Insulin and the kidneys: a contemporary view on the molecular basis

Insulin is a hormone that is composed of 51 amino acids and structurally organized as a hexamer comprising three heterodimers. Insulin is the central hormone involved in the control of glucose and lipid metabolism, aiding in processes such as body homeostasis and cell growth. Insulin is synthesized as a large preprohormone and has a leader sequence or signal peptide that appears to be responsible for transport to the endoplasmic reticulum membranes. The interaction of insulin with the kidneys is a dynamic and multicenter process, as it acts in multiple sites throughout the nephron. Insulin acts on a range of tissues, from the glomerulus to the renal tubule, by modulating different functions such as glomerular filtration, gluconeogenesis, natriuresis, glucose uptake, regulation of ion transport, and the prevention of apoptosis. On the other hand, there is sufficient evidence showing the insulin receptor’s involvement in renal functions and its responsibility for the regulation of glucose homeostasis, which enables us to understand its contribution to the insulin resistance phenomenon and its association with the progression of diabetic kidney disease

Insuficiencia renal en cirrosis: revisión de laliteratura

Introduction: During the cirrhotic patient’s disease, renal failure is a poor prognostic event. Purpose: Knowing the risk factors for AKI in these patients given by the presence of infectious processes, loss of fluids due to hemorrhage, gastrointestinal or kidney, and nephrotoxic agents are essential for initiating therapeutic measures and prophylactic actions. Methodology: A bibliographic search was carried out in the PubMed, EMBASE, Scopus and academic Google databases, using the terms MeSH acute renal failure, creatinine, liver cirrhosis, hepatorenal syndrome. Original articles, meta-analyzes, case reports, case series and literature reviews were obtained, choosing 16 documents for the preparation of this review. Results: The new criteria defined by the International Ascites Club (AKI-IAC), which eliminate urinary out put, are determined by an increase in serum creatinine?0.3 mg / dL in less than 48 hours and improve the prognosis, allowing timely interventions. Conclusions: Creatinine continues to be the most widely used biomarker in AKI, even in cirrhotic patients, despite its multiple limitations. A dynamic criterion modified from the AKIN criteria becomes the gold standard for the diagnosis of AKI in cirrhosis.Contexto: en el curso de la enfermedad del paciente cirrótico, la insuficiencia renal es un eventode mal pronóstico. Objetivo: identificar en estos pacientes los factores de riesgo de IRA, tales como: presencia deprocesos infecciosos, hipovolemia inducida por hemorragia, pérdidas gastrointestinales o renalesy agentes nefrotóxicos, ya que conocer de su aparición es primordial para dar comienzo a lasmedidas terapéuticas y las acciones profilácticas. Metodología: se realizó una búsqueda bibliográca en las bases de datos PubMed, EMBASE,Scopus y Google académico, usando los términos MeSH como insuficiencia renal aguda, creati-nina, cirrosis hepática, síndrome hepatorenal. Se obtuvieron resultados entre artículos originales, metaanálisis, reportes de casos, series de casos y revisiones de la literatura, y se escogieron 16 documentos para la elaboración de esta revisión. Resultados: los nuevos criterios definidos por el Club Internacional de Ascitis (AKI-IAC), loscuales eliminan el gasto urinario, se determinan por un aumento de la creatinina sérica?0,3mg/dL en menos de 48 horas y, mejoran el pronóstico, permitiendo realizar intervenciones opor-tunas. Conclusiones: la creatinina sigue siendo el biomarcador más utilizado en insuficiencia renalaguda (IRA), incluso en pacientes cirróticos, a pesar de sus múltiples limitaciones. Un criterio dinámico modificado a partir de los criterios de AKIN, se convierte en el patrón de oro para eldiagnóstico de IRA en cirrosis

Catástrofes tiroideas en UCI: Coma mixedematoso y tormenta tiroidea. Reporte de casos

Thyroid function disorders are clinical and endocrinological emergencies that rapidly progress to organic failure and are life threatening conditions. Among these thyroid disorders are myxedematous coma being the most extreme manifestation of hypothyroidism, and the thyroid storm resulting from hyperthyroidism. Therapeutic strategies are based on the rapid recognition of the condition, support measures in the critical care unit; without forgetting the treatment of the triggering factor, in order to reduce complications and mortality.Las alteraciones de la función tiroidea son emergencias clínicas y endocrinológicas que rápidamente progresan a disfunción orgánica siendo condiciones potencialmente mortal. Dentro de estos desórdenes tiroideos se encuentran el coma mixedematoso siendo la manifestación más extrema del hipotiroidismo y la tormenta tiroidea resultante del hipertiroidismo. Lasestrategias terapéuticas se basan en el rápido reconocimiento de la condición, medidas de soporte en la unidad de cuidado crítico; sin olvidar el tratamiento del factor desencadenante, con la finalidad de disminuir las complicaciones y la mortalidad

Lazarus phenomenon : return of spontaneous circulation after cessation of prolonged cardiopulmonary resuscitation in a patient with covid-19.

