[Loss of weight in hemodialysis patients after hospitalization is related with length of stay and degree of inflammation]. / La pérdida de peso en pacientes en hemodiálisis tras su hospitalización tiene relación con la duración de la estancia y con el grado de inflamación.

BACKGROUND: It is frequent to observe that hemodialysis patients suffer important loss of weight during hospital stay. This issue has not been investigated previously. Our aim in this study was to analyze factors associated with this loss of weight and what changes occur after admission in biochemical parameters with nutritional interest. PATIENTS AND METHODS: We retrospectively selected patients undergoing chronic hemodialysis who were admitted at hospital for acute or chronic pathologies, with a minimum length of stay of 4 days, taking only one episode of admission per patient. We chose loss of weight observed at hospital discharge, at 2 and 4 weeks later and we also collected routine laboratory data and adequacy parameters before and after the hospital admission and basic biochemical parameters in the first week of hospital stay. RESULTS: We included 77 patients, with 67±12 years and 30±34 months in dialysis. Forty (51.9%) were female (51.9%) and 22 diabetics (28.6%). Length of stay was 17.8±12.6 days (median 12). There were 70.4% patients who suffered a loss of weight at discharge and 81.4% at 4 weeks, without differences in sex or diabetes. Weight decreased significantly with a mean of -1.09 kg (95%CI -0.73 to -1.44). After 2 weeks the loss of weight was -1.64 kg (95%CI -1.21 a -2.07 kg) and after 4 weeks was -1.94 kg (95%CI -1.47 a -2.42 kg). Comparing parameters before and after admission, we observed a significantly decrease in serum urea levels (before 134±40 vs after 119±36 mg/dl; p= 0.001), creatinine (before 8.1±2.6 vs after 7.5±2.6 mg/dl; p < 0.001), phosphate (before 5.2±1.7 vs after 4.3±1.5 mg/dl; p < 0.001) and albumin (before 3.70±0.48 vs after 3.56±0.58 g/dl; p=0.05), without changes in adequacy parameters. Greater loss of weight at 4 weeks from discharge was correlated with larger length of stay (r= 0.41; p < 0.001), greater body mass index at admission (r= -0.23; p=0.05) and lower serum albumin at admission (r= 0.39; p= 0.012). It was also correlated with a lower serum albumin (r= 0.27; p=0.05), lower creatinine (r= 0.30; p= 0.02) and lower protein intake (nPNA) (r= 0.47; p= 0.002) after discharge. Lower serum albumin levels at admission were correlated with greater decreases of creatinine after discharge (r= 0.42; p= 0.009) and larger length of stay (r= -0.61; p < 0.001). Employing multivariate analysis we found that loss of weight was associated to length of stay and serum potassium levels before admission. CONCLUSIONS: Hospitalization of hemodialysis patients have a negative nutritional impact causing a significant loss of weight, probably reflecting a reduction of muscle mass. We found that length of stay in hospital is a basic factor associated with this nutritional impairment. The pathologies promoting hospitalization could influence this derangement through inflammation but this hypothesis should be investigated.

La pérdida de peso en pacientes en hemodiálisis tras su hospitalización tiene relación con la duración de la estancia y con el grado de inflamación / Weight loss in haemodialysis patients following hospitalisation is related to the duration of hospital stay and level of inflammation

Introducción: En pacientes en hemodiálisis es frecuente observar pérdida de peso relacionada con el ingreso hospitalario. Nuestro objetivo fue cuantificar esta pérdida de peso y analizar con qué factores se relaciona. Pacientes y métodos: Seleccionamos a pacientes en hemodiálisis crónica, con ingresos hospitalarios por cualquier etiología con duración mínima de 4 días, recogiendo pérdidas de peso al alta, a las 2 y 4 semanas del alta, así como evolución de variables con interés nutricional (creatinina, albúmina, transferrina, nPNA) tras su alta. Resultados: Incluimos a 77 pacientes, con 67 ± 12 años y 30 ± 34 meses en hemodiálisis, 40 mujeres (51,9%) y 22 diabéticos (28,6%). La estancia hospitalaria fue 17,8 ± 12,6 días (mediana 12 días). El 70,4% mostraron pérdida de peso al alta y un 81,3% a las 4 semanas del alta, sin influir sexo ni diabetes. El peso disminuyó al alta -1,09 kg (IC 95%, -0,73 a -1,44), —1,64 kg (IC 95%, -1,21 a -2,07 kg) a las 2 semanas y -1,94 kg (IC 95%, -1,47 a -2,42 kg) a las 4 semanas. Tras el alta observamos un descenso de urea (antes del alta 134 ± 40 frente a después del alta 119 ± 36 mg/dl; p = 0,001), creatinina (antes del alta 8,1 ± 2,6 frente a después del alta 7,5 ± 2,6 mg/dl; p <0,001), fósforo (antes del alta 5,2 ± 1,7 frente a después del alta 4,3 ± 1,5 mg/dl; p <0,001), albúmina (antes del alta 3,70 ± 0,48 frente a después del alta 3,56 ± 0,58 g/dl; p = 0,05). La pérdida de peso a las 4 semanas se correlacionó con una mayor estancia hospitalaria (r = 0,41; p <0,001), mayor índice de masa corporal en el momento del ingreso (r = —0,23; p = 0,05) y menor albúmina en el ingreso (r = 0,39; p = 0,012) y con albúmina (r = 0,27; p = 0,05), creatinina (r = 0,30; p = 0,02) y nPNA (r = 0,47; p = 0,002) más bajos después del ingreso. Albúminas más bajas en el momento del ingreso se correlacionaron con mayores descensos de la creatinina después del ingreso (r = 0,42; p = 0,009) y con una estancia más prolongada (r = —0,61; p <0,001). Con análisis multivariante, la pérdida de peso se asoció con mayor duración de estancia y con potasio sérico antes del ingreso. Conclusiones: La hospitalización de pacientes en hemodiálisis provoca una pérdida significativa del peso corporal debido a una probable pérdida de la masa muscular. La mayor estancia hospitalaria y el estado inflamatorio durante el ingreso son los factores que se relacionan con el deterioro nutricional que sufren los pacientes en hemodiálisis durante su hospitalización (AU)

