Hiperuricemia, enfermedad renal crónica y trasplante renal (parte I)

Contenido principal del artículo

Liliana Miriam Obregón
Carlos Cobeñas
Carlos Díaz
Gabriela Greco
Rosana Groppa
Nora Imperiali
Hugo Sergio Petrone
Gervasio Soler Pujol
Marcelo Fabián Taylor
Alicia Ester Elbert

Resumen

La hiperuricemia post trasplante ha sido definida con valores iguales a la población general, en su prevalencia pueden alcanzar un 80% en los que ha recibido un trasplante renal, un 5-25% desarrolla crisis gotosas. La edad avanzada al momento del implante, la historia de hiperuricemia o gota, la obesidad, el tratamiento con anticalcineurínicos, el uso de diuréticos y el bajo filtrado glomerular son algunos de los factores implicados en su desarrollo. La hiperuricemia se han relacionado con disminución de la vasodilatación mediada por óxido nítrico y la proliferación del músculo liso vascular a través de efectos proinflamatorios y profibróticos (mediados por células T, macrófagos, PDGF, TGF β, entre otros). Estos efectos se han asociado a su vez con
hipertensión arterial, afecciones cardiovasculares y progresión del daño renal (relacionado con fibrosis túbulo intersticial, arterioloesclerosis de la aferente, atrofia tubular), factores que conllevan a una reducción en la sobrevida del injerto como del paciente. La indicación de tratamiento de la hiperuricemia asintomática en esta población es aún objeto de debate, tanto respecto de la indicación en sí como del tipo de fármaco a utilizar, a diferencia de lo que ocurre en litiasis, tofos o artritis donde se debe encarar el tratamiento, jerarquizando la interacción con las drogas propias del trasplante. Se debe considerar que la mayoría de la información disponible se desprende del análisis sobre población general por lo que se requieren estudios de este grupo poblacional en particular

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1.
Obregón LM, Cobeñas C, Díaz C, Greco G, Groppa R, Imperiali N, Petrone HS, Soler Pujol G, Taylor MF, Elbert AE. Hiperuricemia, enfermedad renal crónica y trasplante renal (parte I). Rev Nefrol Dial Traspl. [Internet]. 1 de marzo de 2016 [citado 20 de octubre de 2021];36(1):48-3. Disponible en: https://www.revistarenal.org.ar/index.php/rndt/article/view/57
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