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Background:X-linked hypophosphatemic rickets is a hereditary disease that generates alterations in bone mineral homeostasis. The morbidity of the condition has been variable in previous decades and even contradictory, probably due to the definition of the case and the diagnostic confirmation. Our propose was to generate evidence-informed recommendations for the diagnosis, treatment, and follow-up of patients with suspected or diagnosed XLHR. Results:After the screening and selection process for 1041 documents, 38 were included to answer the questions raised by the developer group. 97 recommendations about the diagnosis, treatment, and follow-up of patients with suspected or diagnosed XLHR were approved by the experts consulted through modified Delphi consensus. The quality of the evidence was low. Conclusions:The recommendations proposed here will allow early and timely diagnosis of X-linked hypophosphatemic rickets, while optimizing resources for its treatment and follow-up and help clarify the burden of disease and improve health outcomes for this population.

Background: X-linked hypophosphatemic rickets is a hereditary disease that generates alterations in bone mineral homeostasis. The morbidity of the condition has been variable in previous decades and even contradictory, probably due to the definition of the case and the diagnostic confirmation. Our propose was to generate evidence-informed recommendations for the diagnosis, treatment, and follow-up of patients with suspected or diagnosed XLHR. Results: After the screening and selection process for 1041 documents, 38 were included to answer the questions raised by the developer group. 97 recommendations about the diagnosis, treatment, and follow-up of patients with suspected or diagnosed XLHR were approved by the experts consulted through modified Delphi consensus. The quality of the evidence was low. Conclusions: The recommendations proposed here will allow early and timely diagnosis of X-linked hypophosphatemic rickets, while optimizing resources for its treatment and follow-up and help clarify the burden of disease and improve health outcomes for this population.

Background Atypical hemolytic uremic syndrome (aHUS) is a rare complement-mediated kidney disease with genetic predisposition and represents up to 10% of pediatric hemolytic uremic syndrome (HUS) cases. Few studies have evaluated aHUS in Latin American population. We studied a Colombian pediatric cohort to delineate disease presentation and outcomes.Methods A multicenter cohort of 27 Colombian children with aHUS were enrolled between 2010 to 2019. Patients were grouped by age at onset. Clinical features were compared using analysis of variance (ANOVA) and Fisher exact tests. Renal biopsy was performed on six patients who were suspected of having other renal diseases before aHUS diagnosis.Results Most patients were male (70%). The onset of aHUS occurred frequently before age 4 years (60%) and followed gastroenteritis as the main triggering event (52%). Age groups were comparable in clinical presentation, disease severity, treatment, and outcomes. Pulmonary involvement (67%) was the main extrarenal manifestation. A higher frequency was observed in the 1–7 age group (p = 0.01). Renal biopsies were as follows: three had membranoproliferative glomerulonephritis (MPGN) type I, one MPGN type III, one C3-glomerulonephritis, and one rapidly progressive glomerulonephritis. Genetic screening was available in five patients and identified 2xCFHR5, 2xMCP, and 1xADAMTS-13/THBD mutations. A total of 15 relapses were seen, of which 8 (72%) occurred in the 1–7 age group. The renal outcome was not significantly different regardless of age group.Conclusion In our cohort, we observed a relatively high frequency of extrarenal involvement at first presentation represented by pulmonary manifestations. The renal prognosis at initial presentation was worse than in previous reports.

