Male patient, 60 years old, with Alport syndrome, microhematuria and proteinuria of 4 g/day, creatinine of 2 mg/dl, urea 123 mg/dl, moderate loss of hearing 2081 hyperuricaemia, hypertension treated with
Ex-smoker of a pack a day.
Eye disorders
Renal biopsy (performed in 1995): OM (12 glomeruli) and focal segmental glomerular biopsy evolving to sclerosing glomerulopathy IgA, IF with mild tubular IgM in mesangium and tubular
ME 2 glomeruli.
Capillary MB with irregular thickening and focal debonding of the dense lamina.
Pudocytes with total pedicel fusion.
In one sector, there is a blurring of the glomerular structure with abundant amorphous deposit and dense brown.
The alterations of the dense lamina are compatible with Alport's disease, the rest of the findings with focal sclerosing glomerulonephritis.
Renal ultrasound: DR 95.6 x 52 x 53, IR 99 x 51 x 52.
Renal Doppler showed no abnormalities.
A low-protein, hypocaloric diet is indicated and added to losartan treatment at a dose of 75 mg/day (maximum tolerated by the patient).
A very slight reduction in proteinuria to 3.6 g/day is observed.
Surgery for gastric bypass is performed, and in its evolution presents a decrease of 35 kg in total, reaching a BMI of 25.6.
Nephrological control: creatinine 1.56 mg/dl, proteinuria 0.3 g/day, urea 65 mg/dl and normal with enalapril 5 mg/d; minimum dose of lipid lowering drugs, normouricemia and normoglycemia is maintained.
Three years after surgery, the patient's good evolution is related to the treatment adherence (diet), aerobic exercise and clinical and psychological support.
1.
L. Roberto León Institute of Nephrology Sa Buenos Aires.
(Buenos Aires)
