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Resumen Fundamento y objetivo Describir nuestra cohorte de pacientes con nefritis lupica mesangial proliferativa y su seguimiento a largo plazo, con especial atencion a los factores de mal pronostico. Pacientes y metodo Se evaluaron 27 pacientes de forma retrospectiva y controlados en el Servicio de Medicina Interna del Hospital Universitario de Bellvitge entre 1974 y 2010. Se realizo un control al ano, a los 3 y a los 5 anos de la biopsia. Resultados Habia 22 mujeres (81,5%), con una edad media (DE) en el momento del diagnostico de la nefritis de 34,83 (13,45) anos. Al ano de la biopsia 21 pacientes habian alcanzado la remision parcial o completa (80,77%) y a los 5 anos de control 21 pacientes (77,77%) estaban en remision. Cuatro pacientes sufrieron transformacion a otra clase histologica. Recidivaron 7 pacientes (29,63%). En estos 36 anos de seguimiento fallecieron 7 pacientes, 3 de ellos por causas relacionadas con el lupus eritematoso sistemico. Conclusiones El factor pronostico mas claramente relacionado con una mala respuesta es el inicio de la nefritis por encima de los 45 anos, por lo que se deberia valorar el uso de inmunodepresores de entrada asociados a glucocorticoides en estos pacientes.

Fundamento y objetivo El tratamiento combinado de la hepatitis cronica por el virus de la hepatitis C con interferon α-2b mas ribavirina es el mas adecuado hoy dia tanto en pacientes coinfectados con el virus de la inmunodeficiencia humana (VIH) como en los que no lo estan. En un intento de evitar efectos secundarios a los pacientes y costes sanitarios al Estado, se esta buscando indicadores de respuesta virologica precoz (RVP). En este estudio se pretende valorar la eficacia de la RVP a las 4 y 12 semanas del inicio del tratamiento combinado. Pacientes y metodo Se ha estudiado a 127 pacientes consecutivos con hepatitis cronica por el virus C que recibieron tratamiento combinado durante 12 meses en los genotipos 1 y 4, y durante 6 meses en los genotipos 2 y 3. De ellos, 62 estaban coinfectados por el VIH y 65 no presentaban coinfeccion. Se valoraron la respuesta virologica sostenida al final del seguimiento y la RVP a las 4 y 12 semanas del inicio del tratamiento. Resultados La respuesta virologica sostenida fue mayor en ambos grupos para los genotipos 2 y 3. En los genotipos 1 y 4 fue mayor en el grupo de los no coinfectados que en el de los coinfectados. La RVP tuvo un valor predictivo negativo del 100% en ambos grupos a las 12 semanas de tratamiento para los genotipos 1 y 4, y disminuyo a un 79% cuando se valoro a las 4 semanas. En los genotipos 2 y 3 no se observaron diferencias. Conclusiones La RVP a las 12 semanas del inicio del tratamiento tiene un valor predictivo negativo del 100% tanto en coinfectados como en no coinfectados por el VIH. El cumplimiento del tratamiento es un valor predictivo de respuesta a este.

To describe our cohort of 27 biopsy-proven patients and their long-term follow-up, with special attention to prognostic factors.Twenty seven patients were retrospectively collected. They were controlled in the Internal Medicine Department of the Bellvitge's Hospital (Spain) between 1974 and 2010. Evaluation was performed at one, 3 and 5 year follow-up.There were 22 women (81.5%). Mean age at onset of nephritis was 34.83 years (SD 13.45). Partial or complete remission was achieved by 21 patients (80.77%) in the one-year follow-up, 22 patients (84.61%) in the third-year follow-up and 21 patients (77.77%) in the fifth-year follow-up. A change in the histology class was diagnosed in 4 patients. Seven patients suffered flares of nephritis. Seven patients died in the long term follow-up, 3 out of this 7 died because of systemic erythematosus lupus.Nephritis onset beyond 45 years old is the factor mostly related with a poor prognosis. That is the reason why we recommend co-therapy with immunosuppressors from the beginning in such patients.

In order to analyze the prevalence of hyponatremia in in-hospital elderly patients and its prognosis factor value, we performed a transversal prospective study in an Acute Geriatric Unit (AGU).Two hundred and sixty in-hospital patients were collected prospectively in an AGU. Sociodemographic and lab data were collected as well as the Barthel, Pfeiffer and Charlson tests. A questionnaire was performed in hospital. Hyponatremia was considered when the plasmatic sodium was ≤134 mmol/l.The sample consisted of 137 women (52.7%) and 123 men (47.3%). Mean age was 83.6 years (SD 7.9). Mean plasmatic sodium values were 137.3 mmol/l (range 112-168). Emergency lab tests showed 60 patients with hyponatremia (23.7%), 35 (13.6%) in the AGU. Cardiopulmonary were the most related diseases. Mean hospital length of stay was 12.8 days (SD 12.8). In-hospital mortality was 12.9%. We observed a statistic relationship between the presence of hyponatremia and a greater mean length of stay (15.53 vs 11.99 days, P=.003). No relationship was found between hyponatremia and mortality (15 vs 12.7%, P=.588).Hyponatremia in patients admitted in an AGU is a prevalent disorder related with a greater hospital length of stay, but not with mortality.

The most effective currently available therapy for chronic hepatitis C virus infection is the combination of interferon alpha-2b plus ribavirin both, in patients with human immunodeficiency virus (HIV) coinfection and in patients without coinfection. In an attempt to avoid morbidity and health costs we searched for an indicator of early virologic response (EVR). We evaluated the EVR efficiency at 4 and 12-weeks after the initiation of antiviral combination therapy.A total of consecutive 127 patients with chronic hepatitis C virus infection treated with combination therapy for 12 months in genotypes 1 and 4 and for 6 months in genotypes 2 and 3, were studied, 62 HIV-coinfected and 65 non-coinfected. They were evaluated for sustained virologic response and EVR at 4 and 12-weeks to initial therapy.Sustained virologic response was greater in the non-coinfected group than coinfected group; these differences were significant for genotypes 1 and 4. In both groups EVR had a 100% predictive negative value at 12-weeks after the initiation of therapy in genotypes 1 and 4, however came down in 79% at 4-weeks.The EVR at 12-weeks after the initiation of therapy has a 100% predictive negative value in coinfected and non-coinfected patients. Patient adherence to prescribed antiviral therapy is a predictive value of response.