Clinical Nephrology

This cross-sectional analytical study was carried out to determine the frequency of frailty in patients on haemodialysis and to identify predictive clinical parameters. Patients were selected using convenience sampling. Exclusion criteria included acute kidney injury, non-compliance to hemodialysis, limited physical mobility due to cerebrovascular or rheumatological diseases, acute infections and unwillingness. Frailty was assessed using a short physical performance battery (SPPB). Handgrip strength and triceps skin fold thickness were also measured. There were 79 patients enrolled in the study with mean age of 51.86± 14.85 years, including 44 (55.70%) males. The median SPPB score was 8 (4-11). Frailty was observed in 51 (64.56%) patients. SPPB score had significant correlation with handgrip strength (R 2 = 0.309; p<0.001) and triceps skin fold thickness (R 2 = 0.060; p=0.030). On univariate analysis, increasing age, female gender, triceps skin fold thickness and hand grip strength were predictive of frailty. However, only increasing age (p<0.001) was predictive of frailty in multivariate analysis.

The purpose of this cross sectional study was to determine the frequency of under-collected 24 hours urinary samples. Diabetic patients who visited our clinic from June 2012 to November 2012 were explained the procedure for collection verbally in addition to being given written instructions. Adequacy of collection was assessed by measuring creatinine excretion rates. Out of the 112 patients enrolled, 16(14.29%) collected their samples inadequately. The education level (p&lt; 0.001) and urine volume (p= 0.003) were lesser in these 16 patients as compared to others. Inadequate collection was common in the younger patients (22.22% patients aged less than 60 years, 6.90% aged 60 years or older ; p= 0.021). Gender (15.00% men, 12.50% women; p= 0.733) did not impact the collection of samples. Considering the high frequency of under-collections, adequacy of samples should always be checked first before proceeding further with laboratory analysis.

More than 50% of patients with non-Shiga toxin-associated hemolytic uremic syndrome (non-Stx-HUS) progress to ESRD. Kidney transplant failure for disease recurrence is common; hence, whether renal transplantation is appropriate in this clinical setting remains a debated issue. The aim of this study was to identify possible prognostic factors for renal transplant outcome by focusing on specific genetic abnormalities associated with the disease. All articles in literature that describe renal transplant outcome in patients with ESRD secondary to non-Stx-HUS, genotyped for CFH, MCP, and IF mutations, were reviewed, and data of patients who were referred to the International Registry of Recurrent and Familial HUS/TTP and data from the Newcastle cohort were examined. This study confirmed that the overall outcome of kidney transplantation in patients with non-Stx-HUS is poor, with disease recurring in 60% of patients, 91.6% of whom developed graft failure. No clinical prognostic factor that could identify patients who were at high risk for graft failure was found. The presence of a factor H (CFH) mutation was associated with a high incidence of graft failure (77.8 versus 54.9% in patients without CFH mutation). Similar results were seen in patients with a factor I (IF) mutation. In contrast, graft outcome was favorable in all patients who carried a membrane co-factor protein (MCP) mutation. Patients with non-Stx-HUS should undergo genotyping before renal transplantation to help predict the risk for graft failure. It is debatable whether a kidney transplant should be recommended for patients with CFH or IF mutation. Reasonably, patients with an MCP mutation can undergo a kidney transplant without risk for recurrence.

Background. Prostate-specific antigen (PSA) occurs in different molecular forms in serum: free PSA (fPSA) and complexed PSA (cPSA), the sum of which corresponds to total PSA (tPSA). In addition to tPSA, percent fPSA is widely used in the detection of prostate cancer. Free PSA, ∼28 kDa, is eliminated by glomerular filtration. Previous data showed that men with end-stage renal dysfunction requiring chronic dialysis have increased percent fPSA. In this study, we evaluated whether moderate-to-severe chronic renal dysfunction, but with no need for dialysis, also importantly affects percent fPSA. Methods. The study group consisted of 101 men (median age 57 years, interquartile range 46-68) with chronic kidney disease and no diagnosis of prostate cancer. Their median glomerular filtration rate (GFR) was 23 mL/min/1.73 m 2 (interquartile range 16-33; range 8-83), determined by iohexol clearance. Controls included 5264 men (median age 57 years, interquartile range 54-62) attending a prostate cancer screening program with no diagnosis of prostate cancer during 8 years of follow-up. Results. With adjustment for age, median fPSA levels and percent fPSA were significantly higher (P < 0.001) in patients with renal dysfunction, 0.45 µg/L and 47.2%, respectively, compared to controls, 0.29 µg/L and 29.9%, respectively. Regression analysis in the study group showed a significant association between GFR and percent fPSA (P = 0.036). Conclusions. The percent fPSA is importantly influenced by moderately impaired renal function in men with chronic kidney disease. For such men, use of the current clinical decision limits for percent fPSA could cause some men with prostate cancer to be misdiagnosed as having benign disease, and therefore fPSA should not be used to diagnose prostate cancer in these patients.

El hematoma subdural crónico constituye una enfermedad frecuente en la práctica neuroquirúrgica cotidiana. Su diagnóstico se realiza actualmente de forma temprana en la mayoría de los pacientes, a partir de la introducción de las modernas técnicas de imagenología. Se presenta el caso de un enfermo de 84 años de edad con historia de cefalea, mutismo acinético y cuadriparesia, cuyo examen tomográfico mostró una colección extraxial supratentorial hemisférica derecha con calcificación masiva; se practicó la exéresis mediante una craneotomía y el estudio

A 22-year-old male smoker presented with intermittent right flank pain lasting over a year. He had a history of atrophied left kidney and gout. Physical exam revealed mild right renal angle tenderness. Outcome: Initial imaging, pointed to a diagnosis of ureteropelvic junction stenosis. During surgery, a type two retrocaval ureter was discovered. Transposition pyelo-pyelostomy was performed to repair the ureter, and a double-J stent was inserted. Conclusion: This case highlights the challenge of accurately diagnosing retrocaval ureter, especially type, based on initial radiological images.

