Epidemia de glomerulonefrite associada ao streptococcus zooepidemicus em nova serrana, Minas Gerais: seguimento de 10 anos

• Ano de defesa: 2016
• Autor(a) principal: Pinto, Sergio Wyton Lima [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Post infectious glomerulonephritis; Streptococcus zooepidemicus; Hypertensio; Glomerulonefrite pós-infecciosa; Atreptococcus zooepidemicus; Hipertensão arterial
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4812582; http://repositorio.unifesp.br/handle/11600/47593

Introduction: There is little information on the prognosis of patients suffering from an epidemic post-infectious glomerulonephritis. This study was performed to follow for 10 years the patients who developed acute glomerulonephritis in an epidemia caused by Streptococcus zooepidemicus (Lancefield group C) in the Brazilian city of Nova Serrana, in 1998. Such patients were previously assessed by this author, two and five years after the outbreak. Methods: This was a prospective study in which 60 cases (from the initial 134) were reassessed after 10 years, and compared with a control group, and matched for sex and age, chosen in the community. These cases were submitted to clinical evaluation and renal function tests, including measurement of serum cystatin C, estimated glomerular filtration rate (eGFR), albuminuria and glomerular hematuria. Results: Comparisons of clinical and renal function of 60 patients ( group of cases) with 47 individuals (control group) showed no significant differences (eGFR <60 mL/min/1.73 m² and/or albuminuria > 30 mg, 13 8 % vs. 12.2 % respectively, p = 0.817), except for the high frequency of arterial hypertension in the cases(45 % vs. 20 %, p = 0.009). Comparing the same patients affected by acute episodes two, five and ten years after the outbreak, there was improvement in eGFR in the first two years and a trend towards stabilization in five to ten years of follow up. Associated with this, there was a decrease in albuminuria and increased rates of hypertension in the latter assessment. After 10 years, further decrease in renal function measured by serum creatinine, eGFR, and cystatin C was not found. Conclusions: During an acute episode of an epidemic glomerulonephritis, a considerable proportion of patients had hypertension and impairment of GFR. After two years and especially after ten years, the survey did not identify a worsening of these parameters, except for a persistent high frequency of hypertension. Monitoring of patients for an even longer period will be necessary to confirm that a progressive loss of renal function will not occur