Este protocolo aborda la glomerulonefritis rápidamente progresiva (GNRP) ANCA-positiva, una presentación para la cual existe evidencia relativamente sólida. La GNRP pauci-inmune ANCA-negativa se trata de manera idéntica y se encuadra en el mismo marco de guías clínicas.
La guía hace especial énfasis en las presentaciones complicadas por disfunción renal avanzada o hemorragia alveolar difusa. Estas características de alto riesgo determinan si se añade una intervención adicional a la base inmunosupresora.
These guidelines focus on ANCA-positive RPGN, which appears frequently and for which there is relatively strong evidence, and on addressing the severe primary diseases, namely lupus nephritis and anti-GBM antibody RPGN.
For ANCA-negative pauci-immune RPGN, we recommend that the treatment be similar to that of ANCA-positive disease.
In patients with ANCA-positive RPGN complicated with advanced renal dysfunction or pulmonary hemorrhage, the addition of plasmapheresis to immunosuppressive therapy as the initial therapy may improve renal function and survival. We recommend the addition of plasmapheresis in such patients.
The addition of plasmapheresis to the initial therapy with corticosteroids and cyclophosphamide is indicated for patients presenting with advanced kidney failure (serum creatinine, [5.8 mg/dL) or those with diffuse alveolar hemorrhage.
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