2012 ERA-EDTA Registry annual report: Cautious optimism on outcomes, concern about persistent inequalities and data black-outs

The 2012 ERA-EDTA Registry Annual Report contains both good news and bad news. On the bright side, the 2-year survival of patients starting renal replacement therapy (RRT) for chronic kidney disease (CKD), on dialysis or receiving a living-related kidney transplantation, has progressively increased to 82.2, 79.7 and 98.3%, respectively, whereas for cadaveric kidney transplantation it remains stable (96.0–96.1%). On the dark side, inequalities persist between European citizens in access to renal transplantation and in incidence and prevalence of RRT. Living in Greece, Belgium (French- or Dutch-speaking) or Portugal (the GBP countries) is associated with higher chances of initiating RRT than living in other European countries. The adjusted RRT incidence for GBP countries was 188, 201-174 and 220* (* unadjusted) pmp in 2012, respectively (versus 122, 114 and 97 pmp in the Netherlands or two Spanish regions bordering Portugal). In lower income countries, a low RRT incidence may represent lack of access to needed healthcare (e.g. Montenegro 26 pmp). However, how can the high incidence and prevalence of RRT in the GBP countries be explained? Do GBP citizens have access to RRT that is denied, rejected or considered unnecessary in other high income countries? Does the GBP healthcare system fail to prevent progression of CKD? Do local genetic or environmental factors favour CKD progression? Unravelling the underlying reasons is an urgent research need: only an understanding of the causes will allow correction of the problem. Unavailability of data from some large countries (e.g. Germany and Italy) is not helpfulGrant support was provided by ISCIII and FEDER funds PI13/00047, Sociedad Española de Nefrologia, ISCIII-RETIC REDinREN/RD012/0021, Comunidad de Madrid CIFRA S2010/BMD-2378. Salary support was provided by Programa Intensificación Actividad Investigadora (ISCIII/Agencia Laín- Entralgo/CM) to A.O

Haemodialysate: Long neglected, difficult to optimize, may modify hard outcomes

In two recent CKJ reviews, experts (Basile and Lomonte and Locatelli et al.) have reviewed haemodialysate composition. A longneglected issue, observational studies have associated the composition of haemodialysate to adverse outcomes. However, the scarcity of clinical trial-derived information results in limited guideline recommendations on the issue. Indeed, guidelines have more frequently indicated what not to do rather than what to do. In this setting, expert opinion becomes invaluable. In designing haemodialysate composition, a balance should be struck between the need to correct within a time frame of around 4 hours the electrolyte and water imbalances that take 48 to 72 h to build, with the need for gradual correction of these imbalances. The issue is complicated further by the impact of individual variability in dietary habits, medications and comorbidities. In this regard, a personalized medicine approach to individualization of haemodialysate composition offers the best chance of improving patient outcomes. But how can haemodialysate individualization be achieved, and what clinical trial design will best test the impact of such approaches on patient outcomes?Grant support: ISCIII and FEDER funds PI13/00047, Sociedad Española de Nefrologia, ISCIII-RETIC REDinREN/RD012/0021, Comunidad de Madrid CIFRA S2010/BMD-2378. Salary support: Programa Intensificación Actividad Investigadora (ISCIII/Agencia Laín-Entralgo/CM) to A.O

Peritoneal dialysis associated-peritonitis: a preventable complication

Peritoneal dialysis is useful renal replacement therapy for patients with end-stage chronic kidney disease. Latin America has 30% of the world population in peritoneal dialysis and within these countries Mexico covers 73% of them. In our country, the Mexican institute of social security (IMSS by its Spanish acronym) serves more than half of the Mexican population that requires renal replacement therapy. In 2014 it represented 15% of total annual cost of the institution. Peritonitis in peritoneal dialysis is the main complication seen in this renal replacement therapy with morbidity and mortality from 2 to 6%. The epidemiology of peritonitis associated with peritoneal dialysis varies according to the continent, country and dialysis center. The rate of peritonitis per year of each center reflects their quality of care. The prevention, diagnosis and treatment of peritonitis impact in the quality of life of the patient, the success of renal replacement therapy, public health costs and associated mortality. This review addresses the epidemiology, diagnosis, treatment, and preventive measures of peritonitis, focused on the procedures for improving the standards of care

