Publication: Valor de la hematuria como factor predictor en la nefropatía
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2021-02-15
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Universidad Complutense de Madrid
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Abstract
La nefropatía por inmunoglobulina IgA (NIgA) o enfermedad de Berger, es la glomerulopatía primaria más frecuente en el mundo. Pese a que es una enfermedad heterogénea en su forma de presentación clínica, lo más habitual es que los enfermos que la padecen debuten con hematuria, proteinuria y en ocasiones distintos grados de insuficiencia renal. Existen otras formas menos frecuentes de presentación clínica, como el síndrome nefrótico, la hipertensión arterial maligna y el fracaso renal agudo (FRA).Sin embargo, independientemente de cuál sea la forma de presentación de la enfermedad, prácticamente el 100% de los enfermos al momento del debut presentan hematuria en mayor o menor grado. En el pasado se consideraba poco frecuente que los pacientes con NIgA desarrollaran insuficiencia renal crónica terminal (IRCT). Sin embargo, distintos trabajos han demostrado que la IRCT puede aparecer en el 20%-40% de los casos tras un seguimiento de 20 años. Los factores de riesgo predictores de una mala evolución en la NIgA más reconocidos son la hipertensión arterial (HTA), la proteinuria y la presencia de deterioro de la función renal al debut del cuadro. Recientemente también se han descrito algunas lesiones histológicas recogidas en la clasificación de Oxford y la proliferación extracapilar como importantes predictores de la enfermedad...
Immunoglobulin A nephropathy (IgAN) or Berger's disease is the most common primary glomerulopathy around the world. Although IgAN is characterized by its very heterogeneous clinical presentation, the most common is that patients with this disease develop hematuria, proteinuria and sometimes different degrees of renal failure at the debut of the disorder. There are other less frequent forms of clinical presentation, such as nephrotic syndrome, malignant hypertension and acute kidney injury (AKI).However, regardless of the form of presentation of the disease, practically 100% of patients at the time of debut have hematuria to a greater or lesser degree. In the past, it was thought that the development of end stage renal disease (ESRD) was a rare phenomenon among patients with IgAN. However, different studies have shown that it can appear in 20%-40% of cases after 20 years of follow-up. The most recognized risk factors for a poor evolution in IgAN patients are arterial hypertension, proteinuria and the presence of impaired renal function at the onset of the symptoms. Recently, some histological lesions collected in the Oxford classification and extracapilar proliferation have been described as important predictors of the disease too...
Immunoglobulin A nephropathy (IgAN) or Berger's disease is the most common primary glomerulopathy around the world. Although IgAN is characterized by its very heterogeneous clinical presentation, the most common is that patients with this disease develop hematuria, proteinuria and sometimes different degrees of renal failure at the debut of the disorder. There are other less frequent forms of clinical presentation, such as nephrotic syndrome, malignant hypertension and acute kidney injury (AKI).However, regardless of the form of presentation of the disease, practically 100% of patients at the time of debut have hematuria to a greater or lesser degree. In the past, it was thought that the development of end stage renal disease (ESRD) was a rare phenomenon among patients with IgAN. However, different studies have shown that it can appear in 20%-40% of cases after 20 years of follow-up. The most recognized risk factors for a poor evolution in IgAN patients are arterial hypertension, proteinuria and the presence of impaired renal function at the onset of the symptoms. Recently, some histological lesions collected in the Oxford classification and extracapilar proliferation have been described as important predictors of the disease too...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 01-10-2020