The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. Aggravatingly, CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume up to 3% of the annual healthcare budget in high-income countries. Crucially, however, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventionsbe it primary, secondary or tertiary. This complementing article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tracts, as well as exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD,

Background. Calcium phosphate (CaP) renal stones appear to be increasing in prevalence, and are caused by high urine CaP supersaturation, which arises from genetic hypercalciuria and high urine pH. Renal damage from stones or procedures, or treatments for stone could raise urine pH; alternatively pH may be intrinsically high in some people who are thereby predisposed to CaP stones. Methods. To distinguish these alternatives we sequenced changes in urine pH and stone CaP content asking which occurs first in patients whose stones showed progressive increase in CaP over time. From 4767 patients we found 62 in whom we could document transformation from calcium oxalate (CaOx) to CaP stones, and 134 CaOx controls who did not transform. Laboratory and clinical finding were contrasted between these groups. Results. Even when patients were forming relatively pure CaOx stones, those destined to increase stone CaP had higher urine pH than controls who never did so. Their higher pH was present before and during treatments to prevent new stone formation. Shock wave lithotripsy was strongly associated with increasing stone CaP but urine pH bore no relationship to number of procedures. Conclusion. We conclude that high pH may not be acquired as a result of stones or their treatments but may precede transformation from CaOx to CaP stones and arise from diet or possibly heredity.

La constipación severa o las complicaciones del megacolon chagásico fueron clásicamente de resolución quirúrgica. Numerosos estudios fueron hechos, como así también muchas técnicas quirúrgicas fueron descritas para el abordaje de esta patología. La progresiva disminución del número de pacientes tratados quirúrgicamente es el resultado de la aplicación de las políticas públicas de salud, que evitan los nuevos casos y las complicaciones crónicas de esta entidad.

Se realizo un estudio con el fin de conocer la incidencia de la crisis hipertensiva, las características clínicas de los enfermos y el manejo en el servicio de urgencias del Hospital Obrero Nº 2 de la CNS Cochabamba para, recomendar pautas de actuación en urgencias ante una crisis hipertensiva (CH) de acuerdo con los resultados. Es un estudio prospectivo, transversal y descriptivo, desarrollado

Renal biopsy(RB) is necessary for the diagnosis, prognosis, and therapy guidance of native kidney diseases. Few studies have compared outcomes of RB procedures. We compared the efficiency and safety of five biopsy procedures. Number of glomeruli on light microscopy(LM) and on immunofluorescence(IF) and serious adverse events following RB performed in five nephrology units(C1-C5) were retrospectively collected. C1 performed ultrasound assessment before RB and used a 14-gauge core-cutting needle biopsy gun, C2 ultrasound guidance and a 14-gauge needle, C3 tomodensitometry guidance and a 14-gauge needle, C4 ultrasound guidance and a 16-gauge needle, and C5 tomodensitometry guidance and a 16-gauge needle. Data from 943 RB performed between January 2006 and July 2010 were collected (C1: 408; C2: 254; C3: 81; C4: 136; C5: 64). On LM, mean number of glomeruli on biopsy core was 14.2±8.6. It was higher in C1 and C2 than in C3, C4, and C5(p=0.01). At least 10 glomeruli were found in 69% of biopsies. This rate was higher in C1 and C2 than in C3, C4, and C5(p=0.004). On IF, mean number of glomeruli was 4.4±3.3. It was higher in C1 and C2 than in C3, C4, and C5(p<0.001). In multivariate analysis, the only factor that influenced number of glomeruli on LM(p=0.004) and IF(p=0.004) was the nephrology unit. Serious adverse events occurred in 1.5% of biopsies. Complication rate was not different between nephrology units. Efficiency and safety of kidney biopsy 4 RB is safe but radiological guidance, needle-size, and experience influence the quality of biopsies.

Development of steroid dependency in patients with nephrotic syndrome may require a long-term multi-drug therapy at risk of drug toxicity and renal failure. Rituximab treatment reduces the steroid dosage and the need for immunosuppressive therapy in pediatric patients. Here we retrospectively analyze the efficacy and safety of rituximab in adult patients with steroid-dependent minimal change disease. To do this, we analyzed the outcome of all adult patients treated with rituximab for steroid-dependent minimal change nephrotic syndrome over a mean follow-up of 29.5 months (range 5.1-82 months). Seventeen patients with steroid-dependent or frequently relapsing minimal change nephrotic syndrome, unresponsive to several immunosuppressive medications, were treated with rituximab. Eleven patients had no relapses after rituximab infusion (mean follow-up 26.7 months, range 5.1-82 months) and nine of them were able to come off all other immunosuppressive drugs and steroids during follow-up. Six patients relapsed at least once after a mean time of 11.9 months (mean follow-up 34.5 months, range 16.9-50.1 months), but their immunosuppressive drug treatment could be stopped or markedly reduced during this time. No adverse events were recorded. Thus, rituximab is efficient and safe in adult patients suffering from severe steroid-dependent minimal change disease. Prospective randomized trials are needed to confirm this study.

