Nefropatía por IgA. Revisión y conducta terapéutica a propósito de un caso clínico
Resumen
La Nefropatía por Inmunoglobulina A (NIgA), también conocida como enfermedad de Berger, fue descrita por primera vez en 1968 por Berger e Hinglais. Se trata de una enfermedad heterogénea, tanto desde el punto de vista clínico, como histológico, caracterizada por la presencia de depósitos mesangiales de IgA. La clínica de presentación es extremadamente variable, pudiendo manifestarse desde microhematuria aislada hasta un deterioro agudo de la función renal por una glomerulonefritis extracapilar superpuesta. Inicialmente se la consideraba una entidad de buen pronóstico, pero con el paso del tiempo y a partir de un mayor conocimiento de la NIgA, se constató que la realidad era otra y que del 20 al 30% de los pacientes a los 20 años evolucionaban a la insuficiencia renal crónica (IRC) terminal y otro 20% mostraba una pérdida significativa de la función renal. En el presente artículo se describe un caso clínico de un paciente en el que se detectan casualmente marcadores de daño renal en la orina, y en quien los hallazgos histológicos observados en la biopsia renal modificaron su pronóstico y la conducta terapéutica. A partir de este caso clínico se realiza una actualización sobre la Nefropatía por IgA.
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