33 research outputs found
Primary prevention for acute kidney injury in ambulatory patients
Acute kidney injury (AKI) is a heterogeneous group of conditions characterized by a sudden decrease in glomerular filtration rate (GFR), which usually induces the accumulation of nitrogenous-waste substances in the blood. It is expressed as an increase in serum creatinine levels (≥ 0.3 mg/dl within 48 hours or ≥1.5 times from baseline within the previous 7 days) or by a urine volume reduction of ˂0.5 ml/kg/h in 6 hours [1]. AKI is a relevant condition since it is usually associated with 1–7% and 30–50% of hospital and intensive care unit (ICU) admissions, respectively; showing a significant morbidity-mortality rate, and
progression to chronic kidney disease (CKD) [1–7]. Even though many strategies have been proposed to achieve an early AKI diagnosis (e.g. novel biomarkers, informatics alarms), and an AKI effective treatment (e.g. renal protective drugs, biocompatible renal replacement therapies), both objectives remain unachieved; therefore, AKI prevention is currently the best ‘therapeutic’ strategy for this condition
Características sociodemográficas y clínicas de pacientes con nefritis lúpica. Barranquilla, Colombia
La Nefritis Lúpica (NL) es una complicación relevante del paciente con lupus eritematoso sistémico (LES). Las condiciones socio demográficas pueden ser vulnerables a la aparición de la enfermedad?. Estudio cuantitativo, descriptivo y transversal. Población conformada por 22 pacientes con (NL) del programa de Nefrored del Caribe que asistieron a una institución prestadora de salud en la ciudad de Barranquilla, de enero de 2017 a enero de 2018. La muestra fue por conveniencia. La información se realizó a través de instrumento tipo escala de Likert, conformada por las variables: características socio demográficas (sexo, ubicación geográfica, estado civil), tiempo de diagnóstico de la enfermedad y toma del medicamento ordenado. El 96% era de sexo femenino y el 4% de sexo masculino, 27.3% estuvo entre edades de 34 y 45 años, el 54.5% era procedente de la ciudad de Barranquilla, y el 2.7% de los pacientes tenìan diagnóstico en un plazo de tiempo menor a los 2 años de haber presentado manifestaciones clínicas. Las condiciones sociodemograficas y clinicas de los pacientes con LES que desarrollan NL permitirán desarrollar acciones para un diagnóstico oportuno e intervención efectiva que coadyuven a la adherencia al tratamiento, y a reducir la morbilidad en los pacientes de la Region Caribe Colombiana
Cell Signaling in Neuronal Stem Cells
The defining characteristic of neural stem cells (NSCs) is their ability to multiply through
symmetric divisions and proliferation, and differentiation by asymmetric divisions, thus giving rise
to different types of cells of the central nervous system (CNS). A strict temporal space control of the
NSC differentiation is necessary, because its alterations are associated with neurological dysfunctions
and, in some cases, death. This work reviews the current state of the molecular mechanisms that
regulate the transcription in NSCs, organized according to whether the origin of the stimulus that
triggers the molecular cascade in the CNS is internal (intrinsic factors) or whether it is the result of
the microenvironment that surrounds the CNS (extrinsic factors)
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
Complex Posterior reversible encephalopathy syndrome with ACA infarct a woman with Lupus: Case Repor and Review
Posterior reversible encephalopathy syndrome is a clinical–radiological disorder, which usually progresses with classical acute neurological symptoms (visual impairment, acute headache, altered level of consciousness, seizures, and even focal neurological deficit). A case presented with a review of the currently available literature is reported in this article
Case-Serie of 4 COVID-19 patients hospitalized in an intensive care unit in a hospital institution in Barranquilla, Colombia
Objetivo: Presentar una serie de casos de COVID-19 con requerimiento
de ingreso a Unidad de Cuidados Intensivos. Métodos: La información fue tomada
de las historias clínicas, y su evaluación y diagnóstico fue realizado mediante
estudios paraclínicos en sangre, orina, PCR e imágenes diagnósticas en 4 pacientes
con diferentes comorbilidades y nexo epidemiológico presente para desarrollo de la
enfermedad. El caso 1 desarrolló falla orgánica múltiple, incluyendo injuria renal
aguda con una estancia en UCI de 4 dias antes de su fallecimiento, mientras los
casos 2, 3 y 4 tuvieron una evolución favorable y fueron dados de alta de UCI. Los
cuatro casos fueron manejados con cloroquina 300 mg via oral cada 12 horas y
azitromicina 1 gr via oral cada 24 horas durante 5 dias sin complicaciones ni
toxicidad asociada. Conclusiones: Se requieren estudios multicéntricos rápidos
que orienten científicamente hacia un mejor abordaje diagnóstico y manejo, en el
contexto de una enfermedad con un comportamiento clínico-epidemiologico que
debe estudiarse en profundidad y que probablemente cobrará muchas vidas,
ademas, debido a la ausencia de pruebas diagnósticas rápidas, la utilización de una
clasificación basada en la severidad de lesiones radiológicas llamada CO-RADS
(Covid-19 Imaging Reporting and Data System), podría ser de gran importancia para
instalar de manera temprana los tratamientos farmacológicos disponibles y la
asistencia respiratoria mecánica precoz.Objective: To present a COVID-19 case series with clinical admission
criteria to Intensive Care Unit. Methods: Patients information was obtained from
medical records, and daily clinical evaluation whereas diagnosis was carried out
through paraclinical studies in blood, urine, PCR and diagnostic images in 4 patients
