Acompanhamento de pacientes vítimas da epidemia de Glomerulonefrite por Streptococcus Zooepidemicus, em Nova Serrana, Minas Gerais, Brasil
Data
2022-09-26
Tipo
Tese de doutorado
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Resumo
Introdução: Existe uma grande controvérsia quanto ao prognóstico, em longo prazo, de pacientes vítimas de GNPA, em especial, quando se considera a população adulta. Neste estudo, fizemos um acompanhamento longitudinal do RFGe da população acometida por uma epidemia de glomerulonefrite pós-estreptocócica aguda, na cidade de Nova Serrana, MG, Brasil, provocada por um Streptococcus do grupo C de Lancfield, o Streptococcus zooepidemicus, cujos dados puderam ser resgatados em 2019. Concomitantemente, fizemos um corte transversal para avaliamos como se encontra essa população, segundo uma série de variáveis clínico-laboratoriais, 20 anos após o episódio agudo. Métodos: Buscamos os dados dos pacientes que foram estudados, nos anos 1998, 2000, 2003, 2008 e 2019. Inferimos o RFGe de cada grupo em cada uma dessas visitas. O último grupo avaliado (2019) foi submetido a uma avaliação clínica e laboratorial. Medimos a PA e solicitamos os seguintes exames laboratoriais: HbsAg, ácido úrico, proteinúria, HDL, LDL, VLDL, triglicérides, Hb, Ht e hematúria. Estimamos o RFG dos pacientes encontrados, em 2019 e fizemos uma comparação com o RFGe calculado nas visitas anteriores. Resultados: Encontramos os dados de 66 dos pacientes estudados, em 1998, dados de 49 dos pacientes que foram estudados, em 2000, 40 dos pacientes que foram estudados em 2003, 60 dos pacientes que foram estudados, em 2008 e revimos, em 2019, 47 dos pacientes do grupo original. Na análise do corte transversal, 40% tinham HAs e 32% HAd. 21 pacientes apresentaram RFGe < 60 ml/mim/173 m2 e 8 com PCU > 150, sendo que 25 pacientes dos 47 apresentaram RFGe < 60 ml/mim/173 m2 ou PCU > 150 mg/g. Na análise univariada do corte transversal, as variáveis com p < 0,2 foram levadas para a análise multivariada. Apenas a idade apresentou significância estatística. Na análise univariada longitudinal, observamos um ganho importante do RFGe, após a fase aguda, que se manteve, durante 10 anos. Porém, na avaliação de 20 anos, o RFGe, praticamente, retornou aos mesmos níveis da primeira fase. Nesse caso, também a idade foi o que mais impactou na queda do RFGe. Na análise multivariada longitudinal, calculamos que a perda do RFGe, nos últimos 10 anos, foi de 3,2 ml/ano, configurando uma perda acelerada do RFGe.
Introduction: There is significant controversy regarding the long-term prognosis of patients victims of APSG, especially when considering the adult population. In this study, we carried out a longitudinal follow-up of the RFGe of the population affected by an epidemic of acute post-streptococcal glomerulonephritis in Nova Serrana, MG, Brazil. The disease is caused by a Lancefield Group C Streptococcus, Streptococcus zooepidemicus, whose data could be retrieved in 2019. At the same time, we performed a cross-section to assess the condition of this population, according to a series of clinical and laboratory variables, 20 years after the acute episode. Methods: We sought data from patients studied in 1998, 2000, 2003, 2008, and 2019. We inferred the RFGe of each group at each visit. The last group evaluated (2019) underwent clinical and laboratory evaluation. We measured the blood pressure and ordered the following laboratory tests: HbsAg, uric acid, proteinuria, HDL, LDL, VLDL, triglycerides, Hb, Ht and hematuria. We estimated the RFG of patients found in 2019 and compared it to the RFG calculated in previous visits. Results: We found data from 66 of the patients studied in 1998, 49 of the patients studied in 2000, 40 of the patients studied in 2003, 60 of the patients studied in 2008, and reviewed, in 2019, 47 of the patients of the original group. In the cross-sectional analysis, 40% presented HAs and 32% had HAd. Twenty-one patients had RFGe < 60 ml/min/173 m2 and 8 with PCU > 150, and 25 out of 47 patients had RFGe < 60 ml/min/173 m2 with PCU > 150 mg/g. The univariate cross-sectional analysis showed variables with p < 0.2, which were carried to the multivariate analysis. Only age was statistically significant. The longitudinal univariate analysis showed an important RFGe gain after the acute phase, maintained for ten years. However, at the 20-year evaluation, RFGe practically returned to the same levels as the acute phase. In this case, age was also the variable that most impacted the drop in RFGe. In the longitudinal multivariate analysis, we calculated that the loss of RFGe over the last ten years was 3.2 ml/year, configuring an accelerated loss of RFGe.
Introduction: There is significant controversy regarding the long-term prognosis of patients victims of APSG, especially when considering the adult population. In this study, we carried out a longitudinal follow-up of the RFGe of the population affected by an epidemic of acute post-streptococcal glomerulonephritis in Nova Serrana, MG, Brazil. The disease is caused by a Lancefield Group C Streptococcus, Streptococcus zooepidemicus, whose data could be retrieved in 2019. At the same time, we performed a cross-section to assess the condition of this population, according to a series of clinical and laboratory variables, 20 years after the acute episode. Methods: We sought data from patients studied in 1998, 2000, 2003, 2008, and 2019. We inferred the RFGe of each group at each visit. The last group evaluated (2019) underwent clinical and laboratory evaluation. We measured the blood pressure and ordered the following laboratory tests: HbsAg, uric acid, proteinuria, HDL, LDL, VLDL, triglycerides, Hb, Ht and hematuria. We estimated the RFG of patients found in 2019 and compared it to the RFG calculated in previous visits. Results: We found data from 66 of the patients studied in 1998, 49 of the patients studied in 2000, 40 of the patients studied in 2003, 60 of the patients studied in 2008, and reviewed, in 2019, 47 of the patients of the original group. In the cross-sectional analysis, 40% presented HAs and 32% had HAd. Twenty-one patients had RFGe < 60 ml/min/173 m2 and 8 with PCU > 150, and 25 out of 47 patients had RFGe < 60 ml/min/173 m2 with PCU > 150 mg/g. The univariate cross-sectional analysis showed variables with p < 0.2, which were carried to the multivariate analysis. Only age was statistically significant. The longitudinal univariate analysis showed an important RFGe gain after the acute phase, maintained for ten years. However, at the 20-year evaluation, RFGe practically returned to the same levels as the acute phase. In this case, age was also the variable that most impacted the drop in RFGe. In the longitudinal multivariate analysis, we calculated that the loss of RFGe over the last ten years was 3.2 ml/year, configuring an accelerated loss of RFGe.