Objetivo: Describir la producción científica peruana que sobre diabetes mellitus 2 (DM) y nefropatía diabética (NFD) se ha escrito en la literatura médica. Material y métodos: Se realizó una revisión bibliográfica no sistemática de la producción científica que sobre DM y NFD en población peruana y que ha sido publicada en revistas médicas nacionales e internacionales hasta febrero de 2015. Se consultaron las bases de datos Medline, Web of Science, Scopus, SciELO y Google Scholar. Los resultados se dividieron a priori en cinco áreas temáticas: prevalencia de DM, manejo clínico de los pacientes diabéticos, diagnóstico de la NFD, factores de riesgo para albuminuria, y evaluación temprana de la NFD. Resultados: Se encontraron 22 artículos. La prevalencia de la DM varía dependiendo la definición y población estudiada siendo mayor en la costa que en la sierra (4,3% vs. 2,1%). El 40% de los pacientes diabéticos en hospitales públicos de Lima tiene HBA1C > 7%. Así mismo, el control de los pacientes DM en Perú es deficiente comparado con sus pares latinoamericanos. El "screening" de la NFD es infrecuente, solo 8,9% de los pacientes tiene albuminuria en sus evaluaciones en hospitales a nivel nacional. Se encontraron factores modificables asociados a la albuminuria en pacientes con NFD tales como glicemia (OR 1,19 IC 95%: 1,05-1,34), hipertensión arterial (OR 0,48 IC 95%: 0,33-0,70) y estadios de enferme-

Patients on chronic maintenance dialysis have an alarmingly high mortality of approximately 15-20%. This rate is mainly due to cardiovascular comorbidity and, secondarily in part to the increasing prevalence of changes in blood pressure. These blood pressure changes are the most common complications that occur in these patients, most commonly hypotension, with Intradialytic Hypertension (IDH) occurring second. This single center, hospital based prospective observational cohort, research study investigated on (a) the prevalence of IDH and (b) determine the demographic, clinical profile and modifiable factors which can predict the occurrence of IDH. Three hundred thirty two (332) patients enrolled at the center were included in the study, with only 307 giving consent. Percentage prevalence of intradialytic hypertension and a higher odds ratio will depict the highest risk in determining IDH. Incidence of IDH in the study was at 37% which was higher as compared to the worldwide rate of 5-15% as well as to studies made in India, Nigeria and South Africa at 34.51%, 31% and 28% prevalence respectively. Males are significantly greater than women in the prevalence of IDH. Presence of hypertension as a comorbid is significantly higher in the IDH than in the non IDH group. Among the modifiable factors, serum albumin levels, ultra filtrate volumes, mean heart rate and arterial pressures showed significant difference between the WOH and WIH. Results from the bio impedance monitor likewise showed that the volumes of total fluid, extracellular water and intracellular water, levels of urea content and masses of adipose tissue and lean tissue were significantly higher in those with IDH. Using a logistic regression analysis, results revealed that those with the highest odds ratio in predicting the onset of IDH were ultra-filtrate volumes, serum albumin levels and intradialytic hypotension at 14.75 (3.782-57.534), 8.635 (3.603-20.696) and 1.167 (0.411-3.315) respectively. The high incidence of IDH should serve as an alarm to the institution. Measures should be taken to reduce its incidence by modifying certain practice that are already used to reduce its presence in hemodialysis patients and preventing more morbid complications like death.

Hyperuricemia is a condition of increased uric acid levels in the blood that can trigger various complications, such as gout and nephropathy. Allopurinol is a pharmacological agent that is widely used to inhibit the xanthine oxidase enzyme, thereby reducing uric acid production. This study aims to evaluate the effectiveness and safety of allopurinol in reducing uric acid levels in hyperuricemia patients. The study was conducted by analyzing the results of previous studies involving hyperuricemia patients who received allopurinol therapy with doses adjusted based on the severity of hyperuricemia and kidney function. The results of the study showed that consistent use of allopurinol can significantly reduce uric acid levels, especially in patients with chronic gout. However, side effects such as hypersensitivity reactions and impaired liver function require close monitoring. Therefore, the use of allopurinol needs to be adjusted to the patient's profile to maximize the benefits of therapy and minimize the risk of side effects.

Hyperuricemia is a condition of increased uric acid levels in the blood that can trigger various complications, such as gout and nephropathy. Allopurinol is a pharmacological agent that is widely used to inhibit the xanthine oxidase enzyme, thereby reducing uric acid production. This study aims to evaluate the effectiveness and safety of allopurinol in reducing uric acid levels in hyperuricemia patients. The study was conducted by analyzing the results of previous studies involving hyperuricemia patients who received allopurinol therapy with doses adjusted based on the severity of hyperuricemia and kidney function. The results of the study showed that consistent use of allopurinol can significantly reduce uric acid levels, especially in patients with chronic gout. However, side effects such as hypersensitivity reactions and impaired liver function require close monitoring. Therefore, the use of allopurinol needs to be adjusted to the patient's profile to maximize the benefits of therapy and minimize the risk of side effects.

Acute granulomatous tubulointerstitial nephritis (GTIN) is a rare finding in renal biopsy. Differential diagnosis is facilitated when GTIN is associated with granulomatous bilateral anterior uveitis (GBAU). Nevertheless, differentiation between a rare form of granulomatous tubulointerstitial nephritis and uveitis syndrome (TINU) and sarcoidosis can be challenging. We report a case of biopsy-proven GTIN with concomitant GBAU, leading to a dead-end diagnosis. We discuss workup and propose a diagnostic algorithm based on a literature review. We also report a successful treatment of ophthalmologic and renal relapse using mycophenolate mofetil.

