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 one puncture, obtaining an average of 12 glomeruli. The mean BUN and serum creatinine were 36 mg/dl and 1.94 mg/dl, respectively and the mean Hgb (hemoglobin) was 12.87 ±2.81g/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 (GD), crescentic glomerulonephritis (GN), 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: Percutaneous kidney biopsy 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.

Waldenström's Macroglobulinemia and Cryoglobulinemic Glomerulonephritis: An Unusual Case of Monoclonal Gammopathy of Renal Significance.

Cryoglobulins are immunoglobulins that precipitate at temperatures below 37 °C and dissolve upon reheating. They can induce small-vessel vasculitis with renal involvement. Cryoglobulinemic glomerulonephritis is a rare manifestation that occurs in patients with monoclonal gammopathy, specifically Waldenström's macroglobulinemia. We present the case of a 52-year-old patient with a history of cutaneous vasculitis and hypothyroidism, who presented with generalized edema, moderate anemia, hypercholesterolemia, nephrotic range proteinuria of 12.69 g/day, microhematuria, arterial hypertension, and hypocomplementemia via the classical pathway, without acute kidney injury and with negative serological studies and positive cryoglobulins in the second determination. Serum and urine protein electrophoresis and immunofixation studies showed a monoclonal band of IgM and kappa light chain. Renal biopsy was consistent with cryoglobulinemic glomerulonephritis. In the context of dysproteinemia and cryoglobulinemic glomerulonephritis, bone-marrow aspiration and biopsy were performed, leading to the diagnosis of Waldenström's macroglobulinemia. Monoclonal gammopathies have been described in association with type I cryoglobulinemias. This described association is uncommon, which is why we present this case, along with a review of the literature.

Monoclonal Gammopathy of Renal Significance with Deposits of Infrequent Morphology: Two Case Reports of Light and Heavy Chain Deposition Disease with Atypical Presentation and Literature Review.

BACKGROUND: Monoclonal immunoglobulin deposition disease (MIDD) includes three entities: light chain deposition disease (LCDD), heavy chain deposition disease (HCDD) and light and heavy chain deposition disease (LHCDD). The renal presentation can manifest with varying degrees of proteinuria and/or nephrotic syndrome, microhematuria, and often leads to end-stage renal disease. Given the rarity of LHCDD, therapeutic approaches for this condition remain inconclusive, as clinical trials are limited. CASE PRESENTATION: We report two male patients with underlying monoclonal gammopathy of renal significance (MGRS) associated with LHCDD lesions. Both cases had non-nephrotic proteinuria, moderately impaired renal function, and normal levels of C3 and C4. Light microscopy of the renal biopsies in both patients did not show lesions of nodular glomerulosclerosis. Immunofluorescence showed a staining pattern with interrupted linear IgA-κ in patient #1 and IgA-λ in patient #2 only along the glomerular basement membrane (GBM). Electron microscopy of patient #1 revealed electrodense deposits in the subendothelial and mesangial areas only along the GBM. DISCUSSION: In this case series, we discuss the clinical, analytical, and histopathological findings of two rare cases of LHCDD. Both patients exhibited IgA monoclonality and were diagnosed with monoclonal gammopathy of undetermined significance (MGUS) by the hematology department at the time of renal biopsy. Treatment with steroids and cytotoxic agents targeting the clone cells responsible for the deposition disease resulted in a favorable renal and hematologic response.

An Unusual Case of Seronegative Cryoglobulinemic Glomerulonephritis with Dominant Organized IgA Deposits Associated with Staphylococcal Infection: Casual or Causal Relationship?

Introduction: Cryoglobulinemia refers to the presence of cryoglobulins (CGs) in the serum, encompassing a group of diseases caused by the type of circulating GC. Cryoglobulinemic glomerulonephritis (CryoGN) is the principal manifestation of renal involvement. The diagnosis may be challenging because the hallmark of cryoglobulinemia is the detection of CG in the serum. However, cases of CryoGN without serological evidence of CGs are not uncommon in clinical practice, often diagnosed by anatomopathological findings in the renal biopsy. Case Presentation: We report the case of an 86-year-old male who developed renal impairment, nephritic syndrome, and nephrotic-range proteinuria, without serological evidence of CGs, associated with staphylococcal bacteremia without apparent focus. Renal biopsy and pathological examination showed a membranoproliferative glomerulonephritis pattern with CD61-negative pseudothrombi. Immunofluorescence microscopy showed atypical IgA-dominant deposits. Electron microscopy revealed amorphous subendothelial and mesangial deposits and organized electrodense deposits within capillary loops (pseudothrombi) with microtubular substructure measuring 20-40 nm in thickness. These findings were consistent with seronegative CryoGN and microtubular organized atypical IgA-dominant deposits. Discussion: In this report, we discuss the clinical, analytical, and histopathological findings of a rare case of CryoGN without serological evidence of CGs. Regarding the etiology that triggered the glomerular disease in our patient, we conducted an exhaustive study in order to determine the underlying cause of CryoGN. At the time of biopsy, the patient had an active staphylococcal bacteremia. There are reports that postulate that staphylococcal antigens drive activation of immune system and in consequence, could cause this rare form of IgA-dominant glomerulonephritis with cryoglobulinemic features. After ruling out other causes of cryoglobulinemia, we discuss a plausible causal relationship of the staphylococcal infection in the pathogenesis of CryoGN in our patient.

Development of Methotrexate Complexes Endowed with New Biological Properties Envisioned for Musculoskeletal Regeneration in Rheumatoid Arthritis Environments.

Methotrexate (MTX) administration is the gold standard treatment for rheumatoid arthritis (RA), but its effects are limited to preventing the progression of the disease. Therefore, effective regenerative therapies for damaged tissues are still to be developed. In this regard, MTX complexes of general molecular formula M(MTX)·xH2O, where M = Sr, Zn, or Mg, were synthesized and physicochemically characterized by TGA, XRD, NMR, ATR-FTIR, and EDAX spectroscopies. Characterization results demonstrated the coordination between the different cations and MTX via two monodentate bonds with the carboxylate groups of MTX. Cation complexation provided MTX with new bioactive properties such as increasing the deposition of glycosaminoglycans (GAGs) and alternative anti-inflammatory capacities, without compromising the immunosuppressant properties of MTX on macrophages. Lastly, these new complexes were loaded into spray-dried chitosan microparticles as a proof of concept that they can be encapsulated and further delivered in situ in RA-affected joints, envisioning them as a suitable alternative to oral MTX therapy.

The effect of adenosine monophosphate-activated protein kinase on lipolysis in adipose tissue: an historical and comprehensive review.

CONTEXT: Lipolysis is one of the most important pathways for energy management, its control in the adipose tissue (AT) is a potential therapeutic target for metabolic diseases. Adenosine Mono Phosphate-activated Protein Kinase (AMPK) is a key regulatory enzyme in lipids metabolism and a potential target for diabetes and obesity treatment. OBJECTIVE: The aim of this work is to analyse the existing information on the relationship of AMPK and lipolysis in the AT. METHODS: A thorough search of bibliography was performed in the databases Scopus and Web of Knowledge using the terms lipolysis, adipose tissue, and AMPK, the unrelated publications were excluded, and the documents were analysed. RESULTS: Sixty-three works were found and classified in 3 categories: inhibitory effects, stimulatory effect, and diverse relationships; remarkably, the newest researches support an upregulating relationship of AMPK over lipolysis. CONCLUSION: The most probable reality is that the relationship AMPK-lipolysis depends on the experimental conditions.

Vitamin B9 derivatives as carriers of bioactive cations for musculoskeletal regeneration applications: Synthesis, characterization and biological evaluation.

The development of new drugs for musculoskeletal regeneration purposes has attracted much attention in the last decades. In this work, we present three novel vitamin B9 (folic acid)-derivatives bearing divalent cations (ZnFO, MgFO and MnFO), providing their synthesis mechanism and physicochemical characterization. In addition, a strong emphasis has been placed on evaluating their biological properties (along with our previously reported SrFO) using human mesenchymal stem cells (hMSC). In all the cases, pure folate derivatives (MFOs) with a bidentate coordination mode between the metal and the folate anion, and a 1:1 stoichiometry, were obtained in high yields. A non-cytotoxic dose of all the MFOs (50 µg/mL) was demonstrated to modulate by their own the mRNA profiles towards osteogenic-like or fibrocartilaginous-like phenotypes in basal conditions. Moreover, ZnFO increased the alkaline phosphatase activity in basal conditions, while both ZnFO and MnFO increased the matrix mineralization degree in osteoinductive conditions. Thus, we have demonstrated the bioactivity of these novel compounds and the suitability to further studied them in vivo for musculoskeletal regeneration applications.