Introduction Atypical hemolytic uremic syndrome (aHUS) is a rare and genetically mediated systemic disease most often caused by uncontrolled and chronic complement activation that leads to systemic thrombotic microangiopathy, renal and extra-renal damage. Materials and methods This is descriptive, retrospective and multicenter study, which reports demographic, clinical, laboratory, and genetic characteristics, as well as their treatment response and outcome of 20 aHUS patients diagnosed between 2014 and 2018. Results Most patients were female adults (75%) and 30% were associated to pregnancy/postpartum, 15% to autoimmune disease, and 65% to infections. Gastrointestinal involvement (75%) was the most frequent extra-renal organ damage. Antenatal mortality and mortality rate were 5% and 10%, respectively. 25% of the patients progressed to end-stage renal disease. In 4/8 of patients treated within 1 week of presentation, eculizumab treatment restored multi-organ function after 4 weeks of treatment. CFH (37%) and CFI (25%) mutations were the most frequent. Conclusion This is the first series of aHUS cases of Colombian Caribbean region which reports the clinical and epidemiological characteristics of this condition in this region.

Introduction Frailty is a multicausal syndrome characterized by a decrease in strength, resistance and physiological function, which makes the individual vulnerable and dependent, and increases his/her mortality. This syndrome is more prevalent among older individuals, and chronic kidney disease patients, particularly those on dialysis. Dialysis dose is currently standardized for hemodialysis (HD) patients regardless of their age and functional status. However, it has been postulated that the dialysis dose required in older patients, especially frail ones, should be lower, since it could increase their degree of frailty. Then, the purpose of this study was to evaluate if there would be a correlation between the dose of Kt/V and the degree of frailty in a population of adult patients on HD. Materials and methods A cross-sectional study with 82 patients on HD in Barranquilla (Colombia) and Lobos (Argentina) was conducted. Socio-demographic and laboratory data, as well as dialysis doses (Kt/V) were recorded and scales of fragility, physical activity, gait and grip strength were applied. Then these data were correlated by a Spearman’s correlation and a logistic regression. Results CFS, social isolation, physical activity, gait speed, and prehensile strength tests were outside the reference ranges in the studied group. No significant correlation was found between dialysis dose and all the above mentioned functional tests. However, a significant and inverse correlation between physical activity and CFS was documented (score − 1.41 (CI − 2.1 to − 0.7). Conclusion No significant correlation was documented between Kt/V value and different parameters of the frailty status, but this status correlated significantly and inversely with physical activity in this group. Frailty status in hemodialysis patients was significantly higher in older individuals, although young individuals were not exempt from it.

Introduction: Making an early diagnosis of acute kidney injury (AKI) is crucial. Classical biomarkers are not capable of early detection of AKI, but novel biomarkers that do have this capability are expensive and not universally available. This prospective study attempts to mitigate these limitations through the evaluation of daily urine analysis on patient admitted to a critical care unit in order to detect early AKI. Methods: Daily urinary indices were measured on every patient admitted to the intensive care unit (ICU) from the time of admission until his/her discharge from the ICU or death. This renal monitoring consisted of daily blood and spot morning urine samples in order to measure creatinine, urea, sodium, chloride and potassium in order to calculate the fractional excretion of sodium (FENa), chloride, urea and potassium. The data collected on these patients in the previous days was analyzed to determine whether or not there was a significant statistical difference in the urinary indices one day before the clinical diagnosis of AKI (day – 1) and 2 days before the diagnosis (day – 2). The statistical test applied was a single rank test, using as a limit of significance a value of P < 0.05. Results: Of the 203 patients included, 61 developed AKI. A statistical significant difference was documented only in the value of urinary sodium (UNa) and FENa between day-1 (one day before AKI clinical diagnosis) and day-2 (two days before AKI clinical diagnosis). Conclusion: Daily monitoring of UNa and FENa detected a significant change in their basal values 24 hours before clinical diagnosis of AKI was made.

This paper describes the main characteristics of coronavirus diseases 2019 (COVID-19) patients suffering from acute kidney injury (AKI) assisted at a high complexity clinic in Barranquilla, Colombia. The patients included in this study (n = 48) were those with a positive diagnosis of COVID-19 confirmed by polymerase chain reaction detection of severe acute respiratory syndrome coronavirus 2, who had developed AKI during their hospital stay. Serum and urine parameters, as well as patient's viral load and clinical frailty scale (CFS) were recorded. A statistical analysis of the recorded parameters, such as comparisons, and correlations between variables of interest, were explored. The prevalence of COVID-19 induced AKI was 41%, being the majority of them classified as AKI network classification 3, with a renal replacement therapy requirement of 29%, and an associated mortality of 73%. AKI patients' mortality showed a significant positive correlation (33%) with patients' CFS score but not with their viral load. COVID-19 induced AKI significantly correlated with patients' frailty status but not to their viral load.

