Search

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The worldwide prevalence of arterial hypertension in pediatric patients is 3.5%, and it has repercussions at renal, cardiovascular, neurological, and lifestyle levels. This study aimed to estimate the prevalence of arterial hypertension, mortality, and follow-up in patients with acute renal failure in the nephrology outpatient clinic at a second-level hospital in Northwestern Mexico. Methods: We conducted a descriptive, retrospective, and observational study. Men and women aged 1-18 years diagnosed with acute kidney injury were analyzed from January 1, 2012, to December 31, 2021. The medical and electronic records of the candidate patients were analyzed, and nutritional data, laboratory analysis, most frequent etiology, and follow-up in the pediatric nephrology clinic were collected. Those with exacerbated chronic kidney disease and previous diagnosis of high blood pressure were excluded. Results: One hundred and seventy-four patients were evaluated, and only 40 were eligible for the study (22.98%), predominantly males with a mean age of 9.9 years. The degree of arterial hypertension was 50% for grade I and 50% for grade II (p = 0.007); the mortality rate was 32%. One hundred percent of hypertension cases were controlled at 6 months after discharge (p = 0.000080). Conclusions: Our results were similar to those reported in other studies. Follow-up and early detection of arterial hypertension in children need to be strengthened. [ABSTRACT FROM AUTHOR]

RESUMEN Introducción y objetivos: La nefropatía inducida por contraste (NIC) es una potencial complicación de los procedimientos angiográficos. El sistema DyeVert Power (Osprey Medical, Estados Unidos) permite reducir la concentración renal del medio de contraste al disminuir la cantidad administrada a los pacientes. Al contrario que sobre los sistemas manuales, existen pocos datos disponibles sobre el sistema DyeVert, que se utiliza junto a la inyección automática de contraste. El objetivo principal de este estudio fue evaluar su eficacia en procedimientos de intervencionismo coronario percutáneo (ICP). Métodos: Entre 2020 y 2022 se incluyó a 101 pacientes a quienes se realizó ICP utilizando el sistema DyeVert Power XT (grupo de casos) para evaluar la cantidad ahorrada de medio de contraste, así como la tasa, la gravedad y los predictores de NIC. Además, se seleccionó un grupo control de pacientes a los que se había realizado ICP sin utilizar el sistema DyeVert para comparar la cantidad de medio de contraste administrado y la tasa de NIC. Resultados: En el grupo de casos se redujo la administración de medio de contraste en 114 ± 42 ml (una media del 32% del total). Desarrollaron NIC 14 pacientes (13,9%). Los predictores de NIC fueron el hematocrito (OR = 0,86; IC95%: 0,74-0,99; p = 0,04) y la fracción de eyección (OR = 0,88; IC95%: 0,82-0,95; p = 0,001). Como resultado de la utilización del sistema DyeVert, la cantidad administrada de medio de contraste fue menor, pero sin diferencias estadísticamente significativas (252 frente a 267 ml; p = 0,42). La tasa de NIC fue menor con el sistema DyeVert, pero sin alcanzar la significación estadística (14,3 frente a 16,3%; p = 1,0). Conclusiones: El hematocrito y la fracción de eyección, más que la cantidad de contraste administrada, pueden ser predictores de NIC en los pacientes que reciben ICP. El beneficio del sistema DyeVert fue bajo.

Receptor interacting protein kinase 3 (RIPK3) is an intracellular kinase at the crossroads of cell death and inflammation. RIPK3 contains a RIP homotypic interaction motif (RHIM) domain which allows interactions with other RHIM-containing proteins and a kinase domain that allows phosphorylation of target proteins. RIPK3 may be activated through interaction with RHIM-containing proteins such as RIPK1, TRIF and DAI (ZBP1, DLM-1) or through RHIM-independent mechanisms in an alkaline intracellular pH. RIPK3 mediates necroptosis and promotes inflammation, independently of necroptosis, through either activation of NFκB or the inflammasome. There is in vivo preclinical evidence of the contribution of RIPK3 to both acute kidney injury (AKI) and chronic kidney disease (CKD) and to the AKI-to-CKD transition derived from RIPK3 deficient mice or the use of small molecule RIPK3 inhibitors. In these studies, RIPK3 targeting decreased inflammation but kidney injury improved only in some contexts. Clinical translation of these findings has been delayed by the potential of some small molecule inhibitors of RIPK3 kinase activity to trigger apoptotic cell death by inducing conformational changes of the protein. A better understanding of the conformational changes in RIPK3 that trigger apoptosis, dual RIPK3/RIPK1 inhibitors or repurposing of multiple kinase inhibitors such as dabrafenib may facilitate clinical development of the RIPK3 inhibition concept for diverse inflammatory diseases, including kidney diseases. Resumen: La proteína quinasa 3 que interactúa con el receptor (RIPK3) es una quinasa intracelular que se encuentra a medio camino entre la muerte celular y la inflamación. La RIPK3 contiene un dominio motivo de interacción homotípica de RIP (RHIM), que permite las interacciones con otras proteínas que contienen RHIM, y un dominio de quinasa que permite la fosforilación de las proteínas diana. La RIPK3 puede ser activada a través de la interacción con las proteínas que contienen RHIM tales como RIPK1, TRIF y DAI (ZBP1, DLM-1), o a través de mecanismos independientes de RHIM en un pH intracelular alcalino. La RIPK3 media en la necroptosis y promueve la inflamación, independientemente de la necroptosis, bien a través de la activación de NFκB, o del inflamasoma. Existe evidencia preclínica in vivo de la contribución de RIPK3 a la insuficiencia renal aguda (IRA) y la enfermedad renal crónica (ERC), así como a la transición IRA-ERC derivada de ratones con deficiencia de RIPK3 o del uso de pequeñas moléculas inhibidoras de RIPK3. En dichos estudios, el tener a RIPK3 como objetivo redujo la inflamación, pero la nefropatía mejoró solo en algunos contextos. La traducción clínica de estos hallazgos se ha demorado debido al potencial de ciertas pequeñas moléculas inhibidoras de la actividad de la quinasa RIPK3 para activar la muerte celular induciendo cambios conformacionales de la proteína. Comprender mejor los cambios conformacionales de RIPK3 activadores de la apoptosis, los inhibidores duales RIPK3/RIPK1 o la reconversión de múltiples inhibidores de la quinasa tales como dabrafenib podría facilitar el desarrollo clínico del concepto de la inhibición de RIPK3 para diversas enfermedades inflamatorias, incluyendo las enfermedades renales.

