Evaluación de la nefropatía lúpica esteroideo-resistente tratada con micofenolato de mofetil, Hospital Dr. Teodoro Maldonado Carbo, 2005-2010
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2011
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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La nefropatía lúpica (NL) es una patología de difícil manejo terapéutico puesto que generalmente, no siempre responde a los esquemas farmacológicos existentes hasta el momento. En esta situación se ha recomendado como alternativa el uso de micofenolato de mofetil (MMF) debido a que numerosos estudios reportan resultados favorables, Sin embargo otros autores informan que no se pueden observar mejoras significativas con este fármaco, por lo que su uso genera controversias. Con el objetivo de evaluar si la evolución clínica de la nefropatía lúpica esteroideo-resistente o refractaria tratada con MMF sufre cambios significativos, se realizó un estudio de tipo descriptivo y correlacional, de diseño no experimental, longitudinal retrospectivo en el que se incluyeron todos los expediente clínicos de pacientes diagnosticados con NL esteroideo-resistente o refractaria que fueron atendidos en la consulta externa (n=47) del Servicio de Nefrología del Hospital Regional 2 IESS “ Dr. Teodoro Maldonado Carbo” en el período de tiempo comprendido entre enero del 2005 a octubre del 2010 y a los cuales se les administró MMF. Se realizó una comparación de la respuesta clínica a los diferentes regímenes terapéuticos empleados. Obteniéndose como resultado una población de pacientes diagnosticados con NL en los años mencionados de 47. El Sexo femenino predominó en una proporción de 4 a 1. El grupo de edad mas frecuente fue de 20 a 40 años, el 21% de los pacientes fueron esteroideo-resistentes ó refractarios y el hallazgo histológico más frecuente en las biopsias renales fue la clase IV. El uso de MMF en los pacientes refractarios provocó el aumento de remisiones completas y parciales de la enfermedad. Concluyéndose que si hay modificación de la evolución clínica de la NL esteroideo-resistente cuando se agrega al tratamiento el MMF, superando esquemas tradicionales como la ciclofosfamida y prednisona Para el análisis estadístico se utilizó estadística descriptiva para las variables demográficas y fisiológicas renales; para evaluar las diferencias entre los valores basales y los valores de 6 y 12 meses para la proteinuria, depuración de creatinina y creatinina sérica se realizó la prueba de Krus Kall-Wallis, considerando significativos valores de P < 0.05.
Lupus nephropathy (NL) is a pathology that is difficult to manage because it does not always respond to the pharmacological schemes that have existed up to now. In this situation, the use of mycophenolate mofetil (MMF) has been recommended as an alternative because numerous studies report favorable results. However, other authors report that no significant improvements can be observed with this drug, so its use generates controversies. In order to evaluate if the clinical evolution of refractory steroid-resistant or refractory lupus nephropathy treated with MMF undergoes significant changes, a descriptive and correlational study of a non-experimental, longitudinal retrospective design was carried out in which all the files were included. of patients diagnosed with steroid-resistant or refractory NL who were treated in the outpatient clinic (n = 47) of the Nephrology Service of the Regional Hospital 2 IESS "Dr. Teodoro Maldonado Carbo" in the period from January 2005 to October 2010 and to which MMF was administered. A comparison of the clinical response to the different therapeutic regimens used was made. Obtaining as a result a population of patients diagnosed with NL in the aforementioned years of 47. Female sex predominated in a ratio of 4 to 1. The most frequent age group was 20 to 40 years, 21% of the patients were steroidal -resistant or refractory and the most frequent histological finding in renal biopsies was class IV. The use of MMF in refractory patients led to an increase in complete and partial remissions of the disease. It was concluded that if there is modification of the clinical evolution of the steroid-resistant NL when MMF is added to the treatment, overcoming traditional schemes such as cyclophosphamide and prednisone. For the statistical analysis descriptive statistics were used for the demographic and physiological renal variables; To evaluate the differences between the baseline values and the values of 6 and 12 months for proteinuria, creatinine clearance and serum creatinine, the Krus Kall-Wallis test was performed, considering significant values of P <0.05.
Lupus nephropathy (NL) is a pathology that is difficult to manage because it does not always respond to the pharmacological schemes that have existed up to now. In this situation, the use of mycophenolate mofetil (MMF) has been recommended as an alternative because numerous studies report favorable results. However, other authors report that no significant improvements can be observed with this drug, so its use generates controversies. In order to evaluate if the clinical evolution of refractory steroid-resistant or refractory lupus nephropathy treated with MMF undergoes significant changes, a descriptive and correlational study of a non-experimental, longitudinal retrospective design was carried out in which all the files were included. of patients diagnosed with steroid-resistant or refractory NL who were treated in the outpatient clinic (n = 47) of the Nephrology Service of the Regional Hospital 2 IESS "Dr. Teodoro Maldonado Carbo" in the period from January 2005 to October 2010 and to which MMF was administered. A comparison of the clinical response to the different therapeutic regimens used was made. Obtaining as a result a population of patients diagnosed with NL in the aforementioned years of 47. Female sex predominated in a ratio of 4 to 1. The most frequent age group was 20 to 40 years, 21% of the patients were steroidal -resistant or refractory and the most frequent histological finding in renal biopsies was class IV. The use of MMF in refractory patients led to an increase in complete and partial remissions of the disease. It was concluded that if there is modification of the clinical evolution of the steroid-resistant NL when MMF is added to the treatment, overcoming traditional schemes such as cyclophosphamide and prednisone. For the statistical analysis descriptive statistics were used for the demographic and physiological renal variables; To evaluate the differences between the baseline values and the values of 6 and 12 months for proteinuria, creatinine clearance and serum creatinine, the Krus Kall-Wallis test was performed, considering significant values of P <0.05.
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Nefropatía lúpica, Lupus eritematoso sistémico, Acido micofenólico, Epidemiolgía descriptiva, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador