The nephrologist's role in metformin-induced lactic acidosis.

Metformin is an antihyperglycemic agent commonly used in diabetic patients. It is very effective and is able to reduce the plasma glucose and HbA1C. However, in some patients, specially those with comorbidities, metformin can provoke severe lactic acidosis with high morbimortality. Treatment of the lactic acidosis induced by metformin is based on the use of supportive general measures; in severe cases, procedures of extrarrenal purification like hemodialysis or continuous hemodiafiltration have been successfully used.

Papel del nefrólogo en la acidosis láctica grave por metformina / The nephrologist's role in metformin-induced lactic acidosis

La metformina es un fármaco ampliamente utilizado en sujetos con diabetes mellitus y su eficacia para descender la glucemia y la hemoglobina A1C (HbA1C) es notable. Sin embargo, en algunos pacientes, sobre todo en los que presentan comorbilidades, puede provocar una acidosis láctica grave que origina una elevada morbimortalidad. El tratamiento de esta complicación se basa en la utilización de medidas de soporte y, en los casos más graves, en procedimientos de depuración extrarrenal, como la hemodiálisis o la hemodiafiltración continua (AU)

Metformin is an antihyperglycemic agent commonly used in diabetic patients. It is very effective and is able to reduce the plasma glucose and HbA1C. However, in some patients, specially those with comorbidities, metformin can provoke severe lactic acidosis with high morbimortality. Treatment of the lactic acidosis induced by metformin is based on the use of supportive general measures; in severe cases, procedures of extrarrenal purification like hemodialysis or continuous hemodiafiltration have been successfully used (AU)

Feocromocitoma con consecuencias fatales. ¿Qué podemos aprender de este caso? / Pheochromocytoma with fatal outcome. What can we learn from this case?

Describimos el caso de un paciente de 42 años que desarrolló shock cardiogénico con elevación de enzimas cardíacas y coronariografía normal, cuyo diagnóstico final fue feocromocitoma. El paciente tuvo una evolución tórpida con fracaso multiorgánico y necesidad de intubación orotraqueal, balón de contrapulsación y hemodiafiltración continua. Finalmente tuvo hematoma parenquimatoso cerebral con deterioro neurológico irreversible. Además destacamos el papel de la ecografía abdominal en el diagnóstico de feocromocitoma en pacientes críticos(AU)

The case of a 42-year old male patient diagnosed of adrenal pheochromocytoma who developed cardiogenic shock, with increased cardiac enzymes and normal coronary arteriography is described. The patient had a torpid clinical course with multiorgan failure and was treated with tracheal intubation, balloon contrapulsation and continuous hemodiafiltration. Finally, he had intracerebral hematoma with irreversible neurologic damage. We highlight the value of abdominal ultrasonography in the diagnosis of pheochromocytoma in critical patients(AU)

[Minimal changes nephrotic syndrome associated to penicillamine treatment]. / Síndrome nefrótico por cambios mínimos asociado a tratamiento con penicilamina.

We describe three patients with minimal change nephrotic syndrome associated with penicillamine treatment. Two patients had systemic sclerosis and one had rheumatoid arthritis. Cumulative dose of D-penicillamine was similar in all cases, and nephrotic syndrome appeared after 15-33 months of treatment. The drug was stopped and nephrotic syndrome disappeared in 2-4 months, suggesting a possible causal relationship between penicillamine and minimal change disease.

Diabetes insípida nefrogénica secundaria a nefritis intersticial crónica asociada a tratamiento con mesalazina

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[Autosomal dominant polycystic kidney disease. A comparative genetic and clinico-radiological study between patients with normal renal function and their healthy relatives]. / Enfermedad renal poliquística autosómica dominante. Estudio genético y clínico-radiológico comparativo entre los pacientes con función renal normal y sus familiares sanos.

We studied 6 families with autosomal dominant polycystic kidney disease (ADPKD), to compare patients with normal renal function and healthy family members. From 38 subjects, 20 were carried of the genetic abnormality associated to the disease (however, in 4 renal cysts were absent) and 18 were healthy relatives. We did not found any difference between the two groups in respect to clinical manifestations, physical examination or blood chemistry and renal function tests studied, except an increase of phosphaturia in ADPKD patients. However, an increase in kidney size in ADPKD was noted, more evident in hypertensive patients. The blood pressure was correlated with kidney size in patients with ADPKD, but not in healthy relatives. We conclude that in early stages of the disease, patients with ADPKD do not have clinical or analytical abnormalities although they have an increase in kidney size. Genetic studies have great value to detect patients in early stages of the disease.