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2014, Número 2

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MEDICC Review 2014; 16 (2)


Actualización sobre enfermedad renal crónica de etiología desconocida en la zona seca norte-central de Sri Lanka

Wanigasuriya K

Idioma: Español
Referencias bibliográficas: 45
Paginas: 61-65
Archivo PDF: 235.00 Kb.


RESUMEN

Introducción: Este manuscrito actualiza una revisión previamente publicada en una revista local en el 2012, sobre una nueva forma de enfermedad renal crónica de causa desconocida que ha surgido hace más de dos décadas en la zona seca norte central de Sri Lanka, donde las causas subyacentes parecen ser indeterminadas. La carga de la enfermedad es más elevada en esta área, particularmente en la provincia norte central y afecta a una población rural y socialmente desventajada involucrada en el cultivo de arroz. En las últimas décadas algunos de los estudios se han encaminado a estimar la prevalencia e identificar factores determinantes de la enfermedad renal crónica de etiología desconocida.
Objetivo: Resumir la evidencia disponible sobre la prevalencia, el perfil clínico y los factores de riesgo de la enfermedad renal crónica de etiología desconocida.
Métodos: La búsqueda en PubMed localizó16 manuscritos que se publicaron en revistas arbitradas. De las presentaciones en las conferencias científicas nacionales se incluyeron tres resúmenes arbitrados.
Resultados: La prevalencia de la enfermedad fue de 5.1%–16.9%, y fue mayor en los hombres que en las mujeres. Los pacientes en estadios de la enfermedad de ligero a moderado fueron asintomáticos o tuvieron síntomas inespecíficos; el sedimento urinario fue claro; la excreción de proteína en orina en 24 horas fue ‹ 1 g; y el ultrasonido demostró riñones pequeños. La fibrosis intersticial fue la característica patológica principal en la biopsia renal. Se consideró la posibilidad etiológica de toxinas medioambientales sobre un grupo poblacional vulnerable en un área geográfica específica. Se detectaron residuos de pesticidas en orinas de pacientes afectados y micotoxinas en alimentos que estaban por debajo de los límites máximos legales. En regiones endémicas predominó el tipo de agua bicarbonatada con altas concentraciones de fluoruro. Los niveles significativamente elevados de cadmio en la orina de los pacientes, en comparación con los controles, así como la respuesta de la enfermedad relacionada con estos niveles, ha llamado la atención sobre este elemento como un posible factor contribuyente. La agrupación familiar de los pacientes sugiere un patrón de herencia poligénica, esta asociación es comparable con las que se presentan en las enfermedades de etiología multifactorial.
Conclusiones: La base de datos disponible sugiere que la enfermedad renal crónica de etiología desconocida es una enfermedad medioambiental adquirida pero hasta ahora no se han identificado factores causales definitivos. La distribución geográfica y los hallazgos de la investigación sugieren una etiología multifactorial.


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