Preeclampsia de presentación grave asociada a hígado graso agudo del embarazo / Severe preeclampsia associated with acute fatty liver of pregnancy / Pré-eclâmpsia grave associada a fígado gorduroso agudo da gravidez

La preeclampsia se puede asociar a una patología poco frecuente como es el hígado graso agudo del embarazo. Se reporta el caso clínico de una paciente de 35 años, tercigesta, cursando embarazo gemelar que presenta preeclampsia con elementos de gravedad, asociada a hígado graso agudo del embarazo. Se realiza diagnóstico y tratamiento precoz de ambas patologías, presentando buena evolución materno-fetal.

Preeclampsia can be associated with acute fatty liver of pregnancy, a rare disease. This report describes the case of a 35-year-old patient, gravida 3, pregnant with twins, who presented with severe pre-eclampsia associated with acute fatty liver of pregnancy. Early diagnosis and treatment of both pathologies was performed, resulting in good maternal-fetal evolution.

A pré-eclâmpsia pode estar associada a uma patologia rara, como o fígado gorduroso agudo da gravidez. Neste relato, apresentamos uma paciente de 35 anos, terciária, em gestação gemelar, apresentando pré-eclâmpsia grave, associada a esteatose hepática aguda na gestação. É realizado diagnóstico e tratamento precoces de ambas as patologias, apresentando boa evolução materno-fetal.

Manifestaciones dematológicas en pacientes con insuficiencia renal crónica, en diálisis perinatal automatizada intermitente / Dermatological Manifestations in Patients with Chronic Renal Failure in Intermittent Automated Peritoneal Dialysis

La enfermedad renal crónica es la vía final común de distintas patologías que afectan al parénquima renal. La prevalencia e incidencia de esta enfermedad se ha incrementado en las últimas décadas de forma exponencial, que la convierte en un grave problema de salud pública a nivel mundial, de acuerdo a su estadio requiere terapia de sustitución renal tipo diálisis peritoneal. La piel y sus anexos son afectados cuando existe un deterioro crónico de la función renal, algunas de las cuales influyen notoriamente en la calidad de vida de estos pacientes. Objetivo: identificar las manifestaciones en piel de los pacientes con enfermedad renal crónica, en diálisis peritoneal. Material y Métodos: estudio no experimental, transversal, descriptivo. Previo consentimiento informado, se evaluó a todos los 87 pacientes en diálisis peritoneal automatizada intermitente, de la sala de Nefrología del Hospital Escuela Universitario, de julio a diciembre del 2017. Se aplicó instrumento obteniendo datos generales, condición metabólica actual, tiempo en diálisis peritoneal y se realizó examen físico en búsqueda de manifestaciones dermatológicas por un dermatólogo, el día que asistieron a su sesión programada de diálisis. Se utilizó el programa estadístico Epi-Info versión 7.2. Resultados: todos los pacientes estudiados tenían al menos 2 manifestaciones dermatológicas, las de mayor frecuencia fueron: xerosis 72(82.8%), palidez 80(81.4%), alteraciones ungüeales 64(73.4%), prurito 56(64.4%), alteraciones pigmentarias 47(54%) y alteraciones en pelo 46(52.9%). Conclusión: la xerosis fuela manifestación más frecuente; no se encontró relación entre xerosis y prurito, ni entre prurito y niveles de azoados, calcio o fosforo. La principal manifestación en uñas fue onicopaquia y en pelo dermatitis seborreica.La incidencia de manifestaciones dermatológicas en pacientes con enfermedad renal crónica fue mayor a la de otros estudios, es importante identificar estos signos y síntomas para realizar diagnósticos tempranos y tratamientos oportunos...(AU)

O papel da ecografia vascular no manejo das complicações associadas ao acesso venoso central para hemodiálise em pacientes oncológicos: relato de dois casos e revisão da literatura / The role of vascular echography in the management of complications associated with central venous access for hemodialysis in cancer patients: two case reports and literature review

