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