[Frequency of chronic kidney disease among ambulatory patients with type 2 diabetes]. / Prevalencia y clasificación de enfermedad renal crónica en pacientes con diabetes mellitus tipo 2 en el centro comunitario de salud familiar Pantanosa, Frutillar.

BACKGROUND: Type 2 diabetes mellitus is the main cause of chronic kidney disease in developed countries. AIM: To study the prevalence of chronic kidney disease among adults with diabetes mellitus attended at a public primary health care clinic in southern Chile. MATERIAL AND METHODS: One hundred patients with type 2 diabetes mellitus, aged more than 15 years participated in this cross sectional study. Chronic kidney disease was defined as the presence of a urine albumin/creatinine ratio over 30 mg/g or an estimated glomerular filtration rate of less than 60 mL/min/1,73 m², detected in at least two opportunities, separated at least by three months. RESULTS: Thirty four percent of participants had chronic kidney disease (17% stage 1 or 2 and 17% stage 3). Thirty percent of participants had an abnormal urinary albumin/creatinine ratio. Halfof the patients with an estimated glomerular filtration rate below 60 mL/min/1,73 m², had a normal urinary albumin/creatinine ratio. CONCLUSIONS: The rates of chronic kidney disease in this group of diabetic patients are very similar to those reported elsewhere.

Prevalencia y clasificación de enfermedad renal crónica en pacientes con diabetes mellitus tipo 2 en el centro comunitario de salud familiar Pantanosa, Frutillar / Frequency of chronic kidney disease among ambulatory patients with type 2 diabetes

Background: Type 2 diabetes mellitus is the main cause of chronic kidney disease in developed countries. Aim: To study the prevalence of chronic kidney disease among adults with diabetes mellitus attended at a public primary health care clinic in southern Chile. Material and Methods: One hundred patients with type 2 diabetes mellitus, aged more than 15 years participated in this cross sectional study. Chronic kidney disease was defined as the presence of a urine albumin/creatinine ratio over 30 mg/g or an estimated glomerular filtration rate of less than 60 mL/min/1,73 m², detected in at least two opportunities, separated at least by three months. Results: Thirty four percent of participants had chronic kidney disease (17% stage 1 or 2 and 17% stage 3). Thirty percent of participants had an abnormal urinary albumin/creatinine ratio. Halfof the patients with an estimated glomerular filtration rate below 60 mL/min/1,73 m², had a normal urinary albumin/creatinine ratio. Conclusions: The rates of chronic kidney disease in this group of diabetic patients are very similar to those reported elsewhere.

Anticuerpos antifosfolípidos en nefropatía membranosa idiopática / Antiphospholipid antibodies in idiopathic membranous nephropathy

Background: Antiphospholipid antibodies have been found in the sera from patients with idiopathic and secondary glomerulopathies, mainly related to lupus. No special attention has been devoted to idiopathic membranous nephropathy, a glomerular disease with a high frequency of thrombotic complications, particularly of the renal vein. Aim: To study the presence and significance of antiphospholipid antibodies in idiopathic membranous nephropathy. Material and methods: Anticardiolipin and anti-ß2-glycoprotein-I IgG antibodies were measured in serum samples from 21 patients with idiopathic membranous nephropathy (age range 11-75 years, 5 female). The medical records of 20 of these patients were reviewed, looking for vascular complications and nephrological evolution during a follow-up period that ranged from two to 277 months. Results: Five patients had anticardiolipin antibody titers over the cutoff for normal values, and two others were positive for anti-ß2-glycoprotein-I, without cross-reactivity. There was no difference in the incidence of thrombotic complications in the renal vein, or other locations, between these seven patients and the remaining patients. No differences in the clinical course of the nephropathy were detected either. Conclusions: Antiphospholipid antibodies may be found in patients with primary membranous nephropathy. They are not related to thrombosis or a worse evolution.

[Toxocariasis in an adult manifested as hypereosinophilic syndrome with predominant neurological involvement. Clinical case]. / Toxocariasis en adulto manifestada como síndrome hipereosinofílico con compromiso neurológico predominante. Caso clínico.

Hypereosinophilic syndrome is characterized by persistent hypereosinophilia and signs or symptoms due to organ involvement, specially nervous system, heart and skin. It can be primary or secondary to allergies, parasites or cancer. Toxocariasis is an uncommon parasitic disease in adults. There is a variant, called visceral larva migrans, that can involve different organs, and among those, the central nervous system. We report a 61 years old male, with a cerebrovascular disease. There were focalizing symptoms, the CAT scan showed multiple ischemic lesions and a peripheral eosinophilia of 12,152 cells/mm3 was present. Anti toxocara IgG antibody titers were 1/1000. The patient was treated with albendazole for 14 days. After a 2 years follow up the patients is in good conditions and, for the first time, his eosinophil count is within normal limits.

[Anti LKM-1 antibodies and cryoglobulinemia in autoimmune chronic hepatitis and virus C hepatitis]. / Anticuerpos anti LKM-1 y crioglobulinemia en hepatitis crónica autoinmune y por virus C de la hepatitis.

