RESUMO
Introducción. La biopsia renal percutánea es uno de los procedimientos que más ha contribuido al conocimiento de las enfermedades renales. Nuestro país no cuenta con datos actualizados sobre este tema en específico. Nuestro objetivo es reportar la proporción de los diferentes tipos de la glomerulopatías primarias y secundarias en las biopsias renales ejecutadas por el Servicio de Nefrología del Hospital Nacional Dos de Mayo desde el año 2007 al año 2016. Métodos. Series de casos retrospectivo con revisión de fichas clínicas en el Servicio de Nefrología del Hospital Nacional Dos de Mayo. Se tomó el registro de biopsias renales del Servicio de Nefrología desde el año 2007 al 2016. Se revisaron los resultados de los reportes de biopsias renales, los resultados se reportan en proporciones. Resultados. Se registraron 139 biopsias renales. En relación con las glomerulopatías primarias, la causa más frecuente reportada fue la glomerulonefritis focal y segmentaria luego la glomerulonefritis membranoproliferativa con 50 (36%) y 26 (18,7%) casos respectivamente. Dentro de las glomerulopatías secundarias la causa más frecuente fue nefritis lúpica con 5 (3,6%) casos. Conclusiones. La glomerulonefritis focal y segmentaria es el reporte más frecuente en las biopsias efectuadas en los registros del Hospital Nacional Dos de Mayo. Este resultado se correlaciona con la casuística latinoamericana.
Introduction. Percutaneous renal biopsy is one of the procedures that has contributed most to the knowledgeof kidney diseases. Our country does not have updated data on this specific topic. Our objective is to report the proportion of different types of primary and secondary glomerulopathies in renal biopsies performed by the Nephrology Service of the National Hospital Dos de Mayo from 2007 to 2016. Methods. Retrospective case series with review of records clinics in the Nephrology Service of the Dos de Mayo National Hospital. The renal biopsies registry of the Nephrology Department was taken from 2007 to 2016. The results of the reports of renal biopsies were reviewed, the results are reported in proportions. Results. 139 kidney biopsies were recorded. In relation to primary glomerulopathies, the most frequent cause reported was focal and segmental glomerulonephritis, then membranoproliferative glomerulonephritis with 50 (36%) and 26 (18,7%) cases respectively. Within the secondary glomerulopathies the most frequent cause was lupus nephritis with 5 (3,6%) cases. Conclusions. The focal and segmental glomerulonephritis is the most frequent report in the biopsies carried out in the Dos de Mayo National Hospital. This result correlates with the Latin American casuistry.
RESUMO
Abstract The pauci-immune crescentic glomerulonephritis (PICGN) is generally associated with small-vessel vasculitis with a few reported cases associated with other autoimmune diseases such as Systemic Lupus Erythematosus (SLE). We present the case of a female 34-year-old patient with acute kidney injury symptoms with indication for renal replacement therapy in the context of clinical SLE diagnosis. A kidney biopsy was conducted and it was found that most glomeruli showed some segmental sclerosis with synechia to the Bowman's capsule. 67% of the glomeruli had fibroepithelial crescents. Moreover, the interstitial space had a moderate lymphomononuclear infiltration and mild fibrosis. In the arterioles, there were walls thickened by subintimal sclerosis. Direct immunofluorescence detected limited IgM and C3 deposits in capillary loops and negative mensangium for IgG, IgA and C1q. A therapy using corticosteroids and intravenous cyclophosphamide was initiated with stable evolution. PICGN associated with SLE is a rare pathology with clinical presentation, varied evolution and without a standard medical treatment.
Resumo A glomerulonefrite rapidamente progressiva pauci-imune apresenta-se geralmente associada a vasculite de pequenos vasos, com poucos casos associados a outras doenças imunes como o lúpus eritematoso sistêmico (LES). Apresentamos no presente artigo o caso de uma mulher de 34 anos de idade com sintomas de insuficiência renal aguda e indicação de terapia renal substitutiva, no contexto de diagnóstico clínico de LES. A biópsia renal realizada revelou que a maioria dos glomérulos apresentavam um certo grau de esclerose segmentar e sinéquias com a cápsula de Bowman. Sessenta e sete por cento dos glomérulos apresentava crescentes fibroepiteliais. Além disso, o espaço intersticial exibia infiltrado linfomononuclear moderado e fibrose discreta. Nas arteríolas, as paredes encontravam-se espessadas por esclerose subintimal. A imunofluorescência direta detectou depósitos limitados de IgM e C3 nas alças capilares e mesângio negativo para IgG, IgA e C1q. Tratamento com corticosteroides e ciclofosfamida endovenosa foi iniciado com evolução estável. A glomerulonefrite rapidamente progressiva pauci-imune associada a LES é uma patologia rara com manifestação clínica e evolução variada, sem tratamento clínico padronizado.