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Federación Mexicana de Ginecología y Obstetricia, A.C.

2018, Número 07

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Ginecol Obstet Mex 2018; 86 (07)


Tratamiento de la nefropatía lúpica en la embarazada

Barroso-Domínguez S

Idioma: Español
Referencias bibliográficas: 45
Paginas: 478-484
Archivo PDF: 239.08 Kb.


RESUMEN

Antecedentes: El lupus eritematoso sistémico es una enfermedad crónica, autoinmunitaria y multisistémica de etiología desconocida que puede afectar el funcionamiento de múltiples órganos y tejidos, como la piel o los riñones. La afectación renal perjudica a más de 50% de las embarazadas, su coexistencia incrementa la morbilidad y mortalidad materno-fetal y condiciona la evolución del embarazo.
Objetivo: Describir el tratamiento adecuado de la nefropatía lúpica en la embarazada para saber diagnosticar y prevenir las complicaciones.
Caso clínico: Paciente de 36 años, en el segundo embarazo, con lupus eritematoso sistémico y nefropatía lúpica tipo IV. El embarazo previo trascurrió con deterioro de la función renal y motivó la finalización en la semana 37. Tres meses antes de la concepción se le tomó una biopsia renal que demostró ausencia de actividad lúpica. Las cifras de creatinina sérica basal fueron: 1.4-1.5 mg/dL. Durante el primer trimestre se diagnosticó hipertensión arterial y, debido al deterioro progresivo de la función renal, con cifras de creatinina sérica de 2.09 mg/dL se finalizó el embarazo en la semana 34+3 después de la maduración pulmonar fetal.
Conclusiones: El éxito gestacional de las pacientes con nefritis lúpica depende de una buena planificación previa a la concepción y de tratamiento multidisciplinario estrecho. Es importante curar o controlar la enfermedad en los 4-6 meses anteriores, el grado de insuficiencia renal, la hipertensión arterial y la preeclampsia o crecimiento intrauterino restringido.


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