Efecto de la natación sobre la proteinuria en nefropatía-IgA. Estudio de Caso. [Effect of swimming on proteinuria in IgA-nephropathy. A case study].

Resumen

Resumen

La proteinuria es un factor de progreso de la nefropatía-IgA (N-IgA). La actividad física (AF) favorece el incremento de la proteinuria. Por ello, tradicionalmente no se recomendaba AF a estos enfermos. Este trabajo estudia la influencia de la natación, en la N-IgA y la necesidad de una prescripción adecuada. Se diseñó como estudio de caso único dentro de los Mixed Methods. Los datos cuantitativos recogieron la carga de AF y tests de orina mediante tira reactiva. Los datos cualitativos registraron, mediante diario, la actividad cotidiana del sujeto y otros aspectos sobre su calidad de vida. Los resultados, muestran un aumento de proteinuria post-ejercicio, con un descenso en patrón repetido, sumando una menor proteinuria diaria. Mejoró también la calidad de vida: menor fatiga, reducción del dolor y rigidez artro-muscular, entre otras. Cabe pensar la idoneidad de la prescripción de natación aeróbica ligera a sujetos con N-IgA, aunque se precisa más investigación.

Abstract

Proteinuria is a factor in the progression of IgA-Nephropathy (N-IgA). Physical activity (PA) is related to an increase in proteinuria. For this reason, PA was not traditionally recommended for these patients. This work studies the influence of swimming on N-IgA and the need for an adequate prescription. It was designed as a single case study within the Mixed Methods paradigm. The quantitative data collected the PA load performed and urine tests using a dipstick. The qualitative data recorded, through a diary, the subject's daily activity and other aspects of their quality of life. The results show an increase in post-exercise proteinuria, with a decrease in a repeated pattern, adding a lower daily proteinuria. The quality of life also improved: less fatigue, reduced pain and arthro-muscular stiffness, among others. The suitability of prescribing light aerobic swimming for subjects with N-IgA may be considered, although more research is needed.

https://doi.org/10.5232/ricyde2021.06406

Referencias/references

Bellinghieri, G.; Savica, V., & Santoro, D. (2008). Renal Alterations During Exercise. Journal of Renal Nutrition, 18(1), 158–164.
https://doi.org/10.1053/j.jrn.2007.10.031

Bogataj, Š.; Pajek, J.; Buturović Ponikvar, J.; Hadžić, V., & Pajek, M. (2020). Kinesiologist-guided functional exercise in addition to intradialytic cycling program in end-stage kidney disease patients: a randomised controlled trial. Scientific Reports 10(5717), 1-10.
https://doi.org/10.1038/s41598-020-62709-1

Castañer Balcells, M.; Camerino Foguet, O., y Anguera Argilaga, M. (2013). Métodos mixtos en la investigación de las ciencias de la actividad física y el deporte. Apunts. Educación física y deportes, 2(112), 31-36. Recuperado de:
https://www.raco.cat/index.php/ApuntsEFD/article/view/268185

Chemouny, J. M.; Gleeson, P. J.; Abbad, L.; Lauriero, G.; Boedec, E.; Le Roux, K.; Monot, C.; Bredel, M.; Bex-Coudrat, J.; Sannier, A.; Daugas, E.; Vrtovsnik, F.; Gesualdo, L.; Leclerc, M.; Berthelot, L.; Ben Mkaddem, S.; Lepage, P., & Monteiro, R. C. (2018). Modulation of the microbiota by oral antibiotics treats immunoglobulin A nephropathy in humanized mice. Nephrology Dialysis Transplantation, 34(7), 1135-1144.
https://doi.org/10.1093/ndt/gfy323

Colado Sanchez, J. C.; Moreno Murcia, J. A., y Vidal Vidal, J. (2000). Fitness acuático: una alternativa a las gimnasias de mantenimiento. Apunts. Educación física y deportes, 4(62), 68-79. Recuperado de:
https://www.raco.cat/index.php/ApuntsEFD/article/view/306878

Di Carlo, L.J, Sparling, P.B.; Millard-Stafford, M.L., & Rupp, J.C. (1991). Peak Heart Rates Turing Maximal Running and Swimming: Implications for Exercise Prescription. International Journal of Sports Medicine, 12(3), 309-312.
https://doi.org/10.1055/s-2007-1024687

Dharmaratnam, A.; Wilkinson, T.; Nixon, D.; O'sullivan, T.; Niyi-Odumosu, F.; Palmer, J., & Smith, A. (2019). Determinig which symptons have the greates impact on quality of live in patients with non-dialysis dependent CKD. Nephrology Dialysis Transplantation, 34(Supplement 1).
https://doi.org/10.1093/ndt/gfz106.FP425

Floege, J., & Feehally, J. (2015). The mucosa–kidney axis in IgA nephropathy. Nature Reviews Nephrology, 12(3), 147–156.
https://doi.org/10.1038/nrneph.2015.208

Fuiano, G.; Mancuso, D.; Cianfrone, P.; Comi, N.; Mazza, G.; Marino, F.; Fuiano, L.; Zamboli, P.; Caglioti, A., & Andreucci, M. (2004). Can young adult patients with proteinuric IgA nephropathy perform physical exercise? American Journal of Kidney Diseases, 44(2), 257–263.
https://doi.org/10.1053/j.ajkd.2004.04.030 