La gastrostomía endoscópica percutánea (GEP), descrita por primera vez en la década de 1980, es un procedimiento universalmente utilizado para asegurar alimentación enteral en pacientes que conservan la función del tracto digestivo, pero que por alguna condición médica o quirúrgica no pueden ingerir alimentos sólidos o líquidos. La realización de GEP en pacientes con diálisis peritoneal (DP) sigue siendo controvertida, considerándose una contraindicación absoluta para muchos autores, teniendo en cuenta el alto riesgo de morbimortalidad asociada a infección intraperitoneal. Presentamos el caso de un paciente de 70 años, con antecedente de enfermedad renal crónica en estadío terminal portador de catéter de diálisis peritoneal, que requirió GEP; socializamos la estrategia utilizada en este caso particular.

Introducción: el hiperparatiroidismo primario se caracteriza por hipercalcemia y niveles elevados de hormona paratiroidea y se puede manifestar como tres fenotipos clínicos: clásico, asintomático y normocalcémico. Objetivo: presentar un caso de hiperparatiroidismo primario de fenotipo clásico y discutir su fisiopatología, abordaje y tratamiento. Presentación del caso: mujer de 36 años quien consultó por tres fracturas patológicas simultáneas y disminución en la densidad mineral ósea (DMO), asociado al hallazgo intrahospitalario de nefrocalcinosis, insuficiencia renal, hipercalcemia y niveles aumentados de hormona paratiroidea. Según estos hallazgos, se dio diagnóstico de hiperparatiroidismo primario de fenotipo clásico, secundario a adenoma paratiroideo izquierdo y que recibió tratamiento quirúrgico. Discusión y conclusión: el hiperparatiroidismo primario de fenotipo clásico es una entidad patológica poco frecuente y se relaciona con graves complicaciones esqueléticas y renales. Hay pocos casos descritos en la literatura, por lo que se requiere realizar más estudios en nuestro medio para definir las particularidades epidemiológicas de los pacientes, logrando de esta manera evitar los casos con manifestaciones clínicas en etapas avanzadas de la enfermedad.

Resumen Introduccion El lupus eritematoso sistemico (LES) es una enfermedad cronica, autoinmune, de etiologia desconocida, que afecta a cualquier organo o tejido. La nefritis lupica (NL) es la causa mas frecuente de compromiso renal en LES. Aproximadamente el 50% de los pacientes con LES presentan NL en algun momento de su enfermedad, siendo un factor de riesgo para morbimortalidad. Objetivo Proveer informacion actualizada sobre la NL, evaluando la fisiopatologia y las manifestaciones clinicas, como tambien poniendo especial enfasis en el diagnostico y las estrategias terapeuticas utilizadas en la practica clinica. Metodos Se realizo una revision narrativa con respecto a pacientes con LES que desarrollaron NL, en las bases de datos Google Scholar, Embase, SciELO, Scopus y Medline, utilizando los terminos MeSH nefritis lupica, biopsia, lupus eritematoso sistemico y tratamiento. Resultados Se escogieron 54 estudios que llenaban los requisitos de la busqueda, 18 fueron articulos originales, 13 revisiones de temas, 9 casos y controles, 7 estudios de cohorte y 7 estudios experimentales. La fisiopatologia es heterogenea y los factores geneticos y ambientales contribuyen a ella. Entre las principales manifestaciones clinicas se encuentran la proteinuria, la hematuria y las anormalidades tubulares. No existe una forma exclusiva de tratar la NL, varia segun la gravedad de la enfermedad y el riesgo de dano renal progresivo, de acuerdo con el resultado de la biopsia renal estandarizada por la clasificacion de ISN/RPS. Conclusiones El objetivo del tratamiento es mejorar la funcion renal, disminuir la proteinuria y corregir marcadores inmunologicos, evitando asi la aparicion de complicaciones. Para mejorar el pronostico deben desarrollarse nuevas tecnicas que permitan evaluar el inicio temprano de la actividad de la enfermedad renal o su recaida para dar inicio al manejo temprano, de manera que se genere una reduccion en la mortalidad y que la calidad de vida mejore.

