Characterization of renal damage in Wilson's disease-Detailed analysis of 20 Chinese cases.

OBJECTIVE: Copper metabolism disorder disease is thought to contribute to renal symptoms in Wilson's disease (WD). Nonetheless, there remains limited knowledge regarding the precise characteristics of renal damage in individuals with Wilson's disease, encompassing clinical presentations, biochemical indicators, imaging findings, and renal histopathological alterations. METHODS: In this study, 20 patients diagnosed with Wilson's disease and renal involvement were enrolled in our hospital. These patients met the validated European criteria for Wilson's disease, and those with primary kidney disease or secondary renal damage caused by other underlying conditions were excluded. The baseline data of patients were collected. Various biochemical and hematological parameters were monitored. Biochemical examinations were measured using an automatic biochemistry analyzer, blood routines were tested by flow cytometry analysis, 24-h urine copper was tested by atomic absorption spectrophotometer. Besides, CER was measured by turbidimetric immunoassay with a Hitachi 7020 automatic biochemical analyzer (the intraplate and interplate coefficients of variation were 2.7% and 5.13% respectively). Copper oxidase was tested by colorimetric method using p-phenylenediamine hydrochloride (the intraplate and interplate coefficients of variation were both <10%). Diagnostic criteria for Wilson's disease and kidney damage were established based on the European Association for the Study of the Liver (EASL) and CKD Epidemiology Collaboration guidelines, respectively. Statistical analysis was carried out using t-tests and χ2 tests in SPSS 22.0 software. Significant differences were considered when P<0.05. RESULTS: In those patients with Wilson's disease-related renal damage, edema, gross hematuria, oliguria, and lumbar pain were present in most patients. Microscopic haematuria and proteinuria were also observed in 19 patients. Compared to patients without renal involvement, those with renal complications exhibited a significant increase in white blood cell (WBC) and neutrophil counts (P<0.05). Additionally, patients with renal damage showed a noteworthy rise in both diastolic and systolic blood pressure, along with a significant reduction in hemoglobin levels (P<0.05). Color Doppler ultrasound results revealed diffuse lesions in both kidneys in 12 patients, renal cysts were identified in 5 patients, and 2 patients exhibited abnormal renal blood flow signals. Meanwhile, varying degrees of IgA, IgM, IgG-based immunoglobulins, complement C3 and C1q deposition in the glomerular mesangial area were detected by immunofluorescence. Furthermore, renal puncture biopsy results revealed a spectrum of findings, including minimal change nephrosis in 1 case, IgA nephropathy in 3 cases, atypical membranous proliferative nephropathy in 2 cases, and focal segmental glomerulosclerosis in 1 case. CONCLUSION: This study comprehensively elucidates the distinct attributes of renal damage related to Wilson's disease, while also speculating that renal dysfunction in Wilson's disease could be linked to immune complex deposition. Depending on the underlying pathogenesis, kidney injury associated with Wilson's disease can be classified as primary or secondary. To slow down the progression of renal impairment, it is essential to undergo a renal biopsy pathological examination as early as possible to clarify the type of impairment and take the appropriate treatment.

Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study.

PURPOSE: It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI. DESIGN: Multicenter prospective international cohort study. SETTING: Fourteen university hospitals in Spain and the United Kingdom. PARTICIPANTS: We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37). CONCLUSIONS: Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.

Thrombotic microangiopathy secondary to Capnocytophaga canimorsus bacteremia / Microangiopatía trombótica secundaria a bacteriemia por Capnocytophaga canimorsus

Capnocytophaga canimorsus is an Anaerobic Gram-Negative bacterium present in the oral microbiology of cats and dogs. It can produce infections in humans, being capable of causing severe complications with the development of septic shock. There are known cases where this bacterium developed medical complications like thrombotic microangiopathy and disseminated intravascular coagulation. We have the case of 79 years old male that developed thrombotic microangiopathy and splenic infarction linked to bacteraemia by Capnocytophaga canimorsus. Due to its severity, it was necessary to start renal replacement therapy and several sessions of plasmapheresis with good evolution. (AU)

Capnocytophaga canimorsus es una bacteria anaerobia gramnegativa presente en la microbiología oral de gatos y perros. Puede producir infecciones en humanos, siendo capaz de provocar un diagnóstico severo con desarrollo de shock séptico. Existen casos descritos con complicaciones médicas como Microangiopatía Trombótica y Coagulación Intravascular Diseminada. Presentamos el caso de un varón de 79 años que desarrolló microangiopatía trombótica e infarto esplénico asociado a bacteriemia por Capnocytophaga canimorsus. Por su gravedad, fue necesario iniciar terapia de reemplazo renal y varias sesiones de plasmaféresis con buena evolución. (AU)

Daño renal asociado al trasplante hepático / Kidney injury associated with liver transplantation

Introducción: El daño renal es frecuente en niños con trasplante hepático (TH), aunque su detección es un desafío. Nuestro objetivo fue evaluar el daño renal agudo (DRA) perioperatorio y analizar la prevalencia de enfermedad renal crónica (ERC) mediante diferentes fórmulas de estimación de la tasa de filtración glomerular (TFG). Métodos: Análisis transversal unicéntrico de una cohorte de niños menores de 18años con TH. Estimamos la TFG utilizando la fórmula Schwartz bedside 2009 basada en la creatinina, Caucasian Asian Pediatric and Adult cohort (CAPA) para cistatinaC y la fórmula combinada de Pottel Full Age Spectrum (FAS). Analizamos la concordancia mediante prueba de Bland Altman y el índice kappa. Medimos la albuminuria, la presión arterial y el volumen urinario por 100ml de filtrado glomerular. Analizamos los factores de riesgo asociados a ERC mediante un análisis univariante y multivariante. Resultados: Se incluyeron 52 pacientes, con una mediana de edad de 9,21años y 5,42años de evolución. Quince (28,8%) tuvieron DRA. Cinco niños (10%) presentaban ERC. El único factor de riesgo asociado fue el fallo hepático agudo en el momento del TH (OR: 8,57, p=0,04). Hubo poca concordancia entre las diferentes fórmulas de estimación. La fórmula de Schwartz clasificó a un paciente con ERC, mientras que Pottel FAS combinada y CAPA clasificaron a cuatro. Hasta el 42% de los niños sin ERC tenían algún marcador de daño renal. Conclusiones: El uso exclusivo de la fórmula Schwartz bedside 2009 para estimar el FG puede limitar el diagnóstico de ERC en niños con TH. La presencia de otros marcadores de daño renal es frecuente y su detección puede prevenir la progresión de la ERC. (AU)

