New Biomarkers in Acute Tubulointerstitial Nephritis: A Novel Approach to a Classic Condition

Acute tubulointerstitial nephritis (ATIN) is an immunomediated cause of acute kidney injury. The prevalence of ATIN among the causes of acute kidney injury (AKI) is not negligible, especially those cases related to certain drugs. To date, there is a lack of reliable non-invasive diagnostic and follow-up markers. The gold standard for diagnosis is kidney biopsy, which shows a pattern of tubulointerstitial leukocyte infiltrate. The urinalysis findings can aid in the diagnosis but are no longer considered sensitive or specific. Atthe present time, there is a rising attentiveness tofinding trustworthy biomarkers of the disease, with special focus in urinary cytokines and chemokines that may reflect kidney local inflammation. Cell-based tests are of notable interest to identify the exact drug involved in hypersensitivity reactions to drugs, manifesting as ATIN. Certain single-nucleotide polymorphisms in HLA or cytokine genes may confer susceptibility to the disease according to pathophysiological basis. In this review, we aim to critically examine and summarize the available evidence on this topic

Coffee By-Products: Nowadays and Perspectives

Coffee is one of the most consumed products around the world; 2.25 billions of coffee cup are consumed everyday in the world. For coffee crop production, different by-products are produced, such as coffee peel, coffee husk, parchment, and spent coffee grounds. These by-products have several problems associated at the final disposition. In this book chapter, we study the main coffee varieties produced in the world, the by-products produced, and its composition and finally assess the potential of supramolecular solvents (SUPRAS) and water as green solvents for high-added-value compound extractions. Bioactive compounds were extracted from fresh and dried coffee peel in an acceptable rate for industrial applications. SUPRAS offer advantages in terms of rapidity (5 min) and simplicity (stirring and centrifugation at room temperature), thus avoiding costly processes based on high pressure and temperature. Extractions carried out using water as solvent is another technique of extraction mixing temperature (above 60°C) and time (4.5 min) obtained a beverage or solution with presence a bioactive compounds how caffeine, chlorogenic acid and polyphenols

T-lymphocyte in ANCA-associated vasculitis: what do we know? A pathophysiological and therapeutic approach

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is an autoimmune condition that commonly causes kidney impairment and can be fatal. The key participation of B-lymphocytes as ANCA producers and neutrophils as target of these antibodies is widely described as the mechanism of endothelial damage in this disease. There has been a rising interest in the role of T-lymphocytes in AAV in recent years. Evidence is strong from animal models, and T-lymphocytes can be found infiltrating kidney tissue and other tissue sites in AAV patients. Furthermore, the different subsets of T-lymphocytes are also key players in the aberrant immune response observed in AAV. Polarization towards a predominant Th1 and Th17 response in the acute phase of the disease has been described, along with a decline in the number of T-regulatory lymphocytes, which, in turn, show functional impairment. Interactions between different T-cell subsets, and between T-cells and neutrophils and B-cells, also enhance the inflammatory response, constituting a complex network. Novel therapies targeting T-cell immunity are emerging in this scenario and may constitute an interesting alternative to conventional therapy in selected patients. This review aims to summarize the available evidence regarding T-cell imbalances and functional impairment, especially focusing on renal involvement of AAV

Calprotectin as a smoldering activity detection tool and renal prognosis biomarker in ANCA associated vasculitis

Background Calprotectin is produced by neutrophils and macrophages, and released during the acute phase of the ANCA vasculitis. The aim of our study was to determine if serum and urine calprotectin are disease activity and prognosis biomarkers in ANCA vasculitis patients during remission. Methods Forty-two ANCA vasculitis patients were included. Twenty-seven patients were in remission phase under immunosuppressive therapy, and 15 patients were in the acute phase. Four healthy controls were included. We determined calprotectin in serum and urine samples at the time of the inclusion. We recorded the incidence of relapse and the evolution of GFR, proteinuria, hematuria, and C reactive protein and ANCA titer during 24 months of follow-up. Results In remission phase, serum calprotectin was higher than in healthy controls but lower compared to acute patients (p = 0.05). Serum calprotectin at inclusion was higher in patients who increased proteinuria during follow-up (p = 0.04), with hematuria (p = 0.08), and with non-decreasing ANCA titer (p = 0.0019). Serum calprotectin at inclusion in stable patients who subsequently decreased GFR during follow-up was higher compared with those with a stable or improving GFR (p = 0.03). Urine calprotectin was lower in patients with sclerotic histology in remission (p = 0.03) and acute phase (p = 0.12) compared to the rest of histologies. Conclusions Worsening of renal function, hematuria, rising proteinuria and non-decreasing ANCA correlated with higher levels of serum calprotectin at recruitment. Low urine calprotectin was found in patients with sclerotic histology. Calprotectin during remission in ANCA vasculitis may be useful to identify subclinical inflammation and worse renal prognosis patients

