Hipoaldosteronismo

Descripción General

Definición

El hipoaldosteronismo se define como la disminución de la secreción de aldosterona de la zona glomerulosa Zona Glomerulosa The narrow subcapsular outer zone of the adrenal cortex. This zone produces a series of enzymes that convert pregnenolone to aldosterone. The final steps involve three successive oxidations by cytochrome p-450 cyp11b2. Adrenal Glands: Anatomy de la corteza suprarrenal, que puede ser de naturaleza primaria o secundaria.

Epidemiología

• Se desconoce la incidencia exacta.
• Edad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el momento del diagnóstico:
  • Generalmente ocurre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adultos mayores (> 50 años de edad)
  • Puede ocurrir en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños con trastornos subyacentes (e.g., diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus, anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types de células falciformes)
• Hombre = mujer
• Tendencia racial/étnica: más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum negros, nativos americanos e hispanos

Etiología y Fisiopatología

Revisión de fisiología

• La aldosterona es estimulada directamente por:
  • Angiotensina II
  • Hiperpotasemia
• Eje renina-angiotensina-aldosterona (SRAA):
  • La renina (secretada por las células yuxtaglomerulares dentro de los LOS Neisseria riñones) → convierte el angiotensinógeno (secretado por los LOS Neisseria hepatocitos) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum angiotensina I
  • La ECA (secretada por el endotelio vascular pulmonar) → convierte la angiotensina I en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum angiotensina II
  • La angiotensina II → estimula la liberación de aldosterona (secretada por la zona glomerulosa Zona Glomerulosa The narrow subcapsular outer zone of the adrenal cortex. This zone produces a series of enzymes that convert pregnenolone to aldosterone. The final steps involve three successive oxidations by cytochrome p-450 cyp11b2. Adrenal Glands: Anatomy en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la corteza suprarrenal)
• Factores que normalmente activan el eje SRAA (y, por tanto, ↑ la aldosterona):
  • ↓ Presión arterial o volumen de sangre
  • ↓ Suministro de sodio al AL Amyloidosis riñón
  • ↑ Tono simpático
• Efectos de la aldosterona:
  • Estimula la producción de las siguientes proteínas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células principales de los LOS Neisseria túbulos renales distales:
    • Na⁺/K⁺ ATPasa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el lado basolateral
    • ENaC ENaC Sodium channels found on salt-reabsorbing epithelial cells that line the distal nephron; the distal colon; salivary ducts; sweat glands; and the lung. They are amiloride-sensitive and play a critical role in the control of sodium balance, blood volume, and blood pressure. Liddle Syndrome (canales de sodio epiteliales) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el lado de la luz: permite la reabsorción de Na⁺ desde el lumen hacia las células principales
    • ROMK (canal de potasio medular externo renal) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el lado de la luz: permite la excreción de K⁺ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la orina
  • Estimula la reabsorción de Na⁺ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria túbulos renales:
    • El agua sigue al AL Amyloidosis Na⁺.
    • Crea un gradiente eléctrico negativo a través del lumen, promoviendo la secreción de K⁺ y H⁺ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la orina

Etiología

Los LOS Neisseria dos mecanismos principales que causan el hipoaldosteronismo son la reducción de la producción de aldosterona (que puede ser hiporeninémica o hiperreninémica) y la resistencia a la aldosterona. Los LOS Neisseria medicamentos suelen ser la causa de ambos mecanismos.

