Biomarcadores en fluídos biológicos y su potencial uso como indicadores de nefritis lúpica en individuos con lupus eritematoso sistémico

Lupus nephritis is one of the most severe manifestations of systemic lupus erythematous. Renal involvement in patients with systemic lupus erythematous is an important cause of morbidity and mortality. The pathogenesis of lupus nephritis involve multiple factors, wich include genetic predisposition, epigenetic regulation and environmental interaction. Conventional clinical parameters such as creatinine clearance, proteinuria, urinary sediments, antibodies anti-double- strand DNA and complement proteins they are not enough sensitive or specific to detect disease activity. In the last decades, “Omics” technologies (Proteomic, genomic, transcriptomic, metobolomic) have been used in an extensive way looking for biomarkers, which allowed to discovery variants associated with systemic lupus erythematous and lupus nephritis. Such findings have expanded our knowledge about molecular basis of disease and they have been very important to identification of potential therapeutic targets to prediction of disease and early treatment. In this review, we resume some of recent studies focused in identification of biomarkers associated with lupus nephritis in diverse biological fluids.La nefritis lúpica es una de las manifestaciones más severas del lupus eritematoso sistémico. El compromiso renal en pacientes con lupus eritematoso sistémico es un causal importante de morbilidad y mortalidad. La patogénesis de la nefritis lúpica involucra múltiples factores, entre los que se incluyen predisposición genética, regulación epigenética e interacción ambiental. Los parámetros clínicos convencionales tales como eliminación de creatinina, proteinuria, sedimentos urinarios, anticuerpos anti-ADN de doble cadena y niveles del complemento no son lo suficientemente sensibles o específicos para detectar actividad de la enfermedad.En las últimas décadas, las técnicas basadas en “Ómicas” (proteómica, genómica, transcriptómica, metabolómica) han sido utilizadas de manera extensa para la búsqueda de biomarcadores, las cuales han permitido descubrir una amplia variedad de variantes que son asociadas con lupus eritematoso sistémico y nefritis lúpica.Esos descubrimientos han expandido nuestro entendimiento de las bases moleculares de la enfermedad y han sido muy importantes para la identificación de potenciales blancos terapéuticos para predicción de la enfermedad y tratamiento temprano. En esta revisión, resumimos algunos de los estudios recientes enfocados en la identificación de biomarcadores asociados a nefritis lúpica en diversos fluidos biológicos

Insuficiencia renal aguda inducida por mordedura de serpiente Bothrops

Mujer de 58 años de edad, remitida a urgencias por presentar cuadro clínico de insuficiencia renal aguda (IRA) secundaria a mordedura de serpiente (Bothrops Atrox). Ingresa hipotensa con elevación de azoados e hiperkalemia, ecografía renal dentro de parámetros normales. Se maneja terapia dialítica con lo cual presenta mejoría clínica. En este reporte se detallan aspectos del diagnóstico, manejo clínico y posibles mecanismos fisiopatológicos que explican el daño renal

Comportamiento del infarto agudo de miocardio en pacientes de 30 a 50 años en el hospital Universitario San Jorge, 2013 a 2017

La enfermedad cardiovascular (ECV) es una importante causa de mortalidad y morbilidad, considerándose actualmente la primera causa de muerte e invalidez a nivel mundial. En las últimas décadas, se ha presentado el auge y desarrollo de ciertas enfermedades metabólicas, estrechamente ligadas a cambios en el estilo de vida, aumento del sedentarismo y dieta abundante

Atención interdisciplinar para una adecuada adherencia al tratamiento en pacientes con nefritis lúpica

The review is based on the contribution that each discipline should provide the patient for a holistic care, which include medical assessment, monitoring and counselling as emotional support, assessment and nutritional monitoring as a key element in core requirements, physical activity that optimize the quality of life, social activities that can enter the individual in active groups, follow-up by nurses to the fulfillment of the ordered drug treatment, car care and orientation education to the family. The novelty of this proposal is to basically carry out care of the interdisciplinary team for treatment adherence. This review concluded that patients with lupus nephritis (NL) treated after assessment and follow-up holistic, such as system monitoring and adherence to the treatment of comprehensive care, provides better quality of life, and minimizes the risks of complication of the patient, avoiding recurrent hospitalizations.La revisión está fundamentada en el aporte en que cada disciplina debe brindar al paciente para un cuidado holístico, entre los cuales están la valoración médica, seguimiento y apoyo psicológico como soporte emocional, valoración y seguimiento nutricional como elemento fundamental en requerimientos primordiales, actividad física que optimice la calidad de vida, actividades sociales que logren incursionar al individuo en grupos activos, seguimiento por parte de enfermería al cumplimiento del tratamiento farmacológico ordenado, educación de auto cuidado y orientación a la familia. Lo novedoso de esta propuesta es básicamente llevar a cabo los cuidados del equipo interdisciplinario para la adherencia del tratamiento. Esta revisión permitió concluir, que los pacientes con Nefritis Lúpica (NL) tratados tras valoración y seguimiento holístico, como sistema de vigilancia y adherencia al tratamiento del cuidado integral, brindan mejor calidad de vida, minimiza los riesgos de complicación del paciente evitando hospitalizaciones recurrent