The kidneys contribute to maintain plasma osmolality in normal range by achieving the adequate daily osmolar urine excretion (DOUE). An equation has been described for estimating the expected daily urine volume necessary to excrete the osmolar load required to keep serum osmolality in normal range. According to this equation, a difference between real and expected daily osmolar diuresis (DOD) can be obtained, being normally this difference value zero (± 500 cc). However, a positive DOD difference signifies a reduced urine concentration capability, while a negative DOD difference signifies a reduced urine dilution capability. Therefore, we decided to originally investigate how DOUE, and DOD difference are modified through the different stages of CKD.61 patients suffering from CKD (stages I-V) secondary to glomerulopathies were studied. Creatinine clearance (CrCl), DOUE, and difference between real and expected DOD were obtained from each patient. Besides, correlation (Spearman) between CrCl and DOUE, and between CrCl and real-expected DOD difference were also obtained.Spearman correlation between CrCl and DOUE was positive and significant (Spearman's ρ = 0.63, p 0.0001). In addition, CKD patients who were not able to achieve the minimal DOUE required (600 mOsm/day) were mostly those with CrCl 40 mL/min. Spearman correlation between CrCl and real-expected DOD difference was negative and significant (Spearman's ρ = - 0.4, p 0.0013). Additionally, abnormal DOD difference ( 500 cc) was found in CKD patients with CrCl 80 mL/min/1.73 mDaily osmolar urine excretion, and difference between real and expected daily osmolar diuresis are simple and significant clinical parameter which can be useful to easily evaluate urine concentration-dilution capability (tubular function) in CKD patients.

Statistical data extracted from national databases demonstrate a continuous growth in the incidence and prevalence of chronic kidney disease (CKD) and the ineffectiveness of current policies and strategies based on individual risk factors to reduce them, as well as their mortality and costs. Some innovative programs, telemedicine and government interest in the prevention of CKD did not facilitate timely access to care, continuing the increased demand for dialysis and transplants, high morbidity and long-term disability. In contrast, new forms of kidney disease of unknown etiology affected populations in developing countries and underrepresented minorities, who face socioeconomic and cultural disadvantages. With this background, our objective was to analyze in the existing literature the effects of social determinants in CKD, concluding that it is necessary to strengthen current kidney health strategies, designing in a transdisciplinary way, a model that considers demographic characteristics integrated into individual risk factors and risk factors population, incorporating the population health perspective in public health policies to improve results in kidney health care, since CKD continues to be an important and growing contributor to chronic diseases.

Background In this review, we were interested to identify the wide universe of enzymes associated with epigenetic modifications, whose gene expression is regulated by miRNAs with a high relative abundance in Crohn's disease (CD) affected tissues, with the aim to determine their impact in the pathogenesis and evolution of the disease. Methods We used HMDD and Bibliometrix R-package in order to identify the miRNAs overexpressed in CD. The identified enzymes associated with epigenetic mechanisms and post-translational modifications, regulated by miRNAs upregulated in CD, were analyzed using String v11 database. Results We found 190 miRNAs with great abundance in patients with CD, of which 26 miRNAs regulate the gene expression of enzymes known to catalyze epigenetic modifications involved in essentials pathophysiological processes, such as chromatin architecture reorganization, immune response regulation including CD4+ T cells polarization, integrity of gut mucosa, gut microbiota composition and tumorigenesis. Conclusion The integrated analysis of miRNAs with a high relative abundance in patients with CD showed a combined and superimposed gene expression regulation of enzymes associated with relevant epigenetic mechanisms and that could explain, in part, the pathogenesis of CD.

