40 research outputs found
Vascular calcification in the uremic patient: A cardiovascular risk?
Vascular calcification in the uremic patient: A cardiovascular risk?BackgroundSeveral factors suggest that the presence of vascular calcification (VC) is associated with a high risk of cardiac events in uremic patients. The aim of this study was to analyze the influence of VC on cardiac morbidity and mortality in our hemodialysis (HD) patients.MethodsWe studied 79 patients on HD: 43 males, mean age 48 卤 15 years old, mean time on HD 83 卤 63 months. The presence of VC was evaluated by radiologic series. Other cardiovascular risk factors analyzed were arterial hypertension, diabetes mellitus, obesity, cigarette smoking, anemia, and dyslipidemia. All patients underwent M-mode, two-dimensional, Doppler echocardiography. Patients were followed for two years. During this time, clinical information collected included predialysis blood pressure, incidence of ischemic heart disease, episodes of congestive heart failure, and mortality due to cardiovascular event.ResultsVC was observed in 55.7% of patients. Left ventricular hypertrophy, diastolic dysfunction, and cardiac valve calcification were significantly associated with VC. Ischemic heart disease (71.4% vs. 28.6%) and episodes of cardiac failure (0.41 vs. 0.18 per year; P < 0.05) appeared more frequently in the patient group with VC. VC was present in 80.6% of patients who developed episodes of heart failure. Eight patients died from cardiac disease; each of them had VC.ConclusionThe presence of VC can help to identify those HD patients with a higher cardiovascular risk
Blockade of interleukin-6 as a possible therapeutic target for AA amyloidosis
Introducci贸n
La amiloidosis secundaria (AA) es una complicaci贸n grave asociada a enfermedades inflamatorias. Se caracteriza por el dep贸sito sist茅mico de prote铆na fibrilar AA, con especial repercusi贸n renal. La participaci贸n de la interleucina 6 en su mecanismo patog茅nico ha supuesto que tocilizumab (TCZ) sea considerado una opci贸n terap茅utica en estos pacientes. Varias series publicadas muestran su eficacia en el tratamiento de la amiloidosis AA, permitiendo incluso la regresi贸n de dep贸sitos renales ya presentes.
Material y m茅todo
Revisi贸n retrospectiva que incluy贸 pacientes con diagn贸stico histol贸gico de amiloidosis renal AA en tratamiento con TCZ durante los a帽os 2018-2019 en nuestro centro. Registramos variables cl铆nicas y demogr谩ficas; evaluamos la funci贸n renal mediante filtrado glomerular (FG) calculado por CKD-EPI e 铆ndice prote铆na/creatinina a los 3, 6 y 12 meses de seguimiento. Definimos 芦respuesta renal禄 como la disminuci贸n > 30% de la proteinuria y/o estabilizaci贸n o mejor铆a del FG. Consideramos 芦respuesta antiinflamatoria禄 la disminuci贸n > 50% de las cifras de prote铆na s茅rica amiloide (PSA) y/o prote铆na C reactiva (PCR).
Resultados
Presentamos una serie de 3 pacientes (2 varones y una mujer; 55, 74 y 75 a帽os, respectivamente), con un tiempo de seguimiento de 13, 14 y 75 meses, respectivamente. Con la terapia con TCZ, el FG se estabiliz贸 en 2 pacientes; el tercero permaneci贸 en hemodi谩lisis durante el seguimiento, aunque con excelente control de su enfermedad inflamatoria de base; a los 12 meses recibi贸 un trasplante renal. En los 3 casos se objetiv贸 reducci贸n de prote铆na PSA y PCR. No se han producido eventos adversos.
Conclusiones
El TCZ es una opci贸n terap茅utica eficaz y segura para los pacientes con amiloidosis AA y afectaci贸n renal. Nuestros resultados lo posicionan como una opci贸n terap茅utica a considerar en estos casos, aunque ser铆a necesario la realizaci贸n de estudios prospectivos en los que se eval煤e el papel global de TCZ en la amiloidosis AA.Introduction
AA (secondary) amyloidosis is a severe complication of chronic inflammatory disorders. It is characterized by the systemic deposition of an abnormal protein called amyloid, affecting mainly renal function. IL-6 is a cytokine with a relevant role in this disease development. Interleukin-receptor antagonists, like Tocilizumab (TCZ), have become possible treatment choice for AA amyloidosis. In published reports, TCZ has shown good efficacy for AA amyloidosis, being associated with regression of renal amyloid deposits.
Methods
Retrospective review that included patients with histological diagnosis of AA renal amyloidosis under treatment with TCZ during the years 2018-2019 in our center. We have registered clinical and demographic variables. Renal function was measured by means of CKD-EPI equation to estimate the glomerular filtration rate (FG) and protein/creatinine ratio (IPC) at 3, 6 and 12 months. We define renal response as a decrease by at least 30% of proteinuria and/or stabilization or improvement of FG. We consider that an anti-inflammatory response is a decrease of more than 50% in serum amyloid protein (PSA) and/or C-reactive protein (CRP).
