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Acute phosphate nephropathy (APN) is an acute renal failure secondary to the use of oral sodium phosphate (OSP) laxatives, with a high risk of progression to chronicity. We report a 60-year-old woman with mixed connective tissue disease whose serum creatinine increased up to 2.0 mg/dL in her regular control tests, without an evident causative factor. Kidney biopsy showed numerous intratubular calcium phosphate deposits, consistent with APN. She had a history of OSP laxative intake, and a sodium phosphate enema was used before a colonoscopy performed six months earlier. The temporal association between the use of OSP laxatives and acute kidney injury, should lead to the suspicion of APN. The urine sediment is generally normal or with mild to moderate proteinuria. The diagnosis is confirmed with a kidney biopsy. Until now, there is no specific treatment for APN, thus prevention is essential. In high-risk patients for developing APN, the administration of these laxatives should be avoided.

Background: Excessive sodium intake is associated with increased cardiovascular morbidity and mortality. Daily sodium intake is usually inferred from sodium excretion in a 24-hour urine collection, which is cumbersome and prone to errors. Different formulas have attempted to estimate 24-hour urinary sodium from a spot urine sample. Unfortunately, their concordances are insufficient and have not been tested in our population. Aim: To develop an equation to predict 24-hour urine sodium from parameters in plasma and spot urine samples. To validate the equation and compare it with other formulas in Chilean population. Material and Methods: Analysis of 24-hour urine collections, plasma sample and spot urine sample from 174 adult outpatients (81% females) with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73m2. These were collected between 2015 and 2019 using standardized methods and educating patients about the correct method to collect 24 h urine samples. In all these patients, creatinine and electrolytes were measured in plasma and urine. A new equation was developed using a multiple linear regression model. Results: Twenty-four-hour urine sodium excretion was significantly correlated with age, weight, height, eGFR, plasma osmolarity, urine electrolytes and parameters obtained from spot urine sample, among others. The new equation had a linear correlation with 24-hour natriuresis of 0.91 and the concordance was 0.9. The predictive capacity of the new equation was better than the existing formulas. Conclusions: We developed a formula to accurately predict daily natriuresis in the Chilean population.

Glomerular filtration rate (GFR) is routinely estimated using endogenous biomarkers due to the complexity of direct measurement methods. Cystatin C is a protease inhibitor produced in all nucleated cells. It is freely filtered and then catabolized by renal tubular cells. Therefore, plasma concentration of cystatin C depends primarily on GFR. Serum cystatin C is less affected by muscle mass, diet, race, gender and age than creatinine. In the general population, equations to estimate GFR based on cystatin C do not have a better performance than those based on creatinine. However, formulas that combine creatinine and cystatin C are more accurate and precise. Estimation of GFR based on cystatin C could be useful in populations in which creatinine value may be biased, such as people with extremely low or high muscle mass, cirrhosis and chronic cardiorenal syndrome. Due to its higher cost in comparison to creatinine, we recommend measuring cystatin C on these clinical situations and when a more accurate estimation of GFR is required.

Spinal muscular atrophy is an uncommon cause of ketoacidosis, where there is a decrease in muscle mass, an abnormal metabolism of glucose and fatty acids, and changes in neuroendocrine function. These conditions favor the accumulation of keto acids and the development of metabolic acidosis. We report a 26-year-old female, with a history of spinal muscular atrophy type III, consulting for abdominal pain and vomiting lasting one week. She was admitted to the emergency service somnolent and poorly perfused. She had a pH of 6.98, HCO3- of 3.8 mmol/L, pCO2 of 16.4 mmHg, BE of -26 mmol/L, delta ratio of 1.05, anion gap of 31 mEq/L, creatinine of 0.37 mg/dL, sodium of 147 mEq/L, potassium of 3.7 mEq/L, chloride of 112 mEq/L, lactate of 1.2 mmol/L, glucose of 108 mg/dL, albumin of 4.2 g/dL, ketonemia +++, ketonuria +, measured plasma osmolality of 322 mOsm/kg, estimated osmolality of 314 mOsm/kg, toxilab negative, salicylate levels < 3 µg/mL, acetaminophen levels < 1.2 µg/mL. Intravenous hydration and bicarbonate were started, without satisfactory response. Interpreting the clinical picture as a ketoacidosis induced by stress in a patient with spinal muscular atrophy, it was handled with glucose, amino acids, vitamins and trace elements, with a favorable response.

Several lifestyle and sociodemographic factors are associated with blood pressure (BP). The authors conducted a retrospective study of 4870 subjects from the National Health Survey 2009 in Chile to identify exposure factors associated with increasing BP levels. Subjects with isolated urinary excretion of sodium (n = 2873), potassium, and creatinine were included to estimate daily salt intake and urinary sodium/potassium (Na/K) ratio. Hypertension was defined according to European guidelines 2018 and American guidelines ACC/AHA 2017. Proportional odds models were developed to analyze education level, sedentarism, smoking, alcohol intake, estimated urinary Na/K ratio, estimated daily salt intake, and body mass index (BMI) as factors associated with increasing BP levels (from high‐normal BP to hypertension). Logistic regression models were checked for overdispersion. Mean age and BMI of the population were 42 years old and 27 kg/m(2), respectively; 19% had low education level and 27% had hypertension according to European guidelines, whereas 47% according to ACC/AHA criteria. Mean estimated urinary Na/K ratio was 4 ± 2, and mean salt consumption was 10 ± 2 g/day. Estimated urinary Na/K ratio (OR, 1.11; 95% CI, 1.01‐1.21), BMI (OR, 1.10; 95% CI, 1.07‐1.13), estimated daily salt intake (OR, 1.10; 95% CI, 1.03‐1.17), and alcohol intake (OR, 1.03; 95% CI, 1.01‐1.05) were significantly associated with hypertension. This study highlights that a healthy diet and weight control should be important components of BP management plans, and it suggests that public policies should include close monitoring of these factors to reduce hypertension prevalence and improve its management in a Latino population.