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and objectives: Acute kidney injury (AKI) is a common devastating complication characterized by an abrupt loss of renal function. It is of great significance to explore promising biomarkers for AKI treatment. Materials and methods: Here, we established LPS (lipopolysaccharide)-induced AKI mice models and LPS-induced AKI mouse renal tubular epithelial cell model. The severity of AKI was determined by the levels of BUN (blood urea nitrogen) and SCr (serum creatinine), the observation of pathological section as well as the renal tubular injury score. The apoptosis was determined by the measurement of Caspase-3 and Caspase-9 activities, and cell apoptosis assays. qRT-PCR (quantitative real-time PCR) and western blot revealed that miR-322-5p (microRNA-322-5p) was up-regulated in LPS -induced AKI models while Tbx21 (T-box transcription factor 21) was down-regulated in LPS-induced AKI models. Dual-luciferase reporter and RNA pulldown assays detected the interaction of Tbx21 with miR-322-5p. Results: We found that miR-322-5p was overtly over-expressed in the in vitro LPS-induced AKI model and promoted the apoptosis of AKI mouse renal tubular epithelial cells via inhibiting Tbx21, which suppressed the mitochondrial fission and cell apoptosis through MAPK/ERK (mitogen-activated protein kinase/extracellular signal-related kinase) pathway. Conclusions: We demonstrated that miR-322-5p promotes LPS-induced mouse AKI by regulating Tbx21/MAPK/ERK axis, which might provide new sights for AKI research. Resumen: Introducción y objetivos: La insuficiencia renal aguda (IRA) es una complicación común devastadora caracterizada por una pérdida abrupta de la función renal. Es de vital importancia explorar biomarcadores prometedores para el tratamiento de la IRA. Materiales y métodos: Establecimos aquí un modelo de ratones con IRA inducido por lipopolisacáridos (LPS) y un modelo de células epiteliales del túbulo renal en ratones. La severidad de IRA fue determinada por los niveles de NUS (nitrógeno ureico en sangre) y SCr (creatinina sérica), la observación de la sección patológica, así como la puntuación del daño renal tubular. La apoptosis fue determinada mediante la medición de las actividades de Caspasa-3 y Caspasa-9, y los ensayos de apoptosis celular. Las pruebas qRT-PCR (PCR cuantitativa en tiempo real) y Western blot revelaron que miR-322-5p (microRNA-322-5p) se incrementaba en los modelos de IRA inducidos por LPS, mientras que Tbx21 (factor 21 de transcripción de T-box) disminuía en los modelos de IRA inducidos por LPS. Los ensayos del reportador de luciferasa dual y de precipitación pulldown de ARN detectaron la interacción entre Tbx21 y miR-322-5p. Resultados: Encontramos que miR-322-5p se hallaba manifiestamente incrementado en el modelo in vitro de IRA inducido por LPS, y promovió la apoptosis de células epiteliales del túbulo renal de IRA en ratones mediante la inhibición de Tbx21, lo cual suprimió la fisión mitocondrial y la apoptosis a través de la vía MAPK/ERK (proteína quinasa activada por mitógeno/quinasa relacionada con la señal extracelular). Conclusiones: Demostramos que miR-322-5p promueve la IRA inducida por LPS en ratones mediante la regulación del eje Tbx21/MAPK/ERK, lo cual podría aportar una percepción nueva para la investigación sobre la IRA.

La insuficiencia renal aguda (IRA) es una de las complicaciones más frecuentes en los pacientes hospitalizados, siendo un factor de riesgo de mortalidad. Es de suma importancia identificar la asociación de factores clínicos que empeoran la mortalidad en pacientes con IRA internados en una unidad de terapia intensiva (UTI). Se incluyeron 218 pacientes, de los cuales el 63,7% (n=139) correspondieron a hombres con un promedio de edad de 43±19 años. El análisis de correlación de variables de control, dependiente e independiente fue a través del coeficiente de Spearman y el OR fue analizado mediante regresión logística. De los 218 pacientes, falleció el 33% (n=72) de los pacientes internados en UTI. La IRA ocurrió en 28,4% (n=62) del total de pacientes y de estos, el 61,3% (n=38) fallecieron, con un OR de 4,94 (p 0,0001). La mayor proporción de fallecidos perteneció a la categoría AKIN 3. Las variables clínicas de ventilación mecánica (PR 3,57, IC 95%, 0,34-37,93), uso de drogas vasoactivas (PR 8,32, IC 95%, 3,20-21,64), puntuación APACHE III (PR 1,12, IC 95%, 1,03-1,23), edad (PR 1,01, IC 95%, 0,99-1,04) y los sometidos a cirugía (PR 0,28, IC 95%, 0,10-0,80) tuvieron asociación positiva y aumentaron la mortalidad. La presencia de variables clínicas de ventilación mecánica, la utilización de drogas vasoactivas, sepsis, el estudio APACHE III, la edad, la categoría AKIN 3, y el antecedente de cirugía previo al ingreso a UTI aumentan significativamente la mortalidad en pacientes con IRA en UTI.

The most widely used approach in the immunotherapy treatment of cancer is the administration of monoclonal antibodies directed against regulatory molecules of immune control that inhibit the activation of T cells, the so-called check point inhibitors (ICI). ICI nephrotoxicity epidemiology and pathology; its diagnosis with or without kidney biopsy; the type and duration of treatment; the possibility of rechallenging after kidney damage; and its indication in patients with cancer and renal transplantation are certainly controversial. In the absence of definitive studies, this document is intended to specify some recommendations agreed by the group of Onconephrology experts of the Spanish Society of Nephrology in those areas related to ICI nephrotoxicity, in order to help decision-making in daily clinical practice in Onconephrology consultations. Resumen: El enfoque más utilizado en el tratamiento inmunoterápico del cáncer es la administración de anticuerpos monoclonales dirigidos contra moléculas reguladoras del control inmunitario que inhiben la activación de las células T, los llamados inhibidores del Check-Point (ICP). La epidemiología y patología de la nefrotoxicidad por los ICP; su diagnóstico con o sin biopsia renal; el tipo y la duración del tratamiento; la posibilidad de retratar después del daño renal; y su indicación en pacientes con cáncer y trasplante renal son ciertamente controvertidas. En ausencia de estudios definitivos, este documento está destinado a concretar unas recomendaciones consensuadas por el grupo de expertos de Onconefrología de la S.E.N en aquellas áreas relacionadas con la nefrotoxicidad por los ICP, con la finalidad de ayudar en la toma de decisiones en la práctica clínica diaria de las consultas de Onconefrología.

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Thrombotic microangiopathies (TMA) are rare diseases usually presenting with renal, haematological, neurologic and cardiovascular involvement and nonspecific but severe symptoms. A registry of TMA cases managed in Spanish paediatric intensive care units (the MATUCIP Registry) was established with the aim of gaining knowledge on their clinical characteristics, diagnosis and acute-phase treatment. Methods: We conducted a prospective multicentre observational study in 20 paediatric intensive care units (PICUs) in Spain from January 2017 to December 2021 in children aged more than 1 month with TMAs, who were followed up through the discharge from the PICU. Results: The sample included 97 patients (51.5% female) with a median age of 2.6 years (interquartile range [IQR], 1.6–5.7). The initial manifestations were gastrointestinal (74.2%), respiratory (14.4%), fever (5.2%), neurologic (3.1%) and other (3.1%). At admission, 75.3% of patients had microangiopathic haemolytic anaemia, 95.9% thrombocytopenia and 94.8% acute kidney injury. Of the total sample, 57.7% of patients received a diagnosis of Shiga toxin-associated haemolytic uraemic syndrome (HUS), 14.4% of Streptococcus pneumoniae-associated HUS, 15.6% of atypical HUS, 10.3% of secondary TMA and 2.1% of thrombotic thrombocytopenic purpura. Eighty-seven patients (89.7%) developed arterial hypertension, and 49.5% gastrointestinal, 22.7% respiratory, 25.8% neurologic and 12.4% cardiac manifestations. Also, 60.8% required renal replacement therapy and 2.1% plasma exchange. Twenty patients received eculizumab. The median PICU stay was 8.5 days (IQR, 5–16.5). Two children died. Conclusions: The MATUCIP registry demonstrates the clinical variability of TMA cases requiring admission to the PICU. Knowledge of the presentation and outcomes of TMAs can facilitate early aetiological diagnosis. This registry can help improve our understanding of the clinical spectrum of these diseases, for which there is a dearth of published data. Resumen: Introducción: Las microangiopatías trombóticas (MAT) son entidades infrecuentes que suelen causar afectación renal, hematológica, neurológica y cardiovascular, con síntomas inespecíficos pero graves. Con la finalidad de mejorar el conocimiento de sus características clínicas, proceso diagnóstico y tratamiento en la fase aguda, se ha creado el registro de MAT en las Unidades de Cuidados Intensivos Pediátricos (UCIP) de España (Registro MATUCIP). Pacientes y métodos: Estudio observacional, multicéntrico realizado en 20 UCIP españolas desde enero 2017 hasta diciembre de 2021 que incluyó niños mayores de 1 mes con diagnóstico de MAT y seguimiento hasta el alta de UCIP. Resultados: Se incluyeron 97 pacientes (51,5% mujeres), con mediana de edad de 2,6 años (RIQ 1,6–5,7). La clínica inicial fue de tipo gastrointestinal (74,2%), respiratoria (14,4%), cuadro febril (5,2%), neurológica (3,1%) y otras (3,1%). Al ingreso, 75,3% presentaban anemia hemolítica microangiopática, 95,9% trombocitopenia y 94,8% daño renal agudo. Fueron diagnosticados de Síndrome Hemolítico Urémico (SHU) asociado a Escherichia coli productora de toxina Shiga 57,7%, SHU por Streptococcus pneumoniae 14,4%, SHU atípico 15,6%, MAT secundaria 10,3% y púrpura trombocitopénica trombótica 2,1%. Desarrollaron hipertensión arterial 89,7%, manifestaciones digestivas 49,5%, respiratorias 22,7%, neurológicas 25,8% y cardiacas 12,4%. El 60,8% requirieron depuración extrarrenal y 2,1% plasmaféresis. Recibieron eculizumab 20 pacientes. La mediana de estancia en UCIP fue 8,5 días (RIQ 5–16,5). Dos niños fallecieron. Conclusiones: El registro MATUCIP muestra la variabilidad clínica de las MAT que ingresan en UCIP. Conocer la forma de presentación y evolución de las MAT puede facilitar el diagnóstico etiológico precoz. Este registro permite conocer mejor el espectro clínico de estas entidades donde los datos publicados son escasos.

Aim: This study aims to investigate the 90-day and 1-year mortality and the affecting factors of mortality in patients who have started dialysis treatment for the first time. Methods: Patients who started intermittent hemodialysis for the first time in the hemodialysis unit were evaluated. Patients who received hemodialysis treatment for any reason before, patients who underwent hemodialysis due to methyl alcohol, lithium, or mushroom poisoning, and patients who started dialysis in the intensive care unit were excluded from the study. The clinical and laboratory data were obtained from the patients, at admission time, from the electronic data record system and patients' charts. Univariate and multivariate logistic regression analyses were used to identify predictive factors for 90-days and 1-year mortality-dependent variables. Results: 229 patients were included in this study. 133(58.8%) of the patients were male, 96(41.9%) were female, and the median age was 64 years. While 166 patients had pre-existing renal disease, 63 patients had no prior renal disease. The number of patients who died within 90 days, which refers to short-term mortality, was 49 (21.4%). 73 patients (31.9%) died in one year (long-term mortality). At the end of one year, 38% of the whole group of patients continued receiving renal replacement therapy, while 10% of all CKD patients had not a requirement of dialysis, and only 9.17% of the patients had renal recovery. In the multivariate analysis established for short-term mortality, the following parameters showed significant predictive features: ejection fraction (OR = 3.80, 95% CI: 1.05-13.72, p=0.042), CRP (OR = 0.20, 95% CI: 0.04-0.92, p= 0.039), age (OR = 0.21, 95% CI: 0.05-0.91, p= 0.038), and diastolic blood pressure (OR = 0.08, 95% CI: 0.02-0.28, p< 0.001). The multivariate analysis for long-term mortality indicated that systolic blood pressure (OR = 0.26, 95% CI: 0.08-0.82, p= 0.022), diastolic blood pressure (OR = 0.21, 95% CI: 0.68-0.66, p= 0.008), and potassium (OR = 0.27, 95% CI: 0.10-0.70, p= 0.007) were independent predictive markers. Conclusion: Patients with CKD who have not yet started hemodialysis treatment should be followed closely, as hypervolemia, hypotension, and hemodynamic instability increase the risk of death, according to our study. In addition, we recommend that clinical conditions such as hemodynamic instability or sepsis, which may cause hypotension in AKI-D, should be addressed as soon as possible, and optimizing the fluid-electrolyte balance carefully in those patients we determined to be at risk. [ABSTRACT FROM AUTHOR]

Introduction: Renal ischemia (I) could develop due to decreased or ceased blood flow to the kidney in some clinical conditions such as shock, sepsis, and kidney transplantation. The re-supply of blood to the kidney is called reperfusion (R). Ischemia and reperfusion periods can cause severe kidney damage. Objectives: When we examined the I/R molecular progression, antioxidant molecules such as vitamin A seem promising treatment agents. This study aimed to investigate the effects of vitamin A on renal I/R injury. Material and Methods: In the study, 40 Sprague-Dawley male rats were divided into five groups (n=8): the control group, only I/R, I/R+1000, I/R+3000, and I/R+9000 IU/kg of Vitamin A groups. Vitamin A was administrated to each group for seven days via oral gavage. Blood and kidney tissue samples were collected at the end of the experiment. We took blood samples for Superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT), blood urea nitrogen (BUN), and creatinine (Cr) levels, and determined their values. The tissue samples were stained with hematoxylin/eosin to examine the renal changes histopathologically and stereologically under a light microscope. Results: Histopathological changes caused by I/R were decreased with vitamin A administration in a dose-dependent manner (p<0.05). Vitamin A administration decreased MDA levels and increased SOD and CAT activities (p<0.05). The most effective dose among treatment groups was 9000 IU/kg. There was no significant difference between the controls and all other groups regarding BUN and Cr concentrations. Conclusions: Consequently, administration of vitamin A after renal I/R reduced the histological damage and ameliorated the antioxidant state. These results showed that vitamin A could be a promising agent in treating I/R-induced acute kidney injury. [ABSTRACT FROM AUTHOR]

Introducción: En los pacientes con obstrucción ureteral unilateral, alrededor de 1-10% desarrollan una falla renal aguda. Su baja incidencia se debe a los niveles de creatinina que generalmente son normales debido a que el riñón contralateral mantiene su capacidad funcional excretora intacta. Objetivo: Realizar una descripción amplia y específica acerca de los procesos fisiopatológicos involucrados en la obstrucción ureteral unilateral que conllevan a una falla renal aguda y/o crónica. Métodos: Para el análisis y estructuración del artículo, se utilizó PRISMAP, extensión ScR para revisiones de alcance. La búsqueda se realizó en PubMed, Medline y Embase y con artículos que trataran sobre falla renal por obstrucción unilateral ureteral. La revisión de los artículos se hizo por dos revisores de forma independiente. Resultados: Una vez se evaluaron y excluyeron los artículos que no cumplían, se analizaron 16 referencias. Se describen los mecanismos fisiopatológicos teniendo en cuenta el tiempo de evolución de la obstrucción y se plantean posibles causas de la falla renal en pacientes que cuentan con otro riñón sano. Se plantean como hipótesis dos eventos cruciales que causan falla renal en la obstrucción ureteral unilateral. A) La disminución del flujo sanguíneo renal (FSR) dada la producción de ANG II y su impacto en el músculo liso vascular, disminuyendo la tasa de filtración glomerular (TFG) y B) la extravasación perirrenal de orina y su papel en la elevación de la creatinina. Conclusiones: El entendimiento de este proceso permite ampliar el conocimiento en el mecanismo del daño, el tiempo en el que esté sucede y su progresión

BACKGROUND: Exertional rhabdomyolysis is induced by physical overexertion; it is reported since the beginning of the millennium with increasing frequency and coincides with the greater participation of the general population in sports centers and groups promoted by a higher level of awareness of the need to adhere to healthy lifestyles. This disease can account for one third of cases complicated by acute renal failure that, with aggressive initial medical management based on fluid replacement and close monitoring, is associated with low risk of mortality and other sequelae. CLINICAL CASI A 33-year-old male patient who suffered acute renal failure, diagnosed with exertional rhabdomyolysis with good clinical response to management measures and positive final evolution. Approach, initial and subsequent management correlated with close clinical-laboratory monitoring of patient are presented. CONCLUSIONS: It is noted that even the evidence available for the management of these patients could induce over-treatment or increase in hospital stay, which could indicate that more evidence is needed to generate management and follow-up guidelines according to the characteristics of the patient with exertional rhabdomyolysis that differentiate him from the patient with rhabdomyolysis due to other causes. It is also recommended to initiate prevention process in sports centers and groups. [ABSTRACT FROM AUTHOR]

Introduction: Renal ischemia (I) could develop due to decreased or ceased blood flow to the kidney in some clinical conditions such as shock, sepsis, and kidney transplantation. The re-supply of blood to the kidney is called reperfusion (R). Ischemia and reperfusion periods can cause severe kidney damage. Objectives: When we examined the I/R molecular progression, antioxidant molecules such as vitamin A seem promising treatment agents. This study aimed to investigate the effects of vitamin A on renal I/R injury. Material and Methods: In the study, 40 Sprague-Dawley male rats were divided into five groups (n=8): the control group, only I/R, I/R+1000, I/R+3000, and I/R+9000 IU/kg of Vitamin A groups. Vitamin A was administrated to each group for seven days via oral gavage. Blood and kidney tissue samples were collected at the end of the experiment. We took blood samples for Superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT), blood urea nitrogen (BUN), and creatinine (Cr) levels, and determined their values. The tissue samples were stained with hematoxylin/eosin to examine the renal changes histopathologically and stereologically under a light microscope. Results: Histopathological changes caused by I/R were decreased with vitamin A administration in a dose-dependent manner (p<0.05). Vitamin A administration decreased MDA levels and increased SOD and CAT activities (p<0.05). The most effective dose among treatment groups was 9000 IU/kg. There was no significant difference between the controls and all other groups regarding BUN and Cr concentrations. Conclusions: Consequently, administration of vitamin A after renal I/R reduced the histological damage and ameliorated the antioxidant state. These results showed that vitamin A could be a promising agent in treating I/R-induced acute kidney injury. [ABSTRACT FROM AUTHOR]

Objective: To assess incidence, risk factors and impact of acute kidney injury(AKI) within 48 h of intensive care unit(ICU) admission on ICU mortality in patients with SARS-CoV-2 pneumonia. To assess ICU mortality and risk factors for continuous renal replacement therapy (CRRT) in AKI I and II patients., Design: Retrospective observational study., Setting: Sixty-seven ICU from Spain, Andorra, Ireland., Patients: 5399 patients March 2020 to April 2022., Main Variables of Interest: Demographic variables, comorbidities, laboratory data (worst values) during the first two days of ICU admission to generate a logistic regression model describing independent risk factors for AKI and ICU mortality. AKI was defined according to current international guidelines (kidney disease improving global outcomes, KDIGO)., Results: Of 5399 patients included 1879 (34.8%) developed AKI. These patients had higher ICU mortality and AKI was independently associated with a higher ICU mortality (HR 1.32 CI 1.17-1.48; p < 0.001). Male gender, hypertension, diabetes, obesity, chronic heart failure, myocardial dysfunction, higher severity scores, and procalcitonine were independently associated with the development of AKI. In AKI I and II patients the need for CRRT was 12.6% (217/1710). In these patients, APACHE II, need for mechanical ventilation in the first 24 h after ICU admission and myocardial dysfunction were associated with risk of needing CRRT. AKI I and II patients had a high ICU mortality (38.5%), especially if CRRT were required (64.1% vs. 34,8%; p < 0.001)., Conclusions: Critically ill patients with SARS-CoV-2 pneumonia and AKI have a high ICU mortality. Even AKI I and II stages are associated with high risk of needing CRRT and ICU mortality., (Copyright © 2024 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.)

