Exploring kidney biopsy findings in congenital heart diseases: Insights beyond cyanotic nephropathy.

BACKGROUND: The association between congenital heart disease and chronic kidney disease is well known. Various mechanisms of kidney damage associated with congenital heart disease have been established. The etiology of kidneydisease has commonly been considered to be secondary to focal segmental glomerulosclerosis (FSGS), however, this has only been demonstrated in case reports and not in observational or clinical trials. AIM: To identify baseline and clinical characteristics, as well as the findings in kidney biopsies of patients with congenital heart disease in our hospital. METHODS: This is a retrospective observational study conducted at the Nephrology Department of the National Institute of Cardiology "Ignacio Chávez". All patients over 16 years old who underwent percutaneous kidney biopsy from January 2000 to January 2023 with congenital heart disease were included in the study. RESULTS: Ten patients with congenital heart disease and kidney biopsy were found. The average age was 29.00 years ± 15.87 years with pre-biopsy proteinuria of 6193 mg/24 h ± 6165 mg/24 h. The most common congenital heart disease was Fallot's tetralogy with 2 cases (20%) and ventricular septal defect with 2 (20%) cases. Among the 10 cases, one case of IgA nephropathy and one case of membranoproliferative glomerulonephritis associated with immune complexes were found, receiving specific treatment after histopathological diagnosis, delaying the initiation of kidney replacement therapy. Among remaining 8 cases (80%), one case of FSGS with perihilar variety was found, while the other 7 cases were non-specific FSGS. CONCLUSION: Determining the cause of chronic kidney disease can help in delaying the need for kidney replacement therapy. In 2 out of 10 patients in our study, interventions were performed, and initiation of kidney replacement therapy was delayed. Prospective studies are needed to determine the usefulness of kidney biopsy in patients with congenital heart disease.

Feasibility and Safety of Percutaneous Kidney Biopsy in Small Kidneys: Breaking the Paradigm.

INTRODUCTION: The percutaneous kidney biopsy (PKB) is an essential tool in nephrology; small kidney size has been a relative contraindication to PKB and there is limited data on the safety and utility of performing PKB in this setting. Our aim was to describe the complications of PKB in small kidneys and to assess if kidney biopsy results have an impact on medical decisions and outcomes. METHODS: This was a retrospective, descriptive, and observational study. Patients older than 16 years of age with a decreased kidney size (≤8 cm) and undergoing PKB of native kidneys from July 2019 to December 2022 were included. RESULTS: Twenty-five patients were included, 19 women and 6 men. The mean age was 42.3 ± 18.04. The mean kidney length was 7.56 ± 0.33 and the mean width was 4.2 cm. All patients received only 1 puncture, obtaining an average of 12 glomeruli. The mean blood urea nitrogen and serum creatinine were 36 mg/dL and 1.94 mg/dL, respectively and the mean Hgb (hemoglobin) was 12.87 ± 2.81 g/dL. Minor complications occurred in 5 patients, perirenal hematoma in 3 patients, hematuria in 1 patient, and hematoma plus hematuria in 1 patient. Histological examination showed FSGS, lupus nephritis, other Glomerular disease, crescentic glomerulonephritis, and tubulointerstitial nephritis in 36%, 20%, 16%, 16%, and 12% of the cases, respectively. Biopsy resulted in management modification in 64% of cases. In a bivariate analysis, kidney size was not associated with higher complication rates. CONCLUSIONS: PKB in small kidneys is a feasible and safe procedure when properly planned, providing an adequate sample in all cases, with an insignificant number of minor complications, and that is clinically relevant.

Plasma miR-150-5p in Renal Transplant Recipients with Acute Antibody-Mediated Rejection.

Background: Rejection continues to be the main cause of renal graft loss. Currently, the gold standard for diagnosis is an allograft biopsy; however, because it is time-consuming, costly, and invasive, the pursuit of novel biomarkers has gained interest. Variation in the expressions of miRNAs is currently considered a probable biomarker for the diagnosis of acute rejection. This study aimed to determine whether miR-150-5p in serum is related to microvascular damage in patients with acute antibody-mediated rejection (ABMR). Methods: A total of 27 patients who underwent renal transplantation (RT) with and without ABMR were included in the study. We performed the quantification of hsa-miR-150-5p, hsa-miR-155, hsa-miR-21, hsa-miR-126, and hsa-miR-1 in plasma by RT-qPCR. The expressions between the groups and their correlations with the histological characteristics of the patients with ABMR were also investigated. Results: miR-150-5p significantly increased in the plasma of patients with rejection (p < 0.05), and the changes in miR-150-5p were directly correlated with microvascular inflammation in the allograft biopsies. Clinical utility was determined by ROC analysis with an area under the curve of 0.873. Conclusions: Our results show that the patients with RT with ABMR exhibited increased expression of miR-150-5p compared to patients without rejection, which could have clinical consequences, as well as probable utility in the diagnosis of ABMR, and bioinformatics may help in unraveling the molecular mechanisms underlying ABMR conditions.

Pérdida de peso no intencionada, un diagnóstico de patología orgánica con costos a la salud.

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Fungal Peritonitis Associated With Peritoneal Dialysis Due to Non-Albicans Candida: A Case Series.