Goodpasture Syndrome is described as a single episode disease entity. It is diagnosed with the demonstration of antiglomerular basement (anti-GBM) antibodies in plasma or renal tissue. Although the recurrence of anti-GBM disease is rare, it has been reported in up to 3% of cases. Recurrence with negative anti-GBM antibodies in plasma is even less frequent We report a 63 years old male in whom anti-GBM disease recurred without detectable anti-GBM antibodies in plasma, despite having positive antibodies at the onset.

Purpose Latin American reports on pheochromocytomas and paragangliomas (PPGLs) are scarce. Recent studies demonstrate changes in clinical presentation and management of these patients. Herein, we assessed the main characteristics of PPGL patients in our academic center over the past 4 decades. Methods Demographic, clinical, biochemical, and perioperative data from 105 PPGL patients were retrospectively and prospectively collected over the 1980–2019 period. Data were organized into 4 periods by decade. Results Age at diagnosis, gender, tumor size and percentage of bilaterality, percentage of paragangliomas, and metastases remained stable across the 4 decades. The proportion of genetic testing and incidentalomas increased in recent decades (all P < 0.001). Therefore, we compared PPGLs diagnosed as incidentalomas (36%) with those clinically suspected (64%). Incidentalomas had fewer adrenergic symptoms (38 vs. 62%; P < 0.001) and lower rates of hypertension (64% vs. 80%; P = 0.01) and hypertensive crisis (28% vs. 44%; P = 0.02); also, they had lower functionality (79% vs. 100%; P = 0.01) and lower catecholamines levels (8.4-fold vs. 12.5-fold above upper cutoffs; P = 0.04). Regarding management of all PPGLs over the decades, we observed significant increases in both perioperative doxazosin dose (P = 0.003) and laparoscopic approach rates (P < 0.001), along with a decrease in the length of hospital stays (P = 0.007). Conclusions We observed a change in the clinical presentation of PPGL in recent decades, with a marked increase in incidental cases and milder symptoms. The implementation of a multidisciplinary program for adrenal disorders in our institution has translated into more timely diagnoses, more genetic testing, and improvements in perioperative management.

Objective: Latin American reports on pheochromocytomas and paragangliomas (PPGL) are scarce. Recent studies have shown changes in both clinical presentation and management of these patients. We aimed to assess the main characteristics of PPGL patients in a single academic center over the last four decades. Experimental design: Cohort study. Patients and methods: Demographic, clinical, biochemical, genetic and perioperative data from 105 PPGL patients were retrospectively and prospectively collected over the 1980–2019 period. Patients were categorized into four groups (14 patients in the 1st, 25 patients in the 2nd, 27 patients in the 3th and 39 patients in the 4th decade) according to the date of diagnosis. Results: The mean age at diagnosis was 46±19 years, and the tumor size was 5.3±2.2 cm, female gender was 63%, bilateral tumor of 15%, paragangliomas 9% and metastatic disease in 15%. The aforementioned parameters remained stable across the four decades. During the study period we observed significant increases in doxazosin dosing (2.7±2.6 mg vs. 8.0±4.5 p marked increase in incidental cases, which highlights the importance of early diagnosis and treatment.

Acute phosphate nephropathy (APN) is an acute renal failure secondary to the use of oral sodium phosphate (OSP) laxatives, with a high risk of progression to chronicity. We report a 60-year-old woman with mixed connective tissue disease whose serum creatinine increased up to 2.0 mg/dL in her regular control tests, without an evident causative factor. Kidney biopsy showed numerous intratubular calcium phosphate deposits, consistent with APN. She had a history of OSP laxative intake, and a sodium phosphate enema was used before a colonoscopy performed six months earlier. The temporal association between the use of OSP laxatives and acute kidney injury, should lead to the suspicion of APN. The urine sediment is generally normal or with mild to moderate proteinuria. The diagnosis is confirmed with a kidney biopsy. Until now, there is no specific treatment for APN, thus prevention is essential. In high-risk patients for developing APN, the administration of these laxatives should be avoided.

