Hyperuricemia and chronic kidney disease: to treat or not to treat / Hiperuricemia e doença renal crônica: tratar ou não tratar

Abstract Hyperuricemia is common in chronic kidney disease (CKD) and may be present in 50% of patients presenting for dialysis. Hyperuricemia can be secondary to impaired glomerular filtration rate (GFR) that occurs in CKD. However, hyperuricemia can also precede the development of kidney disease and predict incident CKD. Experimental studies of hyperuricemic models have found that both soluble and crystalline uric acid can cause significant kidney damage, characterized by ischemia, tubulointerstitial fibrosis, and inflammation. However, most Mendelian randomization studies failed to demonstrate a causal relationship between uric acid and CKD, and clinical trials have had variable results. Here we suggest potential explanations for the negative clinical and genetic findings, including the role of crystalline uric acid, intracellular uric acid, and xanthine oxidase activity in uric acid-mediated kidney injury. We propose future clinical trials as well as an algorithm for treatment of hyperuricemia in patients with CKD.

Resumo A hiperuricemia é comum na doença renal crônica (DRC) e pode estar presente em até 50% dos pacientes que se apresentam para diálise. A hiperuricemia pode ser secundária ao comprometimento da taxa de filtração glomerular (TFG) que ocorre na DRC. No entanto, ela também pode preceder o desenvolvimento da doença renal e mesmo prever uma DRC incidente. Estudos experimentais de modelos hiperuricêmicos descobriram que tanto o ácido úrico solúvel quanto o cristalino podem causar danos renais significativos, caracterizados por isquemia, fibrose tubulointersticial e inflamação. Entretanto, a maioria dos estudos de randomização Mendeliana falhou em demonstrar uma relação causal entre o ácido úrico e a DRC, e os ensaios clínicos têm apresentado resultados variáveis. Aqui sugerimos explicações potenciais para os achados clínicos e genéticos negativos, incluindo o papel do ácido úrico cristalino, do ácido úrico intracelular e da atividade da xantina oxidase na lesão renal mediada por ácido úrico. Propomos ensaios clínicos futuros, bem como um algoritmo para o tratamento de hiperuricemia em pacientes com DRC.

Funcionalidad de prótesis de mano impresa en 3D en adolescentes con amputación congénita parcial de mano: una serie de casos / 3D-printed hand prostheses function in adolescents with congenital hand amputation: a case series

Resumen: Objetivo: Describir el efecto de la prótesis impresa en 3D Cyborg Beast en la funcionalidad de miembros superiores (MMSS) en adolescentes con amputación congénita parcial de mano. Casos Clínicos: Se seleccionaron 5 pacientes entre 12 y 17 años con amputación congénita parcial de mano en el Instituto Teletón Santiago. Los pacientes fueron entrenados en el uso de la prótesis por 4 sesiones. Se evaluó la función basal (sin prótesis), al mes y los 4 meses de uso de la prótesis con la pauta Bilan 400 points modificada y la percepción de funcionalidad de MMSS sin y con prótesis con la "Upper Extremity Function Index (UEFI)". Al mes y 4 meses de uso, el porcentaje de cambio para funcionalidad de mano fue de -11% y -4% para la extremidad no afectada y de -9% y -2% para la afectada. El porcentaje de cambio para la percepción de funcionalidad de MMSS fue de -62%. Conclusiones: El uso de la prótesis de mano Cyborg Beast no fue una solución funcional para los 5 pacientes incluidos en este estudio. Futuras investigaciones son necesarias para poder mejorar la funcionalidad de estos diseños de prótesis impresa en tecnología 3D.

Abstract: Objective: To describe the effect of the 3D-printed Cyborg Beast prosthesis on upper limbs function in adolescents with congenital hand amputation. Clinical Cases: Five patients aged between 12 and 17 years, with congenital hand amputation were selected. All patients were from the Teletón Institute in Santiago, Chile. The patients were trained for prosthesis use in four sessions. Hand function was evaluated without prosthesis, at 1 and 4 months of use with the modified Bilan 400 points scale, and upper limb function perception was evaluated with the 'Upper Extremity Functional Index (UEFI)'. At 1 month and 4 months of use, the percentage change for hand functionality for the unaffected limbs was between -11% and -4%; and -9% and -2% for the affected limb. The percentage change for the upper limbs perceived function was -62%. Conclusions: The use of the 3D-printed Cyborg Beast prosthesis was not a functional solution for the 5 patients included in this study. Future research is needed to improve the functionality of these types of 3D-printed hand prostheses.

Experiencias del uso de ortoprótesis de mano impresa en 3D (Cyborg Beast) en adolescentes con amputación congénita de mano y sus cuidadores principales: un estudio de casos / Experiences of the use of 3D printed hand ortoprosthesis (Cyborg Beast) in adolescents with congenital hand amputation and their main caregivers: a study of cases

OBJETIVO: Describir la experiencia del uso de la ortoprótesis de mano impresa en 3D Cyborg Beast, en adolescentes usuarios de Teletón Santiago con amputación congénita de mano y sus cuidadores principales, que participaron en un estudio de casos para evaluar la funcionalidad de la mano proté sica. CASO CLÍNICO: Investigación de estudio de casos de tipo descriptivo, mediante entrevistas semi- estructuradas a cinco adolescentes con amputación congénita de mano y a sus cuidadores principales, las cuales fueron transcritas y analizadas mediante codificación abierta. Los participantes visualizan la ortoprótesis como una oportunidad para ellos asociándola a la normalidad. Asimismo, identificaron características positivas y negativas, enfatizando en estas últimas. Además, describieron efectos positivos y negativos producidos al utilizar la prótesis, destacando que el uso de la prótesis les permite ha blar sobre su condición. Finalmente, se presentan propuestas de mejora para la prótesis, definiéndose que se debe corregir el prototipo y cambiar la edad de la población objetivo. CONCLUSIONES: El estudio se configura como pionero al investigar un tema poco explorado, permitiendo entregar información respecto de la experiencia subjetiva de adolescentes que utilizan una ortoprótesis que actualmente tiene gran importancia mediática. Los participantes del estudio relataron dificultades para usar la ortoprótesis de mano, ya sea por aspectos de materialidad y diseño. La ortoprótesis no cumplió las expectativas de uso y estética.

OBJECTIVE: To describe the experience of using the 3D-printed prosthetic hand Cyborg Beast in ado lescents of Teletón Santiago with congenital hand amputation and their main caregivers who partici pated in a case study to evaluate the functionality of the prosthetic hand. CLINICAL CASE: Qualitative and descriptive research of case studies using semi-structured interviews with five adolescents with congenital hand amputation and their main caregivers. The information was transcribed and ana lyzed through open coding. Participants visualize the prosthesis as an opportunity for them by asso ciating it with normality. They also identify positive and negative characteristics, emphasizing in the latter. In addition, they described positive and negative effects produced when using the prosthesis, highlighting that the use of the prosthesis allows them to talk about their condition. Finally, im provement proposals for the prosthesis are presented, defining that the prototype must be corrected and change the age of the target population. CONCLUSIONS: The study is the first to investigate a little explored topic, allowing to provide information regarding the subjective experience of adolescents who use a prosthesis that currently has great media importance. The study participants reported dif ficulties in using the hand prosthesis, either due to materiality and design aspects. The prosthesis did not meet the expectations of use and esthetic.