O implante de cateter venoso central para hemodiálise é comumente realizado em grandes centros e suas complicações estão, por vezes, associadas ao treinamento insuficiente de quem o realiza, mas também às condições clínicas do próprio doente. O presente estudo relata dois casos de intercorrências relacionadas ao uso do cateter de curta permanência para hemodiálise. No primeiro caso, houve inserção inadvertida da cânula na artéria subclávia esquerda e consequente trombose arterial, que foi conduzida conservadoramente, documentando-se uma boa perfusão colateral com ecografia vascular. O segundo caso ilustra o achado incidental de uma trombose venosa séptica central em paciente que havia feito uso do cateter por uma semana, optando-se por tratá-la com antibioticoterapia, anticoagulação plena e controle ecográfico. Em ambos os casos, a intervenção cirúrgica seria de alto risco devido ao prognóstico reservado dos doentes. A ultrassonografia vascular permitiu o monitoramento das situações clínicas e o emprego de terapêutica menos agressiva

Central venous catheter implantation for hemodialysis is commonly performed in large centers and its complications are sometimes associated with insufficient training of those who perform it, but may also be related to the patient's clinical condition. The present study reports two cases of complications related to use of a short-stay catheter for hemodialysis. In the first case, the cannula was inadvertently inserted into the left subclavian artery, causing arterial thrombosis, which was conservatively managed and good collateral perfusion was documented with vascular echography. The second case illustrates an incidental finding of Central Venous Septic Thrombosis in a patient who had used a catheter for a week, which was treated with antibiotic therapy, anticoagulation, and ultrasound control. In both cases, surgical intervention would have been high risk because of the patients' poor prognosis. Vascular ultrasonography enabled monitoring of these clinical situations and use of less aggressive treatments

Doença cística adventicial da artéria radial / Adventitial cystic disease of the radial artery

A doença cística adventicial (DCA) da artéria radial é uma condição rara, com poucos casos descritos na literatura. Relatamos o caso de um paciente do sexo masculino, 62 anos, branco, diabético, hipertenso, com insuficiência renal crônica e indicação para terapia substitutiva renal, em quem foi encontrada uma lesão cística da artéria radial durante operação para confecção de fistula arteriovenosa para hemodiálise. Após a dissecção da artéria radial, ficou evidenciado um importante envolvimento do vaso por uma formação cística. A técnica cirúrgica adotada foi a ressecção do segmento cístico comprometido e preservação da artéria radial. A confecção da fistula arteriovenosa foi realizada com sucesso. O diagnóstico precoce e o tratamento adequado da DCA mostram se eficientes e podem prevenir complicações e recidivas

Adventitial cystic disease (ACD) of the radial artery is a rare condition, with few cases described in the literature. We report the case of a 62-year-old white male with a history of diabetes, hypertension, and chronic kidney disease with indications for renal replacement therapy who was found to have a cystic lesion of the radial artery while undergoing surgical creation of an arteriovenous fistula. The surgical technique adopted was resection of the cystic segment and preservation of the radial artery. Fistula creation was completed successfully. Early diagnosis and appropriate treatment of ACD are effective, and can prevent complications and recurrence.

Hemofagocitosis secundaria a dengue / Hemophagocytosis secondary to dengue fever

La infección por el virus del dengue constituye un problema de salud pública mundial. Causada por un virus de la familia Flaviviridae, presenta un amplio espectro clínico, desde formas asintomáticas frecuentes hasta las formas graves de fiebre hemorrágica y shock por fuga capilar. Existen cuatro serotipos; los serotipos 2 y 3 están asociados a las formas graves de la enfermedad. El diagnóstico definitivo de infección por dengue depende del aislamiento del virus en sangre, de la detección del antígeno viral o el ARN viral en suero o tejido, o detección de anticuerpos específicos. El síndrome hemofagocítico se produce ante la desregulación del sistema inmune que lleva a la activación macrofágica descontrolada, y se manifiesta con alteraciones clínicas, hematológicas, bioquímicas e histológicas. La asociación entre ambas entidades se encuentra descripta como una forma inusual y grave de presentación que responde a la tormenta de citocinas liberadas durante la enfermedad. Presentamos el caso de un paciente adulto con dengue, hemofagocitosis y valores inusualmente elevados de ferritina en sangre que evolucionó favorablemente con tratamiento de soporte.

