A reappraisal of the criteria to diagnose plasma leakage in dengue hemorrhagic fever.

A study was undertaken to analyze the usefulness of radiographic and ultrasonographic findings and area specific hematocrit cut off values in Dengue Hemorrhagic Fever (DHF). Of the 65 cases, 35 were DHF and 30 were Dengue Fever as per the WHO case definition. Among the DHF cases, hemoconcentration (>20%) was detected in 20 cases (57.14%), hypoproteinemia in 11 (31.42%) and clinical evidence of pleural effusion and or ascites in 25 (71.42%). Hemoconcentration based on area specific hematocrit cut off values was observed in 32 cases (91.42%). Ultrasonographic evidence of plasma leakage was seen in 32 cases (91.42%). In detecting plasma leakage, area specific hematocrit cut off values and ultrasonography had the highest sensitivity (91.42%), while ultrasonography had the highest negative predictive value of 84.21%. Clinical evidence of plasma leakage was more frequent than hemoconcentration or hypoproteinuria. Ultrasonography is an ideal non-invasive investigation to detect plasma leakage and area specific hematocrit values are useful as evidence of plasma leakage.

Aspectos ultraestructurales del riñón remanente en ratas uninefrectomizadas sometidas a dietas hipoproteicas suplementadas con aminoácidos esenciales y no esenciales / Ultrastructural aspects of remaining kidney of unilaterally nephrectomized rats receiving hypoproteic diets enriched with amino acids

Es bien conocido el efecto benéfico de la restricción en la ingesta proteica de la dieta para la preservación de la función renal, cuando la masa renal se encuentra reducida, en un intento de aumentar la sobrevida de los pacientes. Sin embargo, la literatura al respecto es extremadamente contradictoria. En este trabajo estudiamos el efecto de la alimentación con dietas hipoprotéicas ricas en aminoácidos esenciales (lisina y arginina) y no esenciales (asparagina, prolina y ácido glutámico) sobre la ultraestructura del riñón remanente de ratas uninefrectomizadas. Después de 9 semanas de realizada la intervención quirúrgica, bajo Nesdonal, durante las cuales las ratas uninefrectomizadas fueron alimentadas con dietas especialmente diseñadas para el experimento, se retiraron los riñones remanentes y se procesaron para ser observados al Microscopio Electrónico de transmisión, siguiendo el procedimiento convencional. Como conclusión del estudio microscópico, para todas las dietas estudiadas se observó una vacuolización prominente de las células tubulares proximales así como hinchamiento tanto de las mitocondrias como pérdida de material en áreas tubulares. Se apreciaron túbulos con lúmina dilatada, mitocondrias dispuestas irregularmente y con un engrosamiento de la membrana basal, característica inespecífica pero constante de las enfermedades renales en diabéticos y glomérulos alterados. Por consiguiente, la adición de ciertos aminoácidos a la dieta no parece proteger eficientemente contra el deterioro histológico en riñones fisiológicamente comprometidos.

Dietary restriction of proteins has been used in patients with kidney failure in an attempt to preserve renal functionand prolong their lives. However, literature shows contradictory results. We studies the effects of diets enriched with essential (lysine, arginine) or non-essential (asparagine, proline or glutamic acid) amino acids on the ultrastructure of remaining kidney of uninephrectomized rats. The kidney was removed under barbiturate anesthesia and after that the animals received specially designed diets during nine weeks. Then, the remaining kidney was removed and conventionally processed to be studies by transmission electronic microscope. For all the diets used, we observed a prominent vacuolisation of proximal tubular cells, as well as mithocondrial edema and tissue loss at the tubular level. The preparations showed tubules with dilated lumen, irregularly placed mithocondria and basal membrane thickening, a non-specific but constant finding in diabetic kidneys and in some glomerulopathies. In conclusion, amino acid-enriched diets are not effective to protect functionally compromised kidneys against progressive anatomical changes.