Excessive sodium intake is associated with increased cardiovascular morbidity and mortality. Daily sodium intake is usually inferred from sodium excretion in a 24-hour urine collection, which is cumbersome and prone to errors. Different formulas have attempted to estimate 24-hour urinary sodium from a spot urine sample. Unfortunately, their concordances are insufficient and have not been tested in our population.To develop an equation to predict 24-hour urine sodium from parameters in plasma and spot urine samples. To validate the equation and compare it with other formulas in Chilean population.Analysis of 24-hour urine collections, plasma sample and spot urine sample from 174 adult outpatients (81% females) with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73m2. These were collected between 2015 and 2019 using standardized methods and educating patients about the correct method to collect 24 h urine samples. In all these patients, creatinine and electrolytes were measured in plasma and urine. A new equation was developed using a multiple linear regression model.Twenty-four-hour urine sodium excretion was significantly correlated with age, weight, height, eGFR, plasma osmolarity, urine electrolytes and parameters obtained from spot urine sample, among others. The new equation had a linear correlation with 24-hour natriuresis of 0.91 and the concordance was 0.9. The predictive capacity of the new equation was better than the existing formulas.We developed a formula to accurately predict daily natriuresis in the Chilean population.

Glomerular filtration rate (GFR) is routinely estimated using endogenous biomarkers due to the complexity of direct measurement methods. Cystatin C is a protease inhibitor produced in all nucleated cells. It is freely filtered and then catabolized by renal tubular cells. Therefore, plasma concentration of cystatin C depends primarily on GFR. Serum cystatin C is less affected by muscle mass, diet, race, gender and age than creatinine. In the general population, equations to estimate GFR based on cystatin C do not have a better performance than those based on creatinine. However, formulas that combine creatinine and cystatin C are more accurate and precise. Estimation of GFR based on cystatin C could be useful in populations in which creatinine value may be biased, such as people with extremely low or high muscle mass, cirrhosis and chronic cardiorenal syndrome. Due to its higher cost in comparison to creatinine, we recommend measuring cystatin C on these clinical situations and when a more accurate estimation of GFR is required.

Toxic alcohols can produce severe poisoning with multiple organic involvement and even death. The most common form is ethylene glycol. The diagnosis can be extremely difficult if there is no history of its consumption. Its clinical presentation can simulate other conditions. Ethylene glycol poisoning is characterized by an initial rise in plasma osmolal gap that decreases during the evolution, while alcohol is metabolized to acids. This last condition causes a metabolic acidosis with elevated anion gap. The clinical manifestations are diffuse neurological involvement initially, followed by hemodynamic alterations due to myocardial damage associated with hypocalcemia and acidemia. Subsequently, severe tubular renal damage appears, which may require renal replacement therapy, and finally, focal neurological alterations. To treat this poisoning, it is necessary to inhibit the transformation of alcohol into acids, increase the metabolism of the latter or withdraw them directly with hemodialysis.

Hemolytic uremic syndrome (HUS) is a type of thrombotic microangiopathy where organic damage predominates in the kidney. Atypical HUS (aHUS) is a rare disease that affects young adults and causes terminal chronic renal failure ending in dialysis, in most cases. It also recurs after kidney transplantation. aHUS is associated with genetic defects of the alternative complement pathway or its activation by other factors such as drugs, autoimmune diseases, infections, malignant hypertension and ischemia-reperfusion. We report two women aged 17 and 25 years old with catastrophic aHUS. In both cases, complement amplifying factors (drugs and infections) were added and acted on a genetic vulnerability to precipitate complement activation and produce aHUS. Both patients developed terminal renal failure and had to undergo hemodialysis. Fortunately, after a broad etiological study, it was possible to make the diagnosis of aHUS and start treatment with Eculizumab, a monoclonal antibody that changed the natural history of aHUS. It inhibits complement activity controlling microangiopathy and preventing the development of end-stage renal disease. It also improves the success rate in kidney transplantation. In the case of our patients, both discontinued dialysis after chronic treatment with Eculizumab.

RESUMEN La hipertension arterial es uno de los principales factores de riesgo de las enfermedades cardiovasculares. El diagnostico de esta enfermedad y su tratamiento se basa en una correcta medicion de la presion arterial. Sin embargo, la tecnica de medicion de la presion arterial tiende a ser subvalorada y en muchas ocasiones efectuada incorrectamente. La correcta medicion de la presion arterial en la consulta requiere seguir determinados pasos y utilizar equipos certificados y calibrados. En la actualidad, se recomienda complementar estas mediciones con mediciones de la presion arterial fuera de la consulta, ya sea monitoreo ambulatorio o autocontroles domiciliarios para confirmar el diagnostico y descartar la presencia de hipertension arterial de delantal blanco. En el futuro proximo, el monitoreo ambulatorio de la presion arterial o autocontroles domiciliarios seran utilizados cada vez con mayor frecuencia dada sus reconocidas ventajas sobre la medicion de la presion arterial de consulta. El primero fundamentalmente en el diagnostico del paciente hipertenso y el segundo en el seguimiento del hipertenso bajo tratamiento para comprobar la efectividad de este.

RESUMEN Una pregunta habitual para los clinicos frente al paciente con hipertension arterial es: cuales son las metas de presion arterial sistolica y diastolica, para lograr los beneficios cardiovasculares, pero sin aumentar los efectos indeseables. Las guias internacionales de hipertension arterial han ido cambiando estos valores, siendo entonces dificil generalizar y, en consecuencia, aplicar estas recomendaciones. En poblaciones especiales, como los pacientes con diabetes mellitus, enfermedad renal cronica, cardiopatia coronaria o en los ancianos, existen discrepancias entre las diferentes guias en relacion a las metas de presion arterial. Las metas de presion arterial surgen en las diferentes guias mayoritariamente de un consenso de expertos mas que de estudios clinicos controlados aleatorizados o de meta-analisis. Establecer metas de presion arterial en hipertension arterial es un tema de discusion y de creciente incertidumbre para los clinicos. Este panorama cambiante es comprensible dada la escasez de estudios clinicos controlados aleatorizados disenados para responder a estas interrogantes, en especial en determinadas condiciones clinicas. Describimos las recomendaciones de las guias internacionales mas conocidas, para luego revisar y analizar en detalle las metas de PA para aquellos grupos de pacientes con hipertension arterial donde existen mayores discrepancias.