Results
We collected 3 cases of patients with histologically proven AA amyloidosis treated with TCZ (2 men; 1 woman; aged 55, 74 and 75 years). The follow-up was 13, 14 and 75 months. FG was stabilized in two patients. The third patient remained on hemodialysis during follow-up, although with excellent control of her underlying inflammatory disease. In all three cases, reduced PSA and CRP were observed. There have been no adverse events.
Conclusions
The TCZ may be an effective and safe option in treatment of AA amyloidosis with renal involvement. Our results position it as an interesting therapeutic option to consider in these cases, although prospective studies would be necessary to evaluate the global role of TCZ in AA amyloidosis
Nefritis intersicial aguda por rabeprazol
Acute interstitial nephritis is an increasingly common cause of acute kidney damage. The incidence is variable according to the series and challenging to quantify with precision due to the long-time interval between taking the drug and detecting kidney damage. Proton pump inhibitors are currently selected as one of the main drugs responsible for this entity after antibiotics. Early diagnosis and drug withdrawal are essential to treatment. Increased awareness might facilitate more rapid diagnosis and management of this potentially reversible kidney injury and avoid chronic kidney disease.La nefritis tubulointersticial aguda (NTIA) asociada a f谩rmacos es una causa cada vez m谩s frecuente de da帽o renal agudo. Su incidencia es variable y dif铆cil de cuantificar con precisi贸n por el intervalo de tiempo entre la toma del f谩rmaco y la detecci贸n de la lesi贸n renal. Los inhibidores de la bomba de protones (IBP) se consideran uno de los principales f谩rmacos responsables de esta entidad tras los antibi贸ticos. Una mayor conciencia acerca de la NTIA por IBP podr铆a facilitar un diagn贸stico y manejo m谩s r谩pidos de esta lesi贸n renal potencialmente reversible y evitar as铆 la progresi贸n a enfermedad renal cr贸nica
Consensus document for ultrasound training in the specialty of Nephrology
Grupo de Trabajo en Nefrolog铆a Diagn贸stica e Intervencionista (GNDI) de la Sociedad Espa帽ola de Nefrolog铆a (SEN).[ES] La ecograf铆a es una herramienta esencial en el manejo del paciente nefrol贸gico que permite el diagn贸stico, el seguimiento y la realizaci贸n de intervencionismo sobre el ri帽贸n. La utilidad de los ultrasonidos en Nefrolog铆a no se circunscribe exclusivamente al estudio ecogr谩fico del ri帽贸n. Mediante ecograf铆a el nefr贸logo puede, adem谩s, optimizar el manejo de la f铆stula arteriovenosa para hemodi谩lisis, medir el riesgo cardiovascular (grosor 铆ntima-media), implantar cat茅teres centrales para hemodi谩lisis ecoguiados y ayudar en la colocaci贸n de los peritoneales, as铆 como calcular la volemia del paciente mediante ecograf铆a cardiaca b谩sica, ecograf铆a de la vena cava inferior y pulmonar.
Desde el Grupo de Trabajo en Nefrolog铆a Diagn贸stica e Intervencionista (GNDI) de la Sociedad Espa帽ola de Nefrolog铆a (SEN) hemos elaborado este documento de consenso en el que se resumen las principales aplicaciones de la ecograf铆a en Nefrolog铆a, incluyendo los requisitos t茅cnicos b谩sicos necesarios, el marco normativo y el nivel de capacitaci贸n de los nefr贸logos en esta materia. El objetivo de este trabajo es promover la inclusi贸n de la ecograf铆a, tanto diagn贸stica como intervencionista, en la pr谩ctica cl铆nica habitual del nefr贸logo y en la cartera de servicios de Nefrolog铆a con la finalidad de ofrecer un manejo diligente, eficiente e integral al paciente nefrol贸gico.[EN] Ultrasound is an essential tool in the management of the nephrological patient allowing the diagnosis, monitoring and performance of kidney intervention. However, the usefulness of ultrasound in the hands of the nephrologist is not limited exclusively to the ultrasound study of the kidney. By ultrasound, the nephrologist can also optimize the management of arteriovenous fistula for hemodialysis, measure cardiovascular risk (mean intimate thickness), implant central catheters for ultrasound-guided HD, as well as the patient's volemia using basic cardiac ultrasound, ultrasound of the cava inferior vein and lungs.
