Consequences of morbid obesity on the kidney. Where are we going?

Obesity and morbid obesity are modifiable risk factors for the development and progression of kidney disease. Obesity has reached epidemic proportions and is currently an important health problem in Europe, so it is necessary to develop therapeutic and preventive strategies. The obesity-related glomerulopathy has been defined as a secondary form of focal segmental glomerulosclerosis, and its most characteristic feature is glomerulomegaly. The renal evolution of patients with obesity-related glomerulopathy (ORG) who have not been treated is unfavourable. However, morbidly obese patients with ORG that underwent bariatric surgery and drastic weight loss had a better outcome. Many inflammatory factors have been implicated in the pathogenic mechanism of renal disease in obesity. Hypoadiponectinaemia, hyperleptinaemia and hyperaldosteronism have been associated with glomerular injury in obese patients. The application of modern techniques has provided important insights that increase the current understanding of ORG. However, further investigation is needed

Eficiencia de la inspección de SUNAFIL y el cumplimiento de las obligaciones sociolaborales de los empleadores del hogar-Piura 2021

La presente investigación tuvo como objetivo general analizar si la inspección de Sunafil es eficiente frente a las obligaciones socio laborales de los empleadores del hogar- Piura 2021, para lo cual se empleó una investigación de tipo básica descriptiva, con un enfoque cualitativo y un diseño no experimental transversal. Además, se empleó la técnica de la entrevista y análisis documental, cuyos instrumentos fueron la guía de entrevista y la guía de análisis documental y cuentan con la validación de tres expertos, obteniendo los siguientes resultados: La labor de inspección que efectúa Sunafil es ineficiente debido a que no se cumple con el objeto de la inspección, además se determinó que existen diversos factores que generan inspecciones deficientes, por ello debería modificarse la Ley 28806. Se concluyó que la inspección de Sunafil es ineficiente frente a las obligaciones socio laborales de los empleadores del hogar debido a la acción tardía ejecutada por los inspectores, toda vez que no realizan la acción inspectiva necesaria en el momento requerido. Asimismo, se concluyó que debería modificarse la Ley N° 28806 a fin de mejorar la función inspectiva, teniendo en cuenta que la relación laboral de una trabajadora del hogar es de una naturaleza muy distinta a los demás empleados

Nivel de conocimiento sobre triaje en la capacidad de respuesta frente a desastres, en el personal de enfermería en emergencia del Hospital Nacional Sergio e. Bernales de Collique 2019

Se realizó con el objetivo de determinar el nivel de conocimiento sobre triaje influye en la capacidad de respuesta frente a desastres, en el personal de enfermería en emergencia del Hospital Nacional Sergio E. Bernales de Collique, 2019. El trabajo fue de tipo cuantitativa, con diseño no experimental, descriptivo-correlacional de corte transversal. La población fue 40 y la muestra también fue conformada por 40 enfermeras, a quienes se les aplico el instrumento: La técnica utilizada fue la encuesta con un cuestionario para cada instrumento. Los datos obtenidos a través de los cuestionarios fueron procesados con el programa Excel y SPSS. Los resultados indican que, hay un bajo nivel de conocimientos sobre triaje y capacidad de respuesta frente a desastres. Se demostró que la respuestas de la encuesta a los 40 enfermeras del Hospital Nacional Sergio Bernales de Collique nos muestra una tendencia marcada respecto a los CONOCIMIENTOS SOBRE TRIAJE en relación a la CAPACIDAD DE RESPUESTA FRENTE A DESASTRES, recogiendo un marcado porcentaje alto del 77,50% de bajos conocimientos, en tanto un 20% posee conocimientos medios, y apenas un 2,5 con conocimientos altos, lo que muestra una gran preocupación por la forma ideal en que deberían desempeñarse dicho personal de enfermería.Tesis de segunda especialida

Urinary Peptide Profiling to Differentiate between Minimal Change Disease and Focal Segmental Glomerulosclerosis