Dengue virus infection constitutes a major public health problem worldwide. It is caused by a virus belonging to the Flaviviridae family. It produces a wide range of clinical presentations, from asymptomatic infection to severe forms of the disease with hemorrhagic fever or shock secondary to capillary leak syndrome. Four serotypes have been described; serotype 2 and serotype 3 are associated with the most severe forms of the disease. The diagnosis is based on laboratory tests aimed to detect antibodies, viral RNA, or antigens in serum. The hemophagocytic syndrome is generated by a dysfunction of the immune system with clinical, hematological, biochemical and histological manifestations. The association between these two entities is described as an unusual and severe presentation of dengue fever. We present a case of an adult patient with this association and very high blood levels of ferritin, who responded favorably to supportive care.

Plomo y nefropatía: biomarcadores urinarios en la detección de daño renal precoz / Blood lead levels and markers of renal dysfunction among mechanical workshop workers

The role of lead (Pb) as an environmental cause of nephropathy is difficult to ascertain due to the difficulty to determine clinically its exposure. Aim: To assess lead levels and renal function in a group of males working in mechanical workshops. Material and Methods: Blood and urine samples were obtained from 100 mechanical workshop workers aged 38 ± 16 years and 95 non-exposed office clerks aged 37 ± 17 years. Blood lead and creatinine levels were determined. In exposed workers, urinary excretion of intestinal alkaline phosphatases (IAP) and N-acetyl-glucosaminidase (NAG) were measured as early markers of renal failure. Results: Blood lead levels were 66.4 ± 43 and 33.6 ± 18 µg/L among mechanical workshop workers and non-exposed controls, respectively, p < 0.01. The figures for serum creatinine were 0.9 ± 0.1 and 0.9 ± 0.1 respectively, p = NS. Among exposed workers urinary excretion of IAP was 0.47 ± 0.6 U/L and of NAG, 0.92 ± 1.1 U/L. There was a positive correlation between blood lead levels and NAG excretion (r = 0.284) and IAP excretion (r = 0.346). Conclusions: Exposed workers had higher blood lead levels and there was a weak positive association between these levels and the urinary excretion of NAG and IAP.

Síndrome de artrogriposis, disfunción tubular renal y colestasis: causa de colestasis neonatal. A propósito de un caso / Arthrogryposis-renal tubular dysfunction-cholestasis syndrome: a cause of neonatal cholestasis. Case report

El síndrome de artrogriposis, disfunción tubular renal y colestasis es un trastorno fatal infrecuente que compromete múltiples aparatos y sistemas de órganos. Es un trastorno autosómico recesivo hereditario, causado por defectos en los genes VPS33B y VIPAR. Los tres signos primordiales de este síndrome son la artrogriposis, la disfunción tubular renal y la colestasis. Otros compromisos orgánicos a veces asociados con este síndrome son ictiosis, malformación del sistema nervioso central, anomalías trombocíticas, defectos cardíacos congénitos y grave retraso del crecimiento. Las manifestaciones clínicas, la biopsia de un órgano y los análisis de mutaciones pueden ayudar con el diagnóstico, pero no existe un tratamiento curativo; solamente puede instaurarse un tratamiento sintomático. Varios síntomas de esta afección usualmente se manifiestan en el período neonatal: artrogriposis, colestasis neonatal, lesiones cutáneas, entre otros. En general, la supervivencia se prolonga hasta el primer año de vida. Presentamos el caso de una recién nacida con una rápida evolución y desenlace fatal.

Arthrogryposis-renal dysfunction-cholestasis syndrome is a rare lethal disorder that involves multipl organ system. It is inherited autosomal recessive and caused by defects in the VPS33B and VIPAR genes. Three cardinal findings of this syndrome are arthrogryposis, renal tubular dysfunction and cholestasis.The other organ involvements including ichthyosis, central nervous system malformation, platelet anomalies, congenital heart defects and severe failure to thrive are sometimes associated with this syndrome. Clinical findings, organ biopsy and mutational analysis can help for diagnosing but there is no curative treatment except supportive care. Several symptoms of this condition are already usually present in the neonatal period: arthrogryposis, neonatal cholestasis, skin lesions, among others. Usually survival is until the first year of life. We present a newborn whose evolution was rapidly fatal.

