Trastornos glomerulares en la práctica médica / Glomerulopathies in the medical practice

RESUMEN Las glomerulopatías agrupan varias nefropatías con lesiones fundamentalmente del corpúsculo renal y que se expresan principalmente por proteinuria, hematuria, edemas e hipertensión arterial. La presentación clínica varía en dependencia del tipo de enfermedad de que se trate. Constituye la causa más frecuente de enfermedad renal crónica en adultos jóvenes, por lo que su estudio resulta imprescindible sobre todo para el nivel primario de salud. El propósito fue actualizar consideraciones pertinentes sobre la conducta diagnóstica y terapéutica integral ante una glomerulopatía y valorar emisión de recomendaciones al respecto. Se realizó una búsqueda, análisis y síntesis de información a través de Bases de datos ScieLO Cuba, ScieLO regional, Pubmed, Cumed, Clinical Key en el período 2012-2017 con las palabras clave: síndrome nefrótico, glomerulonefritis, diagnóstico, terapéutica, atención integral. El abordaje en las glomerulopatías es integral, multidisciplinario e individualizado. En Cuba constituyen la cuarta causa de enfermedad renal crónica y predomina el síndrome nefrítico agudo postinfeccioso. El método clínico juega en ello un papel trascendental a la hora de reconocer y registrar sus aspectos clínicos, su etiología, su fisiopatología, y los exámenes complementarios que confirman su presencia o sus complicaciones, así como un tratamiento oportuno que garanticen el perfeccionamiento asistencial. El arma más poderosa ante el reto de los trastornos glomerulares es la visión integradora y con enfoque individual y social protagonizado por el médico ante este grupo de nefropatías en adultos.

ABSTRACT Glomerulopathies encompass a group of several renal disorders with lesions, mainly in the renal corpuscle, expressed in proteinuria, hematuria, edemas and arterial hypertension. Their clinical manifestations change in dependence of the kind of disease. They are the most frequent cause of chronic renal disease in young adults; therefore their study is very important above all in the health care primary level. The aim was updating pertinent considerations on the diagnostic behavior and comprehensive therapy in the case of glomerulopathy, and evaluating the emission of recommendations regarding to them. A search, analysis and synthesis of information was carried out in the databases ScieLO Cuba, ScieLO regional, Pubmed, Cumed, and Clinical Key in the period 2012-2017, using the key words nephrotic syndrome, glomerulonephritis, diagnosis, therapeutics, comprehensive care. The approach to glomerulopathies is comprehensive, multidisciplinary and individualized. They are the fourth cause of chronic renal disease; the acute post-infectious nephritic syndrome predominates. The clinical method plays a transcendental role at the moment of recognizing and registering their clinical characteristics, etiology and physiopathology, while complementary tests confirm their presence or complications, and therefore an opportune treatment guarantying the healthcare improvement. The most powerful weapon against the challenge of the glomerular disorders is the integrated vision with an individual and social approach led by the physician in the case of these nephropathies in adults.

Síndrome pulmón-riñón: serie de 12 casos / Pulmonary renal syndrome: series of 12 cases

El síndrome pulmón-riñón es una entidad infrecuente, que comprende un gran espectro de patologías, como las vasculitis asociadas a ANCA y la enfermedad por anticuerpos antimembrana basal glomerular entre otras. Se describen en esta serie 12 casos donde las entidades más prevalentes fueron las antes mencionadas, observándose además un caso de lupus y uno de granulomatosis con poliangeítis, que se encuentran dentro de las causas menos frecuentes. La forma de presentación clínica inicial fue simultánea renal y pulmonar en 5/12 pacientes y renal en 7/12 de los mismos. El diagnóstico temprano de dichas patologías basándose en criterios clínicos, radiológicos, de laboratorio e histológicos, permite instaurar terapéuticas tempranas como la inmunosupresión y plasmaféresis, pudiendo prevenir complicaciones tales como las infecciones y la insuficiencia renal crónica terminal, siendo las primeras la principal causa de muerte (AU)

Pulmonary-renal syndrome is an infrequent condition. It includes a wide variety of conditions such as ANCA (antineutro-phil cytoplasmic autoantibody) associated with systemic vasculitis and anti-GBM (anti-glomerular basement membrane) disease among others. In this series we describe twelve cases, in which the most prevalent diseases were the above mentioned as well as one case of lupus and one of granulomatosis with polyangiitis (these being less frequent causes). The clinical presentation was both renal and pulmonary simultaneously in five of twelve patients and renal in seven of twelve patients. Early diagnosis of this condition on the basis of clinical, radiological, histological and analytic criteria allows early treatments such as immunosuppression and plasma exchange, thus avoiding complications such as infections (the main cause of death) and terminal chronic renal failure (AU)

