Anticuerpos antifosfolípidos en nefropatía membranosa idiopática / Antiphospholipid antibodies in idiopathic membranous nephropathy

Background: Antiphospholipid antibodies have been found in the sera from patients with idiopathic and secondary glomerulopathies, mainly related to lupus. No special attention has been devoted to idiopathic membranous nephropathy, a glomerular disease with a high frequency of thrombotic complications, particularly of the renal vein. Aim: To study the presence and significance of antiphospholipid antibodies in idiopathic membranous nephropathy. Material and methods: Anticardiolipin and anti-ß2-glycoprotein-I IgG antibodies were measured in serum samples from 21 patients with idiopathic membranous nephropathy (age range 11-75 years, 5 female). The medical records of 20 of these patients were reviewed, looking for vascular complications and nephrological evolution during a follow-up period that ranged from two to 277 months. Results: Five patients had anticardiolipin antibody titers over the cutoff for normal values, and two others were positive for anti-ß2-glycoprotein-I, without cross-reactivity. There was no difference in the incidence of thrombotic complications in the renal vein, or other locations, between these seven patients and the remaining patients. No differences in the clinical course of the nephropathy were detected either. Conclusions: Antiphospholipid antibodies may be found in patients with primary membranous nephropathy. They are not related to thrombosis or a worse evolution.

Enfermedad renal crónica: clasificación, mecanismos de progresión y estrategias de renoprotección / Chronic kidney disease: Classification, mechanisms of progression and strategies for renoprotection

Chronic kidney disease is a worldwide health problem. The incidence and prevalence of kidney failure is in constant increase, involving poor outcomes and high costs. The leading causes of kidney failure are type 2 diabetes and hypertension. The new initiative "Kidney Disease Improving Global Outcomes (KDIGO)" is a global public health approach to face this problem. A formal definition for chronic kidney disease and a staging of kidney diseases from kidney damage with preserved function to kidney failure, were proposed. We reviewed the main mechanisms involved in renal disease progression, with emphasis in the proteinuria and the intrarenal activation of renin angiotensin system. Moreover, the evidence in the literature of therapeutical interventions with proved efficacy in slowing the rate of reduction of renal function is discussed, particularly the optimal control of hypertension, reduction of proteinuria and renin angiotensin system blocking. Finally, we recommend a strategy for the clinical management of patients in the different stages of chronic kidney disease.

Tendinitis aquiliana asociada al uso de levofloxacino: comunicación de cuatro casos / Levofloxacin associated achilles tendinitis: report of 4 cases

Fluoroquinolone-associated tendinitis are well described in the literature, but these are not frequently observed and usually are related to the oldest fluoroquinolones. Levofloxacin is a recently introduced fluoroquinolone. In this paper we report four cases (three female, aged 39 to 70 years old) of Achilles tendinitis occurring in a period of few months. Two patients on chronic dialysis, one kidney transplant recipient, and one patient with chronic vasculitis, both with normal renal function. All were chronically using corticosteroids. In the four cases, tendinitis had an acute onset with bilateral involvement and was invalidating. In 3 cases the onset of tendinitis was early during levofloxacin treatment and in 1 case, it began 10 days after the end of the treatment. All patients were treated with rest and physiotherapy, two were treated with non-steroidal anti-inflammatory drugs. All patients had a complete recovery alter 3-8 weeks

Anticuerpos anticitoplasmas de neutrófilos y colitis ulcerosa inespecífica / Neutrophil anticytoplasmic antibodies and idiopathic ulcerative colitis

We studied tha presence of antineutrophil cytoplasmic antibodies in 16 patients with idiopathic ulcerative colitis, using an indirect immunofluorescence technique and specific ELISA for myeloperoxidase and proteinase 3. Twelve patients had an active disease and in ten, antineutrophil cytoplasmic antibodies were positive, with a predominantly perinuclear distribution and without specificity for myeloperoxidase or proteinase 3. These antiantineutrophil cytoplasmic antibodies could be serologic indicators of disease activity in patients with ulcerative colitis

Virus hepatitis C: resultados de detección en algunos grupos de riesgo en la X región de Chile / Hepatitis C virus: results on detection in some risk groups in X region of Chile

The aim of this study was to determine the prevalence of hepatitis C virus antibodies in high rosk patients coming from Valdivia, Osorno and Puerto Montt. Fiftysix patients in hemodialysis, 51 renal grafts recipients, 42 cirrhotic and 14 patients with acute non A non B hepatitis were studied. Antibodies were detected with a second generation ELISA technique and positive cases were confirmed with RIBA. All hemodialysis patients and renal grafts recipients were negative for hepatitis C virus antibodies. In one non alcoholic patient with cirrhosis, a positive ALISA was confirmed with RIBA. Six patients with acute hepatitis had a positive ALISA tests but none was confirmed with RIBA. It is concluded that the prevalence of hepatitis C virus antibodies in this region of Chile is very low

Factor natriurético auricular / Atrial natriuretic factor

Se revisan algunas de las características bioquímicas y fisiológicas de un nuevo sistema hormonal, el Factor Natriurético Auricular, destacando su participación en la regulación de la presión arterial y del balance hidroelectrolítico en condiciones normales y patológicas

Experiencia en trasplante renal / Experience in renal transplantation

Se presenta la experiencia inicial del Programa del Trasplante Renal de la Universidad Austral y Hospital de Valdivia, con una serie de 10 pacientes , 8 hombres y 2 mujeres, con una edad promedio de 24,1 años. En 7 casos el riñón provino de un hermano y en 3 casos de un padre. El trasplante se efectuó según técnica quirúrgica clásica ubicando el injerto en fosa ilíaca derecha. En 2 casos había una arteria polar que se anastomosó a la arteria renal con técnica de microcirugía. El reimplante ureteral se hizo con técnica antireflujo. 7 pacientes hicieron un rechazo que fué tratado con series de Metilprednisolona y en 3 casos se adicionó radioterapia local. La principal complicación fué una necrosis ureteral que se solucionó anastomosando el ureter del donante al del receptor. Complicaciones secundarias fueron una fístula urinaria vesico-cutánea y un hematoma de la fosa ilíaca. Un paciente hizo una enfermedad tubular aguda post-trasplante que se recuperó totalmente. Como complicaciones de la terapia inmunosupresora hemos tenido cataratas, herpes simple y TBC pulmonar. La sobrevida varía entre 3 y 50 meses. Ocho pacientes vivos (uno con rechazo crónico) y dos fallecidos por rechazo crónico