Ciencias de la Salud
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Item “Lupus eritematoso sistémico complicado con nefritis”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-09-01) Miniguano Caiza, Johanna Karolina; Esp. Silva Tirado, Mónica Paulina Dra.Systemic lupus erythematosus is a systemic autoimmune disease, its prevalence in our environment is 4 - 250 cases / 100,000, being more frequent in women who are between 15 - 45 years of age. It can affect at the same time numerous systems of the organism, but lupus nephritis is its greatest manifestation. Renal damage is caused by the deposit of intravascular immune complexes in the glomeruli, clinically we can find a silent disease, abnormal urinary sediment, a nephrotic or nephrotic syndrome with rapid progression. Renal biopsy is indicated in all circumstances in which proteinuria is evidenced. The treatment is established taking into account the age, clinical picture, systemic compromise, histological class and comorbidities. The present case describes a female patient of 18 years of age, with no significant pathological history who presented intermittent holocranial headache, pulsatile type of great intensity of 1 year of evolution, receiving analgesic treatment for several times without improvement, referred myalgia for 5 months , arthralgia and 3 months ago has asthenia with unquantified weight loss. Two weeks ago bilateral edema appeared in lower limbs with high blood pressure, received antihypertensive treatment (losartan 50mg), presented mild normochromic normocytic anemia, hematuria and proteinuria establishing a nephritic syndrome and to rule out collagen disease due to the presence of other organic compromises. Additional studies are requested in which ANA and positive DNA antibodies are evidenced. In addition C3 and C4 serum complement decreased, reaching a diagnosis of lupus erythematosus, then performed renal biopsy reporting class IV lupus nephritis initiating 1 pulse of cyclophosphamide and then mycophenolate mofetilItem “Lupus eritematoso sistèmico con compromiso en la funciòn renal”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-06-01) Lascano Solís, Jorge Geovanny; Philco Toaza, Priscila Elizabeth Dra. Esp.The present case corresponds to a 16-year-old woman who, after pregnancy, starts with marked proteinuria, without presenting symptoms, being referred to a second level hospital, with suspicion of chronic kidney disease, she enters the Internal Medicine service, where she is valued by Nephrology. Nephrology due to the presence of a marked hematuria, proteinuria and granular cylinders in a woman of childbearing age, suspicion of Lupus Nephropathy, immunology tests are requested reporting a decrease in complement and increase of anti-DNA titers, so it is decided to perform a biopsy , for post-pregnancy immunosuppression management patient underwent percutaneous kidney biopsy reporting Lupus Nephritis G V.Item “Proteinuria como causa de nefropatía”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2017-07-01) Peñafiel Ortiz, Magaly Consuelo; Guacho Guacho, Juan SebastiánDr. Esp.Glomerulopathy is designated a set of diseases that are characterized by a loss of normal functions of the renal glomerulus. They are characterized by the appearance of form elements or proteins in the urine, with varying degrees of renal failure. From the clinical point of view, they present with several alterations, denominated nefrítico syndrome, nefrótico syndrome, alterations of the urinary sediment, acute renal failure, fast progressive and chronic. However, these clinical designations are insufficient to accurately characterize these processes, so it has been fundamental to introduce anatomopathological criteria in their classification. Certain NG occur in the context of systemic (secondary) diseases, while in others renal lesions develop in isolation (primary). The following case is about a female patient, who attends to present edema in lower limbs, is admitted for a study of etiology and chronicity of renal disease with diagnosis of nephrotic - nephrotic syndrome currently in renal function replacement therapy.Item “determinación de proteinuria/creatinuria (pr/cr) en pacientes con sospecha de preeclampsia y su relaciòn con proteinuria de 24 horas”.(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Laboratorio Clínico, 2017-06-01) Castro Echeverría, Valeria Viviana; Tabares Rosero, Lourdes Gioconda Dra. Mg.The present research project aimed to determine proteinuria / creatinuria (Pr / Cr) in patients with suspected preeclampsia and its relation with 24-hour proteinuria, the purpose was to encourage physicians, the importance of the use of proteinuria index / Creatinuria for the diagnosis of preeclampsia so that they can make appropriate decisions in the shortest time possible. Regarding the methodology, the work approach was quantitative, applying field research, laboratory, and a level of observational analytical research, with a high correlation level due to the direct and safe determination of the relationship between the Variables studied, Prospective Method and Cross-Cutting. We worked with 55 patients with suspected preeclampsia who were added using inclusion and exclusion criteria. We performed the measurement of Pr / Cr index in random urine and 24-hour proteinuria performed on the cobas c 501 equipment . Statistical analysis was performed with descriptive statistics, obtaining an average of 0,3469 for the proteinuria / creatinuria index and 760,779 for 24-hour proteinuria. The hypothesis test was performed using Student's T, a significance of 0.000 was obtained That the alternative hypothesis was accepted, it was concluded that if there is a relationship between proteinuria / creatinuria index and 24-hour proteinuria in preeclamptic pregnant womenItem Enfermedad Renal Crónica Secundaria A Glomeruloesclerosis Focal y Segmentaria(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Gavilánez Guerrero, Silvia Janeth; Lituma Jumbo, Rosalina de Lourdes Dra.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.