Nefropatía por enfermedad relacionada a IGG4 / Nephropathy due to IGG4-related disease

IgG4-related disease (ER-IgG4) is a group of systemic fibro-inflammatory diseases, whose renal involvement is rare and difficult to diagnose. Diagnosis is usually made by serological and histological studies. Treatment is based on systemic corticosteroids. The renal prognosis is determined by the patient's comorbidities and the degree of fibrosis in the renal biopsy. We present the case of an elderly patient with exacerbated chronic kidney disease, whose study showed nephropathy associated with ER-IgG4.

La enfermedad relacionada a IgG4 (ER-IgG4) es un grupo de enfermedades fibro-inflamatorias sistémicas, cuya afectación renal es poco frecuente y de difícil diagnóstico. Habitualmente el diagnóstico se realiza mediante estudios serológicos e histológicos. El tratamiento se basa en corticoides sistémicos. El pronóstico renal está determinado por las comorbilidades del paciente y el grado de fibrosis en la biopsia renal. Se presenta el caso de un paciente adulto mayor con enfermedad renal crónica reagudizada, cuyo estudio demostró nefropatía asociada a ER-IgG4.

Diabetic nephropathy in patients with type 2 diabetes mellitus and its correlation with diabetic retinopathy / Nefropatia diabética em pacientes portadores de diabetes mellitus tipo 2 e sua correlação com a retinopatia diabética

Objective: the present study aimed to evaluate the prevalence of diabetic nephropathy and diabetic retinopathy, in addition to the associations that can be established between these microvascular complications of diabetes mellitus. Methods: this was a retrospective study, a systematic review without metaanalysis. The authors used the Pubmed and SciELO databases to search the terms "diabetic nephropathy", "diabetic retinopathy" and "type 2 diabetes", including publications dated 2011 to 2021. Results/Discussion: the results presented were a synthesis of patients with both pathologies and their correlations, in addition to associated laboratory changes and agreement between the stages or severity of both conditions. Conclusions: DN and DR are pathologies that are directly interconnected and cause repercussions for patients.

Objetivo: o presente estudo teve como objetivo avaliar a prevalência de nefropatia diabética e retinopatia diabética, além das associações que podem ser estabelecidas entre essas complicações microvasculares do diabetes mellitus. Métodos: estudo retrospectivo, revisão sistemática sem metanálise, os autores utilizaram as bases de dados Pubmed e SciELO para busca dos termos "nefropatia diabética", "retinopatia diabética" e "diabetes tipo 2", incluindo publicações datadas de 2011 a 2021. Resultados/Discussão: os resultados apresentados foram uma síntese dos pacientes com ambas as patologias e suas correlações, além de alterações laboratoriais associadas e concordância entre os estágios ou gravidade de ambas as condições. Conclusões: ND e RD são patologias que estão diretamente interligadas e causam repercussões aos pacientes.

Hipopotasemia no medicamentosa como biomarcador de nefropatía crónica temprana en adultos del sur de Honduras / Non-drug Hypokalemia as Biomarker of Early Chronic Kidney Disease in Adults from Southern Honduras

Introducción: La hipopotasemia es un trastorno hidroelectrolítico frecuente, asociado a enfermedades sistémicas y multifactoriales, cuya forma aguda puede complicarse y causar la muerte, pero en su presentación crónica puede ser un marcador de nefropatía. Objetivo: Caracterizar el perfil del paciente con hipopotasemia no medicamentosa atendidos de emergencia. Métodos: Se revisaron los registros de pacientes mayores de 18 años con diagnóstico de hipopotasemia, ingresados en el hospital en el período de junio 2018 a diciembre de 2019. Se colectaron datos demográficos, antecedentes médicos y evolución postratamiento. Se comparó con 108 pacientes sin hipopotasemia atendidos en el período de estudio. Resultados: Se encontraron 87 casos con edad media de 38,5 años. El 90,8 por ciento eran hombres menores de 50 años, de oficio agricultor (29,9 por ciento), con historia de exposición a plaguicidas y a altas temperaturas ambientales. La mayoría de ellos no tenía historia de enfermedad cardiometabólicas o renal previa. El 48,3 por ciento de todos los pacientes con hipopotasemia (n = 42) tenía creatinina mayor a 1,2 mg/dL y 63 por ciento tenía hiponatremia. La hipopotasemia fue moderada en 39 por ciento y severa en 12 por ciento, los hombres 4,7 veces más afectados que las mujeres. Respecto al grupo sin hipopotasemia y creatinina anormal, tenían mayor frecuencia de enfermedad crónica (92,5 por ciento versus 8 por ciento). Conclusiones: Se encontró hipopotasemia no medicamentosa en varones agricultores, sin enfermedad crónica, pero con datos de nefropatía temprana e hiponatremia, se sugirió la posibilidad de nefropatía mesoamericana. Debe establecerse una alerta epidemiológica regional y un programa de prevención y control(AU)

Introduction: Hypokalemia is a frequent hydroelectrolytic disorder, associated with systemic and multifactorial diseases, whose acute form can be complicated and cause death, but in its chronic presentation it can be a marker of nephropathy. Objective: To characterize the profile of the patient with non-drug hypokalemia seen in an emergency. Methods: The records of patients older than 18 years diagnosed with hypokalemia, admitted to the hospital from June 2018 to December 2019, were reviewed. Demographic data, medical history, and post-treatment evolution were collected. It was compared with 108 patients without hypokalemia seen in the same period. Results: 87 cases with mean age of 38.5 years were studied. 90.8% were men under 50 years of age, who worked as farmers (29.9percent), with history of exposure to pesticides and high ambient temperatures. Most of them had no history of previous cardiometabolic or renal disease. 48.3percent of all patients with hypokalemia (n = 42) had creatinine higher than 1.2 mg/dL and 63percent had hyponatremia. Hypokalemia was moderate in 39% and severe in 12percent, and it was found that men were affected 4.7 times more than women. Regarding the group without hypokalemia and abnormal creatinine, they had higher frequency of chronic disease (92.5percent versus 8percent). Conclusions: Non-drug hypokalemia was found in male farmers, without chronic disease, but with evidence of early nephropathy and hyponatremia. The possibility of Mesoamerican nephropathy was suggested. A regional epidemiological alert and a prevention and control program should be established(AU)

Glomerulonefritis rápidamente progresiva mediada por inmunocomplejos (tipo II). Revisión de la literatura / Immune complex-mediated rapidly progressive glomerulonephritis (type II). Literature review

La glomerulonefritis rápidamente progresiva mediada por complejos inmunes (GMNRP II) es un síndrome clínico caracterizado por el rápido deterioro de la función renal asociado a hematuria, edemas y oliguria. Histológicamente se manifiesta como una glomerulonefritis crescéntica, con la presencia de depósitos granulares en la inmunofluorescencia. Aunque es una enfermedad rara, es grave y puede evolucionar a una enfermedad renal crónica, por lo cual es fundamental su identificación temprana. A continuación, se presenta una revisión sobre este tipo de glomerulonefritis, con énfasis en su etiología y en las opciones terapéuticas existentes en la actualidad