Gallè, F.; Valeriani, F.; Cattaruzza, M.S.; Ubaldi, F.; Romano Spica, V., & Liguori, G. (2019). Exploring the association between physical activity and gut microbiota composition: a review of current evidence. Annale di Igiene, 31(6), 582-589.
https://doi.org/10.7416/ai.2019.2318

Han, L.; Fang, X.; He, Y., & Ruan, X.Z. (2016). IgA nephropathy (IgAN), the gut microbiota, and gut-kidney crosstalk. Kidney International Reports, 1(3), 189-196.
https://doi.org/10.1016/j.ekir.2016.08.002

Huang, P.P.; Shu, D.H.;  Su, Z.; Luo, S.N.; Xu, F.F., & Lin, F. (2019). Association between lifestyle, gender and risk for developing end-stage renal failure in IgA nephropathy: a case-control study within 10 years. Renal Failure, 41(1), 914-920.
https://doi.org/10.1080/0886022X.2019.1635029

Kiryluk, K.; Li, Y.; Scolari, F.; Sanna-Cherchi, S.; Choi, M.; Verbitsky, M.; Fasel, D.; Lata, S.; Prakash, S.; Shapiro, S.; Fischman, C.; Snyder, H.J.; Appel, G.; Izzi, C.; Viola, B.F.; Dallera, N.; Del Vecchio, L.; Barlassina, C.; Salvi, E. … Ravani, P. (2014). Discovery of new risk loci for IgA nephropathy implicates genes involved in immunity against intestinal pathogens. Nature Genetics, 46(11), 1187–1196.
https://doi.org/10.1038/ng.3118

Magistroni, R.; D'Agati, V. D.; Appel, G. B., & Kiryluk, K. (2015). New developments in the genetics, pathogenesis, and therapy of IgA nephropathy. Kidney international, 88(5), 974–989.
https://doi.org/10.1038/ki.2015.252

McArdle, W.D.; Katch, F.I., y Katch, V.L. (1990). Fisiología del Ejercicio. Energía, nutrición y rendimiento humano. Madrid: Alianza Editorial.

Motiani, K.; Collado, M.C.; Eskelinen, J.; Virtanen, K.; Löyttyniemi, E.; Salminen, S.; Nuutila, P.; Kalliokoski, K., & Hannukainen, J. (2019). Exercise Training Modulates Gut Microbiota Profile and Improves Endotoxemia. Medicine & Science in Sports & Exercise, 52(1), 94-104.
https://doi.org/10.1249/MSS.0000000000002112

Ortiz-Álvarez, L.; Xu, H., & Martínez-Tellez, B. (2020). Influence of Exercise on the Human Gut Microbiota of Healthy Adults: A Systematic Review. Clinical and Translational Gastroenterology,11(2), 1-9.
https://doi.org/10.14309/ctg.0000000000000126

Pérez Redondo, R.; Bustamante, J., y De Paz, J.A. (2002). La actividad física como modificador de la función renal. Revisión histórica. Nefrología, 22(1), 15-23. Recuperado de:
https://www.revistanefrologia.com/es-la-actividad-fisica-como-modificadora-articulo-X021169950201446X

Reich, H, N.; Troyanov, S.; Scholey, J.W., & Cattran, D.C. (2007). Remission of Proteinuria Improves Prognosis in IgA Nephropathy. Journal of the American Society of Nephrology, 18(12), 3177-3183.
https://doi.org/10.1681/ASN.2007050526

Robergs, R.A., & Landwehr, R. (2002). The surprising history of the "HRmax=220-age" equation. Journal of Exercise Physiology-online, 5(2), 1-10. Recuperado de:
https://www.asep.org/asep/asep/Robergs2.pdf

Smith, A.C., & Burton, J.O. (2012). Exercise In Kidney Disease And Diabetes: Time For Action. Journal of Renal Care, 38 (Suppl 1), 52–58.
https://doi.org/10.1111/j.1755-6686.2012.00279.x

Tomino, Y., & Sakai, H. (2003). Clinical guidelines for immunoglobulin A (IgA) nephropathy in Japan, second version. Clinical and Experimental Nephrology, 7(2), 93–97.
https://doi.org/10.1007/s10157-003-0232-4

Villanego, F.; Naranjo Muñoz, J.; Vigara, L.; Cazorla, J.; Montero, M.; Garcia, T.; Torrado, J., y Mazuecos, A. (2020). Impacto del ejercicio físico en pacientes con enfermedad renal crónica: revisión sistemática y metaanálisis. Nefrología, 40(3), 237-252.
https://doi.org/10.1016/j.nefro.2020.01.002

Zhao, Q.-G.; Zhang, H.-R.; Wen, X.; Wang, Y.; Chen, X.-M.; Chen, N.; Sun, Y.; Liu, H., & Lu, P.-J. (2019). Exercise interventions on patients with end-stage renal disease: a systematic review. Clinical Rehabilitation, 33(2), 147–156.
https://doi.org/10.1177/0269215518817083

Zhao, Y.; Chen, Y.; Wu, Y.; Bao, B., & Fan, H. (2020). Effect of physical activity on depression symptoms in patients with IgA nephropathy. Journal of International Medical Research, 48(1), 1-9.
https://doi.org/10.1177/0300060519898008