Comparative analysis of primary and secondary glomerulopathies in the northeast of Brazil: data from the Pernambuco Registry of Glomerulopathies - REPEG / Análise comparativa de glomerulopatias primária e secundária no nordeste do Brasil: dados do Registro Pernambucano de Glomerulopatias - REPEG

Abstract Introduction: In Brazil, glomerulopathies are the third leading cause of chronic renal disease, accounting for 11% of dialysis patients. Studies on the prevalence of this disease in Northeastern Brazil are scarce. Objective: The aim was to describe the findings of biopsies and to conduct a comparative analysis on the clinical laboratory presentation of primary glomerulopathies (PG) and secondary glomerulopathies (SG). Methods: This was a retrospective study conducted at two public teaching hospitals in the state of Pernambuco, Northeastern Brazil. Results: A total of 1151 biopsies performed between 1998 and 2016 were analyzed. The sample consisted of 670 biopsies of native kidneys, after excluding extra glomerular diseases and unsuitable material. PG were more frequent than SG (58% vs. 42%). There was a prevalence among PG of focal segmental glomerulosclerosis (43%). Membranoproliferative glomerulonephritis and collapsing glomerulopathy, accounted for 9% and 3% of the PG, respectively. For SG, the main etiologies were lupus nephritis (67%) and infections (10%). Female sex, hematuria and an elevated level of creatinine were related to a greater chance of SG, at multivariate analysis. An increase of proteinuria reduced this chance. Nephrotic syndrome was more common among the PG, while urinary abnormalities and nephritic syndrome prevailed in patients with SG. Conclusion: This is the first registry of glomerulopathies in Northeastern Brazil. It also presents a comparative analysis of the main clinical laboratory abnormalities of PG and SG, and includes the current classifications of glomerular diseases.

Resumo Introdução: No Brasil, glomerulopatias são a terceira causa de doença renal crônica terminal, responsáveis por 11% dos pacientes em diálise. Entretanto, estudos sobre a prevalência desta patologia no nordeste do Brasil são escassos. Objetivo: O objetivo foi descrever os achados das biópsias e analisar comparativamente a apresentação clínico laboratorial entre as glomerulopatias primárias (GP) e as glomerulopatias secundárias (GS). Métodos: Estudo retrospectivo, realizado em dois hospitais públicos de ensino do estado de Pernambuco, nordeste do Brasil. Resultados: Foram avaliadas 1.151 biópsias, de 1998 a 2016. A amostra foi composta por 670 biópsias de rins nativos, após exclusão de patologias extra glomerulares e materiais inadequados. GP foram mais frequentes do que GS (58% × 42%). Dentre as GP, houve predomínio de glomeruloesclerose segmentar e focal (GESF). Glomerulonefrite membranoproliferativa e glomerulopatia colapsante foram responsáveis por 9% e 3% das GP, respectivamente. Das GS, as etiologias principais foram nefrite lúpica (67%) e infecciosas (10%). Sexo feminino, hematúria e nível elevado de creatinina estiveram relacionadas a uma maior chance de GS na análise multivariada. Síndrome nefrótica foi mais comum dentre as GP, já anormalidades urinárias e síndrome nefrítica prevaleceram nos pacientes com GS. Conclusões: Este é o primeiro registro de glomerulopatias do nordeste do Brasil. Demonstrou-se também uma análise comparativa das principais alterações clínico laboratoriais das GP e GS, com classificações atualizadas das doenças glomerulares.

Prevalencia de enfermedad renal en pacientes adolescentes internados en el Servicio de Nefrología del Hospital de Niños Dr. Ricardo Gutierrez / Prevalence of renal disease in adolescents patients treated in Nephrology Unit of Children´s Hospital Dr. Ricardo Gutierrez