INTRODUCTION: Infective endocarditis (IE) due to Granulicatella adiacens is a rare disease in children, but with significant morbidity and mortality. Children with congenital heart disease (CHD) are at increased risk of developing IE, and Granulicatella species endocarditis can be difficult to treat. PRESENT THE CASE: Seven-year-old male patient with a history of pulmonary atresia, patent ductus arteriosus (PDA), uncorrected ventricular septal defect (VSD) and multiple aortopulmonary collaterals (MAPCAS), who presented signs and symptoms of IE, with vegetations on echocardiogram and a positive blood culture for Granulicatella adiacens. He received ceftriaxone plus vancomycin for six weeks and gentamicin for the first two weeks. The patient developed immune-mediated glomerulonephritis and acute renal failure. A clinical and laboratory improvement was achieved; and no vegetation was found at discharge. CONCLUSIONS: IE due to Granulicatella is an entity that should be considered in the pediatric population with CHD, especially of the cyanotic type. Treatment with p-lactams plus aminoglycosides is usually first-line empirical therapy. Vancomycin may also be an alternative drug option in resistant strains. We suggest an approximate follow-up of kidney involvement that can develop as a complication of IE itself, as well as due to drug nephrotoxicity. [ABSTRACT FROM AUTHOR]

Copyright of Revista Argentina de Cardiología is the property of Sociedad Argentina de Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJETIVO: A prevalência e os fatores de risco associados ao desenvolvimento de IRA nos pacientes submetidos a transplante no Hospital de Clínicas de Porto Älegre (HCPA) no período de setembro/96 a setembro/98. PACIENTES E MÉTODOS: Foram comparados os pacientes que desenvolveram IRA (grupo 1) com os que não desenvolveram (grupo 2). Foram analisados no préoperatório: etiologia da isuficiência hepática, classificação de Child-Pugh, diabete melito (DM) e nível de creatinina; no trans-operatório: tempo de isquemia quente, tempo cirúrgico, tempo de anestesia, unidades de concentrado de hemácias (CHAD), tipo de anastomose porto-cava; e no pós-operatório: níveis de creatinina, infecções, necessidades de diálise, permanência na unidade de tratamento intensivo (UTI), níveis de ciclosporina, reintervenções e mortalidade. Todos os dados foram avaliados nos primeiros 7 dias de pós-operatório, com exceção de insuficiência renal crônica e mortalidade avaliados por 3 meses. RESULTADOS: A prevalência de IRA foi elevada, sendo de aproximadamente 49%. Verificamos que a presença de DM prévia (P = 0,03), unidades de CHAD utilizados no trans-operatório (p = 0,046), o tempo de internação na UTI (P = 0,001), técnica cirúrgica (P = 0,04) e necessidade de reintervenção cirúrgica (P = 0,02) estiveram associados significativamente com o desenvolvimento de IRA no pós-operatório de TxH em nossa amostra. Os pacientes que desenvolveram IRA apresentaram uma significativa mortalidade (P = 0,02). Concluímos que a IRA é uma causa significativa de mortalidade nos pacientes submetidos à transplante hepático estando associada a múltiplos fatores de risco.

Introducción: la poliangeítis microscópica (PAM) hace parte del grupo de vasculitis asociadas a anticuerpos anticitoplasmáticos de neutrófilos (ANCA), cuya presencia de anticuerpos contra mieloperoxidasa (MPO) se observa en la mayoría de los casos (70-95?%), asimismo, el compromiso renal presagia mayores tasas de morbilidad y mortalidad, sin embargo, la coexistencia con lupus eritematoso sistémico (LES) es poco frecuente y con mayor énfasis en la variante de LES del adulto mayor o de inicio tardío. Objetivo: dar a conocer un caso poco común de dos enfermedades autoinmunes, lo cual ha sido reportado como síndrome de superposición y brindar información útil que permita ampliar los diagnósticos diferenciales. Presentación del caso: se presenta el caso de un paciente masculino de 76 años con historia de poliartralgias progresivas en deterioro del estado general, con debut en síndrome confusional agudo, caída de filtrado glomerular, microhematuria y proteinuria casi nefrótica. A la evaluación inicial se encontró anemia y trombocitopenia severa, en perfil inmune ANA 1/320 y complemento consumido, cumpliendo criterios para LES, ANCA reactivo específicamente MPO ANCA (1/320) y sospecha de glomerulonefritis con patrón rápidamente progresivo (GNRP). Dado el contexto clínico, se decidió comenzar con pulsos de metilprednisolona consecutivos, seguidos de prednisolona oral y, como terapia de mantenimiento, se instauró ciclofosfamida. Finalmente, con una biopsia renal se confirmó el diagnóstico de vasculitis sistémica pauciinmune con formación de crescencia celular. La evolución clínica del paciente fue satisfactoria, logrando la estabilización de órganos y la normalización de la función renal, hematopoyética y el estado neurológico. Discusión y conclusión: dado que la presentación clínica de LES es heterogénea, se ha reportado su asociación con vasculitis, las cuales comparten un compromiso común de órganos como articulaciones, piel y riñones. Los hallazgos paraclínicos, como por biopsia, fueron consistentes tanto con PAM como con LES, por lo tanto, se diagnosticó como un caso de superposición. Este caso demuestra el enigma del diagnóstico y la complejidad en el manejo de entidades poco frecuentes, de etiologías inmunológicas superpuestas que ponen en peligro la vida de quien la(s) padece, de no tener un diagnóstico oportuno y un tratamiento temprano.

Hypouricemia is a biochemical disorder and marker for primary or secondary tubulophaty and other underlying illnesses, defined as a serum uric acid concentration lesser than 2 mg/dL. It occurs in approximately 2% of hospitalized patients and in lesser than 0.5% of general population. Hypouricemia may be caused by decreased uric acid production, uric acid oxidation or decreased renal tubular reabsortion. Differential diagnosis of hypouricemia is usually made by evaluating the fractional excretion of uric acid. Patients with hypouricemia may have an increased incidence of acute kidney injury related to exercise and reduced kidney function. The aim of this paper is to review current concepts related to hypouricemia and emphasize the importance of its evaluation and follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Acute kidney injury is a complication described in patients with SARS-CoV-2 infection that is around 0.5-7% of cases. Objective: evaluate the prognostic value of kidney involvement in patients hospitalized for COVID-19 disease. Methods: A prospective cohort of patients over 18 years with a diagnosis of COVID-19 disease in the period from May to October 2020 was analyzed. All were followed up until hospital discharge or death. Clinical and biochemical parameters, Charlson score, mortality and severity of COVID-19 disease were evaluated. Results: Four hundred twelve patients entered the study, 57% men and mean age 51 ± 16 years. Twenty percent had a Charlson score ≥3, the incidence of acute kidney injury, defined as the increase in serum creatinine 0.3 mg / dl from baseline, was 5.5% (n = 23) and hospital mortality was 2.2% (n = 9). The bivariate and multivariate analysis showed that the male sex [OR= 0.32 (IC 0.12-0.82), p = 0.017], D-dimer> 500 ng/ml [OR= 3.68 (IC 1.23-10.96), p = 0.019], urinary protein/creatinine > 0.20 [OR= 2.43 (CI 1.03-5.74), p = 0.043], and AKI [OR= 10.53 (CI 2.99-37.09), p <0.0001] were predictors of severe COVID-19, defined as respiratory rate >30 x min, oxygen saturation <93% or PO2/FIO2 <300. The univariate analysis of mortality was associated with the development of severe COVID-19 [OR= 68.76 (CI 8.39-563.36), p <0.0001] and acute kidney injury [OR= 45.41 (CI 10.45-197.22), p <0.0001]. Conclusion: Renal involvement is associated with worse evolution and higher mortality in COVID-19. The assessment of renal function and proteinuria are accessible parameters that should be included as risk factors in the initial evaluation of these patients. [ABSTRACT FROM AUTHOR]

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.