From the Working Group on Interventional Nephrology (GNDI) of the Spanish Society of Nephrology (SEN) we have prepared this consensus document that summarizes the main applications of ultrasound to Nephrology, including the necessary basic technical requirements, the framework normative and the level of training of nephrologists in this area. The objective of this work is to promote the inclusion of ultrasound, both diagnostic and interventional, in the usual clinical practice of the nephrologist and in the Nephrology Services portfolio with the final objective of offering diligent, efficient and comprehensive management to the nephrological patient
Consensus document for lipid profile determination and reporting in Spanish clinical laboratories
Las enfermedades cardiovasculares (ECV) siguen siendo la principal causa de muerte en nuestro pa铆s. El control adecuado de las alteraciones del metabolismo lip铆dico es un reto clave en prevenci贸n cardiovascular que est谩 lejos de alcanzarse en la pr谩ctica cl铆nica real. Existe una gran heterogeneidad en los informes del metabolismo lip铆dico de los laboratorios cl铆nicos espa帽oles, lo que puede contribuir al mal control del mismo. Por ello, un grupo de trabajo de las principales sociedades cient铆ficas implicadas en la atenci贸n de los pacientes de riesgo vascular hemos elaborado este documento con una propuesta b谩sica de consenso sobre la determinaci贸n del perfil lip铆dico b谩sico en prevenci贸n cardiovascular, recomendaciones para su realizaci贸n y unificaci贸n de criterios para incorporar los objetivos de control lip铆dico adecuados al riesgo vascular de los pacientes en los informes de laboratorio.Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports
Association of Candidate Gene Polymorphisms With Chronic Kidney Disease: Results of a Case-Control Analysis in the Nefrona Cohort
Chronic kidney disease (CKD) is a major risk factor for end-stage renal disease, cardiovascular disease and premature death. Despite classical clinical risk factors for CKD and some genetic risk factors have been identified, the residual risk observed in prediction models is still high. Therefore, new risk factors need to be identified in order to better predict the risk of CKD in the population. Here, we analyzed the genetic association of 79 SNPs of proteins associated with mineral metabolism disturbances with CKD in a cohort that includes 2, 445 CKD cases and 559 controls. Genotyping was performed with matrix assisted laser desorption ionizationtime of flight mass spectrometry. We used logistic regression models considering different genetic inheritance models to assess the association of the SNPs with the prevalence of CKD, adjusting for known risk factors. Eight SNPs (rs1126616, rs35068180, rs2238135, rs1800247, rs385564, rs4236, rs2248359, and rs1564858) were associated with CKD even after adjusting by sex, age and race. A model containing five of these SNPs (rs1126616, rs35068180, rs1800247, rs4236, and rs2248359), diabetes and hypertension showed better performance than models considering only clinical risk factors, significantly increasing the area under the curve of the model without polymorphisms. Furthermore, one of the SNPs (the rs2248359) showed an interaction with hypertension, being the risk genotype affecting only hypertensive patients. We conclude that 5 SNPs related to proteins implicated in mineral metabolism disturbances (Osteopontin, osteocalcin, matrix gla protein, matrix metalloprotease 3 and 24 hydroxylase) are associated to an increased risk of suffering CKD
Reflections on the need for Nephropathology Reference Units
RESUMEN1. La ERC tiene una elevada incidencia y prevalencia con unalto impacto sobre la calidad de vida y mortalidad de lospacientes, lo que supone un importante consumo de recur-sos sanitarios.2. En un porcentaje relevante de pacientes no se dispone deun diagn贸stico etiol贸gico de la ERC, lo que limita sus posi-bilidades de tratamiento y curaci贸n.3. Las acciones dirigidas a mejorar el diagn贸stico permitir谩nfavorecer un mejor conocimiento de las causas de la ERC yoptimizar el tratamiento.4. La biopsia renal, constituye el procedimiento necesa-rio para el estudio histopatol贸gico del tejido renal quepermitir谩 establecer el diagn贸stico, las posibilidades de tra-tamiento y el pron贸stico del da藴no renal.5. El trasplante renal constituye la mejor opci贸n de TRS. Lacausa m谩s frecuente de p茅rdida del injerto renal es elrechazo. La biopsia renal es el 煤nico m茅todo para establecerel tipo de rechazo e iniciar el tratamiento m谩s adecuado.6. La planificaci贸n del tratamiento de la enfermedad renalse establece con base en un diagn贸stico preciso y este sebasa en el diagn贸stico histol贸gico. La falta de una ade-cuada interpretaci贸n diagn贸stica, bien por inexperienciadel pat贸logo, bien por falta de medios diagn贸sticos (micro-scopia electr贸nica), condiciona y limita las opciones detratamiento en perjuicio del enfermo
Taurolidina como tratamiento adyuvante en casos de peritonitis recidivante en pacientes en di谩lisis peritoneal.
Relapsing peritonitis in peritoneal dialysis patients is one of the complications that jeopardizes the continuity of the technique. It is often associated with the formation of biofilm in the lumen of the catheter. To date, its removal remains the only recommended attitude. Due to its antimicrobial and antifungal properties, taurolidine has been previously used for the sealing of central line catheters and hemodialysis. Despite the good results obtained, there is no evidence available regarding its utility in peritoneal dialysis. This case report describes the use of taurolidine (TauroLock鈩EP500) in 5 patients with relapsing peritonitis after antibiotic treatment completion. Mean follow-up for the detection of recurrences was 13.4 months. In 4 patients with infections caused by Staphylococcus epidermidis, eradication was achieved. In the remaining case, caused by Staphylococcus aureus, the taurolidine seal was ineffective and the removal of the catheter was required