Rapidly progressive immune complex-mediated glomerulonephritis (RPGNMN II) is a clinical syndrome characterized by severe deterioration of renal function associated with hematuria, edema, and oliguria. It is histologically characterized as a crescentic glomerulonephritis, with the presence of granular deposits on immunofluorescence. Although it is a rare condition, it is a potentially serious disease that may progress to chronic renal disease, therefore its early identification is essential. Here we present a review of this form of glomerulonephritis, with emphasis on its etiology and the currently available therapeutic options

Vasculitis inusual asociada a anticuerpos anticitoplasma de neutrófilos / Unusual vasculitis associated with antineutrophil cytoplasmic antibodies

Introducción: Las vasculitis asociadas a autoanticuerpos citoplasmáticos de neutrófilos son afecciones infrecuentes con una incidencia reportada de 46 a 184 casos por millón de personas y aparecen, generalmente, en edades tardías de la vida. Objetivo: Describir los hallazgos de una paciente en la que se diagnosticó vasculitis pauciinmune tipo poliangeítis microscópica tardíamente. Caso clínico: Se presenta el caso de una paciente de 60 años con antecedente de enfermedad renal crónica y compromiso respiratorio manifestado por disnea, tos productiva, malestar general y fiebre. En las imágenes se evidenció bronquiectasias y en los exámenes de laboratorio factor reumatoideo alto, autoanticuerpos citoplasmáticos antineutrófilos perinucleares positivos, anticuerpos antinucleares negativos y hemosiderófagos en el lavado broncoalveolar. Se instauró manejo con corticoides sistémicos con franca mejoría clínica. Sin embargo, una malformación arteriovenosa que originó una hemorragia en la fosa posterior, le ocasionó la muerte. Conclusiones: El diagnóstico de las vasculitis es complejo y depende en gran medida del criterio clínico, por lo que el médico debe estar presto a la interpretación de las manifestaciones clínicas y de los hallazgos paraclínicos(AU)

Introduction: Vasculitis associated with neutrophil cytoplasmic autoantibodies are infrequent conditions with a reported incidence of 46 to 184 cases per million people and it generally appears late in life. Objective: To describe the findings of a patient in whom microscopic polyangiitis-type pauciimmune vasculitis was late diagnosed. Clinical case report: We report a case of a 60-year-old patient with history of chronic kidney disease and respiratory compromise exhibited by dyspnea, productive cough, general malaise and fever. The images showed bronchiectasis and laboratory tests revealed high rheumatoid factor, positive perinuclear antineutrophil cytoplasmic autoantibodies, negative antinuclear antibodies, and bronchoalveolar lavage exposed hemosiderophages. Management with systemic corticosteroids was established with clear clinical improvement. However, an arteriovenous malformation that caused a hemorrhage in the posterior fossa caused his death. Conclusions: The diagnosis of vasculitis is complex and depends largely on clinical criteria, so physicians must be ready to interpret the clinical manifestations and paraclinical findings(AU)

Periodontal management of a patient with chronic kidney disease: a case report

The association between periodontal disease and chronic kidney disease (CKD) has been recognized over the years. Gingival overgrowth may be a side effect of some of the drugs prescribed for patients with CKD. Objective: The objective of this manuscript was to report the dental management of a patient with chronic renal disease who presented periodontitis and gingival overgrowth. Case report: A 55 years old male patient sought dental treatment, and was diagnosed with generalized periodontitis in advanced stage and gingival overgrowth. The overgrowth was associated to the use of amlodipine, a longacting calcium channel blocker. The treatment consisted of interruption of amlodipine, sessions of oral hygiene instruction and basic periodontal therapy. Thereafter, conventional periodontal therapy, with scaling and root planning of the four hemiarches, surgical periodontal therapy and gingivectomy of the overgrowth were performed. Considering periodontal sites with a probing depth (PD) > 4mm at baseline, mean PD was reduced (baseline: 5.94 ± 1.80; follow-up: 2.76 ± 1.38), as well as mean clinical attachment loss (baseline: 5.55 ± 1.51; followup: 4.52 ± 1.47). Periodontal disease was controlled and there was no recurrence of gingival overgrowth after 18 months of follow-up. Conclusion: The management of the reported patient with CKD and periodontal involvement included discontinuation of amlodipine, basic and advanced periodontal therapy and gingivectomy. Proper oral hygiene may help to prevent recurrence of the gingival overgrowth and to maintain periodontal health.

Introdução: A associação entre doença periodontal e doença renal crônica (DRC) tem sido reconhecida nos últimos anos. O crescimento gengival excessivo pode ser um efeito colateral de alguns medicamentos prescritos para pacientes com DRC. Objetivos: O objetivo deste estudo foi relatar o manejo odontológico de um paciente com DRC que apresentava periodontite e aumento gengival. Relato do caso: Um paciente do sexo masculino, 55 anos, procurou atendimento odontológico e foi diagnosticado com periodontite generalizada em estágio avançado e crescimento gengival associado ao uso de anlodipina, um bloqueador dos canais de cálcio de ação prolongada. O tratamento consistiu em interrupção da anlodipina, sessões de instruções de higiene bucal e terapia periodontal básica. Posteriormente, foi realizada terapia periodontal convencional, com raspagem e alisamento radicular dos quatro hemiarcos, seguida de cirurgia periodontal a retalho e gengivectomia. Considerando os sítios periodontais com profundidade de bolsa à sondagem (PBS) > 4mm no início do tratamento, a média de PBS foi reduzida (início: 5,94 ± 1,80; final: 2,76 ± 1,38), bem como a média do nível clínico de inserção (início: 5,55 ± 1,51; final: 4,52 ± 1,47). A doença periodontal foi controlada e não houve recorrência do crescimento gengival após 18 meses de acompanhamento. Conclusão: O tratamento odontológico deste paciente com DRC e envolvimento periodontal incluiu a interrupção da anlodipina, terapia periodontal básica e avançada e gengivectomia. A higiene bucal adequada pode ajudar a prevenir a recorrência do crescimento gengival excessivo e a manutenção de um estado periodontal saudável.