Background: It is frequent to observe that hemodialysis patients suffer important loss of weight during hospital stay. This issue has not been investigated previously. Our aim in this study was to analyze factors associated with this loss of weight and what changes occur after admission in biochemichal parameters with nutritional interest. Patients and methods: We retrospectively selected patients undergoing chronic hemodialysis who were admitted at hospital for acute or chronic pathologies, with a minimum length of stay of 4 days, taking only one episode of admission per patient. We chose loss of weight observed at hospital discharge, at 2 and 4 weeks later and we also collected routine laboratory data and adecuacy parameters before and after the hospital admission and basic biochemical parameters in the first week of hospital stay. Results: We included 77 patients, with 67±12 years and 30±34 months in dialysis. Forty (51,9%) were female (51,9%) and 22 diabetics (28,6%). Length of stay was 17,8±12,6 days (median 12). There were 70,4% patients who suffered a loss of weight at discharge and 81,4% at 4 weeks, without differences in sex or diabetes. Weight decreased significantly with a mean of -1,09 kg (95%CI -0,73 to -1,44). After 2 weeks the loss of weight was -1,64 kg (95%CI -1,21 a -2,07 kg) and after 4 weeks was -1,94 kg (95%CI -1,47 a -2,42 kg). Comparing parameters before and after admission, we observed a significantly decrease in serum urea levels (before 134±40 vs after 119±36 mg/dl; p= 0,001), creatinine (before 8,1±2,6 vs after 7,5±2,6 mg/dl; p<0,001), phosphate (before 5,2±1,7 vs after 4,3±1,5 mg/dl; p< 0,001) and albumin (before 3,70±0,48 vs after 3,56±0,58 g/dl; p=0,05), without changes in adequacy parameters. Greater loss of weight at 4 weeks from discharge was correlated with larger length of stay (r= 0,41; p<0,001), greater body mass index at admission (r= -0,23; p=0,05) and lower serum albumin at admission (r= 0,39; p= 0,012). It was also correlated with a lower serum albumin (r= 0,27; p=0,05), lower creatinine (r= 0,30; p= 0,02) and lower protein intake (nPNA) (r= 0,47; p= 0,002) after discharge. Lower serum albumin levels at admission were correlated with greater decreases of creatinine after discharge (r= 0,42; p= 0,009) and larger length of stay (r= -0,61; p<0,001). Employing multivariate analysis we found that loss of weight was associated to length of stay and serum potasium levels before admission. Conclusions: Hospitalization of hemodialysis patients have a negative nutritional impact causing a significant loss of weight, probably reflecting a reduction of muscle mass. We found that length of stay in hospital is a basic factor associated with this nutritional impairment. The pathologies promoting hospitalization could influence this derangement through inflammation but this hypothesis should be investigated (AU)

[Lipid nutrition and the epidermal barrier: The connection between immune-mediated inflammatory diseases and peroxisome proliferator-activated receptors, a new therapeutic target in psoriasis and atopic dermatitis]. / Barrera epidérmica y nutrición lipídica. La conexión PPAR e inmunopatología inflamatoria como nuevas dianas de tratamiento en dermatitis atópica y psoriasis.

The authors describe peroxisome proliferator-activated receptor (PPAR) transcription factors as connectors between the enzymatic mechanisms of the epidermal barrier and the abnormal immune and inflammatory responses that characterize atopic dermatitis and psoriasis. Also described is a new connection between lipid metabolism and the epidermal barrier. A suggestion that emerges is that atopic dermatitis and psoriasis share at least 2 pathogenic mechanisms-namely, deficient expression of PPAR-#a and impaired production of interleukin-10 and interferon-γ-in spite of differences in causes and manifestations. A standardized olive oil formulation with powerful bactericidal and fungicidal effects also has the ability to increase serum levels of these 2 cytokines and regulate serum levels of high-density lipoprotein cholesterol in patients at high risk for inflammatory and cardiovascular disease, suggesting that these may be among the mechanisms responsible for the benefits observed following oral and/or topical administration in patients with atopic dermatitis or psoriasis.