Spinal muscular atrophy is an uncommon cause of ketoacidosis, where there is a decrease in muscle mass, an abnormal metabolism of glucose and fatty acids, and changes in neuroendocrine function. These conditions favor the accumulation of keto acids and the development of metabolic acidosis. We report a 26-year-old female, with a history of spinal muscular atrophy type III, consulting for abdominal pain and vomiting lasting one week. She was admitted to the emergency service somnolent and poorly perfused. She had a pH of 6.98, HCO3- of 3.8 mmol/L, pCO2 of 16.4 mmHg, BE of -26 mmol/L, delta ratio of 1.05, anion gap of 31 mEq/L, creatinine of 0.37 mg/dL, sodium of 147 mEq/L, potassium of 3.7 mEq/L, chloride of 112 mEq/L, lactate of 1.2 mmol/L, glucose of 108 mg/dL, albumin of 4.2 g/dL, ketonemia +++, ketonuria +, measured plasma osmolality of 322 mOsm/kg, estimated osmolality of 314 mOsm/kg, toxilab negative, salicylate levels3 µg/mL, acetaminophen levels1.2 µg/mL. Intravenous hydration and bicarbonate were started, without satisfactory response. Interpreting the clinical picture as a ketoacidosis induced by stress in a patient with spinal muscular atrophy, it was handled with glucose, amino acids, vitamins and trace elements, with a favorable response.

Goodpasture Syndrome is described as a single episode disease entity. It is diagnosed with the demonstration of antiglomerular basement (anti-GBM) antibodies in plasma or renal tissue. Although the recurrence of anti-GBM disease is rare, it has been reported in up to 3% of cases. Recurrence with negative anti-GBM antibodies in plasma is even less frequent We report a 63 years old male in whom anti-GBM disease recurred without detectable anti-GBM antibodies in plasma, despite having positive antibodies at the onset.

Atypical hemolytic uremic syndrome (aHUS) is a rare thrombotic microangiopathy, characterized by microangiopathic hemolytic anemia, thrombocytopenia and renal involvement. It causes end stage renal disease requiring dialysis in most affected patients. It mainly affects young adults (contrary to what was thought years ago). When aHUS is primary, the cause is a genetic mutation in the alternative complement pathway. Instead, secondary aHUS is caused by external factors that trigger the disease by themselves or in combination with a genetic vulnerability. The type of mutation determines the severity of the disease, prognosis, response to therapy and renal transplantation. Advances in the understanding of renal diseases associated with complement defects and the development of specific biologic therapies changed the course of this disease. Eculizumab is internationally approved for the treatment of primary aHUS. Its inhibitory action on the complement cascade leads to hematologic remission and restoration of renal function. We present a review of aHUS detailing its etiology, pathogenesis, clinical presentation, diagnosis and treatment.

Glomerular filtration rate (GFR) is the best approximation to global renal function and its estimation is of great relevance for clinical practice. Since the measurement of GFR by reference methods is complex, costly and not widely available, its routine evaluation is performed using endogenous biomarkers. Within these, creatinine is the most commonly used. It allows the estimation of GFR by means of its clearance or by formulas based on its concentration on plasma. Creatinine measurement should be performed using enzimatic methods as they confer more accurate values than Jaffe methods, especially for normal and low creatinine levels.

Hemolytic uremic syndrome (HUS) is a type of thrombotic microangiopathy where organic damage predominates in the kidney. Atypical HUS (aHUS) is a rare disease that affects young adults and causes terminal chronic renal failure ending in dialysis, in most cases. It also recurs after kidney transplantation. aHUS is associated with genetic defects of the alternative complement pathway or its activation by other factors such as drugs, autoimmune diseases, infections, malignant hypertension and ischemia-reperfusion. We report two women aged 17 and 25 years old with catastrophic aHUS. In both cases, complement amplifying factors (drugs and infections) were added and acted on a genetic vulnerability to precipitate complement activation and produce aHUS. Both patients developed terminal renal failure and had to undergo hemodialysis. Fortunately, after a broad etiological study, it was possible to make the diagnosis of aHUS and start treatment with Eculizumab, a monoclonal antibody that changed the natural history of aHUS. It inhibits complement activity controlling microangiopathy and preventing the development of end-stage renal disease. It also improves the success rate in kidney transplantation. In the case of our patients, both discontinued dialysis after chronic treatment with Eculizumab.

