Chronic kidney disease prevalence in asymptomatic patients with risk factors-usefulness of serum cystatin C: a cross-sectional study.

Background: Chronic kidney disease is recognized as a worldwide public health problem, particularly within an increasing prevalence of obesity, diabetes mellitus, and hypertension. This disease affects more than 13% of the world's population and is increasing. Further biochemical assessment with new biomarkers, such as serum cystatin C (CysC), would improve patient care and disease control. The aim of this study was to detect chronic kidney disease (CKD) in asymptomatic subjects with risk factors and evaluate CysC as early biomarker of renal damage and accurate test to estimation glomerular filtration (GF). Methods: This observational analytic and cross-sectional design included 195 patients of both sexes. A full clinical evaluation included height, weight, waist circumference, body mass index (BMI), blood pressure (BP), and family history of disease. Renal function was evaluated through serum creatinine (SCrea), serum CysC, urinary albumin, and urinary creatinine. GF was calculated using CKD-EPI creatinine (CKD-EPI Crea) and CKD-EPI creatinine-cystatin C equations (CKD-EPI Crea-CysC). Results: Renal injury showed 24% of patients with albuminuria; 18% of them were categorized as A2 and 6% as A3. Therefore, 73% had no progression risk (baseline risk), 20% moderate risk, and 7% high risk. Among analyzed groups, significant differences were found in BMI, BP, Screa, CysC, CKD-EPI Crea, and CKD-EPI Crea-CysC. Overweight population was analyzed by assessing CysC and calculating CKD-EPI Crea-CysC, showing an important change with respect to the general population. Conclusion: Combined CysC and Crea measurement provides incremental improvement in predicting measured GF.

Hepatic fibrogenesis and transforming growth factor/Smad signaling activation in rats chronically exposed to low doses of lead.

Lead is an important heavy metal pollutant in the environment. The nervous system, kidney and liver are the most susceptible organs to lead deposition, showing that this pollutant has no single target system. To examine the cellular and molecular mechanisms involved in their pathobiology of chronic lead at low-dose exposure in the liver, male Wistar rats were exposed to 0.06% lead acetate in drinking water every day for 4 months. At the end of the study, hepatic metal accumulation, morphology and function were examined. Immunochemical staining and Western blot analysis were performed to detect extracellular matrix proteins, α-smooth muscle actin and transforming growth factor (TGF)ß1/Smad pathway expression. Results showed increased laminin, collagen IV and fibronectin, located at the perisinusoidal space. Phenotypic transformation of hepatic stellate cells into myofibroblast-like cells was evidenced at the ultrastructural level and a significant expression of α-smooth muscle actin in Disse's space was observed. These findings were associated with a marked increase in TGFß1/Smad2/3 signaling. Our data suggest that, chronically, exposure to low levels of lead could trigger the onset of a hepatic fibrogenic process through upregulated TGFß1/Smad signaling.

Inflammatory and prothrombotic activation with conserved endothelial function in patients with chronic, asymptomatic Chagas disease.

UNLABELLED: Previously, our group showed a prothrombotic state in asymptomatic patients with chronic Chagas disease. The current paper studies the inflammatory status and endothelial function in these patients. METHODS: In 40 patients and 40 healthy volunteers, we evaluated prothrombotic state, blood parasitemia (molecular biology: polymerized chain reaction [PCR]-amplification), tissue factor pathway inhibitor antibodies (aTFPI), interleukin 6 (IL-6), and vascular cell adhesion molecule-1 (VCAM-1). Endothelial function was determined by reactive hyperemia (pulse plethysmography). RESULTS: In patients, prothrombin fragment 1 + 2, d-dimer, PAI-1, and fibrinogen were higher. Amplification of 121/122 primers (Trypanosoma cruzi) was positive in 45% of the patients. Patients presented higher values of aTFPI- immunoglobulin G (IgG; P < .05), aTFPI-IgM (P < .001), IL-6 (P = .004), and VCAM-1 (P = .00001). In both groups, endothelial function was preserved. CONCLUSIONS: We found that asymptomatic patients with chronic Chagas disease presented a prothrombotic/inflammatory status. The fact that endothelial function is still preserved suggests that prothrombosis and inflammation are primarily implicated in the beginning of cardiovascular damage.

Probables mecanismos involucrados en la etiopatogenia del estado protrombótico en la enfermedad de Chagas crónica. ¿Activación inflamatoria con función endotelial conservada? / Possible mechanisms involved in the pathogenesis of prothrombotic state Chronic Chagas disease. Inflammatory activation with preserved endothelial function?