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.

Contexto: en el curso de la enfermedad del paciente cirrótico, la insuficiencia renal es un eventode mal pronóstico. Objetivo: identificar en estos pacientes los factores de riesgo de IRA, tales como: presencia deprocesos infecciosos, hipovolemia inducida por hemorragia, pérdidas gastrointestinales o renalesy agentes nefrotóxicos, ya que conocer de su aparición es primordial para dar comienzo a lasmedidas terapéuticas y las acciones profilácticas. Metodología: se realizó una búsqueda bibliográfica en las bases de datos PubMed, EMBASE,Scopus y Google académico, usando los términos MeSH como insuficiencia renal aguda, creatinina, cirrosis hepática, síndrome hepatorenal. Se obtuvieron resultados entre artículos originales, metaanálisis, reportes de casos, series de casos y revisiones de la literatura, y se escogieron 16 documentos para la elaboración de esta revisión. Resultados: los nuevos criterios definidos por el Club Internacional de Ascitis (AKI-IAC), loscuales eliminan el gasto urinario, se determinan por un aumento de la creatinina sérica?0,3mg/dL en menos de 48 horas y, mejoran el pronóstico, permitiendo realizar intervenciones opor-tunas. Conclusiones: la creatinina sigue siendo el biomarcador más utilizado en insuficiencia renalaguda (IRA), incluso en pacientes cirróticos, a pesar de sus múltiples limitaciones. Un criterio dinámico modificado a partir de los criterios de AKIN, se convierte en el patrón de oro para eldiagnóstico de IRA en cirrosis.

La esclerosis sistémica (ES) es una enfermedad inmunomediada, caracterizada por la presenciade fibrosis e inflamación tisular, que conlleva a cambios degenerativos vasculares de la piel yórganos internos tales como pulmón, corazón, tracto gastrointestinal y riñón. Tiene formas depresentación localizadas y sistémicas. La crisis renal esclerodérmica (CRE) es la manifestacióngrave en el riñón que se caracteriza por: a) hipertensión maligna, de inicio súbito asociado a aumento de actividad de renina plasmática. Hay una variante clínica que cursa con normotensión,la cual es de peor pronóstico; b) insuficiencia renal aguda (IRA); c) microangiopatía trombótica. A continuación, se relata la presentación de un caso de CRE en un paciente de sexo femeninode 60 años, que ingresó a la Institución con un cuadro caracterizado por crisis hipertensiva tipoemergencia, caída de filtrado glomerular severa, microhematuria y proteinuria; la cual recibiótratamiento médico, pero por persistencia de signos y síntomas, se decidió realizar una punciónbiopsia renal, la cual confirmo el diagnóstico.

Introduction: Acute kidney injury (AKI) is a very common complication among patients in critical conditions and it is associated with a high morbidity and mortality rate. Objectives: The aims of this study were the following: analyze the incidence, risk factors and mortality related to AKI in patients in critical conditions, as well as to determine the incidence of RRT (renal replacement therapy) requirement. Methods: A prospective cohort observational study was performed. Patients admitted to the intensive care units of the Hospital Privado Universitario de Córdoba (Private Medical College Hospital of Córdoba) in 2016, between January and March, were included. A 7-day follow-up was conducted. Results: There were 150 patients included in this study. Incidence of AKI was of 44.7% (n=67). Causes of AKI were prerenal in 70.1% (n=47) of cases; whereas 73.1% (n=49) of patients were admitted due to some pathology. Risk factors for AKI found through multivariate analysis were Chronic Kidney Disease (CKD) and a high SOFA score. Adjusted for other variables, patients with CKD are four times more likely to suffer from AKI (adjusted OR= 4.76; 95% CI= 1.93-11.75; p=0.001), whereas for each additional point in the SOFA score, risk was 25% higher (adjusted OR=1.25; 95% CI=1.08-1.44; p=0.003). The same analysis showed that the mortality variables were the use of vasopressors and AKI. AKI patients had a mortality risk six times higher over time (adjusted HR=6.33; 95% CI= 1.41-28.4, p=0.016). Conclusion: Presence of CKD and a high SOFA score were the risk factors which triggered AKI, whereas AKI was an independent risk factor for short-term mortality.

Objective: To evaluate renal responsiveness in oliguric critically ill patients after a fluid challenge. Methods: We conducted a prospective observational study in one university intensive care unit. Patients with urine output < 0.5mL/kg/h for 3 hours with a mean arterial pressure > 60mmHg received a fluid challenge. We examined renal fluid responsiveness (defined as urine output > 0.5mL/kg/h for 3 hours) after fluid challenge. Results: Forty-two patients (age 67 ± 13 years; APACHE II score 16 ± 6) were evaluated. Patient characteristics were similar between renal responders and renal nonresponders. Thirteen patients (31%) were renal responders. Hemodynamic or perfusion parameters were not different between those who did and those who did not increase urine output before the fluid challenge. The areas under the receiver operating characteristic curves were calculated for mean arterial pressure, heart rate, creatinine, urea, creatinine clearance, urea/creatinine ratio and lactate before the fluid challenge. None of these parameters were sensitive or specific enough to predict reversal of oliguria. Conclusion: After achieving hemodynamic stability, oliguric patients did not increase urine output after a fluid challenge. Systemic hemodynamic, perfusion or renal parameters were weak predictors of urine responsiveness. Our results suggest that volume replacement to correct oliguria in patients without obvious hypovolemia should be done with caution. [ABSTRACT FROM AUTHOR]

A doença renal aguda (DRA) refere-se a uma síndrome clínica associada a alta morbidade e mortalidade, fazendo parte da síndrome de disfunção de múltiplos órgãos. Em medicina veterinária, estudos sobre a incidência de casos com DRA ainda são pouco elucidados, e a fisiopatologia da lesão renal aguda (LRA) é complexa, sendo caracterizada pela rápida diminuição da função excretora renal e consequente acúmulo de produtos do metabolismo de nitrogênio. Nesse contexto, o objetivo desse estudo foi apresentar a DRA com dados atuais sobre etiologia, patogenia, diagnóstico e tratamento.