Evaluation of SiC Schottky diodes using pressure contacts

The thermomechanical reliability of SiC power devices and modules is increasingly becoming of interest especially for high power applications where power cycling performance is critical. Press-pack assemblies are a trusted and reliable packaging solution that has traditionally been used for high power thyristor- based applications in FACTS/HVDC, although press-pack IGBTs have become commercially available more recently. These press-pack IGBTs require anti-parallel PiN diodes for enabling reverse conduction capability. In these high power applications, paralleling chips for high current conduction capability is a requirement, hence, electrothermal stability during current sharing is critical. SiC Schottky diodes not only exhibit the advantages of wide bandgap technology compared to silicon PiN diodes, but they have significantly lower zero temperature coefficient (ZTC) meaning they are more electrothermally stable. The lower ZTC is due to the unipolar nature of SiC Schottky diodes as opposed to the bipolar nature of PiN diodes. This paper investigates the implementation and reliability of SiC Schottky diodes in press-pack assemblies. The impact of pressure loss on the electrothermal stability of parallel devices is investigated

Non-canonical NFκB activation promotes chemokine expression in podocytes

TNF-like weak inducer of apoptosis (TWEAK) receptor Fn14 is expressed by podocytes and Fn14 deficiency protects from experimental proteinuric kidney disease. However, the downstream effectors of TWEAK/Fn14 in podocytes are poorly characterized. We have explored TWEAK activation of non-canonical NFκB signaling in cultured podocytes. In cultured podocytes, TWEAK increased the expression of the chemokines CCL21, CCL19 and RANTES in a time-dependent manner. The inhibitor of canonical NFκB activation parthenolide inhibited the CCL19 and the early RANTES responses, but not the CCL21 or late RANTES responses. In this regard, TWEAK induced non-canonical NFκB activation in podocytes, characterized by NFκB2/p100 processing to NFκB2/p52 and nuclear migration of RelB/p52. Silencing by a specific siRNA of NIK, the upstream kinase of the non-canonical NFκB pathway, prevented CCL21 upregulation but did not modulate CCL19 or RANTES expression in response to TWEAK, thus establishing CCL21 as a non-canonical NFκB target in podocytes. Increased kidney Fn14 and CCL21 expression was also observed in rat proteinuric kidney disease induced by puromycin, and was localized to podocytes. In conclusion, TWEAK activates the non-canonical NFκB pathway in podocytes, leading to upregulation of CCL21 expression. The non-canonical NFκB pathway should be explored as a potential therapeutic target in proteinuric kidney disease.Grants support: FEDER funds and FIS ISCIII-RETIC REDinREN RD12/0021, PI15/00298, PI13/00047, CP14/00133, CP12/03262, Spanish Society of Nephrology, FRIAT-IRSIN, Comunidad de Madrid (CIFRA S2010/ BMD-2378), CYTED IBERERC, Programa Intensificación Actividad Investigadora (ISCIII) to AO, Miguel Servet to MDSN and ABS and FIS to LVR and LG

Biosíntesis de nanopartículas de plata con Chlorella sp.

Neste trabalho, mostramos os resultados da biossíntese de nanopartículas de prata utilizando a microalga Chlorella sp. cultivada em diversos meios contendo concentrações de glicerol que variam entre 5% e 20%, e condições variáveis de luz e temperatura. A síntese de nanopartículas foi realizada utilizando sobrenadantes e pelotas de culturas de microalgas autotróficas, heterotróficas e mixotróficas. A presença de nanopartículas de prata foi verificada por espectroscopia ultravioleta - visível, e as amostras que apresentam as maiores concentrações de nanopartículas foram caracterizadas por microscopia eletrônica de varredura. As condições mixotróficas melhoraram a excreção de exo-polímeros que melhoraram a redução de prata e a síntese de nanopartículas. As nanopartículas obtidas mostraram forma elipsoidal com dimensões de 108 nm x 156 nm e 87 nm x 123 nm para síntese realizada com sobrenadantes de culturas mixotróficas com glicerol 5% e 10%, respectivamente.In this work, we show the results of the biosynthesis of silver nanoparticles using the microalga Chlorella sp. cultured in several media containing glycerol concentrations ranging between 5% and 20%, and varying light and temperature conditions. Nanoparticle synthesis was performed using supernatants and pellets of autotrophic, heterotrophic, and mixotrophic microalgae cultures. The presence of silver nanoparticles was verified by ultraviolet – visible spectroscopy, and samples that show the highest nanoparticle concentrations were characterized using scanning electronic microscopy. Mixotrophic conditions enhanced the excretion of exo-polymers that improved silver reduction and nanoparticle synthesis. The obtained nanoparticles showed cylindrical shape with dimensions of 108 nm x 156 nm and 87 nm x 123 nm for synthesis undertaken with supernatants of mixotrophic cultures with glycerol 5% and 10%, respectively.En este trabajo se muestran los resultados de la biosíntesis de nanopartículas de plata mediante el uso de la microalga Chlorella sp, utilizando medios de crecimiento con diferentes concentraciones de glicerol, entre el 5% - 20%, y diferentes condiciones de luz y temperatura. La síntesis de las nanopartículas se estudió utilizando los sobrenadantes y pellets de los cultivos autótrofos, heterótrofos y mixotróficos de la microalga. La presencia de nanopartículas se verificó por espectroscopía ultravioleta – visible y las muestras que mostraron mayor concentración de nanopartículas fueron caracterizadas por microscopía electrónica de barrido. Las condiciones de crecimiento mixotrófico favorecieron la excreción de exopolímeros que mejoraron la reducción de la plata y por ende la formación de nanopartículas. Las nanopartículas obtenidas presentaron forma predominantemente elipsoidal con dimensiones de 108 nm x 156 nm y 87 nm x 123 nm para las reducciones llevadas a cabo con los sobrenadantes de los cultivos mixotróficos con glicerol al 5% y 10%, respectivamente

