Excreción urinaria de albúmina en diabéticos no insulino-dependientes: efecto de un inhibidor de la enzima convertidora de angiotensina / Albumin urinary excretion in non insulin dependent diabetic patients: effects of an angiotensin converting enzyme inhibitor

Microalbuminuria in diabetic patients is diagnostic of early renal involvement and angiotensin converting enzyme inhibitors reduce albumin excretion in these subjects. To asses the effect of ACEI on urinary albumin excretion, non insulin dependent diabetic patients with normal blood pressure were randomly assigned to receive enalapril 10 mg/day or placebo and followed during 18 months. Those with high blood pressure were randomly assigned to receive enalapril or acebutolol in doses necessary to normalize blood pressure and followed during 12 months. Every 3 month, urinary albumin excretion was measured in a 4 hour urine sample by radioimmunoassay. One hundred fifty two patients were recruited for the study and 46 were lost from follow up. In 17 subjects with normal blood pressure initial urinary albumin excretion below cutoff values (30 mg/24 h) and treated with enalapril, this parameter did not change; in 20 treated with placebo, it incresed from 5.8ñ6.1 to 18.2ñ7.5 mg/24 h. In 11 patients with normal pressure and initial urinary albumin, this parameter did not change with enalapril and increased in 10 with placebo from 87.3ñ75.1 to 253.6ñ61.1 mg/24 h. In hypertensive patients with normal urinary albumin excretion, no changes in this parameter were observed in those treated with acebutolol (n=10) or enalapril (n=14). In hypertensive with high urinary albumin excretion, it decreased from 119.2ñ8.5 to 40.0ñ4.7 mg/24 h with enalapril treatment (n=12) and no change was observed in those treated with acebutolol (n=11). In Conclusion, enalapril decreases urinary albumin excretion in non insulin dependent diabetic patients

Correlación entre clearence de creatinina de 4 horas y la prueba de Cr-EDTA / Correlation between 4 hours creatinine clearence and Cr-EDTA test

Creatinine clearence as a measure of glomerular filtration rate has several sources of error such as tubular creatinine secretion or faulty urine collections. On the other hand 51Cr-EDTA test is reliable and accurate, except in patients with edema, in whom the radioisotope equilibrium is retarded after injection. Aim: to validate a 4 hours creatinine clearence correlating it with 51Cr-EDTA test. Methods: In 59 non insulin dependent diabetic patients without diabetic nephropathy, glomerular filtration rate was measured using one 50 µCi injection of 51Cr-EDTA and collecting blood samples for radioactivity measurement at 10, 30, 120 and 240 min. Simultaneously, creatinine clearence was measured using a 4 hours urine collection. Results: The general correlation coefficient between both methods was 0,85 (p<0,001). For glomerular filtration rates below 95 ml/min, the correlation coefficient was 0,8(p<0,001), for values between 95 and 127 ml/min, the correlation was 0,51(p<0,001) and for values over 127 ml/min the correlation was 0,8(p<0,001). The regression equation obtained was y=1,2x+13 where y was the glomerular filtration rate measured with 51Cr-EDTA and x the same value measured with creatinine clearence. Conclusions: The four hours creatinine clearence is a reliable method to estimate glomerular filtration rate

Doce años de tratamiento de la insuficiencia renal crónica términal mediante trasplante renal en el Hospital San Juan de Dios / 12 years in the treatment of terminal chronic renal insufficiency with kidney transplants at San Juan de Dios Hospital

Se analiza retrospectivamente una serie de 31 trasplantes renales realizados en el Hospital San Juan de Dios entre 1978 y 1990. El 68% de los casos fueron hombres y el 32% mujeres con edad promedio de 29,5 años ñ 12,0 y un rango de 7 a 55 años. El 87% de ellos fueron previamente hemodializados durante un tiempo promedio de 22,9 meses. El 71% de los trasplantes se efectuaron con riñones de donantes vivos y sólo el 29% con riñones de cadáveres. En 19 casos se tipificaron sólo los antígenos A y B de histocompatibilidad y en los otros 12 casos también los antígenos DR. En el 90% de los casos el tratamiento inmunosupresor utilizado fue prednisona-azatioprina. La ciclosporina sólo se empleó desde el inicio en 10% y esporádicamente en 20%. Al cabo de un período de observación promedio de 35 meses, el injerto se encuentra funcionando en el 71% de los casos y ha fallecido el 12,9% de los pacientes. La sobrevida actuarial de los enfermos es 91% a los 3 años y la de los injertos de 77%

Pielonefritis enfisematosa: 3 casos / Enphysematous pyelonephritis: 3 cases

We report 3 patients who developed enphysemathous pyelonephritis. All were diabetic females over 50 years of age with unilateral necrotizing pyelonephritis. Intra and perirenal gas was demosntrated and all patients had infection by E. coli X ray and ultrasound studies allowed the diagnosis. Antibiotic therapy was unsuccessful and all patients had to be operated on

Hormona natriurética / Natriuretic hormone

Se analizan y resumen los conocimientos acumulados hasta la fecha en lo que respecta a la hormona natriurética en sus aspectos fisilógicos, farmacodinámicos y fisiopatológicos. En resumen puede decirse que se trata de un nuevo sistema hormonal de órgano endocrino capaz de entregar a la circulación un polipéptido de 28 aminoácidos cuando enfrentan sobrecargas salinas y/o de volumen. Esta susbstancia determina, principalmente por cambios hemodinámicos intraparenquimatosos renal aunque también a nivel de los grandes vasos, de las cápsulas suprarrenales y del sistema nervioso central, un aumento de la diuresis y de la natriuresis. La síntesis de la hormona natriurética abre, sin lugar a dudas, nuevas e importantes perspectivas terapéuticas de insospechables proyecciones particularmente en cardiópatas y nefrópatas.