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ANTICUERPOS ANTIFOSFOLIPIDOS EN LA NEFRITIS LUPICA

ANTICUERPOS ANTIFOSFOLIPIDOS EN LA NEFRITIS LUPICA

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En los pacientes con lupus eritematoso sistémico, la presencia de anticuerpos antifosfolípidos positivos es elemento de predicción de mal pronóstico renal.
Autor:
Gabriella Moroni
Columnista Experto de SIIC
Artículos publicados por Gabriella Moroni
Coautores
Beniamina Gallelli* Piergiorgio Messa* Claudio Ponticelli** 
Fondazione Ospedale Maggiore, Milán, Italia*
IRCCS Neuromed, Pozzilli, Italia**
Recepción del artículo
25 de Febrero, 2007
Aprobación
30 de Marzo, 2007
Primera edición
12 de Febrero, 2008
Segunda edición, ampliada y corregida
17 de Febrero, 2010

Resumen
Se ha descrito un espectro amplio de manifestaciones clínicas en asociación con los anticuerpos antifosfolípidos (Ac aFL), como estenosis de la arteria renal, infarto renal, trombosis de la vena renal y el cuadro descrito más recientemente, "nefropatía por anticuerpos antifosfolípidos (NAAF)": lesiones vasooclusivas de los vasos intrarrenales que asocian trombosis aguda con lesiones arteriolares crónicas que conducen a una zona de atrofia isquémica cortical. Se ha demostrado que la NAAF aguda y crónica se asocia significativamente con la presencia de Ac aFL en pacientes con nefritis lúpica. Desde un punto de vista clínico las manifestaciones renales de la nefritis lúpica y las de la NAAF pueden ser similares. Se observa más a menudo insuficiencia renal e hipertensión arterial en la NAAF, mientras que la proteinuria y la hematuria son más frecuentes en la nefritis lúpica. El impacto de los Ac aFL sobre la historia natural de la nefritis lúpica está lejos de ser claro. En teoría, las lesiones renales histológicas producidas por Ac aFL así como la aparición de hipertensión arterial persistente en una cantidad importante de pacientes positivos para Ac aFL con nefritis lúpica deben considerarse elementos de predicción de mal pronóstico renal. En nuestra experiencia, después de un seguimiento medio de 14 años, el 45% de los pacientes Ac aFL positivos comparados con el 19.5% de los pacientes negativos (p = 0.01) sufrieron insuficiencia renal crónica.

Palabras clave
anticuerpos antifosfolípidos, síndrome antifosfolipídico, nefropatía por anticuerpos antifosfolípidos, nefritis lúpica, pronóstico renal


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Abstract
A large spectrum of renal manifestations has been described in association with antiphospholipid antibodies (aPL Ab) such as renal artery stenosis, renal infarction, renal vein thrombosis, and the more recently described "antiphospholipid antibodies nephropathy" (APSN): a vaso occlusive lesions of intrarenal vessels associating acute thrombosis with chronic arteriolar lesions leading to zone of cortical ischemic atrophy. Acute and chronic APSN have been demonstrated to be significantly associated with presence of aPL Ab in patients with lupus nephritis (LN). From a clinical point of view the renal manifestations of LN and those of APSN may be similar. Renal insufficiency and arterial hypertension are more frequently observed in APSN while proteinuria and hematuria are more frequent in LN. The impact of aPL Ab on the natural history of lupus nephritis is still far from being clarified. Theoretically the histologic renal lesions caused by aPL Ab as well as the development of persistent arterial hypertension in a consistent number of aPL Ab positive patients with LN should be considered as predictors of a bad renal outcome. In our experience, after a mean follow-up of 14 years, 45% of aPL Ab positive patients vs 19.5% of negative patients (p = 0.01) developed chronic renal insufficiency.

Key words
antiphospholipid antibodies, antiphospholipid syndrome, antiphospholipid antibodies nephropathy, lupus nephritis, renal prognosis


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Clasificación en siicsalud
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Especialidades
Principal: Diagnóstico por Laboratorio, Nefrología y Medio Interno
Relacionadas: Anatomía Patológica, Bioquímica, Inmunología, Medicina Interna, Reumatología



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Enviar correspondencia a:
Gabriella Moroni, Fondazione Ospedale Maggiore Divisione di Nefrologia & Dialisi, 20122, Via della Commenda 15, Milán, Italia
Patrocinio y reconocimiento:
Agradecimiento: Este estudio fue financiado por la beca "Proyecto sobre glomerulonefritis" en memoria de Pippo Neglia.
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