Resumen: La disminucion en la produccion de estro-genos durante la menopausia favorece una disminucion en la funcion endotelial y en la mineralizacion osea, ade-mas de cambios en la distribucion de la grasa corporal. Estos cambios favorecen un aumento en la prevalencia de hipertension arterial en mujeres mayores de 50 anos, junto con un aumento en otros factores de riesgo cardio-vascular y una disminucion de la densidad osea (DO). La terapia de reemplazo hormonal utilizada en estas mu-jeres para mitigar los cambios descritos, se ha asociado a un mayor riesgo de desarrollar nefrolitiasis. La dieta DASH ha demostrado ser efectiva en reducir la presion arterial y en este trabajo se discuten otros beneficios de esta dieta asociados a otros factores de riesgo, a la DO y en la mantencion de la homeostasis urinaria. Por este motivo, se discute si la dieta DASH seria efectivamente beneficiosa en este grupo de mujeres independiente de sus efectos en la presion arterial. Dieta DASH y menopausia: Mas alla de los beneficios en hipertension arterial

Glomerular filtration rate (GFR) is the best approximation to global renal function and its estimation is of great relevance for clinical practice. Since the measurement of GFR by reference methods is complex, costly and not widely available, its routine evaluation is performed using endogenous biomarkers. Within these, creatinine is the most commonly used. It allows the estimation of GFR by means of its clearance or by formulas based on its concentration on plasma. Creatinine measurement should be performed using enzimatic methods as they confer more accurate values than Jaffe methods, especially for normal and low creatinine levels.

Rosai-Dorfman-Destombes disease (RDD) or sinus histiocytosis with massive lymphadenopathy (SHML), is a rare disorder, first described by Destombes in 1965 and then Rosai and Dorfman reported the first clinical series in 1969. The etiology of RDD is unknown, and the treatment is not standardized. There is no data about the true number of cases that exist worldwide. This disease occurs mainly in children and young adults, however, it may occur at any age. It is more common in males and individuals of African descent. RDD, presents clinically as painful bilateral massive cervical lymphadenopathies, with fever, night sweats and weight loss. Mediastinum, inguinal region and retroperitoneum lymph nodes may also be involved. The course of the disease is unpredictable, usually characterized by episodes of exacerbation and remission. It can last for many years and is usually self-limited, with good outcomes. Extranodal compromise is unusual but can affect almost any organ. Involvement of the kidney has been stated as a poor prognostic predictor.1 We present an unusual case of RDD in a 64 year old woman with a literature review of renal RDD.

Last National Chilean Health Survey (NHS) has shown that the mean salt intake was 9 gr/day. Sodium intake is directly associated with higher blood pressure (BP). Potassium intake attenuates the hypertensive effect of salt. To determine the predictive power of urinary sodium/potassium ratio (Nau/Ku

Antecedentes: La determinacion del riesgo cardiovascular en adultos con exceso de peso es complejo, ya que generalmente presentan un puntaje de Framingham (FRAM) bajo, y por ello, no son intervenidos. El uso de marcadores no tradicionales podria ser de utilidad en la evaluacion de este grupo. Hipotesis: Las personas con sobrepeso/obesas, sin sindrome metabolico (SMET), tienen mayor riesgo cardiovascular basado en su grosor intima media carotideo (IMT) y proteina C-reactiva ultrasensible (PCRus), que los sujetos normopeso. Metodos: En 1558 sujetos (816 mujeres, edad 45 ± 11 anos) asintomaticos, medimos: IMC, cintura, presion arterial, perfil lipidico, glicemia, FRAM, PCRus e IMT. Para el analisis se dividio a los sujetos en 3 grupos, de acuerdo a IMC y presencia de factores de riesgo (FR) de SMET segun ATPIII: 1) IMC Resultados: A pesar de que los sujetos del grupo 2 (IMC ?25 y 2 mg/dl =32%; Grupo 1: IMT=0,57 mm y PCRus>2 mg/dl=19%, respectivamente, p Conclusion: Este estudio demuestra los sujetos sobrepeso/obesos sin SMET, si bien tienen un bajo riesgo cardiovascular por FRAM presentan una carga inflamatoria y de aterosclerosis subclinica importante. Es decir, estos sujetos estan en "riesgo cardiovascular", y por lo tanto, son merecedores de intervenciones apropiadas.

Atherosclerotic renal artery stenosis may result in hypertension and ischemic nephropathy. Renal artery endovascular stenting has emerged as current therapy; however, the percentage of patients who benefit from this procedure is still not well established. The authors studied 116 hypertensive patients with atherosclerotic renovascular stenosis who underwent successful renal artery stenting for the first time. At 1 year, there was a significant overall decrease in blood pressure in the group after stenting; however, there was no change in renal function. Also, no significant change in the number of antihypertensive drugs was noted. Blood pressure improved in 55% of the patients, worsened in 14%, and remained unchanged in 31%. Renal function improved in 16% of the patients, worsened in 30%, and remained stable in 54%. In relation to blood pressure control, patients with resistant or difficult‐to‐control hypertension showed the most improvement in blood pressure control after stenting.

