BK virus nephropathy in a heart transplant recipient / Nefropatia pelo vírus BK em um receptor de transplante cardíaco

Abstract BK virus nephropathy in kidney transplantation is widely recognized as an important cause of graft dysfunction and loss. In the case of transplants of organs other than kidney, BK virus nephropathy in native kidneys has been recognized as a cause of chronic kidney disease, which is related with immunosuppression; however, the diagnosis is usually late because the renal dysfunction is attributed to other causes, such as toxicity by anticalcineurinic drugs, interstitial nephritis due to medications, hemodynamic changes, diabetes, hypertension, etc. We report a case of BK virus nephropathy in a patient who underwent heart transplantation due to peripartum cardiomyopathy. The kidney biopsy reported active chronic tubulointerstitial nephritis associated with late stage polyomavirus nephritis and the blood viral load for BK virus was positive (logarithm 4.5). The immunosuppressive treatment was reduced, and after two years of follow-up, the patient had stable renal function with a serum creatinine of 2.5 mg/dL (GFR of 23.4 mL/min/1.73m2). We recommend that the BK virus be considered as a cause of renal dysfunction in heart transplant recipients, with the aim of detecting its replication in time to reduce immunosuppressive therapy before irreversible compromise of renal function may manifest.

Resumo A nefropatia pelo vírus BK no transplante renal é amplamente reconhecida como uma importante causa de disfunção e perda do enxerto. No caso de transplantes de órgãos que não sejam rins, a nefropatia pelo vírus BK em rins nativos tem sido reconhecida como uma causa de doença renal crônica, que está relacionada com imunossupressão; entretanto, o diagnóstico é geralmente tardio porque a disfunção renal é atribuída a outras causas, tais como toxicidade por drogas anticalcineurínicas, nefrite intersticial devido a medicamentos, alterações hemodinâmicas, diabetes, hipertensão, etc. Relatamos um caso de nefropatia pelo vírus BK em um paciente que foi submetido a transplante cardíaco devido à cardiomiopatia periparto. A biópsia renal relatou nefrite túbulo-intersticial crônica ativa associada à nefrite por poliomavírus em estágio avançado e a carga viral sanguínea para o vírus BK foi positiva (logaritmo 4,5). O tratamento imunossupressor foi reduzido, e após dois anos de acompanhamento, o paciente apresentava função renal estável com creatinina sérica de 2,5 mg/dL (TFG de 23,4 mL/min/1,73m2). Recomendamos que o vírus BK seja considerado como uma causa de disfunção renal em receptores de transplante cardíaco, com o objetivo de detectar sua replicação a tempo de reduzir a terapia imunossupressora antes que um comprometimento irreversível da função renal possa se manifestar.

Consenso colombiano de expertos sobre recomendaciones informadas en la evidencia para la prevención, diagnóstico y manejo de la infección por SARS-CoV-2/COVID-19 en paciente pediátrico con enfermedad renal crónica o lesión renal aguda asociada a COVID-19 / Colombian consensus of experts on evidence-informed recommendations for the prevention, diagnosis, and management of SARS-CoV-2 / COVID-19 infection in pediatric patients with chronic kidney disease or acute kidney injury associated with COVID-19

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Abstract Introduction: The numbers of SARS-CoV-2 infection in the pediatric population are low so far. There is limited information about the behavior of SARS-CoV-2 in a pediatric patient with chronic kidney disease. Objective: To formulate informed recommendations to the prevention, diagnosis, and management of SARS-CoV-2 infection in pediatric patients with kidney disease or acute kidney injury associated with COVID-19 in Colombia. Methodology: A rapid systematic review was performed in Embase and Pubmed databases and scientific societies, to answer questions prioritized by clinical experts in pediatric nephrology. The quality of the evidence was evaluated with validated tools according to the type of study. The preliminary recommendations were consulted by an expert group. The agreement was defined when approval was obtained from at least 70% of the experts consulted. Results: A response was obtained from ' 9 experts in pediatric nephrology in Colombia, who declared the conflict of interest before the consultation. The range of agreement for the recommendations ranged from 78.9% to '00%. The recommendations did not require a second consultation. Conclusion: The evidence-based recommendations for the management of a patient with kidney disease and COVID-19 in the Colombian context are presented.

Scleroderma renal crisis in a kidney transplant patient / Crisis renal de esclerodermia en una paciente trasplantada renal

Abstract Renal crisis is a complication with significant morbidity and mortality in scleroderma patients and a rare entity in kidney transplantation. It may present with highly variable clinical manifestations, mainly arterial hypertension, acute kidney failure and multisystemic involvement. Following is the report of a patient with late reoccurrence of scleroderma crisis in kidney transplantation, who was given successful treatment with angiotensin-converting enzyme inhibitors.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1215).

