Adulto joven con glomerulonefritis membranoproliferativa primaria. Reporte de caso

Abstract

Background: Membranoproliferative glomerulonephritis (MPGN) is a rare glomerular disease derived from characteristic histological lesions, preferentially presenting at early ages and associated with a poor prognosis compared to other glomerulonephritis as it progresses to renal failure up to a terminal stage in advanced phases. Its incidence has considerably decreased in recent decades in developed countries; however, it is considered a common entity in underdeveloped countries. Clinical case summary: We present a clinical case of a 24-year-old male patient, with a history of poorly controlled hypertension, who went to the emergency room of the health house in Azogues due to symptoms of asthenia, fever, non-productive cough, and facial and lower limb edema. Proteinuria and increased blood urea nitrogen (BUN) were evident, so hospitalization was decided for disease study and the possibility of renal replacement therapy. Subsequently, a renal biopsy was decided with a diagnosis of Glomerulonephritis due to immune complexes with a Membranoproliferative pattern, complicated with post-puncture hematoma, without signs of hemodynamic decompensation, and finally, by consensus, the patient, Internal Medicine and Nephrology decide to use secondline treatment with mycophenolate 360mg and medical discharge. Discussion: The symptomatology is very variable due to its progressive course, however, the nephrotic syndrome is the main clinical picture of an MPGN, as it occurs in 50% of patients, although in some cases it can present as nephritic syndrome or a combination of both. Renal biopsy is the gold standard for a definitive diagnosis of glomerular diseases and the presence of nephrotic syndrome represents the first indication for RB. Treatment based on optimal control of blood pressure, lipid-lowering therapy, and diuretics appears to be mainly appropriate and most widely used. Currently, the use of MMF is controversial, its application has been associated with a decrease in the progression to renal failure compared to other immunosuppressants, however, the response of patients to this therapy is not clear especially in the younger population since 50% will present a complete remission and 50% partial remission.