Introducción: Los pacientes adolescentes representan un desafío para el nefrólogo. Aunque la patología renal del mismo se asemeja más a la del adulto, tiene una epidemiología única a considerar. Métodos: Estudio descriptivo, retrospectivo. Se relevaron 43 historias clínicas de pacientes entre 10 Y 18 anos ingresados por primera vez en nefrología entre enero de 2009 y mayo de 2011, analizando datos demográficos, motivo de consulta, lugar de referencia, tiempo entre inicio de síntomas y la referencia al servicio, días de internación, diagnóstico de enfermedad renal y causas de ingreso a diálisis. Resultados: Se internaron 394 pacientes, 136 fueron adolescentes. 43 internaciones de primera vez, y de estos, 24 mujeres. Edad promedio 13,5 años ± 2,37. 27 pacientes de provincia de Bs. As., 11 CABA, y 5 resto del País. 27 derivados desde nuestro propio hospital y 16 de otros centros médicos. Los síntomas y signos más frecuentes fueron hematuria, edemas, proteinuria y disminución del filtrado glornerular. La media entre inido de síntomas y la consulta fue 15 días (rango 1-30). Promedio de días de internación 13,7 (rango 2-95). Las patologías prevalentes fueron las glomerulopatias y la nefropatía lúpica la enfermedad renal más frecuente. 11 pacientes requirieron diálisis, y 9 permanentemente. Conclusiones: Los adolescentes presentan prevalencia patológica diferente a la de pediatría. La presencia de IRCT sin diagnóstico previo fue significativa.

Introduction: Teenager patients represent a challenge for Nephrologists. Although renal pathology of such patients is similar to adults, it has a unique epidemiology which must be considered. Methods: Retrospective, descriptive study. 43 clinical histories of patients between 10 and 18 years old admitted for the first time in Nephrology division between January 2009 and May 2011 were reported. We analyzed demographic data, consultation cause, reference place, time between the beginning of symptoms and the reference to the division, days of hospitalization, renal disease diagnosis and dialysis admission causes. Results: 394 patients were admitted, 136 were teenagers, 43 admissions for the first time and from these 24 women. Average age 13,5 years old +-2,37.27 patients from Buenos Aires province, 11 Capital City of Buenos Aires and 5 from the rest of the country. 27 referred from our own hospital and 16 from other medical centers. The 139 most frequent symptoms and signs were hematuria, edema, proteinuria and decrease of glomerular filtration. The average between the beginning of symptoms and consultation was 15 days (range1-30). Admission day average 13,7(range 2-95). Prevalent pathologies were glomerulopathies and lupic nephropathy the most frequent renal disease. 11 patients required dialysis. Conclusions: Teenagers show different pathological evidence in comparison to pediatrics. The presence of IRCT without previous diagnosis was significant.

Henoch-Schõnlein purpura: recurrence and chronicity

OBJETIVOS: Descrever um grupo de pacientes com púrpura de Henoch-Schõnlein seguido em nosso serviço, com ênfase nos casos recorrentes e crônicos, e comparar pacientes com doença monocíclica ou recorrente segundo características clínicas e demográficas. MÉTODOS: Foram avaliados dados de 67 pacientes atendidos desde o início da doença. Doze pacientes foram excluídos, pois abandonaram o seguimento antes de 3 meses de acompanhamento, sendo incluídas 55 crianças no estudo. Recorrência foi definida pela presença de novo quadro após um período de 3 meses sem sintomas, e cronicidade como persistência de manifestações cutâneas, abdominais e renais por um período ≥ 12 meses. RESULTADOS: Foi observada recorrência em 8/55 pacientes (14,4 por cento) e cronicidade em quatro (7,2 por cento). Em 29/55 pacientes (52,7 por cento), foi constatada infecção como fator desencadeante. Curso monocíclico esteve presente em 43 pacientes (26 meninas, média de idade de 5,4 anos). Acometimento gastrointestinal e renal foi observado em 55,8 e 20,9 por cento dos pacientes, respectivamente. Dentre os 12 pacientes com púrpura de Henoch-Schõnlein recorrente ou crônica, três apresentaram artrite, quatro tiveram sinais e sintomas de comprometimento abdominal e sete de doença renal: hematúria microscópica em cinco, hematúria macroscópica em um e hematúria com proteinúria em um paciente. Idade de início tardia foi a única variável relacionada com a presença de recorrência (p < 0,05). CONCLUSÕES: Como observado na literatura médica, o curso monocíclico é mais freqüente nas crianças com início da doença em idade mais precoce. Pacientes com púrpura de Henoch-Schõnlein devem ser seguidos a longo prazo, uma vez que recorrências e/ou cronicidade são observadas em mais de 20 por cento dos casos.