Proteinuria en habitantes de una aldea costera de Santa Rosa, Guatemala / Proteinuria in inhabitants of a coastal village of Santa Rosa, Guatemala

Objetivo: determinar la presencia de proteinuria en habitantes de una aldea de la región costera de Santa Rosa, Guatemala, julio del año 2019. Material y métodos: estudio descriptivo y transversal, en una muestra de 575 habitantes de la aldea Casas Viejas, captada por durante cuatro jornadas médicas. Las muestras de orina fueron analizadas con tiras reactivas. Resultados: de los habitantes que participaron, 55.48 % (319) fueron de sexo femenino, la mediana de edad fue de 24 años, el 39.820% (229) estudiante y el 85.2 % (490) sin antecedentes patológicos. De los factores predisponentes de enfermedad renal, el 56.170% (323) consume antiinflamatorios no esteroideo -AINES-, el 82.26 % (473) bebidas carbonatadas, el 13.570% (78) bebidas alcohólicas; la mediana de consumo de agua fue de 6 vasos diarios y 13.22 % (76) han estado expuestos a agroquímicos. Proteinuria se documentó en 8.87 % (51) de los habitantes. Conclusiones: más de la mitad de los sujeto de estudio son de sexo femenino y sin antecedentes patológicos; de los factores predisponentes a enfermedad renal los más frecuentes son el consumo de -AINES-, bebidas carbonatadas y la hidratación inadecuada. Nueve de cada cien sujetos de estudio presentan proteinuria.

Objetive: to establish urine protein presence in inhabitants of a small village of the coastal region in Santa Rosa, Guatemala. July 2019. Material y methods: Descriptive and transversal study performed on 575 persons from Casas Viejas village, using a nonprobabilistic sampling. Proteinuria was determined by urine test strips. Results: Of the persons studied, 55.48% (319) were female, mean age was 24 years old, 39.82% (229) were students and 85.25% had no pathological background. Predisposing factors of kidney disease were noted, 56.17% (323) consumed Non-steroidal Anti-inflammatory Drugs (NSAIDs), 82.26% (473) consumed carbonated drinks, 13.57% (78) alcoholic beverages, the mean water consumption was 6 glasses per day, and 13.22% (76), were exposed to agrochemical pesticides. Proteinuria was found in 8.87% (51) of the sample. Conclutions: more than half of population were female and didn´t showed pathological signs. Predisposing factors to kidney disease were, frequent NSAIDs use, carbonated drinks consumption a no adequate hydration. Nine of each one hundred people studied presented urine protein.

Caracterización de las complicaciones renales en pacientes con anemia de células falciformes / Characterization of kidney complications in patients with sickle cell anemia

Resumen: Introducción: La nefropatía falciforme (NF) es una complicación poco estudiada en la edad pediátrica, que se manifiesta en diferentes formas, incluyendo la glomerulopatía y la tubulopatía. Objetivo: Descri bir las complicaciones renales agudas y crónicas de niños con anemia de células falciformes (ACF). Pacientes y Método: Estudio de cohorte restrospectiva. Se incluyeron pacientes pediátricos con diagnóstico confirmado de enfermedad de células falciformes que tuvieran estudio nefro-urológico. Se consignó patrón electroforético de hemoglobina, presencia y tipo de afectación renal, y presencia de compromiso cardiológico. Se realizó análisis bivariado para comparar pacientes con y sin NF. Resultados: Se incluyeron 79 pacientes, 59.5% hombres, siendo el patrón electroforético más fre cuente Hb-SS (60.9%). La NF se presentó en el 70% de ellos, con una edad de 114 meses (RIQ 65-157). Las alteraciones más frecuentemente encontradas fueron hiperfiltración glomerular, mi croalbuminuria, lesión renal aguda, hipertensión arterial e hipostenuria. En el análisis bivariado, un ecocardiograma anormal fue más frecuente en los pacientes con NF (84,8% vs 54,3% p = 0,01), así como tuvieron una tendencia a mayor uso de medicamentos nefrotóxicos (74,5% vs 54,2% p = 0,07). Conclusiones: Nuestros hallazgos sugieren que la nefropatía falciforme puede presentarse a tempra na edad, siendo muy frecuente la hiperfiltración glomerular. Las complicaciones cardiopulmonares en ACF se podrían asociar con la presencia NF.

Abstract: Introduction: Sickle cell nephropathy (SCN) is a poorly studied complication of pediatric patients. It appears in different forms, including glomerulopathy, and tubulopathies. Objective: To describe acute and chronic renal complications in patients with sickle cell anemia (SCA). Patients and Method: Re trospective study. Pediatric patients with confirmed diagnosis of sickle cell disease were included who had a nephro-urology study. Hemoglobin electrophoresis pattern, presence and type of renal involvement, and presence of cardiac involvement were recorded. Bivariate analysis was perfor med to compare patients with and without SCN. Results: 79 patients were included, 59.5% of them were men, and the most frequent electrophoresis pattern was Hb-SS (60.9%). The SCN oc curred in 70% of patients with an average age of 114 months (RIQ 65-157). The most frequently observed alterations were glomerular hyperfiltration, microalbuminuria, acute kidney injury, ar terial hypertension, and hyposthenuria. In the bivariate analysis, an abnormal echocardiogram result was presented more frequently in patients with SCN (84.8% vs. 54.3% p = 0.01), as well as more frequent use of nephrotoxic drugs (74.5% vs. 54.2% p = 0.07). Conclusions: Our findings suggest that sickle cell nephropathy may occur at an early age, where glomerular hyperfiltration is very common. Cardiopulmonary complications in patients with SCA may be related to the presence of SCN.

Estudo da morfologia e status oxidativo em rim de ratos com nefropatia isquêmica após tratamento com células-tronco mesenquimais de tecido adiposo / Study of morphology and oxidative status in kidney of rats with ischemic nephropathy after treatment with adipose tissue mesenchymal stem cells

A nefropatia isquêmica é uma doença renal crônica provocada pela redução do fluxo sanguíneo renal que pode progredir para a doença renal terminal, cujo tratamentos disponíveis se baseiam em terapias substitutivas da função renal, como diálise ou transplante renal. No entanto, devido ao alto custo dos tratamentos e a carência de órgãos, se faz necessária a busca por novas terapias, como as células-tronco (CT). Apesar do potencial terapêutico das CT em doenças crônicas, não está claro se essas células mantêm seus efeitos benéficos em órgãos lesionados por tempo prolongado. O objetivo desse estudo foi avaliar os efeitos precoces e tardios do tratamento com células-tronco adiposas (CTA) sobre a morfologia e o status oxidativo em rins de ratos com nefropatia isquêmica. A isquemia renal foi induzida pelo modelo 2rins-1clip (2R1C) e, depois de um mês da clipagem da artéria renal, foram injetadas 106 células-tronco na região subscapsular do rim afetado. Após 15 e 30 dias da injeção das CTA, a morfologia renal foi verificada por meio da análise macroscópica, microscópica e ultraestrutural. Além disso, o status oxidativo foi avaliado no tecido renal através da mensuração da atividade das enzimas antioxidantes catalase e glutationa peroxidase; e de marcadores biológicos de dano oxidativo, como proteínas carboniladas, 3-Nitrotirosina e 4-Hidroxinonenal. Por imunoperoxidase foi possível localizar as células-tronco adiposas GFP+ foram rastreadas e encontradas tanto 15 dias, quanto 30 dias após a injeção na região subcapsular. A restauração da arquitetura renal foi evidenciada 15d após o uso das células, onde detectamos redução na deposição de fibras colágenas no parênquima renal, o que não foi observado 30d após o uso das células. Os resultados também foram confirmados através da análise da ultraestrutura renal que mostraram restauração da arquitetura renal no grupo de 15d, não evidenciada no grupo de 30d. Quanto a análise do status oxidativo, somente os animais com nefropatia isquêmica mais prolongada apresentaram estresse oxidativo com redução da atividade da enzima antioxidante catalase no tecido renal. Além disso, foi observado dano proteico e lipídico, sem melhora dessa condição nos animais 30d após o tratamento com as células-tronco. No modelo de nefropatia isquêmica avaliado, o tratamento com CTA mostrou benefícios na morfologia renal a curto prazo, mas não tardiamente, apesar da permanência dessas células no tecido. Acreditamos que o estresse oxidativo, evidenciado somente no tecido renal com isquemia mais prolongada, possa ter dificultado a ação das células-tronco, contribuindo para tais achados. Esses resultados abrem perspectivas para o aprofundamento do estudo quanto à caracterização dos mecanimos de ação das CTA nas respostas anti-fibrogênicas, assim como o estabelecimento do número, frequência, vias de administração e melhor momento para uso dessas células no tratamento de doenças renais crônicas.

