Publication: Glomerulopatía del trasplante y su relación con el virus de la hepatitis C
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2017-09-20
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Universidad Complutense de Madrid
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Abstract
El trasplante renal es la terapia de elección para la mayoría de los pacientes con Enfermedad Renal Crónica en diálisis. En los pacientes que además presentan infección crónica por el virus de la hepatitis C (VHC) es igualmente la mejor opción terapéutica, ya que su supervivencia es mayor que la de los pacientes que se mantienen en lista de espera de trasplante renal. El virus de la hepatitis C (VHC), es un RNA virus de la cadena simple y polaridad positiva que pertenece a la familia Flaviviridae, que provoca hepatitis aguda o cronificación de la enfermedad a lo largo del tiempo, manteniéndose estabilizada o evolucionando hacia la fibrosis-cirrosis o hepatocarcinoma como principales manifestaciones hepáticas, con un importante aumento de la morbimortalidad de los pacientes. Afortunadamente en los últimos años, estamos asistiendo a una disminución de la prevalencia fundamentalmente en los países desarrollados, no obstante, la prevalencia del VHC en la población en diálisis, fundamentalmente en hemodiálisis, es mayor que en la población general. Cuando se ha evaluado la supervivencia de los injertos y de los pacientes trasplantados renales seropositivos para el VHC, se objetiva en diversos estudios y metanálisis que es significativamente menor que la de los seronegativos. La razón de esta diferencia viene condicionada por la morbimortalidad asociada al VHC + que presentan estos pacientes, de carácter hepático y extrahepático, además de poder generar diversas lesiones de novo o de recidiva sobre el propio injerto renal entre las que destaca la glomerulonefritis membrano-proliferativa, entre otras. Recientemente se ha relacionado a la infección por el VHC con una lesión histológica de mal pronóstico llamada glomerulopatía del trasplante...
Kidney transplant is the therapy of choice for most patients with chronic kidney disease on dialysis. In patients who in addition present chronic infection by hepatitis C virus (HCV) it is also the best therapeutic option, because their survival is greater than patients on the waiting list for a kidney transplant. Hepatitis C virus (HCV) is a RNA virus of the single chain and positive polarity which belongs to the Flaviviridae family. It causes acute hepatitis or chronic disease over time, remaining stable or progressing to fibrosis-cirrhosis or hepatocellular carcinoma as main manifestations, with a significant increase in patients morbidity and mortality. Fortunately, in recent years, we are witnessing a decline in the prevalence mainly in developed countries. However, the prevalence of HCV in the dialysis population, mainly in hemodialysis, is higher than in the general population. To assess the graft survival and renal transplant of seropositive patients for HCV, it is objective in several studies and meta-analysis, that it is significantly lower than that of seronegative. The reason for this difference is conditioned by the morbidity and mortality associated with HCV+ presented by these patients of hepatic and extra hepatic character, besides being able to generate several new lesions or recurrence of kidney graft itself most notably membranous-proliferative glomerulonephritis, inter alia. Recently HCV infection has been linked to a poor prognosis histological lesion called transplant glomerulopathy. Transplant glomerulopathy (TG) is a histological lesion characterized by glomerular basement membrane reduplication in the absence of electron-dense deposits. Clinically, it is manifested by impaired renal function and increased proteinuria which can reach the nephrotic range...
Kidney transplant is the therapy of choice for most patients with chronic kidney disease on dialysis. In patients who in addition present chronic infection by hepatitis C virus (HCV) it is also the best therapeutic option, because their survival is greater than patients on the waiting list for a kidney transplant. Hepatitis C virus (HCV) is a RNA virus of the single chain and positive polarity which belongs to the Flaviviridae family. It causes acute hepatitis or chronic disease over time, remaining stable or progressing to fibrosis-cirrhosis or hepatocellular carcinoma as main manifestations, with a significant increase in patients morbidity and mortality. Fortunately, in recent years, we are witnessing a decline in the prevalence mainly in developed countries. However, the prevalence of HCV in the dialysis population, mainly in hemodialysis, is higher than in the general population. To assess the graft survival and renal transplant of seropositive patients for HCV, it is objective in several studies and meta-analysis, that it is significantly lower than that of seronegative. The reason for this difference is conditioned by the morbidity and mortality associated with HCV+ presented by these patients of hepatic and extra hepatic character, besides being able to generate several new lesions or recurrence of kidney graft itself most notably membranous-proliferative glomerulonephritis, inter alia. Recently HCV infection has been linked to a poor prognosis histological lesion called transplant glomerulopathy. Transplant glomerulopathy (TG) is a histological lesion characterized by glomerular basement membrane reduplication in the absence of electron-dense deposits. Clinically, it is manifested by impaired renal function and increased proteinuria which can reach the nephrotic range...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina Interna, leída el 26-01-2016