The present review examines the types of hypertension that women may suffer throughout life, their physiopathological characteristics and management. In early life, the currently used low-dose oral contraceptives seldom cause hypertension. Pregnancy provokes preeclampsia, its main medical complication, secondary to inadequate transformation of the spiral arteries and the subsequent multisystem endothelial damage caused by deportation of placental factors and microparticles. Hypertension in preeclampsia is an epiphenomenon which needs to be controlled at levels that reduce maternal risk without impairing placental perfusion. The hemodynamic changes of pregnancy may unmask a hypertensive phenotype, may exacerbate a chronic hypertension, or may complicate hypertension secondary to lupus, renovascular lesions, and pheochromocytoma. On the other hand a primary aldosteronism may benefit from the effect of progesterone and present as a postpartum hypertension. A hypertensive pregnancy, especially preeclampsia, represents a risk for cardiac, vascular and renal disease in later life. Menopause may mimic a pheochromocytoma, and is associated to endothelial dysfunction and salt-sensitivity. Among women, non-pharmacological treatment should be forcefully advocated, except for sodium restriction during pregnancy. The blockade of the renin-angiotensin system should be avoided in women at risk of pregnancy; betablockers could be used with precautions during pregnancy; diuretics, ACE inhibitors and angiotensin receptor antagonists should not be used during breast feeding. Collateral effects of antihypertensives, such as hyponatremia, cough and edema are more common in women. Thus, hypertension in women should be managed according to the different life stages.

Atypical hemolytic uremic syndrome (aHUS) is a rare but catastrophic disease. It is characterized by a triad of microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. When the aHUS is primary, the cause is due to mutations in proteins that regulate the alternative pathway of complement, such as Factor H, Factor I, Factor B, C3, Membrane Co-Factor Protein and Thrombomodulin. Usually primary aHUS is associated with other amplifiers complement factors. We present a case of aHUS in a 25-year-old female patient; she presented with malignant hypertension and severe renal failure. After a widespread study, the etiology of the aHUS was a mutation in the complement factor H, not previously described in the literature (p.Tyr1177His). After treatment with Eculizumab (C5 inhibitor monoclonal antibody), she recovered renal function with not hemodialysis requirements.

The typical symptoms of pheochromocytoma are palpitations, sweating, headaches and hypertension. We report a 70-year-old female admitted to the hospital due to a sudden onset of precordial pain with electrocardiographic changes. After admission the patient evolved with recurrent chest pain accompanied by hypertensive paroxysms and a pheochromocytoma was suspected. Measurement of catecholamines and metanephrines confirmed the diagnosis and an abdominal magnetic resonance localized the tumor. The patient underwent surgery with successful removal of the pheochromocytoma and was discharged in good conditions.

Chronic renal failure (CRF) courses with both systemic inflammatory reaction and haemostatic activation. We explored the relationship of these processes with plasma levels of free, activated protein C (APC) and complexes of APC with its inhibitors in patients with CRF under conservative treatment. Plasma concentrations of inflammatory cytokines [tumour necrosis factor alpha (TNFα) and interleukin 8], acute-phase proteins (C-reactive protein, fibrinogen, α1-anti-trypsin and von Willebrand factor), and markers of haemostatic activation (thrombin–anti-thrombin complexes, plasmin–anti-plasmin complexes, and fibrin and fibrinogen degradation products) were higher in patients than in controls. Inflammatory and haemostatic markers were significantly and positively correlated. Total plasma APC and APC:α1-anti-trypsin (α1AT) complexes were 44% and 75% higher in patients than in controls (P = 0·0001), whereas free APC was 20% lower (P

Plasma von Willebrand factor antigen, soluble thrombomodulin, and tissue factor were increased in 31 patients with severe chronic renal failure (creatinine clearance

The typical symptoms of pheochromocytoma are palpitations, sweating, headaches and hypertension. We report a 70-year-old female admitted to the hospital due to a sudden onset of precordial pain with electrocardiographic changes. After admission the patient evolved with recurrent chest pain accompanied by hypertensive paroxysms and a pheochromocytoma was suspected. Measurement of catecholamines and metanephrines confirmed the diagnosis and an abdominal magnetic resonance localized the tumor. The patient underwent surgery with successful removal of the pheochromocytoma and was discharged in good conditions.

Recognizing cardiovascular risk in overweight adults is challenging, as they usually have a low Framingham risk score (FRAM). In these subjects, non-traditional biomarkers could improve risk stratification.To assess carotid intima media thickness (CIMT) and ultrasensitive C-reactive protein (usCRP) among overweight and obese subjects without metabolic syndrome (MetSyn).In 1558 asymptomatic participants (816 women, 45 ± 11 years) we measured body mass index (BMI), waist circumference, blood pressure, lipid profile, blood glucose, FRAM, usCRP and CIMT. For analytical purposes, we divided the subjects in three groups according to BMI and number of ATPIII-MetSyn risk factors (RF): 1) BMI25 and3RF, 2) BMI ≥ 25 and3RF and 3) BMI ≥ 25 and ≥ 3RF.Participants of group 2 (BMI ≥ 25 and3RF) had a low FRAM (8%). Compared with participants of group 1, they had a higher CIMT (0.61 ± 0.1 and 0.57 ± 0.09 mm, respectively, p0.01) and usCRP (2.1 ± 2.1 and 1.5 ± 1.9 mg/L respectively, p0.01).This study shows that although subjects with overweight/obesity without MetSyn have low cardiovascular risk based on FRAM, they have higher CIMT and usCRP than their normal weight counterparts.

