Enfoque fisiopatológico, clínico y genético en el síndrome nefrótico: Eventos trombóticos en pacientes pediátricos
Palabras clave:
Síndrome nefrótico, trombosis, biomarcadores, genética, anticoagulantes, glucocorticoides.Resumen
El síndrome nefrótico es una enfermedad renal crónica caracterizada por proteinuria masiva, hipoalbuminemia, edema y dislipidemia, siendo frecuente en la población pediátrica. Esta condición se asocia a un estado de hipercoagulabilidad que predispone a eventos trombóticos, como la trombosis venosa profunda y la trombosis del seno venoso cerebral, especialmente en pacientes con hipoalbuminemia severa. La fisiopatología incluye alteraciones inmunológicas, estructurales del podocito y factores genéticos, como mutaciones en TRPC6. Se destacan biomarcadores como el dímero D, la antitrombina III y microARNs (como miR-30a-5p y miR-150, entre otros) con potencial diagnóstico y terapéutico. El tratamiento se basa en glucocorticoides, con buena respuesta en la mayoría de los casos, aunque una proporción significativa puede desarrollar resistencia. Las complicaciones trombóticas requieren manejo anticoagulante, incluyendo heparinas de bajo peso molecular o uroquinasa, y existe un creciente interés en fármacos como el apixabán. La detección temprana y el seguimiento de biomarcadores son esenciales para mejorar el pronóstico clínico.
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