The pandemic caused by the SARS-CoV-2 or COVID-19 infection has had an unimaginable impact on health systems worldwide. Cardiorespiratory arrest remains a potentially reversible medical emergency that requires the performance of a set of maneuvers designed to replace and restore spontaneous breathing and circulation. Suspending cardiopulmonary resuscitation (CPR) usually corresponds to an ethical-clinical dilemma that the health professional in charge must assume. The “Lazarus phenomenon” is an unusual syndrome with a difficult pathophysiological explanation, defined as the spontaneous return of circulation in the absence of any life support technique or after the cessation of failed CPR maneuvers. We present the case of a 79-year-old patient hospitalized in the intensive care unit for septic shock of pulmonary origin associated with COVID-19 infection who presented cardiorespiratory arrest that required unsuccessful resuscitation maneuvers for 40 minutes, declared deceased. After 20 minutes of death, he presented a return to spontaneous circulation. The pathophysiological changes of the Lazarus phenomenon remind us of the limitations we have in determining when to end cardiopulmonary resuscitation and that its interruption must be approached with more caution, especially in the context of the COVID-19 pandemic

Trombosis de seno venoso asociada con infección por SARS-CoV-2

INTRODUCCION: La trombosis del seno venoso se considera una de las causas más infrecuentes de enfermedad cerebrovascular (ECV), prevalente en la edad joven. Suele tener un inicio insidioso, lo cual dificulta su diagnóstico y el inicio oportuno del tratamiento, y se encuentra asociada con múltiples factores de riesgo, incluyendo estados de hipercoagulabilidad, como en aquellos pacientes que cursan con infección por SARS-CoV-2. REPORTE DE CASO: Se presentan dos casos clínicos de pacientes con alteraciones neurológicas, diplopia y estatus epiléptico, en quienes se documentó por medio de la sintomatologia y de estudios imagenológicos, trombosis venosas extensas de localización infrecuente, se descartaron las principales etiologías asociadas, y el único nexo asociado fue la infección por SARS-CoV-2. Ambos pacientes recibieron tratamiento con anticoagulación parenteral, al que respondieron de forma exitosa, por lo cual se logró el alta posteriormente con anticoagulación oral. DISCUSIÓN: Es imprescindible el conocimiento de esta enfermedad, asociada con una alta sospecha diagnóstica, dadas sus manifestaciones clínicas variadas y su asociación cada vez más frecuente con infección por covid-19

Enfermedad Hepática Grasa No Alcohólica: Perspectiva general y riesgo cardiovascular

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide. It is considered the hepatic expression of metabolic syndrome; the different components of this syndrome behave as potential factors of onset and progression of the NAFLD; Within these patients’ cardiovascular disease is the primary cause of mortality and morbidity. Consequently, a greater interest has been developed in generating strategies that can impact the effect of NAFLD on cardiovascular disease. Objective: To evaluate the contribution of non-alcoholic fatty liver disease to cardiovascular disease. Material and Methods: Electronic search in the databases: PubMed, ScienceDirect, Scopus and Medline of review and original articles mostly published between 1997 and 2019. Conclusion: The NAFLD is a fundamental component of cardiovascular risk, it is an element associated with adverse cardiovascular outcomes, therefore it demands a greater interest on the part of the clinician. The therapeutic options, although varied, are far from providing an efficient solution to the metabolic problem triggered by this condition, nonpharmacological strategies being the cornerstone in its approach.Introducción: la enfermedad hepática grasa no alcohólica (EHGNA) es la causa más común de enfermedad hepática crónica a nivel mundial. Se considera la expresión hepática del síndrome metabólico, los distintos componentes de este síndrome se comportan como factores potenciales de aparición y progresión de la EHGNA; dentro de estos pacientes la enfermedad cardiovascular constituye la causa primaria de mortalidad y morbilidad. En consecuencia se ha desarrollado un interés mayor en generar estrategias que permitan impactar el efecto de la EHGNA sobre la enfermedad cardiovascular. Objetivo: evaluar la contribución de la enfermedad hepática grasa no alcohólica a la enfermedad cardiovascular. Metodología: se realiza búsqueda electrónica en las bases de datos: PubMed, ScienciaDirect, Scopus y Medline de artículos originales y de revisión en el período entre 1997 y 2019. Conclusión: La EHGNA es un componente fundamental del riesgo cardiovascular, constituye un elemento asociado a desenlaces cardiovasculares adversos, por lo tanto demanda un mayor interés por parte del clínico. Las opciones terapéuticas aunque variadas, distan de dar una solución eficiente al problema metabólico desencadenado por esta condición, siendo las estrategias no farmacológicas la piedra angular en su abordaj