Introducción: En el estadio indeterminado de la enfermedad de Chagas crónica, se comprobó un estado protrombótico asociado con factores de riesgo trombofílicos. La etiopatogenia de la enfermedad de Chagas es multifactorial sin que ninguno de los mecanismos involucrados explique por sí mismo el inicio y progresión de las lesiones. Objetivo: Evaluar probables mecanismos involucrados en la etiopatogenia del estado protrombótico en el estadio indeterminado de la enfermedad de Chagas crónica. Material y Métodos: Desde marzo de 2004 hasta diciembre de 2006 se evaluaron 40 pacientes chagásicos crónicos, 14 varones y 26 mujeres, (33.5 ± 4.9 años); en clase funcional I, de la clasificación clínica de la miocardiopatía chagásica crónica, comparándolos con un muestreo accidental de 40 voluntarios sanos, 19 varones y 21 mujeres (28.8 ± 6.3 años). Se evaluó la presencia del parásito por técnica de amplificación de las cadenas de polimerasa (PCR) y se determinó anticuerpo inhibidor de la vía extrínseca de la coagulación (aTFPI) por un método de ELISA optimizado, con valor de corte para aTFPI IgG >18 Uml-1 y para aTFPI IgM >15 Uml-1. Valores altos de aTFPI (IgG e IgM) se consideraron los >50 Uml-1. Se tomaron también muestras de sangre para la determinación por ELISA de dos marcadores de inflamación; Interleuquina 6 (IL-6) y de la molécula de adhesión a célula vascular (VCAM-1). La función endotelial se evaluó por pletismografía de onda de pulso digital para determinar hiperemia reactiva, la que discrimina sujetos con y sin disfunción endotelial. Resultados: En los pacientes chagásicos estudiados se detectó presencia del parásito por la técnica de amplificación de PCR utilizada en el 45 por ciento (n=18) de los casos. Los pacientes chagásicos presentaron valores de aTFPI mayores que los controles, con una p<0.05 para aTFPI IgG y p<0.001 para aTFPI IgM; superando en muy pocos casos los valores de corte establecidos para el método...

[Cardiovascular risk factors in children with type 1 diabetes and their relationship with the glycemic control]. / Factores de riesgo cardiovascular en niños con diabetes tipo 1 y su relación con el control de la glucemia.

Diabetics have an increased risk of cardiovascular disease (CVD). The objective of this work was to evaluate the cardiovascular risk factors in infant-juvenile type 1 diabetics and their association with the degree of glycemic control. A total of 52 patients, aged 5-15 years, were studied and compared with 37 control subjects. The degree of glycemic control, lipid profile, plasma fibrinogen, microalbuminuria and blood pressure were investigated. The patients were grouped in diabetics with good glycemic control [DGGC, glycosilated hemoglobin (HbA1c) < 8%] and poor glycemic control [DPGC, HA1c > or = 8%]. Diabetic patients presented incremented values of total cholesterol (4.1 +/- 0.9 vs. 3.1 +/- 0.7 mmol/l, p = 0.0008), LDL-cholesterol (2.4 +/- 0.9 vs. 1.7 +/- 0.7 mmol/l, p = 0.0001), HDL-cholesterol (1.2 +/- 0.3 vs. 1.0 +/- 0.2 mmol/l, p = 0.0002), with respect to control group. Eighty three per cent of diabetics showed a poor glycemic control. There were not significant differences in lipid profile between DGGC and DPGC, excepting HDL-cholesterol which was higher in DPGC group (p = 0.007). Plasma fibrinogen levels were similar in diabetics and controls, but they were higher in DPGC than in DGGC (265 +/- 46 vs. 229 +/- 22 mg/dl, p = 0.02). Three patients with microalbuminuria and none with hypertension were detected. In these patients the most pronounced risk factors for CVD were dyslipidemia and hyperglycemia, which justify the need for the early detection of these factors as well as strict metabolic control.

Factores de riesgo cardiovascular en niños con diabetes tipo 1 y su relación con el control de la glucemia. / [Cardiovascular risk factors in children with type 1 diabetes and their relationship with the glycemic control]

Diabetics have an increased risk of cardiovascular disease (CVD). The objective of this work was to evaluate the cardiovascular risk factors in infant-juvenile type 1 diabetics and their association with the degree of glycemic control. A total of 52 patients, aged 5-15 years, were studied and compared with 37 control subjects. The degree of glycemic control, lipid profile, plasma fibrinogen, microalbuminuria and blood pressure were investigated. The patients were grouped in diabetics with good glycemic control [DGGC, glycosilated hemoglobin (HbA1c) < 8

] and poor glycemic control [DPGC, HA1c > or = 8

]. Diabetic patients presented incremented values of total cholesterol (4.1 +/- 0.9 vs. 3.1 +/- 0.7 mmol/l, p = 0.0008), LDL-cholesterol (2.4 +/- 0.9 vs. 1.7 +/- 0.7 mmol/l, p = 0.0001), HDL-cholesterol (1.2 +/- 0.3 vs. 1.0 +/- 0.2 mmol/l, p = 0.0002), with respect to control group. Eighty three per cent of diabetics showed a poor glycemic control. There were not significant differences in lipid profile between DGGC and DPGC, excepting HDL-cholesterol which was higher in DPGC group (p = 0.007). Plasma fibrinogen levels were similar in diabetics and controls, but they were higher in DPGC than in DGGC (265 +/- 46 vs. 229 +/- 22 mg/dl, p = 0.02). Three patients with microalbuminuria and none with hypertension were detected. In these patients the most pronounced risk factors for CVD were dyslipidemia and hyperglycemia, which justify the need for the early detection of these factors as well as strict metabolic control.