Exploring frequencies of circulating specific Th17 cells against myeloperoxidase and proteinase 3 in ANCA associated vasculitis

Background: the role of the T helper 17 (Th17) cell subset in anti-neutrophil cytoplasm antibodies (ANCA) associated vasculitis (AAV) is controversial. We hypothesized that a specific Th17 response to myeloperoxidase (MPO) or proteinase 3 (PR3) is detectable in AAV patients and is different among the disease phases. Methods: we analyzed 43 AAV patients with renal involvement (21 acute and 22 remission patients), and 12 healthy controls. Peripheral blood mononuclear cells (PBMCs) were cultured with PR3/MPO over 48 h. Thereafter, frequencies of MPO/PR3-specific Th17 cells were assessed using an enzyme-linked immunosorbent spot (ELISpot) assay. Supernatant IL-17 concentration was quantified using ELISA. Finally, specific Th17 response after depletion of T regulatory lymphocytes (T-regs) in some remission patients was compared to the non T-reg-depleted response. Results: specific Th17 cell number was higher in acute patients compared to remission (p = 0.004). Specific Th17 cell number performed well in the disease activity detection (ROC curve area under the curve (AUC) = 0.87; p = 0.0001) with an optimal cut-off of 6 spots/million. Patients above this cut-off showed higher serum creatinine (p = 0.004), C-reactive protein (CRP) (p = 0.001) and ANCA titer (p = 0.032). Supernatant IL-17 concentration was higher in acute patients compared to remission (p = 0.035) and did not normalize to healthy control levels (p = 0.01). Conclusions: a specific Th17 cell response is present in AAV patients. This response is more pronounced in the acute phase, but persists in remission

Acute Tubulointerstitial Nephritis in Clinical Oncology: A Comprehensive Review

Acute kidney injury in patients who suffer a malignancy is a common complication. Due to its high prevalence and effective treatment, one of the most frequent causes that both oncologists and nephrologists must be aware of is acute tubulointerstitial nephritis (ATIN). ATIN is an immunomediated condition and the hallmark of the disease, with the presence of a tubulointerstitial inflammatory infiltrate in the renal parenchyma. This infiltrate is composed mainly of T lymphocytes that can be accompanied by macrophages, neutrophils, or eosinophils among other cells. One of the major causes is drug-related ATIN, and some antineoplastic treatments have been related to this condition. Worthy of note are the novel immunotherapy treatments aimed at enhancing natural immunity in order to defeat cancer cells. In the context of the immunosuppression status affecting ATIN patients, some pathogen antigens can trigger the development of the disease. Finally, hematological malignancies can also manifest in the kidney leading to ATIN, even at the debut of the disease. In this review, we aim to comprehensively examine differential diagnosis of ATIN in the setting of a neoplastic patient

Lights and shadows of reconciliation in families with children with specific needs of learning support: study in Galicia