OBJECTIVES: To describe a group of patients treated at our service for Henoch-Schõnlein purpura, with emphasis on recurrent and chronic cases, and to compare clinical and demographic characteristics of patients with monocyclic and recurrent disease. METHODS: Data on 67 patients who had been treated since disease onset were analyzed. Twelve patients were excluded because they failed to return for follow-up consultations after less than 3 months, leaving a total of 55 children in the study sample. Recurrence was defined as the presence of a fresh episode after a period of at least 3 months without symptoms, and cases were defined as chronic when cutaneous, abdominal and renal manifestations persisted for a period of 12 months or more. RESULTS: Recurrence was observed in 8/55 patients (14.4 percent) and four cases were chronic (7.2 percent). In 29/55 patients (52.7 percent), infection was identified as the trigger factor. A monocyclic clinical course was observed in 43 patients (26 of whom were girls, with a mean age of 5.4 years). Gastrointestinal and renal involvement was observed in 55.8 and 20.9 percent of patients, respectively. Among the 12 patients with recurrent or chronic Henoch-Schõnlein purpura, three had arthritis, four exhibited signs and symptoms of abdominal involvement and seven of kidney disease: microscopic hematuria in five, macroscopic hematuria in one and hematuria with proteinuria in one other. Late onset was the only variable related to recurrence (p < 0.05). CONCLUSIONS: As is observed in medical literature, monocyclic cases are more common among children with early onset disease. Patients with Henoch-Schõnlein purpura should be followed over the long term, since recurrent and chronic cases account for more than 20 percent of the total.

Paquimeningitis hipertrófica, glomerulonefritis y vasculitis de pequeños vasos asociada a ANCA / Hypertrophic pachymeningitis, glomerulonephritis and P-ANCA associated small vessel vasculitis

La paquimeningitis hipertrófica es una enfermedad poco frecuente caracterizada por engrosamiento de la duramadre. Presentamos una paciente con esta enfermedad que se manifestó con cefalea crónica y en la que concomitantemente se evidenció una glomerulonefritis necrotizante extracapilar pauciinmune asociada a anticuerpos anticitoplasma de neutrófilos de patrón perinuclear (ANCA-P). El diagnóstico se estableció por resonancia nuclear magnética. Recibió tratamiento inmunosupresor con prednisona y ciclofosfamida con evolución favorable.

Hypertrophic pachymeningitis is a very unusual disease, the main characteristic of which is thickening of the dura mater. We describe a patient who started this illness showing chronic headache and pauci-immune necrotizing extracapillary perinuclear antineutrophil cytoplasmic antibody (P-ANCA) associated glomerulonephritis. The diagnosis was made by brain magnetic resonance image. She received immunosuppressant therapy with prednisonel and cyclophosphamide with clinical improvement.

Alterações morfológicas e funcionais dos rins de cães com insuficiência renal crônica / Morphologic and functional alterations of the kidneys of dogs with chronic renal failure

Alterações morfológicas de 11 casos de cães com insuficiência renal foram caracterizadas e classificadas de acordo com os padrões estabelecidos pela Organização Mundial de Saúde para seres humanos. Glomerulonefrite esclerosante difusa foi diagnosticada em 82,0 por cento dos animais e nefrite intersticial crônica nos 18,0 por cento restantes. Os tipos e freqüência das lesões identificadas foram similares às encontradas na literatura para a insuficiência renal crônica.

Morphologic alterations of 11 cases of dogs with renal failure were characterized and classified according to the patterns established by the World Health Organization for human beings. Diffuse sclerosing glomerulonephritis was diagnosed in 82.0 percent of the animals and chronic interstitial nephritis in the remaining 18.0 percent. The types and frequencies of lesions were similar to the those noticed in the literature for chronic renal failure.

La progresión de la enfermedad renal: una revisión / The progression of renal disease: a review

La progresión de la enfermedad renal es un tema de actualidad para los nefrólogos y otros integrantes del equipo de salud que se ocupan de este tipo de enfermedades. Su importancia deriva del hecho de que con un tratamiento conservador adecuado se puede retardar el inicio de los tratamientos de suplencia los cuales son muy costosos y aún de dificil realización en países como los nuestros en los cuales más del 40 por ciento de la población vive en pobreza crítica. En este trabajo se presentan las bases fisiopatológicas de la enfermedad renal, los factores de riesgo que aceleran la progresión de la enfermedad renal y algunas medidas terapeúticas que mejoran dicha progresión

Síndrome de Sweet asociado a compromiso articular y renal / Sweet syndrome associated with articular and renal involvement

