Acidosis láctica severa por metformina y fracaso renal agudo tras realización de cateterismo cardíaco / Metformin-associated lactic acidosis and acute renal failure secondary to cardiac catheterism

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Hipokaliemia sintomática asociada a enfermedad de Cacchi-Ricci / Hipokaliemia sintomática asociada a enfermedad de Cacchi-ricci

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Estudio sobre el grado de cumplimiento ambulatorio del documento de consenso 2002 para el control de la nefropatía diabética en Cataluña (ECCODIAB) / Compliance with the document of the Spanish society of nephrology 2002 document for the control of diabetic nephropathy in Catalonia. (ECODIAB)

Objetivo: Evaluar el grado de cumplimiento del documento de consenso 2002 (SEN) sobre pautas de detección, prevención y tratamiento de la nefropatía diabética en Cataluña. Pacientes y métodos: Estudio multicéntrico de corte transversal (23 centros hospitalarios), observacional y descriptivo, realizado sobre un total de 413 pacientes diabéticos (61,7% hombres y 38,3% mujeres) con una edad media de 66,2 ± 11,5 años (26-93 años). Para el análisis estadístico entre los diferentes grados de nefropatía diabética y las variables del estudio, se utilizó un test de ANOVA con valoración post-hoc (p 30 kg/m2: 48,7%) y perímetro de cintura 104,1 ± 14 cm (48,6% hombres > 102 cm y 78,9% mujeres > 88 cm). El valor de la creatinina sérica 1,9 ± 1,3 mg/dl y el GFR estimado con la ecuación MDRD simplificada (MDRDs) 45,3 ± 25,0 ml/min/1,73 m2 [65,8% con ERC estadios 3 y 4]. El 80% de los pacientes tenían examen oftalmológico y el 52,8% recibía tratamiento antiagregante. La Hb A1c fue 7,3 ± 1,3%, pero el porcentaje de pacientes con glicadas > 7% y 8% resultó del 54,9 y 28,6% respectivamente [tan sólo el 50,2% había sido visitado por el endocrinólogo en los últimos 6 meses]. El 52,8% de los pacientes se encontraban en tratamiento con insulina y el 44,1% con ADOs, pero tan sólo un 19,6% con antidiabéticos de metabolización hepática. El 61% de la muestra tenia un LDLc > 100 mg/dl (61% tratados) y el 44% triglicéridos (TG) > 150 mg/dl (72% tratados). El 95% de los pacientes presentaban antecedentes de hipertensión arterial (>= 130/80 mmHg) y de estos el 91% se encontraban con tratamiento hipotensor (79,7% con IECAS y/o ARA tipo II). El 81% de los microalbuminúricos y el 78% de los macroalbuminúricos recibía algún tipo de tratamiento antiproteinúrico. Entre el grupo de pacientes considerados con HTA refractaria (>3 fármacos), tan sólo el 29% tenía un MAPA. Se obtuvieron relaciones significativas entre los diferentes estadios de nefropatía diabética y el control glucémico (HBA1c; p = 0,048), tensión arterial sistólica (TAS; p = 0,024), perfil lipídico (HDLc; p = 0,015 y TG; p = 0,034), anemia (Hb; p = 0,010) y grado de ERC (creatinina sérica y MDRDs; p = 0,000). El grado de cumplimiento terapéutico sobre el control lipídico (LDL <= 100 mg/dl y TG <= 150 mg/dl), TA <= 130/80 mmHg y HbA1c <= 7%; fue 1 objetivo: 68%, 2 objetivos: 21,8% y 3 objetivos: sólo el 4% de la muestra. Conclusiones: Según los resultados obtenidos en nuestro estudio, tan sólo un reducido porcentaje de pacientes cumplieron los diferentes «end points» terapéuticos marcados. Futuras acciones deberán ir encaminadas a potenciar la relación entre médico-paciente, con el principal objetivo de intensificar aquellas medidas terapéuticas encaminadas a un mejor control metabólico y tensional, nefroprotector y prevención de los eventos cardiovasculares