[ES] La diversidad de factores e implicaciones inherentes a la conciliación de los tiempos laborales, familiares y personales conlleva tanto la percepción de limitaciones o dificultades en la ardua tarea de conciliar, como el reconocimiento de posibilidades y apoyos pedagógico-sociales que faciliten dicha tarea. El objetivo del trabajo que se presenta es conocer los obstáculos y las alternativas que perciben las familias gallegas con hijos e hijas con Necesidades Específicas de Apoyo Educativo (NEAE) escolarizados/as en centros de Educación Primaria en torno a la armonización de sus tiempos cotidianos. Este estudio de tipo exploratorio y descriptivo forma parte de una investigación más amplia –denominada Concilia_d@s–, basada en la aplicación de un cuestionario, creado y validado ad hoc, a las familias del alumnado de Educación Primaria (n=2037; e=2,2%; confianza= 95,5%) de la Comunidad Autónoma de Galicia. Los resultados muestran las dificultades de organización temporal a las que las familias con hijos/as con NEAE (n=127) deben hacer frente respecto a su cuidado, así como los recursos y alternativas pedagógico-sociales que garantizarían una mejor conciliación de sus tiempos, favoreciendo la atención educativa de la infancia y la construcción de una sociedad más inclusiva. En base a la reflexión teórica realizada y al análisis de los datos obtenidos se han conocido algunas de las “luces” y “sombras” que influyen en las familias gallegas –particularmente en aquellas con hijos/as con NEAE– a la hora de conciliar sus tiempos y apoyar el proceso de inclusión social y educativa de la infancia. [EN] The diversity of factors and implications that are inherent to reconciliation of working, family and personal times involves the perception of limitations or difficulties in the arduous task of reconciling on the one hand and the identification of possible ways and social-pedagogical supports to facilitate it on the other. The goal of the present article is to identify the obstacles and alternatives for families with children with specific needs of learning support (SNLS) attending primary school in Galicia regarding the issue of harmonizing daily times. This exploratory and descriptive study belongs to a wider investigation -entitled Concilia_d@s- based on the implementation of an ad hoc questionnaire, in a target group consisting of families of the student body of Primary Education (n=2037; e=2,2%; confidence= 95,5%) in the Autonomous Community of Galicia. The outcome showed the difficulties for the organization of times encountered by families with children with SNLS (n=127) due to their need of special attention, as well as the resources and social-pedagogical alternatives that could guarantee a better distribution of times, promoting childhood education and the construction of a more inclusive society. Analyzing the data obtained, we noted “lights” and “shadows” affecting families in Galicia –specifically those families with children with SNLS– for managing their times and supporting the process of social and educational inclusion of childhood

Luzes e sombras em torno da conciliação das familias com filhos e filhas com NEAE: um estudo na Galiza

La diversidad de factores e implicaciones inherentes a la conciliación de los tiempos laborales, familiares y personales conlleva tanto la percepción de limitaciones o dificultades en la ardua tarea de conciliar, como el reconocimiento de posibilidades y apoyos pedagógico- sociales que faciliten dicha tarea. El objetivo del trabajo que se presenta es conocer los obstáculos y las alternativas que perciben las familias gallegas con hijos e hijas con Necesidades Específicas de Apoyo Educativo (NEAE) escolarizados/as en centros de Educación Primaria en torno a la armonización de sus tiempos cotidianos. Este estudio de tipo exploratorio y descriptivo forma parte de una investigación más amplia –denominada Concilia_d@s–, basada en la aplicación de un cuestionario, creado y validado ad hoc, a las familias del alumnado de Educación Primaria (n=2037; e=2,2%; confianza= 95,5%) de la Comunidad Autónoma de Galicia. Los resultados muestran las dificultades de organización temporal a las que las familias con hijos/as con NEAE (n=127) deben hacer frente respecto a su cuidado, así como los recursos y alternativas pedagógico-sociales que garantizarían una mejor conciliación de sus tiempos, favoreciendo la atención educativa de la infancia y la construcción de una sociedad más inclusiva. En base a la reflexión teórica realizada y al análisis de los datos obtenidos se han conocido algunas de las “luces” y “sombras” que influyen en las familias gallegas –particularmente en aquellas con hijos/as con NEAE– a la hora de conciliar sus tiempos y apoyar el proceso de inclusión social y educativa de la infancia.The diversity of factors and implications that are inherent to reconciliation of working, family and personal times involves the perception of limitations or difficulties in the arduous task of reconciling on the one hand and the identification of possible ways and social- pedagogical supports to facilitate it on the other. The goal of the present article is to identify the obstacles and alternatives for families with children with specific needs of learning support (SNLS) attending primary school in Galicia regarding the issue of harmonizing daily times. This exploratory and descriptive study belongs to a wider investigation -entitled Concilia_ d@s- based on the implementation of an ad hoc questionnaire, in a target group consisting of families of the student body of Primary Education (n=2037; e=2,2%; confidence= 95,5%) in the Autonomous Community of Galicia. The outcome showed the difficulties for the organization of times encountered by families with children with SNLS (n=127) due to their need of special attention, as well as the resources and social-pedagogical alternatives that could guarantee a better distribution of times, promoting childhood education and the construction of a more inclusive society. Analyzing the data obtained, we noted “lights” and “shadows” affecting families in Galicia –specifically those families with children with SNLS– for managing their times and supporting the process of social and educational inclusion of childhood.A diversidade de fatores e implicações inerentes à conciliação dos tempos de trabalho, familiares e pessoais, implica a perceção de limitações ou dificuldades na árdua tarefa de conciliação, bem como o reconhecimento de apoios pedagógico-sociais que a facilitem. O objetivo do trabalho que é apresentado é conhecer os obstáculos e as alternativas que as famílias galegas com filhos e filhas com necessidades específicas de apoio educacional (NEAE) em escolas de ensino primário identificam em torno da harmonização de seus tempos diários. Este estudo exploratório e descritivo faz parte de uma pesquisa mais ampla –denominada Concilia_d @ s–, com base na aplicação de um questionário, criado e validado ad hoc, às famílias dos alunos do ensino primário (n=2037; e=2,2%; confiança=95,5%) da comunidade autónoma da Galiza. Os resultados mostram as dificuldades que as famílias com crianças com NEAE (n=127) devem enfrentar no que se refere à organização dos seus cuidados, relativamente aos recursos e às alternativas pedagógicas-sociais que garantam uma melhor conciliação dos seus tempos, favorecendo a atenção educacional da infância e a construção de uma sociedade mais inclusiva. Com base na reflexão teórica feita e na análise dos dados obtidos, foi possível cohecer algumas das “luzes” e “sombras” que influenciam as famílias galegas –particularmente naquelas com crianças com NEAE– na conciliação dos seus tempos e no apoio ao processo de inclusão social e educacional das crianças.S