Introduction: Kidney injury associated with paediatric liver transplantation (LT) is common, but its evaluation is challenging. Our aim was to analyse the presence of perioperative acute kidney injury (AKI) and study the prevalence of chronic kidney disease (CKD) using different glomerular filtration rate (GFR) estimation formulas. Methods: We conducted a cross-sectional study in a cohort of children aged less than 18years with a history of LT followed up for 5.42years. We estimated the GFR using the creatinine-based Schwartz bedside formula (2009), the cystatin C-based Caucasian Asian Pediatric and Adult cohort (CAPA) equation and the combined full-age spectrum (FAS) formula as modified by Pottel. We analysed the agreement between them using the Bland-Altman method and the kappa statistic. We measured the albumin level in urine, the urine volume adjusted to 100mL of GFR and blood pressure. We performed univariate and multivariate analyses of the risk factors associated with CKD. Results: The sample included 52 patients with a median age of 9.21years. Fifteen (28.8%) had AKI. Five (10%) had CKD and the only associated risk factor was acute liver failure at the time of LT (odds ratio, 8.57; P=.04). There was poor agreement between the different estimation formulas. One patient was classified as having CKD with the Schwartz formula compared to four patients with the CAPA and the Pottel combined FAS formulas. Up to 42% of children without CKD had some positive marker of kidney injury. Conclusions: The exclusive use of the 2009 Schwartz bedside formula to estimate GFR may lead to underdiagnosis of CKD in children post LT. Other markers of kidney injury are common, and their detection may help prevent the progression of CKD. (AU)

Kidney injury associated with liver transplantation.

INTRODUCTION: Kidney injury associated with paediatric liver transplantation (LT) is common, but its evaluation is challenging. Our aim was to analyse the presence of perioperative acute kidney injury (AKI) and study the prevalence of chronic kidney disease (CKD) using different glomerular filtration rate (GFR) estimation formulas. METHODS: We conducted a cross-sectional study in a cohort of children aged less than 18 years with a history of LT followed up for 5.42 years. We estimated the GFR using the creatinine-based Schwartz bedside formula (2009), the cystatin C-based Caucasian Asian Pediatric and Adult cohort (CAPA) equation and the combined Full-Age Spectrum (FAS) formula as modified by Pottel. We analysed the agreement between them using the Bland-Altman method and the kappa statistic. We measured the albumin level in urine, the urine volume adjusted to 100 mL of GFR and blood pressure. We performed univariate and multivariate analyses of the risk factors associated with CKD. RESULTS: The sample included 52 patients with a median age of 9.21 years. Fifteen (28.8%) had AKI. Five (10%) had CKD and the only associated risk factor was acute liver failure at the time of LT (odds ratio, 8.57; P = 0.04). There was poor agreement between the different estimation formulas. One patient was classified as having CKD with the Schwartz formula compared to four patients with the CAPA and the Pottel combined FAS formulas. Up to 42% of children without CKD had some positive marker of kidney injury. CONCLUSIONS: The exclusive use of the 2009 Schwartz bedside formula to estimate GFR may lead to underdiagnosis of CKD in children post LT. Other markers of kidney injury are common, and their detection may help prevent the progression of CKD.

¿Debemos manejar la hiperuricemia asintomática para proteger al riñón?

Contexto: el ácido úrico es el producto final de la degradación de las purinas en los primates, en condiciones normales es un agente antioxidante endógeno y participa en varias vías fisiológicas, sin embargo, cuando los niveles séricos de urato se incrementan, estos participan en el desarrollo de diversas enfermedades. Desde el siglo XIX se conoce de la asociación entre hiperuricemia y daño renal, aunque ninguna guía de manejo recomienda el uso de fármacos hipouricemiantes en pacientes asintomáticos, en algunos casos especiales, el manejo farmacológico beneficiará a pacientes con hiperuricemia, brindando protección al riñón y disminuyendo el riesgo de desarrollar enfermedad renal terminal. Objetivo: describir la relación entre hiperuricemia y daño renal, y analizar los casos en los que el manejo de esta condición con medicamentos resultará en un beneficio para el riñón de los pacientes. Metodología: revisión de la literatura sobre la participación de la hiperuricemia en el daño renal y análisis de los artículos revisados. Resultados: el manejo de la hiperuricemia asintomática puede proteger el riñón en algunas situaciones específicas. Conclusiones: hay situaciones específicas para la disminución de los niveles séricos de ácido úrico.

Background: Uric acid is the end product of purine degradation in primates, under normal conditions it is an endogenous antioxidant agent and participates in several physiological pathways. However, when serum urate levels are increased, they participate in the development of various diseases. Since the nineteenth century, the association between hyperuricemia and kidney damage has been known. Although no management guideline recommends the use of hypouricemic drugs in asymptomatic patients, in some special cases pharmacological management will benefit patients with hyperuricemia, providing protection to the kidney and decreasing the risk of developing end-stage renal disease. Purpose: To describe the relationship between hyperuricemia and kidney damage, and to analyze the cases in which the management of this condition with medications will result in a benefit for the kidney of patients. Methodology: Review of the literature on the involvement of hyperuricemia in kidney damage, analysis of the reviewed articles. Results: Management of asymptomatic hyperuricemia may protect the kidney in some specific situations. Conclusions: There are specific situations for the decrease of serum uric acid levels.