Comparison of Urinary Protein Creatinine Index (uPCI) and Dipsticks for the Prediction of Renal Dysfunction in Chronic Cigarette Smokers.

Background: Proteinuria is recognized as one of the earliest sign of renal function deterioration in chronic smokers. Proteinuria occurs due to alteration in glomerular permeability and later due to failure of reabsorption of filtered protein by the tubular cells. Normally, most healthy adults excrete 20 – 150 mg of protein in urine over 24 hours. However, it is difficult to collect 24 hrs urine samples. Objectives: To advocate the use of PCI (protein creatinine index) in assessment of proteinuria and to compare dipstick result with PCI in the assessment of proteinuria in chronic cigarette smokers. Material & Methods: A total of 30 cigarette smokers and 40 age and sex matched controls were included for the study. A random specimen of urine collected from each cigarette smoker and non- smoker was tested quantitatively by manual sulfosalicylic acid colorimetric method for the estimation of protein concentration. Creatinine concentration in each specimen was measured by modified Jaffe’s method and the urinary PCI was calculated. Results: Normal range of PCI which has been established in this study is 50 to 259. Significantly higher amounts of protein were found to be excreted in urine in chronic smokers (9.313 ± 4.003 mg/dl) as compared to healthy non smokers (7.738 ± 2.05 mg/dl). On comparison of PCI between healthy non smoker and chronic smoker subjects, PCI has been found to be significantly elevated in chronic smokers (healthy non smoker- 118.32 ± 56.86, chronic smoker- 180.1 ± 88.23) (p=0.001). Conclusion: PCI of random urine sample can provide a very useful, simple and convenient method for the quantitative assessment of proteinuria to confirm the advent of kidney damage, avoiding the drawbacks of 24 hrs urine collection.

Effect of revascularization strategy in patients with acute myocardial infarction and renal insufficiency with multivessel disease

BACKGROUND/AIMS: The aim of this study was to compare the risk of complications and outcome between infarct-related artery (IRA)-only revascularization and multivessel (MV) revascularization in patients with acute myocardial infarction (MI) with renal insufficiency and MV disease. METHODS: A total of 1,031 acute MI patients with renal insufficiency and MV disease who were registered in the Korea Working Group on Myocardial Infarction were enrolled. They were divided into two groups (IRA-only revascularization group, n = 404; MV revascularization group, n = 627), and investigated the cumulative incidence of major adverse cardiac events (MACE) and the incidence of complications after percutaneous coronary intervention (PCI). RESULTS: Complications after PCI occurred in 19.9% of all patients (206/1,031). Complications after PCI occurred more frequently in the MV revascularization group compared with the IRA-only revascularization group (20.1% [126/627] vs. 15.3% [62/404], respectively; p = 0.029]. The overall in-hospital mortality rate was 6.3%, and there was no significant difference between the groups (5.2% in the IRA-only revascularization group vs. 7.0% in the MV revascularization group; p = 0.241). The total incidence of MACE was 11.1%, and there was no significant difference between the groups (11.6% in the IRA-only revascularization group vs. 10.7% in the MV revascularization group; p = 0.636). CONCLUSIONS: The incidence of complications after PCI was significantly lower in the IRA-only revascularization group compared with the MV revascularization group. However, there were no significant difference in the 12-month outcomes between groups in patients with acute MI and renal insufficiency with MV disease.

