[Urinary glycosaminoglycans after extracorporeal shock wave lithotripsy in patients with kidney lithiasis]. / Glicosaminoglicanos urinarios tras litotricia extracorpórea por ondas de choque en pacientes con litiasis renal.

OBJECTIVE: Extracorporeal shock wave lithotripsy (ESWL) is a technique that is not free of adverse effects. Renal changes detected during complementary exploratory procedures have been described, although these are minimal, resolve within a few days, do not present clinical manifestations and are not detected on ultrasound in most of the cases. For this reason, we studied a marker for renal injury, the urinary excretion of glycosaminoglycans (GAG) in patients with renal calculi, before, immediately after and 30 days following ESWL. The novelty of the study lies in that we have classified the patients with calculi according to the degree of renal function before ESWL, since it is recognized that the obstructive features of lithiasis can cause some degree of renal impairment. METHODS: Urinary GAG was quantified according to the colorimetric method described by Pennock. RESULTS: Urinary GAG levels were found to be lower in patients with renal calculi and preserved renal function than in healthy control subjects. In the presence of renal failure, these levels are elevated due to the obstructive nephropathy caused by calculi. Urinary GAG significantly increased post-ESWL in patients with renal lithiasis and preserved renal function or renal failure. At 30 days post-ESWL, GAG returned to pre-test levels. CONCLUSIONS: Quantification of urinary GAG is a useful biochemical method in the evaluation of renal parenchymal injury produced by ESWL.

Urinary beta-glucuronidase in renal cell carcinoma.

The aim of the paper was to study the urinary beta-glucuronidase activity in 30 patients with renal cell carcinoma (RCC), histopathologically proven after surgery, and 32 healthy subjects taken as controls. Classification of patients was done using the TNM system. A statistically significant increase (p < 0.01) in this enzyme was found in RCC patients, without relation to the changes in the urinary sediment (hematuria, pyuria, bacteriuria) or tumor dissemination. Urinary beta-glucuronidase is a useful marker in the diagnosis of malignant renal tumors.

Urinary N-acetyl-beta-glucosaminidase in the prediction of preeclampsia.

The urinary excretion of N-acetyl-beta-glucosaminidase (NAG), a lysosomal enzyme of the renal tubular cells was analyzed in 177 women divided into nonpregnant healthy controls (n = 46), normal pregnant women in their third trimester (n = 49), pregnant women with transient hypertension (n = 43), and women with preeclampsia (n = 39). Urinary activity of NAG was increased in normal pregnant women and in patients with transient hypertension in pregnancy compared to nonpregnant healthy controls. In preeclamptic women, this increase was found to be much higher than that corresponding to their gestational age; this fact is due to the tissue ischemia that precedes glomerular endotheliosis, but also tubular lesions caused by arteriolar vasoconstriction may have an important role.

[Microalbuminuria in arterial hypertension]. / Microalbuminuria en la hipertensión arterial.

Microalbuminuria is a considerable good indicator of atherogenic disease and cardiovascular risk. In the arterial hypertension, the main centre organ is the kidney. Structural and functional changes that happen in the hypertensive nephropathy are going to cause alterations m the albumin urinary excretion. The authors have done a revision of the main factors which can origin the existence of microalbuminuria in patients with arterial hypertension, and they conclude that this is an useful biochemist indicator in order to evaluate the degree of renal disease in these patients.

[Early biochemical indicators of renal damage in arterial hypertension]. / Indicadores bioquímicos precoces de daño renal en la hipertensión arterial.

Hypertensive nephropathy is an important complication of arterial hypertension, being a cause of chronic renal insufficiency in a considerable number of patients. For years it has been attempted to find an useful marker of nephropathy in the incipient phases of the disease. We revised the main biochemical indicators of renal damage, paying special attention to hyperuricemia, microalbuminuria, and urinary excretion of beta-2-microglobulin and N-acetyl-beta-glucosaminidase. Each one of them expresses alterations in the glomerular filtrate, lesion of capillary endothelium or anomalies of the tubular function. None of them demonstrated to be specific to nephroangiosclerosis, but they guide us on the structural and functional alterations occurring in the first stages of hypertensive nephropathy.

Sjögren's syndrome and pernicious anaemia.

We describe seven patients (five females and two males) with pernicious anaemia and Sjögren's syndrome. The diagnosis of pernicious anaemia was confirmed by bone marrow aspiration and a Schilling's test. Sjögren's syndrome was diagnosed by the Schirmer-I tear test, salivary gland scintigraphy, minor salivary gland biopsy and determination of lacrimal lysozyme. We have reviewed the literature and found few cases reported of the association of these two diseases.

[The treatment of incipient diabetic nephropathy (2nd of 2 parts)]. / Consideraciones sobre el tratamiento de la nefropatía diabética incipiente (segunda de dos partes).

Besides diabetic patients are controlled with glycosylated hemoglobins not exceeding 7% and the normalization of blood pressure with some hypotensive drugs, it has been noted the important role of protein restriction in diet in order to retard nephropathy progression. For some years, various aldose reductase inhibitors (ARIs) have been used, which avoid the accumulation of sorbitol in tissues as well as complications. Platelet antiaggregants are also used for the treatment of diabetic nephropathy, but at a lower level.

[Considerations on the treatment of incipient diabetic nephropathy (lst of 2 parts)]. / Consideraciones sobre tratamiento de la nefropatía diabética incipiente (Primera de dos partes).

Diabetic nephropathy is the third cause of renal failure after pyelonephritis and glomerulonephritis. Lately, many efforts have been made for the early identification (on the silent stage) of patients with a high risk of developing this disease. On these initial stages, therapeutic attitude has changed very much, emphasizing nowadays the importance of glucose levels control, avoiding maintained conditions of hyperglycemia and maintaining blood pressure within the limits, by using the therapeutic store available, basically calcium antagonists and angiotensin-converting enzyme inhibitors.