Resumen La crisis renal es una complicación con importante morbilidad y mortalidad en pacientes con esclerodermia y una rara entidad en trasplante renal, que se puede presentar con manifestaciones clínicas muy variables, principalmente hipertensión arterial, falla renal aguda y compromiso multisistémico. A continuación se reporta el caso de una paciente con recurrencia tardía de la crisis esclerodérmica en el trasplante renal, que recibió tratamiento exitoso con inhibidores de la enzima convertidora de angiotensina.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1215).

Linfohistiocitosis hemofagocítica en trasplante renal / Haemophagocytic lymphohistiocytosis in kidney transplant recipients

RESUMEN La linfohistiocitosis hemofagocítica (LHH) posterior al trasplante renal hace referencia a un estado hiperinflamatorio grave, asociado a la activación no controlada de los linfocitos T citotóxicos y macrófagos por causa infecciosas y/o secundaria al tratamiento inmunosupresor. Las causas más prevalentes dentro de las infecciones son la histoplasmosis, la tuberculosis y las infecciones por virus herpes. Se caracteriza por fiebre, organomegalias, citopenias, hiperferritinemia, hipertrigliceridemia y/o hipofibrinogenemia; puede acompañarse con hemofagocitosis documentada en la médula ósea, el hígado u otros órganos. Su curso puede ser fulminante con progresión a falla multisistémica y la muerte. El tratamiento va enfocado a controlar tempranamente la causa desencadenante, reducir la inmunosupresión y controlar la inflamación. En pocos casos es necesario el uso de otros inmunosupresores, quimioterapia o, en situaciones muy seleccionadas, se puede requerir el trasplante de médula ósea.

SUMMARY Hemophagocytic lymphohistiocytosis (HLH) in renal transplant recipients is a life-threatening hyper-inflammatory syndrome; associated with uncontrolled activation of cytotoxic T-lymphocytes and macrophages due to infections or immunosuppressive therapy. Histoplasmosis, tuberculosis and herpes virus infection are among the leading infectious causes. It is characterized by fever, organomegaly, cytopenia, hyperferritinemia, hypertrigiceridemia and/or hypofibrinogenemia; which may be accompanied by hemophagocytosis in bone marrow, liver or other organs. HLH can follow a rapidly fatal course, with progression to multisystemic failure and death. The treatment is based on early control of the triggering cause, reducing immunosuppression and stop the inflammatory process. In some cases, is necessary to use other immunosuppressant, chemotherapy and in a very few cases, a bone marrow transplant may be required.

Exposición periconcepcional a factores ambientales y de consumo en padres y cuidadores de niños menores de 5 años en Santander / Periconceptional Exposure to Environmental and Consumer Factors in Parents and Caregivers of Children Under 5 Years Old in Santander / Exposição periconcepcional aos fatores ambientais e do consumo dos pais e dos cuidadores de crianças menores de 5 anos de idade no estado de Santander

Introducción: El desarrollo de estrategias que faciliten el cribado, diagnóstico y abordaje de factores medioambientales durante el embarazo y la lactancia, etapas donde la salud materno-infantil está expuesta de manera activa o pasiva a diferentes agentes; requiere implementar formatos facilitadores de abordaje preventivo. Objetivo: Identificar los factores medioambientales, desde la etapa periconcepcional hasta la infancia, utilizando como herramienta compartida la hoja verde de salud ambiental. Metodología: Estudio observacional, descriptivo de corte transversal. La muestra fue de 204 mujeres gestantes y/o lactantes entre 13-46 años de edad, de municipios de Santander. Se realizó un análisis estadístico descriptivo, de acuerdo a la naturaleza de las variables. Resultados: La edad promedio fue de 25.12 años (DE=5.94). El promedio de semanas gestacionales fue de 36.65 (DE=5.63). Consumo de alcohol preconcepciónal del 48.52% (n=99), donde 91.91% (n=91) consumió cerveza con frecuencia de consumo pregestacional de 4.96 cervezas/mes (DE= 4.58) (n=64). El consumo de cigarro materno en etapas periconcepcionales, fue de 4.90% con promedio de 2.03 cigarros/día (DE=4.35). Conclusiones: Este estudio aporta datos del ámbito local, y traslada una herramienta válida de promoción y prevención en salud medioambiental, por lo que la aplicación de este instrumento permitiría el abordaje integral de la consulta de atención madre-hijo.

Introduction: The development of strategies that facilitate the screening, diagnosis and approach of environmental factors during pregnancy and lactation, stages in which maternal and child health is exposed in an active or passive way to different agents; it requires implementing facilitative formats of a preventive approach. Objective: To identify environmental factors, from the periconceptional stage to childhood by using the "Green Page" of environmental health as a shared tool. Methodology: This is an observational and descriptive cross-sectional study. The sample consisted of 204 pregnant women and / or infants between 13 - 46 years old, from different municipalities in Santander. According to the nature of the variables, a descriptive statistical analysis was carried out. Results: The average age was 25.12 years (SD = 5.94). The pregnancy weeks average was 36.65 (SD = 5.63). Preconception of alcohol intake of 48.52% (n = 99), in which 91.91% (n = 91) consumed beer with a frequency of pre-pregnancy intake of 4.96 beers / month (SD = 4.58) (n = 64). The cigar intake of women in periconceptional stages was 4.90% with an average of 2.03 cigars / day (SD = 4.35). Conclusions: This study provides data from the local area, and moves a valid tool promotion and prevention tool to environmental health, so the application of this instrument would allow the integral approach of the mother-child care consultation.

