Enfermedad por citomegalovirus en los pacientes inmunodeprimidos por glomerulonefritis necrosante pauciinmune / Cytomegalovirus disease in immunosuppressed patients with necrotizing pauci-immune glomerulonephritis

Introducción: La afectación renal por glomerulonefritis necrosante pauciinmune (GNPI) asociada a vasculitis de pequeño vaso requiere tratamiento inmunodepresor, cuyos efectos secundarios incluyen un mayor riesgo de procesos infecciosos, como la enfermedad por citomegalovirus (CMV), aunque no hay recomendaciones sobre su manejo en las guías de práctica clínica (GPC).ObjetivoEstudiar la incidencia de enfermedad por CMV y sus determinantes.Pacientes y métodosPacientes con diagnóstico histológico de GNPI en los últimos 10 años, determinando la carga viral de CMV y analizando los determinantes de su concurrencia.ResultadosSe realizaron 44 biopsias durante el periodo de estudio. Del total, 11 pacientes (25%) desarrollaron enfermedad por CMV; todos habían recibido tratamiento inmunodepresor. Cuatro (30,8%) fallecieron durante el ingreso. Los factores determinantes de la enfermedad fueron la edad (por cada 10 años OR: 3,0, IC 95%: 1,0 a 8,9, p = 0,012) y la albúmina (por cada g/L OR: 0,8, IC 95%: 0,6 a 1,0, p = 0,012).ConclusionesLa incidencia de enfermedad por CMV en pacientes inmunodeprimidos por GNPI es alta, con alta mortalidad. Sería necesario incluir estrategias en las GPC para prevenir su desarrollo. (AU)

Introduction: Renal involvement due to necrotizing pauci-immune glomerulonephritis (PIGN) associated with small vessel vasculitis requires the use of immunosuppressive. Associated side effects include an increased risk of infectious processes, such as cytomegalovirus (CMV) disease; therefore, there are no recommendations on its management in the various clinical practice guidelines (CPG).ObjectiveTo study the incidence of CMV disease and its determinants.Patients and methodsPatients with histological diagnosis of necrotizing pauci-immune glomerulonephritis in the last 10 years, who were determined the viral load of CMV, analyzing the determinants of its occurrence.ResultsForty-four biopsies were performed during the study period. Eleven patients (25%) developed CMV disease; all had received immunosuppressive treatment. Four (30.8%) died during admission. The determinants of CMV disease were age (for every 10 years OR: 3.0, 95% CI: 1.0-8.9, p = 0.012), and plasma albumin (for each g/L OR: 0.8, 95% CI: 0.6-1.0, p = 0.012).ConclusionsThe incidence of CMV disease in immunocompromised patients due to PIGN is high, with high mortality. It would be necessary to include strategies in the CPGs to prevent it. (AU)

[Cytomegalovirus disease in immunosuppressed patients with necrotizing pauci-immune glomerulonephritis]. / Enfermedad por citomegalovirus en los pacientes inmunodeprimidos por glomerulonefritis necrosante pauciinmune.

INTRODUCTION: Renal involvement due to necrotizing pauci-immune glomerulonephritis (PIGN) associated with small vessel vasculitis requires the use of immunosuppressive. Associated side effects include an increased risk of infectious processes, such as cytomegalovirus (CMV) disease; therefore, there are no recommendations on its management in the various clinical practice guidelines (CPG). OBJECTIVE: To study the incidence of CMV disease and its determinants. PATIENTS AND METHODS: Patients with histological diagnosis of necrotizing pauci-immune glomerulonephritis in the last 10 years, who were determined the viral load of CMV, analyzing the determinants of its occurrence. RESULTS: Forty-four biopsies were performed during the study period. Eleven patients (25%) developed CMV disease; all had received immunosuppressive treatment. Four (30.8%) died during admission. The determinants of CMV disease were age (for every 10 years OR: 3.0, 95% CI: 1.0-8.9, p = 0.012), and plasma albumin (for each g/L OR: 0.8, 95% CI: 0.6-1.0, p = 0.012). CONCLUSIONS: The incidence of CMV disease in immunocompromised patients due to PIGN is high, with high mortality. It would be necessary to include strategies in the CPGs to prevent it.

