Nefritis Lúpica : Una Revisión Sistemática de su Manejo

Autores/as

  • María Isabel Bojorquez Ortiz Facultad de Medicina, Universidad Francisco Marroquín
  • Izabel Paola Hernández Cabrera Facultad de Medicina, Universidad Francisco Marroquín

DOI:

https://doi.org/10.37345/23045329.v2i1.115

Palabras clave:

nefritis lúpica, clasificación histopatológica, tratamiento, inhibidores de calcineurina, anticuerpos monoclonales, inmunosupresión

Resumen

Introducción: La nefritis lúpica (NL) es una complicación grave del lupus eritematoso sistémico (LES). Afecta principalmente a las mujeres y, en ellas, tiene una tasa de mortalidad seis veces mayor que la población general. La inmunopatología de la NL implica el depósito de complejos inmunes en los glomérulos y su clasificación histopatológica se basa en la biopsia renal.  Objetivos: Evaluar la eficacia y la seguridad de los tratamientos disponibles para la NL en adultos e identificar las intervenciones emergentes para su manejo.  Métodos: Se llevó a cabo una revisión sistemática según las directrices PRISMA, abarcando estudios publicados hasta enero de 2024. La búsqueda se realizó en PubMed, la biblioteca de Cochrane y Google Académico, con dos revisores encargados de la selección y extracción de datos, evaluando el riesgo de sesgo en los ensayos clínicos aleatorizados (ECA) mediante la herramienta Cochrane.  Resultados: Se revisaron 212 artículos, eliminando 31 duplicados y 35 por falta de relevancia. De los 146 restantes, se excluyeron aquellos con defectos en el diseño, objetivos o población inadecuados, quedaron finalmente 31 artículos que cumplían los criterios de inclusión, incluidos 21 estudios analíticos y 10 ECA.  Discusión: Se recomienda el tratamiento inmunosupresor para NL clase III y IV, mientras que para NL clase I o II se evalúa el uso de glucocorticoides con otros agentes inmunosupresores si hay síndrome nefrótico o proteinuria en rango nefrótico. En casos refractarios, terapias emergentes, como guselkumab, ofrecen nuevas perspectivas. Es crucial garantizar una cumplimiento adecuada al tratamiento para maximizar los resultados terapéuticos en estos casos.   Conclusiones: Para el manejo de la NL, se resalta la importancia de reducir la proteinuria y se recomienda hidroxicloroquina (HCQ) para todos estos pacientes. Se sugieren diferentes tratamientos inmunosupresores según la clase de nefritis. La retirada segura de la inmunosupresión es un desafío, requiere de evaluación y seguimiento cercano para evitar riesgos de brotes renales.

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31-05-2024

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Nefritis Lúpica : Una Revisión Sistemática de su Manejo. (2024). Revista De La Facultad De Medicina, 2(1), 46-67. https://doi.org/10.37345/23045329.v2i1.115

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