We report a 29 years old female presenting with fever and painful infiltrated erythematous and violaceous plates with pseudo vesicles in the surface, located in both arms, four days after having suffered a tonsillitis. She was admitted with the diagnosis of Sweet syndrome and the lesions disappeared spontaneously. Two months later, she presented with a similar condition, again after an upper respiratory infection. Five months later, she was admitted with arthralgias with positive rheumatoid factor and antinuclear antibodies. Three years after the first admission, she was admitted with an acute glomerulonephritis and renal failure after another upper respiratory infection. Sweet syndrome was described in 1964 and, although initially considered benign, its association with inflammatory diseases or cancer has been reported

Tuberculosis: búsquedas de Antígenos de Mycobacterium en glomérulos / Tuberculosis: searching for mycobacterium antigens in glomerull

El objetivo del presente trabajo fue conocer la frecuencia de glomerulonefritis secundaria a tuberculosis, mediante el estudio retrospectivo de 42 autopsias y 3 biopsias post-mortem de 45 pacientes portadores de tuberculosis y lesion renal. Se realizó el estudio en el Instituto de Patología de la Facultad de Medicina-UNMSM. Se identificó por técnicas de inmunomicroscopía la presencia de antígenos del Mycobacterium en glomérulos renales, clasificándose la lesión glomerular de acuerdo a lo recomendado por la OMS en 1988. Posteriormente, se realizó la corelación clínico-patológica. Encontramos antígenos de Mycobacterium en los glomérulos en el 37,8 por ciento de los casos estudiados; en todos los casos positivos, la lesión glomerular correspondió a glomerulonefritis membranoproliferativa o mesangiocapilar; los pacientes portadores de glomerulonefritis secundaria a tuberculosis tenían lesión tuberculosa crónica, preferentemente pulmonar.

Anemia refractaria al uso de la eritropoyetina recombinante humana en un paciente con insuficiencia renal crónica terminal / Refractory anemia to the use of the erythopoyetin human recombinante in a patient with inadequacy renal terminal chronicle

Presentamos un caso de un paciente con insuficiencia renal crónica terminal secundaria a glomerulonefritis crónica y en hemodiálisis; con anemia refractaria al uso de la eritropoyetina recombinante humana. Utilizamos dosis de 50 Uds/kg post-hemodiálisis, vía subcutánea, con una frecuencia de diálisis de 2 ó 3 por semana, aumentando la dosis de acuerdo a la respuesta; encontrando niveles de hierro sérico bajos, niveles de ferritina elevados y, a nivel de médula ósea, depósitos importantes de hemosiderina

Estudo comparativo entre glomerulonefrite aguda pós-infecçäo estreptocócica cutânea e de orofaringe / Comparative study between acute glomerulonephritis post-infections streptococcal cutanea and of oropharynx

Existem diferença epidemiológica e bacteriológicas bem documentadas entre glomerulonefrite difusa aguda (GNA) após infecçäo de orofaringe e de pele. O objetivo deste estudo foi comparar estas duas situaçöes quanto às manifestaçöes clínicas e determinaçöes laboratoriais. Foram estudadas 77 crianças, entre 2 e 12 anos de idade, portadoras de GNA sintomática, distribuídas em três grupos; Grupo I- constituído por crianças com infecçäo de orofaringe; Grupo II- constituído por crianças com infecçäo de pele; e Grupo III- constituído por crianças sem evidências de infecçäo estreptocócica. Os grupos foram comparados quanto à idade de aparecimento da doença, sexo, presença de hematúria de 24 horas, determinaçöes séricas de uréia e creatinina, sódio, potássio, complemento, antiestreptolisina O. Näo houve diferenças significantes quando comparados os três grupos. A incidência de complicaçöes foi pequena, sugerindo que GNA na infância é benigna com boa evoluçäo a curto prazo. Metade dos casos apresentou infecçäo cutânea, chamando a atençäo para a necessidade do tratamento precoce de piodermite no nosso meio. Conclui-se que o comportamento clínico e laboratorial de GNA, após infecçäo de pele e orofaringe, é semelhante, näo

Renal involvement in prolonged Salmonella bacteremia: the role of schistosomal glomerulopathy

Renal involvement has been well documented in patients with hepatosplenic schistosomiasis and in patients with prolonged Salmonella bacteremia (PSB). Whether there is a specific renal lesion related to PSB or the chronic bacterial infection aggravates a pre-existing schistosomal glomerulopathy has been a matter of controversy. To analyze the clinical manifestations and histopathological findings of the renal involvement, 8 patients with hepatosplenic schistosomiasis and PSB (group I) were compared with 8 patients with schistosomal glomerulopathy (group II) matched by sex and glomerular disease. The mean age in group I was 17.7 years. All patients presented with hematuria, in 4 cases associated with non-nephrotic proteinuria. In group II the mean age was 23 years; nephrotic syndrome was the clinical presentation in 7 of the 8 patients in the group. All patients in group I experienced remission of the clinical and laboratory abnormalities as the salmonella infection was cured; in group II the patients had persistent, steroid-resistant, nephrotic syndrome. On histological examination, no difference was noted between the two groups, except for pronounced glomerular hypercellularity and interstitial mononuclear cell infiltration in group I. These observations strongly suggest that PSB exacerbates a pre-existing sub-clinical schistosomal glomerulopathy by the addition of active lesions directly related to the prolonged bacteremia

Doença de Goodpasture: hemorragia pulmonar e glomerulonefrite mediadas por anticorpos antimembrana basal / Goodpasture's disease: antibasement membrane antibody mediated hemorrhagic pneumonitis and glomerulonephritis

Doença de Goodpasture tem sido o nome proposto como o mais adequado para denominar a doença induzida por auto-anticorpos antimembrana basal que se manifesta clinicamente com hemorragia pulmonar e glomerulonefrite. Nesta revisäo säo apresentados conceitos atuais sobre aspectos clínicos, laboratoriais, etiopatogênicos e terapêuticos dessa doença

Descripcion clinico-patologica de las enfermedades glomerulares: estudio de 383 biopsias renales / Clinical and pathological description of glomerular diseases: study of 383 kidney biopsies

Entre enero de 1983 y diciembre e 1988 estudiamos 383 biopsias renales realizadas en nuestra institucion. La edad promedio de los pacientes fue 29 +- 0.6 anos (ESM) y de ellos 176 (46%) fueron hombres. El criterio minimo de inclusion fue la presencia de por lo menos 5 glomerulos en la muestra para microscopia de luz. Trescientas sesenta y tres biopsias (95%) fueron percutaneas y 20 (5%) quirurgicas; el numero promedio de glomerulos en las primeras fue 16.5 +-0.4. Se realizo inmunofluorescencia en 137 casos (35.7%). Los diagnosticos clinicos fueron sindrome nefrotico en 161 casos (42%), glomerulonefritis (GN) en 108 (28.2%), hematuria aislada en 76 (19.8%) e insuficiencia renal (aguda o cronica) en 26 (6.8%). Los hallazgos anatomopatologicos mas importantes fueron cambios glomerulares minimos en 105 (30%), hialinosis focal y segmentaria en 81 (21.1%), GN proliferativa endocapilar difusa en 40(10.4%), glomerulopatia membranosa en 39 (10.2%), GN proliferativa endo y extracapilar difusa en 31 (8.1%), inclasificable en 27 (7%), GN membranoproliferativa tipo I en 16 (4.2%) y otros en 34 (8.8%). La correlacion entre la clinica y la anatomia patologica fue varible pero en general sigue el patron aceptado para cada entidad. La biopsia renal como instrumento insustituible para la clasificacion de las glomerulopatias, permite precisar los diagnosticos clinicos, disenar un manejo adecuado de los pacientes y formular un pronostico mas apropiado para cada caso. Nuestros hallazgos contribuyen a establecer un marco epidemiologico de referencia para facilitar el enfoque

Estudio de contactos familiares de casos de glomerulonefritis aguda postestreptocócica / Family contacts of post streptococcal acute glomerulonephritis

Este trabajo complementa la caracterización epidemiológica de la glomerulonefritis postestreptocócica (GNPE), considerando el estudio de contactos familiares. Se evaluó situación socioeconómica (SS), actividad estreptocócica (AE) serológica-bacteriológica y actividad nefrítica (AN). Se estudió 143 familias (868 personas), con grupo familiar promedio de 20,8 (51,8% mujeres y 48,2% hombres). Indice personas-pieza mayor que 4 (23,4%) e índice personas-cama mayor que 2 (21,4%). Vivienda y barrio, calificaron en el nivel más bajo (55,2% y 62,5%) de una clasificación convencional. El 13,5% de frotis faríngeos y el 47,7% de frotis cutáneos dio estreptococo grupo A. Títulos significativos de A.S.O. (333 UT) en el 20%, hematuria presente en 10,6%, C3 bajo en 17,7%. Ambos en 2,6%, y en 1,3% considerando AE en casos índices, contactos y población general: la SS familiar en pacientes con GNPE es de peor nivel que en la población general; la AE es mayor y existe AN subclínica, fundamentando así la prevención primaria en los contactos