Síndrome nefrótico secundario a preeclampsia: presentación, manejo y evolución clínica observados en 5 años de experiencia / Nephrotic syndrome due to preeclampsia: Presentation, management and clinical evolution observed in 5 years experience

Introducción: El síndrome nefrótico (SN) es una entidad rara durante el embarazo. En esta etapa, la preeclampsia (PE) severa es la principal causa. Nuestro objetivo fue describir la presentación clínica, las características analíticas, el manejo médico y la evolución de mujeres con SN por PE. Materiales y métodos: Estudio descriptivo, retrospectivo, realizado entre el 1 de enero de 2017 y el 1 de enero de 2022 (5años). Incluyó mujeres con embarazo ≥20semanas de edad gestacional (EG), internadas por trastorno hipertensivo del embarazo (THE), sin evidencia de daño renal previo a la gestación. Resultados: Entre 652 THE se identificaron 452 PE y 21 SN. La edad materna fue de 25±5,7 años, y la EG al diagnóstico, de 33,1±5,1 semanas. Todas presentaron edema facial y periféricos: 5 derrame pleural, 3 derrame pericárdico y 2 anasarca. La P24 fue de 6,17±2,34g (3,10-10,8), la albúmina sérica de 2,5±0,27g/dl (2,10-2,90) y el colesterol sérico de 281,4±21,7mg/dl (251-316). Hubo 13 que desarrollaron complicaciones maternas: daño renal agudo, edema pulmonar, miocardiopatía dilatada, eclampsia y síndrome HELLP. Todas permanecieron hipertensas en el posparto, requiriendo combinación de dos a tres fármacos antihipertensivos. En el posparto todas recibieron estatinas e inhibidores de la enzima convertidora de angiotensina (IECA) para el manejo de la proteinuria; ninguna desarrolló hiperkalemia o elevaciones de creatinina. La estancia hospitalaria fue de 10,4±3,7 días. Todas revirtieron los parámetros proteinúricos de rango nefrótico antes del alta. No se registraron muertes. Conclusión: La presentación incluyó desde edemas periféricos hasta compromiso seroso. La severidad de la proteinuria fue variable. El uso de IECA no precipitó hiperkalemia ni fallo renal. Las complicaciones maternas fueron frecuentes, pero no se observaron óbitos. (AU)

Introduction: Nephrotic syndrome (NS) is rare during pregnancy. The main cause is severe pre-eclampsia (PR). Our aim was to describe the clinical presentation, analytical features, medical management, and progress of women with NS due to PE. Materials and methods: A descriptive, retrospective study, conducted from 01/01/2017 to 01/01/2022 (5years). Women with a gestational age (GA) ≥20weeks were included in the study, hospitalised due to hypertensive disorders in pregnancy (HDP), with no evidence of kidney damage prior to gestation. Results: Of the 652 HDP, 452 PE and 21 NS were identified. Maternal age was 25±5.7 years, GA at diagnosis was 33.1±5.1 weeks. All the women had facial and peripheral oedema: 5 pleural effusion, 3 pericardial effusion, and 2 anasarca. Their p24 was 6.17±2.34grams (3.10-10.8), serum albumin 2.5±0.27g/dL (2.10-2.90), and serum cholesterol 281.4±21.7mg/dL (251-316). Thirteen developed maternal complications: acute kidney damage, pulmonary oedema, dilated cardiomyopathy, eclampsia, and HELLP syndrome. They all remained hypertensive postpartum, and required a combination of two to three antihypertensive drugs. They all received statins postpartum, and angiotensin converting enzyme (ACE) inhibitors to manage proteinuria. None developed hyperkalaemia or creatinine elevation. Hospital stay was 10.4±3.7days. All nephrotic range proteinuria parameters reversed prior to discharge. No deaths were recorded. Conclusion: Presentation ranged from peripheral oedema to serous involvement. Severity of proteinuria varied. Use of ACE inhibitors did not precipitate hyperkalaemia or kidney failure. Maternal complications were frequent, but no deaths were recorded. (AU)

[Nephrotic syndrome due to preeclampsia: Presentation, management and clinical evolution observed in 5 years experience]. / Síndrome nefrótico secundario a preeclampsia: presentación, manejo y evolución clínica observados en 5 años de experiencia.