Barrera epidérmica y nutrición lipídica. La conexión PPAR e inmunopatología inflamatoria como nuevas dianas de tratamiento en dermatitis atópica y psoriasis / Lipid Nutrition and the Epidermal Barrier: The Connection Between Immune-Mediated Inflammatory Diseases and Peroxisome Proliferator-Activated Receptors, a New Therapeutic Target in Psoriasis and Atopic Dermatitis

Los autores describen los factores peroxisome proliferator-activated receptors (PPAR) como conectores entre los mecanismos enzimáticos de la barrera epidérmica (BE) y las alteraciones inmuno/inflamatorias que caracterizan a dermatitis atópica (DA) y psoriasis. Igualmente, se describe una nueva conexión entre el metabolismo lipídico y la BE. El análisis de estos hechos permite sugerir que DA y psoriasis, aunque diferentes en su causalidad y clínica, exhiben al menos dos hechos patogénicos comunes, que se manifiestan por defectos en la expresión de PPAR-ά y en la producción de IL-10 e IFN-γ. La capacidad de una formulación magistral de aceites de oliva (FMAO) para aumentar los niveles séricos de ambas citocinas, y regular el colesterol HDL sérico, en pacientes con alto riesgo inflamatorio/cardiovascular, junto a sus potentes efectos bactericidas y fungicidas, sugiere que estos sean algunos de los mecanismos responsables de los positivos efectos observados con la FMAO (oral y/o tópica) en pacientes con DA y psoriasis (AU)

The authors describe peroxisome proliferator-activated receptor (PPAR) transcription factors as connectors between the enzymatic mechanisms of the epidermal barrier and the abnormal immune and inflammatory responses that characterize atopic dermatitis and psoriasis. Also described is a new connection between lipid metabolism and the epidermal barrier. A suggestion that emerges is that atopic dermatitis and psoriasis share at least 2 pathogenic mechanisms–namely, deficient expression of PPAR-ά and impaired production of interleukin-10 and interferon- IFNγ–in spite of differences in causes and manifestations. A standardized olive oil formulation with powerful bactericidal and fungicidal effects also has the ability to increase serum levels of these 2 cytokines and regulate serum levels of high-density lipoprotein cholesterol in patients at high risk for inflammatory and cardiovascular disease, suggesting that these may be among the mechanisms responsible for the benefits observed following oral and/or topical administration in patients with atopic dermatitis or psoriasis (AU)

Análisis de la eficacia y de los factores que influyen en la respuesta del hiperparatiroidismo secundario de pacientes en hemodiálisis a cinacalcet / Analysis of the efficacy and factors influencing the response of secondary hyperparathyroidism patients on hemodialysis to cinacalcet

Introducción: Aunque el cinacalcet ha mejorado el control del hiperparatiroidismo secundario en hemodiálisis, todavía un 50% de los pacientes no alcanzan las cifras de PTH recomendadas por las guías K/DOQI. El objetivo de este estudio fue analizar la eficacia del tratamiento del hiperparatiroidismo secundario con cinacalcet en pacientes no seleccionados en hemodiálisis crónica, de acuerdo con los objetivos marcados por las guías K/DOQI y KDIGO. Además, investigamos qué factores pueden influir en el grado de respuesta del hiperparatiroidismo secundario a cinacalcet. Material y métodos: Recogimos retrospectivamente la evolución de 74pacientes en hemodiálisis con hiperparatiroidismo secundario que fueron tratados con cinacalcet durante al menos 6 meses. Resultados: De acuerdo con las guías K/DOQI, la proporción de pacientes con PTHi >300 pg/ml se redujo al 50%, la presencia de hiperfosforemia descendió del 38,4 al 23,3% y el producto Ca x P >55 mg2/dl2 bajó de 37,8 a 15,1%. La prevalencia de hipocalcemia aumentó de 2,7 al 12,3%. Con respecto a las guías KDIGO, la proporción con PTHi >600 pg/mlse redujo desde 41,1 al 16,4% y la de hiperfosforemia del68,5 al 52,1%; pero al considerar a pacientes con PTHi inicial>600 pg/ml, la prevalencia de P >4,5 mg/dl descendió de 83,3 del 55,2%. Observamos un incremento de la dosis de carbonato cálcico (basal 0,61 ± 1,53 g de calcio elemento/día frente a final 0,95 ± 1,98 g de calcio elementto/día; p = 0,03), debido más a la hipocalcemia que a la necesidad de quelar el fósforo. Encontramos menores descensos de la PTHi entre los pacientes que tenían prescrito inicialmente más sevelamer, y al final del seguimiento presentan mayores niveles séricos de PTHi (no sevelamer: 312 ± 245 pg/ml; sevelamer < _ 6,4 g/día: 510 ± 490 pg/ml; sevelamer >6,4 g/día: 526 ± 393 pg/ml; p = 0,04) y de fósforo (no sevelamer: 4,5 ± 1,2 mg/dl; sevelamer < _ 6,4 g/día: 4,2 ± 1,5 mg/dl; sevelamer >6,4 g/día: 5,7 ± 0,9 mg/dl; p = 0,01). El tratamiento asociado con paricalcitol no mostró ninguna in- fluencia en el grado de respuesta. Los pacientes que alcanzaron los objetivos de PTH mostraron ya a los 3 meses de tratamiento un mayor descenso en los niveles séricos de PTHi (159 ± 84 frente a 630 ± 377 pg/ml; p <0,001), con dosis significativamente menores de cinacalcet (33,8 ± 22,5 frente a 51,1 ± 25,1 mg/día; p = 0,003). Con análisis multivariante, el grado de reducción de la PTHi dependió de sus cifras séricas iniciales y de la dosis inicial de sevelamer. Conclusiones: Ci- nacalcet mejora el control del hiperparatiroidismo secunda- rio, si bien la respuesta es menor en los casos de mayor gra- vedad, representados por niveles más altos de PTH y mayores dosis iniciales de sevelamer. Por el contrario, un descenso im- portante de PTH a los 3 meses con dosis relativamente bajas de cinacalcet sería un marcador pronóstico de buena respuesta (AU)