Higher Proportion of Non-1-84 PTH Fragments in Peritoneal Dialysis Patients Compared to Hemodialysis Patients Using Solutions Containing 1.75 mmol/l Calcium

Background: The prevalence of low- turnover bone disease (LTBD) in peritoneal dialysis (PD) patients is higher than in hemodialysis (HD) patients. LTBD patients may be at risk for vascular calcification, and cardiovascular disease. Current therapy for chronic kidney disease metabolic bone disorders (CKD-MBD) is guided by biochemical parameters, as bone biopsy is not used in routine clinical care.Methods: We assessed intact PTH (iPTH: 1-84PTH plus non-1-84PTH), 1-84PTH, and the 1-84PTH/non-1-84PTH ratio in 129 hemodialysis and 73 PD prevalent patients dialyzed with solutions containing 1.75 mmol/L calcium.Results: Hemodialysis and PD patients presented similar iPTH and tCa values and prevalence of putative LTBD as defined according to KDOQI iPTH cut-off levels or 1-84 PTH levels. However, iCa accounted for a higher percentage of tCa in PD (53%) than in hemodialysis (39%) p < 0.001, and the 1-84PTH/non-1-84PTH ratio was lower in PD than in hemodialysis patients (0.44 ± 0.12) vs. (0.60 ± 0.10), p < 0.001. The prevalence of putative LTBD when using the coexistence of 1-84PTH/non-1-84PTH ratio < 1.0 and iPTH < 420 pg/m, was higher in PD than in hemodialysis patients (73 vs. 16% respectively, p < 0.001). In a multivariate logistic regression analysis, dialysis modality was the main determinant of the 1-84PTH/non-1-84PTH ratio.Conclusion: Solutions containing 1.75 mmol/L calciums are associated to a higher proportion of non-1-84PTH fragments in PD than in HD patients. Different analytical criteria result in widely different estimates of LTBD prevalence, thus impairing the ability of clinicians to optimize therapy for CKD-MBD

Small vessel microembolization and acute glomerulonephritis following infection of aesthetic filler implants

Background: The systemic consequences of esthetic filler injections are poorly understood. Case presentation: We report a patient with a past history of subcutaneous injection of aesthetic filler material in the lower legs, who presented with post-infectious glomerulonephritis following necrotic leg ulcers at the injection site. Kidney biopsy revealed the presence of translucent, non-birefringent microspherical bodies compatible with polymethylmetacrylate (PMMA) microspheres in some capillary lumens. This had not previously been described. PMMA is a biphasic aesthetical filler composed of polymethylmetacrylate microspheres suspended in a biodegradable bovine collagen carrier. The solid phase (PMMA microspheres) persists in tissues for years. Although PMMA was thought to not disseminate systemically, tissue necrosis may have favored systemic dissemination of the microspheres, although entry in the circulation and microembolization at the time of administration cannot be ruled out. Conclusions: In conclusion, aesthetic filler implants may cause microembolization into small vessels. Recognition of the characteristic morphology may expedite diagnosis and avoid unnecessary further testing.AO and CMC were supported by ISCIII and FEDER funds PI13/00047, REDinREN RD012/0021, Comunidad de Madrid CIFRA S2010/BMD-2378 and Programa Intensificación Actividad Investigadora. BFF by ISCIII Joan Rodes

