Recurrencia de glomerulonefritis pos-trasplante renal : características clínico-patológicas

Abstract

RESUMEN: Introducción: las glomerulonefritis (GN) son una de las principales causas de enfermedad renal terminal (ERT) en todo el mundo y por lo tanto una causa frecuente de trasplante renal, con la posibilidad de recurrencia de la GN (GNR: Glomerulonefritis recurrente) en riñón trasplantado. El propósito del estudio fué identificar características clínico-patológicas de las GNR en una población de pacientes trasplantados. Materiales y métodos: se realizó un estudio descriptivo, retrospectivo, transversal en 109 pacientes en quienes se documentó la GNR en riñón trasplantado demostrado por biopsia durante el periodo comprendido entre 1998 - 2021. Resultados: La GNR más frecuente fue GNIgA, en el 38.5%(42), seguida por GEFS con el 31.2% (34); estas mismas entidades fueron las que presentaron mayor disfunción del injerto, con el 50%(21) y 26.2%(11) respectivamente. Los rangos de proteinuria que indicaron la biopsia fueron 31.2%(34) con rango de 500 a 3500 mg/24h y 34.9%(38) con proteinuria > 3500 mg/24h. En relación con el tiempo transcurrido entre el trasplante y el diagnóstico de la GNR, el 33%(36) de los casos fue >5 años, seguido por 1 a 5 años en el 26.6%(29); la recurrencia en los pacientes con GNIgA ocurrió en su mayoría luego de los 5 años postrasplante con un 45.2%(19) y para la GEFS fue entre 1 y 6 meses. Conclusión: encontramos una frecuencia de presentación general de las GNR similar a reportadas por otros centros donde realizan biopsias por indicación clínica, encontrando que las GN que recurrieron con más frecuencia son la GNIgA y la GEFS.

ABSTRACT: Introduction: primary glomerulonephritis is one of the main causes of end-stage renal disease worldwide and occurs in more than 30% of transplant recipients. However, there is a possibility of recurrence of glomerulonephritis in the transplanted kidney, defined as the presence of the same glomerulonephritis diagnosed in the native kidney causing chronic kidney disease in the post-transplanted kidney, with the absence of kidney disease. primary in the donor kidney. The purpose of this study was to identify the clinicopathological characteristics of the most frequent recurrent glomerulonephritis in our population, which allows us to provide useful tools in the healthcare area for better monitoring and management of the allograft. Materials and methods: a descriptive, retrospective, cross-sectional study was carried out in 109 patients in whom recurrent glomerulonephritis was documented in the transplanted kidney demonstrated by biopsy, which were studied in the Department of Pathology of the University of Antioquia during the period of 1998. to 2021. Clinico-pathological variables were included, and descriptive statistics were used for the analysis. Results: a total of 109 patients were included, with an average age of 39 years, 72.5% were male. The most frequent recurrent glomerulonephritis was immunoglobulin A nephropathy, in 38.5% (42) of cases, followed by focal and segmental glomerulosclerosis with 31.2% (34); Additionally, it was found that these same entities were the ones with the highest percentage of graft dysfunction, with 50% (21) and 26.2% (11), respectively. The ranges of proteinuria that indicated the biopsy were 31.2% (34) with a range of 500 to 3500 mg/24h and 34.9% (38) with proteinuria 3500 mg/24h. In relation to the time elapsed between the transplant and the diagnosis of recurrent glomerulonephritis, 33% (36) of the cases were >5 years, followed by 1 to 5 years in 26.6% (29); Recurrence in patients with immunoglobulin A nephropathy occurred mostly after 5 years post-transplant with 45.2% (19) and for focal and segmental glomerulosclerosis it was between 1 and 6 months. Regarding the type of rejection according to the Banff classification, 60.6% (66) did not present this concomitant diagnosis; Furthermore, chronicity, assessed by the percentage of tubular atrophy and interstitial fibrosis in 33% (36), was found between 10-25%. Conclusion: In Latin America there are few studies of recurrent glomerulonephritis, which has great relevance for the prognosis and management of the renal allograft. This study provides information that may allow in the future to provide pre-transplant counseling in those people who have risk factors for recurrence or have primary glomerulonephritis that recurs more frequently in their region, to achieve an early diagnosis that facilitates treatment prompt.