Glomerulonefritis primarias en niños que asisten a un Centro de Referencia en la Región Caribe colombiana

Introduction: Primary glomerulonephritis are diseases that affect the structure and function of the glomerulus. For proliferative glomerulopathies, it has been observed that for IgA and IgM mesangial GN, they are the ones that mostly evolve to end-stage renal failure, followed by membranous-proliferative or mesangiocapillar GN. The clinical manifestation of GN is the result of the combination of hematuria, proteinuria and the presence of acute or chronic renal failure.Material and methods: Medical records were reviewed. They were collected in a database of all biopsies performed from 2008 to 2014. An ?² was used to establish associations between variables (? = 95%). For the differences among proportions Student’s t or U-Mann-Whitney were used.Results: 146 (88%) patients who had complete data were selected. The mean age was 8 ± 4 years old for both sexes. No significant difference was found between gender by age (p? 0.05), nor was there an association between gender and age (p? 0.05). The predominant NGs with the highest prevalence were Proliferative Mesangial and IgA Nephropathy. NGs by Thin Basal Membrane, Nephropathy by C3 and Cq were not present in male patients. The most prevalent syndromic picture was the Nephrotic Syndrome (58%).Conclusions: The existence of this registry of renal biopsies is the basis for the creation of the Registry of Glomerulopathies in children in Colombia, whose data are necessary to establish programs for the treatment and prevention of glomerular diseases in our country in order to decrease its progression.Introducción:Las glomerulonefritis (GN) primarias son enfermedades que afectan a la estructura y función del glomérulo. Dentro de las glomerulopatías proliferativas se ha observado que la GN mesangial por IgA e IgM, son las que evolucionan con mayor frecuencia a la insuficiencia renal permanente; seguida de la GN membrano-proliferativa o mesangiocapilar. La presentación clínica de la GN incluye hematuria, proteinuria e insuficiencia renal aguda o crónica.Material y métodos: Se revisaron las historias clínicas y se acopiaron en una base de datos todas las biopsias realizadas entre los años 2008 a 2014. Se realizó un ?², para establecer las asociaciones entre variables (? = 95%) y para las diferencias entre proporciones se utilizó t de Studentó U- Mann-Whitney.Resultados: Se seleccionaron 146 pacientes (88% del total analizado) que tenían los datos completos. La edad promedio fue de 8±4 años para ambos sexos. No se encontraron diferencias significativasni asociaciones entre el sexo y la edad (p? 0,05). Las GN predominantes fueron las proliferativa mesangial y la nefropatía por IgA. Las GN por membrana basal delgada, nefropatía por C3 y C4 q no se presentaron en varones. La presentación clínica más frecuente fue el Síndrome Nefrótico (58%).Conclusiones: Los hallazgos de éste registro de biopsias renales podrían ser la base para la creación de un Registro de Glomerulopatías en niños en Colombia, instrumento necesario para establecer programas de tratamiento y prevención de las enfermedades glomerulares en nuestro país a fin de disminuir su progresión

Asociación de obesidad con la Enfermedad Renal Crónica de pacientes atendidos en la Clínica de la Costa. 2005-2014

Introduction: Obesity is a risk factor for the development and the progression of the Chronic Kidney Disease (CKD). In Latin America there are few studies where the stages of CKD and the degrees of obesity are related.Objective:The objective of the study is to evaluate the association of obesity with the chronic renal disease in patients seen in the extern consult of the department of Nephrology at the Clinic of the Coast in Barran-quilla, Colombia.Materials and Methods: A descriptive case series study was conducted. The sample consisted of 300 pa-tients collected in NefroRed©. Measurements of central tendency Y and X2were conducted to establish the association between degrees of obesity with CKD stages. Statistical analyseswere performed in R-CRAN. When the test was realized an association between degrees of obesity and the different stages of CKD was found [x2: 48.62; p-value <0.01].Conclusion: No statistical evidence of association was found between waist circumference and the stages of CKD [x2: 8.82; p-value ? 0.05]. There is an association between levels of obesity and the different stages of CKD. No relationship between waist circumference and the stages of CKD was found.Introducción: La obesidad es un factor de riesgo de desarrollo y progresión de enfermedad renal crónica (ERC). En Latinoamérica existen pocos estudios donde se relacionen los estadios de ERC y grados de obesidad.Objetivo: El objetivo de estudio es evaluar la asociación de obesidad con la enfermedad renal crónica de pacientes atendidos en la consulta externa del departamento de Nefrología en la Clínica de la Costa en Barranquilla, Colombia.Materiales y métodos: Se realizó un estudio observacional descriptivo tipo serie de casos. La muestra estuvo compuesta por 300 pacientes acopiados en NefroRed©. Se realizaron medidas de tendencia central y un ?² para establecer la asociación entre los grados de obesidad con los estadios de la ERC. Los análisis estadísticos se realizaron en R-CRAN. Al realizar la prueba, se encontró una asociación entre los grados de obesidad y los diferentes estadios de la ERC [?²: 48,62; p-valor < 0,01].Conclusión: No se encontró evidencia estadística de asociación entre el Perímetro Abdominal y los estadios de ERC [?²: 8,82; p-valor ? 0,05]. Existe asociación entre los grados de obesidad y los diferentes estadios de la ERC. No se encontró la relación entre perímetro abdominal y los estadios de ERC