Fisiopatología

• Resultado final de ↓ aldosterona:
  • ↑ K⁺ sérico (↓ excreción urinaria de K⁺)
  • Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica (↓ excreción urinaria de H⁺): acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal tipo 4
  • ↓ Na⁺ sérico (↑ excreción urinaria de Na⁺)
  • Reducción de volumen e hipotensión
• Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal tipo 4:
  • ↑ K⁺ → inhibe la síntesis renal de amoníaco y la excreción urinaria de amoníaco.
  • ↓ En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la excreción urinaria de amoníaco → acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica leve ( acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal tipo 4).
• Mecanismos del hipoaldosteronismo inducido por medicamentos:
  • Medicamentos que provocan un ↓ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la síntesis o liberación de aldosterona:
    • IECA/ARA
    • Heparina (efecto tóxico directo sobre las células de la zona glomerulosa Zona Glomerulosa The narrow subcapsular outer zone of the adrenal cortex. This zone produces a series of enzymes that convert pregnenolone to aldosterone. The final steps involve three successive oxidations by cytochrome p-450 cyp11b2. Adrenal Glands: Anatomy suprarrenal)
    • AINE/Inhibidores de la COX-2
    • Betabloqueadores
  • Inhibir los LOS Neisseria efectos de la aldosterona:
    • Antagonistas del receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors de aldosterona: espironolactona, eplerenona
    • Inhibidores de ENaC ENaC Sodium channels found on salt-reabsorbing epithelial cells that line the distal nephron; the distal colon; salivary ducts; sweat glands; and the lung. They are amiloride-sensitive and play a critical role in the control of sodium balance, blood volume, and blood pressure. Liddle Syndrome: amilorida, trimetoprim, pentamidina
  • Inducir la resistencia a la aldosterona: inhibidores de la calcineurina, ciclosporina y tacrolimus Tacrolimus A macrolide isolated from the culture broth of a strain of streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. Immunosuppressants

Presentación Clínica

• Suele ser asintomático (se descubre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum una evaluación de laboratorio rutinaria)
• La hiperpotasemia (> 5 mEq/L) puede presentarse con:
  • Arritmias cardíacas
  • Debilidad muscular
• Hiponatremia (< 135 mEq/L):
  • Más frecuente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños y en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con insuficiencia suprarrenal
  • Puede presentarse con:
    • Poliuria
    • Deshidratación
    • Náuseas y vómitos
    • Síntomas neurológicos: pérdida de memoria a corto plazo, confusión, letargo, convulsiones
• Características clínicas que sugieren condiciones asociadas (e.g., anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types de células falciformes, LES, insuficiencia suprarrenal)

Diagnóstico

El diagnóstico de hipoaldosteronismo debe considerarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cualquier paciente con hiperpotasemia persistente sin una causa obvia, como la insuficiencia renal o los LOS Neisseria diuréticos ahorradores de potasio.

• Pruebas específicas de aldosterona:
  • Aldosterona sérica:
    • ↓ En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todos los LOS Neisseria casos de hipoaldosteronismo verdadero
    • ↑ En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos de pseudohipoaldosteronismo (resistencia a la aldosterona)
  • Actividad de la renina plasmática:
    • ↓ En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal de tipo 4 (hipoaldosteronismo hiporeninémico)
    • ↑ En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la insuficiencia suprarrenal primaria
  • Gradiente de potasio transtubular: estima la acción de la aldosterona en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria túbulos colectores corticales
    • Gradiente de potasio transtubular = [K en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina ÷ (osmolalidad urinaria/osmolalidad sérica)] ÷ K sérico
    • ↓ Gradiente de potasio transtubular (< 7) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum presencia de hiperpotasemia: Es probable el hipoaldosteronismo.
  • Cortisol Cortisol Glucocorticoids sérico: para detectar insuficiencia suprarrenal
    • ↓ En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la insuficiencia suprarrenal
    • Normal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el hipoaldosteronismo aislado
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal de tipo 4 (hipoaldosteronismo hiporeninémico), las pruebas de laboratorio mostrarán:
  • Resultados de las pruebas específicas de aldosterona:
    • ↓ Aldosterona sérica
    • ↓ Actividad de la renina plasmática
    • ↓ Gradiente de potasio transtubular
  • Resultados del panel metabólico básico:
    • Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica sin brecha aniónica
    • ↓ HCO₃ sérico (generalmente leve, 18–22 mEq/L)
    • ↑ K⁺
    • ↑ Cl^–
    • Los LOS Neisseria marcadores de ↓ función renal son comunes (e.g., ↑ creatinina)
  • Hallazgos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la orina:
    • ↓ K⁺ urinario
    • Fosfato urinario normal
    • Calcio urinario normal o ↓
    • pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance de la orina < 5,3–5,5
• Electrocardiograma (debido a los LOS Neisseria riesgos cardíacos ↑ asociados a la hiperpotasemia)
• Pruebas para descartar otras condiciones asociadas, si se sospecha:
  • 17-hidroxiprogesterona (hiperplasia suprarrenal congénita)
  • Prueba del VIH

