RESUMO
La glomerulopatía C3 es una nueva entidad descrita recientemente que ha cambiado la visión, el tratamiento y la clasificación de algunas enfermedades glomerulares. Engloba 2patologías similares pero claramente diferenciadas: la enfermedad por depósitos densos y la glomerulonefritis C3 propiamente dicha. La vía alternativa del complemento juega un papel fundamental en su patogenia, y en concreto las mutaciones o defectos en sus factores reguladores (fundamentalmente factorH y factorI), así como la presencia de autoanticuerpos adquiridos (factor nefrítico C3) que generan una activación desenfrenada del sistema, y en último término un depósito de sus productos a nivel glomerular. Su mal pronóstico y la aparición en población joven hacen preciso el estudio de nuevas alternativas terapéuticas. Recientemente eculizumab, un anticuerpo anti C5, ha demostrado efectividad en el tratamiento de estos pacientes (AU)
C3 glomerulopathy is a new, recently described entity that has changed the perspective, treatment and classification of a number of glomerular diseases. It encompasses 2 similar but clearly differentiated pathologies the dense-deposit disease and C3 glomerulonephritis itself. The alternative complement pathway plays a fundamental role in its pathogenesis and, specifically, the mutations and defects in its regulatory factors (mainly factor H and factorI), as well as the presence of acquired autoantibodies (C3 nephritic factor), which generates an unbridled activation of the system, and ultimately, a deposit of its products at the glomerular level. Its poor prognosis and onset in young populations makes the detailed study of new therapeutic alternatives for this disease essential. Recently eculizumab, an anti-C5 antibody, has demonstrated effectiveness in the treatment of these patients (AU)
Assuntos
Humanos , Glomerulonefrite/diagnóstico , Fator Nefrítico do Complemento 3 , Fator H do Complemento , Fator I do Complemento , Anticorpos Monoclonais/uso terapêutico , Autoanticorpos , Complemento C5/antagonistas & inibidoresRESUMO
C3 glomerulopathy is a new, recently described entity that has changed the perspective, treatment and classification of a number of glomerular diseases. It encompasses 2 similar but clearly differentiated pathologies -the dense-deposit disease and C3 glomerulonephritis itself. The alternative complement pathway plays a fundamental role in its pathogenesis and, specifically, the mutations and defects in its regulatory factors (mainly factor H and factor I), as well as the presence of acquired autoantibodies (C3 nephritic factor), which generates an unbridled activation of the system, and ultimately, a deposit of its products at the glomerular level. Its poor prognosis and onset in young populations makes the detailed study of new therapeutic alternatives for this disease essential. Recently eculizumab, an anti-C5 antibody, has demonstrated effectiveness in the treatment of these patients.
Assuntos
Autoanticorpos/imunologia , Fator Nefrítico do Complemento 3/imunologia , Glomerulonefrite Membranoproliferativa/fisiopatologia , Anticorpos Monoclonais Humanizados/farmacologia , Anticorpos Monoclonais Humanizados/uso terapêutico , Complemento C3/imunologia , Complemento C5/antagonistas & inibidores , Via Alternativa do Complemento/imunologia , Glomerulonefrite/tratamento farmacológico , Glomerulonefrite/imunologia , Glomerulonefrite/fisiopatologia , Glomerulonefrite Membranoproliferativa/tratamento farmacológico , Glomerulonefrite Membranoproliferativa/imunologia , Humanos , PrognósticoRESUMO
Metformin is an antihyperglycemic agent commonly used in diabetic patients. It is very effective and is able to reduce the plasma glucose and HbA1C. However, in some patients, specially those with comorbidities, metformin can provoke severe lactic acidosis with high morbimortality. Treatment of the lactic acidosis induced by metformin is based on the use of supportive general measures; in severe cases, procedures of extrarrenal purification like hemodialysis or continuous hemodiafiltration have been successfully used.
Assuntos
Acidose Láctica/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Nefrologia , Papel do Médico , Injúria Renal Aguda/complicações , Idoso , Idoso de 80 Anos ou mais , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antidepressivos/uso terapêutico , Fármacos Cardiovasculares/administração & dosagem , Fármacos Cardiovasculares/efeitos adversos , Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/tratamento farmacológico , Coma/induzido quimicamente , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Sinergismo Farmacológico , Quimioterapia Combinada , Emergências , Evolução Fatal , Feminino , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Ibuprofeno/efeitos adversos , Ibuprofeno/farmacologia , Ibuprofeno/uso terapêutico , Masculino , Metformina/administração & dosagem , Metformina/uso terapêutico , Pessoa de Meia-Idade , PolimedicaçãoRESUMO
La metformina es un fármaco ampliamente utilizado en sujetos con diabetes mellitus y su eficacia para descender la glucemia y la hemoglobina A1C (HbA1C) es notable. Sin embargo, en algunos pacientes, sobre todo en los que presentan comorbilidades, puede provocar una acidosis láctica grave que origina una elevada morbimortalidad. El tratamiento de esta complicación se basa en la utilización de medidas de soporte y, en los casos más graves, en procedimientos de depuración extrarrenal, como la hemodiálisis o la hemodiafiltración continua (AU)
Metformin is an antihyperglycemic agent commonly used in diabetic patients. It is very effective and is able to reduce the plasma glucose and HbA1C. However, in some patients, specially those with comorbidities, metformin can provoke severe lactic acidosis with high morbimortality. Treatment of the lactic acidosis induced by metformin is based on the use of supportive general measures; in severe cases, procedures of extrarrenal purification like hemodialysis or continuous hemodiafiltration have been successfully used (AU)
