Urinary exosomal miR-146a as a marker of albuminuria, activity changes and disease flares in lupus nephritis.

BACKGROUND: Urinary exosomes, especially microRNAs (miRNAs) packaged within, are ideal sources of renal damage markers. We investigated the association between exosomal miR-146a, (anti-inflammatory regulator) and disease activity, proteinuria and systemic lupus erythematosus (SLE) flares over a 36-month follow-up period. METHODS: We isolated urinary exosomes from 41 SLE patients, 27 with lupus nephritis (LN) and 20 healthy controls, and exosomal miR-146a, quantified by the real-time quantitative polymerase chain reaction (RT-qPCR), was correlated with histological features in 13 renal biopsies. We also analysed the association between the exosomal miR-146a and TRAF6 axis. RESULTS: Exosomal miR-146a showed an inverse association with circulating C3 and C4 complement components, proteinuria, and with histological features such as chronicity index. This marker was able to identify LN with an AUC of 0.82 (p = 0.001). Basal exosomal miR-146a was associated with disease activity and proteinuria changes and was an independent marker of 36-month follow-up flares (OR 7.08, p = 0.02). Pathway analysis identified IRAK1 and TRAF6 as miR-146a target genes. Finally, in vitro experiments suggested that miR-146a exerts a protective effect through negative regulation of inflammation by suppressing IRAK1 and TRAF6. CONCLUSIONS: Urinary exosomal miR-146a levels are correlated with lupus activity, proteinuria and histological features, discriminating patients with LN and being a good baseline marker of SLE flares. We have identified a relevant biological miR-146a-TRAF6 axis association in LN renal fibrosis progression.

Crizotinib and renal insufficiency: a case report and review of the literature.

A 69 year old man with idiopathic chronic kidney disease was diagnosed with relapsing EGFR negative, ALK positive lung adenocarcinoma, and treated with chemotherapy and antiangiogenic treatment, under which his renal insufficiency worsened. During second line crizotinib treatment, further worsening of the renal function was seen, with very clear correlation with crizotinib withdrawal and rechallenge. No further drug causes for the worsening blood creatinine values were detected.

Advancing in the management of chronic kidney disease: the results of implementing a quick resolution consultation.

BACKGROUND: Currently, chronic kidney disease (CKD) is understood as global important public health problem, a situation that requires a new approach. OBJECTIVES: To show the results obtained after implementing a quick resolution consultation for CKD management. METHODS: Results were analysed during 6 month time period. RESULTS: A total of 9.61% of received proposals were referred to primary care without in-person visits. In addition, 28.05% of patients were initially evaluated through high resolution clinics and 62.33% were directly referred to other clinics. From the initial 28.05% mentioned, once evaluated, treatment adjusted and informed about the disease, 70% were referred over to primary care for monitoring and the remaining 30% were given specialist appointments. As a consequence, 70.65% of patients were selected for monitoring by nephrology from all proposals received, and 29.35% for primary care monitoring. We observed a significant decrease in the delay until the first medical appointment. CONCLUSIONS: Quick resolution consultations demonstrated to be an efficient tool for CKD management. Its implementation allowed both low consumption of health care resources, selected patients with high risk of progressive cardiovascular disease for long term monitoring, and offered not only an initial evaluation and adjustment of treatment with information provided to those who would be monitored by primary care, but also diminished primary care delays significantly.

Avanzando en el manejo de la enfermedad renal crónica: resultados de la implantación de una consulta de rápida resolución / Advancing in the management of chronic kidney disease: the results of implementing a quick resolution consultation

Antecedentes: La enfermedad renal crónica (ERC) se entiende actualmente como un importante problema de salud pública global, que requiere una nueva aproximación. Objetivos: Mostrar los resultados de la implantación de una consulta de rápida resolución para el manejo de la ERC. Métodos: Se han analizado de manera retrospectiva los resultados obtenidos durante un período de seis meses, entre septiembre de 2011 y febrero de 2012. Las variables estudiadas han sido la edad de los pacientes, el origen de las propuestas, la causa de las remisiones, el destino inicial dado a estas y el destino final de los pacientes. Resultados: Un 9,61 % de las propuestas recibidas se ha remitido a Atención Primaria sin consulta presencial. Un 28,05 % de los pacientes han sido evaluados inicialmente en la consulta de alta resolución y un 62,33 % se ha citado directamente para el resto de las consultas. Del 28,05 % inicial, tras el proceso de evaluación, ajuste e información acerca de la enfermedad un 70 % ha sido remitido nuevamente a Primaria para seguimiento, y el otro 30 % se ha citado para su seguimiento en consultas. Por tanto, del total de propuestas se ha seleccionado un 70,65 % de pacientes para seguimiento por Nefrología y un 29,35 % para seguimiento por Atención Primaria. Por otro lado, se ha disminuido la demora para primeras visitas a menos de la mitad. Conclusiones: La consulta de alta resolución se ha mostrado como un instrumento eficiente en el manejo de la ERC. Su implantación ha permitido, consumiendo un mínimo de los recursos asistenciales, seleccionar para seguimiento a largo plazo a aquellos pacientes de mayor riesgo de progresión y cardiovascular pero ofreciendo también una evaluación inicial, ajuste de tratamiento e información a los que serán seguidos por Atención Primaria, y disminuir la demora en primeras visitas de manera significativa (AU)

Background: Currently, chronic kidney disease (CKD) is understood as global important public health problem, a situation which requires a new approach. Objectives: To show the results obtained after implementing a quick resolution consultation for CKD management. Methods: Results were analysed during 6 month time period. Results: A total of 9.61% of received proposals were referred to primary care without in-person visits. In addition, 28.05% of patients were initially evaluated through high resolution consults and 62.33% were directly referred to other consults. From the initial 28.05% mentioned, once evaluated, treatment adjusted and informed about the disease, 70% were referred over to primary care for monitoring and the remaining 30% were given specialist appointments. As a consequence, 70.65% of patients were selected for monitoring by nephrology from all proposals received, and 29.35% for primary care monitoring. We observed a significant decrease in the delay until the first medical appointment. Conclusions: Quick resolution consultations demonstrated to be an efficient tool for CKD management. Its implementation allowed both low consumption of health care resources, selected patients with high risk of progression cardiovascular disease for long term monitoring, and offered not only an initial evaluation and adjustment of treatment with information provided to those who would be monitored by primary care, but also diminished primary care delays significantly (AU)