Nanosystems of plant-based pigments and its relationship with oxidative stress.

Plant-based pigments are widely present in nature, they are classified depending on their chemical structure as tetrapyrroles, carotenoids, polyphenolic compounds, and alkaloids and are extensively used in medicine, food industry, clothes, and others. Recently they have been investigated due to their role in the areas of food processing, food safety and quality, packaging, and nutrition. Many studies indicate a relationship between bioactive pigments and Non-Communicable Diseases derived from oxidative stress. Their biological applications can help in preventing oxidative injuries in the cell caused by oxygen and nitrogen reactive species. Those pigments are easily degraded by light, oxygen, temperature, pH conditions, among others. Nanotechnology offers the possibility to protect bioactive ingredients and increase its bioavailability after oral administration. Safety to humans (mainly evaluated from toxicity data) is the first concern for these products. In the present work, we present a comprehensive outlook of the most important plant-based pigments used as food colorants, the principal nanotechnology systems prepared with them, and the relationship of these compounds with the oxidative stress and related Non-Communicable Disease.

Effects of Biotin Supplementation in the Diet on Adipose Tissue cGMP Concentrations, AMPK Activation, Lipolysis, and Serum-Free Fatty Acid Levels.

Several studies have shown that pharmacological concentrations of biotin decrease hyperlipidemia. The molecular mechanisms by which pharmacological concentrations of biotin modify lipid metabolism are largely unknown. Adipose tissue plays a central role in lipid homeostasis. In the present study, we analyzed the effects of biotin supplementation in adipose tissue on signaling pathways and critical proteins that regulate lipid metabolism, as well as on lipolysis. In addition, we assessed serum fatty acid concentrations. Male BALB/cAnN Hsd mice were fed a control or a biotin-supplemented diet (control: 1.76 mg biotin/kg; supplemented: 97.7 mg biotin/kg diet) over 8 weeks postweaning. Compared with the control group, biotin-supplemented mice showed an increase in the levels of adipose guanosine 3',5'-cyclic monophosphate (cGMP) (control: 30.3±3.27 pmol/g wet tissue; supplemented: 49.5±3.44 pmol/g wet tissue) and of phosphorylated forms of adenosine 5'-monophosphate-activated protein kinase (AMPK; 65.2%±1.06%), acetyl-coenzyme A (CoA), carboxylase-1 (196%±68%), and acetyl-CoA carboxylase-2 (78.1%±18%). Serum fatty acid concentrations were decreased (control: 1.12±0.04 mM; supplemented: 0.91±0.03 mM), and no change in lipolysis was found (control: 0.29±0.05 µmol/mL; supplemented: 0.33±0.08 µmol/mL). In conclusion, 8 weeks of dietary biotin supplementation increased adipose tissue cGMP content and protein expression of the active form of AMPK and of the inactive forms of acetyl-CoA carboxylase-1 and acetyl-CoA carboxylase-2. Serum fatty acid levels fell, and no change in lipolysis was observed. These findings provide insight into the effects of biotin supplementation on adipose tissue and support its use in the treatment of dyslipidemia.

Análisis de la función ventricular izquierda en pacientes con hipertensión arterial inducida por el embarazo con ecocardiografía doppler y doppler tisular / Analysis of the left ventricular function in patients with pregnancy-induced hpertension by doppler echocardiography and pulsed tisular doppler

El objetivo del trabajo es la evaluación de la función ventricular izquierda en mujeres con hipertensión arterial inducida por el embarazo mediante la ecocardiografía Doppler y el Doppler pulsado tisular

Estudio de la función ventricular izquierda con eco-Doppler cardíaco y Doppler tisular en deportistas y sedentarios: correlación con la capacidad aeróbica máxima / Doppler echocardiography and tisular Doppler study of the ventricular function in athletes and sedentary people: correlation with maximun aerobic capacity

