Vasculitis asociada a anticuerpo anticitoplasma de neutrófilo en paciente con enfermedad de Crohn en tratamiento con adalimumab / Antineutrophil cytoplasmic antibodies associated vasculitis in patient with Crohn's disease treated with adalimumab

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Remisión completa de síndrome nefrótico en mujer con amiloidosis renal por fiebre mediterránea familiar / Complete remission of nephrotic syndrome in a woman with renal amyloidosis due to familial mediterranean fever

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Asociación de nefropatía por cambios mínimos y policitemia en un paciente muy anciano / Association of minimal-change disease and polycythaemia in a very elderly patient

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Rabdomiólisis severa tras una agresión física y agravada por anfetaminas / Rhabdomyolysis after physical aggression and aggravated by amphetamines

(AU) Describimos el caso de un varón joven, con un fracaso renal agudo anúrico severo e hiperpotasemia tóxica, relacionados con una rabdomiólisis tras una agresión física y que había pasado desapercibida en 2 visitas previas a Urgencias y, posteriormente, agravada por consumo de anfetaminas. Este caso ilustra la necesidad de considerar la posibilidad de una rabdomiólisis ante paciente con cualquier grado de daño muscular

Changes in body composition parameters in patients on haemodialysis and peritoneal dialysis.

INTRODUCTION: Proper hydration is one of the major aims in haemodialysis (HD) and peritoneal dialysis (PD). Bioimpedance spectroscopy appears to be a promising method for the evaluation and follow up of the hydration status in dialysis patients (P). OBJECTIVES: We compared body composition between stable patients on HD and PD after six months. PATIENTS AND METHOD: An observational study with 62 P on HD and 19 P on PD was performed. Clinical, biochemical and bioimpedance parameters were analysed. RESULTS: In the comparative study, PD P were younger (50 ± 10 vs 57 ± 14 years, P=.031). The Charlson Comorbidity Index (4.8 ± 3 vs 7.5 ± 3, P<.001), time on dialysis (16.9 ± 18.01 vs 51.88 ± 68.79 months, P=.020) and C-Reactive Protein [3 (3-9.3) vs 5.25 (1-76.4)] were lower. Total protein levels (7.46 ± 0.44 vs 7.04 ± 0.55 g/dl, P=.005) and transferrin levels (205 ± 41 vs 185 ± 29 mg/dl, P=.024) were higher. BIS: Intracellular water (19.67 ± 3.61 vs 16.51 ± 3.36 litres, P=.010), lean tissue mass (LTM) (37.20 ± 8.65 vs 32.57 ± 8.72 kg, P=.029), total cellular mass (TCM) (20.53 ± 5.65 vs 17.56 ± 5.91 kg, P=.033), and bioelectrical impedance phase angle (Phi 50) (5.81 ± 0.86 vs 4.74 ± 0.98, P=.000) were higher than in HD P. Overhydration: 22% in HD y 10% in PD, in conditions referred to in methods. Six months later, PD P increased in weight (73.75 ± 12.27 vs 75.22 ± 11.87 kg, P=.027), total fat (FAT) (26.88 ± 10 vs 30.02 ± 10 kg, P=.011) and relative fat (Rel FAT) (35.75 ± 9.87 vs 39.34 ± 9.12, P=.010); and decreased in ICW (18.56 ± 3.45 vs 17.65 ± 3.69 l, P=.009), LTM (36.95 ± 8.88 vs 34 ± 9.70 kg, P=.008) and relative LTM (Rel LTM) (50.85 ± 12.33 vs 45.40 ± 11.95%, P=.012). In the multivariate analysis, weight variation (∆) was related to ∆ FAT (P < .001). We found a correlation between fat increase and lean tissue mass decrease. Six months later, in HD P, we observed a reduction in ECW (15.11 ± 2.45 vs 14.00 ± 2.45, P.001), without changes in other parameters. CONCLUSIONS: Bioelectrical impedance analysis facilitates the assessment of changes in body composition so as to correct dry weight and to introduce changes in treatment schedule..

Cambios en los parámetros de composición corporal en pacientes en hemodiálisis y diálisis peritoneal / Changes in body composition parameters in patients on haemodialysis and peritoneal dialysis