Background: Treatment of secondary hyperparathyroidism with cinacalcet improves control of PTH, phosphorus, calcium and Ca X P product, enabling to achieve targets recommended by K/DOQI guidelines for PTHi in only 30-50%of patients, in studies with a very selected population. The aim of this study was to analyze its effectiveness in real clinical practice, comparing results with targets recommended by K/DOQI and KDIGO guidelines and to investigate factors having influence on PTH responsiveness to cinacalcet. Methods: We collected data of evolution of 74 patients on hemodialysis with secondary hyperparathyroidism who were treated with cinacalcet for at least 6months. Results: According K/DOQI targets we observed a reduction of proportion of patients with PTHi >300 pg/mlto 50%, a decrease of hyperphosphoremia from 38.4% to23.3% and proportion of patients with Ca x P product >55mg2/dl2 from 37.8% to 15.1%. By contrast, presence of hypocalcemia increases from 2.7% to 12.3%. Comparing with KDIGO targets, proportion of patients with PTHi >600pg/ml decreased from 41.1% to 16.4% and with hyperphosphoremia from 68.5% to 52.1%. However, when considering patients with baseline PTHi >600 pg/ml prevalence of P >4.5 mg/dl decreased from 83.3% to 55.2%. We observed significant changes of phosphate binders after cinacalcet treatment with an increase in calcium carbonate doses (pre 0.61 ± 1.53 g of calcium/day vs post-cinacalcet (..) (AU)

[Analysis of the efficacy and factors influencing the response of secondary hyperparathyroidism patients on hemodialysis to cinacalcet]. / Análisis de la eficacia y de los factores que influyen en la respuesta del hiperparatiroidismo secundario de pacientes en hemodiálisis a cinacalcet.

BACKGROUND: Treatment of secondary hyperparathyroidism with cinacalcet improves control of PTH, phosphorus, calcium and Ca x P product, enabling to achieve targets recommended by K/DOQI guidelines for PTHi in only 30-50% of patients, in studies with a very selected population. The aim of this study was to analyze its effectiveness in real clinical practice, comparing results with targets recommended by K/DOQI and KDIGO guidelines and to investigate factors having influence on PTH responsiveness to cinacalcet. METHODS: We collected data of evolution of 74 patients on hemodialysis with secondary hyperparathyroidism who were treated with cinacalcet for at least 6 months. RESULTS: According K/DOQI targets we observed a reduction of proportion of patients with PTHi > 300 pg/ml to 50%, a decrease of hyperphosphoremia from 38.4% to 23.3% and proportion of patients with Ca x P product > 55 mg2/dl2 from 37.8% to 15.1%. By contrast, presence of hypocalcemia increases from 2.7% to 12.3%. Comparing with KDIGO targets, proportion of patients with PTHi > 600 pg/ml decreased from 41.1% to 16.4% and with hyperphosphoremia from 68.5% to 52.1%. However, when considering patients with baseline PTHi > 600 pg/ml prevalence of P > 4.5 mg/dl decreased from 83.3% to 55.2%. We observed significant changes of phosphate binders after cinacalcet treatment with an increase in calcium carbonate doses (pre 0.61 +/- 1.53 g of calcium/day vs post-cinacalcet 0.95 +/- 1.98 g of calcium/day; p = 0.03) that was prescribed to prevent hypocalcemia and not as phosphate binder. Responsiveness were lower in patients who were taking higher doses of sevelamer at baseline, showing at the end of the study higher PTHi (no-sevelamer: 312 +/- 245 pg/ml; sevelamer < 6.4 g/day: 510 +/- 490 pg/ml; sevelamer > 6.4 g/day: 526 +/- 393 pg/ml; p = 0.04) and phosphorus (no-sevelamer: 4.5 +/- 1.2 mg/dl; sevelamer < 6.4 g/day: 4.2 +/- 1.5 mg/dl; sevelamer > 6.4 g/day: 5.7 +/- 0.9 mg/dl; p=0.01) serum levels. Use of paricalcitol did not show any influence on PTH response. Patients achieving targets for PTH at the end of the study showed a good response early, with a significant decrease of PTHi levels at three months (159 +/- 84 vs 630 +/- 377 pg/ml; p < 0.001) with significantly lower doses of cinacalcet (33.8 +/- 22.5 vs 51.1 +/- 25.1 mg/day; p = 0.003). Using multivariate analysis we found that percent of PTHi reduction was related with baseline PTHi levels and taking sevelamer as phosphate binder at baseline. CONCLUSION: Use of cinacalcet improves grade of control of secondary hyperparathyroidism in non-selected patients in hemodialysis, showing poor response in population with higher PTHi levels and who takes higher doses of sevelamer at baseline. By contrast, a reduction of PTHi levels at 3 months of treatment with relatively lower doses is a pronostic marker of good response to cinacalcet treatment.

