Compromiso pulmonar en vasculitis asociadas a anticuerpos anticitoplasma de neutrófilos / Pulmonary manifestations of anti-neutrophil cytoplasmic antibody associated vasculitis

This article reviews the pulmonary manifestations of anti-neutrophil cytoplasmic antibody associated vasculitis (AAV). Its frequency in the different phenotypes of the disease, clinical manifestations and updated therapeutic recommendations are reviewed, aiming to alert the medical community about the existence of these diseases. We pretend to stimulate a timely suspicion, diagnostic precision, and the implementation of effective therapies, to reduce the eventual sequelae derived from a diagnostic omission or an inappropriate treatment for the different clinical scenarios in which these diseases appear.

Necrosis papilar renal bilateral de resolución espontánea como causa de hematuria microscópica. Caso clínico / Bilateral renal papillary necrosis of spontaneous resolution as a cause of microscopic hematuria. Report of one case

Renal papillary necrosis is an infrequent cause of hematuria characterized by ischemic necrosis of the renal medulla, especially the papilla. Its most common cause is analgesic abuse. Despite being oligo-symptomatic, in many cases its presence is associated with serious functional sequelae. Imaging, especially computed tomography, is essential to make the diagnosis. We report a 63-year-old female studied for an asymptomatic microscopic hematuria whose tomographic study showed a bilateral renal papillary necrosis. No etiology was found, and she evolved with a spontaneous complete remission.

Prescripción de fármacos bloqueadores del sistema renina angiotensina en pacientes con enfermedad renal crónica etapa 3 en atención primaria de salud / Prescription of renin-angiotensin-aldosterone system blockers in patients with stage 3 chronic kidney disease

Background: To reduce the progression of chronic kidney disease (CKD) and cardiovascular risk, the guidelines recommend the blockade of the renin-angiotensin-aldosterone system (RAAS) in patients with proteinuria. Aim: To assess the frequency of enalapril or losartan use in diabetics or hypertensive patients with stage 3 CKD. Material and Methods: Review of clinical records of patients with CKD in an urban primary care clinic. Results: We identified 408 subjects aged 40 to 98 years (66% women) with stage 3 CKD. Sixty six percent had only hypertension and 34% were diabetic with or without hypertension. Seventy four percent received RAAS blockers (52% used enalapril, 45% losartan and 2% both medications). RAAS blockers were used in 70% of hypertensive and 78% of diabetic patients. The prescription in hypertensive diabetics with microalbuminuria was lower than in those without microalbuminuria (72% vs 87%, p < 0.05), but the opposite occurred in pure hypertensive patients with and without microalbuminuria (88% vs 69%, p < 0.05). There were no significant differences in blood pressure levels, microalbuminuria or serum potassium levels between RAAS blocker users and non-users. No differences were observed either between enalapril and losartan users. Conclusions: The adherence to clinical guidelines is insufficient and users of the recommended drugs did not achieve the expected goals.

Daño hepatocelular, proteinuria y autoinmunidad: ¿enfermedad multisistémica o coincidencia de enfermedades? Caso clínico / Hepatocellular damage, proteinuria and autoimmunity: multisystemic disorder or coexistence of diseases?

We report a 19 years old male presenting with knee pain, elevated liver enzymes and proteinuria. Further investigation found positive antinuclear and anti-smooth muscle antibodies and a liver biopsy revealed the presence of an autoimmune hepatitis. Treatment with corticosteroids and azathioprine was started, resulting in normalization of liver enzymes but proteinuria persisted and a kidney biopsy disclosed a focal segmental glomerulosclerosis. The use of lisinopril resulted in a significative reduction of proteinuria and, after 30 months of follow up, he continues with azathioprine, lisinopril and a low prednisone dose without evidence of liver or kidney disease activity.

Compromiso renal en vasculitis asociadas a anticuerpos anticitoplasma de neutrófilos. Recomendaciones de consenso de las Sociedades Chilenas de Nefrología y Reumatología / Renal involvement in antineutrophil cytoplasmic antibodies (ANCA) associated vasculitides. Recommendations of the Chilean Societies of Nephrology and Rheumatology

Renal involvement is a frequent complication in antineutrophil cytoplasmic antibodies (ANCA)associated vasculitides, adding morbidity and mortality, such as chronic kidney disease and the need for renal replacement therapy. With the aim of reaching a consensus on relevant issues regarding the diagnosis, treatment and follow-up of patients with these diseases, the Chilean Societies of Nephrology and Rheumatology formed a working group that, based on a critical review of the available literature and their experience, raised and answered consensually a set of questions relevant to the subject. This document includes aspects related to the clinical diagnosis, the histological characteristics, the therapeutic alternatives to induce and maintain the remission of the disease, relapse surveillance strategies and complementary therapies.