with different comorbidities and epidemiological link for the development of COVID19. The case 1 developed multiple organ failure, including acute kidney injury with
an ICU stay of 4 days before his death, while cases 2, 3 and 4 had a favorable
evolution and were discharged from the ICU. All four cases were managed with
chloroquine 300 mg orally every 12 hours and azithromycin orally every 24 hours for
5 days without complications or associated toxicity. Conclusions: rapid multicenter
studies are required to scientifically guide a better diagnostic and management
approach, in the context of a disease with a clinical-epidemiological behavior that
must be studied in depth and will probably take many lives. In addition, due to the
absence of sufficiently rapid tests, the use of a classification based on the severity
of radiological lesions called CO-RADS (Covid-19 Imaging Reporting and Data
System), could be of great importance to install av
Osmotic diuresis in chronic kidney disease: its significance and clinical utility
Introduction The kidneys contribute to maintain plasma osmolality in normal range by achieving the adequate daily osmolar
urine excretion (DOUE). An equation has been described for estimating the expected daily urine volume necessary to excrete
the osmolar load required to keep serum osmolality in normal range. According to this equation, a difference between real
and expected daily osmolar diuresis (DOD) can be obtained, being normally this difference value zero (± 500 cc). However,
a positive DOD difference signifies a reduced urine concentration capability, while a negative DOD difference signifies a
reduced urine dilution capability. Therefore, we decided to originally investigate how DOUE, and DOD difference are modified
through the different stages of CKD.
Materials and methods 61 patients suffering from CKD (stages I–V) secondary to glomerulopathies were studied. Creatinine
clearance (CrCl), DOUE, and difference between real and expected DOD were obtained from each patient. Besides,
correlation (Spearman) between CrCl and DOUE, and between CrCl and real–expected DOD difference were also obtained.
Results Spearman correlation between CrCl and DOUE was positive and significant (Spearman’s ρ = 0.63, p < 0.0001). In
addition, CKD patients who were not able to achieve the minimal DOUE required (600 mOsm/day) were mostly those with
CrCl < 40 mL/min. Spearman correlation between CrCl and real–expected DOD difference was negative and significant
(Spearman’s ρ = − 0.4, p < 0.0013). Additionally, abnormal DOD difference (> 500 cc) was found in CKD patients with
CrCl < 80 mL/min/1.73 m2.
Conclusion Daily osmolar urine excretion, and difference between real and expected daily osmolar diuresis are simple and
significant clinical parameter which can be useful to easily evaluate urine concentration–dilution capability (tubular function)
in CKD patients
Alactic base excess (ABE): a novel internal milieu parameter—its concept and clinical importance
Inspired by the Stewart-Figge acid–base approach, Gattinoni et al. recently introduced a new internal milieu parameter known as alactic base excess (ABE). The authors defined ABE as the sum of lactate and standard base excess. In the context of sepsis, ABE has been proposed as a valuable marker to discern between metabolic acidosis resulting from the accumulation of lactate and the retention of fixed acids, which can occur in cases of renal failure. Multiple studies have demonstrated that a
negative ABE value (<−3 mmol/L) represents an early marker of renal dysfunction, and significantly correlates with higher mortality rates in septic patients. In conclusion, ABE is a simple and useful parameter that can be used to better interpret a patient’s acid–base status, assess renal function, and general prognosis in sepsis. By incorporating ABE into clinical practice, healthcare professionals can enhance their understanding of the complex acid–base imbalances in their patients and tailor
more individualized, effective treatment plans
Obesity and glomerular filtration rate
Obesity has received considerable attention in general medicine and nephrology over the last few years. This condition
increases the risk of metabolic syndrome, diabetes mellitus, hypertension, and dyslipidemia, which are the main risk factors
for developing chronic kidney disease (CKD). Kidney damage caused by obesity can be explained by many mechanisms,
such as sympathetic nervous and renin-angiotensin-aldosterone systems activation, mechanical stress, hormonal unbalance,
as well as inflammatory cytokines production. Even though creatinine-based glomerular filtration rate (GFR) equations in
obese individuals have been validated (Salazar-Corcoran and CKD-MCQ), changes in body weight after bariatric surgery
(BS) leads to changes in creatininemia, affecting its reliability. Thus, an average between creatine and cystatin-based GFR
equations would be more appropriate in this setting. Bariatric surgery can reverse diabetes mellitus and improve hypertension,
which are the main causes of CKD. Conclusion: GFR can be affected by obesity and BS, and its value should be cautiously
evaluated in this setting
The Impact of Ketoanalogues on Nephropathy Progression in Advanced Chronic Kidney Disease Older Patients
Advanced chronic kidney disease (CKD) can be treated with conservative care or renal replacement therapies. CKD
is associated with an increased risk of nephropathy progression, and death. Therefore, slow down CKD progression is crucial, and
there is consensus regarding protein intake regulation benefit in delaying this progression. Ketoanalogues are nitrogen-free analogs
of essential amino acids which supplements low protein diets. Thus, it was decided to evaluate if keto diet had benefit in reducing
CKD progressio