Ischemic nephropathy is a chronic kidney disease caused by reduced kidney blood flow that can progress to end stage kidney disease, whose available treatments are based on kidney function replacement therapies, such as dialysis or kidney transplantation. However, due to the high cost of treatments and the lack of organs, it is necessary to search for new therapies, such as stem cells (SC). Despite the therapeutic potential of SC in chronic diseases, it is unclear whether these cells maintain their beneficial effects on injured organs for a long time. The aim of this study was to evaluate the early and late effects of adipose-derived stem cells (ADSC) treatment on the morphology and oxidative status in kidneys of rats with ischemic nephropathy. Renal ischemia was induced by the 2kidneys-1clip (2K1C) model and, after a month of clipping the renal artery, 106 stem cells were injected into the subscapsular region of the affected kidney. After 15 and 30 days of ADSC injection, renal morphology was verified by macroscopic, microscopic, and ultrastructural analysis. In addition, oxidative status was assessed in renal tissue by measuring the activity of the antioxidant enzymes catalase and glutathione peroxidase; and biological markers of oxidative damage, such as carbonylated proteins, 3-nitrotyrosine and 4-hydroxynonenal. By immunoperoxidase, it was possible to locate GFP + adipose-derived stem cells that were tracked and found both 15 days and 30 days after injection in the subcapsular region. The restoration of the renal architecture was evidenced 15d after the use of the cells, where we detected a reduction in the deposition of collagen fibers in the renal parenchyma, which was not observed 30d after the use of the cells. The results were also confirmed by analyzing the renal ultrastructure, which showed restoration of the renal architecture in the 15d group, not evidenced in the 30d group. Regarding the analysis of oxidative status, only animals with more prolonged ischemic nephropathy presented oxidative stress with reduced activity of the antioxidant enzyme catalase in renal tissue. In addition, protein and lipid damage was observed, with no improvement in this condition in the animals 30d after treatment with stem cells. In the evaluated ischemic nephropathy model, treatment with ADSC showed benefits in renal morphology in the short term, but not late, despite the permanence of these cells in the tissue. We believe that oxidative stress, evidenced only in renal tissue with more prolonged ischemia, may have hindered the action of stem cells, contributing to such findings. These results open perspectives for further study on the characterization of ADSC mechanisms of action in anti-fibrogenic responses, as well as the establishment of the number, frequency, routes of administration and the best time to use these cells in the treatment of chronic kidney diseases.

HIV-related nephropathy: new aspects of an old paradigm

SUMMARY The scenario of infection by the human immunodeficiency virus (HIV) has been undergoing changes in recent years, both in relation to the understanding of HIV infection and regarding the treatments available. As a result, the disease, which before was associated with high morbidity and mortality, is now seen as a chronic disease that can be controlled, regarding both transmission and symptoms. However, even when the virus replication is well controlled, the infected patient remains at high risk of developing renal involvement, either by acute kidney injury not associated with HIV, nephrotoxicity due to antiretroviral drugs, chronic diseases associated with increased survival, or glomerular disease associated to HIV. This review will cover the main aspects of kidney failure associated with HIV.

RESUMO O panorama da infecção pelo vírus da imunodeficiência humana (HIV) vem sofrendo alterações nos últimos anos, tanto em relação ao entendimento da infecção pelo HIV quanto aos tratamentos disponíveis. Como resultado, a doença, que antes estava associada a alta morbimortalidade, é agora considerada uma doença crônica que pode ser controlada, tanto em relação à transmissão quanto aos sintomas. No entanto, mesmo quando a replicação viral é bem controlada, o paciente infectado tem um alto risco de desenvolver complicações renais, seja através de lesão renal aguda não relacionada ao HIV, por nefrotoxicidade causada por drogas antirretrovirais, por doenças crônicas associadas com o aumento da sobrevida ou por doença glomerular associada ao HIV. Esta revisão abordará os principais aspectos da insuficiência renal associada ao HIV.

Caracterización clínica de pacientes con nefropatía lúpica en Santander, la importancia de la biopsia renal / Clinical and epidemiological characterization of patients with lupus nephropathy in Santander, Colombia: the importance of the renal biopsy

Resumen Introducción: el lupus eritematoso sistémico (LES) presenta diferentes manifestaciones clínicas, un de estas es la nefropatia lúpica (NL), que se asocia con progresión a enfermedad renal crónica (ERC) avanzada y mortalidad. Objetivo: determinación de las características clínicas y epidemiológicas de la NL en Santander. Métodos: estudio observacional descriptivo tipo serie de casos en pacientes con NL evaluados por primera vez, entre enero de 2017 a enero 2018, en consulta de nefroprevención. Según criterios de inclusión y exclusión se definieron variables cualitativas y cuantitativas. Se revisaron historias clínicas y el análisis de datos se realizó por medio de SPSS®. Resultados: se estudiaron 14 pacientes (85 % mujeres), la edad promedio de diagnóstico de NL fue de 36 años, con ERC 1 y 2 (72 %) y con proteinuria A3 (85 %). Se obtuvo biopsia renal en 64 %, con resultado concluyente en el 50 %, la clase histopatológica IV de NL fue la más común. La terapia de mantenimiento más frecuente fue corticoide en monoterapia (36 %), seguido de la combinación de corticoide y micofenolato (29 %). Conclusión: la NL predomina en mujeres jóvenes, en estadios tempranos de ERC con altos grados de proteinuria, por lo que se debe realizar una evaluación minuciosa en búsqueda de NL a todos los pacientes con LES, mediante programas de detección y seguimiento nefrológico temprano. El grado histopatológico IV fue el más frecuente, similar a lo reportado en Latinoamérica. Existen dificultades administrativas y técnicas en la toma de biopsias renales, se debe hacer énfasis en la necesidad de su realización, por su primordial importancia para definir el tratamiento.

