, three from liver, three from salivary gland, two from skin, two from adipose tissue, and one from bladder, muscle, jejunum, gingiva, intestine and kidney. Amyloid deposition was detected in other organ biopsies of fourteen cases. In ten of them diagnosis could be made without renal biopsy. Amyloid deposition was found in 6 rectum, 6 stomach, 3 salivary gland, 2 bone marrow, one skin, bladder, jejunum and kidney (without glomeruli) biopsies. In three of the cases other biopsies were done for determination of amyloid subtype and the etiology. Incomplete data, technical problems and insufficient biopsy were the reasons that cause delay in diagnosis. Amyloidosis can be identified if the patients' other organ biopsies are reevaluated with sufficient clinical data before considering a renal biopsy. In this situation it is possible to spare the kidney from biopsy.
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Cerrahi
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Ege Tıp Dergisi
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Scopus Q Değeri
Cilt
41
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4
