Presentación atípica y evolución clínina de la nefropatía lúpica mesangial. Estudio de 20 pacientes / Atypical presentation and clinical course in mesangial lupus nephritis

La nefropatía lúpica mensangial (NL II) suele considerarse como de evolución benigna. Se caracteriza por hematuria y proteinuria mínimas, sedimento urinario y valores de depuración de creatinina (DCr) normales. Para evaluar las características clínicas y la evolución de la NL II se estudió a 20 pacientes del Servicio de Reumatología de nuestro centro, con este tipo de nefritis. Encontramos que un porcentaje significativo de estos pacientes no tenía la presentación clínica esperada. Comparamos los datos obtenidos entre los pacientes con presentación considerada clásica y los que tuvieron una presentación atípica. Para la evaluación de los resultados se empleó un análisis estadístico descriptivo y uno inferencial. Los pacientes eran 19 mujeres y 1 varón, con una edad promedio al diagnóstico de la nefropatía de 33,9 años y un tiempo de seguimiento de 4,2 años. Diecisiete de los pacientes tuvieron presentación clínica inusual caracterizada por sedimento urinario anormal (12 pacientes), proteinuria mayor de 1 g/día (7) y disminución en la DCr (14). Dieciséis pacientes presentaron remisión con el tratamiento, con recidiva posterior de la nefritis en 8, que nuevamente respondió al tratamiento. En 5 pacientes se demostró modificación histológica en la nefropatía a NL III y NL IV. Al final del seguimiento, 4 pacientes progresaron a insuficiencia renal crónica. En nuestro grupo de pacientes la NL II no tuvo un comportamiento inicial tan benigno como se describe habitualmente. A pesar de la buena respuesta inicial, el 20% evolucionó a daño renal crónico. La proteinuria inicial y la hiperlipidemia parecen implicar riesgo de evolución más agresiva(AU)

Mesangial lupus nephritis (type II according to the WHO classification) is usually considered a benign variant. Its clinical manifestations are minimal: hematuria and proteinuria, normal sediment, and normal renal function. To evaluate the clinical manifestations and course in mesangial nephritis, we studied 20 patients with a histological diagnosis of type II lupus nephritis who attended our clinic. We found that clinical presentation was atypical in a significant proportion of these patients. Data from the two groups of patients were compared: those with classical presentation and those with atypical presentation. The results were analyzed with descriptive and inferential statistics. Twenty patients (19 women and 1 man) were included. The mean age at nephritis onset was 33.9 years and the mean length of follow-up was 4.2 years. Clinical presentation was atypical in 17 patients, with active urinary sediment in 12, urine protein > 1 g/24 h in 7, and reduction in creatinine clearance in 14. Clinical remission was achieved with treatment in 16 patients, with subsequent flares in 8. All flares responded well to treatment. Biopsies in 5 patients with flares showed progression to type III and IV nephritis. At the end of the follow-up period, 4 patients had chronic renal failure. Some of our patients with mesangial lupus nephritis did not have the benign course that is usually described. Despite a good initial response, 20% of the patients progressed to chronic renal failure. Initial hyperlipidemia and proteinuria seem to correlate with a more aggressive course(AU)

[Atypical presentation and clinical course in mesangial lupus nephritis]. / Presentación atípica y evolución clínina de la nefropatía lúpica mesangial. Estudio de 20 pacientes.

Mesangial lupus nephritis (type II according to the WHO classification) is usually considered a benign variant. Its clinical manifestations are minimal: hematuria and proteinuria, normal sediment, and normal renal function. To evaluate the clinical manifestations and course in mesangial nephritis, we studied 20 patients with a histological diagnosis of type II lupus nephritis who attended our clinic. We found that clinical presentation was atypical in a significant proportion of these patients. Data from the two groups of patients were compared: those with classical presentation and those with atypical presentation. The results were analyzed with descriptive and inferential statistics. Twenty patients (19 women and 1 man) were included. The mean age at nephritis onset was 33.9 years and the mean length of follow-up was 4.2 years. Clinical presentation was atypical in 17 patients, with active urinary sediment in 12, urine protein>1 g/24 h in 7, and reduction in creatinine clearance in 14. Clinical remission was achieved with treatment in 16 patients, with subsequent flares in 8. All flares responded well to treatment. Biopsies in 5 patients with flares showed progression to type III and IV nephritis. At the end of the follow-up period, 4 patients had chronic renal failure. Some of our patients with mesangial lupus nephritis did not have the benign course that is usually described. Despite a good initial response, 20% of the patients progressed to chronic renal failure. Initial hyperlipidemia and proteinuria seem to correlate with a more aggressive course.