Vol. 13. Núm. 79.
Páginas 4685-4694 (Mayo 2023)

Actualización
Afectación renal en las enfermedades raras genéticas

Renal involvement in rare genetic diseases

P. Rodríguez DoyágüezaN.B. BoldobaaR. GimenabB. Hernández SevillanoaR. Torra Ballcellsc
Doi : https://10.1016/j.med.2023.05.004
Opciones
Resumen

Las enfermedades raras se definen como aquellas que afectan a menos de 65 de cada 100 000 personas. Las enfermedades genéticas que afectan al riñón son, en su mayoría, pertenecientes a ese grupo y constituyen un porcentaje significativo de los pacientes en tratamiento renal sustitutivo, especialmente a edades tempranas. Junto con las enfermedades quísticas, las tubulopatías o las mutaciones en genes del complemento con afectación renal existen enfermedades renales genéticas con afectación a distintos niveles. Algunas de ellas tienen como diana el glomérulo, como el síndrome de Alport (que afecta a las proteínas que forman el colágeno tipo IV, cursando con proteinuria, microhematuria y alteraciones visuales y auditivas), la amiloidosis hereditaria (que cursa como la amiloidosis AL y es responsable del 10% total de casos) y el síndrome nefrótico corticorresistente que surge de diversas mutaciones y es resistente a la inmunosupresión. La enfermedad de Fabry provoca la acumulación de glucoesfingolípidos, produciendo una afectación multisistémica con mortalidad cardíaca y renal. La hiperoxaluria primaria destaca por urolitiasis de repetición y nefrocalcinosis con afectación multisistémica cuando hay insuficiencia renal avanzada. Finalmente, el CAKUT comprende un conjunto heterogéneo de mutaciones de genes responsables del desarrollo embrionario del riñón y el tracto urinario.

Palabras clave
Genética
Monogénica
Síndrome de Alport
Abstract

Rare diseases are defined as those which affect fewer than 65 of every 100,000 individuals. Genetic diseases which affect the kidney mostly belong to this group and represent a significant percentage of patients in renal replacement treatment, especially at young ages. Together with cystic diseases, tubulopathies, or complement gene mutations with renal involvement, there are genetic renal diseases which affect different aspects. Some of them target the glomerulus, such as Alport syndrome (which affects the proteins that form type IV collagen, progressing with proteinuria, microscopic hematuria, and visual and auditory abnormalities), hereditary amyloidosis (which progress with AL amyloidosis and is responsible for 10% of all cases), and steroid-resistant nephrotic syndrome which arises from various mutations and is resistant to immunosuppression. Fabry disease causes the accumulation of glycosphingolipids, producing multisystemic involvement with cardiac and renal mortality. Primary hyperoxaluria is notable due to recurrent urolithiasis and nephrocalcinosis with multisystemic involvement when there is end-stage renal failure. Finally, CAKUT comprises a heterogeneous set of mutations in the genes responsible for the embryonic development of the kidney and urinary tract.

Keywords
Genetics
Monogenetic
Alport syndrome

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