INTRODUCTION: Nephrotic syndrome (NS) is rare during pregnancy. The main cause is severe pre-eclampsia (PR). Our aim was to describe the clinical presentation, analytical features, medical management, and progress of women with NS due to PE. MATERIALS AND METHODS: A descriptive, retrospective study, conducted from 01/01/2017 to 01/01/2022 (5years). Women with a gestational age (GA) ≥20weeks were included in the study, hospitalised due to hypertensive disorders in pregnancy (HDP), with no evidence of kidney damage prior to gestation. RESULTS: Of the 652 HDP, 452 PE and 21 NS were identified. Maternal age was 25±5.7 years, GA at diagnosis was 33.1±5.1 weeks. All the women had facial and peripheral oedema: 5 pleural effusion, 3 pericardial effusion, and 2 anasarca. Their p24 was 6.17±2.34grams (3.10-10.8), serum albumin 2.5±0.27g/dL (2.10-2.90), and serum cholesterol 281.4±21.7mg/dL (251-316). Thirteen developed maternal complications: acute kidney damage, pulmonary oedema, dilated cardiomyopathy, eclampsia, and HELLP syndrome. They all remained hypertensive postpartum, and required a combination of two to three antihypertensive drugs. They all received statins postpartum, and angiotensin converting enzyme (ACE) inhibitors to manage proteinuria. None developed hyperkalaemia or creatinine elevation. Hospital stay was 10.4±3.7days. All nephrotic range proteinuria parameters reversed prior to discharge. No deaths were recorded. CONCLUSION: Presentation ranged from peripheral oedema to serous involvement. Severity of proteinuria varied. Use of ACE inhibitors did not precipitate hyperkalaemia or kidney failure. Maternal complications were frequent, but no deaths were recorded.

New insights on ocular surface disease in patients with atopic dermatitis treated with dupilumab.

Our study sought to describe ocular surface alterations at baseline and after 4 months of dupilumab treatment in patients with severe AD. Our findings highlight that all 25 patients showed ocular surface alterations prior to dupilumab treatment. Dupilumab may cause the worsening of clinical or subclinical pre-existing ocular alterations belonging to the spectrum of AKC.

Síndrome HELLP: características clínicas, analíticas y evolutivas observadas en dos años de experiencia / HELLP Syndrome: clinical-analytical characteristics and evolution observed in two years of experience

INTRODUCCIÓN: El síndrome HELLP (H: hemólisis, EL: enzimas hepáticas elevadas y LP: trombocitopenia) es una forma de preeclampsia (PE) grave. El síndrome puede ser: completo o incompleto (con tres criterios analíticos, o sólo uno o dos); Clase i, II o III (según plaquetas < 50.000, 50.000-100.000 o > 100.000/mm3); postparto o anteparto; siendo estos últimos, precoces o tardíos (antes o después de la semana 34 de gestación). Describimos y analizamos las características clínico-analíticas y evolución observadas en embarazadas hipertensas que desarrollaron HELLP. MATERIAL Y MÉTODOS: Estudio descriptivo y analítico, observacional, de tipo cohorte retrospectiva; en un período de dos años. Incluyó embarazadas hipertensas que desarrollaron HELLP, durante el curso de su internación en la maternidad de nuestro hospital de atención terciaria. RESULTADOS: Incluyó 318 embarazadas hipertensas. Se observaron 28 HELLP. La edad materna fue 25,8 ± 7,2 años; la edad gestacional al diagnóstico 31 ± 1 sem. Hubo 4 hipertensas crónicas y 24 hipertensas gestacionales; ocho habían presentado PE en embarazos previos. Hubo 10 síndromes completos y 18 incompletos; de acuerdo a la trombocitopenia, hubo 3 Clase i, 16 Clase II y 9 Clase III. La instalación fue posparto en 3 y anteparto en 25: 18 precoces y 7 tardíos. Hubo 17 pacientes que requirieron cuidados intensivos y 10 desarrollaron complicaciones ligadas al HELLP. No se registraron óbitos maternos. CONCLUSIÓN: La presentación del síndrome fue variable, exhibiéndose mayormente en hipertensas gestacionales con instalación anteparto y precoz. Fue más frecuente la forma incompleta y la trombocitopenia clase ii. Las complicaciones maternas fueron usuales pero no se observaron óbitos

