Enfermedades renales que cursan con hipomagnesemia. Comentarios acerca de una nueva tubulopatía hipomagnesémica de origen genético / Renal diseases that course with hypomagnesemia. Comments on a new hereditary hypomagnesemic tubulopathy

Las enfermedades renales que cursan con hipomagnesemia son un grupo complejo y variopinto de tubulopatías producidas por mutaciones en genes que codifican proteínas que se expresan en la rama gruesa ascendente del asa de Henle y en el túbulo contorneado distal. En el presente artículo revisamos la descripción inicial, la expresividad clínica y la etiología de cuatro de las primeras causas de tubulopatías hipomagnesémicas que se describieron: las enfermedades de Bartter tipo 3 y Gitelman, la hipomagnesemia con hipocalcemia secundaria autosómica recesiva y la hipomagnesemia familiar con hipercalciuria y nefrocalcinosis. A continuación, se describen los patrones bioquímicos básicos que se observan en las hipomagnesemias tubulares renales y las modalidades de transporte e interacción que concurren entre los transportadores implicados en la reabsorción de magnesio en el túbulo contorneado distal. Finalmente, se comunica la reciente descripción de una nueva tubulopatía hipomagnesémica, la hipomagnesemia con hipocalcemia secundaria tipo 2 causada por una reducción de la actividad del canal TRPM7 (AU)

Renal diseases associated with hypomagnesemia are a complex and diverse group of tubulopathies caused by mutations in genes encoding proteins that are expressed in the thick ascending limb of the loop of Henle and in the distal convoluted tubule. In this paper, we review the initial description, the clinical expressiveness and etiology of four of the first hypomagnesemic tubulopathies described: Type 3 Bartter and Gitelman diseases,Autosomal recessive hypomagnesemia with secondary hypocalcemia and Familial hypomagnesemia with hypercalciuria and nephrocalcinosis. The basic biochemical patterns observed in renal tubular hypomagnesemias and the modalities of transport and interaction that occur between the transporters involved in the reabsorption of magnesium in the distal convoluted tubule are described below. Finally, the recent report of a new renal disease with hypomagnesemia, Type 2 hypomagnesemia with secondary hypocalcemia caused by reduced TRPM7 channel activity is described (AU)

Evaluation of the nursing workload through the Nine Equivalents for Nursing Manpower Use Scale and the Nursing Activities Score: a prospective correlation study.

OBJECTIVE: To determine the relationship between nursing workload measured through the nine equivalents of nursing manpower use (NEMS) scale and that measured through the nursing activities score (NAS) scale and to analyse staff needs as determined through each of the scales. METHODS: The study used a descriptive prospective correlational design to collect data between October 2007 and July 2009. Nursing workload data for 730 ICU patients were collected daily using the NAS and NEMS scales. Both scales were then correlated and used to estimate staff needs. FINDINGS: 6815 score pairs were collected, which reflected the nursing workload for each patient as calculated daily using both scales. Pearson's correlation coefficient for individual measurements obtained through the NAS and the NEMS corresponded to .672, and to .932 for the daily total workload in the unit. The staffing requirements based on the NAS scale scores were significantly higher than those based on the NEMS scale. A high correlation existed for individual measurements using both scales and for the total workload measurement in the unit. The main difference was found when analysing staffing requirements, with higher staff numbers needed for the NAS scale. CONCLUSION: Both NAS and NEMS can be used to measure the nursing workload in the ICU. Staffing requirements using NAS were higher than those using NEMS.

[Current status of antibiotic prophylaxis in primary vesicoureteral reflux in children]. / Situación actual de la profilaxis antibiótica en el reflujo vesicoureteral primario en el niño.

OBJECTIVES: To assess the efficacy of antibiotic prophylaxis for prevention of urinary infections and renal parenchymal damage in children with primary vesicoureteral reflux (VUR). METHODS/RESULTS: A search based on MEDLINE and The Cochrane Library was performed selecting those clinical trials and meta-analysis which compared antibiotic prophylaxis (either continuous or intermittent) and placebo or no treatment at all in children with primary VUR. Three systematic reviews were chosen for assessing the efficacy of prophylaxis of urinary infections including trials with a predominant paediatric population without known VUR. Results showed that the use of antibiotics decreased the risk of urinary infection. The quality of the trials was, however, insufficient and therefore of questionable results. We also selected two randomized controlled trials in children with reflux: one had limited information as the degree of reflux was not stated; the second assessed the results in a population of 113 children with VUR grade I to III (55 receiving prophylaxis and 58 not) following acute pyelonephritis. There were no differences with regard to the risk of urinary infection or the risk of renal parenchymal damage. CONCLUSIONS: There is not enough evidence supporting generalized use of antibiotics to prevent urinary infections. No benefit in prophylaxis has been proven for VUR grades I to III. There is no data for high grade VUR. It will be necessary to perform more trials in order to establish more accurate recommendations on prevention of urinary infections in the presence of VUR.