Lipid Nutrition and the Epidermal Barrier: The Connection Between Immune-Mediated Inflammatory Diseases and Peroxisome Proliferator-Activated Receptors, a New Therapeutic Target in Psoriasis and Atopic Dermatitis. / Barrera epidérmica y nutrición lipídica. La conexión PPAR e inmunopatología inflamatoria como nuevas dianas de tratamiento en dermatitis atópica y psoriasis.

The authors describe peroxisome proliferator-activated receptor (PPAR) transcription factors as connectors between the enzymatic mechanisms of the epidermal barrier and the abnormal immune and inflammatory responses that characterize atopic dermatitis and psoriasis. Also described is a new connection between lipid metabolism and the epidermal barrier. A suggestion that emerges is that atopic dermatitis and psoriasis share at least 2 pathogenic mechanisms-namely, deficient expression of PPAR-#a and impaired production of interleukin-10 and interferon-γ-in spite of differences in causes and manifestations. A standardized olive oil formulation with powerful bactericidal and fungicidal effects also has the ability to increase serum levels of these 2 cytokines and regulate serum levels of high-density lipoprotein cholesterol in patients at high risk for inflammatory and cardiovascular disease, suggesting that these may be among the mechanisms responsible for the benefits observed following oral and/or topical administration in patients with atopic dermatitis or psoriasis.

Intoxicación por litio y proteinuria en rango nefrótico / No disponible

No disponible

Repermeabilización de estenosis de arteria renal en paciente con síndrome nefrótico secundario a síndrome antifosfolípido primario. Una inusual presentación clínica / Repermeabilization of renal artery stenosis in a patient with nephrotic syndrome secondary to primary antiphospholipid syndrome. A rare presentation

El síndrome antifosfolípido primario (SAFP) es una entidad clínica que tiene como manifestación más frecuente desde el punto de vista renal la hipertensión, mientras que el síndrome nefrótico es infrecuente. La prevalencia de estenosis de arteria renal en este síndrome es desconocida, al igual que su evolución y tratamiento. Desde el punto de vista terapéutico, en el SAFP está indicada la anticoagulación con dicumorínicos para lograr una ratio normalizada internacional (INR) > 3 para evitar que progresen los eventos trombóticos y la enfermedad renal. A continuación presentamos el caso de un varón de 30 años que diagnosticamos de síndrome antifosfolípido primario que a pesar de presentar una trombosis de arteria renal presentó un ligero deterioro de la función renal sin hipertensión (AU)

Primary antiphospholipid syndrome (PAPS) is a clinical condition whose most frequent manifestation from the renal point of view is hypertension, nephrotic syndrome being a rare presentation form. The prevalence of renal artery stenosis in this syndrome as well as its evolution and treatment are unknown. From the therapeutic point of view, anticoagulation with dicumorinics is indicated in PAPS. An attempt should be made to obtain an international normalized ratio (INR) > 3 to prevent progression of the thrombotic events and renal disease. We present the case of a 30-year old male diagnosed of primary antiphospholipid syndrome. In spite of having renal artery thrombosis, he had a mild deterioration of renal function without hypertension (AU)

[Efficacy of rasburicase therapy in obstructive renal failure secondary to urolithiasis: a novel therapeutic option]. / Eficacia de la rasburicasa en el fracaso renal agudo obstructivo por litiasis: una nueva opción terapéutica.

The overall incidence of nephrolithiasis-related acute and chronic renal failure is poorly known and surely underestimated. However, obstructive nephropathy represents a potentially curable form of kidney disease that often requires for managing an instrumentation of urinary tract. Rasburicase is an enzyme that transforms uric acid to allantoin, a compound more water soluble that will be excreted by the kidney more easily. Rasburicase has been proven to be an effective therapy for prevention of tumour lysis syndrome. But it also represents an interesting new option in managing hyperuricemia in patients with severe tophaceous gout. We administered rasburicase intravenously (0.20 mg/kg/day, for 2 days) in 2 adults with acute obstructive nephropathy from renal calculi, which was receiving temporary haemodialysis. Rasburicase produced a sharp polyuria 12-18 hours after its administration accompanied with a fast reduction of serum creatinine levels, that returned to normal range without further dialysis. If we suppose that rasburicase can pass through glomerular filter by its relatively low molecular weight, it could dissolve tubular uric acid crystals in acute renal failure associated to tumour lysis syndrome, providing the restoration of renal function. But we also could postulate that rasburicase can act in urinary tract, fragmentating renal calculi, promoting relief of obstructive uropathy and the resolution of renal failure. We suggest rasburicase should be tried in this new indication to prove its potential efficacy.