Los cambios que se producen como respuesta al estrés se dividen en “adaptaciones centrales” y “adaptaciones periféricas”; dentro de estas últimas se encuentran los cambios del sistema cardiovascular (el incremento del pulso y la tensión arterial), que no son suficientes en el sistema adaptativo: el sistema inmune debe completar la respuesta clásica al estrés para hacerla plenamente adaptativa y garantía de supervivencia. La conocida relación entre el estrés, la hipertensión arterial y el sistema inmune motivó la realización del presente trabajo, que tiene como objetivo evaluar el comportamiento de la inmunidad natural y humoral en pacientes hipertensos sometidos a estrés. Se estudiaron 33 pacientes a los que se les determinaron las proteínas del complemento C3 y C4 (inmunidad natural) y las inmunoglobulinas IgM, IgG e IgA (inmunidad humoral) por un método turbidimétrico cuantitativo; 16 enfermos tuvieron al menos un parámetro alterado en la inmunidad natural y siete en la humoral; n...

Background: Few studies have explored dialysis patients' perspectives on dialysis decision-making and end-of-lifecare (EoLC) preferences. We surveyed a racially diverse cohort of maintenance dialysis patients in the Cleveland, OH, USA, metropolitan area. Materials and methods: In this cross-sectional study, we administered a 41-item questionnaire to 450 adult chronic dialysis patients. Items assessed patients' knowledge of their kidney disease as well as their attitudes toward chronic kidney disease (CKD) treatment issues and EoLC issues. Results: The cohort included 67% Blacks, 27% Caucasians, 2.8% Hispanics, and 2.4% others. The response rate was 94% (423/450). Most patients considered it essential to obtain detailed information about their medical condition (80.6%) and prognosis (78.3%). Nearly 19% of respondents regretted their decision to start dialysis. 41% of patients would prefer treatment(s) aimed at relieving pain rather than prolonging life (30.5%), but a majority would want to be resuscitated (55.3%). Only 8.4% reported having a designated healthcare proxy, and 35.7% reported completing a living will. A significant percentage of patients wished to discuss their quality of life (71%), psychosocial and spiritual concerns (50.4%), and end-of-life issues (38%) with their nephrologist. Conclusion: Most dialysis patients wish to have more frequent discussions about their disease, prognosis, and EoLC planning. Findings from this study can inform the design of future interventions.

Significance Statement National and international guidelines recommend supportive approaches to AKI management, but organizational strategies to improve delivery of AKI care have not previously been tested in multicenter randomized studies. The authors describe a pragmatic, multicenter, cluster randomized trial across five United Kingdom hospitals of an intervention comprising an AKI detection and e-alert system, an AKI care bundle, and an educational program for health care workers. Although the intervention did not alter the primary outcome of 30-day mortality, it was associated with reductions in length of hospital stay as well as an increase in AKI incidence that likely reflected improved recognition. These results combined with previous evidence show that strategies to improve the systematic delivery of supportive AKI care can lead to improvements in patient outcomes. Background Variable standards of care may contribute to poor outcomes associated with AKI. We evaluated whether...

29.2% of the nurses felt competent in discussing fertility, 8.3% had sufficient knowledge about fertility, and 75.7% needed to expand their knowledge. More knowledge and competence were associated with providing fertility health care (p < 0.01). Conclusions In most nephrology departments, the guidelines to appoint which care provider should provide fertility care to CKD patients are absent. Fertility counseling is routinely provided by most nephrologists, nurses often skip this part of care mainly due to insufficiencies in selfimposed competence and knowledge and barriers based on cultural diversity. The outcomes identified a need for fertility guidelines in the nephrology department and training and education for nurses on providing fertility care.

Esta investigacion se efectuo para ampliar el conocimiento sobre los agentes etiologicos de la uretritis masculina en Asuncion; se baso en una revision retrospectiva de las fichas clinicas de 619 pacientes que acudieron con propositos diagnosticos a tres laboratorios privados y a un laboratorio publico de Asuncion. La edad promedio ± DE fue de 37,6±15,2 anos (rango 0-91 anos), 373 pacientes concurrieron a Meyer Lab, 166 al laboratorio San Roque, 68 al laboratorio de Santa Clara y 12 al laboratorio de Microbiologia del IICS. En total se procesaron muestras de orina de 289 pacientes, secrecion uretral de 326 y en 4 pacientes tanto orina como secrecion uretral. Las indicaciones medicas fueron busqueda de Neisseria gonorrhoeae en 295 pacientes, Chlamydia trachomatis en 256, Ureaplasma urealyticum en 264, Mycoplasma hominis en 199. Se demostro la presencia de N. gonorrhoeae en el 6,4% de los casos, C. trachomatis en el 3,5%, U. urealyticum 11,5% y M. hominis 2,5%. A pesar de que se hallo...

Hoy día existen muchos criterios sobre las características clinicoepidemiológicas y quirúrgicas de las neoplasias primarias del segmento hepatobiliopancreático, lo cual constituye un verdadero problema científico, por las tasas elevadas de letalidad y mortalidad, por cuanto resulta de gran importancia identificar los factores pronósticos de complicaciones y decesos, inherentes a esta entidad clínica, a fin de elaborar un protocolo de actuación y buenas prácticas. Todo ello justifica la necesidad de profundizar en los principales aspectos cognoscitivos relacionados con este tema, puesto que solo contando con equipos de trabajo altamente especializados, podrá elevarse la calidad asistencial y, por tanto, el índice de supervivencia de quienes presenten esa lamentable enfermedad. Palabras clave: neoplasia de hígado, vía biliar, páncreas, tratamiento quirúrgico, quimioterapia, atención secundaria de salud.

