Kliniğinde yatarak incelenip tedavi edilen 10 yıllık 318 vak'aya dayanan bir
klinik çalışmada, akut glomerulonefritte rastlanılan kardiyovasküler bulgular
yukardaki uluslararası kongrede 1977'de bildirilmiş ve ayrıntıları ile mecmuada
Sistemik kan basıncı, röntgende kalp büyüklüğü, konjestiyon, hipervolemi ve bunların seyri üstünde durulmuştur. Vak'aların çoğunda gözlenen ve çabuk geri giden kardiyovasküler bulguların hipervolemiye dayandığı ve genellikle kardiyotonik tedavinin gerekmediği vurgulanmıştır. İnterlober fisür ile kostofrenik mayi birikimi ile pulmoner konjestiyon kalp yetersizliğinden ziyade hipervolemiye bağlanmıştır.
Bu konuda yapılmış en geniş klinik araştırmadır.
The study presents the course of clinical and laboratory findings in 318 cases of post-streptococcic acute glomrulonephritis (AGN) hospitalized in Cerrahpa?a Pediatric Clinic during the years 1967-1976.
According to the median values, age was 7, hospitalization occurred on the 5th day after the onset of initial symptoms and lasted 3 weeks. An antecedant infection like tonsillitis, scarlet fever or pyodermia was present in 88% of cases. Beta hemolytictreptococci could be identified in only 40% of the throat cultures. The median ASO-titer was 800 Todd Units and this showed a mean increase of 140 units during the firs month.
Microhematuria and proteinuria was present in all cases, macrohematuria in 75%. The latter disappeared according to the median valus dn the 10th day,granular casts and proteinuria in 3 weeks, microhematuria after the 4th week. Complications such as encephalopathy was encountered in 1%, congestive heart failure with low cardiac output in 14%
Serum proteins and albumine/globuline ratios were found in normal ranges. Immuneglobulins A, G and M did not show significant differences from either ormal controls, nor from those found in patients with rheumatic fever. Hypercholesterinemia and hyperlipemia were encountered in 1/4th and 1/5th of cases, respectively.
The onset of diuresis, i.e., disappearance of oliguria is a major turning point in the course of the disease. After which dramatic changes with recovery is expected. According to the median values the duration of the oliguric phase lasted 10 days and that of the edematous 16 days.During these phases costo-phrenic effusion, especially on the right side, interlobar fissure, pulmonary congestion, cardiomegalia and uremia were frequent. Hypertension was present in half of the cases and lasted until the edematous phase was over. While the heart size decreases, a significant rise in hematocryte is observed, indicating the existence of significant hypervolemia at the onset of the disease. The cardiac size significantly with the degree of congestion in the chest x-ray, but not with the degree of edema and with systemic blood pressure. Nor did the size differ significantly in cases with or without systemic hypertension.
Electrocardiogram, studied in 58 cases, revealed evidences of right atrial hypertrophy in 45%,
mild abnormal T-wave changes in 41%, the former being commonly accompanied by cardiomegaly and pulmonary congestion in the chest x-ray.
The findings suggest that the cardiomegaly and pulmonary congestion are not due to hypertension and are commonly associatd with hypervolamia. The T-wave changes that regressin the non-edematous phase may be due to interstitial myocardial edema.
The mortality rate was 1.9% with major course of death being peracute congestive heart failure in 5.of the 6 patients that have died.
92- Anahtar kelimeler: Akut glomerulonefrit, röntgen bulguları, plevra mayi birikimi, hipervolemi, kardiyovasküler tutulum.