BACKGROUND: Anti liver kidney microsome antibodies (LKM-1) have been recently incorporated to the study and classification of chronic autoimmune hepatitis (HC-A1). The presence of anti LKM-1 antibodies and essential cryoglobulinemia is frequent in virus C associated chronic hepatitis (HC-VC). AIM: To study the frequency of anti LKM-1 antibodies and cryoglobulin levels in patients with HC-AI, HC-VC and cryptogenic cirrhosis. PATIENTS AND METHODS: Forty-two patients were studied. Nineteen adult women with classic HC-AI with positive antinuclear or anti smooth muscle antibodies. Five patients of less than 20 years old with HC-AI and negative antinuclear and anti smooth muscle antibodies. Ten adult women with cryptogenic cirrhosis, 4 women and 4 men with HC-VC. Serum samples were obtained at 37 degrees C. Antinuclear, anti smooth muscle and anti LKM-1 antibodies were measured by indirect immunofluorescence using Hep-2 cells and rat tissue slices as substrates. Cryoglobulins were determined by the traditional method and cryocrit. RESULTS: All studied patients were anti LKM-1 negative. All had significant circulating cryoglobulin levels. CONCLUSIONS: In this sample of patients with HC-AI or HC-VC, anti LKM-1 antibodies were not detected but all had cryoglobulinemia.

[Unexplained remission of common variable immunodeficiency: analysis of a clinical case]. / Remisión inexplicada de inmunodeficiencia común variable: análisis de un caso clínico.

We report a 26 years old female with a common variable immunodeficiency diagnosed at the age of 21, with recurrent pulmonary and sinusal bacterial infections, that had a clinical and laboratory remission. At the moment of diagnosis, she had agammaglobulinemia in the protein electrophoresis, very low level of IgG and IgM and absence of IgA. Absolute counts of CD4(+) T lymphocytes were low and CD8(+) were normal. B lymphocyte count was normal. Five years later, a repeated study revealed normal levels of all these parameters, excepting IgA that continued to be undetectable. We propose that the remission could be due to a decrease in suppressor activity of T lymphocytes. There is no documented evidence of infectious factors or the use of immunological therapy that could have influenced the course of the disease.

Anticuerpos anticitoplasmas de neutrófilos y colitis ulcerosa inespecífica / Neutrophil anticytoplasmic antibodies and idiopathic ulcerative colitis

We studied tha presence of antineutrophil cytoplasmic antibodies in 16 patients with idiopathic ulcerative colitis, using an indirect immunofluorescence technique and specific ELISA for myeloperoxidase and proteinase 3. Twelve patients had an active disease and in ten, antineutrophil cytoplasmic antibodies were positive, with a predominantly perinuclear distribution and without specificity for myeloperoxidase or proteinase 3. These antiantineutrophil cytoplasmic antibodies could be serologic indicators of disease activity in patients with ulcerative colitis

[Clinical usefulness of Multitest in the evaluation of cellular immunity]. / Utilidad clínica de Multitest en la evaluación de inmunidad celular.

The aim of this work was to assess cellular immunity using the Multitest CMI and relate its results with lymphocyte counts and lymphocyte subpopulations determined using monoclonal antibodies against CD4 and CD8 and fluorescence microscopy. We studied 51 patients (31 male), 20 infected with HIV, 18 recurring infections, 5 with cancer, 2 with tuberculosis and 6 with miscellaneous diagnoses. According to Multitest results, patients were classified as normal, hypoergic or anergic. Twenty five percent of patients were normal, 65% hypoergic and 10% anergic. Eighty percent of anergic patients were infected with HIV. No differences in total lymphocyte count were observed between the three groups. CD4 lymphocyte count was lower in anergic patients when compared with the other two groups. All patients with CD4 counts below 200 cells/mm3 were anergic. It is concluded that Multitest CMI is useful for the assessment of cellular immunity and complements the determination of lymphocyte subpopulations.

[Cryoglobulins in rheumatoid arthritis: exhaustive detection, immunochemical findings and clinical expression]. / Crioglobulinas en artritis reumatoide: detección exhaustiva, hallazgos inmunoquímicos y expresion clínica.

Cryoglobulins were measured in 29 patients (24 female, age 53.8 +/- 9.8 years) with rheumatoid arthritis (70% active). The cryoprecipitate was isolated, characterized and quantified. Cryoglobulinemia, always polyclonal or type III, was found in 83% of patients. The most frequent immunochemical isotypes found were IgG and A. Acrocyanosis was found in 50% and Raynaud phenomenon in 32% of patients with cryoglobulinemia. It is concluded that exhaustive detection of cryoglobulinemia in rheumatoid arthritis demonstrated a higher frequency than previously reported an is important for understanding pathogenesis of the disease.

[The determination of immunological parameters in splenectomized patients]. / Determinación de parámetros inmunológicos en pacientes esplenectomizados.

We studied 15 patients submitted to splenectomy. Humoral immunity was studied with protein electrophoresis and quantification of immunoglobulins; cellular immunity was studied by total and subpopulation lymphocyte counts and evaluation of phagocytosis. Increased levels of IgG, IgM and IgA, a decrease in circulating T-lymphocytes and an increased phagocytosis was seen after operation. These findings correlated to the presence of viral and parasitic infections postoperatively. Preoperative antipneumococcal vaccination prevented infections by this agent. Thus, appropriate preventive measures must be taken to deal with altered immunological responses after splenectomy.

Factor natriurético auricular / Atrial natriuretic factor

Se revisan algunas de las características bioquímicas y fisiológicas de un nuevo sistema hormonal, el Factor Natriurético Auricular, destacando su participación en la regulación de la presión arterial y del balance hidroelectrolítico en condiciones normales y patológicas