Introdução: O desenvolvimento de estratégias que facilitem a triagem, o diagnóstico e a abordagem dos fatores ambientais durante a gestação e a lactação, etapas em que a saúde materno-infantil é exposta de maneira ativa ou passiva a diferentes agentes; requer a implementação de formatos facilitadores d'abordagem preventiva. Objetivo: Identificar fatores ambientais, desde a fase periconcepcional até a infância, utilizando a folha verde da saúde ambiental como ferramenta compartilhada. Metodologia: De tipo descritivo, de observação, e transversal. A amostra realizada foi de 204 gestantes e/ ou lactantes entre 13 e 46 anos de idade, de diferentes municípios de Santander. De acordo com a natureza das variáveis, se realizou uma análise estatística descritiva. Resultados: A idade média foi de 25,12 anos (DP = 5,94). O pro médium de semanas, nas gestantes foi de 36,65 (DP = 5,63). O consumo de álcool na pré concepção é de 48,52% (n = 99), entre ellas, 91,91% (n = 91) beberam cerveja com frequência de 4,96 cervejas ao mês (DE= 4,58) (n = 64). As mães fumadoras no periodo da pré concepção foi de 4,90%, com um pro médium de 2,03 cigarros por dia (DP = 4,35). Conclusões: O estudo apresenta os dados da região e usa uma ferramenta válida de promoção e prevenção em saúde ambiental, para que a aplicação deste instrumento permita a abordagem integral da consulta e dos cuidados materno-infantil, nos casos atendidos.

Irregularidad menstrual y exposición a mercurio en la minería artesanal del oro en Colombia / Human mercury exposure and irregular menstrual cycles in relation to artisanal gold mining in Colombia

Introducción. El proceso de extracción del oro por amalgamación con mercurio es común en la minería artesanal. Los efectos sobre la reproducción de la exposición al mercurio elemental en el contexto de la minería del oro, no han sido suficientemente estudiados. Objetivo. Evaluar el efecto de la exposición al mercurio elemental durante la minería del oro, sobre la regularidad del ciclo menstrual y la presentación de abortos en Colombia. Materiales y métodos. Se hizo un estudio analítico de corte transversal. Las participantes residían en distritos de minería de oro con historia de exposición al mercurio elemental y se las comparó con un grupo de mujeres no expuestas, en cuanto a la regularidad del ciclo menstrual y la ocurrencia de abortos. Para el registro de las variables de exposición y resultado, se usó un cuestionario cuya reproducibilidad prueba-reprueba fue evaluada. Se calcularon las razones de prevalencia mediante un modelo binomial y se evaluó la bondad de ajuste. Resultados. Participaron 72 mujeres expuestas y 121 mujeres no expuestas al mercurio. Entre las mujeres expuestas, el tiempo promedio de exposición al mercurio fue de 19,58 ± 9,53 años. La prevalencia ajustada de menstruación irregular en los últimos seis meses, fue mayor en el grupo de mujeres expuestas crónicamente a vapores de mercurio (razón de prevalencia, RP=1,59, IC 95% 0,93-2,73), pero la proporción de mujeres con historia de abortos no fue diferente. Conclusiones. La exposición al mercurio elemental durante el proceso artesanal de la minería del oro podría estar asociada con una mayor prevalencia de irregularidad del ciclo menstrual, pero no con la presentación de abortos.

Introduction: Artisanal mining commonly extracts gold with an amalgamation process that uses mercury. The reproductive effects from exposure to elemental mercury used in gold mining have not been sufficiently studied. Objective: To evaluate the effect of the exposure to elemental mercury used in gold mining on menstrual cycle regularity and the occurrence of miscarriages in Colombia. Materials and methods: An analytical cross-sectional study was conducted. The participants were female residents of gold mining districts, with a history of exposure to elemental mercury. Menstrual regularity and the occurrence of miscarriages were compared between these women and an unexposed group. Exposure and outcome variables were registered based on a questionnaire which was evaluated for its test-retest reproducibility. Prevalence rates were calculated using a binomial model and goodness-of-fit was evaluated. Results: A total of 72 women exposed to mercury and 121 unexposed women participated. The average time of exposure to mercury among exposed women was 19.58 ± 9.53 years. The adjusted prevalence of irregular menstruation over the last six months was higher in the group of women chronically exposed to mercury vapors (PR=1.59, 95% CI 0.93-2.73), while there was no difference in the proportion of women with a history of miscarriages. Conclusions: Exposure to elemental mercury used in artisanal gold mining may be associated with a higher prevalence of irregular menstrual cycles but not with the occurrence of miscarriage.