Abstract Introduction: Systemic Lupus Erythematosus (SLE) has different clinical manifestations, being very relevant lupus nephropathy (NL) because is associated with progression to advanced chronic kidney disease (CKD) and mortality. Objective: Determination of the clinical and epidemiological characteristics of the NL in Santander. Methods: A descriptive observational study of a series of cases in patients with NL diagnosis, evaluated between January 2017 and 2018 for the first time in a nephroprotection consultation. Qualitative and quantitative variables are defined according to the inclusion and exclusion criteria. Electronic medical records were reviewed, and data analysis was performed through SPSS®. Results: 14 patients (85% women) were studied. The average age of diagnosis of NL was 36 years, mostly with stages of CKD 1 and 2 (72%) with proteinuria A3 (85%).Biopsy renal was performed in the 64%, a conclusive result in the 50%, being the histopathological grade IV of NL the most common. The most frequent maintenance therapy was corticosteroid alone (35.7%), followed by the combination of corticosteroid and mycophenolate (28.5%). Conclusion: NL predominates in young women, and presenting in early stages of CKD, with high degrees of proteinuria, so a thorough evaluation should be performed in search of NL in all patients with SLE through early nephrological screening and monitoring programs. The histopathological grade IV found is like that reported in Latin America. There are administrative and technical difficulties in the performance of renal biopsies, emphasis should be placed on the realization of this procedure because it takes a primary role in defining the treatment.

Predictive value of ATRIA risk score for contrast-induced nephropathy after percutaneous coronary intervention for ST-segment elevation myocardial infarction

SUMMARY BACKGROUND: The AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) risk score used to detect the thromboembolic and hemorrhagic risk in atrial fibrillation patients has been shown recently to predict poor clinical outcomes in patients with acute myocardial infarction (ACS), regardless of having atrial fibrillation (AF). We aimed to analyze the relationship between different risk scores and contrast-induced nephropathy (CIN) development in patients with ACS who underwent urgent percutaneous coronary intervention (PCI) and compare the predictive ability of the ATRIA risk score with the MEHRAN risk score. METHODS: We analyzed 429 patients having St-segment Elevation Myocardial Infarction (STEMI) who underwent urgent PCI between January 2016 and February 2017. Patients were divided into two groups: those with and those without CIN and both groups were compared according to clinical, laboratory, and demographic features, including the CHA2DS2-VASc and ATRIA risk score. Predictors of CIN were determined by multivariate regression analysis. Receiver operating characteristics (ROC) curve analysis was used to analyze the prognostic value of CHA2DS2-VASc and ATRIA risk score for CIN, following STEMI. RESULTS: Multivariate regression analysis showed that Athe TRIA risk score, Opaque/Creatinine Clearance ratio, and low left ventricular ejection fraction was an independent predictor of CIN. The C-statistics for the ATRIA risk score and CHA2DS2-VASC risk score were 0.66 and 0.64 (p<0.001, and p<0.001), respectively. A pair-wise comparison of ROC curves showed that both scores were not inferior to the MEHRAN score in predicting CIN. CONCLUSION: The ATRIA and CHA2DS2-VASC scoring systems were useful for detecting CIN following STEMI.

RESUMO OBJETIVO: O escore Anticoagulação e Fatores de Risco na Fibrilação Atrial (Atria), usado na detecção do risco tromboembólico e hemorrágico de pacientes com fibrilação atrial (FA), recentemente demonstrou predizer resultados clínicos ruins em pacientes com infarto agudo do miocárdio (SCA), independentemente de ter FA. Nosso objetivo foi analisar a relação entre os diferentes escores de risco e o desenvolvimento de nefropatia induzida por contraste (NIC) em pacientes com SCA submetidos à intervenção coronária percutânea (ICP) urgente e comparar a capacidade preditiva do escore de risco Atria com o escore de risco Mehran. MÉTODOS: Foram analisados 429 pacientes com infarto agudo do miocárdio com elevação do segmento ST (IAM-ST) submetidos à ICP de urgência entre janeiro de 2016 e fevereiro de 2017. Os pacientes foram divididos em dois grupos: aqueles com e sem NIC, e ambos os grupos foram comparados de acordo com as características clínicas, laboratoriais e demográficas, incluindo os escores de risco CHA2DS2-VASc e Atria. Preditores de NIC foram determinados por análise de regressão multivariada. A análise da curva características de operação do receptor (ROC) foi utilizada para analisar o valor prognóstico dos escores de risco CHA2DS2-VASc e Atria para NIC, após IAM-ST. RESULTADOS: A análise de regressão multivariada mostrou que o escore de risco Atria, a relação opaca/crCl e a baixa fração de ejeção do ventrículo esquerdo foram preditores independentes de NIC. A estatística-C para o escore de risco Atria e o escore de risco CHA2DS2-VASC foi de 0,66 e 0,64 (p<0,001 e p<0,001), respectivamente. Uma comparação de pares de curvas características de operação do receptor mostrou que ambos os escores foram não inferiores ao escore Mehran na previsão de NIC. CONCLUSÃO: Os sistemas de pontuação Atria e CHA2DS2-VASC foram sistemas úteis para a detecção de NIC após IAM-ST.

Avaliação de marcadores de lesão renal em pacientes diabéticos submetidos à hemodiálise em um hospital do norte do estado do Rio Grande do Sul / Evaluation of renal injury markers in diabetic patients submitted to hemodialysis in a hospital in the north of the Rio Grande do Sul state

A Doença Renal Crônica é a perda gradativa da função renal, ocasionando um desequilíbrio metabólico levando ao aumento da concentração sérica de eletrólitos, tendo como principal causa o Diabetes mellitus. Considerando o apresentado, o objetivo do trabalho foi avaliar os níveis séricos de sódio, potássio, cálcio, fósforo e paratormônio em pacientes diabéticos submetidos à hemodiálise. Foi realizado um estudo descritivo com abordagem retrospectiva documental de prontuários dos pacientes no período de janeiro a março de 2017 em um hospital de referência da região norte do Rio Grande do Sul . Foram encontradas alterações nos resultados de paratormônio e fósforo, com valores médios de 533 pg/mL e 5,4 mg/dL respectivamente, e valores médios dentro do intervalo de referência de sódio, potássio e cálcio. Com exceção dos valores de cálcio, os demais achados são condizentes com as alterações metabólicas causadas pela nefropatia diabética.

