Implicaciones patogénicas, pronósticas y terapéuticas del complemento en las vasculitis asociadas a anticuerpo anticitoplasma de neutrófilo con afectación renal / Complement in vasculitis associated with anti-neutrophil cytoplasm antibodies with renal involvement: pathogenic, prognostic and therapeutic implications

Las vasculitis asociadas a anticuerpo anticitoplasma de neutrófilo son vasculitis primarias, que afectan a vasos pequeños de diversos órganos, entre ellos el riñón. La afectación renal, se caracteriza por presencia de glomerulonefritis con semilunas y necrosis en microscopia óptica y un patrón pauciinmune en la inmunofluorescencia. La participación del complemento en la patogenia de estas entidades se ha puesto en valor en los últimos años, inicialmente en modelos animales y posteriormente en estudios en humanos, al demostrarse la presencia de fragmentos de la vía alternativa complemento, en plasma y en orina, junto con depósitos de complemento en glomérulos y pequeños vasos de pacientes afectos por vasculitis anticuerpo anticitoplasma de neutrófilo. La presencia de complemento en estas entidades confiere peor pronóstico general y renal (AU)

ntineutrophil cytoplasmic antibody-associated vasculitides are primary vasculitides that affect small vessels in various organs, including the kidney. Renal involvement is characterized by the presence of glomerulonephritis with crescents and necrosis in light microscopy and a pauci-immune pattern in immunofluorescence. The participation of complement in the pathogenesis of these entities has been valued in recent years, initially in animal models and later in studies in humans, by demonstrating the presence of fragments of the alternative complement pathway, in plasma and urine, together with complement deposits in glomeruli and small vessels of patients affected by antineutrophil cytoplasmic antibody vasculitis. The presence of complement in these entities confers a worse general and renal prognosis (AU)

[Complement in vasculitis associated with anti-neutrophil cytoplasm antibodies with renal involvement: pathogenic, prognostic and therapeutic implications]. / Implicaciones patogénicas, pronósticas y terapéuticas del complemento en las vasculitis asociadas a anticuerpo anticitoplasma de neutrófilo con afectación renal.

Antineutrophil cytoplasmic antibody-associated vasculitides are primary vasculitides that affect small vessels in various organs, including the kidney. Renal involvement is characterized by the presence of glomerulonephritis with crescents and necrosis in light microscopy and a pauci-immune pattern in immunofluorescence. The participation of complement in the pathogenesis of these entities has been valued in recent years, initially in animal models and later in studies in humans, by demonstrating the presence of fragments of the alternative complement pathway, in plasma and urine, together with complement deposits in glomeruli and small vessels of patients affected by antineutrophil cytoplasmic antibody vasculitis. The presence of complement in these entities confers a worse general and renal prognosis.

Severe Hyponatremia Masking Central Diabetes Insipidus in a Patient with a Lung Adenocarcinoma.

Altered natremia is a common electrolyte disorder in clinical practice and a paraneoplastic manifestation. The syndrome of inappropriate antidiuretic hormone secretion is the first diagnostic suspicion in a patient with cancer and hyponatremia, although entities such as adrenal insufficiency primary or secondary to metastatic involvement must be taken into account. Likewise, immunorelated endrocrinopathies such as hypophysitis have been reported after the introduction of checkpoint inhibitors. A 46-year-old man diagnosed with metastatic adenocarcinoma of the lung with severe hyponatremia (111 mmol/L) consulted due to altered level of consciousness. The initial cranial CT scan did not reveal pituitary brain metastatic involvement; however, an MRI could not be performed due to the patient's clinical situation and subsequent exitus. The water restriction test confirmed the diagnostic suspicion of central diabetes insipidus. Medical treatment with desmopressin was started to avoid fluid depletion with improvement of natremia figures. It represents an exceptional case of central diabetes insipidus masked by severe hyponatremia in a patient with metastatic lung adenocarcinoma without initial evidence of pituitary metastatic involvement by CT imaging in treatment with nivolumab (anti-PD-1 agent). Secondary adrenal insufficiency due to pituitary metastatic involvement and endocrinologic toxicity immunorelated to the new checkpoint inhibitors should be considered as possible etiologic agents of central diabetes insipidus, even with hyponatremia.

Reactivación silenciosa del virus de la hepatitis B en paciente que reinicia diálisis tras trasplante renal. ¿Cómo podemos prevenirlo o anticiparlo en el diagnóstico? / Reactivation of hepatitis B virus in patient that rests dialysis after renal transplantation. How can we prevent it or anticipate it in diagnosis?

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Impacto de la modalidad de terapia de reemplazo renal en adultos mayores frágiles: importancia de las preferencias del paciente / Impact of renal replacement therapy on frail older adults: Importance of patient's preferences

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A propósito de la onconefrología: enfermedad renal crónica en pacientes oncológicos no hospitalizados / About of onco-nephrology: Chronic kidney disease in oncology patients not hospitalized

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Implicaciones del estudio SPRINT en la práctica clínica del anciano hipertenso / Implications of the SPRINT study on the clinical practice of hypertensive elderly people

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Respuesta: Toma de decisiones compartida en la enfermedad renal crónica avanzada del anciano. Un ejemplo a seguir / Reply: Shared decision-making in advanced chronic kidney disease in the elderly. Follow the example

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Predictores de progresión de enfermedad renal en el paciente anciano / Predictors of progression of renal disease in the elderly patient

El riñón del anciano experimenta cambios estructurales y funcionales, que lo convierte en más vulnerable para la enfermedad renal. La mayoría de ancianos con enfermedad renal crónica fallece antes de desarrollar progresión renal. Sin embargo, el principal grupo de pacientes incidentes de nefropatía terminal es el de personas mayores de 65 años, representando la diabetes mellitus y las causas vasculares sus principales etiologías. En esta revisión se analizan elementos renales (filtrado glomerular, proteinuria/albuminuria, potasio, fracaso renal agudo y diuréticos) y factores geriátricos (estado funcional, cognitivo y fragilidad) como predictores de progresión de enfermedad renal. La identificación de estos factores contribuirá a establecer estrategias de prevención renal y al pronóstico de la enfermedad en la toma decisiones

The kidney in elderly people suffers structural and functional changes, which makes it more vulnerable to kidney disease. The majority of the elderly with chronic kidney disease die before developing renal progression. However, the main group of patients that develop terminal nephropathy is that of people older than 65 years, representing diabetes mellitus and vascular causes the main etiologies. In this review, renal elements (glomerular filtration, proteinuria/albuminuria, potassium, acute renal failure and diuretics) and geriatric factors (functional, cognitive and frail state) are analyzed as predictors of renal disease progression. The identification of these factors will help to establish strategies for renal prevention and the prognosis of the disease in decision making