Miranda LJM, Sánchez GA, Saavedra SMA, Jara QLJ

Idioma: Español
Referencias bibliográficas: 41
Paginas: 117-124
Archivo PDF: 218.39 Kb.

RESUMEN

Objetivo: determinar la correlación del examen general de orina y la proteinuria de 24 horas, con el tipo histológico de glomerulonefritis lúpica y con los índices de actividad, cronicidad y patológico. Material y métodos: se revisaron expedientes clínicos de pacientes con lupus eritematoso sistémico (según criterios de la ARA, 1982) y glomerulone-fritis lúpica clasificada mediante biopsia renal per-cutánea. Se empleó estadística descriptiva; las diferencias entre proporciones se compararon con c2; para diferencias entre medias se usó análisis de varianza de una vía y la correlación de Pearson para estimar el grado de asociación. Resultados: se incluyeron 114 casos. Las biopsias renales mostraron dos casos con clase II, 17 con clase III, 83 con clase IV y 12 con clase V, de acuerdo con la Organización Mexicana de la Salud. Las alteraciones en el examen general de orina no correlacionaron significativamente con ninguna de las clases histológicas. Se observó correlación significativa entre albuminuria de 24 horas e índice de actividad (r = 0.25, p = 0.01), el índice de cronicidad (r = 0.3, p = 0.005) y el índice patológico (r = 0.3, p = 0.001). Aun cuando para predecir nefritis clase IV se observó correlación entre las anormalidades en el examen general de orina y anti-DNA de doble cadena, no alcanzó significancia estadística. Conclusiones: el examen general de orina no es un indicador del tipo de glomerulonefritis lúpica, sin embargo, la proteinuria mostró correlación signi-ficativa con los diferentes índices histopatológicos.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Kashgarian M, Wallace DJ, Hahn BH, Klippel JH. Lupus nephritis. En: Wallace DJ, Hahn BH, editors. Dubois’ lupus erythematosus. Textbook. Fifth edition. Williams and Wilkins; 1997. p. 1037-1066.

2. 2. Datta SK. Production of pathogenic antibodies. Cognate interactions between autoimmune T and B cells. Lupus 1998;7(9):585-590.

3. 3. Austin HA. Clinical evaluation and monitoring of lupus kidney disease. Lupus 1998;7(9):618-621.

4. 4. Domoto DT. The significance of electron dense deposits in mild lupus nephritis. Yale J Biol Med 1980;53:317-324.

5. 5. Cameron. Lupus nephritis. J Am Soc Nephrol 1999; 10(2):413-424.

6. 6. Hricik, Chung-Park. Glomerulonephritis. New Engl J Med 1998;339(13):888-898.

7. 7. Golbus J, McCune WJ. Lupus nephritis. Clasifi-cation, prognosis, immunopathogenesis and treat-ment. Rheum Clin North Am 1994;20:213-224.

8. 8. Boumpas DT, Balow JE. Outcome criteria for lupus nephritis trials. A critical overview. Lupus 1998; 7(9):622-629.

9. 9. Austin HA, Muenz LR, Joyce KM, et al. Prognostic factors in lupus nephritis. Contribution of renal histologic data. Am J Med 1983;75:382-391.

10. Austin HA, Muenz LR, Joyce KM, Antonovych TT, Balow JE. Diffuse proliferative lupus nephritis: identification of specific pathologic features affecting renal outcome. Kidney Int 1984;25:689-695.

11. Balow JE, Austin HA. Renal disease in systemic lupus erythematosus. Kidney Disease Section, National Institutes of Health, Bethesda, Maryland. Rheum Dis Clin North Am 1988;14:117-133.

12. Balow JE, Austin HA, Tsokos GC, Antonovych TT, et al. Lupus nephritis. NIH Conference. An Intern Med 1987;106:79-94.

13. Nakashima A. Serological and histological study of lupus nephritis with special reference to anti-SSA antibody. Nippon Jinzo Gakkai Shi 1989;31:743-755.

14. Appel GB, Coehn DJ, Pirani CL, et al. Long-term follow-up of patients with lupus nephritis. A study based on the classification of the World Health Organization. Am J Med 1987;83:877-885.

15. Esdaile JM, Federgreen W, Quintal H, et al. Predic-tors of one year outcome in lupus nephritis. The im-portance of renal biopsy. Q J Med 1991;81: 907-918.

16. Rahman P, Gladman DD, Ibáñez D, Urowitz MB. Sig-nificance of isolated hematuria and isolated pyuria in systemic lupus erythematosus. Lupus 2001;10:418-423.

17. Fairley KF, Birch DF. Microscopic urianalysis in glomerulonephritis. Kidney Int 1993;44:S9-S12.

18. Herbert LA, Dillon JJ, Middendorf, et al. Rela-tionship between appearance of urinary red blood cell/white blood cell casts and the onset of renal relapse in systemic lupus erythematosus. Am J Kidney Dis 1995;26:432-438.

