Hipertrigliceridemia secundaria a suplementación nutricional en enfermedad renal crónica avanzada / Hypertriglyceridemia secondary to nutritional supplementation in advanced chronic kidney disease

La enfermedad renal crónica avanzada (ERCA, estadío 4) es el cuadro clínico que cursa con un descenso importante del filtrado glomerular (FG: < 30 mL/min). Se presenta el caso clínico de una mujer de 81 años de edad con ERCA secundaria a uropatía obstructiva crónica y diagnosticada de incoordinación muscular orofaríngea-disfagia a sólidos y parcialmente a líquidos-. En los últimos 5 años, estaba en tratamiento con suplementación nutricional exclusiva. En el inicio de Unidad ERCA, presentaba hipertrigliceridemia mantenida y aumento de la fracción VLDLc y de la GGT sin patología hepática subyacente. La modificación de la pauta de suplementación nutricional adaptada a las necesidades individuales de energía y nutrientes en ERC, y considerando la cantidad de lípidos y fuente de ácidos grasos de la fórmula permitió normalizar los niveles de triglicéridos plasmáticos, la VLDLc y la GGT, sin deterioro de la función renal y del estado nutricional (AU)

Advanced chronic kidney disease (ACKD, stage 4) is the clinical condition with a severe decrease in glomerular filtration rate (GFR < 30 mL/min). We report the case of an ACKD woman aged 81 with secondary to chronic obstructive uropathy and diagnosed oropharyngeal muscular incoordination -dysphagia to solids and liquids partially-. In the last 5 years, was treated with oral nutritional supplements exclusively. At the beginning of ACKD Unit, presented sustained hypertriglyceridemia and increased VLDLc fraction and GGT, without underlying liver disease. The modification of oral nutritional supplementation regimen tailored to individual needs energy and nutrients in ACKD, by considering the amount of lipids and fatty acid source of the formula, allowed normalize the levels of plasma triglycerides, VLDLc and GGT, without deterioration loss of renal function and nutritional status (AU)

[Evaluation of osteodystrophy parameters in a pre-dialysis unit]. / Valoración de parámetros de osteodistrofia en una unidad de prediálisis.

A cross-sectional study was developed with 100 of the first-time pre-dialysis patients visiting the Princesa University Hospital's Advanced Chronic Kidney Disease (ACKD) unit, with the aim of analysing various parameters of osteodystrophy at this time. Parameters evaluated were: age, gender, renal function, osteodystrophy serum parameters, comorbidity index (ICED) and the patients' origin to establish correlations between these parameters. Mean iPTH levels were higher irrespective of the patients' origin, and were significantly higher in men than in women, the former also having poorer renal function and higher comorbidity score. The mean levels of calcium, phosphorous, alkaline phosphatase and CO2 did not justify this rise in iPTH. Nutritional parameters NPNA and albumin were adequate in spite of ageing. At early stages of ESRD, iPTH could be elevated and ACKD units play an important part its early detection and subsequent treatment.

Valoración de parámetros de osteodistrofia en una unidad de prediálisis / Osteodystrophy parameters evaluation in a predialysis unit

Se estudia mediante un corte transversal como llegan 100 pacientes a la Unidad de Enfermedad Renal Crónica Avanzada (ERCA) (prediálisis) del Hospital Universitario de la Princesa analizando parámetros de osteodistrofia. Se analizan edad, sexo, grado de función renal, comorbilidad y procedencia de los pacientes para intentar establecer correlaciones entre ellos. La media de PTHi es elevada independientemente de la procedencia siendo significativamente mayor en hombres que en mujeres, si bien los hombres tenían menor función renal y mayor comorbilidad. Medias de calcio, P, fosfatasa alcalina o CO2 total no justifican la elevación. A pesar de la edad avanzada el NPNA y albúmina indican nivel de nutrición adecuado. La PTHi puede estar elevada desde estadios precoces de Enfermedad Renal Avanzada (ERC) y en la detección y tratamiento las Unidades de ERCA tienen un papel decisivo (AU)

A cross-sectional study was developed with 100 of the first-time pre-dialysis patients visiting the Princesa University Hospital’s Advanced Chronic Kidney Disease (ACKD) unit, with the aim of analysing various parameters of osteodystrophy at this time. Parameters evaluated were: age, gender, renal function, osteodystrophy serum parameters, comorbidity index (ICED) and the patients’ origin to establish correlations between these parameters. Mean iPTH levels were higher irrespective of the patients’ origin, and were significantly higher in men than in women, the former also having poorer renal function and higher comorbidity score. The mean levels of calcium, phosphorous, alkaline phosphatase and CO2 did not justify this rise in iPTH. Nutritional parameters NPNA and albumin were adequate in spite of ageing. At early stages of ESRD, iPTH could be elevated and ACKD units play an important part its early detection and subsequent treatment (AU)

Negative regulation by protein tyrosine phosphatase of IFN-gamma-dependent expression of inducible nitric oxide synthase.