Diversity and work-life balance in Galicia: a challenge for inclusive education

Los cambios sociales, económicos y culturales han incrementado el interés académico sobre la conciliación de los tiempos laborales, familiares y personales, debido a las dificultades a las que se tienen que enfrentar cotidianamente las personas. Sustentado en los datos obtenidos de la aplicación de un cuestionario a las familias del alumnado de Educación Primaria (n=2037; e=2,2%; confianza=95,5%) de la Comunidad Autónoma de Galicia, el trabajo que se presenta tiene como finalidad conocer e interpretar la percepción que las familias con hijos e hijas con Necesidades Específicas de Apoyo Educativo (n=127) tienen en torno a la conciliación de sus tiempos cotidianos. Además, se estudia la frecuencia de uso de los servicios y recursos para la atención de la infancia, así como las alternativas que en función de sus necesidades facilitarían la organización de su vida diariaThe social, economic and cultural changes have increased the academic interest that exists on the conciliation among work, family and personal life, on account of difficulties which people have to face daily. In this context, the report has been supported in the obtained information through the application of a questionnaire to families of Primary Education (n=2037; e=2,2%; confidence=95,5%) in the Autonomous Community of Galicia (Spain). This research has a the purpose to know and understand the perception of families whose children have Additional Educational Support Needs (n=127) about the conciliation of their daily times. The frequency of use of service and resource for the care of children and alternatives socio-pedagogic which improve the conciliation of daily times are being analyzedS

Clinical features and outcomes in a cohort of patients with immunoglobulin G4-related disease at a university hospital in Spain

Background. Immunoglobulin G4-related disease (IgG4-RD) is a fibro-inflammatory, immune-mediated disorder, which characteristically affects the glandular tissue but has the potential to affect any organ. Methods. We retrospectively reviewed clinical, laboratory, histological characteristics and treatment response during 12 months of follow-up of a cohort of patients with IgG4-RD diagnosed at a tertiary public hospital. Disease activity was assessed by means of the IgG4-RD responder index (IgG4-RD RI). Results. In all, 15 patients have been diagnosed at our Institution and herein studied (80% men), with a median age of 60.7 years and a mean affectation of 2.8 organs per patient. We identified six patients with definitive diagnosis and nine with possible IgG4-RD, according to the Japanese diagnostic algorithm. IgG4-RD RI decreased from a median of 11.3 at baseline to 4.0 after 6 months and 6.2 after 12 months. Relapse occurred in five patients and was associated with lower cumulative steroid doses. Five patients (33.3%) required additional immunosuppressive (IS) drugs. Five adverse events were seen during follow-up: three infections, one deep vein thrombosis and one gastrointestinal bleeding. One patient died of pneumonia. Conclusions. IgG4-RD is an inflammatory disease that can affect any organ. Glucocorticoids were an effective first line of treatment; however, this treatment is associated with important adverse events and relapses occurred in patients with low cumulative doses. As an alternative, IS treatment with rituximab could be an interesting option in those patients