Colorectal cancer (CRC) is one of the main causes of cancer death in the world. Posttranslational modifications (PTMs) have been extensively studied in malignancies due to its relevance in tumor pathogenesis and therapy. This review is focused on the dysregulation of glycosyltransferase expression in CRC and its impact in cell function and in several biological pathways associated with CRC pathogenesis, prognosis and therapeutic approaches. Glycan structures act as interface molecules between cells and their environment and in several cases facilitate molecule function. CRC tissue shows alterations in glycan structures decorating molecules, such as annexin-1, mucins, heat shock protein 90 (Hsp90), 1 integrin, carcinoembryonic antigen (CEA), epidermal growth factor receptor (EGFR), insulin-like growth factor-binding protein 3 (IGFBP3), transforming growth factor beta (TGF- ) receptors, Fas (CD95), PD-L1, decorin, sorbin and SH3 domain-containing protein 1 (SORBS1), CD147 and glycosphingolipids. All of these are described as key molecules in oncogenesis and metastasis. Therefore, glycosylation in CRC can affect cell migration, cell–cell adhesion, actin polymerization, mitosis, cell membrane repair, apoptosis, cell differentiation, stemness regulation, intestinal mucosal barrier integrity, immune system regulation, T cell polarization and gut microbiota composition; all such functions are associated with the prognosis and evolution of the disease. According to these findings, multiple strategies have been evaluated to alter oligosaccharide processing and to modify glycoconjugate structures in order to control CRC progression and prevent metastasis. Additionally, immunotherapy approaches have contemplated the use of neo-antigens, generated by altered glycosylation, as targets for tumor-specific T cells or engineered CAR (Chimeric antigen receptors) T cells.

Geriatrics has classically described four entities of its own, naming them “geriatric giants” because of their high prevalence and great impact on the senile health. These four significant syndromes are delirium, gait disorders and falls, immobility syndrome, and incontinence. Additionally, older people are predisposed to suffer from salt and water alterations since aging induces changes in their renal physiology. These are known as the “nephrogeriatric giants”: reduced glomerular filtration rate, sodium and water reabsorption, and potassium secretion capability. These syndromes, the geriatric giants and the nephrogeriatric giants, usually predispose to one another and potentiate each other, leading to internal milieu disorders and catastrophic clinical events.

Frailty status is a condition which is not merely induced by aging but mainly by a progressive and sustained deterioration of several body physiological processes that lead to an increased vulnerability to stressors. The prevalence of frailty is higher in older individuals with chronic kidney disease (CKD) compared to older people with normal renal function. Frailty prevalence increases with a worsened kidney function, which leads to an increase in falls, hospitalization, dialysis requirement, and mortality. CKD predisposes to frailty through many mechanisms, which can also lead to CKD progression. The coexistence of CKD and frailty phenotype has been considered a particular condition known as “senescent nephropathy,” since it is characterized by significant clinical complications, therapeutic demands, and worse prognosis, in comparison with robust older CKD patients. Frailty status trends should be identified since they represent an opportunity to successfully intervene by optimizing nutritional and rehabilitation efforts. The prevention or delay of the appearance of frailty and sarcopenia can be accomplished by low intensity resistance and aerobic physical exercise, caloric and protein intake, vitamin D supplementation, and avoidance of polypharmacy. In addition, these patients should also receive their corresponding CKD treatment, but even frailty evaluation can contribute to redesign the patient’s therapeutic objectives.

