¿Qué es la insuficiencia renal? Tipos, causas y consecuencias
Descripción y causas de la Insuficiencia renal
La unidad funcional del riñón es la nefrona, y esta se encarga de filtrar la sangre, reabsorber los solutos útiles, regular el volumen de agua para la homeostasis y eliminar las sustancias tóxicas o sobrantes. Cuando las nefronas fallan y los riñones son incapaces excretar de forma adecuada los desechos nitrogenados y metabólicos, como la urea y creatinina, nos encontramos con una insuficiencia renal (IR). Signo de este daño renal son la hipoalbuminemia, albuminuria y disminución de la taza de filtración glomerular (TFG).
Insuficiencia renal aguda
La lesión renal aguda (LRA), conocida como insuficiencia renal aguda (IRA), se caracteriza por una reducción brusca de la TFG, reversible o no, con la consiguiente retención de los productos de desecho metabólicos nitrogenados o hiperazoemia.
Tipos de IRA
Según su origen la IRA suele clasificarse como:
- Prerrenal: refleja una anomalía afuera de los riñones y es el resultado de una disminución el volumen total de sangre que circula por el cuerpo. Representa el 55% al 60% de los casos.
- Renal intrínseca: representa un 35% – 40% de las insuficiencias renales agudas. Dentro de este grupo, la necrosis tubular aguda es la causante del mayor número de casos, seguida por glomerulonefritis, nefritis intersticial aguda, vasculitis y microangiopatía trombótica.
- Postrenal: así denominada cuando la IRA obedece a una obstrucción del tracto urinario inferior, originada por procesos inflamatorios o tumorales. Dicha forma de presentación corresponde a menos del 5% de los casos.
Consecuencias de la Insuficiencia renal
La evolución clínica depende de la severidad y el grado de catabolismo de la enfermedad de base o causa subyacente. Si la lesión se mantiene en el tiempo, las nefronas sanas compensan la actividad de las que han fallado, logrando mantener temporalmente la función renal. Sin embargo, eventualmente estas mueren a causa de la hiperfiltración a la que estas se encuentran sometidas, mermando la funcionalidad del riñón y acercándose progresivamente a una insuficiencia renal crónica (IRC).
También conocida como enfermedad renal terminal, la IRC es la consecuencia de 90 o más días de la agresión renal y en la que se suele dar la terapia de reemplazo renal, aunque no exclusivamente. Consiste en una alteración progresiva, permanente e irreversible, de la función y estructura del riñón. Los pacientes con IRC presentan con frecuencia datos de malnutrición calórico-proteica, a causa de la alteración metabólica y la escasa ingesta de nutrimentos.
Aunque la IR puede ocurrir en personas de cualquier edad, desde recién nacidos hasta adultos mayores, es un diagnóstico relativamente infrecuente en niños. Factores causales en niños comprenden alteraciones congénitas, malformaciones urológicas o riñones displásicos, enfermedad renal poliquística autosómica recesiva, trastornos metabólicos o adquiridos que generan un estado catabólico y una posterior insuficiencia renal.
¿Por qué es necesario hacer un aborde nutricional?
Mantener un buen estado nutricional en pacientes con IRA e IRC se ha relacionado con menores índices de morbilidad, disminución de las complicaciones y elentecimiento de la progresión de la IR. Es importante evaluar detenidamente las particularidades de cada paciente en las distintas etapas de su enfermedad, a fin de evitar el catabolismo proteico y adecuar el aporte de calorías y micronutrientes que permita preservar el estado nutricional sin comprometer la función renal.
La insuficiencia renal respresenta uno de los módulos del posgrado en Enfermedad Renal de 4Doctors. Conoce más sobre este programa pulsando aquí
Muy buen artículo.Muy claro y fácil de interpretar.
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