Fungal peritonitis secondary to non-albicans Candida is reported less frequently. There are uncertainties regarding the treatment of non-albicans Candida infection (i.e., preferred route or initial drug). The objective of this study is to determine the clinical characteristics and treatment used in cases of peritoneal dialysis associated fungal peritonitis secondary to non-albicans Candida. We report four cases with different clinical characteristics and different routes of administration of the antifungal drug, with no deaths. In all four patients, there were risk factors similar to those reported worldwide, without presenting the route of administration of the antifungal drug as a risk factor, suggesting that the mainstay of treatment is early initiation of the antifungal drug and early removal of the catheter.

Lung ultrasound: clinical applications and its teaching in medical education. / Ultrasonido pulmonar: aplicaciones clínicas y su enseñanza en la formación médica.

The ultrasound as care at the bedside of the patient, or POCUS (Point-Of-Care Ultrasound), has taken today a primary place as a complementary tool in the diagnosis and monitoring of patients in different intensive care units and health care services. One of these specialties is internal medicine, since in the area of hospitalization patients with complex and critical clinical conditions are treated, who benefit from this tool for diagnostic complementation, monitoring and performing safer procedures. The pulmonary ultrasound is a tool to integrate the signs, symptoms and physical examination, for a better diagnostic accuracy and monitoring of patients. That is why we consider important the training of the internist not only in the pulmonary ultrasound, but also in other areas related to this diagnostic method. For this reason, we performed a review of the basic concepts of pulmonary ultrasound, a practical guide of how to do it, the current state of education and training in this area. As well as the importance in areas of clinical performance of the internist.

El ultrasonido como estrategia de cuidado a la cabecera del enfermo, o POCUS (Point-Of-Care Ultrasound), ha tomado actualmente un lugar primordial como herramienta complementaria en el diagnóstico y el monitoreo de pacientes hospitalizados en las diferentes unidades de terapia intensiva y servicios de atención médica. Una de las especialidades es medicina interna, debido a que en los servicios de hospitalización se atiende a pacientes con cuadros clínicos complejos y críticos, quienes se benefician de esta herramienta tanto para complementación diagnostica como para monitoreo y realización de procedimientos invasivos más seguros. El ultrasonido pulmonar permite integrar el cuadro clínico y la exploración física para una mejor precisión de diagnóstico y monitoreo de los pacientes. Por ello, esta herramienta es importante en la formación del médico internista no solo en el ultrasonido pulmonar, sino también en diversas áreas afines a este método diagnóstico. Por esta razón realizamos una revisión de los conceptos básicos de ultrasonido y anatomía pulmonar, una guía práctica sobre cómo llevarlo a cabo, el estado actual sobre la enseñanza y formación en esta área, y la importancia en áreas de desempeño clínico del médico internista.

Internalization of Titanium Dioxide Nanoparticles Is Cytotoxic for H9c2 Rat Cardiomyoblasts.

Titanium dioxide nanoparticles (TiO2 NPs) are widely used in industry and daily life. TiO2 NPs can penetrate into the body, translocate from the lungs into the circulation and come into contact with cardiac cells. In this work, we evaluated the toxicity of TiO2 NPs on H9c2 rat cardiomyoblasts. Internalization of TiO2 NPs and their effect on cell proliferation, viability, oxidative stress and cell death were assessed, as well as cell cycle alterations. Cellular uptake of TiO2 NPs reduced metabolic activity and cell proliferation and increased oxidative stress by 19-fold measured as H2DCFDA oxidation. TiO2 NPs disrupted the plasmatic membrane integrity and decreased the mitochondrial membrane potential. These cytotoxic effects were related with changes in the distribution of cell cycle phases resulting in necrotic death and autophagy. These findings suggest that TiO2 NPs exposure represents a potential health risk, particularly in the development of cardiovascular diseases via oxidative stress and cell death.

[Immunohistochemical Expression of CD117 (c-kit) in 75 Renal Cell Tumors]. / Expresión inmunohistoquímica de CD117 (c-kit) en 75 tumores de células renales.

OBJECTIVE: c-kit encodes the membrane-bound tyrosine kinase c-kit, whose expression has been identified in several human neoplasms. We analyzed the immunohistochemical expression of c-kit in renal cell tumors. METHODS: 75 cases of renal cell tumors were obtained from the surgical pathology archives at the ABC Medical Center in Mexico, for the period 2001 to 2011. We selected one representative paraffin block of the tumor and immunohistochemical staining for CD117 (c-kit) was performed. Immunopositivity was analyzed according cell location, intensity and percentage. RESULTS: c-kit was positive in 20 cases (26.66%), all the oncocytomas and chromophobe renal cell carcinoma were positive. A total of 8.27% of conventional clear cell renal cell carcinomas showed cytoplasmic positivity and one case of papillary renal cell carcinoma was positive. In chromophobe renal cell carcinoma c-kit was positive in the membrane and 44.44% showed combined staining. In oncocytoma four cases showed cytoplasmic positivity, with heterogeneous and less intense staining than chromophobe renal cell carcinoma. CONCLUSION: c-kit is a useful marker for the diagnosis of chromophobe renal cell carcinoma and oncocytoma vs. other renal cell tumors. Also it is important to define the cell location, intensity, and percentage of neoplastic cells for the differential between chromophobe renal cell carcinoma and oncocytoma.