Factores de progresión de la enfermedad renal crónica en pacientes atendidos en una consulta de Nefrología comunitaria

Introducción: la enfermedad renal crónica representa un significativo problema de salud en el siglo XXI. Se han identificado diversos factores asociados a un incremento del daño renal y a la consecuente progresión de la enfermedad. Objetivo: analizar el comportamiento de los factores de progresión de la enfermedad renal crónica en pacientes atendidos en una consulta de Nefrología comunitaria. Materiales y métodos: estudio observacional, descriptivo y prospectivo. Se incluyeron 65 pacientes con enfermedad renal crónica, que tuvieron seguimiento estable durante un período de 12 meses en la consulta de Nefrología comunitaria, del municipio Pedro Betancourt, de la provincia Matanzas. Fueron analizadas variables sociodemográficas y las relacionadas con la enfermedad renal crónica (etiología, estadio, factores de progresión y marcadores de daño renal). Resultados: se constató una edad promedio de 68,79 años; el 64,6 % de los enfermos eran blancos; diabéticos el 46,15 %; se expusieron a nefrotóxicos el 93,8 %; el 56,9 % presentó proteinuria; el 66,1 % mostró estabilidad en la función renal, y seis factores de progresión concurrieron en pacientes con estadio 3b. Conclusiones: predominaron los pacientes blancos, longevos y con diabetes como enfermedad de base. Hubo una distribución equitativa en cuanto a sexo. El empleo de fármacos nefrotóxicos, y la proteinuria, hiperuricemia e hiperlipidemia, se destacaron como los principales factores de progresión; no obstante, sola la proteinuria, la anemia y la acidosis estuvieron asociadas estadísticamente con la posible progresión de la enfermedad, que no fue constatada en ningún paciente.

Introduction: chronic kidney disease represents a significant health problem in the 21st century. Various factors associated to kidney damage increase and to the consequent progression of the disease have been identified. Objective: to analyze the behavior of chronic kidney disease progression factors in patients treated in a community nephrology consultation. Materials and methods: observational, descriptive and prospective study. Sixty-five patients with chronic kidney disease that were stably followed up during a twelve-month period in the community nephrology consultation of the Pedro Betancourt municipality, province of Matanzas, were included. Socio-demographic variables and those related to chronic kidney disease (etiology, stage, progression factors, and kidney damage markers) were analyzed. Results: an average age of 68.79 years was found; 64.6% of the patients were white; 46.15% were diabetics; 93.8% were exposed to nephrotoxics; 56.9% presented proteinuria; 66.1% showed renal function stability, and six progression factors concurred in 3b stage patients. Conclusions: white, aged patients predominated, with diabetes as underlying disease. There was an equitable distribution in terms of gender. The use of nephrotoxic drugs, and proteinuria, hyperuricemia, and hyperlipidemia stood out as the main progression factors. However, only proteinuria, anemia and acidosis were statistically associated to the possible disease progression, which was not found in any patient.

Factor reumatoide en vasculitis ANCA asociadas / Rheumatoid factor in ANCA associated vasculitis

Introducción: las pruebas de factor reumatoide (FR) se utilizan principalmente para el diagnóstico de artritis reumatoidea (AR), sin embargo, también pueden estar presentes en otras enfermedades. Su significado clínico en contexto de vasculitis ANCA asociadas (VAA) todavía es incierto. El objetivo de este estudio fue establecer el significado clínico y pronóstico del FR en pacientes con VAA. Materiales y métodos: se realizó un estudio observacional, retrospectivo. Se evaluaron pacientes con diagnóstico de VAA (granulomatosis con poliangitis -GPA-, poliangitis microscópica -PAM- y granulomatosis eosinofílica con poliangitis -GEPA-), mayores de 18 años, con FR solicitado antes del inicio del tratamiento. Se recolectaron los siguientes datos: edad, sexo, tipo de VAA, duración de la enfermedad, tratamiento, órganos afectados, Birmingham Vasculitis Activity Score (BVAS), Five Factor Score (FFS), eritrosedimentación, proteína C reactiva, requerimiento de diálisis, asistencia respiratoria mecánica, mortalidad y causa de muerte. Se calculó el odds ratio (OR) y su intervalo de confianza del 95% (IC 95%) para determinar la fuerza de asociación entre las variables. Resultados: incluimos 32 pacientes en los que encontramos 31,2% de FR positivo. Comparados con aquellos con FR negativo, no hubo diferencias significativas con respecto a manifestaciones clínicas, ni actividad de la enfermedad medida por el BVAS y reactantes de fase aguda. La presencia de factor reumatoide se asoció a menor ingreso a diálisis (OR 0.14 IC 0,02-0,8; p=0,02) y mortalidad (p=0,04). No hubo diferencias significativas con respecto al FFS. Conclusiones: en nuestro estudio la presencia de FR en pacientes con vasculitis ANCA se asoció a menor requerimiento de diálisis y menor mortalidad. Estos hallazgos no se correlacionaron estadísticamente con el FFS. No se encontró asociación entre la presencia de FR y el compromiso de órgano, actividad de la enfermedad, ni requerimiento de asistencia respiratoria mecánica.

Introduction: rheumatoid factor tests are mainly used for the diagnosis of rheumatoid arthritis (RA); however, it may also be present in other diseases. Its clinical significance in the context of ANCA associated vasculitis (AAV) is still uncertain. The objective was to establish the clinical and prognostic significance of RF in patients with AAV. Materials and methods: a retrospective observational study was carried out. Patients with a diagnosis of AAV (GPA, MAP and AGEP) over 18 years of age with RF requested before the start of treatment were evaluated. The following data were collected: age, sex, type of AAV, disease duration, treatment, affected organs, Birmingham Vasculitis Activity Score (BVAS), Five Factor Score (FFS), erythrocyte sedimentation rate, C-reactive protein, dialysis requirement, attendance mechanical ventilation, mortality and cause of death. The odds ratio (OR) and its 95% confidence interval (95%CI) were calculated to determine the strength of association between variables. Results: we included 32 patients in whom we found 31.2% positive RF. Compared to those with negative RF, there were no significant differences with respect to clinical manifestations, nor disease activity measured by BVAS and acute phase reactants. The presence of the rheumatoid factor was associated with lower admission to dialysis (OR 0.14 CI 0.02-0.8 p=0.02) and mortality (p=0.04). There were no significant differences with respect to FFS. Conclusions: in our study, the presence of RF in patients with ANCA vasculitis was associated with a lower requirement for dialysis and lower mortality. These findings were not statistically correlated with the FFS. No association was found between the presence of RF and organ involvement, disease activity, or mechanical ventilation requirement.

