Palabras clave
Glomerulonefritis primarias
nefropatía membranosa
antiPLA2R
recurrencia
factores de riesgo
Cómo citar
Resumen
Contexto: la recurrencia de la enfermedad primaria en el injerto renal es la tercera causa de falla del injerto. Al igual que otras glomerulopatías, la nefropatía membranosa (NM) puede recurrir en el injerto renal y afectar el pronóstico de los pacientes. Se han descrito varios factores de riesgo para la recurrencia, entre los cuales se destaca la presencia de anticuerpos contra el receptor de fosfolipasa A2 en el período pretrasplante, siendo mayor el riesgo a mayor valor de los anticuerpos. Es importante realizar la evaluación acuciosa del riesgo de recurrencia en el período pretrasplante para poder establecer estrategias de seguimiento postrasplante, para permitir el diagnóstico temprano y el tratamiento oportuno de los pacientes.
Objetivo: revisar la evidencia disponible sobre la epidemiología, los factores de riesgo, el diagnóstico y el tratamiento de la recurrencia de la NM en el trasplante renal.
Metodología: se realizó una búsqueda no sistemática en la base de datos PubMed sobre la recurrencia de la NM en el trasplante renal. Se incluyeron estudios observacionales, ensayos clínicos, revisiones y guías de práctica clínica que abordaran la evaluación pretrasplante y postrasplante, así como las estrategias de tratamiento.
Resultados: la recurrencia de la nefropatía membranosa (NM) después del trasplante renal es variable y se asocia con un mayor riesgo de pérdida del injerto. La presencia y los títulos elevados de anticuerpos anti-PLA2R antes del trasplante son los principales factores asociados con la recurrencia. El seguimiento de anti-PLA2R y proteinuria permite identificar pacientes de mayor riesgo y favorecer el diagnóstico temprano. El rituximab es la principal estrategia terapéutica descrita, aunque la evidencia disponible es limitada.
Conclusiones: la recurrencia de la NM requiere una evaluación individualizada del riesgo desde el período pretrasplante y un seguimiento estrecho posterior. La monitorización de anti-PLA2R y proteinuria puede favorecer el diagnóstico y tratamiento oportunos.
Citas
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