The blood and drainage cultures are suggested for early diagnosis of bloodstream infection (BSI), which are time consuming and laborious. Nasal colonization of bacteria is one of the modalities, occasionally can predict BSI. We hypothesized that nasal culture, as an accessible fl uid may be helpful to predict future BSI in hemodialysis patients. The present prospective study evaluated 63 patients undergoing maintenance hemodialysis at the Pars hospital dialysis center, Tehran, Iran, from November 2015 until February 2016. Nasal fl uid of patients were collected from the 1-cm internal anterior part of both nostrils of patients by a sterile swab and cultured in Trypticase soy agar. All patients were followed for three months for BSI. The results of fi rst nasal fl uid sample revealed that 33.3% in fi rst sampling and 27.0% in sampling had positive nasal fl uid culture. The type of bacteria in all positive cases was Staphylococcus aureus. The rate of BSI infection in the patients with positive and negative fi rst nasal fl uid culture was 9.5% and 2.4% respectively with no signifi cant difference. We found also no signifi cant association between BSI positivity and nasal culture results so that positive BSI was revealed in 5.9% of patients with positive nasal fl uid culture and 4.3% in those with negative nasal fl uid culture with no meaningful difference. None of the baseline variables including age and gender, underlying risk factor, access, or duration of dialysis was associated with BSI positivity. In hemodialysis patients, BSI may not be predicted by nasal fl uid culture positivity.

This article is being published in Kidney International and reprinted concurrently in several journals. The articles cover identical concepts and wording, but vary in minor stylistic and spelling changes, detail, and length of manuscript in keeping with each journal's style. Any of these versions may be used in citing this article.

Ferric citrate is an approved phosphate binder for use in patients with chronic kidney disease on dialysis. Clinical trials demonstrated that ferric citrate controlled serum phosphorus levels and increased iron stores. The aim of this retrospective chart review was to evaluate realworld bone mineral and anemia parameter data from patients treated with ferric citrate. 92 adult dialysis patients taking ferric citrate (average starting dose of 6 tablets/ day) for at least 6 months were included. Bone mineral, anemia, and iron biomarker levels were extracted from patient medical records before and during the first 6 months of ferric citrate treatment; 21 (23%) patients were phosphate binder naïve, and 71 (77%) patients had been on other phosphate binders. Before starting ferric citrate, 22% of patients had serum phosphorus ≤ 5.5 mg/dL, increasing to 65% of patients at 6 months of treatment (month 6). Mean (standard error of the mean (SEM)) baseline serum phosphorus was 6.55 ± 0.17 mg/dL decreasing to 5.40 ± 0.17 mg/dL at month 6. Mean (SEM) baseline hemoglobin, ferritin, and transferrin saturation were 10.6 ± 0.2 g/dL, 734 ± 65 ng/mL, and 27.1 ± 1.6%, respectively, and 11.1 ± 0.2 g/dL, 947 ± 66 ng/mL, and 37 ± 1.9%, respectively, at month 6. The serum phosphorus and anemia biomarker levels observed in this retrospective chart review were similar to those seen in clinical trials.

Цель: оценить влияние терапии блокаторами ренин-ангиотензин-альдостероновой системы на уровень альдостерона крови у больных хронической сердечной недостаточностью (ХСН) с сохраненной фракцией выброса (ФВ) левого желудочка (лЖ). Материал и методы: проведено проспективное исследование c участием 158 пациентов (58 мужчин и 100 женщин, средний возраст 62,3 ± 7,4 лет), имеющих компенсированную ХСН с сохраненной (> 50 %) ФВ лЖ и диастолической дисфункцией. Пациенты не страдали первичным гиперальдостеронизмом и не принимали антагонисты минералокортикоидных рецепторов в течение предшествующих 6 недель. У всех больных оценивали длительность лечения и среднесуточную дозу принимаемого ингибитора ангиотензин-превращающего фермента (ИАПФ) или антагониста рецепторов ангиотензина-2 (АРА-2). Дозу каждого препарата оценивали в течение предшествующих 6 месяцев и выражали в виде процента от целевой. Также определяли уровень альдостерона в сыворотке крови, при этом референтными значениями считали концентрацию гормона 40 -160 пг/мл. Результаты: по результатам измерения концентрации альдостерона крови, все пациенты были разделены на две группы. В первую вошли 99 больных (62,7 %), у которых уровень гормона находился в пределах нормы, во вторую -59 пациентов (37,3 %) с гиперальдостеронемией. У пациентов II группы, по сравнению с I, достоверно выше были длительность приема ИАПФ/АРА-2 (6 (3; 8) лет против 4 (2; 5) лет, р < 0,001) и доза принимаемого препарата (50 (25; 50) % против 25 (12,5; 50) % от целевой, р = 0,01). После поправки на возраст, тяжесть ХСН, длительность анамнеза артериальной гипертензии и наличие сопутствующей патологии длительный прием ИАПФ/АРА-2 (> 5 лет) являлся независимым предиктором развития гиперальдостеронемии (отношение шансов 3,16, 95 % доверительный интервал 2,08 -8,24). Среднесуточная доза препарата утрачивала свое прогностическое значение в многофакторной модели. Выводы: у больных ХСН с сохраненной ФВ лЖ уровень альдостерона крови зависит от продолжительности приема препаратов, блокирующих ренин-ангиотензин-альдостероновую систему. Длительная (> 5 лет) терапия ИАПФ/АРА-2 является независимым фактором риска развития вторичного гиперальдостеронизма. Ключевые слова: феномен ускользания альдостерона, ренин-ангиотензин-альдостероновая система, ингибиторы ангиотензин-превращающего фермента, антагонисты рецепторов ангиотензина-2, вторичный гиперальдостеронизм. Для цитирования: Шевелёк А.Н. Влияние терапии блокаторами ренин-ангиотензиновой системы на уровень альдостерона крови у больных хронической сердечной недостаточностью с сохраненной фракцией выброса левого желудочка.