Contribución de fósforo y PTH al desarrollo de hipertrofia y fibrosis cardíaca en un modelo experimental de insuficiencia renal crónica / Contribution of phosphorus and PTH to the development of cardiac hypertrophy and fibrosis in an experimental model of chronic renal failure

Antecedentes y objetivo: Mantener niveles adecuados de fósforo sérico en el paciente con enfermedad renal crónica es fundamental para su correcto manejo clínico. Sin embargo resulta difícil su control de forma aislada porque normalmente se asocian con aumentos séricos de hormona paratiroidea (PTH). En el presente estudio se analizaron los efectos de la hiperfosfatemia aislada, en presencia de PTH elevada y normal, sobre la inflamación, hipertrofia y fibrosis cardíaca en un modelo de insuficiencia renal experimental. Materiales y métodos: Se formaron cuatro grupos de ratas. A dos grupos se les realizó paratiroidectomía total (PTx). A las ratas con Ca < 7,5 mg/dL y PTH < 50 pg/mL se les realizó nefrectomía 7/8 (IRC) y se les colocó un pellet subcutáneo que libera PTH 1-34 (5 μg/kg/día). Un grupo recibió dieta con P normal (PN) (grupo IRC + PTx + rPTH + PN) y otro dieta con P alto (0,9% PA) (grupo IRC + PTx + rPTH + PA). Otros dos grupos que solo tenían IRC recibieron dieta PN (IRC + PN) y PA (IRC + PA). Se añadió también un grupo SHAM para nefrectomía y paratiroidectomía. Tras 14 semanas las ratas fueron sacrificadas. Resultados: Los grupos con dieta alta en fósforo (IRC + PA e IRC + PTx + rPTH + PA) tuvieron una reducción significativa del aclaramiento de creatinina y también del peso corporal, con un aumento del fósforo sérico independientemente de la paratiroidectomía, pero no así con los niveles séricos de calcio, FGF23 y de calcitriol que fueron 2-3 veces superiores en el grupo con hiperparatiroidismo secundario (IRC + PA). El diámetro de los cardiomiocitos fue superior en el grupo IRC + PA, mientras la paratiroidectomía (IRC + PTx + rPTH + PA) los redujo significativamente, a pesar de los elevados y similares valores de fósforo sérico. El TNF-α, Adam17 y la fibrosis cardíaca a nivel histológico y molecular mostraron un patrón similar con aumentos en el grupo con hiperparatiroidismo secundario severo (IRC + PA). (AU)

Background and objective: Adequate serum phosphorus levels in patients with chronic kidney disease is essential for their clinical management. However, the control of hyperphosphatemia is difficult because is normally associated with increases in serum PTH. In the present study, the effects of hyperphosphatemia, in the presence of elevated and normal PTH, on cardiac inflammation, hypertrophy and fibrosis in an experimental renal failure model were analyzed. Materials and methods: Four groups of rats were formed. Two groups underwent total parathyroidectomy (PTx). Rats with Ca < 7.5 mg/dL and PTH < 50 pg/mL underwent 7/8 nephrectomy (CRF) and a subcutaneous pellet was placed that releases PTH 1-34 (5 μg/kg/day). One group received a diet with normal P (NP) (CRF + PTx + rPTH + NP group) and another with a high P diet (0.9% HP) (CRF + PTx + rPTH + HP group). Other two groups that only had CRF received NP (CRF + NP) and HP (CRF + HP) diet. A SHAM group for nephrectomy and parathyroidectomy was also added. After 14 weeks the rats were sacrificed. Results: The groups with a diet high in phosphorus (CRF + H A and CRF + PTx + rPTH + HP) had a significant reduction in creatinine clearance and also in body weight with an increase in serum phosphorus regardless of parathyroidectomy, but not serum levels of calcium, FGF23 and calcitriol that were 2-3 times higher in the group with secondary hyperparathyroidism (CRF + HP). The diameter of the cardiomyocytes was greater in the CRF + HP group, while parathyroidectomy (CRF + PTx + rPTH + HP) significantly reduced them, despite the high and similar serum phosphorus values. TNF-α, Adam17 and cardiac fibrosis at the histological and molecular level showed a similar pattern with increases in the group with severe secondary hyperparathyroidism (CRF + HP). (AU)

Factores asociados a la nefropatía inducida por medios de contraste en pacientes con oclusión coronaria significativa / Contrast-induced nephropathy associated factors in patients with significant coronary obstruction

El intervencionismo coronario se asocia a la aparición de nefropatía inducida por contraste. El propósito del estudio fue evaluar el riesgo de desarrollar nefropatía inducida por contraste (NIC) en pacientes con obstrucción coronaria significativa y su relación con factores de riesgo conocidos para esta nefropatía. Se diseñó un estudio de cohorte prospectiva con 160 pacientes atendidos en el cardiocentro del hospital "Hermanos Ameijeiras", Cuba, a los cuales se les realizó una coronariografía invasiva, entre enero 2016 y julio 2017. La edad promedio fue de 61,6 ± 9,2 años; el 70,6% eran hombres. Predominaron los antecedentes patológicos personales de cardiopatía isquémica (85,6%), y de hipertensión arterial (75,6%). El 75% de los casos presentó una oclusión coronaria significativa. La frecuencia de nefropatía por contraste fue de 42,5%. Los factores que guardaron importante relación estadística con la presencia de oclusión arterial significativa fueron la cardiopatía isquémica conocida (p<0,001), el intervencionismo coronario percutáneo previo (p=0,007), la creatinina después (p=0,043) y la NIC (p=0,016) así como el volumen de contraste administrado (p=0,006). En el subgrupo de pacientes con oclusión significativa el hematocrito bajo (p=0,025) y el intervencionismo coronario percutáneo de urgencia (p=0,007) fueron los factores más influyentes. Se concluye que los pacientes con oclusión coronaria significativa tienen un riesgo aumentado para el desarrollo de la nefropatía por contraste. La corrección de aquellos factores de riesgo que sean modificables (como el hematocrito bajo) y la correcta aplicación del protocolo de hidratación son esenciales para prevenir esta complicación.

Coronary intervention is associated with the appearance of contrast-induced nephropathy. The purpose of the study was to assess the risk of developing contrast-induced nephropathy in patients with significant coronary obstruction and its relationship with known risk factors for this nephropathy. A prospective cohort study was designed with 160 patients treated at the cardiocenter of the "Hermanos Ameijeiras" hospital, Cuba, who underwent invasive coronary angiography, between January 2016 and July 2017. The average age was 61.6 ± 9 ,2 years; 70.6% were men. The personal pathological history of ischemic heart disease (85.6%) and arterial hypertension (75.6%) predominated. 75% of the cases presented a significant coronary occlusion. The frequency of contrast nephropathy was 42.5%. The factors that had an important statistical relationship with the presence of significant arterial occlusion were known ischemic heart disease (p <0.001), previous percutaneous coronary intervention (p = 0.007), creatinine after the procedure (p = 0.043) and CIN (p = 0.016) as well as the volume of contrast administered (p = 0.006). In the subgroup of patients with significant occlusion, low hematocrit (p = 0.025) and emergency percutaneous coronary intervention (p = 0.007) were the most influential factors. It is concluded that patients with significant coronary occlusion have an increased risk for the development of contrast nephropathy. The correction of those risk factors that are modifiable (such as low hematocrit) and the correct application of the hydration protocol are essential to prevent this complication

Contribution of phosphorus and PTH to the development of cardiac hypertrophy and fibrosis in an experimental model of chronic renal failure. / Contribución de fósforo y PTH al desarrollo de hipertrofia y fibrosis cardíaca en un modelo experimental de insuficiencia renal crónica.