Predictive factors for renal failure and a control and treatment algorithm / Fatores preditivos da insuficiência renal e algoritmo de controle e tratamento / Factores de predicción de la insuficiencia renal y el algoritmo de control y tratamiento

OBJECTIVES: to evaluate the renal function of patients in an intensive care unit, to identify the predisposing factors for the development of renal failure, and to develop an algorithm to help in the control of the disease. METHOD: exploratory, descriptive, prospective study with a quantitative approach. RESULTS: a total of 30 patients (75.0%) were diagnosed with kidney failure and the main factors associated with this disease were: advanced age, systemic arterial hypertension, diabetes mellitus, lung diseases, and antibiotic use. Of these, 23 patients (76.6%) showed a reduction in creatinine clearance in the first 24 hours of hospitalization. CONCLUSION: a decline in renal function was observed in a significant number of subjects, therefore, an algorithm was developed with the aim of helping in the control of renal failure in a practical and functional way. .

OBJETIVOS: avaliar a função renal de pacientes em uma unidade de terapia intensiva, identificar os fatores predisponentes ao desenvolvimento da insuficiência renal e desenvolver um algoritmo para auxiliar no controle da doença. MÉTODO: estudo exploratório, descritivo, prospectivo, com abordagem quantitativa. RESULTADOS: trinta pacientes (75,0%) tiveram diagnóstico de insuficiência renal e os principais fatores associados a essa doença foram: a idade avançada, a hipertensão arterial sistêmica, o diabetes mellitus, as doenças pulmonares e o uso de antibióticos. Dos pacientes, 23 (76,6%) apresentaram redução do clearance de creatinina nas primeiras 24 horas de internação. CONCLUSÃO: houve redução da função renal de um expressivo número de sujeitos, portanto, foi desenvolvido um algoritmo com a finalidade de auxiliar o controle da insuficiencia renal de forma prática e funcional. .

OBJETIVOS: evaluar la función renal de pacientes en una unidad de terapia intensiva, identificar los factores predisponentes al desarrollo de la insuficiencia renal y desarrollar un algoritmo para auxiliar en el control de la enfermedad. MÉTODO: estudio exploratorio, descriptivo y prospectivo, con abordaje cuantitativo. RESULTADOS: 30 pacientes (75,0%) tuvieron diagnóstico de insuficiencia renal y los principales factores asociados a esa enfermedad fueron la edad avanzada, la hipertensión arterial sistémica, la diabetes mellitus, las enfermedades pulmonares y el uso de antibióticos. 23 pacientes (76,6%) presentaron reducción del clearance de creatinina en las primeras 24 horas de internación. CONCLUSIÓN: hubo reducción de la función renal de un expresivo número de sujetos, por tanto, fue elaborado un algoritmo con la finalidad de auxiliar en el control de la insuficiencia renal de forma práctica y funcional. .

Effect of Renal Insufficiency on Stone Recurrence in Patients with Urolithiasis

The study was designed to assess the relationship between glomerular filtration rate (GFR) and urinary stone-forming constituents, and to assess the effect of renal insufficiency on stone recurrence risk in first stone formers (SF). Baseline serum creatinine levels were obtained, and renal insufficiency was defined as creatinine clearance < or =60 mL/min (Cockroft-Gault). This retrospective case-control study consists of 342 first SF; 171 SF with normal renal function were selected with 1:1 propensity scores matched to 171 SF with renal insufficiency. Urinary metabolic evaluation was compared to renal function. GFR was positively correlated with urinary calcium, uric acid, and citrate excretion. Subjects with renal insufficiency had significantly lower urinary calcium, uric acid, and citrate excretion than those with normal renal function, but not urine volume. With regard to urinary metabolic abnormalities, similar results were obtained. SF with renal insufficiency had lower calcium oxalate supersaturation indexes and stone recurrence rates than SF with normal renal function. Kaplan-Meier curves showed similar results. In conclusion, GFR correlates positively with urinary excretion of stone-forming constituents in SF. This finding implies that renal insufficiency is not a risk factor for stone recurrence.