The present review examines the types of hypertension that women may suffer throughout life, their physiopathological characteristics and management. In early life, the currently used low-dose oral contraceptives seldom cause hypertension. Pregnancy provokes preeclampsia, its main medical complication, secondary to inadequate transformation of the spiral arteries and the subsequent multisystem endothelial damage caused by deportation of placental factors and microparticles. Hypertension in preeclampsia is an epiphenomenon which needs to be controlled at levels that reduce maternal risk without impairing placental perfusion. The hemodynamic changes of pregnancy may unmask a hypertensive phenotype, may exacerbate a chronic hypertension, or may complicate hypertension secondary to lupus, renovascular lesions, and pheochromocytoma. On the other hand a primary aldosteronism may benefit from the effect of progesterone and present as a postpartum hypertension. A hypertensive pregnancy, especially preeclampsia, represents a risk for cardiac, vascular and renal disease in later life. Menopause may mimic a pheochromocytoma, and is associated to endothelial dysfunction and salt-sensitivity. Among women, non-pharmacological treatment should be forcefully advocated, except for sodium restriction during pregnancy. The blockade of the renin-angiotensin system should be avoided in women at risk of pregnancy; betablockers could be used with precautions during pregnancy; diuretics, ACE inhibitors and angiotensin receptor antagonists should not be used during breast feeding. Collateral effects of antihypertensives, such as hyponatremia, cough and edema are more common in women. Thus, hypertension in women should be managed according to the different life stages.

SummarySeveral parameters of primary hemostasis and markers of activation of coagulation and fibrinolysis were measured in 48 patients with severe (creatinine clearance High levels of plasma thrombin-antithrombin complexes (TAT), prothrombin fragment F1+2, fibrinogen and factor VIIc were observed in patients with CRF, as described in prethrombotic states. Plasmin-antiplasmin complexes (PAP), fibrinogen and fibrin degradation products (FgDP, FnDP) were significantly increased, and the activity of plasminogen activator inhibitor (PAI-1) was slightly reduced, denoting an activation of fibrinolysis.A negative correlation was found between platelet levels of ATP and ADP with plasma TAT, F1+2 and PAP. Furthermore, plasma PAI-1 activity was negatively correlated with the BT and was lower in patients with prolonged BT as compared with controls and patients with normal BT. These links between primary hemostasis and activation of coagulation and fibrinolysis suggest that increased intravascular generation of thrombin and/or plasmin is an important mediator of the defects in primary hemostasis, prolongation of the BT and, probably, bleeding in CRF.

Background: LDL, HDL cholesterol and triglycerides, are the most commonly used lipid cardiovascular risk predictor indicators. However population based studies have shown that non-HDL cholesterol and total/HDL cholesterol ratio are better predictors, are easy to measure and do not require fasting. Aim: To determine which lipid indicators are better determinants of subclinical atherosclerosis, measured by intima media thickness (IMT) among subjects without demonstrated atherosclerosis. Material and Methods: Lipid profile, height, weight, blood pressure and bilateral IMT, measured by ultrasound with automatic border recognition software, were assessed in 770 men and 854 women aged 45 ± 11 years, in Santiago de Chile. Results: Mean total cholesterol was 202, HDL 50, LDL 121, triglycerides 157 and non-HDL cholesterol 152 mg/dl. Total/HDL cholesterol ratio was 4.3. MeanIMTwas 0.62 mm. All lipid markers were significantly correlated with IMT. This correlation was higher for non-HDL cholesterol (r = 0.24, p < 0.0001) and total/HDL cholesterol ratio(r = 0.23, p < 0.0001). In both men and women, total/HDL cholesterol ratio was the best predictor of having an IMT over the 75th percentile (odds ratio 1.21, 95% confidence intervals 1.09-1.35, p < 0.01). Conclusions: Total/HDL cholesterol ratio was the best determinant of subclinical atherosclerosis.

Background: Microalbuminuria is a new tool in the management of patients with diabetes mellitus or hypertension. Microalbuminuria is an easily measured biomarker in a urine sample. Urinary albumin to creatinine ratio in first morning urine sample correlates with 24 hours urinary albumin excretion, but it is easier to obtain, and can identify hypertensive or diabetic patients with high risk for cardiovascular events. Therapeutic interventions such as renin angiotensin system blockade have demonstrated their usefulness in reducing urinary albumin excretion in clinical studies. It would be advisable to incorporate urinary albumin to creatinine ratio to the routine clinical monitoring of patients with cardiovascular risk, such as those with hypertension and diabetes mellitus.

Cardiovascular risk factor (RF) assessment is essential to prevent and predict cardiovascular disease. The presence of RF at early ages, are determinant for the presence of atherosclerosis later in life.To determine the RF profile of young subjects with high carotid intima media thickness (CIMT).We studied 689 subjects (50% women, mean age 36±6 years) from Santiago, Chile. We determined body mass index (BMI), waist circumference, blood pressure, fasting serum lipids, blood glucose and C-reactive protein. CIMT was assessed by ultrasound using an automatic border recognition software.Body mass index, waist circumference, blood pressure and serum lipids were significantly higher among subjects located in the higher CIMT quartile. Also, subjects in the higher quartile of CIMT had a higher prevalence of three or more RF compared with the lower quartile (p = 0.01). Finally, individuals with three or more RF showed three times more risk of being in the higher CIMT quartile, than subjects with no RF (odds ratio = 3.1, p0.01).There is a negative influence of cardiovascular RF on CIMT among young subjects.