BACKGROUND AND OBJECTIVE: Adequate serum phosphorus levels in patients with chronic kidney disease is essential for their clinical management. However, the control of hyperphosphatemia is difficult because is normally associated with increases in serum PTH. In the present study, the effects of hyperphosphatemia, in the presence of elevated and normal PTH, on cardiac inflammation, hypertrophy and fibrosis in an experimental renal failure model were analyzed. MATERIALS AND METHODS: Four groups of rats were formed. Two groups underwent total parathyroidectomy (PTx). Rats with Ca < 7.5 mg/dL and PTH < 50 pg/mL underwent 7/8 nephrectomy (CRF) and a subcutaneous pellet was placed that releases PTH 1-34 (5 µg/kg/day). One group received a diet with normal P (NP) (CRF + PTx + rPTH + NP group) and another with a high P diet (0.9% HP) (CRF + PTx + rPTH + HP group). Other two groups that only had CRF received NP (CRF + NP) and HP (CRF + HP) diet. A SHAM group for nephrectomy and parathyroidectomy was also added. After 14 weeks the rats were sacrificed. RESULTS: The groups with a diet high in phosphorus (CRF + H A and CRF + PTx + rPTH + HP) had a significant reduction in creatinine clearance and also in body weight with an increase in serum phosphorus regardless of parathyroidectomy, but not serum levels of calcium, FGF23 and calcitriol that were 2-3 times higher in the group with secondary hyperparathyroidism (CRF + HP). The diameter of the cardiomyocytes was greater in the CRF + HP group, while parathyroidectomy (CRF + PTx + rPTH + HP) significantly reduced them, despite the high and similar serum phosphorus values. TNF-α, Adam17 and cardiac fibrosis at the histological and molecular level showed a similar pattern with increases in the group with severe secondary hyperparathyroidism (CRF + HP). CONCLUSIONS: Hyperphosphatemia confirmed its importance in the genesis of secondary hyperparathyroidism, but also of kidney damage that was independent of PTH levels. However, inflammation, fibrosis, and cardiomyocyte growth were more closely related to PTH levels, since in the presence of similar severe hyperphosphatemia, parathyroidectomy reduced the values of inflammatory parameters, cardiac hypertrophy, and fibrosis.

Contribution of phosphorus and PTH to the development of cardiac hypertrophy and fibrosis in an experimental model of chronic renal failure.

BACKGROUND AND OBJECTIVE: Adequate serum phosphorus levels in patients with chronic kidney disease is essential for their clinical management. However, the control of hyperphosphatemia is difficult because is normally associated with increases in serum PTH. In the present study, the effects of hyperphosphatemia, in the presence of elevated and normal PTH, on cardiac inflammation, hypertrophy and fibrosis in an experimental renal failure model were analyzed. MATERIALS AND METHODS: 4 groups of rats were formed. Two groups underwent total parathyroidectomy (PTx). Rats with Ca <7.5 mg/dL and PTH < 50 pg/mL underwent 7/8 nephrectomy (CRF) and a subcutaneous pellet was placed that releases PTH 1-34 (5 µg/kg/day). One group received a diet with normal P (NP) (CRF + PTx + rPTH + NP group) and another with a high P diet (0.9% - HP) (CRF + PTx + rPTH + HP group). Other 2 groups that only had CRF received NP (CRF + NP) and HP (CRF + HP) diet. A SHAM group for nephrectomy and parathyroidectomy was also added. After 14 weeks the rats were sacrificed. RESULTS: The groups with a diet high in phosphorus (CRF + H A and CRF + PTx + rPTH + HP) had a significant reduction in creatinine clearance and also in body weight with an increase in serum phosphorus regardless of parathyroidectomy, but not serum levels of calcium, FGF23 and calcitriol that were 2-3 times higher in the group with secondary hyperparathyroidism (CRF + HP). The diameter of the cardiomyocytes was greater in the CRF + HP group, while parathyroidectomy (CRF + PTx + rPTH + HP) significantly reduced them, despite the high and similar serum phosphorus values. TNF-α, Adam17 and cardiac fibrosis at the histological and molecular level showed a similar pattern with increases in the group with severe secondary hyperparathyroidism (CRF + HP). CONCLUSIONS: Hyperphosphatemia confirmed its importance in the genesis of secondary hyperparathyroidism, but also of kidney damage that was independent of PTH levels. However, inflammation, fibrosis, and cardiomyocyte growth were more closely related to PTH levels, since in the presence of similar severe hyperphosphatemia, parathyroidectomy reduced the values ​​of inflammatory parameters, cardiac hypertrophy, and fibrosis.

Monographic consultation of onconephrology. Rationale and implementation.

The increase in demand for medical care for renal complications associated with neoplastic diseases is a reality in most nephrology departments. In response to this overall situation, the creation of healthcare models such as monographic consultations and develop training programs in Onconephrology could improve the care of these patients. Through an exploratory and descriptive study, we identified current situation of kidney involvement in cancer patients. The objective of the present study is to establish the criteria for specific assistance in the field of Onconephrology. For this, we have reviewed key aspects and analyzed the current situation in our country, through a survey addressed to all nephrologists through the Spanish Society of Nephrology., together with the experience of two Spanish centers. From this information, we have established some requirements and recommendations for the start-up of these consultations.

Monographic consultation of onconephrology. Rationale and implementation. / Consulta monográfica de onconefrología. Justificación y puesta en marcha.

