INTERPRETACION UROANALISIS PDF

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Clinical presentation, classification and treatment. Lupus nephritis LN is a major cause of morbility and mortality in patients with systemic lupus erythematosus SLE. It is important that combinations of membranous and proliferative glomerulonephritis should be reported individually in the diagnosis line, as well as the diagnosis should also include notations for any concomitant vascular or tubolointersticial lesions, therefore, one of the main advantages of this classification is that it provides a clear and unequivocal description of the various lesions and classes of lupus nephritis, allowing a better standardization and giving a basis for further clinicopathologic studies.

Otherwise, despite the development of new modalities of treatment in LN, cyclophosphamide remains the preferred initial treatment for severe forms of LN like proliferative and membranous glomerulonephritis associated with both, lesions of class III or class IV; nevertheless, the optimal treatment remains challenging because of the adverse effects associated with cyclophosphamide like sustained amenorrhea, infertility, increased susceptibility to infection, bone marrow suppression, hemorrhagic cystitis, and malignancy.

Finally, due to these adverse effects new alternative approaches to the treatment of LN are desirable and also for some patients who fail to achieve remission with standar cytotoxic therapy and for who relapse when therapy is reduced. For refractory disease, new immunosuppressive and immunomodulating agents, immunoablative high dose of cyclophosphamide, apheresis and the biological response modifiers can be consider.

Al menos uno de los siguientes debe estar presente Biopsia renal que demuestre glomerulonefritis mesangial clase IIb, proliferativa focal, proliferativa difusa o membranosa. Cuerpos ovales grasos o cilindros granulosos, hialinos o eritrocitarios en orina. Por cada uno de los criterios mencionado se deben excluir otras causas.

La raza es un factor de riesgo independiente para el desarrollo de falla renal progresiva debido a NL proliferativa difusa. En ambos centros el riesgo de enfermedad renal terminal fue significativamente mayor para los afro-americanos, a pesar del tratamiento intensivo con esteroides y pulsos de ciclofosfamida.

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Las manifestaciones renales del LES son tan variadas como las manifestaciones extrarrenales de la enfermedad. Los cilindros en orina se presentan en un tercio de los pacientes 3.

Ocasionalmente, la NL se presenta como una insuficiencia renal aguda, explicable por diferentes causas: En general, en pacientes con sospecha de NL la biopsia renal puede ser utilizada para: Estos patrones se dividen en tres grupos En este caso la biopsia puede ayudar a decidir si descontinuar o no el tratamiento.

No obstante, las recomendaciones hechas son Esta clase se divide en: En la NL clase V, puede presentarse cualquier grado de hipercelularidad mesangial. Algunos autores han clasificado las lesiones vasculares intrarrenales de la NL en cinco grupos Nefritis mesangial clase II: El manejo establecido para la nefritis proliferativa consta de dos fases: Tabla 7 70, Debido a los efectos adversos y la baja tolerancia a los esquemas que utilizan pulsos de ciclofosfamida a altas dosis, se ha estudiado la eficacia de pulsos venosos de ciclofosfamida a bajas dosis.

En otro estudio, Appel y cols. Recientemente, Ginzler y cols. Debido a la alta toxicidad asociada con una terapia prolongada con pulsos de ciclofosfamida, se han utilizado otros inmunosupresores como la azatioprina y el MMF como terapia de mantenimiento.

En otro estudio, Chan y cols. Se han utilizado diferentes medidas para evaluar la eficacia del tratamiento inmunosupresor en NL: Anticuerpo monoclonal contra el Interpgetacion ligando: Clinical and laboratory features of lupus nephritis. J Am Soc Nephrol ; Clinical manifestations of lupus nephritis.

Analisis de orina

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Lupus nephritis. Clinical presentation, classification and treatment

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