Tabel 1.

Overzicht rol van ijzer bij nierschade in dierexperimentele studies

Mechanisme Heemgenduceerde nierschade

Diermodel HA HIV-HUS model Rhabdomyolyse Hemoglobine

Onderzoeksresultaten IJzer in cortex 33 IJzer in PT IJzer in urine IJzer in cortex, ijzer in PT, BDI in de nier DFO therapie GFR IJzer in distale nephron (ook PT) DFO inuline klaring IJzer in medulla en enkele cortex tubuli IJzer in urine NHI, totaal ijzer niet significant hoger IJzerdeficint dieet protenurie, glomerulosclerose, hypertensie (p<0,07) IJzer in cortex, buitenste medulla en distale tubuli IJzer in urine niet parallel aan transferrine Vrij ijzer in nier, BDI in urine, ijzer in cortex en DT IJzer in urine correleert met TI schade en plasma creatinine IJzerdeficint dieet nierfunctie (creat ) minder TI schade, protenurie = per DFO ECC , overleving IJzer in urine, ijzer in PT en DT, BDI in glomeruli IJzer in urine niet parallel aan transferrine iv DFO protenurie IJzer in urine, ijzer in cortex IJzerdeficint dieet protenurie ,Feur, , Fecort , NHInier,glom, tub DFO therapie protenurie IJzer in PT, mesangium en DT; IJzer in urine Lysosomale ijzer in PT corr. met protenurie, GFR reductie en UIE Tubulaire schade corr. met lysosomale ijzer, protenurie, UIE en GFR reductie UIE correleerde met protenurie en Tf excretie DFO therapie protenurie , Fenier, schade DFO 42 verlaagde ijzerstapeling maar verergerde de schade IJzerdeficint dieet protenurie = Fenier, schade = BDI in nier DFO creat ureum iv DFO ureum IJzer in urine, BDI in nier iv DFO schade , GFR IJzerdeficint dieet NHI, BDI =, schade =

Ref 33 39 22,23,32,34 24,32 25 35 45 27,36 26,28,95

Systemische ijzerstapeling Nierschade bij hematurie en protenurie

HH (Hepc-/-, HJV-/-) HH (HFE-/-) Spontane GS en protenurie AD NSN

PAN

27,29,37

PHN

30, 107 40,41

Nefron reductie

Cisplatin Gentamycine I/R

31 46 38,44

Ischemie/ Reperfusie genduceerde nierschade

AD: Adriamycine; BDI: Bleomycine detecteerbaar ijzer; cort: cortex; creat: serum creatinine; DFO: Deferoxamine; ECC: estimated creatinine clearance; corr.: correleert; glom: glomerulus, GS: Glomerulosclerose; HA: Hemolytische anemie; Hepc: hepcidin; HFE: HFE eiwit; HH: Hereditaire hemochromatose; HJV: hemojuvelin; I/R: /ischemie/Reperfusie; iv: intraveneus; NHI: non-heem ijzer; NSN: Nephrotoxin serum nefritis; PAN: Puromycin Aminonucleoside; PHN: Passieve Heymann Nefritis; per: peritoneaal; tub: tubulus; Ref: Referenties; TI: tubulo interstitieel, UIE: IJzer excretie in de urine; =: onveranderd

IJzer en nierschade | 1

Tabel 2.
Overzicht rol van ijzer bij nierschade in humane studies

Mechanisme Heemgenduceerde nierschade

Ziektebeeld Intravasculaire hemolyse PNH HIV-HUS SCA Thalassemie Transfusionele ijzerstapeling HH GN Diabetes, DN

Onderzoeksresultaten IJzer in tubuli, PT en LoH, Hbur, HSur. Protenurie, hematurie, ATN IJzer in nier, cortex, tubuli, PT en urine TI schade, protenurie, interstitile fibrose IJzer in PT en urine IJzer in cortex, tubuli, glomeruli en urine IJzer in nier, glomeruli, tubuli (DT>PT) en interstitium Desferrioxamine-B therapietolerantie NAGur Toename ijzer in corticomedullair grensgebied IJzer in DT, LoH en glomeruli, hemosiderinurie IJzer in urine Deferiprone therapie protenurie IJzer in urine. UIE bij diabetespatinten is verhoogd vr het ontstaan van protenurie Deferiprone therapie Alb/Createn stabilisatie nierfunctie (in DN) IJzer in urine Protenurie Macroscopische hematurie ATN in tubuli verstopt met RBC resten Duur van hematurie corr. met finaal Scr IJzerdepositie in nier corr. met NAGur IJzer in PT Lysosomale ijzer in PT corr. met protenurie Tubulaire schade corr. met lysosomale ijzer. IJzerdepositie in nier corr. met NAGur EDTA therapie vertraging progressie nierziekte IJzer in urine, protenurie UIE corr. met Tfur Tfur corr. met protenurie

Systemische ijzerstapeling

Ref 17,55, 56,61,69 17,5860,89 39 17,57,62 17,54,64,71 63 65 3,76 3,74,76

Nierschade bij hematurie en protenurie

IMPG IgA-nefropathie

108 67,68

CKD

66,67,75

Nefrotisch syndroom (MG en FG, MCGN)

16,73

Alb: Albumine; ATN: Acute tubulaire necrose; corr: correleert; DN: Diabetische nefropathie; FG: focale glomerulonefritis; Hbur: Hemoglobinurie; HH: Hereditaire hemochromatose; HIV-HUS: HIV-geassocieerde hemolytisch uremisch syndroom; HSur: Hemosiderinurie; IMPG: Idiopatische membranoproliferatieve glomerulonefritis; MCGN: Minimal change glomerulonefritis; MG: Membraneus glomerulonefritis; LoH: Loop of Henle; MH: Mechanische hemolyse; NAGur: N-acetyl-b-D-glucosaminidase in urine; PNH: Paroxysmal nachtelijke hemoglubinurie; RBC: rode bloedcel; Ref: Referenties; SCA: Sickle cell anemie; Scr: Serum creatinine; Tfur: Transferrine in urine; TM: Thalassemia major

2 | Capita Selecta Nefrologie | nummer 2, 2012

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