The increase in demand for medical care for renal complications associated with neoplastic diseases is a reality in most nephrology departments. In response to this overall situation, the creation of healthcare models such as monographic consultations and develop training programs in onconephrology could improve the care of these patients. Through an exploratory and descriptive study, we identified current situation of kidney involvement in cancer patients. The objective of the present study is to establish the criteria for specific assistance in the field of onconephrology. For this, we have reviewed key aspects and analyzed the current situation in our country, through a survey addressed to all nephrologists through the Spanish Society of Nephrology, together with the experience of 2 Spanish centers. From this information, we have established some requirements and recommendations for the start-up of these consultations.

Dano histológico renal em modelo experimental de hipertrofia ventricular direita induzida por monocrotalina / Renal histological damage in an experimental model of monocrotalin-induced right ventricular hypertrophy

Monocrotalina, alcalóide tóxico obtido de plantas do gênero crotalaria, pode ter potencial efeito tóxico em órgãos do corpo humano, como rins, pulmões, coração, fígado e outros efeitos. O objetivo deste estudo foi avaliar o dano renal causado pela exposição à monocrotalina. Trata-se de estudo experimental em ratos divididos em 4 grupos, um dos quais recebeu injeção de soro fisiológico e os outros três inoculação de monocrotalina, com tempos diferentes para sacrifício; subsequentemente, estudo histológico foi feito a fim de evidenciar as lesões renais. Em conclusão, constatou-se que houve lesão renal. Contudo, não foi possível afirmar o mecanismo exato responsável por elas, ou seja, se foram decorrentes da ação tóxica direta da monocrotalina, ou se, também, esteve relacionado a outros fatores sistêmicos.

Monocrotaline, a toxic alkaloid obtained from plants of the Crotalaria genus, may have a potential toxic effect on human body organs, such as kidneys, lungs, heart, liver and other effects. The aim of this study was to evaluate the kidney damage caused by exposure to monocrotaline. This is an experimental study in rats divided into 4 groups, one of which received saline injection and the other three received monocrotaline inoculation, with different times for sacrifice; subsequently, a histological study was performed in order to evidence renal lesions. In conclusion, it was found that there was kidney damage. However, it was not possible to state the exact mechanism responsible for them, that is, if they were due to the direct toxic action of monocrotaline, or if it was also related to other systemic factors.

Morbilidad y mortalidad por disfunción renal aguda en la unidad de terapia intensiva del Hospital General Docente Dr. Agostinho Neto / Morbidity and mortality for acute kidney failure in the intensive care unit of the General Teaching Hospital ¨Dr. Agostinho Neto¨

RESUMEN Introducción: En el Hospital General Docente "Dr. Agostinho Neto", de Guantánamo, no se ha caracterizado la problemática del daño renal agudo en la unidad de terapia intensiva. Objetivo: caracterizar esta afección en pacientes ingresados en la citada unidad en el periodo 2018-2019. Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal, aprobado por el comité de ética. El universo de estudio se constituyó por el total de pacientes con este diagnóstico según la clasificación Acute Kidney Injury Network (AKIN). Se estudiaron las características de los pacientes (edad, sexo, comorbilidad, etiología, estadía en la unidad de terapia intensiva, necesidad de hemodiálisis, estado al egreso) y del daño renal agudo (estadio según los criterios de la escala AKIN). Resultados: En el 35,6 % de los pacientes se diagnosticó esta enfermedad, sobre todo en hombres (56,7 %) y con edad de 66,3 ± 24,3 años. El 41,4 % padeció hipertensión arterial sistémica. En el 48,9 % la enfermedad se presentó un en estadio 1, y en el 69,4 % la sepsis fue la principal causa. La mortalidad al egreso hospitalario fue de 16,4 %, y a los 30 días fue de 25,4 %. Se realizó hemodiálisis al 13,8 % de los pacientes, en los que el riesgo de muerte fue superior. Conclusiones: En la unidad de terapia intensiva es elevada la proporción de pacientes con daño renal agudo y resulta útil la escala que se utilizó para el diagnóstico y la evaluación de la gravedad y el pronóstico de los pacientes afectados.

ABSTRACT Introduction: Acute kidney injury in the intensive care unit in the General Teaching Hospital ¨Dr. Agostinho Neto¨ in Guantanamo has not been characterized. Objective: To characterize this disease in patients in the intensive care unit in the mentioned institution in the period 2018-2019. Method: A descriptive, retrospective and longitudinal study was undertaken, all approved by the ethics committee. The study population was made out of the total amount of the patients diagnosed according to the classification of the Acute Kidney Injury Network (AKIN). The variables taken into account were: age, gender, comorbidity, etiology, time in the intensive care unit, requirement for hemodialysis and status of the patient at the time of discharge, plus the stages of the acute kidney injury according to the AKIN scale. Results: Acute kidney injury was diagnosed in the 35.6% of the patients, especially in male patients (56.7%) with ages between 66.3 ± 24.3 years. 41.4% of the patients suffered of systemic arterial hypertension. Stage 1 was found in the 48.9% of the cases, and sepsis was the main cause in 69.4%. Mortality at the time of discharge represented the 16.4%; and after the following 30 days went up to 25.4%. Hemodialysis was required in the 13.8% of the patients; in wich the risk of death was significatively higher. Conclusions: There is a high number of patients with acute kidney injury in the intensive care unit, and it was really useful the scale implemented for diagnosis and evaluation of the severity of the condition and the prognosis of the patients.

Consumption of avocado oil (Persea americana) improves the biochemical profile of rats submitted to long-term androgenic stimulation.

INTRODUCTION: Introduction: indiscriminate use of anabolic steroids is associated with cardiovascular diseases, renal damage, and hepatic toxicity. Contrastingly, nutraceutical foods such as avocados prevent and control several diseases, as they can reduce the effects of oxidative stress. Objective: this study evaluates the benefits of consuming an avocado oil-based diet to attenuate the systemic damage caused by supraphysiological doses of testosterone, by analyzing the biochemical profile of 28 42-day-old male Wistar rats. Methods: silicone pellets containing testosterone were surgically implanted, and they received control or avocado oil-based feed. After 20 weeks, all the male rats were anesthetized and their blood samples collected. Results: although the high hormone concentration had a negative influence on the biochemical profile of these animals, the groups that consumed avocado oil exhibited a reduction in serum triacylglycerols (-21 %; p = 0.0001), VLDL (-20 %; p = 0.0085), LDL (-78 %; p < 0.0001), and total cholesterol (-12 %; p < 0.0001), along with positive changes in their HDL concentrations (+7 %; p = 0.001). The avocado oil groups also manifested a reduction in the total concentration of serum proteins (-24 %; p = 0.0357), albumin (-26 %; p = 0.0015), urea (-14 %; p = 0.04), and creatinine (-33 %; p < 0.0001). The concentration of liver transaminases was found to be higher in the animals included in the induced group (ALT, +66 %; p = 0.0005, and AST, +23 %; p = 0.0021), whereas they remained stable in the avocado oil group. Conclusion: from the above, it may be concluded that supraphysiological doses of testosterone are related to increased risk factors for cardiovascular, renal, and hepatic diseases, and that the consumption of avocado oil shields the biochemical profile, thus reducing the associated risk factors.

