Glomerulonefritis membranoproliferativa por depósitos de C3: Estudio clínicopatológico
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Fecha
2019
Autores
Camacho Londoño, Kelly
Lopez Palacio, Ismael
Oliveros Santiz, Mayra
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
Antecedentes: La Glomerulonefritis membranoproliferativa (GNMP) es un patrón de daño caracterizado en la microscopia de luz por hipercelularidad mesangial, engrosamiento de la membrana basal glomerular e interposición mesangial en la pared capilar. Avances recientes en el entendimiento de su patogénesis subyacente llevaron a un esquema de clasificación basado sobre los hallazgos en la inmunofluorescencia. La alteración de la regulación del complemento ha demostrado ser un factor de riesgo para el desarrollo de GNMP.
Objetivos: Determinar la prevalencia de los pacientes con Glomerulonefritis Membranoproliferativa con predominio de C3
Materiales y Métodos: Estudio descriptivo transversal. Los datos se extrajeron de NefroRed©, que es una plataforma Informática que contiene los datos socio-demográficos, antropométricos, clínicos y de laboratorio de 1200 pacientes con biopsias renales entre los años 2008 al 2014. Se seleccionaron para el estudio aquellas que mostraron el patrón de glomerulonefritis membranoproliferativa y depósito de C3 solo o predominante. Cada biopsia se estudió con microscopia de luz e inmunofluorescencia, la microscopia de luz incluyó Hematoxilina-Eosina, PAS, Jones y Tricrómico. La inmunofluorescencia se realizó con anticuerpos dirigidos contra IgG, IgA, IgM, C1Q, C3, Albumina, Fibrinógeno, Cadenas Livianas Kappa y Lambda.
Resultados: La edad promedio de los hombres fue de 42,3 años y para las mujeres fue de 36,7 años. La edad mínima fue 18 años. La edad máxima fue 69 años, 51,85% (n=14) de los pacientes fueron mujeres y 48,14%(n=13) fueron hombres. Las 1200 biopsias mostraron 58 lesiones GNMP (5%), de estos 58 casos, sólo 27 (46,55%) mostraron lesiones únicas o predominantes depósitos de C3.
Conclusiones: El 30% de los pacientes con GMP tienen como mecanismo patogénico la activación del complemento con depósito de complemento C3 en el glomérulo. Nuestro grupo de investigación ha encontrado el depósito de C3 una relación causal con GMP. La presentación clínica más frecuente es el síndrome nefrótico.
Background: Membranoproliferative glomerulonephritis (MPGN) is a pattern of damage characterized in the light microscopy by mesangial hypercellularity, thickening of the glomerular basement membrane and mesangial interposition in the capillary wall. Recent advances in the understanding of its underlying pathogenesis led to a classification scheme based on the findings in the inmunofluorencencia. Alteration complement regulation has proven to be a risk factor for the development of MPGN. Objective: To determine the prevalence of patients with Membranoproliferative Glomerulonephritis with predominance of C3 Materials and Methods: Cross-sectional study. The data were extracted from NefroRed©, a software platform that contains the socio-demographic, anthropometric, clinical and laboratory data of 1200 patients with kidney biopsies from 2008 to 2014. It was selected for the study those patients that showed the pattern of glomerulonephritis and membranoproliferative and C3 deposits only or predominant. Each biopsy was studied by light microscopy and immunofluorescence, light microscopy included hematoxylin-eosin, PAS, and Jones y Tricrómico. Immunofluorescence was performed using antibodies directed against IgG, IgA, IgM, C1q, C3, albumin, fibrinogen, Lightweight Kappa and Lambda chains. Results: Mean age of men was 42.3 years and women was 36.7 years. The mínimum age was 18 years. The maximum age was 69 years; 51.8% (n = 14) of patients were women. The 1200 biopsies showed 58 injuries MPGN (5%) of these 58 cases only 27 (46,55%) lesions showed C3 deposits only or predominant. Conclusions: 30% of patients with GMP have as pathogenic mechanism the complement activation with complement C3 deposition in the glomerulus. Our research group has found C3 deposition causally related to GMP. The most common clinical presentation is nephrotic syndrome.
Background: Membranoproliferative glomerulonephritis (MPGN) is a pattern of damage characterized in the light microscopy by mesangial hypercellularity, thickening of the glomerular basement membrane and mesangial interposition in the capillary wall. Recent advances in the understanding of its underlying pathogenesis led to a classification scheme based on the findings in the inmunofluorencencia. Alteration complement regulation has proven to be a risk factor for the development of MPGN. Objective: To determine the prevalence of patients with Membranoproliferative Glomerulonephritis with predominance of C3 Materials and Methods: Cross-sectional study. The data were extracted from NefroRed©, a software platform that contains the socio-demographic, anthropometric, clinical and laboratory data of 1200 patients with kidney biopsies from 2008 to 2014. It was selected for the study those patients that showed the pattern of glomerulonephritis and membranoproliferative and C3 deposits only or predominant. Each biopsy was studied by light microscopy and immunofluorescence, light microscopy included hematoxylin-eosin, PAS, and Jones y Tricrómico. Immunofluorescence was performed using antibodies directed against IgG, IgA, IgM, C1q, C3, albumin, fibrinogen, Lightweight Kappa and Lambda chains. Results: Mean age of men was 42.3 years and women was 36.7 years. The mínimum age was 18 years. The maximum age was 69 years; 51.8% (n = 14) of patients were women. The 1200 biopsies showed 58 injuries MPGN (5%) of these 58 cases only 27 (46,55%) lesions showed C3 deposits only or predominant. Conclusions: 30% of patients with GMP have as pathogenic mechanism the complement activation with complement C3 deposition in the glomerulus. Our research group has found C3 deposition causally related to GMP. The most common clinical presentation is nephrotic syndrome.
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Palabras clave
Glomerulonefritis, Membranoproliferativa, Complemento, Glomérulo e inmunofluorescencia, Glomerulonephritis, Membranoproliferative, Complement, Glomerulus and inmunofluorescence