[Acute renal failure in a case of nephrotic syndrome secondary to focal and segmental glomerulosclerosis]. / Fracaso renal agudo en síndrome nefrótico secundario a glomeruloesclerosis focal y segmentaria.

Nephrotic syndrome is infrequently complicated with appearance of acute renal failure and minimal change disease is the glomerulopathy more usually involved. Pathogenesis is unclear and three possible mechanisms it has been proposed to explain the decrease of glomerular filtration rate: a severe reduction of glomerular permeability, the presence of acute tubular necrosis or an increased intrarenal pressure related with interstitial oedema. Here we present a 36 years-old-male with a nephrotic syndrome caused by focal and segmental glomerulosclerosis who developed an anuric acute renal failure. Renal function did not change despite oedema removal with haemodialysis and only after corticosteroid and cyclophosphamide therapy introduction we observed a rapid recovery of urinary output and resolution of acute renal failure. Renal biopsy did not show signs of tubular damage or obstruction with proteins nor significant interstitial oedema. Therefore, in this case we think acute renal failure was caused by a severe reduction in glomerular ultrafiltration rate and steroids were the effective treatment that allowed recovery of renal function.

Eficacia de la rasburicasa en el fracaso renal agudo obstructivo por litiasis: una nueva opción terapéutica / Efficacy of rasburicase therapy in obstructive renal failure secondary to urolithiasis: a novel therapeutic option

La incidencia global de la insuficiencia renal crónica o aguda asociada a la litiasis renal es desconocida y probablemente esté infraestimada. Sin embargo, la uropatía obstructiva constituye una causa potencialmente curable de nefropatía que precisa con frecuencia manipulación quirúrgica de la vía urinaria. Rasburicasa es una enzima recombinante que metaboliza el ácido úrico en alantoína, un compuesto más hidrosoluble y fácilmente eliminable por el riñón. Su principal indicación es la prevención de la nefropatía por ácido úrico del síndrome de lisis tumoral. Pero, actualmente, también se considera una posible alternativa al alopurinol en el manejo de la hiperuricemia del paciente con gota tofácea crónica. Presentamos dos casos de fracaso renal agudo anúrico obstructivo provocados por litiasis que precisaron hemodiálisis y a los que se les administró rasburicasa por vía intravenosa (0,20 mg/kg/día durante 2 días).Tras 12-18 horas se observó una poliuria brusca y eficaz que se acompañó de rápida recuperación de la función renal y permitió suspender la hemodiálisis. En virtud del relativo bajo peso molecular de la rasburicasa podemos suponer que es capaz de atravesar el filtro glomerular y aparecer en la orina. Podría así disolver los cristales de ácido úrico formados en el fracaso renal agudo asociado al síndrome de lisis tumoral. Pero también podemos hipotetizar que la rasburicasa actuaría en la vía urinaria fragmentando los cálculos, facilitando su eliminación y liberando la obstrucción, lo que posibilitaría la resolución del fallo renal. Sugerimos que la rasburicasa debería ser ensayada con esta nueva indicación para probar su posible eficacia (AU)

The overall incidence of nephrolithiasis-related acute and chronicrenal failure is poorly known and surely underestimated. However, obstructive nephropathy represents a potentially curable form of kidney disease that often requires for managing an instrumentation of urinary tract. Rasburicase is an enzyme that transforms uric acid to allantoin, a compound more water soluble that will be excreted by the kidney more easily. Rasburicase has been proven to be an effective therapy for prevention of tumourlys is syndrome. But it also represents an interesting new option in managing hyperuricemia in patients with severe tophaceousgout. We administered rasburicase intravenously (0,20mg/kg/day, for 2 days) in 2 adults with acute obstructive nephropathy from renal calculi, which was receiving temporary haemodialysis. Rasburicase produced a sharp polyuria 12-18 hours after its administration accompanied with a fast reduction of serum creatinine levels, that returned to normal range without further dialysis. If we suppose that rasburicase can pass through glomerular filter by its relatively low molecular weight, it could dissolve tubular uric acid crystals in acute renal failure associated to tumourlys is syndrome, providing the restoration of renal function. But we also could postulate that rasburicase can act in urinary tract, fragmentating renal calculi, promoting relief of obstructive uropathy and the resolution of renal failure. We suggest rasburicase should be tried in this new indication to prove its potential efficacy (AU)

Fracaso renal agudo en síndrome nefrótico secundario a glomeruloesclerosis focal y segmentaria / Acute renal failure in a case of nephrotic syndrome secondary to focal and segmental glomerulosclerosis