Objetivo: Evaluar la función ventricular izquierda (VI) sistodiastólica en reposo entre deportistas y sedentarios y su relación con la capacidad aeróbica maxima al esfuerzo (CAMáx). Material y métodos: Se estudiaron dos grupos: G1, deportistas: 35 hombres, jugadores de rugby, edad 25 ± 7 años y G2, sedentarios: 22 hombres, edad 27 ± 7 años. A todos se les efectuó eco-Doppler cardíaco en reposo y ergometría máxima. Se midieron: a)variables de composición corporal, b) dimensiones y variables de función VI sistodiastólica mediante ecocardiografía Doppler y Doppler pulsado tisular y c) variables ergométricas en reposo, máximo esfuerzo y recuperación incluido máximo de O2 indirecto (VO2 Máx). Resultados: El G1 presentó valores superiores en peso, superficie corporal, índices de función sistólica y alcanzó una CAMáx mayor en la ergometría (p < 0,05). No hubo diferencias en los índices de función diastólica y masa VI. El análisis univariado demostró correlación significativa del VO2Máx con la relación E/A y con la onda E tisular en deportistas. La regresión múltiple encontró relación lineal entre el VO2Máx y la E tisular en el mismo grupo (p < 0,05). Conclusiones: La función sistólica VI en el grupo de deportistas mostró mejor eficiencia contráctil que el grupo de sedentarios, a expensas del aumento de la precarga, sin presentar cambios de significancia en la masa ventricular. La función diastólica fue similar en ambas poblaciones. La onda Et del doppler pulsado tisular en reposo resultó ser la única variable predictora de la CAMáx alcanzada por los deportistas en el esfuerzo, lo cual confirma la importancia del componente diastólico miocárdico en el ejercicio.

Efecto de la ventilación por presión positiva sobre los parámetros productivos de pollo de engorda, durante siete semanas en casetas de ambiente natural / Comparison of productive performance in broilers using ventilation by positive pressure during seven weks in houses with a natural environment

Se evaluó el efecto de la ventilación por presión positiva sobre los parámetros productivos en pollo de engorda. Se utilizaron 1524 pollos de engorda de un día de edad, Peterson X Avin Farm no sexados, que se alojaron en una casete de ambiente natural que estaba dividida en dos secciones. Cada sección se dividió en seis subdivisiones. Las aves se asignaron aleatoriamente en dos grupos con seis réplicas cada uno. En la sección donde se alojó el grupo experimental, se instaló un ventilador con un motor de 1/3 HP, con 0.5 m de diámetro en sus aspas y con capacidad para desplazar 300 m cubicos de aire por minuto. En este grupo experimental se aplicó ventilación por presión positiva manteniendo un caudal de 301 de aire/minuto/kg de peso vivo, se hicieron los ajuste necesarios cada cuatro días para mantener el caudal de ventilación adecuado al peso de las aves. El grupo testigo no recibió ventilación por presión positiva. Se administró un sistema de alimentación dividido en tres estapas (iniciación, crecimiento y finalización), no se aplicó ningún tipo de restricción y las aves tuvieron libre acceso al agua y alimento. A los 49 días se determinaron los parámetros productivos de ambos grupos y se compararon mediante prueba "t" de Student, la mortalidad total y por síndrome ascítico fueron normalizados. El grupo experimental consumió menos alimentos que el testigo con 4.41 y 4.58 kg, respectivamente (P< 0.05). Se obtuvo mejor índice de conversión en las aves experimentales (1.853:1) en comparación con las aves testigo (1.940:1) con diferencia estadísticamente significativa (P< 0.05). La mortalidad general y la ocasionada por SA fueron menores en el grupo experimental (11.67 por ciento y 9.44 por ciento, respectivamente), en comparación con las aves testigo (16.53 por ciento y 12.94 por ciento), existiendo diferencias significativas en ambos valores (P< 0.05). Al final del experimento, el grupo experimental alcanzó el mejor índice de productividad (P< 0.05) con 227.84, a diferencia del testigo con 204.32. Finalmente se produjeron 23.76 kg de pollo/m² en el grupo experimental y 22.24/m² en el testigo (P< 0.05). Los resultados demuestran que la aplicación de un sistema de ventilación forzada por presión positiva tuvo un efecto positivo en la mayoría de los parámetros productivos