Objective: To evaluate the level of compliance with the 2002 consensus document (Spanish Society of Nephrology) on guidelines for the detection, prevention and treatment of diabetic nephropathy in Catalonia. Subjects and methods: Multicenter (23 hospitals), observational, cross-sectional, descriptive study conducted in 413 diabetic patients (61.7% men, 38.3% women) with a median age of 66.2 ± 11.5 years (26-93 years). The ANOVA test (post-hoc analysis; p value 30 kg/m2: 48.7%) and waist circumference 104.1 ± 14 cm (48.6% men > 102 cm and 78.9% women > 88 cm). Serum creatinine 1.9 ± 1.3 mg/dl and simplified MDRD equation 45.3 ± 25.0 ml/min/1.73 m2 [65.8% with CKD stages 3 and 4]. 80% of patients had ophthalmologic examination and 52.8% antiplatelet treatment. Hb A1c was 7.3 ± 1.3%, but the percentage of patients with glycated hemoglobin > 7% and 8% was 54.9 and 28.6% [only 50.2% had been seen by an endocrinologist in the last 6 months]. 52.8% of patients were treated with insulin and 44.1% with anti-diabetic drugs, although only 19.6% used the new anti-diabetic drugs. 61% of patients had an LDLc > 100 mg/dl (61% treated) and 44% had triglycerides (TG) > 150 mg/dl (72% treated). 95% of patients presented with hypertension (BP >= 130/80 mmHg), 91% were undergoing antihypertensive treatment (79.7% with angiotensin-converting enzyme inhibitors and / or angiotensin receptor blockers). 81% with microalbuminuria and 78% with established proteinuria were receiving antiproteinuric treatment. Of the patients considered to be refractory to BP (>3 drugs), only 28.9% underwent ambulatory BP monitoring. Significant differences were observed between stages of diabetic nephropathy and glycated hemoglobin (HBA1c; p = 0.048), systolic blood pressure (SBP; p = 0.024), lipidic control (HDLc; p = 0.015 and TG; p = 0.034), anemia (Hb; p = 0.010) and CKD (creatinine and sMDRD; p = 0.000). The levels of compliance with the therapeutic objectives regarding lipid control (LDL <= 100 mg/dl and TG <= 150 mg/dl), BP <= 130/80 mmHg and HbA1c <= 7% were 1 objective: 68%, 2 objectives: 21.8% and 3 objectives: only 4% of patients. Conclusions: According to the results of our study, only a reduced proportion of patients fulfilled the different therapeutic end-points indicated. Future measures will be directed at improving physician-patient relationships with the main aim of intensifying the therapeutic measures to attain better metabolic and blood pressure control, nephroprotection and prevention in the appearance of cardiovascular events

Microangiopatía trombótica asociada a infección por citomegalovirus como manifestación clínica inicial de primoinfección por VIH / Cytomegalovirus infection-associated thrombotic microangipathy as the first clinical manifestation of HIV primary infection

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[Peritoneal implants in patients affected by chronic renal failure in hemodialysis programme]. / Implantes peritoneales en pacientes con insuficiencia renal crónica en programa de hemodiálisis.

The presence of peritoneal implants detected by computered axial tomography (CT) is usually related to mesothelial primary neoformative processes or, more frequently to peritoneal metastasis or peritoneal carcinomatosis. Although the higher prevalence of neoplastic processes in the chronic renal failure population, the association of peritoneal implants and constitutional syndrome is not always correlated to peritoneal carcinomatosis. We present the case of two patients with chronic renal failure in hemodialysis programme, with abdominal insidious clinical, constitutional syndrome and similar peritoneal implants seen by CAT: the histologic analysis of peritoneal implants gave the definitive diagnostic of secondary amyloidosis and peritoneal tuberculosis respectively.

Implantes peritoneales en pacientes con insuficiencia renal crónica en programa dehemodiálisis / Peritoneal implants in patients affected by chronic renal failure in hemodialysis programme

La presencia de implantes peritoneales detectados por tomografía axial computerizada(TAC) suele estar asociada a procesos neoformativos primarios del mesotelioo, más frecuentemente, a metástasis peritoneales o carcinomatosis peritoneal.A pesar de la mayor prevalencia de procesos neoplásicos en la poblaciónafecta de insuficiencia renal crónica, la asociación de implantes peritoneales y síndromeconstitucional no siempre se correlaciona con carcinomatosis peritoneal.Presentamos dos pacientes con insuficiencia renal crónica en programa de hemodiálisis,con clínica insidiosa abdominal, síndrome constitucional e implantesperitoneales de similares características visualizados por TAC. El análisis histológicode los implantes peritoneales permitió el diagnóstico definitivo de amiloidosissecundaria y tuberculosis peritoneal respectivamente

The presence of peritoneal implants detected by computered axial tomography(CT) is usually related to mesothelial primary neoformative processes or, more frequentlyto peritoneal metastasis or peritoneal carcinomatosis. Although the higherprevalence of neoplastic processes in the chronic renal failure population, the associationof peritoneal implants and constitutional syndrome is not always correlatedto peritoneal carcinomatosis. We present the case of two patients with chronicrenal failure in hemodialysis programme, with abdominal insidious clinical,constitutional syndrome and similar peritoneal implants seen by CAT: the histologicanalysis of peritoneal implants gave the definitive diagnostic of secondary amyloidosisand peritoneal tuberculosis respectively

[Compliance with the 2002 consensus document of the Spanish Society of Nephrology for the control of diabetic nephropathy in Catalonia (ECCODIAB)]. / Estudio sobre el grado de cumplimiento ambulatorio del documento de consenso 2002 para el control de la nefropatía diabética en Cataluña (ECCODIAB).