Minimal change disease (MCD) and primary focal segmental glomerulosclerosis (FSGS) are the main causes of primary idiopathic nephrotic syndrome in children and adults, with diagnosis being essential for the appropriate choice of therapy and requiring renal biopsy. However, the presence of only normal glomeruli on renal biopsy of FSGS patients may lead to the misclassification of these patients as having MCD. The aim of this study was to (i) compare the peptide profile of MCD and FSGS patients with that of a group of healthy subjects, (ii) generate and validate a class prediction model to classify MCD and FSGS patients and (ii) identify candidate biomarkers of these glomerular entities by analysis of the urinary peptidome. The urinary peptide profile was analyzed by magnetic bead-based technology combined with MALDI-TOF mass spectrometry in 44 patients diagnosed of MCD (n = 22) and FSGS (n = 22). The resulting spectra were compiled and analyzed using ClinProTools software. A class prediction model was developed to differentiate MCD and FSGS patients. The validation of this model correctly classified 81.8% (9/11) of MCD patients and 72.7% (8/11) of FSGS patients. Moreover, the signal with m/z 1913.60, identified as a fragment of uromodulin, and the signal with m/z 2392.54, identified as a fragment of alpha-1-antitrypsin, showed higher and lower peak areas, respectively, in FSGS patients compared with MCD patients. The simple, non-invasive technique described in the present study may be a useful tool to help clinicians by confirming diagnoses achieved by renal biopsy, thereby reducing misdiagnoses and avoiding the implementation of inappropriate therapies

Long-Term Normal Renal Function after Drastic Weight Reduction in Patients with Obesity-Related Glomerulopathy

No long-term studies of renal function evolution in morbidly obese (MO) patients after weight loss are available. The aim of our work was to ascertain the long-term influence of drastic weight reduction on renal function in MO patients with obesity-related glomerular lesions. 92 MO patients with normal renal function and biopsy evidence of mild obesity-related glomerulopathy underwent bariatric surgery (BS) and subsequent drastic weight loss. A long-term prospective follow-up (mean duration: 76 ± 42 months) was carried out. Basal renal biopsies and basal and long-term metabolic and renal function studies were performed in all cases. Linear mixed models were applied. Blood pressure dropped early after BS and remained stable thereafter. Creatinine clearance and BMI fell in the first 2 years, rose slightly after 5 years and then remained stable. Serum creatinine and albuminuria decreased throughout the follow-up period. Renal function and albuminuria evolution showed non-significant differences in relation to the number of glomerular lesions. Drastic weight loss in BS-treated MO patients with pre-surgical normal renal function and mild obesity-related glomerular lesions is associated with short- and long-term maintenance of normal renal function and improvement in both arterial hypertension and albuminuria

Measured GFR in murine animal models: review on methods, techniques, and procedures

Animal models; Glomerular filtration rate; Kidney damageModels animals; Taxa de filtració glomerular; Dany renalModelos animales; Tasa de filtración glomerular; Daño renalChronic kidney disease (CKD) is one of the most common chronic diseases worldwide, with increasing rates of morbidity and mortality. Thus, early detection is essential to prevent severe adverse events and the progression of kidney disease to an end stage. Glomerular filtration rate (GFR) is the most appropriate index to evaluate renal function in both clinical practice and basic medical research. Several animal models have been developed to understand renal disease induction and progression. Specifically, murine models are useful to study the pathogenesis of renal damage, so a reliable determination of GFR is essential to evaluate the progression of CKD. However, as in clinical practise, the estimation of GFR in murine by levels of serum/urine creatinine or cystatin-C could not be accurate and needed other more reliable methods. As an alternative, the measurement of GFR by the clearance of exogenous markers like inulin, sinistrin, 51Cr-EDTA, 99mTc-DTPA, 125I-iothalamate, or iohexol could be performed. Nevertheless, both approaches—estimation or measurement of GFR—have their limitations and a standard method for the GFR determination has not been defined. Altogether, in this review, we aim to give an overview of the current methods for GFR assessment in murine models, describing each methodology and focusing on their advantages and limitations.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This work is supported by funding from the Instituto de Salud Carlos III with the following grants: AERR is a recipient of a contract from the Sara Borrell programme (C21/00142) and STT of PFIS FI20/00147

