Enfermedad Renal Crónica Secundaria A Glomeruloesclerosis Focal y Segmentaria

Abstract

Patient , 28 , male , without relevant history , reports that approximately 1 year actual date makes presents lower limb edema lasting 2 weeks and subsides spontaneously , then it becomes intermittent with an appearance of 1 once a month and duration of 2 weeks.- 3 days unexplained presents facial edema and palpebral morning , extends to the lower limbs , is symmetrical , cold, painless , soft consistency , inelastic leaves fovea difficult ambulation , accompanied by generalized asthenia, pain the knee joints , not self-medicating patient reports , is referred to internal medicine , where they perform laboratory tests and impaired renal function evidence. Physical examination shows blood pressure of 140/90 mmHg, facial edema is evident, and lower extremity edema soft , inelastic , not painful on palpation, Godet sign +++ / ++++ consistency. The cause of impaired renal function is investigated , performing exams evidenced proteinuria in the nephrotic range , hypoalbuminemia and hypoproteinemia, features of nephrotic syndrome; tests requested to determine its etiology including: renal Eco , eco doopler renal artery , renal biopsy and antibodies to rule autoimmune diseases. Is able to determine focal segmental glomerulosclerosis on biopsy primary etiology because immunological tests were negative , treatment is initiated with corticoid to reverse proteinuria and prevent progression of kidney damage, it is administered for 16 weeks but proteinuria remains in nephrotic range , without changes in renal function , the same as was altered from the beginning , being in chronic kidney disease 3b , due to the lack of response to corticosteroid resistance is considered the same . In an attempt to reduce proteinuria and lack of medication you decide to start with a cycle of methylprednisolone to prevent progression of kidney damage, but despite treatment continues with proteinuria, treatment is suggested with other immunosuppressive so it is transferred to a tertiary hospital where tests performed value note the chronic kidney disease, proteinuria, and anti- refer to this nursing home with no indication of treatment to follow. Given the refusal of tertiary hospital with other immunosuppressants support is decided to administer intravenous pulse cyclophosphamide is administered three times with an interval of 15 days, showing partial reduction of proteinuria levels.