Crohn's disease (CD) results from an aberrant immune response against the commensal microbiota in genetically susceptible hosts. However, the nature of the immune defects, the microflora involved and the genetic susceptibility remain incompletely defined and controversial. Extraintestinal manifestations occur in up to 25-35% of patients and generally precede the onset of gastrointestinal symptoms, which are often of a colonic nature and are influenced by disease activity. Renal manifestations can be considered dependent on the same immune mechanism that determines inflammatory bowel disease in CD. This review seeks to describe the current state of association between CD and kidney disease.

Acute kidney injury (AKI) is a heterogeneous group of conditions characterized by a sudden decrease in glomerular filtration rate (GFR), which usually induces the accumulation of nitrogenous-waste substances in the blood. It is expressed as an increase in serum creatinine levels (≥ 0.3 mg/dl within 48 hours or ≥1.5 times from baseline within the previous 7 days) or by a urine volume reduction of ˂0.5 ml/kg/h in 6 hours [1]. AKI is a relevant condition since it is usually associated with 1–7% and 30–50% of hospital and intensive care unit (ICU) admissions, respectively; showing a significant morbidity-mortality rate, and progression to chronic kidney disease (CKD) [1–7]. Even though many strategies have been proposed to achieve an early AKI diagnosis (e.g. novel biomarkers, informatics alarms), and an AKI effective treatment (e.g. renal protective drugs, biocompatible renal replacement therapies), both objectives remain unachieved; therefore, AKI prevention is currently the best ‘therapeutic’ strategy for this condition.

La Nefritis Lupica (NL) es una complicacion relevante del paciente con lupus eritematoso sistemico (LES). Las condiciones socio demograficas pueden ser vulnerables a la aparicion de la enfermedad?. Estudio cuantitativo, descriptivo y transversal. Poblacion conformada por 22 pacientes con (NL) del programa de Nefrored del Caribe que asistieron a una institucion prestadora de salud en la ciudad de Barranquilla, de enero de 2017 a enero de 2018. La muestra fue por conveniencia. La informacion se realizo a traves de instrumento tipo escala de Likert, conformada por las variables: caracteristicas socio demograficas (sexo, ubicacion geografica, estado civil), tiempo de diagnostico de la enfermedad y toma del medicamento ordenado. El 96% era de sexo femenino y el 4% de sexo masculino, 27.3% estuvo entre edades de 34 y 45 anos, el 54.5% era procedente de la ciudad de Barranquilla, y el 2.7% de los pacientes tenian diagnostico en un plazo de tiempo menor a los 2 anos de haber presentado manifestaciones clinicas. Las condiciones sociodemograficas y clinicas de los pacientes con LES que desarrollan NL permitiran desarrollar acciones para un diagnostico oportuno e intervencion efectiva que coadyuven a la adherencia al tratamiento, y a reducir la morbilidad en los pacientes de la Region Caribe Colombiana.