Effect of Renal Insufficiency on Stone Recurrence in Patients with Urolithiasis

The study was designed to assess the relationship between glomerular filtration rate (GFR) and urinary stone-forming constituents, and to assess the effect of renal insufficiency on stone recurrence risk in first stone formers (SF). Baseline serum creatinine levels were obtained, and renal insufficiency was defined as creatinine clearance < or =60 mL/min (Cockroft-Gault). This retrospective case-control study consists of 342 first SF; 171 SF with normal renal function were selected with 1:1 propensity scores matched to 171 SF with renal insufficiency. Urinary metabolic evaluation was compared to renal function. GFR was positively correlated with urinary calcium, uric acid, and citrate excretion. Subjects with renal insufficiency had significantly lower urinary calcium, uric acid, and citrate excretion than those with normal renal function, but not urine volume. With regard to urinary metabolic abnormalities, similar results were obtained. SF with renal insufficiency had lower calcium oxalate supersaturation indexes and stone recurrence rates than SF with normal renal function. Kaplan-Meier curves showed similar results. In conclusion, GFR correlates positively with urinary excretion of stone-forming constituents in SF. This finding implies that renal insufficiency is not a risk factor for stone recurrence.

Sirolimus Conversion Efficacy for Graft Function Improvement and Histopathology in Renal Recipients with Mild to Moderate Renal Insufficiency

This study was designed to evaluate whether sirolimus (SRL) conversion effectively improves renal function and histopathology in calcineurin inhibitor (CNI)-treated renal recipients with mild to moderate renal insufficiency. SRL conversion from CNI was performed in patients who underwent kidney transplantation from 6 months to 5 yr prior to screening. Forty-five patients were enrolled. The effect of SRL conversion on graft function was evaluated, and protocol biopsies were performed preconversion and 1 yr after conversion. Overall graft function after SRL conversion gradually improved, and the improvement in renal function was closely associated with the shorter duration of CNI exposure. When we divided the patients by the duration of CNI exposure, the patients with less than 1 yr of CNI exposure demonstrated significant improvement, but patients with a greater than 1 yr CNI exposure did not exhibit significant improvement. In contrast, protocol biopsies demonstrated no significant improvements in the modified "ah" score or other Banff scores after SRL conversion. Furthermore, the duration of CNI treatment prior to SRL conversion was not associated with histological findings 1 yr after SRL conversion. SRL conversion improved graft function in renal recipients with mild to moderate renal insufficiency, but this effect is not accompanied by histological improvement.

Biopsia renal en el segundo trimestre del embarazo: Dos casos clínicos / Renal biopsies during the second trimester of pregnancy: Report of two cases

Kidney biopsies were performed in two women during their 21th and 24th week of pregnancy. The first patient developed an abrupt nephrotic syndrome without hypertension or kidney failure. The pathological study disclosed diffuse podocyte alterations such as those observed in focal and segmental glomerulosclerosis, which had a good response to steroidal treatment. The second patient had a progressive renal failure associated with non-nephrotic proteinuria. The biopsy disclosed a fibrillary glomerulopathy.

Síndrome de Hadju-Cheney: alterações renais em um relato de caso / Hadju-Cheney syndrome: kidney disturbs in a case report

A síndrome de Hadju-Cheney é uma doença genética caracterizada por dismorfismos craniofaciais e alterações ósseas responsáveis pelo fenótipo da doença. As alterações renais, como cistos renais corticais, refluxo vesico - ureteral e falência renal, são raramente relatadas, mas são incluídas como apresentações menos comuns. O diagnóstico genético ainda não está disponível e a patogênese é relacionada a mutações no gene NOTCH. Os autores relatam um caso de um homem de 26 anos; porém, com características fenotípicas de um paciente pediátrico. Ele se apresentou com síndrome nefrótica, hipertensão arterial, cistos renais corticais e insuficiência renal aguda requerendo hemodiálise. A biopsia renal evidenciou glomeruloesclerose focal e segmentar e o tratamento para esse paciente foi de suporte com terapia hemodialítica. O diagnóstico da síndrome de Hadju-Cheney foi dado durante investigação do quadro renal.