Treatment of cultured peritoneal macrophages with IFN-gamma resulted in tyrosine phosphorylation of IkappaBalpha and IkappaBbeta, NF-kappaB activation, and expression of inducible NO synthase (iNOS). Since tyrosine phosphorylation of IkappaBalpha is sufficient to activate NF-kappaB in Jurkat cells, macrophages were treated with the protein tyrosine phosphatase inhibitor peroxovanadate (POV), which elicited an intense tyrosine phosphorylation of both IkappaB. However, this phosphorylation failed to activate NF-kappaB. Treatment with POV of macrophages stimulated with IFN-gamma or LPS potentiated the degradation of IkappaBalpha and IkappaBbeta, the activation of NF-kappaB, and the expression of iNOS. Analysis of the iNOS gene promoter activity corresponding to the 5'-flanking region indicated that POV potentiates the cooperation between IFN-gamma-activated transcription factors and NF-kappaB. These results indicate that tyrosine phosphorylation of IkappaB is not sufficient to activate NF-kappaB in macrophages and propose a negative role for protein tyrosine phosphatase in the expression of iNOS in response to IFN-gamma.

Response to high-pressure, low-temperature treatment in vegetables: determination of survival rates of microbial populations using flow cytometry and detection of peroxidase activity using confocal microscopy.

Application of high hydrostatic pressure (200, 300, 350 and 400 MPa) at 5 degrees C for 30 min to different micro-organisms, including Gram-positive and Gram-negative bacteria, moulds and yeasts, proved to be more effective in inactivating these organisms than treatments at 20 degrees C for 10 min and at 10 degrees C for 20 min. Moulds, yeasts, Gram-negative bacteria and Listeria monocytogenes were most sensitive, and their populations were completely inactivated at pressures between 300 and 350 MPa. The same conditions of pressure, temperature, and time were applied to different vegetables (lettuce, tomato, asparagus, spinach, cauliflower and onion), achieving reductions of from 2-4 log units in both viable mesophiles and moulds and yeasts at pressures of between 300 and 400 MPa. Sensory characteristics were unaltered, especially in asparagus, onion, tomato and cauliflower, though slight browning was observed in cauliflower at 350 MPa. Flow cytometry was applied to certain of the microbial populations used in the above experiment before and after the pressurization treatment. The results were indicative of differing percentage survival rates depending on micro-organism type, with higher survival rates for Gram-positive bacteria, except L. monocytogenes, than in the other test micro-organisms. Growth of survivors was undetectable using the plate count method, suggesting that micro-organisms suffering from pressure stress were metabolically inactive though alive. The pressurization treatments did not inactivate the peroxidase responsible for browning in vegetables. Confocal microscopic examination of epidermal tissue from onion showed that the enzyme had been displaced to the cell interior. Use of low temperatures and moderately long pressurization times yielded improved inactivation of micro-organisms and better sensorial characteristics of the vegetables, and should lower industrial costs.

Datura stramonium poisoning. Identification of tropane alkaloids in urine by gas chromatography-mass spectrometry.

A case of acute poisoning by ingestion of Datura stramonium infusion is reported. The patient presented with a typical anticholinergic syndrome (dryness of mouth, mydriasis, flushing, tachycardia, agitation, hallucinations) and was treated with symptomatic and supportive measures. The presence of tropane belladona alkaloids in a urine sample was demonstrated by gas chromatography-mass spectrometry.

Fatal poisoning by Rumex crispus (curled dock): pathological findings and application of scanning electron microscopy.

A case of fatal poisoning due to ingestion of the plant Rumex crispus (curled dock) is described. The patient, a 53-year-old male, presented with gastrointestinal symptoms, severe hypocalcemia, metabolic acidosis and acute hepatic insufficiency. Despite therapeutic measures, the patient died 72 h after ingestion of the plant material. Noteworthy among the pathological findings were centrolobular hepatic necrosis and birefringent crystals in the liver and kidneys that were identified by histochemical techniques and scanning electron microscopy. These observations are compared with other reports in the medical literature, with an emphasis on the risk involved in the use of these plants for culinary or medicinal purposes.

Inhibition of glucose-6-phosphatase and adenosine-triphosphatase activity in rats treated with toxic Spanish rapeseed oil or synthetic anilides.

After having demonstrated the impairment of the microsomal oxidation process in rats treated with toxic Spanish cooking oil or fatty acid anilides, we studied the possibility that the function of the cytoplasmic membrane had been affected. For this, the activities of glucose-6-phosphatase and adenosintriphosphatase were determined, these being enzymes of utmost importance in transport at the liver cell membrane level. Wistar rats received disease-related toxic rapeseed oil (1 mg/kg/day) or linoleilanilide (50 mg/kg/day) for 6 days, and the animals were sacrificed immediately after the administration period and after a 4-, 8- and 12-week latency period. Enzyme activities were measured in the membrane fraction of liver and lung. The results showed considerable reduction (up to 80%) in the activity of these enzymes, confirming that transport mechanisms through cell membranes must have been impaired.