Resumen Introducción. La glomerulonefritis membranoproliferativa (GnMP) es un patrón de lesión glomerular hipercelular mesangial con adelgazamiento de la membrana basal glomerular y proliferación endocapilar que está mediado por las inmunoglobulinas o el sistema del complemento en el mesangio y endotelio capilar. Objetivo. Evaluar la respuesta a la farmacoterapia en pacientes diagnosticados con GnMP en una clínica de Barranquilla entre los años 2007 y 2014. Materiales y métodos. Estudio de cohorte retrospectivo en el que se evaluaron 58 pacientes con diagnóstico de GnMP por biopsia renal, quienes se clasificaron como respondedores y no respondedores. Se realizó una evaluación de tratamiento estándar según tipo de GnMP: mediado por complemento y mediado por inmunocomplejos e inmunofluorescencia negativa a los 6 y 12 meses de tratamiento. Resultados. La edad promedio de los participantes fue de 35±13 años. De 58 pacientes, 52% eran mujeres, 63% desarrolló enfermedad renal crónica (ERC) al año de evaluación, 25.8% logró remisión (22.4% completa y 3.4% parcial) y 74.2% no logró entrar en remisión. Conclusión. La GnMP es una causa importante de ERC entre la población estudiada. La respuesta al tratamiento inmunosupresor no demostró beneficios estadísticamente significativos, independiente del tipo de GnMP. Abstract Introduction: Membranoproliferative glomerulonephritis (MPGN) is a pattern of mesangial hypercellular glomerular lesion with thinning of the glomerular basement membrane and endocapillary proliferation, mediated by immunoglobulin and the complement system of the mesangium and capillary endothelium. Objective: To assess the response to pharmacotherapy in patients diagnosed with MPGN in a hospital of Barranquilla between 2007 and 2014. Materials and methods: Retrospective cohort study in which 58 patients diagnosed with MPGN by renal biopsy were assessed and classified as responsive and non-responsive. A standard treatment assessment was performed according to the type of MPGN: mediated by the complement system, mediated by immunocomplexes, and negative immunofluorescence at 6 and 12 months of treatment. Results: The average age of the participants was 35±13 years. Of 58 patients, 52% were female, 63% developed chronic kidney disease (CKD) one year after the assessment, 25.8% achieved remission (22.4% complete and 3.4% partial) and 74.2% failed to enter remission. Conclusion: MPGN is one of the most important causes of CKD among the studied population. Response to immunosuppressant treatment showed no statistically significant benefits, regardless of the type of MPGN.

Las vías clínicas son instrumentos desarrollados para planificar y coordinar la secuencia de procedimientos clínicos y administrativos necesarios para conseguir la máxima calidad asistencial. Su rápida difusión en EE. UU. explica que más del 60% de los hospitales usen vías clínicas para sus procesos más frecuentes. Esto contrasta con su escasa implementación en Colombia y los países de la Región de las Américas. Las Vías Clínicas se ajustan con el cambio que representa el enfoque en procesos, orientado a optimizar una mejor atención al paciente.

La infección por el síndrome respiratorio agudo severo (SARS-CoV-2) ha causado una de las emergencias epidemiológicas más grandes de los últimos 10 años y sus efectos patológicos son aún estudiados. Por lo anterio, resulta importante describir los mecanismos asociados al compromiso renal y digestivo en la infección por SARS-CoV-2. Los mecanismos patológicos en tejido renal y en intestino causados por la infección por SARS-CoV-2 son propios del tropismo viral por células de estos sistemas y de los mecanismos citopáticos de etapa lítica de la infección, con una liberación continua de viriones que favorece la generación de un entorno inflamatorio con la consecuente secreción descontrolada de citoquinas proinflamatorias que conducen a la infección entérica del intestino y a las alteraciones en el riñón

To present a COVID-19 case series with clinical admission criteria to Intensive Care Unit. Patients information was obtained from medical records, and daily clinical evaluation whereas diagnosis was carried out through paraclinical studies in blood, urine, PCR and diagnostic images in 4 patients with different comorbidities and epidemiological link for the development of COVID-19. All four cases were managed with chloroquine 300 mg orally every 12 hours and azithromycin orally every 24 hours for 5 days without complications or associated toxicity.The case 1 developed multiple organ failure, including acute kidney injury with an ICU stay of 4 days before his death, while cases 2, 3 and 4 had a favorable evolution and were discharged fromthe ICU. Rapid multicenter studies are required to scientifically guide a better diagnostic and management approach, in the context of a disease with a clinical-epidemiological behavior that must be studied in depth and will probably take many lives. In addition, due to the absence of sufficiently rapid tests, the use of a classification based on the severity of radiological lesions called CO-RADS (Covid-19 Imaging Reporting and Data System) could be of great importance to install available pharmacological treatments early and early mechanical respiratory support.