Detección temprana de nefropatía diabética, a propósito de su cribado / Early diagnosis of diabetic nephropathy and its screening

INTRODUCCIÓN: La nefropatía diabética constituye la primera causa de enfermedad renal crónica y sustitución de la función renal a nivel mundial sin excepción, esto debido al acelerado deterioro en la función renal sufrido por los pacientes que se mantienen lejos de las metas de control metabólico en diabetes, así como, las comorbilidades asociadas que contribuyen como factores de progresión adicionales, ocasionando una caída inevitable en la tasa de filtración glomerular con la subsecuente terapia dialítica. Considerando, que actualmente no existen intervenciones preventivas de nefrología enfocados en diabetes, presentamos los resultados de un programa realizado en la atención de primera vez de estos pacientes en el Hospital General Guillermo Álvarez Macías, Tula de Allende, Hidalgo, México. OBJETIVO: La detección temprana de nefropatía diabética y determinación de factores de riesgo asociados. MATERIAL Y MÉTODOS: Estudio descriptivo retrospectivo transversal, mediante análisis de pruebas de función renal, incluido el estudio de albuminuria de 24 horas, se realizó una búsqueda intencionada de hallazgos anormales. Los datos fueron analizados usando el paquete estadístico SPSS versión 15 para Windows. RESULTADOS: Fue posible detectar la nefropatía diabética en el 61% de la población contra 30% mediante técnicas tradicionalmente utilizadas en la consulta general de pacientes diabéticos. Se encontró a la hiperglicemia persistente como el principal factor asociado al desarrollo de nefropatía, constituyendo el nivel de control subóptimo prolongado el denominador común que los diferencia de la población sin nefropatía diabética (p 0.002). CONCLUSIONES: considerando que la nefropatía diabética es una enfermedad prevenible, es de fácil detección al realizar un cribado adecuado en el primer y segundo nivel de atención, que permita su referencia oportuna al especialista en nefrología para su apoyo en el tratamiento

INTRODUCTION: Diabetic nephropathy constitutes the leading cause of chronic kidney disease and renal function substitution all over the world and without exception, given the rapid deterioration of renal function suffered by patients who fail to achieve diabetes metabolic control goals and the associated comorbidities representing additional progression factors. All these cause an unavoidable drop in glomerular filtration rate and a subsequent dialysis treatment. Considering that nowadays there are not any preventive interventions in nephrology focused on diabetes, we present the results of a program conducted on patients treated for the first time at Hospital General Guillermo Álvarez Macías, Tula de Allende, Hidalgo, México. OBJECTIVE: Early diagnosis of diabetic nephropathy and identification of associated risk factors. METHODS: A descriptive, retrospective, cross-sectional study, which included a 24-hour albumin test, was conducted by means of renal function tests deliberately looking for abnormal findings. Data were analyzed using the SPSS 15 statistical software for Windows. RESULTS: By means of traditional techniques used to treat diabetic patients in general, it was possible to diagnose diabetic nephropathy in 61% of the patients vs. 30%. Persistent hyperglycemia was found to be the main factor associated with nephropathy, lengthy suboptimal control levels being the common factor that distinguishes these patients from the population not suffering from diabetic nephropathy (p 0.002). CONCLUSIONS: Given that diabetic nephropathy is a preventable disease, it is easy to diagnose it through an adequate screening at first- and second-level care, which allows a timely referral to a nephrology specialist to treat it

APOL1 risk variants and kidney disease: what we know so far / Variantes de risco APOL1 e doença renal: o que sabemos até agora

ABSTRACT There are striking differences in chronic kidney disease between Caucasians and African descendants. It was widely accepted that this occurred due to socioeconomic factors, but recent studies show that apolipoprotein L-1 (APOL1) gene variants are strongly associated with focal segmental glomerulosclerosis, HIV-associated nephropathy, hypertensive nephrosclerosis, and lupus nephritis in the African American population. These variants made their way to South America trough intercontinental slave traffic and conferred an evolutionary advantage to the carries by protecting against forms of trypanosomiasis, but at the expense of an increased risk of kidney disease. The effect of the variants does not seem to be related to their serum concentration, but rather to local action on the podocytes. Risk variants are also important in renal transplantation, since grafts from donors with risk variants present worse survival.

RESUMO Existem importantes diferenças na doença renal crônica entre caucasianos e afrodescendentes. Foi amplamente aceito que isso ocorreu devido a fatores socioeconômicos, mas estudos recentes mostraram que as variantes gênicas da apolipoproteína L-1 (APOL1) estão fortemente associadas à glomeruloesclerose segmentar e focal, nefropatia associada ao HIV, nefroesclerose hipertensiva e nefrite lúpica na população afrodescendente. Essas variantes chegaram à América do Sul através do tráfico intercontinental de escravos, e proporcionaram uma vantagem evolutiva aos portadores, protegendo contra formas de tripanossomíase, mas à custa de um maior risco de doença renal. O efeito das variantes não parece estar relacionado à sua concentração sérica, mas sim à sua ação local sobre os podócitos. Variantes de risco também são importantes no transplante renal, já que enxertos de doadores com variantes de risco apresentam pior sobrevida.

Hemoglobina A1c, diabetes mellitus, nefropatía diabética y enfermedad renal crónica / Hemoglobin A1c, Diabetes Mellitus, Diabetic Nephropathy and Chronic Kidney Disease

La diabetes mellitus (DBT), la nefropatía diabética (ND) y la enfermedad renal crónica (ERC) son enfermedades prevalentes en nuestra región, Sudamérica. Los niveles de hemoglobina A1c (HbA1c) han sido relacionados al desarrollo y a la evolución de la ND. Hace dos décadas había gran variabilidad en los resultados, los países líderes en investigación científica organizaron programas de estandarización de la HbA1c, logrando mejorar la calidad y la confiabilidad de los resultados. Los objetivos de este trabajo fueron describir el problema DBT, ND y ERC en Sudamérica y en su contexto analizar metodológicamente la HbA1c. Para esto, revisamos el impacto de estas enfermedades en nuestra región, contemplando aspectos básicos de la HbA1c y algunas situaciones que producen interferencias como la carbamilación de la hemoglobina, modificación post-traduccional asociada a la uremia. También nos enfocamos en técnicas estadísticas universalmente utilizadas para la evaluación de ensayos como: linealidad, concordancia y precisión. Adicionalmente, incluimos un análisis de los métodos disponibles y de los precios de cada determinación de HbA1c en diez países de Sudamérica. Para prevenir, diagnosticar y tratar la DBT, la ND y la ERC es indispensable contar con herramientas de última generación, disponibles para todas las personas. En nuestra región el acceso a ensayos, equipos y laboratorios enmarcados en programas de estandarización de la HbA1c, internacionalmente aceptados, es una tarea pendiente. Millones de individuos de las generaciones presentes y futuras de Sudamérica padecerán DBT, ND y ERC, necesitamos llevar la voz de la ciencia a esas personas con el "hacer" cotidiano

