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

Impact of operatoŕs experience on peri-procedural outcomes with Watchman FLX: Insights from the FLX-SPA registry

Background: The Watchman FLX is a device upgrade of the Watchman 2.5 that incorporates several design enhancements intended to simplify left atrial appendage occlusion (LAAO) and improve procedural outcomes. This study compares peri-procedural results of LAAO with Watchman FLX (Boston Scientific, Marlborough, Massachusetts) in centers with varying degrees of experience with the Watchman 2.5 and Watchman FLX. Methods: Prospective, multicenter, 'real-world' registry including consecutive patients undergoing LAAO with the Watchman FLX at 26 Spanish sites (FLX-SPA registry). Implanting centers were classified according to the center's prior experience with the Watchman 2.5. A further division of centers according to whether or not they had performed ≤ 10 or > 10Watchman FLX implants was prespecified at the beginning of the study. Procedural outcomes of institutions stratified according to their experience with the Watchman 2.5 and FLX devices were compared. Results: 359 patients [mean age 75.5 (SD8.1), CHA2DS2-VASc 4.4 (SD1.4), HAS-BLED 3.8(SD0.9)] were included. Global success rate was 98.6%, successful LAAO with the first selected device size was achieved in 95.5% patients and the device was implanted at first attempt in 78.6% cases. There were only 9(2.5%) major peri-procedural complications. No differences in efficacy or safety results according to the centeŕs previous experience with Watchman 2.5 and procedural volume with Watchman FLX existed. Conclusions: The Watchman FLX attains high procedural success rates with complete LAA sealing in unselected, real-world patients, along with a low incidence of peri-procedural complications, regardless of operatoŕs experience with its previous device iteration or the number of Watchman FLX devices implanted

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years

publishersversionPeer reviewe

Paciente con hipertensión y convulsiones

Los feocromocitomas son tumores neuroendocrinos raros con una presentación clínica muy variable, pero más comúnmente presentan episodios de cefaleas, sudoración, palpitaciones e hipertensión. Las complicaciones cardiovasculares graves y potencialmente letales de estos tumores se deben a los potentes efectos de las catecolaminas secretadas. Las pruebas bioquímicas para el feocromocitoma están indicadas no sólo en pacientes sintomáticos, sino también en pacientes con incidentalomas adrenales o predisposiciones genéticas identificadas. El TC o la gammagrafía se utilizan para localizar tumores bioquímicamente probados y el tratamiento de elección es la cirugía laparoscópica. Si la extirpación del feocromocitoma es correcta, el pronóstico es excelente

Sialoadenitis aguda por medio de contraste yodado. A propósito de tres casos

Objetive: Sialadenitis is a rare adverse reaction to administration of iodine contrast, it is usually underdiagnosed. The main etiology is infectious, being rare due to iodinated contrast. The objetive of this reviw is to describe this pathology, mainly due to its infrequent nature and the widespread use of iodinated contrast. Method: Observational, descriptive series of cases. Between 2015 and 2020, medical records of all cases of sialadenitis were reviewed. Results: We have analyzed 3 cases, our population is heterogeneous in age and personal history, they have kidney disease in common in two cases. Beginning 24 hours after the CT scan with iodinated contrast, they begin with clinic of diffuse increase of submandibular region without phlogosic signs, painless. Conclusions: Recognizing this complication is important for the complete management of our pa- tients, given the frequent exposure to contrasts in different diagnostic techniquesObjetivo: La sialoadenitis aguda tras la administración de contraste yodado es una patología excep- cional, suele ser infradiagnosticada. La etiología principal es infecciosa, siendo rara la debida a contraste yodado. El objetivo de esta revisión es describir esta patología, resaltando su interés por su carácter in- frecuente y el uso generalizado del contraste yodado. Método: Observacional, descriptivo de serie de casos. Entre el año 2015 a 2020, se revisaron historias clínicas de todos los casos de sialoadenitis aguda. Resultados: se describen 3 casos, población heterogénea en edad y comorbilidades, destacan la presencia de enfermedad renal previa en dos casos. En los cuales, tras 24 horas desde la realización del TAC con contraste yodado, comienzan con clínica de aumento de volumen difuso de región submandibular sin signos fl ogósicos, indoloro. Conclusiones: Reconocer esta complicación es importante para el manejo completo en nuestros pacientes, dada la exposición frecuente a contrastes en diferentes técnicas diagnósticas

Nefropatía iga en paciente con espondilitis anquilosante

La espondilitis anquilosante es una enfermedad reumática inflamatoria crónica que afecta a la columna vertebral y articulación sacroiliaca, causando dolor de espalda inflamatorio característico, que puede conducir a deterioros estructurales y funcionales y una disminución en la calidad de vida. Ocasionalmente puede expresarse con manifestaciones extraarticulares graves. Presentamos el caso de un paciente de 52 años, con diagnóstico de EA hace 13 años, en tratamiento con fármacos biológicos, que presenta nefropatía IgA requiriendo biopsia renal y tratamiento con corticoides. Destacamos lo raro de la afectación renal como manifestación extraarticular y más aún tras 4 años con biológicos y remisión clínica