Metabolismo fosfocálcico

Mesas sobre hiperparatiroidismo compuestas por un panel de expertos.Facultad de Ciencias Médica

Metabolismo fosfocálcico

Mesas sobre hiperparatiroidismo compuestas por un panel de expertos.Facultad de Ciencias Médica

Citrate salts for preventing and treating calcium containing kidney stones in adults

Background: kidney stones affect people worldwide and have a high rate of recurrence even with treatment. Recurrences are particularly prevalent in people with low urinary citrate levels. These people have a higher incidence of calcium phosphate and calcium oxalate stones. Oral citrate therapy increases the urinary citrate levels, which in turn binds with calcium and inhibits the crystallisation thus reduces stone formation. Despite the widespread use of oral citrate therapy for prevention and treatment of calcium oxalate stones, the evidence to support its clinical efficacy remains uncertain.Objectives: the objective of this review was to determine the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones.Search methods: we searched the Cochrane Kidney and Transplant Specialised Register to 29 July 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review.Selection criteria: we included randomised controlled trials (RCTs) that assessed the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones in adults treated for a minimum of six months.Data collection and analysis: two authors assessed studies for inclusion in this review. Data were extracted according to predetermined criteria. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes.Main results: we included seven studies that included a total of 477 participants, most of whom had oxalate stones. Of these, three studies (247 participants) compared potassium citrate with placebo or no intervention; three (166 participants) compared potassium-sodium citrate with no intervention; and one (64 participants) compared potassium-magnesium citrate with placebo. Overall, quality of the reporting of the included studies was considered moderate to poor, and there was a high risk of attrition bias in two studies.Compared with placebo or no intervention, citrate therapy significantly reduced the stone size (4 studies, 160 participants: RR 2.35, 95% CI 1.36 to 4.05). New stone formation was significantly lower with citrate therapy compared to control (7 studies, 324 participants: RR 0.26, 95% CI 0.10 to 0.68). The beneficial effect on stone size stability was also evident (4 studies, 160 participants: RR 1.97, 95% CI 1.19 to 3.26). Adverse events were reported in four studies, with the main side effects being upper gastrointestinal disturbance and one patient reported a rash. There were more gastrointestinal adverse events in the citrate group; however this was not significant (4 studies, 271 participants: RR 2.55, 95% CI 0.71 to 9.16). There were significantly more dropouts due to adverse events with citrate therapy compared to control (4 studies, 271 participants: RR 4.45, 95% CI 1.28 to 15.50). The need for retreatment was significantly less with citrate therapy compared to control (2 studies, 157 participants: RR 0.22, 95% CI 0.06 to 0.89).Author's conclusions: nitrate salts prevent new stone formation and reduce further stone growth in patients with residual stones that predominantly contain oxalate. The quality of reported literature remains moderate to poor; hence a well-designed statistically powered multi-centre RCT is needed in order to answer relevant questions concerning the efficacy of citrate salts.</p

Nuclear Medicine in Pediatric Nephro-Urology: An Overview.

In the context of ante-natally diagnosed hydronephrosis, the vast majority of children with a dilated renal pelvis do not need any surgical treatment, as the dilatation resolves spontaneously with time. Slow drainage demonstrated at Tc-99m-mercaptoacetyltriglycine (MAG3) renography does not necessarily mean obstruction. Obstruction is defined as resistance to urinary outflow with urinary stasis at the level of the pelvic-ureteric junction (PUJ) which, if left untreated, will damage the kidney. Unfortunately this definition is retrospective and not clinically helpful. Therefore, the identification of the kidney at risk of losing function in an asymptomatic patient is a major research goal. In the context of renovascular hypertension a DMSA scan can be useful before and after revascularisation procedures (angioplasty or surgery) to assess for gain in kidney function. Renal calculi are increasingly frequent in children. Whilst the vast majority of patients with renal stones do not need functional imaging, DMSA scans with SPECT and a low dose limited CT can be very helpful in the case of complex renal calculi. Congenital renal anomalies such as duplex kidneys, horseshoe kidneys, crossed-fused kidneys and multi-cystic dysplastic kidneys greatly benefit from functional imaging to identify regional parenchymal function, thus directing further management. Positron emission tomography (PET) is being actively tested in genito-urinary malignancies. Encouraging initial reports suggest that F-18-fluorodeoxyglucose (FDG) PET is more sensitive than CT in the assessment of lymph nodal metastases in patients with genito-urinary sarcomas; an increased sensitivity in comparison to isotope bone scans for skeletal metastatic disease has also been reported. Further evaluation is necessary, especially with the promising advent of PET/MRI scanners. Nuclear Medicine in paediatric nephro-urology has stood the test of time and is opening up to new exciting developments

Funcionamiento inconscientes del vínculo de pareja, su clínica

Los conflictos de pareja son una problemática muy frecuente en los tratamientos psi­coanalíticos individuales o de otro tipo y ocurre con ellos con frecuencia, como con tantos sufrimientos humanos, que el psicoanalista no puede prestar una ayuda que lleve a una mejoría considerable. La sola mención de la destructividad humana y de la pul­sión de muerte bastaría para entender que ocurre con los conflictos de pareja tal vez lo mismo que en otros terrenos de la existencia humana pero puede pensarse también que los conocimientos psicoanalíticos respecto de este ámbito de la conducta son aún insuficientes y que aumentarlos redundaría en una mejor capacidad de nuestro arsenal terapéutico. Ubicados en esta perspectiva, entonces, surge como pregunta fundamental para el psicoanálisis cuáles son los funcionamientos inconscientes que subyacen a estos conflictos, pregunta sobre la cual han trabajado muchos psicoanalistas desde Freud en adelante. Ahora bien, otra pregunta, que es en la que se centrará esta tesis, se refiere a cuánto de estos funcionamientos pueden atribuirse a uno u otro de los partenaires y cuánto debe atribuirse a la interacción entre ambos, a un encuentro que resulta proble­mático no tanto por las personalidades en sí, que han funcionado diferentemente en otras parejas, sino por algo atribuible al encuentro, a lo que se genera conciente e incon­cientemente en el "entre-dos". El motivo de una investigación de esta naturaleza, tiene un fundamente eminentemente clínico: se trata de construir mejores herramientas teóri­co-clínicas para abordar una fuente habitual de sufrimientos humanos.Fil: Spivacow, Miguel Alejo. Universidad Nacional de La Matanza; Argentin