Vol. 13. Núm. 79.
Páginas 4675-4684 (Mayo 2023)

Actualización
Glomerulonefritis crónicas

Chronic glomerulonephritis

M. Pérez FernándezaC. Castillo TorresbJ. Mancha RamosaM. Morán MagrocA. Blasco Martínezb
Doi : https://10.1016/j.med.2023.05.003
Opciones
Resumen

Las glomerulonefritis crónicas son un conjunto de patologías basadas en la alteración estructural o funcional del glomérulo, debidas a la acción de un agente causal cuya etiología es muy diversa (anticuerpos frente a antígenos propios o frente a antígenos externos, daño secundario a fármacos o infecciones, alteraciones genéticas, etc.), con potencial riesgo de evolución hacia la enfermedad renal crónica. Se manifiestan en forma de alteraciones del sedimento urinario, es decir, síndrome nefrótico, síndrome nefrítico, proteinuria y/o hematuria aisladas. Algunos pacientes pueden asociar hipertensión y deterioro de función renal que pueden aparecer en algún momento durante el seguimiento, junto con las alteraciones en el sedimento, por lo que es necesario evaluar periódicamente a estos pacientes. Los hallazgos clínicos y analíticos pueden orientar hacia el diagnóstico, pero será mandatorio disponer del diagnóstico histológico mediante biopsia renal para poder dirigir el tratamiento inmunosupresor en aquellos casos en los que este esté indicado.

Palabras clave
Glomerulonefritis
Síndrome nefrótico
Hematuria
Abstract

Chronic glomerulonephritis are a set of diseases based on the structural or functional abnormality of the glomerulus due to the action of a causative agent whose etiology is highly diverse (antibodies against the antigens themselves or against external antigens, damage secondary to drugs or infections, genetic abnormalities, etc.), with a potential risk of progression to chronic kidney disease. They manifest in the form of urine sediment abnormalities, that is, nephrotic syndrome, nephritic syndrome, and isolated proteinuria and/or hematuria. Some patients may have associated hypertension and renal function deterioration that can appear at some point during follow-up, together with sediment abnormalities. Therefore, it is necessary to periodically evaluate these patients. The clinical and analytical findings can orient toward the diagnosis, but a histological diagnosis made through a renal biopsy is necessary in order to target immunosuppressive therapy in cases in which it is indicated.

Keywords
Glomerulonephritis
Nephrotic syndrome
Hematuria

Identifíquese

¿Aún no es suscriptor de la revista?

Comprar el acceso al artículo

Comprando el artículo el pdf del mismo podrá ser descargado

Teléfono para incidencias

De lunes a viernes de 9h a 18h (GMT+1) excepto los meses de julio y agosto que será de 9 a 15h

Llamadas desde España 932 415 960
Llamadas desde fuera de España +34 932 415 960
Bibliografía
[1]
M. Vivarelli
202305231130092858
, L. Massella, B. Ruggiero, F. Emma.
Minimal change disease.
Clin J Am Soc Nephrol., (2017), 12 pp. 332-345
[2]
G.B. Appel
202305231130092859
, J. Radhakrishnan, V. D’Agati.
Secondary glomerular diseases.
Brenner and Rector's the kidney, 8ª ed., Saunders/Elsevier, pp. 1067-1146
[3]
J. Hogan
2023052311300928510
, J. Radhakrishnan.
The treatment of minimal change disease in adults.
J Am Soc Nephrol., (2013), 24 pp. 702-711
[4]
Kidney
2023052311300928511
2023052311300928512
disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work, Group.
KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases.
Kidney Int., (2021), 100 pp. S1-S276
[5]
A.Z. Rosenberg
2023052311300928513
, J.B. Kopp.
Focal segmental glomerulosclerosis.
Clin J Am Soc Nephrol., (2017), 12 pp. 502-517
[6]
R.J.H. Maas
2023052311300928514
, J.F.M. Wetzels, J.K.J. Deegens.
Serum-soluble urokinase receptor concentration in primary FSGS.
Kidney Int., (2012), 81 pp. 1043-1044
[7]
V.D. D’Agati, A.B. Fogo, J.A. Bruijn, J.C. Jennette.
Pathologic classification of focal segmental glomerulosclerosis: a working proposal.
Am J Kidney Dis., (2004), 43 pp. 368-382
[8]
L.P. Laurin
2023052311300928515
, A.M. Gasim, C.J. Poulton, S.L. Hogan, J.C. Jennette, R.J. Falk, et al.
Treatment with glucocorticoids or calcineurin inhibitors in primary FSGS.
Clin J Am Soc Nephrol., (2016), 11 pp. 386-394
[9]
P.N. Cunningham
2023052311300928516
, R.J. Quigg.
Contrasting roles of complement activation and its regulation in membranous nephropathy.
J Am Soc Nephrol., (2005), 16 pp. 1214-1222
[10]
J.M. Hofstra
2023052311300928517
, L.H. Beck Jr., D.M. Beck, J.F. Wetzels, D.J. Salant.
Anti-phospholipase A2 receptor antibodies correlate with clinical status in idiopathic membranous nephropathy.
Clin J Am Soc Nephrol., (2011), 6 pp. 1286-1291
[11]
A.S. De
2023052311300928518
2023052311300928519
Vriese, R.J. Glassock, K.A. Nath, S. Sethi, F.C. Fervenza.
A Proposal for a serology-based approach to membranous nephropathy.
J Am Soc Nephrol., (2017), 28 pp. 421-430
[12]
R. Wyatt
2023052311300928520
, B. Julian.
IgA Nephropathy.
N Engl J Med, (2013), 368 pp. 2402-2414
[13]
Working
2023052311300928521
2023052311300928522
Group of the International IgA Nephropathy Network and the Renal Pathology Society, D.C. Cattran, R. Coppo, H.T. Cook, J. Feehally, I.S. Roberts, S. Troyanov, et al.
The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification.
Kidney Int., (2009), 76 pp. 534-545
[14]
S.J. Barbour
2023052311300928523
, R. Coppo, H. Zhang, Z.H. Liu, Y. Suzuki, K. Matsuzaki, et al.
Application of the International IgA nephropathy prediction tool one or two years post-biopsy.
Kidney Int., (2022), 102 pp. 160-172
[15]
D.C. Wheeler
2023052311300928524
2023052311300928525
, R.D. Toto, B.V. Stefánsson, N. Jongs, G.M. Chertow, T. Greene, et al.
DAPA-CKD Trial Committees and Investigators. A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathy.
Kidney Int., (2021), 100 pp. 215-224
[16]
S. Sethi
2023052311300928526
, F.C. Fervenza.
Membranoproliferative glomerulonephritis - a new look at an old entity.
N Engl J Med., (2012), 366 pp. 1119-1131
[17]
S. Sethi
2023052311300928527
, F.C. Fervenza, Y. Zhang, L. Zand, J.A. Vrana, S.H. Nasr, et al.
C3 Glomerulonephritis: clinicopatological findings, complement abnormalities glomerular, proteomic profile, treatment and follow up.
Kidney Int., (2012), 82 pp. 465-473