La realizacion de multiples ensayos clinicos y estudios multicentricos en Cardiologia, ha permitido reunir un enorme numero de evidencias clinicas, que han modificado de forma radical el diagnostico y tratamiento del sindrome de insuficiencia cardiaca. En la actualidad, las diferentes sociedades de Cardiologia de Norteamerica y Europa han elaborado guias de buenas practicas y guias de actuacion que abordan el tema y establecen recomendaciones segun sus grados y nivel de evidencia, para tratamientos complejos que tienen como objetivo tratar tanto la enfermedad como sus frecuentes complicaciones, prevenir su progresion, y adecuarse a cada periodo evolutivo de la misma. En esta publicacion se hace una apretada sintesis de las mejores practicas mundiales y se particulariza en la disponibilidad de medicamentos de nuestro cuadro basico. A forma de conclusion se establece, ademas, un grupo de recomendaciones practicas para el medico generalista.

La hernia lumbar es un defecto poco frecuente de la pared posterior del abdomen, representa menos del 1% de todas las hernias de la pared abdominal. Este tipo de hernia es más frecuente en un solo lado y sobre todo, en los hombres de mediana edad, ancianos y rara vez contienen un saco herniario real. Existen dos maneras diferentes de abordar su reparación: por vía laparoscópica o por vía convencional. El valor de este artículo es describir un caso de hernia lumbar bilateral de Grynfelt tratada por cirugía abierta convencional y la colocación de una malla.

Introduction: the laser therapy is a therapeutical option to treat vascular malformations. Objective: this study was done with the objectives:, to characterize the sample socialdemographically, to classify lesions topographically, to determine effectiveness of endoluminal diode laser sclerosis in the treatment of low flow vascular malformations, to determine changes in diameter and lesions presence, to identify accidents and complications. Method: a study of cases was carried out in 12 patients of the total of patients who attended with the diagnosis of low flow vascular malformations, at the Department of Maxillofacial Surgery, Faculty of Dentistry "Raúl González Sánchez", from October 2011 to February 2012.The patients were treated by endoluminal sclerosis with diodo laser. Was assessment age, sex, area, diameter, and lesion presence chronologically. Results: 12 patients was studied, the 66.7 % of the sample were female, the 33,3% of the patients were with age among 30-39 years. The 50% had regression of lesion after one session of treatment. The complication most frequent was swelling. Conclusions: the endoluminal laser sclerosis was a safe and efficacy method to treat low flow vascular orofacial lesions.

El plasmocitoma de la mama es muy infrecuente y en la mayoria de los casos aparece asociado a mieloma multiple. Se describe una paciente  de 42 anos de edad con diagnostico conocido de plasmocitoma solitario del cuello asociado a mieloma multiple, que 11 meses despues de alcanzada la remision se presenta con  una tumoracion  en la mama derecha sin manifestaciones sistemicas de mieloma. El estudio histologico e inmunohistoquimico del tumor confirmaron el diagnostico de plasmocitoma. El diagnostico diferencial en ocasiones es dificil y debe hacerse con tumores primarios y secundarios de la mama. El tratamiento de eleccion es la radioterapia local siempre que no existan manifestaciones sistemicas de la enfermedad subyacente.

RESUMEN Fundamento: la insuficiencia renal crónica es la pérdida gradual, progresiva e irreversible de las funciones renales. Las fórmulas más empleadas para su diagnóstico son las de Cockcroft-Gault y la Modificación de Dieta en la Enfermedad Renal. En Matanzas se habían utilizado en estudios poblacionales. Objetivos: calcular la prevalencia de la insuficiencia renal crónica en el municipio de Matanzas y comparar ambas fórmulas. Métodos: se realizó un estudio descriptivo de tipo transversal. Muestra 2 326 personas. Las variables utilizadas fueron edad, sexo, peso, talla, color de la piel y creatinina sérica. Se utilizaron los intervalos de confianza del 95 % para comparar las prevalencias por ambos métodos. Resultados: la prevalencia fue de 6,4 por 100 personas por Cockcroft-Gault y 5,0 por Modificación de Dieta en la Enfermedad Renal. Se incrementó directamente proporcional a la edad, el sexo femenino fue el más afectado, al igual que el color de piel blanca. No hubo diferencias significativas entre los datos de ambos métodos en el análisis de estas variables. La media de filtrado glomerular fue superior por la fórmula de Cockcroft-Gault. Igualmente por esta ecuación, fue superior la prevalencia en el grupo de 65 a 74 y en las personas con peso saludable. Conclusiones: se considera que ambos métodos son válidos para el cálculo de FG y por tanto para el diagnóstico de insuficiencia renal crónica, por su sencillez, y bajo costo, cuando se trabaja con grupos poblacionales grandes.