Diabetes mellitus (DM), diabetic nephropathy (DN) and chronic kidney disease (CKD) are prevalent diseases in our region, South America. The levels of hemoglobin A1c (HbA1c) have been related to the development and progression of the DN. Two decades ago there was great variability in the results; the leading countries in scientific research then organized programs of HbA1c standardization, which improved the quality and reliability of the findings. The objectives of this study were to describe the problem of DM, DN and CKD in South America and to analyze HbA1c methodologically in this context. Thus, the impact of these diseases in our region was reviewed, contemplating basic aspects of HbA1c and some situations that produce interferences such as carbamylation of hemoglobin, the post-translational modification associated with uremia. We also focused on statistical techniques universally used for the evaluation of assays such as linearity, concordance and precision. Additionally, we included an analysis of the existing methods and the prices of each HbA1c determination in ten countries in South America. To prevent, diagnose and treat DM, DN and CKD, it is essential to have state-of-the-art tools available to all people. In our region, access to trials, equipment and laboratories within HbA1c standardization programs, internationally accepted, is a pending task. Millions of individuals from the present and future generations of South America will suffer from DM, DN and CKD, so we need to take the voice of science to these people through the daily "doing"

The Oxford Classification predictors of chronic kidney disease in pediatric patients with IgA nephropathy / Preditores da doença renal crônica segundo a Classificação de Oxford em pacientes pediátricos com nefropatia por IgA

Abstract Objective: The Oxford Classification for Immunoglobulin A nephropathy (IgAN) identifies pathological variables that may predict the decline of renal function. This study aimed to evaluate the Oxford Classification variables as predictors of renal dysfunction in a cohort of Brazilian children and adolescents with IgAN. Methods: A total of 54 patients with IgAN biopsied from 1982 to 2010 were assessed. Biopsies were re-evaluated and classified according to the Oxford Classification. Multivariate analysis of laboratory and pathological data was performed. The primary outcomes were decline of baseline estimated glomerular filtration rate (eGFR) greater than or equal to 50%. Results: Mean follow-up was 7.6 ± 5.0 years. Mean renal survival was 13.5 ± 0.8 years and probability of decline ≥50% in baseline eGFR was 8% at five years of follow-up and 15% at ten years. Ten children (18.5%) had a decline of baseline eGFR ≥ 50% and five (9.3%) evolved to end-stage renal disease. Kaplan-Meier analysis showed that baseline proteinuria, proteinuria during follow-up, endocapillary proliferation, and tubular atrophy/interstitial fibrosis were associated with the primary outcome. Multivariate Cox analysis showed that only baseline proteinuria (HR, 1.73; 95% CI, 1.20-2.50, p = 0.003) and endocapillary hypercellularity (HR, 37.18; 95% CI, 3.85-358.94, p = 0.002) were independent predictors of renal dysfunction. No other pathological variable was associated with eGFR decline in the multivariate analysis. Conclusion: This is the first cohort study that evaluated the predictive role of the Oxford Classification in pediatric patients with IgAN from South America. Endocapillary proliferation was the unique pathological feature that independently predicted renal outcome.

Resumo Objetivo: A Classificação Oxford para a Nefropatia por Imunoglobulina A (IgAN) identificou variáveis patológicas de risco para disfunção renal. O presente estudo teve como objetivo avaliar as variáveis da Classificação de Oxford como preditores de disfunção renal em crianças brasileiras com IgAN. Métodos: Foram analisados 54 pacientes com diagnóstico de IgAN entre 1982-2010. As biópsias renais foram reavaliadas pela Classificação de Oxford. Foram feitas análises uni e multivariada das variáveis clínicas e patológicas. O desfecho primário foi queda da taxa de filtração glomerular (TFG) ≥ 50% da filtração basal. Resultados: O acompanhamento médio foi de 7,6 ± 5,0 anos. A sobrevida renal média foi de 13,5 ± 0,8 anos e a probabilidade de atingir o desfecho primário foi de 8% em cinco anos e 15% em 10 anos de seguimento. Dez crianças (18,5%) apresentaram queda na TFG basal ≥ 50% e cinco (9,3%) evoluíram para doença renal crônica terminal. A análise de Kaplan-Meier mostrou que a proteinúria basal e de seguimento, a proliferação endocapilar e a atrofia tubular/fibrose intersticial foram associadas com o desfecho primário. A análise multivariada de Cox mostrou que a proteinúria basal (HR = 1,73; IC95% 1,20-2,50, p = 0,003) e a proliferação endocapilar (HR = 37,18; IC95% 3,85-358,94, p = 0,002) foram preditores independentes de disfunção renal. Nenhuma outra variável patológica foi associada com declínio da TFG na análise multivariada. Conclusão: Este é o primeiro estudo brasileiro que avaliou a Classificação Oxford em crianças com IgAN. A proliferação endocapilar foi a única característica patológica capaz de predizer independentemente o declínio da função renal.

Caracterización de la nefropatía inducida por medios de contraste en pacientes hospitalizados en la Clínica General del Norte de Barranquilla, durante el periodo de enero a junio de 2017 / Characterization of nephropathy induced by contrast media in patients hospitalized in the general clinic of northern Barranquilla, during the period from January to June 2017

Objetivo: Caracterizar la nefropatía inducida por medios de contraste en pacientes hospitalizados en la clíni Objetivo: Caracterizar la nefropatía inducida por medios de contraste en pacientes hospitalizados. Metodología: Investigación transversal, cuyos datos se obtuvieron de fuente secundaria; realizada en 534 pacientes mayores de 18 años que requirieron procedimientos o estudios diagnósticos con medios de contraste en una Clínica de 4° nivel (Clínica General del Norte. Colombia), durante el periodo enero a junio de 2017; se tuvo en cuenta el valor de creatinina tanto inicial como el posterior a aplicación del contraste, cantidad y osmolalidad del medio de contraste, estadío de la Insuficiencia Renal Crónica antes y después del procedimiento, tipo de procedimiento y comorbilidades. Resultados: Predominó el género masculino (55%); la mayoría fueron adultos mayores (45,5%); el NIC estuvo presente en 2,8 % de los pacientes y su frecuencia fue mas alta en mujeres (66,6%); los casos de NIC en procedimientos intervencionistas duplicaron a los imagenológicos (10 vs 5) y el volumen de medio de contraste utilizado fue < 100 mL; el 86,66% de los NIC se presentó en pacientes bajo nefroprotección con solución salina; la mayoría de los pacientes (66,6%), incrementaron su estadío de Enfermedad Renal Crónica inmediatamente después de NIC; en cuanto a las comorbilidades, 10, presentaron entre tres y cuatro 4 y uno tuvo 5, las más frecuentes fueron las neoplasias y la anemia. Estos resultados son similares a los de otros autores. Conclusión: Tanto los procedimientos diagnósticos como los intervencionistas con medios de contraste, son relativamente seguros; la edad avanzada y el género femenino aumentan la probabilidad de desarrollar NIC.