A insuficiência renal aguda no pós-operatório de cirurgia cardíaca, embora não seja freqüente, é considerada uma das mais importantes complicações, devido à alta mortalidade associada com essa condição, principalmente quando algum tipo de terapia de substituição renal se faz necessária. Vários fatores de risco têm sido identificados como significativos para o desenvolvimento da insuficiência renal aguda, entre eles a idade avançada, a insuficiência renal prévia, o tempo de circulação extracorpórea e o tipo de cirurgia realizada. A etiologia é multifatorial, identificando-se fatores genéticos e aspectos relacionados com o procedimento cirúrgico. Uma vez estabelecida a insuficiência renal aguda, medidas de suporte devem ser iniciadas, evitando perpetuar a lesão renal. A terapia de substituição renal não deve ser postergada, sendo, até o momento, a única ação terapêutica efetiva em termos de melhorar o prognóstico desses pacientes. Unitermos: Insuficiência renal aguda, pós-operatório de cirurgia cardíaca.

RESUMO A insuficiência renal aguda é um problema clínico freqüente em pacientes hospitalizados (5%), principalmente em unidades de terapia intensiva. Apesar dos avanços na medicina, a insuficiência renal aguda ainda está associada a uma mortalidade que pode variar de 50 a 80%. Esta revisão aborda os aspectos relevantes quanto ao diagnóstico, patogênese, prevenção e tratamento da insuficiência renal aguda. Unitermos: Insuficiência renal aguda, patogênese, tratamento.

Introducción: la nefropatía inducida por medios de contraste (NIC) es la injuria secundaria a la exposición en procedimientos diagnósticos e intervencionistas. Representa la tercera causa de insuficiencia renal aguda hospitalaria. Esta investigación buscó establecer factores de riesgo para NIC en cateterismo cardiaco izquierdo (CCI) en pacientes hospitalizados en el Hospital de San José de Bogotá, durante tres años. Métodos: estudio de cohorte retrospectiva en pacientes con CCI y exposición a medios de contraste y estrategias de nefroprotección con líquidos, bicarbonato o N-acetilcisteína. Se incluyeron todos los atendidos entre 2014 y 2016. Se definió la NIC como el aumento de 0,5 mg/dL de creatinina en 72 horas o del 25% de la basal. De 495 pacientes, se excluyeron 15 con hemodiálisis previa. Se tomaron registros clínicos electrónicos realizando análisis estadístico multivariado. Se utilizó el paquete estadístico stata 13. Resultados: en 480 pacientes la incidencia de NIC fue 13,1%; tener una hemoglobina mayor 13 gr/dL en hombres, fue un factor protector para NIC OR: 0,29 (p=0.004). La creatinina basal mayor de 1,5 mg/dL aumentó el riesgo de NIC OR: 2,56 (IC 95: 1,35-4,85; p=0.004), así como la coexistencia de diabetes y enfermedad renal crónica OR: 2,73 (IC 95: 1,25 – 5.95; p=0,005). Otros factores como edad, falla cardiaca, volumen de contraste, IAM anterior y estrategias de nefroprotección, no mostraron asociación significativa. En relación con NIC la incidencia de muerte fue 9,5% y hemodiálisis 2,5%. Conclusiones: la incidencia de NIC se asocia con aumento de la mortalidad; los factores de riesgo asociados fueron creatinina >1.5 mg/dL y diabetes más enfermedad renal crónica. La hemoglobina normal en hombres se asoció con efecto protector.

Bee envenomation is frequent in humans and dogs, but uncommon in horses. This study aimed to describe a case of acute renal failure following mass envenomation in a horse. A mare was attacked by a swarm of bees and showed reluctance to move, epistaxis, and darkbrown urine. Biochemical exams revealed increase in urea and creatine serum levels. The mare did not respond to treatment and euthanasia was elected after four days of clinical course. At the necropsy, there were multifocal pinpoint to elevated skin lesions associated with edema and hemorrhage, which extended to the subcutaneous tissue and skeletal muscle, and the kidneys were diffusely dark-brown and friable. Microscopically, renal tubules were distended and filled with an orange-red, hyaline globular material, and had severe epithelial tubular cell necrosis. The diagnosis was established based on clinical and histological analysis, and pathological evaluation was essential to confirm acute renal failure due to bee sting toxicity. [ABSTRACT FROM AUTHOR]

Acute Kidney Disease (AKD) in cats is quite recurrent in the small animal clinic. Early diagnosis and monitoring of this disease are important, given that its presence promotes or causes urinary toxins, in addition to causing hydroelectrolytic imbalance and basic acid in the body. In order to diagnose an AKD, the veterinarian will assist with laboratory tests, such as blood count, biochemical, in addition to imaging tests such as ultrasound examination. An ultrasound in veterinary medicine has advanced in order to allow exams to be carried out before only possible human patients. The use of ultrasonography in Doppler mode and ultrasound contrast with the monitoring of patients affected by kidney diseases, such as AKD, through the observation of vascular lesions in the kidneys, enabling the assessment of disease progression in these patients. In this way, literature review can present an ultrasound as an important diagnostic tool, addressing its aid in the identification of acute kidney disease in felines, in addition to presente informations of ultrasound innovations in veterinary medicine, such as an ultrasound in Doppler and contrast mode. [ABSTRACT FROM AUTHOR]

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Scleroderma renal crisis is a rare and severe complication of systemic sclerosis. There are many risk predictors for the development of this complication. Diagnostic criteria are non-consensual, including arterial hypertension and oliguric acute kidney injury (AKI). Angiotensin-converting enzyme inhibitors are an effective treatment, with huge impact in prognosis. We describe a case of a scleroderma renal crisis in a 78-years-old woman who was diagnosed with systemic sclerosis and treated with prednisone at high dosage, who presented with new onset congestive heart failure, arterial hypertension and oliguric AKI. The diagnosis of scleroderma renal crisis was performed, and angiotensin-converting enzyme inhibitor was initiated with blood pressure control and slightly improved renal function. The prognosis of scleroderma renal crisis remains poor with high 5-year mortality rate. Medical awareness on tensional values and well-known risk factors could have a huge impact in diagnosis and prognosis and even on prevention of this complication. [ABSTRACT FROM AUTHOR]

