Brief history of nephrology in Chile

The development of nephrology in Chile is described. The advances in the study and treatment of acute renal failure, urinary tract infections, hypertension, glomerulopathies and other areas are analyzed. The present state of dialysis and transplantation programs is highlighted and the activities of Pediatric and Internal Medicine nephrology branches are summarized

The National Health Survey of Chile gives useful information to health policy planning. Analysis of Diabetic Nephropathy as an index of potential saving

Artículo de publicación IS

Pielonefritis enfisematosa: 3 casos

We report 3 patients who developed emphysematous pyelonephritis. All were diabetic females over 50 years of age with unilateral necrotizing pyelonephritis. Intra and perirenal gas was demonstrated and all patients had infection by E coli. X ray and ultrasound studies allowed the diagnosis. Antibiotic therapy was unsuccessful and all patients had to be operated on

Effect of a simultaneous potassium and carbohydrate load on extrarenal K homeostasis in end-stage renal failure

Patients with chronic renal failure (CRF) are continuously exposed to hyperkalemia. In these patients the extrarenal disposal of a potassium load may be very important to determine the plasma potassium levels. We studied the effects of a combined oral load of potassium (0.5 mEq/kg body weight) and carbohydrate (0.5 g/kg body weight) to mimic normal ingestion of potassium. Eight CRF patients and 5 control subjects were studied. The maximal increase in plasma potassium levels achieved was significantly higher in the patients (1.07 ± 0.1 mEq/l) than in controls (0.39 ± 0.05 mEq/l). Basal insulin levels were higher in the CRF patients and increased with the oral potassium and carbohydrate load in both controls and patients. In the CRF patients only 58.9 ± 3% of the potassium load was translocated to the intracellular space compared to 81 ± 6% in the controls. No correlation was found between the acid base status and maximal potassium increase. We conclude that patients with CRF exhibit a

Comparison of extra renal potassium disposal in hypertensive, diabetic and normal subjects Estudio comparativo del manejo extrarrenal de potasio en sujetos controles, pacientes hipertensos y diabéticos

Background: Sodium and potassium ions are involved in the regulation of blood pressure and the genesis of hypertension. Aim: To assess internal potassium balance, as a measure of sodium pump activity, in subjects with essential hypertension and diabetic patients. Patients and methods: Eleven hypertensive subjects, 5 non-insulin-dependent diabetics and 16 age matched controls were studied. An acute oral load of 0.8 mEq/Kg body weight of KCl was administered and blood samples were drawn every 30 min thereafter, until 120 min, to measure plasma K+ levels. Urinary K+ excretion during this period was also measured. In eight hypertensive patients, the test was repeated after two week of supplementation with 60 mEq/day of KCl. The maximal increase in plasma potassium levels and the time required to achieve the maximum concentration was recorded. Results: All patients had normal serum creatinine levels. Mean fasting blood glucose of diabetic patients was 133 ± 15.1 mg/dl. No difference betwee

Effect of Chronic Renal Failure on NaK-ATPase A1 and a2 mRNA Transcription in Rat Skeletal Muscle

Artículo de publicación ISIPrevious studies have suggested that an alteration in the expression of the NaK-ATPase of muscle may be an important determinant of enhanced insulin sensitivity in chronic renal failure. Therefore, in the present studies we have examined the effect of uremia on the NaK-ATPase a isoforms in skeletal muscle, at the level of mRNA expression and enzymatic activity. The activity of the sodium pump, as measured ouabain-sensitive 'Rb/K uptake in soleus muscle, revealed a reduction in the activity in uremia, related to the increment in plasma creatinine values. The decrement in 86Rb uptake by the rat soleus muscle of experimental animals was associated with changes on NaK-ATPase gene product. Northern analysis of mRNA revealed isoform-specific regulation of Na,K-ATPase by uremia in skeletal muscle: a decrease of - 50% in al subunit Na,K-ATPase mRNA, as compared to controls. The decrement in al mRNA correlates with the decreased activity of the Na,K-ATPase in uremia, under basal conditions and with the almost complete inhibition of the Na,K-ATPase, of uremic tissue by a concentration of 10-' M ouabain. Although the activity of the a2 isoform pump was not modified by uremia, the 3.4-kb message for this enzyme was increased 2.2-fold; this discrepancy is discussed. Altogether these findings demonstrate that the defective extrarenal potassium handling in uremia is at least dependent in the expression of a1 subunit of the Na,K-ATPase

Assessment and follow up of diabetic patients in hemodialysis Diabetes y hemodiálisis. Caracterización de una cohorte y seguimiento a cuatro años

Background: Despite a better management of the variables that influence the development of diabetic nephropathy, there is a progressive increase in the prevalence of terminal renal failure among diabetics, whose cause is not clear. Aim: To study, in a group of patients in hemodialysis, the quality of diabetes control previous to the entry to dialysis, their physical condition and their evolution. Material and methods: Diabetic patients with at least three months of hemodialysis answered a questionnaire about diabetes control quality previous to dialysis and had physical and laboratory assessment. They were followed for at least four years thereafter. Results: Fifty seven patients aged 62±11 years were studied. Eighty four percent had some degree of disability. Eighty seven percent had high blood pressure and 73% had to enter dialysis as an emergency. Mean glycosilated hemoglobin was 7.7% and 58% had a dialysis dose with a Kt/V of less than 1.2. Fifty eight percent died during follow u