Immunological Pattern in IgA Nephropathy

The current gold-standard diagnostic technique for IgA nephropathy (IgAN), the leading form of primary glomerulonephritis, is renal biopsy. CD89 (the main IgA receptor) is expressed on the surface of monocytes and plays a role in disease pathogenesis. Immunocomplexes formed by sCD89 (soluble form) and Gd-IgA1 are related to disease prognosis. We hypothesize that reduced CD89 surface expression on monocytes may be a marker of disease severity. We aimed to analyze leukocyte subpopulations in peripheral blood and CD89 surface expression on monocytes in a prospective study of 22 patients and 12 healthy subjects (HS). Leukocyte subpopulations and CD89 expression were analyzed by flow cytometry. IgAN patients had a higher percentage of activated and effector memory CD4 + and CD8 + T lymphocytes, a lower percentage of transitional B lymphocytes and plasmablasts, and a higher percentage of CD56 dim CD16 + NK cells and myeloid dendritic cells compared with HS. Correlations between reduced CD89 expression levels on nonclassical monocytes, histological findings of a poor prognosis on renal biopsy and baseline renal function were observed. IgAN patients show a characteristic immunological pattern in peripheral blood. A reduced expression level of CD89 on nonclassical monocytes identifies patients with a worse renal prognosis

Long-Term Normal Renal Function after Drastic Weight Reduction in Patients with Obesity-Related Glomerulopathy

Aims: No long-term studies of renal function evolution in morbidly obese (MO) patients after weight loss are available. The aim of our work was to ascertain the long-term influence of drastic weight reduction on renal function in MO patients with obesity-related glomerular lesions. Methods: 92 MO patients with normal renal function and biopsy evidence of mild obesity-related glomerulopathy underwent bariatric surgery (BS) and subsequent drastic weight loss. A long-term prospective follow-up (mean duration: 76 ± 42 months) was carried out. Basal renal biopsies and basal and long-term metabolic and renal function studies were performed in all cases. Linear mixed models were applied. Results: Blood pressure dropped early after BS and remained stable thereafter. Creatinine clearance and BMI fell in the first 2 years, rose slightly after 5 years and then remained stable. Serum creatinine and albuminuria decreased throughout the follow-up period. Renal function and albuminuria evolution showed non-significant differences in relation to the number of glomerular lesions. Conclusions: Drastic weight loss in BS-treated MO patients with pre-surgical normal renal function and mild obesity-related glomerular lesions is associated with short- and long-term maintenance of normal renal function and improvement in both arterial hypertension and albuminuria

Integrated miRNA–mRNA Analysis Reveals Critical miRNAs and Targets in Diet-Induced Obesity-Related Glomerulopathy

This study aimed to investigate obesity-related glomerulopathy (ORG) at cellular, structural, and transcriptomic levels. Thirty Wistar rats were randomized into two groups: 15 rats were fed with a standard diet (SD-rats), and 15 rats were fed with a high-fat diet (HFD-rats). After 10 weeks, the weight, kidney function, histological features, and transcriptomic changes were assessed. HFD-rats gained significantly more weight (55.8% vs. 29.2%; p < 0.001) and albuminuria (10,384.04 ng/mL vs. 5845.45 ng/mL; p < 0.001) compared to SD-rats. HFD-rats exhibited early stages of ORG, with predominant mesangial matrix increase and podocyte hypertrophy (PH). These lesions correlated with differentially expressed (DE) genes and miRNAs. Functional analysis showed that miR-205, which was DE in both the kidneys and urine of HFD-rats, negatively regulated the PTEN gene, promoting lipid endocytosis in podocytes. The downregulation of PTEN was proved through a higher PTEN/nephrin ratio in the SD-rats and the presence of lipid vacuoles in HFD-podocytes. This study has found a specific targetome of miRNAs and gene expression in early stages of ORG. Also, it emphasizes the potential value of miR-205 as a urinary biomarker for detecting podocyte injury in ORG, offering a tool for early diagnosis, and opening new avenues for future therapeutic research of obesity-related glomerulopathy

Memorias : Coloquio los Métodos en el Diseño y la Arquitectura

1 archivo PDF (190 páginas)Memorias del Coloquio Departamental Los Métodos en el Diseño y la Arquitectura, el cual tuvo dos objetivos: el primero, mostrar las reflexiones en tomo a las metodologías en el diseño y la arquitectura que utilizan los profesores tanto en la investigación como en la docencia, y el segundo, exponer ante los alumnos el trabajo previo que los profesores realizan para impartir las Unidades de Enseñanza Aprendizaje en el salón de clases