INTRODUCCIÓN: Introducción: el uso indiscriminado de esteroides anabólicos se asocia con enfermedades cardiovasculares, daño renal y toxicidad hepática. En cambio, los alimentos nutracéuticos como el aguacate previenen y controlan varias enfermedades, ya que pueden reducir los efectos del estrés oxidativo. Objetivo: este estudio evalúa los beneficios de consumir una dieta basada en aceite de aguacate para atenuar el daño sistémico causado por dosis suprafisiológicas de testosterona mediante el análisis del perfil bioquímico de 28 ratas Wistar macho de 42 días de edad. Métodos: se implantaron quirúrgicamente perdigones de silicona que contenían propionato de testosterona y los animales recibieron una alimentación de control o una basada en el aceite de aguacate. Después de 20 semanas se anestesiaron todos los animales y se recogieron sus muestras de sangre. Resultados: aunque la alta concentración de hormonas tuvo una influencia negativa en el perfil bioquímico de estos animales, los grupos que consumieron aceite de aguacate mostraron una reducción de los triglicéridos séricos (-21 %; p = 0,0001), las VLDL (-20 %; p = 0,0085), las LDL (-78 %; p < 0,0001) y el colesterol total (-12 %; p < 0,0001), con cambios positivos en las LDL (+7 %; p = 0,001). Los grupos alimentados con aceite de aguacate manifestaron una reducción de la concentración total de proteínas séricas (-24 %; p = 0,0357), albúmina (-26 %; p = 0,0015), urea (-14 %; p = 0,04) y creatinina (-33 %; p < 0,0001). Se encontró que la concentración sérica de transaminasas hepáticas era mayor en los animales del grupo inducido (ALT: +66 %; p = 0,0005, y AST: +23 %; p = 0,0021), mientras que en los grupos con aceite de aguacate, los parámetros hepáticos se mantuvieron estables. Conclusión: de todo ello se puede concluir que las dosis suprafisiológicas de testosterona están relacionadas con un aumento de los factores de riesgo de sufrir enfermedades cardiovasculares, renales y hepáticas, y que el consumo de aceite de aguacate protege el perfil bioquímico, lo que reduce los factores de riesgo asociados.

Daño renal agudo en pacientes con ventilación mecánica invasiva, Guantánamo 2018-2019 / Acute kidney injury in patients with invasive mechanical ventilation in Guantanamo, 2018-2019

RESUMEN Introducción: El daño renal agudo es una complicación frecuente en las Unidades de Terapia Intensiva, sobre todo en pacientes con ventilación mecánica. Objetivo: Caracterizar el daño renal agudo en los pacientes tratados con ventilación mecánica invasiva en la Unidad de Terapia Intensiva del Hospital General Docente "Dr. Agostinho Neto" durante el periodo 2108-2019. Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal, que se aprobó por el Comité de Ética. El universo de estudio se constituyó por el total de pacientes con este diagnóstico según la clasificación Acute Kidney Injury Network (AKIN). Se estudiaron las características de los pacientes (necesidad y duración de la VAM, necesidad de hemodiálisis, estado al egreso) y del daño renal agudo (estadio y etiología). Resultados: El 47,5 % de los pacientes tratados con este soporte vital presentó un daño renal agudo, sobre todo los que la demandaron por siete o más días (68,4 %). El riesgo de muerte fue superior en los pacientes que requirieron ventilación mecánica o hemodiálisis. En los pacientes con daño renal estadio 2 y 3 de la clasificación que se utilizó presentaron un riesgo tres veces o más superior comparado con los que no necesitaron estas terapias. La sepsis (69,4 %) fue la principal causa del daño renal agudo. Conclusiones: El uso de ventilación mecánica invasiva y la presentación de un daño renal agudo son condiciones con una fuerte asociación, juntas y separadas se correlacionan con la mortalidad.

ABSTRACT Introduction: Acute kidney injury is a very common complication in the intensive care units, especially in patients with invasive mechanical ventilation. Objective: To characterize acute kidney damage in patients with invasive mechanical ventilation in the intensive care unit at the General Teaching Hospital ¨Dr. Agostinho Neto¨ within the period 2018-2019. Method: A descriptive, retrospective and longitudinal study approved by the Ethics Committee was carried out. The study population was constituted by the total of patients with the diagnosis, according to the Acute Kidney Injury Network (AKIN). Characteristics and variables like: reason for the invasive mechanical ventilation, its duration, hemodialysis, and status of the patient at time of discharge were taken into account, along with the characteristics of the kidney injury (stages and etiology). Results: 47.5 % of the patients treated with life support showed acute kidney injury, especially the ones with more than a week of mechanical ventilation (68.4 %). The risk of death was higher in the patients with mechanical ventilation and hemodialysis. In the patients with stage 2 and 3 of the scale used for kidney injury presented 3 times more risk compared to those who did not require these treatments. Sepsis was the main cause of acute kidney injury (69.4 %). Conclusions: the use of invasive mechanical ventilation and acute kidney injury are deeply related to each other, both of them constitute main issues in the variables of mortality.