19. Urowitz MB, Gladman DD, Tozman EC, Goldsmith CH. The lupus activity criteria count (LACC). J Rheumatol 1984;11:783-787.

20. Bombardier C, Gladman DD, Urowitz MB, et al. Derivation of the SLEDAI. A disease activity index for lupus patients. Arthritis Rheum 1992; 35:630-640.

21. Donadio JV, et al. Prognosis determinants in lupus nephritis: a long-term clinicopathologic study. Lupus 1995;4:109-115.

22. Austin HA, Boumpas DT, Vaughan EM, Balow JE. High-risk features of lupus nephritis: importance of race and clinical and histological factors in 166 pa-tients. Nephrol Dial Transplant 1995;10:1620-1628.

23. Mitjavila F, Pac V, Moga I, et al. Clinicopathological correlations and prognostic factors in lupus nephritis. Clin Exp Rheumatol 1997;15:625-631.

24. Tan EM, Cohen AS, Fries JF. The 1982 revised criteria for the classification of systemic lupus erythe-matosus. Arthritis Rheum 1982;25:1271-1277.

25. Churg J, Bernstein J, Glassock RJ. Lupus nephritis. En: Churg J, Bernstein J, Glassock RJ, editors. Renal diseases classification and atlas of glomerular diseases. New York: Igaku-Shoin; 1995. p. 151.

26. Berden JHM. Lupus nephritis. Kydney Int 1997;52: 538-558.

27. Conlon PJ, Fisher CA, et al. Clinical, biochemical, and pathological predictors of poor response to intra-venous cyclophosphamide in patients with prolife-rative lupus nephritis. Clin Nephrol 1996;46:170-175.

28. Austin HA, Klippel JH, Balow JE, LeRiche NGH, et al. Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs. New Engl J Med 1986;314:614-619.

29. Schwartz MM, Lan SP, Bernstein J, et al. Role of pathology indices in the management of severe lupus glomerulonephritis. Kidney Int 1992;42:743-748.

30. Remuzzi G, Negri M, et al. Gruppo Italiano per lo Studio della Nefrite Lupica (GINSEL). Lupus nephritis: Prognostic factors and probability of maintaining life-supporting renal function 10 years after diagnosis. Am J Kidney Dis 1992;19:473-479.

31. Schena FP, Gesualldo L, Grandallano G, Montinaro V. Progression of renal damage in human glomerulo-nephritis: Is there sleight of hand in winning the game? Kidney Int 1997;52:1439-1457.

32. Tanaka H, Akama H, Tominaga N, et al. Progres-sive renal failure in patients with lupus nephritis. J Intern Med 1993;234:257-262.

33. McLaughlin JR, Bombardier C, Farewell VT, et al. Kid-ney biopsy in systemic lupus erythematosus. III. Survival analysis controlling for clinical and labo-ratory variables. Arthritis Rheum 1994;37:559-567.

34. Neuman K, Wallace DJ, Azen C, et al. Lupus in the 1980s: III. Influence of clinical variables, biopsy, and treatment on the outcome in 150 patients with lupus nephritis seen at a single center. Sem Arthritis Rheum 1995;25:47-55.

35. Lim CS, Chin HJ, Jung YC, et al. Prognostic factors of diffuse proliferative lupus nephritis. Clin Nephrol 1999;52:139-147.

36. Nossent HC, Henzen-Logmans SC, Vroom TM, et al. Contribution of renal biopsy data in predicting outcome in lupus nephritis. Analysis of 116 patients. Arthritis Rheum 1990;33:970-977.

37. Jacobsen S, Starkilnt H, Petersen J, et al. Prognosis value of renal biopsy and clinical variables in patients with lupus nephritis and normal serum creatinine. Scand J Rheumatol 1999;28:288-299.

38. Hill GS, Delahousse M, Nochy D, et al. A new morphologic index for the evaluation of renal biopsies in lupus nephritis. Kidney Int 2000;58: 1160-1173.

39. Nakamura T, Ushiyama C, Suzuki S, et al. Urinary podocytes for the assessment of disease activity in lupus nephritis. Am J Med Sci 2000;320:112-116.

40. Miranda JM, Prieto RE, Paniagua R, García G, Amato D, Barile L, Jara LJ. Clinical significance of serum and urine prolactin levels in lupus glomerulo-nephritis. Lupus 1998;7:387-91.

41. Miranda JM, García-Torres R, Jara LJ, Medina F, Cervera H, Fraga A. Renal biopsy in systemic lupus erythematosus: significance of glomerular thrombosis. Analysis of 108 cases. Lupus 1994;3: 25-29.