Comparación de los hallazgos histopatológicos con la respuesta clínica en los pacientes con biopsia renal consecutiva en nefritis lúpica 2008-2021
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Fecha
2023
Autores
Villadiego Rojas, Rafael Emigdio
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
El Lupus eritematoso sistémico (LES) es una enfermedad autoinmune inflamatoria, que involucra varios sistemas, como el renal, membranas vasculares y serosas, con un aumento significativo de la morbimortalidad. La nefritis lúpica (NL) implica peor pronóstico para los pacientes con LES, la biopsia renal es la mejor herramienta para su diagnóstico siendo un método seguro, con una baja tasa de complicaciones, que se presentan usualmente durante las primeras 24 horas.
Objetivo: Evaluar la relación entre los hallazgos histopatológicos y la respuesta clínica en pacientes con nefritis lúpica que han tenido una biopsia renal consecutiva entre 2008 y 2021
Material y Métodos: Estudio observacional, analítico y retrospectivo; se analizó la base de datos de biopsia renal de la Clínica de la Costa, desde el año 2008 hasta el 2021
Resultados: La mediana del tiempo transcurrido entre la primera y la segunda biopsia renal fue de 850 días, Se encontraron diferencias significativas en el índice de cronicidad, siendo este mayor al momento de la segunda biopsia (p <0.001). Los valores de creatinina y complemento C4 fueron significativamente mayores al momento de la segunda biopsia (p-valor=0.007 y p-valor=0.005 respectivamente). Para la tasa de filtración glomerular y la proteína urinaria también se hallaron diferencias significativas, pero en estos casos los valores disminuyeron entre la primera y la segunda biopsia (p-valores = 0.002 y 0.035, respectivamente).
Conclusión: La biopsia renal consecutiva puede ser una herramienta útil en NL, con baja tasa de complicaciones y con posibilidad de brindar un manejo médico óptimo basado en hallazgos histopatológicos.
Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease, which involves several systems, such as the renal, vascular and serous membranes, with a significant increase in morbidity and mortality. Lupus nephritis (LN) implies worse prognosis for patients with SLE, and renal biopsy is the best diagnostic tool. It is a safe method, with a low rate of complications, which usually occur during the first 24 hours. Objective: Evaluate the relationship between the histopathological findings and the clinical response of patients with lupus nephritis that have had a consecutive renal biopsy between 2008 and 2021. Material and Methods: Observational, analytical and retrospective study; the renal biopsy database of Clínica de la Costa was analyzed, from 2008 to 2021. Results: The median time elapsed between the first and second renal biopsy was 850 days, Significant differences were found in the chronicity index, being higher at the time of the second biopsy (p<0.001). Creatinine and complement C4 values were significantly higher at the time of the second biopsy (p-value=0.007 and p-value=0.005 respectively). For glomerular filtration rate and urinary protein significant differences were also found, but in these cases the values decreased between the first and second biopsy (p-values=0.002 and 0.035, respectively). Conclusion: Consecutive renal biopsy can be a useful tool in LN, with low complication rate and possibility to provide optimal medical management based on histopathological findings.
Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease, which involves several systems, such as the renal, vascular and serous membranes, with a significant increase in morbidity and mortality. Lupus nephritis (LN) implies worse prognosis for patients with SLE, and renal biopsy is the best diagnostic tool. It is a safe method, with a low rate of complications, which usually occur during the first 24 hours. Objective: Evaluate the relationship between the histopathological findings and the clinical response of patients with lupus nephritis that have had a consecutive renal biopsy between 2008 and 2021. Material and Methods: Observational, analytical and retrospective study; the renal biopsy database of Clínica de la Costa was analyzed, from 2008 to 2021. Results: The median time elapsed between the first and second renal biopsy was 850 days, Significant differences were found in the chronicity index, being higher at the time of the second biopsy (p<0.001). Creatinine and complement C4 values were significantly higher at the time of the second biopsy (p-value=0.007 and p-value=0.005 respectively). For glomerular filtration rate and urinary protein significant differences were also found, but in these cases the values decreased between the first and second biopsy (p-values=0.002 and 0.035, respectively). Conclusion: Consecutive renal biopsy can be a useful tool in LN, with low complication rate and possibility to provide optimal medical management based on histopathological findings.
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Palabras clave
Lupus eritematoso sistémico, Nefritis lúpica, Biopsias renal consecutivas, Índice de actividad, Índice de cronicidad, Systemic lupus erythematosus, Lupus nephritis, Consecutive renal biopsies, Activity index, Chronicity index