Ameliorative effect of vitamin E on biochemical and ultrastructural changes in artemether-induced renal toxicity in rats / Efecto paliativo de la vitamina E sobre los cambios bioquímicos y ultraestructurales en la toxicidad renal inducida por arteméter en ratas

This experiment was designed to study the administration of normal doses of one of recent antimalarial drug and coadministration of vitamin E on the kidney tissue. A total twenty-four adult male albino rats were used and divided into four groups: the first one served as a control, the second received artemether orally for three days consecutively. The rats of the third and fourth groups received the same dose of artemether concomitantly with 50 and 100 mg/kg vitamin E orally daily for 2 weeks. After the last dose, the rats were sacrificed and the kidney tissues with blood samples obtained and processed for light, electron microscopic and biochemical analysis. Histologically, artemether treated kidneys showed atrophied glomeruli with widened urinary space and kidney tubules were degenerated with disturbed contour and some vacuoles inside it. Ultrastructurally, the glomeruli of this group showed hypertrophic endothelial cells, irregularity of its basement membrane, disrupted foot processes and filtration slits. The kidney tubule cells showed loss of basal infoldings, cytoplasmic vacuolation, polymorphic damaged swollen mitochondria a loss of its microvilli towards its capillary lumen. Artemether plus vitamin E of the rat kidney groups showed improvement of morphological changes compared to the changes seen in artemether alone. These data were confirmed by biochemical findings with marked improvement of blood urea and creatinine levels and increase of anti-oxidant enzyme activities of glutathione peroxidase and superoxide dismutase in the vitamin E treated groups. The results of this study revealed that vitamins E can improve the adverse changes of artemether of rat renal tissue.

Este proyecto fue diseñado para estudiar la administración de dosis normales de uno de los medicamentos antipalúdicos y de la administración de vitamina E en el tejido renal. Se utilizaron 24 ratas albinas machos adultas divididas en cuatro grupos: el primero sirvió como control, el segundo recibió arteméter por vía oral durante tres días consecutivos. Las ratas del tercer y cuarto grupos recibieron la misma dosis de arteméter concomitantemente con 50 y 100 mg / kg de vitamina E por vía oral diariamente durante 2 semanas. Después de la última dosis, las ratas fueron sacrificadas y se obtuvo el tejido renal de cada muestra los cuales fueron procesados para análisis con microscopías de luz y electrónica, además de exámenes bioquímicos. Histológicamente, los riñones tratados con arteméter mostraron atrofia glomerular con espacio urinario ensanchado y túbulos renales degenerados con contorno alterado y algunas vacuolas en su interior. Ultraestructuralmente, los glomérulos de este grupo mostraron células endoteliales hipertróficas, irregularidad de su membrana basal, procesos alterados del pie y hendiduras de filtración. Las células del túbulo renal mostraron pérdida de inflexiones basales, vacuolación citoplasmática, mitocondrias dañadas y pérdida de sus microvellosidades hacia la luz capilar. Arteméter más vitamina E en los grupos de riñón de rata mostraron una mejora de los cambios morfológicos, en comparación con los cambios observados en arteméter solamente. Estos datos fueron confirmados por hallazgos bioquímicos con una marcada mejoría de los niveles de urea y creatinina en sangre y un aumento de las actividades enzimáticas antioxidantes de la glutatión peroxidasa y la superóxido dismutasa en los grupos tratados con vitamina E. Los resultados de este estudio revelaron que la vitamina E puede mejorar los cambios adversos del arteméter del tejido renal de la rata.

Assessment of renal function in obese and overweight children with NGAL and KIM-1 biomarkers.

INTRODUCTION: Aim and background: the incidence of obesity has increased among children, and obesity has been considered an independent risk factor for chronic kidney disease. We aimed to determine the degree of kidney function impairment by evaluating urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) levels. Materials and methods: in total, 15 obese, 26 overweight, and 26 control adolescents aged 10 to 16 years were enrolled into the study. Urine samples were evaluated for NGAL and KIM-1 levels using enzyme-linked immunosorbent assay kits. We investigated the association between obesity and related comorbidities with urinary NGAL and KIM-1 excretion. Results: no significant differences were noted between the obese, overweight, and control groups in urinary NGAL and KIM-1 excretion (p = 0.327 and p = 0.917, respectively). In the obese and overweight groups urinary NGAL levels were 50.39 [30.88-74.22] in females and 26.67 [23.24-45.59] in males (p = 0.013). Also, urinary NGAL levels were increased in obese and overweight adolescents with LDL dyslipidemia at 64.12 [30.98-114.32] as compared to those without LDL dyslipidemia: 39.51 [25.59.56.37] (p = 0.024). Furthermore, a correlation was observed between insulin and homeostasis model assessment of insulin resistance levels with the NGAL/creatinine ratio in the overweight group (r = 0.515; p = 0.008, and r = 0.483; p = 0.014, respectively). Such correlation was not found in the obese group. Conclusion: the effect of obesity on renal function could not be determined in children. A longer exposure may be required for obesity-induced disruption of renal function in children. Renal function may be disrupted by dyslipidemia in obese adolescents. Furthermore, obesity impaired renal function in female adolescents. The normalization of these urinary markers as related to urine creatinine should be discussed.

INTRODUCCIÓN: Introducción: la incidencia de la obesidad en la edad infantil ha aumentado. Se considera la obesidad como un factor de riesgo independiente para el desarrollo de la enfermedad renal crónica. El objetivo de este estudio fue valorar el grado de alteración de la función renal evaluando los niveles urinarios de NGAL y KIM-1. Material y métodos: el estudio incluyó a 15 adolescentes con obesidad, 26 con sobrepeso y 26 controles sanos.Edades de los participantes entre los 10 y los 16 años. Los niveles de NGAL y KIM-1 en orina se determinaron mediante kit ELISA. Se investigó asociación entre obesidad y su comorbilidad con excreción urinaria de NGAL y KIM-1. Resultados: no se encontraron diferencias significativas en la excreción urinaria de NGAL y KIM-1 entre los sujetos con obesidad, los sujetos con sobrepeso y los controles sanos (p = 0,327 y 0,917, respectivamente). En el grupo con sobrepeso y obesidad, los niveles de NGAL en las niñas fueron de 50,39 (30,88-74,22), mientras que en los niños fueron de 26,67 (23,24-45,59) (p = 0,013). Para los sujetos con dislipemia de LDL, el nivel de NGAL fue de 64,12 (30,98-114,32) frente a 39,5 (25,59-56,37) entre los que no la tenían (p = 0,024). Se encontró correlación entre los nivles de insulina, el HOMA-IR y la ratio NGAL/creatinina en el grupo con sobrepeso (r = 0,515; p = 0,008, y r = 0,483; p = 0,014, respectivamente). En el grupo con obesidad no se encontró dicha correlación. Conclusiones: se precisa una duración más prolongada para encontrar alterada la función renal en los niños con exceso de peso. La función renal puede alterarse por la dislipemia en el caso de los adolescentes con obesidad. La función renal se afecta más en las adolescentes femeninas.