Sin resumen

O Cobre (Cu) é um microelemento considerado essencial e tóxico para o animal, essa toxidade varia de acordo com a espécie ruminante, sendo os pequenos ruminantes os mais sensíveis. Muitos produtores empregam uma dieta mineral de bovinos para caprinos, desencadeando distúrbios metabólicos como a intoxicação por cobre. O quadro clínico de intoxicação se baseia em um quadro agudo, caracterizado por gastroenterite e um quadro crônico, caracterizado pelo acúmulo gradativo de cobre em tecidos, principalmente no fígado gerando um quadro hemolítico e nefropatia. O objetivo do presente trabalho foi relatar um caso de suspeita de intoxicação por cobre em caprino. Foi realizado atendimento a um caprino, fêmea, 3 anos de idade, com 48kg apresentando como queixa principal diarreia e apatia. Durante a anamnese o proprietário relatou que fornecia sal mineral de bovinos para o animal. Ao exame físico geral foi possível observar taquicardia, taquipneia, atonia ruminal, 39,6 ºC, mucosa ocular congesta e TPC 3’’, além de evidenciar desidratação de 10%. De acordo com a anamnese e os sinais clínicos, a suspeita inicial foi de intoxicação por cobre. Para a confirmação da suspeita a colheita de sangue foi realizada para hemograma e mensuração de cobre no soro. No hemograma detectou-se anemia grave, VG=10%, e devido a hemólise não foi possível realizar a mensuração do cobre. O tratamento inicial instituído foi a fluidoterapia com solução de Ringer com Lactato. Após a realização da fluidoterapia observou-se hemoglobinúria em pequena quantidade. O animal desenvolveu um quadro de insuficiência renal aguda (IRA) devido a hemólise intravascular grave, e não produziu mais urina durante a fluidoterapia. Optou-se então pela administração de furosemida, após 1 hora sem produção de urina uma nova administração foi realizada, porém com insucesso novamente. Devido a insuficiência renal aguda e a intensa hemólise intravascular o animal desenvolveu edema pulmonar e em membros, e o proprietário optou pela eutanásia. É importante orientar os produtores de pequenos ruminantes para não ofertar sal mineral de bovinos, devido a necessidade de cobre ser diferente entre as espécies, favorecendo a intoxicação.

Introduction: Severe renal lesion after cardiac surgery remains as an important cause of postoperative morbidity and the occurrence of non-communicable chronic diseases in patients referred for this type of surgical procedure is higher. The incidence of the severe renal lesion depends on the type of surgery and on renal functions before the operation, but many are the factors contribution to the onset of such lesion. Objectives: To expand current knowledge about patients with acute kidney failure in relation to the main aspects of their incidence after cardiac surgery or not associated with extracorporeal circulation and its influence on anesthetic conduction and postoperative behavior in the appearance of the referred kidney damage. Methods: We consulted the bibliographic databases Pubmed, Hinari, Clinical Key, Lilacs, specialty textbooks and doctoral dissertations, from which more than 25 review articles, mostly updated, were taken Results: The decrease in morbidity and mortality depends on the knowledge about risk factors associated with the onset of acute kidney failure in the postoperative period of the cardiovascular surgical intervention, as well as the preparation of the conditions to confront the possible complications. Conclusions: The correct choice of anesthetic technique, as well as the monitoring of hematological and clinical parameters in the perioperative period improves recovery, less stay in the intensive care and cardiology units, considerable saving of resources and greater well-being for patients.

Introducción: La lesión renal aguda después de una cirugía cardíaca persiste como una causa importante de morbilidad posoperatoria, y la existencia de enfermedades crónicas no transmisibles en pacientes que se remiten a este tipo de procedimiento quirúrgico, es mayor. La incidencia de lesión renal aguda depende del tipo de cirugía y de la función renal previa a la operación, pero muchos son los factores que contribuyen a la manifestación de dicha lesión. Objetivos: Ampliar los conocimientos actuales sobre el paciente con insuficiencia renal aguda en relación con los aspectos principales de su incidencia después de la cirugía cardíaca asociada o no a la circulación extracorpórea y su influencia en la conducción anestésica y la conducta posoperatoria en la aparición del referido daño renal. Métodos: Se consultaron las bases de datos bibliográficas Pubmed, Hinari, Clinical Key, Lilacs, libros de textos de la especialidad y tesis doctorales de donde se extrajeron más de 25 artículos de revisión en su mayoría actualizados. Resultados: La disminución de la morbilidad y mortalidad depende del conocimiento de los factores de riesgo asociados a la aparición de insuficiencia renal aguda en el posoperatorio de la intervención quirúrgica cardiovascular, así como la preparación de las condiciones para enfrentar las posibles complicaciones. Conclusiones: La correcta elección de la técnica anestésica, la monitorización de parámetros hematológicos y clínicos en el perioperatorio mejora la recuperación, menor estadía en las unidades de cuidados intensivos y cardiología, considerable ahorro de recursos y mayor bienestar para los pacientes.

Introduction and Objectives: Acute kidney injury (AKI) is a common devastating complication characterized by an abrupt loss of renal function. It is of great significance to explore promising biomarkers for AKI treatment., Materials and Methods: Here, we established LPS (lipopolysaccharide)-induced AKI mice models and LPS-induced AKI mouse renal tubular epithelial cell model. The severity of AKI was determined by the levels of BUN (blood urea nitrogen) and SCr (serum creatinine), the observation of pathological section as well as the renal tubular injury score. The apoptosis was determined by the measurement of Caspase-3 and Caspase-9 activities, and cell apoptosis assays. qRT-PCR (quantitative real-time PCR) and western blot revealed that miR-322-5p (microRNA-322-5p) was up-regulated in LPS -induced AKI models while Tbx21 (T-box transcription factor 21) was down-regulated in LPS-induced AKI models. Dual-luciferase reporter and RNA pulldown assays detected the interaction of Tbx21 with miR-322-5p., Results: We found that miR-322-5p was overtly over-expressed in the in vitro LPS-induced AKI model and promoted the apoptosis of AKI mouse renal tubular epithelial cells via inhibiting Tbx21, which suppressed the mitochondrial fission and cell apoptosis through MAPK/ERK (mitogen-activated protein kinase/extracellular signal-related kinase) pathway., Conclusions: We demonstrated that miR-322-5p promotes LPS-induced mouse AKI by regulating Tbx21/MAPK/ERK axis, which might provide new sights for AKI research., (Copyright © 2023 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)

Copyright of Revista Médica de Rosario is the property of Circulo Medico de Rosario and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The association of acute renal failure in patients with liver cirrhosis has always been established in the context of hepatorenal syndrome, but there are several etiologies in addition to this cause. Acute renal failure is a therapeutic challenge in patients with liver cirrhosis. Acute renal failure is due to prerenal factors, intrinsic factors of the kidney or post-renal. The prevalence of acute renal failure in cirrhosis has been reported from 14 to 50% in patients with cirrhosis. Its prevalence is approximately 50% in patients with cirrhosis and ascites and 20% in patients with advanced stage cirrhosis who are hospitalized. In 2015, the International Ascitis Club established a new definition and staging of acute renal failure in patients with liver cirrhosis. [ABSTRACT FROM AUTHOR]