INTRODUCTION: HELLP syndrome (H: hemolysis, EL: elevated liver enzymes and LP: low platelets) is a form of severe preeclampsia (PE). The syndrome can be: complete or incomplete (with three analytical criteria, or only one or two); Class i, II or III (according platelets < 50,000; 50,000-100,000 or > 100,000/mm3); postpartum or antepartum; with early or late installation (before or after the 34nd week of gestation). We describe and analyze characteristics and evolution observed in hypertensive pregnant patients who developed HELLP. MATERIAL AND METHODS: Retrospective cohort with observation period of two years. It included pregnant hypertensive women who developed HELLP, during the course of their hospitalization in the maternity hospital of our tertiary care hospital. RESULTS: It included 318 hypertensive pregnant women. We observed 28 HELLP. Maternal age was 25.8 ±7.2 years and gestational age at diagnosis 31 ± 1 week. Hypertension was chronic in 4 and gestational in 24; eight had presented PE in the previous pregnancy. There were 10 complete and 18 incomplete syndromes; according to platelet disease there were 3 Class i, 16 Class II and 9 Class III. HELLP was postpartum in 3 and antepartum in 25: 18 early and 7 late. There were 17 patients who required intensive care and 10 developed complications linked to HELLP. No maternal deaths were recorded. CONCLUSION: Presentation was variable, exhibiting mostly in gestational hypertension, antepartum and early. Incomplete form and class II thrombocytopenia were more frequent. Maternal complications were frequent but no deaths were observed

[HELLP Syndrome: clinical-analytical characteristics and evolution observed in two years of experience]. / Síndrome HELLP: características clínicas, analíticas y evolutivas observadas en dos años de experiencia.

INTRODUCTION: HELLP syndrome (H: hemolysis, EL: elevated liver enzymes and LP: low platelets) is a form of severe preeclampsia (PE). The syndrome can be: complete or incomplete (with three analytical criteria, or only one or two); Class i, ii or iii (according platelets < 50,000; 50,000-100,000 or > 100,000/mm3); postpartum or antepartum; with early or late installation (before or after the 34nd week of gestation). We describe and analyze characteristics and evolution observed in hypertensive pregnant patients who developed HELLP. MATERIAL AND METHODS: Retrospective cohort with observation period of two years. It included pregnant hypertensive women who developed HELLP, during the course of their hospitalization in the maternity hospital of our tertiary care hospital. RESULTS: It included 318 hypertensive pregnant women. We observed 28 HELLP. Maternal age was 25.8 ±7.2 years and gestational age at diagnosis 31 ± 1 week. Hypertension was chronic in 4 and gestational in 24; eight had presented PE in the previous pregnancy. There were 10 complete and 18 incomplete syndromes; according to platelet disease there were 3 Class i, 16 Class ii and 9 Class iii. HELLP was postpartum in 3 and antepartum in 25: 18 early and 7 late. There were 17 patients who required intensive care and 10 developed complications linked to HELLP. No maternal deaths were recorded. CONCLUSION: Presentation was variable, exhibiting mostly in gestational hypertension, antepartum and early. Incomplete form and class II thrombocytopenia were more frequent. Maternal complications were frequent but no deaths were observed.

Cistatina C: Biomarcador de riesgo cardiovascular en VIH / Cystatin C: Biomarker of cardiovascular risk in HIV