Introducción: el COVID-19 es una enfermedad causada por un nuevo beta coronavirus (SARS-CoV-2), cuyo espectro incluye casos severos con neumonía y complicaciones sistémicas que se dan como consecuencia de una liberación exagerada de mediadores inflamatorios conocida como “tormenta de citoquinas”. En este tipo de pacientes las terapias de purificación sanguínea, incluyendo la hemoadsorción y la terapia plasmática podrían tener un beneficio clínico importante y evitar las complicaciones como disfunción multiorgánica y muerte. Objetivo: revisar toda la literatura disponible acerca de las terapias de purificación sanguínea y sus beneficios en los pacientes con COVID-19. Materiales y métodos: se realizó una búsqueda de la literatura en las bases de datos ClinicalKey, Embase, PubMed y Ovid con los términos “COVID-19”, “sepsis”, “SARS-CoV-2”, “citosinas”, “insuficienciencia renal”, “neumonía”. Resultados: se encontraron 246 referencias y luego de aplicar los filtros, se seleccionaron 61 publicaciones con contenido relevante para la presente revisión. Conclusión: teniendo en cuenta su gran evidencia científica en el manejo de la tormenta de citoquinas en otros escenarios, las terapias de purificación sanguínea, que incluyen técnicas difusivas, convectivas, de hemoadsorción y terapia plasmática, pueden ser herra- mientas de tratamiento muy prometedoras en pacientes con COVID-19

The aim of this study was to identity in silico the relationships among microRNAs (miRNAs) and genes encoding transcription factors, ubiquitylation, DNA methylation, and histone modifications in systemic lupus erythematosus (SLE). To identify miRNA dysregulation in SLE, we used miR2Disease and PhenomiR for information about miRNAs exhibiting differential regulation in disease and other biological processes, and HMDD for information about experimentally supported human miRNA–disease association data from genetics, epigenetics, circulating miRNAs, and miRNA–target interactions. This information was incorporated into the miRNA analysis. High-throughput sequencing revealed circulating miRNAs associated with kidney damage in patients with SLE. As the main finding of our in silico analysis of miRNAs differentially expressed in SLE and their interactions with disease-susceptibility genes, post-translational modifications, and transcription factors; we highlight 226 miRNAs associated with genes and processes. Moreover, we highlight that alterations of miRNAs such as hsa-miR-30a-5p, hsa-miR-16-5p, hsa-miR-142-5p, and hsa-miR-324-3p are most commonly associated with post-translational modifications. In addition, altered miRNAs that are most frequently associated with susceptibility-related genes are hsa-miR-16-5p, hsamiR- 374a-5p, hsa-miR-34a-5p, hsa-miR-31-5p, and hsa-miR-1-3p.

Introduccion: La obesidad es un factor de riesgo de desarrollo y progresion de enfermedad renal cronica (ERC). En Latinoamerica existen pocos estudios donde se relacionen los estadios de ERC y grados de obesidad. Objetivo: El objetivo de estudio es evaluar la asociacion de obesidad con la enfermedad renal cronica de pacientes atendidos en la consulta externa del departamento de Nefrologia en la Clinica de la Costa en Barranquilla, Colombia. Materiales y metodos: Se realizo un estudio observacional descriptivo tipo serie de casos. La muestra estuvo compuesta por 300 pacientes acopiados en NefroRed©. Se realizaron medidas de tendencia central y un χ² para establecer la asociacion entre los grados de obesidad con los estadios de la ERC. Los analisis estadisticos se realizaron en R-CRAN. Al realizar la prueba, se encontro una asociacion entre los grados de obesidad y los diferentes estadios de la ERC [χ²: 48,62; p-valor < 0,01]. Conclusion: No se encontro evidencia estadistica de asociacion entre el Perimetro Abdominal y los estadios de ERC [χ²: 8,82; p-valor ≥ 0,05]. Existe asociacion entre los grados de obesidad y los diferentes estadios de la ERC. No se encontro la relacion entre perimetro abdominal y los estadios de ERC.