OBJECTIVE: To evaluate the level of compliance with the 2002 consensus document (Spanish Society of Nephrology) on guidelines for the detection, prevention and treatment of diabetic nephropathy in Catalonia. SUBJECTS AND METHODS: Multicenter (23 hospitals), observational, cross-sectional, descriptive study conducted in 413 diabetic patients (61.7% men, 38.3% women) with a median age of 66.2 +/-11.5 years (26-93 years). The ANOVA test (post-hoc analysis; p value< 0.05) was used to study the relationships between the stages of diabetic nephropathyand different variables. RESULTS: 90.3% of the patients had type 2 DM. The following anthropometric parameters were observed: BMI 29.8 +/- 5 kg/m2 (BMI > 30 kg/m2: 48.7%) and waist circumference 104.1 +/- 14 cm (48.6% men > 102 cm and 78.9% women > 88 cm). Serum creatinine 1.9 +/- 1.3 mg/dl and simplified MDRD equation 45.3 +/- 25.0 ml/min/1.73 m2 [65.8%with CKD stages 3 and 4]. 80% of patients had ophthalmologic examination and 52.8% antiplatelet treatment. Hb A1c was 7.3 +/- 1.3%, but the percentage of patients with glycated hemoglobin > 7% and 8% was 54.9 and 28.6% [only 50.2% had been seen by an endocrinologist in the last 6 months]. 52.8% of patients were treated with insulin and 44.1% with anti-diabetic drugs, although only 19.6% used the new anti-diabetic drugs. 61% of patients had an LDLc > 100 mg/dl (61% treated) and 44% had triglycerides (TG) > 150 mg/dl (72% treated). 95% of patients presented with hypertension (BP > or = 130/80 mmHg),91% were undergoing antihypertensive treatment (79.7% with angiotensin-converting enzyme inhibitors and / or angiotensin receptor blockers). 81% with microalbuminuria and 78%with established proteinuria were receiving anti-proteinuric treatment. Of the patients considered to be refractory to BP (>3 drugs), only 28.9% underwent ambulatory BP monitoring. Significant differences were observed between stages of diabetic nephropathy and glycated hemoglobin (HBA1c; p = 0.048), systolic blood pressure (SBP; p = 0.024), lipidic control (HDLc; p = 0.015 and TG; p = 0.034), anemia (Hb; p = 0.010) and CKD (creatinine and sMDRD; p = 0.000). The levels of compliance with the therapeutic objectives regarding lipid control (LDL < or = 100 mg/dl and TG< or = 150 mg/dl), BP < or = 130/80 mmHg and HbA1c < or =7% were 1 objective: 68%, 2 objectives: 21.8% and 3 objectives: only 4% of patients. CONCLUSIONS: According to the results of our study, only a reduced proportion of patients fulfilled the different therapeutic end-points indicated. Future measures will be directed at improving physician-patient relationships with the main aim of intensifying the therapeutic measures to attain better metabolic and blood pressure control, nephroprotection and prevention in the appearance of cardiovascular events.

Hemotórax masivo a las cuarenta y ocho horas de la cateterización de la vena yugular interna sin control ecográfico

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La angiorradiología como diagnóstico y tratamiento de un pseudoaneurisma de la fístula arterio-venosa interna

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Neurotoxicidad post-primera dosis de valaciclovir vía oral en una paciente en hemodiálisis

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Fracaso renal agudo como forma de presentación clínica de linfoma de Burkitt renal en un paciente HIV positivo / Burkitt’s lymphoma in an hiv positive patient presenting with acute renal failure

El linfoma de Burkitt es un tumor frecuentemente asociado a situaciones de inmunodepresión como puede ser leucemia aguda linfoblástica (L3) o infecciones por el virus de la inmunodeficiencia humana (VIH). La incidencia de la afectación renal es variable (34-62%), respondiendo a diferentes etiologías. Presentamos un caso de fracaso renal agudo en un paciente con linfoma de Burkitt con infiltración renal e infectado por el virus de la inmunodeficiencia humana (AU)

Burkitt’s lymphoma is a tumour often associated with low immunity as acutelymphoblastic leukaemia (l3) or infection by the human immunodeficiency virus(HIV). The incidence of renal affection is variable (34-62%) and there are different aetiologies. We present a case of acute renal failure in a patient with a Burkitt’s lymphoma and renal infiltration, and infected by the human immunodeficiency virus (AU)

[Renal expression of intercellular adhesion molecule-1 (ICAM-1) in IgA deposit mesangial nephropathy. A tubulointerstitial lesion marker]. / Expresión renal de la molécula de adhesión intercelular-1 (ICAM-1) en la nefropatía mesangial por depósitos de IgA. Un marcador de lesión tubulointersticial.