INTRODUCCIÓN: Los pacientes infectados por el virus de la inmunodeficiencia humana (VIH) tienen mayor riesgo cardiovascular (RCV). El desarrollo de enfermedad cardiovascular (ECV) en esta población involucra factores de RCV tradicionales y factores relacionados con la propia infección, como el estado proinflamatorio crónico, la disfunción inmune y el tratamiento antirretroviral recibido. La cistatina C (CC) ha demostrado utilidad para valorar la presencia de factores de RCV y ECV establecida en población general, ancianos y enfermos renales. Analizamos dicha asociación en una población VIH+. MATERIAL Y MÉTODOS: Estudio analítico, observacional, transversal. Se recogieron factores de RCV y presencia de ECV en pacientes VIH+, obteniendo determinación de CC. Se establecieron 2 grupos: grupo1=CC elevada (≥0,95mg/L) y grupo 2=CC normal (<0,95mg/L). RESULTADOS: Se incluyeron 95 pacientes, grupo1=27 (28,4%) y grupo2=68 (71,5%). Un valor de CC≥0,95mg/L se relacionó con la presencia de ECV (p = 0,01); con aumento de medias de circunferencia de cintura (p = 0,05), circunferencia de cuello (p = 0,04), presión arterial sistólica (p = 0,04), presión arterial diastólica (p = 0,01), puntaje al score de riesgo de Framingham (p = 0,03) y puntaje al score de riesgo de Framingham adaptado para VIH (p = 0,01). Después de realizarse análisis multivariado con incorporación de variables con asociación bivariada a ECV, solo CC≥0,95mg/L continuó relacionándose con ECV. CONCLUSIÓN: CC≥0,95mg/L se relacionó de forma independiente con la presencia de ECV. Este punto de corte también se vinculó a mayores niveles de presión arterial y mayor RCV a 10 años calculado por score de Framingham y score adaptado para población VIH

INTRODUCTION: Patients infected with the human immunodeficiency virus (HIV) have a higher cardiovascular risk (CVR). The development of cardiovascular disease (CVD) in this population involves traditional CVR factors and factors related to the infection itself, such as chronic inflammatory status, immune dysfunction, as well as the antiretroviral therapy received. Cystatin C (CC) has shown to be useful in assessing the presence of CVR factors and CVD established in the general population, the elderly population, and patients with chronic kidney disease. An analysis was performed on this association in an HIV positive population (HIV+). MATERIAL AND METHODS: Analytical, observational, cross-sectional study was conducted, and included collecting information about CVR factors and CVD in HIV+, as well as measuring CC. The patients were divided into 2 groups: Group1=high CC (≥0.95mg/L) and Group2=normal CC (<0.95mg/L). RESULTS: A total of 95 patients were included. Group1=27 (28.4%) and Group2=68 (71.5%). A value of CC≥0.95mg/L was related to the presence of CVD (P=.01). It was also related with and an increase in waist circumference (P=.05), neck circumference (P=.04), systolic blood pressure (P=.04), diastolic blood pressure (P=.01), Framingham score (P=.03), and Framingham score adapted for HIV (P=.01). After performing multivariate analysis with incorporation of variables associated with CVD in the bivariate analysis, only CC≥0.95mg/L continued to be related to CVD. CONCLUSION: CC≥0.95mg/L was independently associated with CVD. This cut-off point was also linked to higher levels of blood pressure, and higher CVR at 10 years using the Framingham Score and Framingham Score adapted for HIV population

[Cystatin C: Biomarker of cardiovascular risk in HIV]. / Cistatina C: Biomarcador de riesgo cardiovascular en VIH.

INTRODUCTION: Patients infected with the human immunodeficiency virus (HIV) have a higher cardiovascular risk (CVR). The development of cardiovascular disease (CVD) in this population involves traditional CVR factors and factors related to the infection itself, such as chronic inflammatory status, immune dysfunction, as well as the antiretroviral therapy received. Cystatin C (CC) has shown to be useful in assessing the presence of CVR factors and CVD established in the general population, the elderly population, and patients with chronic kidney disease. An analysis was performed on this association in an HIV positive population (HIV+). MATERIAL AND METHODS: Analytical, observational, cross-sectional study was conducted, and included collecting information about CVR factors and CVD in HIV+, as well as measuring CC. The patients were divided into 2 groups: Group1=high CC (≥0.95mg/L) and Group2=normal CC (<0.95mg/L). RESULTS: A total of 95 patients were included. Group1=27 (28.4%) and Group2=68 (71.5%). A value of CC≥0.95mg/L was related to the presence of CVD (P=.01). It was also related with and an increase in waist circumference (P=.05), neck circumference (P=.04), systolic blood pressure (P=.04), diastolic blood pressure (P=.01), Framingham score (P=.03), and Framingham score adapted for HIV (P=.01). After performing multivariate analysis with incorporation of variables associated with CVD in the bivariate analysis, only CC≥0.95mg/L continued to be related to CVD. CONCLUSION: CC≥0.95mg/L was independently associated with CVD. This cut-off point was also linked to higher levels of blood pressure, and higher CVR at 10 years using the Framingham Score and Framingham Score adapted for HIV population.