LDL, HDL cholesterol and triglycerides, are the most commonly used lipid cardiovascular risk predictor indicators. However population based studies have shown that non-HDL cholesterol and total/HDL cholesterol ratio are better predictors, are easy to measure and do not require fasting.To determine which lipid indicators are better determinants of subclinical atherosclerosis, measured by intima media thickness (IMT) among subjects without demonstrated atherosclerosis.Lipid profile, height, weight, blood pressure and bilateral IMT, measured by ultrasound with automatic border recognition software, were assessed in 770 men and 854 women aged 45 ± 11 years, in Santiago de Chile.Mean total cholesterol was 202, HDL 50, LDL 121, triglycerides 157 and non-HDL cholesterol 152 mg/dl. Total/HDL cholesterol ratio was 4.3. Mean IMT was 0.62 mm. All lipid markers were significantly correlated with IMT. This correlation was higher for non-HDL cholesterol (r = 0.24, p0.0001) and total/HDL cholesterol ratio(r = 0.23, p0.0001). In both men and women, total/HDL cholesterol ratio was the best predictor of having an IMT over the 75th percentile (odds ratio 1.21, 95% confidence intervals 1.09-1.35, p0.01).Total/HDL cholesterol ratio was the best determinant of subclinical atherosclerosis.

Background: Cardiovascular risk factor (RF) assessment is essential to prevent and predict cardiovascular disease. The presence of RF at early ages, are determinant for the presence of atherosclerosis later in life. Aim: To determine the RF profile of young subjects with high carotid intima media thickness (CIMT). Material and Methods: We studied 689 subjects (50% women, mean age 36±6 years) from Santiago, Chile. We determined body mass index (BMI), waist circumference, blood pressure, fasting serum lipids, blood glucose and C-reactive protein. CIMT was assessed by ultrasound using an automatic border recognition software. Results: Body mass index, waist circumference, blood pressure and serum lipids were significantly higher among subjects located in the higher CIMT quartile. Also, subjects in the higher quartile of CIMT had a higher prevalence of three or more RF compared with the lower quartile (p = 0.01). Finally, individuals with three or more RF showed three times more risk of being in the higher CIMT quartile, than subjects with no RF (odds ratio = 3.1, p < 0.01). Conclusions: There is a negative influence of cardiovascular RF on CIMT among young subjects.

Carotid intima media thickness (CIMT) is a marker of cardiovascular damage that can be modified by traditional risk factors.To determine attributable risk factors for a high CIMT among healthy adults.A sample of 1270 individuals (636 males and 634 females) aged 44 ± 11 years, was studied. Blood pressure, weight, height, lipid profile and blood glucose were measured in all. CIMT and the presence of atherosclerotic plaques were determined by carotid ultrasound. Standard criteria were used to define hypertension, dyslipidemia and diabetes.Mean CIMT in the sample studied was 0.62 ± 0.01 mm and percentile 75 was 0.67. The most important risk factor for a CIMT over percentile 75 and the presence of atherosclerotic plaques was hypertension with attributable risks of 54 and 57%, respectively.In this sample, the main risk factor for a high CIMT was hypertension.

Microalbuminuria is a new tool in the management of patients with diabetes mellitus or hypertension. Microalbuminuria is an easily measured biomarker in a urine sample. Urinary albumin to creatinine ratio in first morning urine sample correlates with 24 hours urinary albumin excretion, but it is easier to obtain, and can identify hypertensive or diabetic patients with high risk for cardiovascular events. Therapeutic interventions such as renin angiotensin system blockade have demonstrated their usefulness in reducing urinary albumin excretion in clinical studies. It would be advisable to incorporate urinary albumin to creatinine ratio to the routine clinical monitoring of patients with cardiovascular risk, such as those with hypertension and diabetes mellitus.

Serum samples from 85 patients with proven typhoid fever, 11 patients with p-typhoidal fever, 101 patients with febrile non-typhoidal, and 130 healthy subjects were tested for immunoglobulin G (IgG), IgA, and IgM antilipopolysaccharide (LPS) of Salmonella typhi antibodies by enzyme-linked immunosorbent assay (ELISA) and Widal test. The levels of all three classes of immunoglobulin anti-LPS of S. typhi were higher in typhoid patients than in healthy or febrile nontyphoidal groups; we selected various combinations between the three classes of immunoglobulin to obtain the best combination of sensitivity and specificity. The sum of the absorbance values obtained from the ELISA assay for IgG+IgA+IgM (sigma lgs) was the best choice for diagnostic utility for typhoid fever. We selected a positive test at a decision level of sigma lgs > or = 1.2 with a sensitivity of 94% and a specificity of 92% with a frequency of false negative of 5.9%. The frequency of false positives for healthy controls was 7.7% and, for the febrile nontyphoidal group, it was 7.9%. We also compared receiver (or relative) operating characteristic (ROC) curves for the diagnostic usefulness of the ELISA with that of the Widal test, whose merits and limitations, especially in endemic regions, are discussed. The ELISA assay was much more sensitive and specific than any combination of the Widal test, and hence it could be a useful tool for the serologic diagnosis of typhoidal fever with a single blood sample.