Executive functioning in adolescents and sexual risk behaviors

Introducción. Uno de los principales problemas de salud que enfrentan los adolescentes son las Conductas Se- xuales de Riesgo (CSR). Los objetivos del estudio fueron: Comparar las CSR entre un grupo de adolescentes con distintos niveles de funcionamiento ejecutivo y analizar mediante un modelo de regresión lineal los factores que se relacionan con estas conductas. Método. La muestra se conformó por 50 adolescentes, 25 hombres y 25 mujeres. Para medir las CSR se utilizó la Escala de Conductas Sexuales y el cuestionario de la Encuesta Nacional de Salud y Hábitos Sexuales, para la evaluación de las funciones ejecutivas, las subpruebas del índice Orbito Medial de la Batería de Funciones Ejecutivas y Lóbulos Frontales. Resultados. Se realizó un ANOVA tomando como variable dependiente la puntuación CSR y como variable independiente el nivel obtenido en el índice Orbito Medial. Asimismo, se realizó un modelo de mínimos cuadrados ordinarios. Acorde a los resultados, no se encontraron diferencias significativas entre los grupos p = .525. No obstante, aquellos con menor puntuación en las tareas que evaluaron el control inhibitorio y el procesamiento de riesgo beneficio obtuvieron mayores puntuaciones de CSR. Por otro lado, la CSR que principalmente se relaciona con un nivel de alto riesgo es: la temprana edad de inicio de relaciones sexuales (-.930). Conclusión. Se enfatiza en la importancia de estudiar el fenómeno y su relación con los procesos cognitivosIntroduction. One of the main health problems faced by adolescents is Risky Sexual Behavior. The aims of the study were: To compare the CSR among a group of adolescents with different levels of executive functioning and to analyze the factors related to these behaviors using a linear regression model.Method. The sample consisted of 50 adolescents, 25 men and 25 women. To measure the CSR was used, the Scale of Sexual Behaviors and the questionnaire of the National Survey of Health and Sexual Habits, for the evaluation of the executive functions, the subtests of the Orbito Medial index of the Battery of Executive Functions and Lobes Frontals. Results: An ANOVA was performed taking the CSR score as the dependent variable and the level obtained in the Medial Orbit index as the independent variable. Likewise, an ordinary least squares model was made. According to the results, no signifi- cant differences were found between the groups p = .525. However, those with lower scores on tasks that evaluated inhibitory control and benefit-risk processing obtained higher CSR scores. On the other hand, the CSR that is mainly related to a high-risk level is: the early age of beginning sexual relations (-.930).Conclusions.Emphasis is placed on the importance of studying the phenomenon and its relationship with cognitive processe

Urinary Kininogen-1 and Retinol binding protein-4 respond to Acute Kidney Injury: Predictors of patient prognosis?

Implementation of therapy for acute kidney injury (AKI) depends on successful prediction of individual patient prognosis. Clinical markers as serum creatinine (sCr) have limitations in sensitivity and early response. The aim of the study was to identify novel molecules in urine which show altered levels in response to AKI and investigate their value as predictors of recovery. Changes in the urinary proteome were here investigated in a cohort of 88 subjects (55 AKI patients and 33 healthy donors) grouped in discovery and validation independent cohorts. Patients'urine was collected at three time points: within the first 48 h after diagnosis(T1), at 7 days of follow-up(T2) and at discharge of Nephrology(T3). Differential gel electrophoresis was performed and data were confirmed by Western blot (WB), liquid chromatography/mass spectrometry (LC-MS/MS) and enzyme-linked immunosorbent assay (ELISA). Retinol binding protein 4 (RBP4) and kininogen-1 (KNG1) were found significantly altered following AKI. RBP4 increased at T1, and progressively decreased towards normalization. Maintained decrease was observed for KNG1 from T1. Individual patient response along time revealed RBP4 responds to recovery earlier than sCr. In conclusion, KNG1 and RBP4 respond to AKI. By monitoring RBP4, patient's recovery can be anticipated pointing to a role of RBP4 in prognosis evaluation.Funding: from Instituto de Salud Carlos III: FIS PI11/01401, PI13/01873, FIS IF08/3667-1, CP09/00229, PI13/00047, PI10/00624, ISCIII-RETIC REDinREN RD012/0021. FEDER funds, Comunidad de Madrid/CIFRA S2010/BMD-2378, Programa Intensificación Actividad Investigadora (ISCIII/Agencia Laín-Entralgo/CM) to AO, IDCSalud (3371/002) and Fundación Conchita Rábago de Jiménez Díaz, Proteomic Facility from Universidad Complutense de Madrid-Fundación Parque Científico de Madrid (UCM-FPCM), Spain, a member of ProteoRed-ISCIII Network member of ProteoRed- ISCIII Networ