Introduction: a descriptive study was conducted to characterize the patterns of encephalic lesions found in patients with HIV/AIDS during the period 2008-2011. Methods: the sample was composed of 53 patients. Sociodemographic, clinical, anatomical and imaging variables were used to characterize, compare and group the lesions according to presentation patterns and to issue an imaging diagnostic impression. The information was processed by a statistical method using SPSS, basic version, also using frequency distributions and contingency tables to correlate clinical and imaging diagnosis with the diagnosis of certainty. Results: the most frequent imaging pattern was the focal mass with contrast enhancement (71.70 %), followed by diffuse compromise of the white matter (11.32 %). A significant correlation was found between the Sibtain imaging patterns and others and the diagnosis of certainty (contingency coefficient: 0.935). Conclusions: the diagnosis made with the use of imaging patterns is highly reliable in central neurological affections in patients with HIV/AIDS.

How to cite this article: Diab A, Anthony P, Berryman H, Diab K. Acute Kidney Injury due to spontaneous Atheroembolic disease, superimposed on diabetic nephropathy, with no recent vascular or cardiac intervention, presented as Rapidly Progressive Glomerulonephritis (RPGN).

IntroductIon Nesfatin-1, which was discovered in 2006, consists of an 82-amino acid polypeptide. It has an active core that has an anorexigenic effect, which is the mid-fragment that consists of 29 amino acids, through which it regulates food intake, gastrointestinal function, glucose and lipid Background Nesfatin-1 is considered an anorexigenic peptide that plays an important role in appetite regulation, weight loss, and malnutrition. Although the cause of anorexia in CKD patients is not totally understood, both anorexia and malnutrition are common presentations of chronic kidney disease (CKD) patients who are susceptible to worse outcomes. Our aim of the work To study the relation of serum nesfatin-1 and its relation to the nutritional status of end-stage renal disease (ESRD), who are maintained on regular hemodialysis. Patients and methods A total of 60 ESRD patients are maintained on regular hemodialysis, and apparently healthy thirty persons (control group) were included in this study. Those included represented 45 males and 45 females with an age range from 19 to 68 years old. Based on malnutrition inflammation score (MIS), we had three groups, the first & second group, each included 30 ESRD patients maintained on regular HD without & with malnutrition respectively. 3rd group included 30 apparently healthy control persons; all subjects were exposed to full history, clinical examination, MIS questioner, and lab. Tests in the form of Complete blood count, liver function test, Kidney Function test, s.Calcium, Phosphrus, Parathyroid hormone, iron profile, C reactive protein titer, interleukin 6, and serum nesfatin 1. Results There were significant increases in s. nesfatin-1 and CRP levels in groups 1, 2 more than that of the control group, with a significant increase in group 2 in comparison to other groups. Group 2 had a statistically significantly increase of IL6 and MIS when compared to group 1. In group 2. while there was a highly significant positive correlation between nesfatin-1with MIS and IL6, but a significantly negative correlation with BMI, Ph. and serum parathyroid hormone. In group 1, while there was a highly significant positive correlation between nesfatin-1with MIS and IL6, a significantly positive correlation with duration of dialysis but a significantly negative correlation with ferritin, calcium, and cholesterol. The cutoff level in group1 patients versus group 2 was more than 16.6, with a sensitivity of 56.7% and specificity of 83.3%. In conclusion, s. nesfatin-1 is specific for the detection of malnutrition in hemodialysis patients.

transcraneal (DTC) es una técnica de ultrasonido no invasiva que permite evaluar la velocidad y dirección del flujo sanguíneo en los segmentos proximales de las principales arterias cerebrales. Se utiliza principalmente en la evaluación y seguimiento de pacientes con enfermedades cerebrovasculares, por lo que se ha convertido en herramienta fundamental para el monitoreo en la fase aguda y de apoyo para el diagnóstico de la muerte encefálica. En esta revisión se resalta la importancia del DTC como herramienta diagnóstica y terapéutica en pacientes con afecciones cerebrovasculares ingresados en una unidad de ictus y como prueba complementaria en el diagnóstico de la muerte encefálica.

transcraneal (DTC) es una técnica de ultrasonido no invasiva que permite evaluar la velocidad y dirección del flujo sanguíneo en los segmentos proximales de las principales arterias cerebrales. Se utiliza principalmente en la evaluación y seguimiento de pacientes con enfermedades cerebrovasculares, por lo que se ha convertido en herramienta fundamental para el monitoreo en la fase aguda y de apoyo para el diagnóstico de la muerte encefálica. En esta revisión se resalta la importancia del DTC como herramienta diagnóstica y terapéutica en pacientes con afecciones cerebrovasculares ingresados en una unidad de ictus y como prueba complementaria en el diagnóstico de la muerte encefálica.

Youth, which is forgiven everything, forgives itself nothing: age, which forgives itself everything, is forgiven nothing. -George Bernard Shaw The proportion of older people in the general population is steadily increasing worldwide, with the most rapid growth in low-and middle-income countries. 1 This demographic change is to be celebrated, because it is the consequence of socioeconomic development and better life expectancy. However, population aging also has important implications for society -in diverse areas including health systems, labor markets, public policy, social programs, and family dynamics. 2 A successful response to the aging population will require capitalizing on the opportunities that this transition offers, as well as effectively addressing its challenges. Chronic kidney disease (CKD) is an important public health problem that is characterized by poor health outcomes and very high health care costs. CKD is a major risk multiplier in patients with diabetes, hypertension, heart disease and stroke -all of which are key causes of death and disability in older people. Since the prevalence of CKD is higher in older people, the health impact of population aging will depend in part on how the kidney community responds. March 13, 2014 will mark the celebration of the 9 th World Kidney Day (WKD), an annual event jointly sponsored by the International Society of Nephrology and the International Correspondence to: (no_reprints@med. ualberta.ca).