El fracaso renal agudo en el síndrome nefrótico es poco frecuente y suele asociarse con una nefropatía de cambios mínimos. Su etiopatogenia es oscura y se relaciona con una reducción de la permeabilidad glomerular, con necrosis tubular aguda o con un incremento de la presión intrarrenal debido al edema intersticial. Presentamos un varón de 36años con un síndrome nefrótico por glomérulo esclerosis focal y segmentaria que desarrolló un fracaso renal agudo anúrico. A pesar de reducir el edema con hemodiálisis fue tras iniciar tratamiento con esteroides e inmunosupresores cuando la diuresis se restableció y mejoró rápidamente la función renal. En la biopsia renal no se observaron datos de necrosis u obstrucción tubular ni de edema intersticial, por lo que atribuimos el fracaso renal agudo a una severa reducción del coeficiente de ultrafiltración glomerular (AU)

Nephrotic syndrome is infrequently complicated with appearance of acute renal failure and minimal change disease is the glomerulopathy more usually involved. Pathogenesis is unclear and three possible mechanisms it has been proposed to explain the decrease of glomerular filtration rate: a severe reduction of glomerular permeability, the presence of acute tubular necrosis or an increased intrarrenal pressure related with interstitial oedema. Here we presenta 36 years-old-male with a nephrotic syndrome caused by focal and segmental glomerulosclerosis who developed an anuricacute renal failure. Renal function did not change despite oedema removal with haemodialysis and only after corticosteroid and cyclophosphamide therapy introduction we observed a rapid recovery of urinary output and resolution of acute renal failure. Renal biopsy did not show signs of tubular damage or obstruction with proteins nor significant interstitial oedema. Therefore, in this case we think acute renal failure was caused by a severe reduction inglomerular ultrafiltration rate and steroids were the effective treatment that allowed recovery of renal function (AU)

[Preliminary study on efficacy and tolerance of a "coupage" of olive oil in patients with chronic kidney disease. Nutritonal evaluation]. / Estudio preliminar sobre eficacia y tolerancia de un "coupage" de aceite de oliva en pacientes con enfermedad renal crónica. Evaluación del estado de nutrición.

The discrepancies among data reported by using olive oil (OO) in humans appear to be due to the great differences between the different OO used. Based on structure/function relationships we have chemically optimized an OO through the rational mixture ("coupage") of several Spanish extra virgin olive oils (methodology "oHo"). Patients with chronic kidney disease (CKD) develop a progressive picture of malnutrition and inflammation that lead them to an elevated risk of cardiovascular disease. In a pilot, randomised trial the nutritional efficacy and safety of "oHo" were evaluated in 32 patients (mean age 60,8 +/- 13,2 years old; 16 women) with CKD (KDIGO stages 4-5) at predialysis. After a 7 days wash out for statins and ACE inhibitors 19 patients had "oHo" at doses of 60 mL/day (20 mL t.i.d) for 30 consecutive days, whilst 13 patients remain as a control group without "oHo". At the end of the study only patients having "oHo" showed significant increases of serum albumin (p<0.05) and not significant increases of total proteins, weight, and BMI. Total cholesterol (p<0.05) and HDL-cholesterol (p<0.01) increased with "oHo". The number of cases with pathologic HOMA-IR in the control group increased from 1 to 2 patients whilst in the "oHo" group decreased from 2 to none. No significant changes of minerals, arterial pressure, hemoglobin, and other parameters related to CKD were seen. After a 30 days follow-up in the "oHo" group all parameters came back to basal ones, excepting for blood pressure that significantly decreased (p<0,05). Tolerance was excellent and constipation significantly diminished (p<0,001) in the "oHo" group. Of importance, none of these biological changes were seen in regular consumers of other conventional olive oils (control group). These intriguing results, seen by the first time, appear to partially satisfy the recent claims ("reverse epidemiology") about the need of a more correct nutrition in CKD patients. However, these data need to be proved in more larger trials as well as in CKD patients under dialysis with harder inflammatory/malnutrition conditions.

Estudio preliminar sobre eficacia y tolerancia de un «coupage» de aceite de oliva en pacientes con enfermedad renal crónica. Evaluación del estado de nutrición / Preliminary study on efficacy and tolerance of a 'coupage' of olive oil in patients with chronic kidney disease. Nutritional evaluation