BACKGROUND: The aim of this study was to determine the significance of the renal expression of ICAM-1 in IgA nephropathy (IgAN). PATIENTS AND METHOD: First, we identified ICAM-1 (CD54) expression in tubular epithelial cells and interstitial leucocytes in renal biopsies from 45 patients with IgAN and 29 patients with non-glomerulonephritis nephropathy (non-GN). We then analysed the relationship between this expression and both histological and clinical data at the time of renal biopsy and after 2.4 (2) (X [SD]) years in IgAN, and 1.8 (1.5) years in non-GN. RESULTS: In IgAN, tubular ICAM-1 positive staining was seen in 25 (55%) biopsies; it was associated with extracapillary proliferation, glomerulosclerosis involving less than 50% of glomerular area, interstitial cell infiltration and tubular atrophy. ICAM-1 positive interstitial leucocytes were 234 (307)/mm2; this expression correlated with glomerulosclerosis, tubular atrophy, interstitial fibrosis and serum creatinine (Cr) level. In patients with 50% increase in Cr level, ICAM-1 positive interstitial leucocytes were 516 (360)/mm2 as compared with 66 (87.8)/mm2 (U = 16; p < 0.005) in patients with stable Cr. In non-GN, tubular ICAM-1 expression was observed in 7 (24%) biopsies. CONCLUSIONS: Tubular and Interstitial expression of ICAM-1 can be a marker of tubulointerstitial damage in IgAN. Interstitial ICAM-1, rather than tubular ICAM-1, may predict the progression of this disease.

[Acute kidney failure as the clinical presenting form of renal Burkitt's lymphoma in an HIV-positive patient]. / Fracaso renal agudo como forma de presentación clínica de linfoma de Burkitt renal en un paciente HIV positivo.

Burkitt's lymphoma is a tumour often associated with low immunity as acute lymphoblastic leukaemia (l3) or infection by the human immunodeficiency virus (HIV). The incidence of renal affection is variable (34-62%) and there are different aetiologies. We present a case of acute renal failure in a patient with a Burkitt's lymphoma and renal infiltration, and infected by the human immunodeficiency virus.

Efficacy and tolerance of interferon-alpha(2b) in the treatment of chronic hepatitis C virus infection in haemodialysis patients. Pre- and post-renal transplantation assessment.

BACKGROUND: Hepatitis C virus (HCV) infection represents an important problem for the dialysis population due to its high prevalence and the long-term development of chronic liver disease, particularly following renal transplantation. METHODS: In order to assess the efficacy and tolerance of interferon (IFN) in the treatment of chronic hepatitis C in haemodialysis (HD) patients and their clinical course following renal transplantation, a multicentre, randomized, open-label study was conducted to compare IFN therapy vs a control group. RESULTS: Nineteen HCV RNA-positive patients received 3 x 10(6) U of IFN s.c., three times a week (post-HD), and 17 HCV RNA-positive patients were assigned to the control group. Tolerance to IFN therapy was good in nine patients, while treatment was discontinued in the other 10 due to the occurrence of side effects. HCV RNA was negative at the end of treatment in 14 out of 19 patients (74%) receiving IFN and in one patient (5%) in the control group. Six out of the 14 patients who initially responded to IFN therapy had a virological relapse (43%). Eight patients (42%) remained HCV RNA-negative, three of them until the day that renal transplantation (RT) was performed (7, 12 and 27 months, respectively), as did five patients on HD during the follow-up (27+/-5 months). Eight out of the nine patients (89%) who completed therapy were HCV RNA-negative at the end of treatment, and seven of them (78%) remained HCV RNA-negative during the follow-up on dialysis (21+/-8 months). Mean transaminase (ALT) values were significantly decreased following IFN therapy, while no changes were observed during the follow-up period in the control group. Fifteen patients (10 in the treatment group and five in the control group) underwent RT. Three patients in the treatment group were HCV RNA-negative at RT, and one of them had a virological relapse 20 months after RT, while the other two remained HCV RNA-negative at 3 months and 24 months after RT, respectively. In contrast to the control group, transaminase (ALT) remained within normal limits in all patients in the treatment group. Finally, during the post-RT follow-up, the transaminase mean values were significantly lower in treated patients vs patients in the control group (P<0.05). CONCLUSIONS: It is concluded that the biochemical and virological response to IFN therapy is good in HD patients. In addition, IFN therapy appears to exert a beneficial effect on the course of liver disease following RT, regardless of the virological response. Despite the fact that IFN therapy was discontinued in 10 out of the 19 patients due to the occurrence of side effects, these disappeared following discontinuation of therapy. Therefore, IFN therapy is advisable for HCV-infected dialysis patients who are candidates for RT.