Pericarditis bacteriana por Cardiobacterium hominis: un caso clínico inusual / Cardiobacterium hominis pericarditis: an unusual case

The case of a male patient under hemodialytic therapy, who developed right heart failure is presented. Echocardiography revealed pericardial effusion, constrictive pattem in the right cavities, septation, without valvular damage and preserved systolic and diastolic function. Pericardial drainage and extensive pericardiectomy was performed obtaining cultures of pericardial tissue positive for an HACEK group organism, Cardiobacterium hominis, with repeatedly negative blood cultures. This is a rare clinical presentation of isolated bacterial pericarditis by an atypical microorganism, without associated endocarditis. The infection mechanisms are presented and the scarce available scientific literature is discussed in this study.

Se presenta el caso de un paciente de sexo masculino, de 35 años de edad, en hemodiálisis, que desarrolló un cuadro progresivo de insuficiencia cardíaca de predominio derecho. Una ecocardiografía reveló derrame pericárdico con patrón constrictivo en el llenado de cavidades derechas, tabicación, ausencia de daño valvular y buena función sistólica y diastólica del ventrículo izquierdo. Se realizó un drenaje pericárdico con pericardiectomía amplia, aislándose en el cultivo de líquido y tejido pericárdico un microorganismo del grupo HACEK, Cardiobacterium hominis, con hemocultivos reiteradamente negativos. Es un caso infrecuente de pericarditis bacteriana por una bacteria atípica, sin endocarditis. Se postulan los mecanismos de infección y se discute la escasa literatura científica disponible.

Recomendaciones sobre el manejo del compromiso renal del lupus eritematoso sistémico: Documento de Consenso de las Sociedades Chilenas de Nefrología y Reumatología / A consensus of the Chilean Nephrology and Rheumatology Societies on renal involvement in systemic lupus erythematosus

Renal involvement affects over one half of patients with Systemic Lupus Erythematosus increasing their mortality and morbidity, including chronic renal disease and the need of renal replacement therapies. Aiming to achieve a consensus in the most relevant topics on diagnosis, therapy and follow-up of patients with lupus renal disease, the Chilean Societies of Nephrology and Rheumatology constituted a workgroup that, based on a critical review of the available literature and their experience, raised and answered by consensus a set of relevant questions. This document includes aspects related to the clinical diagnosis, the importance of a suitable histological classification, therapeutic alternatives to induce and maintain disease remission, strategies for follow-up, additional therapies and ginecological-obstetric issues.

Obesidad y enfermedad renal crónica: Una peligrosa asociación / Association between obesity and chronic renal disease

A higher frequency of chronic renal disease is observed in obese patients, suggesting a pathogenic association between both conditions. Obesity unmasks clinical manifestations of chronic kidney disease such as high blood pressure, which may accelerate its progression. Obesity also promotes hyper filtration and the appearance of microalbuminuria, activates the renin-angiotensin-aldosterone system and is associated with high levels of pro-inflammatory cytokines. Therefore weight reduction may slow the progression of chronic renal disease and reduce its associated cardiovascular risk factors.

Rol del riñón en la hipertensión sal-sensible / Role of the kidney in salt sensitive hypertension

An important proportion of patients with essential hypertension are salt sensitive, defined as those who experience signifcant blood pressure changes according to the amount of salt intake. They have a disturbance in the pressure induced natriuresis mechanism and their kidneys have functional and morphological alterations con-sistent with an acquired tubulointerstitial alteration, afferent arteriole damage and alteration of peritubular capillaries. All these alterations lead to disturbances in sodium load excretion under normal pressures. There is also an associated activation of kidney vasoconstrictor/salt retaining systems and a reduction in the vasodilator/ salt eliminating mechanisms. These alterations, that originate early in life, generate a new blood pressure level, that corrects natriuresis at the expense of a sustained hypertension.

Enfermedad renal en la diabetes: a propósito del día mundial del riñón: [editorial] / Diabetic renal disease: the World Kidney Day in Chile: [editorial]

The third version of the World Kidney Day will be held on May 13, 2010 in Chile and will be focused in diabetic renal damage, the main cause of chronic kidney disease (CKD). Currently, we are living a pandemia of CKD, a progressive and irreversible condition with high social and economic impact. In Chile, we have 857 patients per million inhabitants in hemodialysis and 35 percent are secondary to diabetes. Our general prevalence of diabetes is 4.2 percent, rising to 15 percent in people aged more than 64 years. With a 34 percent prevalence of hypertension, an aging population, high prevalence of obesity, and a sedentary lifestyle, there is an estimation of a rise in 85 percent of the prevalence of diabetes in South-America, for the next decades. The steps to be taken are clear: campaigns should be aimed at (1) prevention of type 2 diabetes; (2) screening for early diabetic kidney disease; (3) increasing patient awareness of kidney disease; (4) using medications of proven strategy and fnally (5) research on new therapies. These concepts must be included in community and professional education to reduce the effects of this pandemia.