Las discrepancias en las acciones del aceite de oliva (AO) en humanos, parecen deberse a las diferencias existentes entre los distintos aceites utilizados en los estudios publicados, fundamentalmente en sujetos sanos. Basados en relaciones estructura/función, se ha optimizado químicamente un AO mediante la mezcla racional («coupage») de diversos aceites de oliva virgen extra españoles (metodología «oHo»®). Los pacientes con enfermedad renal crónica (ERC) desarrollan un cuadro progresivo de malnutrición e inflamación sobre el que asienta su elevado riesgo de enfermedad cardiovascular. En un estudio piloto, controlado y aleatorizado se ha evaluado la eficacia y seguridad de «oHo» en 32 pacientes (16 mujeres) con ERC (estadios 4-5) en prediálisis, (edad media 60,8 ± 13,2 años). Tras un período de lavado de 7 días para inhibidores de la ECA y estatinas, 19 pacientes tomaron «oHo» (60 ml/día, en 3 tomas) durante 30 días consecutivos y 13 permanecieron como grupo control. Al final del estudio, solamente los pacientes con «oHo» mostraron incrementos significativos en los niveles de albúmina sérica (p < 0,05), así como tendencia al aumento del peso y de las proteínas totales. Las cifras de colesterol total (p < 0,05) y HDL (p < 0,01) aumentaron en el grupo «oHo». El número de casos con HOMA patológico subió de 1 a 2 pacientes en el control, mientras que en el grupo «oHo» los 2 pacientes iniciales con HOMA patológico normalizaron sus índices. No se observaron cambios en los parámetros relacionados específicamente con la ERC: minerales, creatinina, anemia, etc. Tras un período de seguimiento de 30 días, todos los parámetros que cambiaron en el tratamiento regresaron a cifras basales, excepto la presión arterial media, que disminuyó (p < 0,05). La tolerancia fue excelente y el estreñimiento disminuyó significativamente (< 0,001) en el grupo «oHo». Dada la originalidad del estudio, estos resultados deberán ser comprobados con estudios más amplios

The discrepancies among data reported by using olive oil (OO) in humans appear to be due to the great differences between the different OO used. Based on structure/function relationships we have chemically optimized an OO through the rational mixture («coupage») of several Spanish extra virgin olive oils (methodology «oHo»®). Patients with chronic kidney disease (CKD) develop a progressive picture of malnutrition and inflammation that lead them to an elevated risk of cardiovascular disease. In a pilot, randomised trial the nutritional efficacy and safety of «oHo» were evaluated in 32 patients (mean age 60,8 ± 13,2 years old; 16 women) with CKD (KDIGO stages 4-5) at predialysis. After a 7 days wash out for statins and ACE inhibitors 19 patients had «oHo» at doses of 60 mL/day (20 mL t.i.d) for 30 consecutive days, whilst 13 patients remain as a control group without «oHo». At the end of the study only patients having «oHo» showed significant increases of serum albumin (p < 0.05) and not significant increases of total proteins, weight, and BMI. Total cholesterol (p < 0.05) and HDL-cholesterol (p < 0.01) increased with «oHo». The number of cases with pathologic HOMA-IR in the control group increased from 1 to 2 patients whilst in the «oHo» group decreased from 2 to none. No significant changes of minerals, arterial pressure, hemoglobin, and other parameters related to CKD were seen. After a 30 days follow- up in the «oHo» group all parameters came back to basal ones, excepting for blood pressure that significantly decreased (p < 0,05). Tolerance was excellent and constipation significantly diminished (p < 0,001) in the «oHo» group. Of importance, none of these biological changes were seen in regular consumers of other conventional olive oils (control group). These intriguing results, seen by the first time, appear to partially satisfy the recent claims («reverse epidemiology») about the need of a more correct nutrition in CKD patients. However, these data need to be proved in more larger trials as well as in CKD patients under dialysis with harder inflammatory/malnutrition conditions

Trombosis del acceso vascular en pacientes hemodializados. Racional para el uso preventivo del aceite de oliva / Thrombosis of the vascular access in hemodialysis patients. Rationale for the preventive use of olive oil

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[Guidelines of the Spanish Society of Nephrology. Clinical practice guidelines for peritoneal dialysis]. / Guías Sociedad Española de Nefrología. Guías de práctica clínica en diálisis peritoneal.

In Spain and in each of its autonomous communities, the dialysis treatment of chronic renal disease stage 5 is totally covered by public health. Peritoneal dialysis, in any of its modalities, is established as the preferred home dialysis technique and is chosen by high percentage of patients as their choice in dialysis treatment. The Spanish Society of Nephrology has promoted a project of creation of performance guides in the field of peritoneal dialysis, entrusting a work group composed of members of the Spanish Society of Nephrology a with the development of these guides. The information offered is based on levels of evidence, opinion and clinical experience of the most relevant publications of the topic. In these guides, after defining the concept of << peritoneal dialysis>>, the obligations and responsibilities of the sanitation team of the peritoneal dialysis unit are determined, and protocols and performance procedures that try to include all the aspects that concern the patient with chronic renal disease in substitute treatment with this technique are developed. They propose prescription objectives based on available clinical evidence and, lacking this, on the consensus of the experts' opinions. The final aim is to improve the care and quality of the of the patient in peritoneal dialysis, optimizing in this way the survival of the patient and of the technique. In Spain, as in other neighbouring countries, peritoneal dialysis has an incidence and prevalence that is much lower than that of hemodialysis, ranging in the last evaluation by the Spanish Society of Nephrology between 5 and 24% in the different autonomous communities. The great majority of peritoneal dialysis units form part of the public network of the Spanish state, with special representation as a Satellite Unit or Concerted Center related to the public hospital of reference, on which it must depend.