Objective: To characterize the nephropathy induced by contrast media in hospitalized patients. Metho-dology: Cross-sectional research, whose data were obtained from a secondary source; performed in 534 patients older than 18 years who required diagnostic or interventional procedures with contrast media in a 4th level Clinic (General Clinic of the North, Colombia), during the period January to June 2017; the creatinine value was taken into account both initially and after the application of the contrast, amount and osmolality of the contrast medium, stage of the Chronic Renal Failure before and after the procedure, type of procedure and comorbidities. Results: Male gender predominated (55%); the majority were elderly (45.5%); NIC was present in 2.8% of the patients and its frequency was higher in women (66.6%); the cases of CIN in interventional procedures doubled the imaging (10 vs. 5) and the volume of contrast medium used was <100 mL; 86.66% of the NICs occurred in patients under nephroprotection with saline; the majority of patients (66.6%) increased their stage of Chronic Kidney Disease immediately after NIC; in terms of comorbidities, 10 presented between three and four and one had 5, the most frequent were neoplasms and anemia. These results are similar to those of other authors. Conclusion: Both diagnostic and interventional procedures with contrast media are relatively safe; advanced age and female gender increase the likelihood of developing CIN.

Clinical outcomes of kidney transplants on patients with end-stage renal disease secondary to lupus nephritis, polycystic kidney disease and diabetic nephropathy / Resultados clínicos de trasplantes de riñón en pacientes con enfermedad renal en etapa terminal secundaria anefritis lupus, enfermedad poliquística renal y nefropatía diabética

Background: Patients with lupus nephritis could progress to endstage renal disease (10-22%); hence, kidney transplants should be considered as the treatment of choice for these patients. Objective: To evaluate the clinical outcomes after kidney transplants in patients with chronic kidney diseases secondary to lupus nephritis, polycystic kidney disease and diabetes nephropathy at Pablo Tobon Uribe Hospital. Methods: A descriptive and retrospective study performed at one kidney transplant center between 2005 and 2013. Results: A total of 136 patients, 27 with lupus nephritis (19.9%), 31 with polycystic kidney disease (22.8%) and 78 with diabetes nephropathy (57.4%), were included in the study. The graft survivals after one, three and five years were 96.3%, 82.5% and 82.5% for lupus nephritis; 90%, 86% and 76.5% for polycystic kidney disease and 91.7%, 80.3% and 67.9% for diabetes nephropathy, respectively, with no significant differences (p= 0.488); the rate of lupus nephritis recurrence was 0.94%/person-year. The etiology of lupus vs diabetes vs polycystic disease was not a risk factor for a decreased time of graft survival (Hazard ratio: 1.43; 95% CI: 0.52-3.93). Conclusion: Kidney transplant patients with end stage renal disease secondary to lupus nephritis has similar graft and patient survival success rates to patients with other kidney diseases. The complication rate and risk of recurrence for lupus nephritis are low. Kidney transplants should be considered as the treatment of choice for patients with end stage renal disease secondary to lupus nephritis.

Antecedentes: Pacientes con nefritis lúpica pueden progresar a enfermedad renal crónica terminal (10-22%); en estos pacientes el trasplante renal debe ser considerado como la terapia de elección. Objetivo: Evaluar los desenlaces clínicos de un grupo de pacientes con enfermedad renal crónica terminal por nefropatía lúpica, enfermedad renal poliquística y nefropatía diabética que fueron sometidos a trasplante renal en el Hospital Pablo Tobón Uribe. Métodos: Estudio retrospectivo, descriptivo, realizado en un solo centro de trasplante renal, durante el período 2005-2013. Resultados: Se evaluaron 136 pacientes: 27 con nefritis lúpica (19.9%), 31 con enfermedad renal poliquística (22.8%) y 78 con nefropatía diabética (57.4%). La supervivencia del injerto a uno, tres y cinco años fue de de 96.3%, 82.5% y 82.5% en nefropatía lúpica, 90%, 86% y 76.5% en enfermedad renal poliquística y 91.7%, 80.3% y 67.9% en nefropatía diabética respectivamente, sin diferencias estadísticas significativas (Long Rank test= 0.488). La tasa de recurrencia de nefritis lúpica posterior al trasplante renal fue de 0.94%/persona-año. Tener lupus vs diabetes o enfermedad renal poliquística no fue un factor de riesgo para disminución del tiempo de supervivencia del injerto (Hazard ratio= 1.43; 95% IC= 0.52-3.93). Conclusiones: Los pacientes enfermedad renal crónica terminal secundaria a nefritis lúpica, que son llevados a trasplante renal tienen tasas de éxito similar en cuanto a supervivencia del injerto y del paciente, al compararlos con otras enfermedades renales. La tasa de complicaciones y el riesgo de recurrencia de la nefropatía lúpica son bajos. El trasplante renal debe ser considerado como la terapia de elección para los pacientes con enfermedad renal crónica estadio terminal secundaria a nefritis lúpica.

Nefropatía por IgA. revisión y conducta terapéutica a propósito de un caso clínico / Therapeutic management of an IgA nephropathy case and disease review

La Nefropatía por Inmunoglobulina A (NIgA), también conocida como enfermedad de Berger, fue descrita por primera vez en 1968 por Berger e Hinglais. Se trata de una enfermedad heterogénea, tanto desde el punto de vista clínico, como histológico, caracterizada por la presencia de depósitos mesangiales de IgA. La clínica de presentación es extremadamente variable, pudiendo manifestarse desde microhematuria aislada hasta un deterioro agudo de la función renal por una glomerulonefritis extracapilar superpuesta. Inicialmente se la consideraba una entidad de buen pronóstico, pero con el paso del tiempo y a partir de un mayor conocimiento de la NIgA, se constató que la realidad era otra y que del 20 al 30% de los pacientes a los 20 años evolucionaban a la insuficiencia renal crónica (IRC) terminal y otro 20% mostraba una pérdida significativa de la función renal. En el presente artículo se describe un caso clínico de un paciente en el que se detectan casualmente marcadores de daño renal en la orina, y en quien los hallazgos histológicos observados en la biopsia renal modificaron su pronóstico y la conducta terapéutica. A partir de este caso clínico se realiza una actualización sobre la Nefropatía por IgA

Inmunoglobulin A (NIgA) Nephropathy also known as Berger disease, was described for the first time in 1968 by Berger and Hinglais. It is a heterogeneous disease, not only from clinical point of view but also from the histologicalone. Characterized by the presence of IgA mesangials deposits. Clinical presentation is extremely variable and can vary from isolated microhematuria up to a severe damage of renal function due to superimposed extracapillary glomerulonephritis. Initially it was considered an entity with good prognosis, but over time and more knowledge about IgAN, it was shown that 20 to 30% of 20 years old patients evolved to end stage renal failure and other 20% had important renal function loss. In the present article we describe a case of a patient in whom we detected by chance renal damage markers in the urine, and then the histologic findings observed in renal biopsy, modified the prognosis and therapeutic procedure. From this clinical case, we performed an update on IgA Nephropathy