Introducción: La normohidratación es uno de los mayores objetivos en hemodiálisis (HD) y diálisis peritoneal (DP). La bioimpedancia por espectroscopia (BIS) se postula como el método más prometedor para la evaluación y seguimiento del estado de hidratación en pacientes en diálisis. Objetivo: Comparar la composición corporal de pacientes prevalentes en HD y DP en un intervalo de seis meses. Pacientes y métodos: Estudio observacional de 62 pacientes en HD y 19 en DP comparando los parámetros clínicos, bioquímicos y de bioimpedancia. Resultados: En el estudio comparativo, los pacientes en DP fueron más jóvenes (50 ± 10 vs. 57 ± 14 años, p = 0,031). El índice de comorbilidad de Charlson (4,8 ± 3 vs. 7,5 ± 3, p < 0,001), tiempo en diálisis (16,9 ± 18,01 vs. 51,88 ± 68,79 meses, p = 0,020) y proteína C reactiva [3 (3-9,3) vs. 5,25 (1-76,4)] fueron menores. Los niveles de proteínas totales (7,46 ± 0,44 vs. 7,04 ± 0,55 g/dl, p = 0,005), y transferrina (205 ± 41 vs. 185 ± 29 mg/dl, p = 0,024) fueron más elevados. BIS: agua intracelular (AIC) (19,67 ± 3,61 vs. 16,51 ± 3,36 litros, p = 0,010), masa muscular total (MM) (37,20 ± 8,65 vs. 32,57 ± 8,72 kg, p = 0,029), masa celular total (MCT) (20,53 ± 5,65 vs. 17,56 ± 5,91 kg, p = 0,033) y ángulo de fase (Phi 50) (5,81 ± 0,86 vs. 4,74 ± 0,98, p = 0,000) fueron más elevados que en HD. Sobrehidratados 22% en HD y 10% en DP, en las condiciones referidas en métodos. A los seis meses en DP observamos aumento de peso (73,75 ± 12,27 vs. 75,22 ± 11,87 kg, p = 0,027), grasa total (MG) (26,88 ± 10 vs. 30,02 ± 10 kg, p = 0,011) y relativa (MG %) (35,75 ± 9,87 vs. 39,34 ± 9,12, p = 0,010); disminución de AIC (18,56 ± 3,45 vs. 17,65 ± 3,69 l, p = 0,009), MM (36,95 ± 8,88 vs. 34 ± 9,70 kg, p = 0,008) y MM relativa (MM %) (50,85 ± 12,33 vs. 45,40 ± 11,95%, p = 0,012). En el análisis multivariante, la variación (DELTA) de peso guarda relación con el DELTA de grasa (p < 0,001). Encontramos correlación entre el incremento de grasa y el decremento de masa muscular (p = 0,01). A los seis meses en HD no se observaron cambios en estos parámetros, salvo una reducción en el agua extracelular (15,11± 2,45 vs. 14,00 ± 2,45, p = 0,001). Conclusiones: BIS permite valorar los cambios en la composición corporal y ayuda a establecer el peso seco e introducir cambios en las pautas de tratamiento (AU)

Introduction: Proper hydration is one of the major aims in haemodialysis (HD) and peritoneal dialysis (PD). Bioimpedance spectroscopy appears to be a promising method for the evaluation and follow up of the hydration status in dialysis patients (P). Objectives: We compared body composition between stable patients on HD and PD after six months. Patients and method: An observational study with 62 P on HD and 19 P on PD was performed. Clinical, biochemical and bioimpedance parameters were analysed. Results: In the comparative study, PD P were younger (50±10 vs 57±14 years, P=.031). The Charlson Comorbidity Index (4.8±3 vs 7.5±3, P<.001), time on dialysis (16.9±18.01 vs 51.88±68.79 months, P=.020) and C-Reactive Protein [3 (3-9.3) vs 5.25 (1-76.4)] were lower. Total protein levels (7.46±0.44 vs 7.04±0.55 g/dl, P=.005) and transferrin levels (205±41 vs 185±29 mg/dl, P=.024) were higher. BIS: Intracellular water (19.67±3.61 vs 16.51±3.36 litres, P=.010), lean tissue mass (LTM) (37.20±8.65 vs 32.57±8.72 kg, P=.029), total cellular mass (TCM) (20.53±5.65 vs 17.56±5.91 kg, P=.033), and bioelectrical impedance phase angle (Phi 50) (5.81±0.86 vs 4.74±0.98, P=.000) were higher than in HD P. Overhydration: 22% in HD y 10% in PD, in conditions referred to in methods. Six months later, PD P increased in weight (73.75±12.27 vs 75.22±11.87 kg, P=.027), total fat (FAT) (26.88±10 vs 30.02±10 kg, P=.011) and relative fat (Rel FAT) (35.75±9.87 vs 39.34±9.12, P=.010); and decreased in ICW (18.56±3.45 vs 17.65±3.69 l, P=.009), LTM (36.95±8.88 vs 34±9.70 kg, P=.008) and relative LTM (Rel LTM) (50.85±12.33 vs 45.40±11.95%, P=.012). In the multivariate analysis, weight variation (DELTA) was related to DELTA FAT (P<.001). We found a correlation between fat increase and lean tissue mass decrease. Six months later, in HD P, we observed a reduction in ECW (15.11±2.45 vs 14.00±2.45, P.001), without changes in other parameters. Conclusions: Bioelectrical impedance analysis facilitates the assessment of changes in body composition so as to correct dry weight and to introduce changes in treatment schedule (AU)

Serum alkaline phosphatase levels and left ventricular diastolic dysfunction in patients with advanced chronic kidney disease.

BACKGROUND: High levels of alkaline phosphatase (ALP) have been associated with increased mortality in patients with advanced chronic kidney disease (CKD). We hypothesize that elevated ALP could be partly explained by subclinical liver congestion related to left ventricular diastolic dysfunction. METHODS: Doppler echocardiography was performed in 68 patients with advanced CKD followed up for a median of 2.1 years. Time-averaged levels of ALP and γ-glutamyl transferase (GGT) were compared between patients with and without diastolic dysfunction. We also evaluated the effect of intensifying diuretic treatment on ALP levels in a small group of 16 patients with high ALP and signs of volume overload. RESULTS: ALP correlated significantly (p < 0.001) with GGT but not with parathyroid hormone (p = 0.09). Patients with diastolic dysfunction showed higher ALP (p = 0.01), higher GGT (p = 0.03) and lower albumin (p = 0.04). The highest values of ALP were observed in patients with diastolic dysfunction plus pulmonary hypertension (p = 0.01). Intensifying diuretic therapy in a subgroup of patients with signs of fluid overload induced a significant reduction in body weight, GGT (p < 0.001) and ALP levels (p < 0.001). CONCLUSIONS: Elevated ALP in patients with advanced CKD could be partly explained by subclinical liver congestion related to left ventricular diastolic dysfunction, hypervolemia or both. The worse prognosis of these patients could be explained by their myocardial damage.