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

The Role of Glycosyltransferases in Colorectal Cancer

Colorectal cancer (CRC) is one of the main causes of cancer death in the world. Posttranslational modifications (PTMs) have been extensively studied in malignancies due to its relevance in tumor pathogenesis and therapy. This review is focused on the dysregulation of glycosyltransferase expression in CRC and its impact in cell function and in several biological pathways associated with CRC pathogenesis, prognosis and therapeutic approaches. Glycan structures act as interface molecules between cells and their environment and in several cases facilitate molecule function. CRC tissue shows alterations in glycan structures decorating molecules, such as annexin-1, mucins, heat shock protein 90 (Hsp90), 1 integrin, carcinoembryonic antigen (CEA), epidermal growth factor receptor (EGFR), insulin-like growth factor-binding protein 3 (IGFBP3), transforming growth factor beta (TGF- ) receptors, Fas (CD95), PD-L1, decorin, sorbin and SH3 domain-containing protein 1 (SORBS1), CD147 and glycosphingolipids. All of these are described as key molecules in oncogenesis and metastasis. Therefore, glycosylation in CRC can affect cell migration, cell–cell adhesion, actin polymerization, mitosis, cell membrane repair, apoptosis, cell differentiation, stemness regulation, intestinal mucosal barrier integrity, immune system regulation, T cell polarization and gut microbiota composition; all such functions are associated with the prognosis and evolution of the disease. According to these findings, multiple strategies have been evaluated to alter oligosaccharide processing and to modify glycoconjugate structures in order to control CRC progression and prevent metastasis. Additionally, immunotherapy approaches have contemplated the use of neo-antigens, generated by altered glycosylation, as targets for tumor-specific T cells or engineered CAR (Chimeric antigen receptors) T cells

Consecutive renal biopsy in a cohort of patients with lupus nephritis of the Colombian Caribbean

Background: Renal biopsy is the gold standard for the diagnosis and classification of lupus nephritis (LN). However, a consecutive biopsy can predict the clinical course and optimize the therapeutic strategies. Objectives: To compare the histopathological findings with clinical responses. Patients and Methods: Thirty patients with active LN were included. Renal biopsies were performed at the time of diagnosis and subsequently under clinical criteria according to consensus of Spanish Society of Nephrology. The response to treatment was defined as complete response, partial responder or non-responder. The histological change in second biopsy towards LN classes I, II or III/IV-C was defined as histological response (HR). Results: In initial renal biopsy, 28 (93%) patients showed proliferative LN; III-A or A/C (n; 7), IV-A or A/C (n: 19) and mixed; III+IV/V (n; 2). LN class V was presented in two cases. The clinical response was; complete response (10%), partial response (20%), and non-response (70%). HR was manifested in 37% and non-histologic response in 63% of patients. Around 33% of patients with complete response/partial response showed active lesions in the consecutive renal biopsy. Conclusions: In Colombian Caribbean, LN is aggressive and refractory to treatment. The consecutive renal biopsy allowed to demonstrate the persistence of the activity of the lesion in almost half of the patients, which may provide additional information to create better response criteria. The consecutive renal biopsy is a tool that allows improving the evaluation of the response to treatment in the LN

Optimizing dialysis dose in the context of frailty: an exploratory study

Introduction Frailty is a multicausal syndrome characterized by a decrease in strength, resistance and physiological function, which makes the individual vulnerable and dependent, and increases his/her mortality. This syndrome is more prevalent among older individuals, and chronic kidney disease patients, particularly those on dialysis. Dialysis dose is currently standardized for hemodialysis (HD) patients regardless of their age and functional status. However, it has been postulated that the dialysis dose required in older patients, especially frail ones, should be lower, since it could increase their degree of frailty. Then, the purpose of this study was to evaluate if there would be a correlation between the dose of Kt/V and the degree of frailty in a population of adult patients on HD. Materials and methods A cross-sectional study with 82 patients on HD in Barranquilla (Colombia) and Lobos (Argentina) was conducted. Socio-demographic and laboratory data, as well as dialysis doses (Kt/V) were recorded and scales of fragility, physical activity, gait and grip strength were applied. Then these data were correlated by a Spearman’s correlation and a logistic regression. Results CFS, social isolation, physical activity, gait speed, and prehensile strength tests were outside the reference ranges in the studied group. No significant correlation was found between dialysis dose and all the above mentioned functional tests. However, a significant and inverse correlation between physical activity and CFS was documented (score − 1.41 (CI − 2.1 to − 0.7). Conclusion No significant correlation was documented between Kt/V value and different parameters of the frailty status, but this status correlated significantly and inversely with physical activity in this group. Frailty status in hemodialysis patients was significantly higher in older individuals, although young individuals were not exempt from it