Hajdu-Cheney disease is characterized by craniofacial dimorphisms and skeletal changes. Renal disturbs; such as renal cortical cysts, vesico-ureteral reflux and renal failure are rarely related but it is included as a less common feature. The diagnosis is not yet available and the pathogenesis it is related with mutations in the NOTCH gene. The authors report a case of a 26-years-old boy; but with phenotypic characteristics of a pediatric patient. He presented nephrotic syndrome, hypertension, renal cortical cysts, nephrotic range proteinuria and acute renal failure requiring hemodialysis. The renal tissue showed global and segmental glomerulosclerosis and the treatment to this patient it was supporting with hemodialysis. The diagnosis of Hadju-Cheney disease was given during investigation of renal function.

Haematological manifestations of arthrogryposis-renal dysfunction-cholestasis [ARC] syndrome: a case report

Arthrogryposis multiplex congenita, renal dysfunction, and cholestasis [ARC] syndrome is a rare, fatal, multisystem disorder. Bleeding problems, which occur spontaneously and post organ biopsies, have been reported in these patients. We report the case of an infant who had life-threatening spontaneous nasal bleeding. A detailed assessment of her platelet function and morphology is presented

Disfunción renal en el paciente cirrótico: prevención y tratamiento / Renal failure in the cirrhotic patient: prevention and treatment

Prerenal injury and hepatorenal syndrome (HRS) are the main causes of acute renal injury (ARI) in liver cirrhosis. Both can produce a reduction to the blood flow and lead to acute tubular necrosis. Cirrhotic patients may also present with chronic renal diseases, for example, diabetic nephropathy or chronic glomerulonephritis; however these are less frequent in cirrhosis as a cause of renal failure. The causes of acute renal failure that can be excluded before HRS diagnosis are: hypovolemia, shock, parenchymal renal disease and use of nephrotoxic drugs. Parenchymal renal disease must be suspected when there is significant proteinuria and microhematuria, or if renal ultrasound shows abnormal renal size. Renal biopsy might help in the diagnosis. ARI treatment is correction of hypovolemia with plasma expanders in the first place, and then, in case of Type 1 HRS, the use of a vasoconstrictor drug such as terlipressin plus intravenous albumin; both have shown benefit as a bridge to a liver transplant, and the latter is the definitive treatment for HRS. Transjugular intrahepatic portosystemic shunt (TIPS) has shown to reduce portal hypertension, reducing ascites and improving renal function in patients with Type 2 HRS. Intermittent or continuous hemodialysis can be used in Type 1 HRS patients as a bridge to a liver transplant, because without the transplant a minority will survive, even with renal replacement therapy.

La insuficiencia renal pre-renal y el síndrome hepato-renal (SHR) son las principales causas de insuficiencia renal aguda (IRA) en cirrosis hepática. Ambas pueden producir una disminución del flujo sanguíneo renal y conducir a una necrosis tubular aguda. Los pacientes con cirrosis también pueden tener enfermedades renales crónicas, por ejemplo una nefropatía diabética o una glomerulonefritis crónica, pero son menos frecuentes en cirrosis como causa de insuficiencia renal. Las causas de falla renal aguda que pueden ser excluidas antes de llegar al diagnóstico de SHR son: hipovolemia, shock, enfermedad renal parenquimatosa y uso de drogas nefrotóxicas. La enfermedad renal parenquimatosa debe ser sospechada cuando hay proteinuria significativa y microhematuria o si la ecografía renal muestra anormalidades en el tamaño renal. La biopsia renal podría realizarse para ayudar al diagnóstico. El tratamiento de la insuficiencia renal aguda pasa primero por la corrección de la hipovolemia con expansores plasmáticos y luego en el caso del SHR tipo 1, la utilización de un vasoconstrictor como la terlipresina asociado a la albúmina endovenosa, que han demostrado beneficio como puente para el trasplante hepático, siendo este último el tratamiento definitivo del SHR. El shunt transyugular porto sistémico o TIPS ha demostrado beneficio en disminuir la hipertensión portal, reducción de la ascitis y mejoría de la función renal en pacientes con SHR tipo 2. La hemodiálisis intermitente o continua puede usarse en los pacientes con SHR tipo1 como puente para el trasplante, ya que la minoría sobrevivirán incluso con reemplazo renal si no son trasplantados.

Beta-Thalassemia Minor Is Associated with IgA Nephropathy

No abstract available.