Never doubt that a small group of thoughtful, committed citizens can change the world: Indeed, it's the only thing that ever has." -Margaret Mead M arch 13, 2008, heralds the third annual World Kidney Day (WKD), an event that will be celebrated in more than 60 countries. We take this opportunity to recount how this concept has gained worldwide traction and momentum and to reflect on the challenges faced by its creators and supporters.

Background: There is enough evidence to suggest that vancomycin increases the risk of acute kidney injury (AKI) but the exact mechanism is not well understood. This study aims to understand the incidence of vancomycin-associated acute kidney injury (VA-AKI) among hospitalized patients and to identify the risk factors for VA-AKI. Methods: Patients aged 18 and above who received a minimum of 24 hours of intravenous vancomycin and who had serial creatinine measurements over a 13-month period were identifi ed through electronic records. Patients with pre-existing AKI, or eGFR of less than 30ml/min, and patients with end stage kidney disease were excluded. Results were analyzed using t-test and Fisher's test. A logistic regression model was used to identify the predictors for VA-AKI. Results: From the 598 patients who met the inclusion criteria, 70 developed AKI. Compared to those without AKI, patients with VA-AKI had higher mean serum vancomycin trough levels (22.6 mg/L vs. 14.6 mg/L), and a statistically signifi cant longer duration of vancomycin use (6.7 vs. 5.2 days). Multivariate analysis revealed that serum vancomycin level of > 20 mg/L was associated with a six-fold increase in odds of VA-AKI when compared to those with vancomycin levels < 15 mg/L. The presence of hypotension, iodinated contrast use, and concomitant use of piperacillintazobactam were all associated with increased odds of VA-AKI. The incidence of VA-AKI in hospitalized patients with eGFR > 30 ml/min was 11.7%. Serum vancomycin levels of > 20 mg/L, hypotension and administration of iodinated contrast signifi cantly increased the risk of VA-AKI. Piperacillin-tazobactam, when used with vancomycin, was noted to be an independent predictor of AKI, regardless of serum vancomycin trough levels, prompting a reevaluation of the safety of this widespread practice as empiric therapy. Close monitoring of kidney function, avoiding high serum vancomycin levels, maintaining hemodynamic stability, and avoiding unnecessary use of iodinated contrast seem to be essential for the prevention of VA-AKI.

Objective and design: Hightone external muscle stimulation (HTEMS) ameliorates pain and discomfort of patients with polyneuropathy. Since some patients reported about an urge to urinate during these treatments, the potential effects of HTEMS application on renal function were investigated. For this purpose in healthy subjects, we analyzed in the current study the acute effects of electrotherapy on parameters of renal function. Interventions: 24 healthy volunteers (14 women and 10 men), mean age 26 ± 4 years, were enrolled. The protocol was composed of a run-in period, a pre-treatment period, the active HTEMS treatment period of both lower extremities and the post-treatment period. The duration of each period was 60 min. Urine collection and blood samples were taken at the beginning and end of each period. To achieve a sufficient diuresis, the fluid intake was adapted to the amount of diuresis. Parameters of renal function included diuresis, glomerular filtration rate (endogenous creatinine clearance) and absolute and fractional sodium excretion. Moreover blood pressure and heart rate were monitored. Results: HTEMS led to a significant increase of creatinine clearance and fractional sodium excretion which was limited to the active treatment period. Conclusion: These findings show for the first time that HTEMS can transiently increase glomerular filtration rate associated with a decreased tubular sodium reabsorption. The underlying mechanisms are to be elucidated.

Chronic Kidney Disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide. Women • Access to care • Kidney health • Acute and chronic kidney disease • Inequities * Adeera Levin

Ischemic stroke in children may occur in the arterial area, most of them in the carotid zone. The sinovenous obstructions, whose diagnosis requires proper rates of suspicion and imaging diagnostic techniques capable of detecting them are less common. There are many genetic and acquired risk factors related to ischemic stroke. Cardiac diseases, blood coagulation disorders, sickle cell anemia, infections, moyamoya syndrome, arterial dissection, and other rare genetic disorders, are among the most frequent documented risk factors. Sinovenous obstructions seem to be connected with head or neck infections, dehydratation, perinatal complications, and coagulation disorders. There is also the possibility that many of these factors act at the same time on the patient with stroke. The identification and possible control of the risk factors of children's strokes are the objectives of an intensive multicentric research to clear up the physiopathogeny and the real relationship causing them.

A series of 126 adult patients with a serologically confirmed diagnosis of nephropathia epidemica (NE) were studied during the acute phase of the disease. In 86 cases, renal biopsy was performed. The severity of renal failure correlated slightly with blood inflammatory parameters and the degree of hematuria but not with the amount of proteinuria. The degree of hematuria correlated inversely with the level of thrombocytopenia. The most common histopathologic lesion was acute tubulointerstitial nephritis. Interstitial edema and inflammatory cell infiltrations were most usually present, followed by tubular epithelial and luminal alterations. Slight glomerular mesangial changes were present in 25% of the biopsy specimens. Except for hemorrhage in the outer renal medulla, the histologic lesions were relatively mild and unspecific. Interstitial hemorrhage should remind a pathologist of the possibility of NE. Tubular, interstitial and glomerular histologic damage were but vascular lesions were not associated with the clinical severity of renal failure. Glomerular alterations did not relate to the amount of urine protein excretion. Correlations, however, were so weak that in clinical work renal biopsy is usually not indicated for determination of the severity of renal failure in NE. Intrinsic renal events are probably important in the development of renal failure in NE.