Tratamiento

El tratamiento depende de la etiología subyacente.

• Inducido por medicamentos: Ajustar/retirar los LOS Neisseria medicamentos que puedan estar contribuyendo.
• Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal de tipo 4 (hipoaldosteronismo hiporeninémico):
  • Dieta baja en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum potasio
  • Diuréticos de asa ASA Anterior Cord Syndrome o tiazídicos
  • Suplemento alcalino (NaHCO₃) si la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis no mejora
  • No se recomienda la sustitución de mineralocorticoides, ya que muchos pacientes tienen condiciones subyacentes (e.g., edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema, hipertensión) que se exacerbarían.
• Insuficiencia suprarrenal primaria e hiperplasia suprarrenal congénita:
  • Sustitución de mineralocorticoides: fludrocortisona
  • Sustitución de glucocorticoides: hidrocortisona o prednisona
• Hiperpotasemia con cambios en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el ECG ECG An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures. Electrocardiogram (ECG): tratamiento de emergencia a ↓ K⁺

Relevancia Clínica

• Hiperplasia suprarrenal congénita: consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un grupo de trastornos autosómicos recesivos que implican una mutación genética que da lugar a una deficiencia enzimática necesaria para la síntesis de cortisol Cortisol Glucocorticoids y/o aldosterona.
• Enfermedad de Addison primaria: también llamada insuficiencia suprarrenal primaria. Se define como la producción inadecuada de hormonas adrenocorticales, incluyendo glucocorticoides, mineralocorticoides y andrógenos suprarrenales. La insuficiencia suprarrenal primaria está causada por afecciones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la propia glándula. Los LOS Neisseria hallazgos clásicos incluyen hiperpigmentación mucosa y cutánea, hipotensión y síntomas gastrointestinales.
• Nefropatía diabética: La diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus describe un grupo de enfermedades metabólicas que se caracterizan por la hiperglucemia crónica y la resistencia a la insulina. La diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus de larga duración provoca cambios vasculares que acaban provocando complicaciones cardiovasculares, renales, retinales y neurológicas.
• Hiperpotasemia: se define como un nivel elevado de potasio sérico (> aproximadamente 5,5 mEq/L). La afección suele ser un hallazgo incidental en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la población general, pero afecta al AL Amyloidosis 10% de los LOS Neisseria pacientes hospitalizados. Hay muchas causas, entre ellas los LOS Neisseria desplazamientos transcelulares, la descomposición de los LOS Neisseria tejidos, la excreción inadecuada y la inducción por medicamentos. Los LOS Neisseria pacientes suelen ser asintomáticos.
• Hiponatremia: se define como la disminución de la concentración de sodio en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el plasma Plasma The residual portion of blood that is left after removal of blood cells by centrifugation without prior blood coagulation. Transfusion Products (< aproximadamente 135 mEq/L). Esta afección se produce por la pérdida de sodio o por el exceso de agua en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el líquido extracelular.
• Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis Tubular Renal: acumulación de ácido en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuerpo debido a un fallo de los LOS Neisseria riñones para acidificar adecuadamente la orina. La enfermedad se clasifica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 4 tipos.