Pielonefritis enfisematosa: reporte de dos casos con manejo exitoso

Emphysematous pyelonephritis is a serious disease with an infrequent presentation and high mortality. It tends to occur more frequently in the population with risk factors, among which the following stand out: type 2 diabetes mellitus, obstructive uropathy, alcoholism, immunosuppression. The radiological classification of emphysematous pyelonephritis ranges from type one, which comprises gas that involves the collecting system, to type 4, which is a single or bilateral kidney disease.  Treatment will depend on the degree of severity, milder cases can be treated with catheter or percutaneous drainage plus antibiotic therapy, while more severe cases may require paranephrectomy surgery.  Patients with septic shock, thrombocytopenia, acute renal failure, and hypoalbuminemia generally have a poor prognosis.  We present two poorly controlled diabetic patients over 50 years of age diagnosed through computed tomography. One of the patients with obstructive uropathy and the other with horseshoe kidney, both patients successfully treated with medical management and minimally invasive procedure.La pielonefritis enfisematosa es una enfermedad grave, con poca frecuencia de presentación y alta mortalidad. Suele presentarse con mayor frecuencia en población con factores de riesgo dentro de los que se destacan: diabetes mellitus tipo 2, uropatía obstructiva, etilismo, inmunosupresión. La clasificación radiológica de la pielonefritis enfisematosa va desde tipo uno, que comprende gas que compromete el sistema colector hasta un tipo 4 que es la afección de un solo riñón o bilateral. El tratamiento dependerá del grado de severidad, los casos más leves pueden tratarse con catéter o drenaje percutáneo más terapia antibiótica, mientras que los casos más graves pueden necesitar intervención quirúrgica para nefrectomía. En aquellos pacientes con presencia de shock séptico, trombocitopenia, insuficiencia renal aguda e hipoalbuminemia generalmente tienen pronóstico desfavorable. Presentamos dos pacientes diabéticos mal controlados mayores de 50 años de edad diagnosticados a través de tomografia axial computarizada. Uno de los pacientes con uropatía obstructiva y otro con riñón en herradura, ambos pacientes tratados exitosamente con manejo médico y procedimiento mínimamente invasivo

Acute kidney injury in Colombian patients with COVID-19 who received kidney support therapy with genius® 90 technology

Introduction: Acute kidney injury (AKI) is one of the complications associated with severe COVID-19 infection, and it can present in up to 20% to 40% of the cases; of these, approximately 20% will require renal replacement therapy (RRT). Objective: To establish clinical and laboratory characteristics in a group of patients from Colombia with COVID-19 infection and AKI that received intermittent and prolonged RRT with the GENIUS® 90 technology in between March and July 2020. Design: Cross-sectional study. Results: 78.9% of participants were men and 21.1% were women. The main comorbidities were the following: Hypertension (65.3%), diabetes mellitus (38.9%), obesity (26.3%), cancer (5.3%), Chronic obstructive pulmonary disease (11.6%), cardiovascular disease (23.2%), active smoking (11.6%). 33.7% had chronic kidney disease (CKD) in the average serum creatinine on admission was 4.4 mg/dl. The following inflammatory markers were elevated: C-reactive protein (CRP), d-dimer and ferritin (20.3 mg/dl, 931mcg/l and 1174 ng/ml, respectively). 63.5% of patients underwent sustained low-efficiency dialysis (SLED) (6 to 12 hours) and the rest of the patients (36.35%) underwent conventional hemodialysis (less than 4 hours). The mortality of the total patient sample was 36.9%, lower in patients with CKD than in patients with no previous renal disease history (18.7% and 40.1%, respectively). Conclusion: Renal complications are frequent in patients with severe COVID-19. The development of AKI could be an isolated prognostic marker associated with an increase in mortality in patients with COVID-19, and one of the options is intermittent and prolonged RRT with the GENIUS® 90 system