Efecto del cambio en el peso tras el trasplante renal en la supervivencia del injerto / Effect of weight change after renal transplantation on outcomes of graft survival

Antecedentes y objetivo: Tras el trasplante renal se produce de manera global un incremento del peso pudiendo aumentar el riesgo de enfermedad renal crónica (ERC) y de pérdida del injerto. Pero no todos los pacientes ganan peso, y la repercusión sobre el injerto de esta diferente evolución, no está bien estudiado. El objetivo fue determinar las causas de esta diferente evolución y su efecto sobre el injerto. Pacientes y métodos: Estudio de cohortes retrospectivo unicéntrico de 201 pacientes seguidos tras el trasplante, analizando los determinantes de la variación del peso al año mediante regresión logística, y su efecto sobre la pérdida del injerto al final del seguimiento mediante regresión de Cox. Resultados: Globalmente se produjo durante el primer año un aumento de peso de 4,5kg de media, pero un 26,6% perdieron peso. El 37,2% aumentó su índice de masa corporal (IMC), mientras que el 9,5% lo disminuyó. Los determinantes de la diferente evolución del peso fueron la edad (OR por cada 10 años: 0,6; p=0,002), la modalidad de diálisis previa (ref. hemodiálisis) (OR: 0,3; p=0,003) y el IMC previo al trasplante (OR: 0,9; p=0,003). La diferente evolución del peso no influyó en la pérdida del injerto. Sí influyeron el IMC al año como variable continua (HR: 1,3; p=0,003) y la obesidad, con peor evolución (HR: 7,0; p=0,025). Conclusiones: Aunque no todos los pacientes ganan peso tras el trasplante renal, la diferente evolución del peso no influye en la supervivencia del injerto. (AU)

Background and objective: After kidney transplantation, there is an overall increase in weight, which may increase the risk of chronic kidney disease (CKD) and graft loss. But, not all patients gain weight, and the impact on the graft of this different evolution has not been well studied. The objective was to determine the causes of this different evolution and its effect on the graft. Patients and methods: Retrospective single-center cohort study of 201 patients followed up after transplantation, analyzing the determinants of the variation in weight at one year using logistic regression, and its effect on graft survival at the end of follow-up using Cox regression. Results: Globally, there was an average weight gain of 4.5kg in the first year, but 26.6% lost weight. 37.2% increased their BMI, while 9.5% decreased it. The determinants of the different evolution of weight were age (OR for every 10 years: 0.6, P=.002), previous dialysis modality (ref. hemodialysis) (OR 0.3, P=.003), and BMI before transplantation (OR 0.9, P=.017). The different evolution of weight did not influence the final situation of the graft. The BMI at one year did influence as a continuous variable (HR 1.3, P=.003), and obesity, with a worse evolution (HR 7.0, P=.025). Conclusions: Although not all patients gain weight after kidney transplantation, the different evolution of weight does not influence graft survival. (AU)

Effect of weight change after renal transplantation on outcomes of graft survival.

BACKGROUND AND OBJECTIVE: After kidney transplantation, there is an overall increase in weight, which may increase the risk of chronic kidney disease (CKD) and graft loss. But, not all patients gain weight, and the impact on the graft of this different evolution has not been well studied. The objective was to determine the causes of this different evolution and its effect on the graft. PATIENTS AND METHODS: Retrospective single-center cohort study of 201 patients followed up after transplantation, analyzing the determinants of the variation in weight at one year using logistic regression, and its effect on graft survival at the end of follow-up using Cox regression. RESULTS: Globally, there was an average weight gain of 4.5 kg in the first year, but 26.6% lost weight. 37.2% increased their BMI, while 9.5% decreased it. The determinants of the different evolution of weight were age (OR for every 10 years: 0.6, p = 0.002), previous dialysis modality (ref. hemodialysis) (OR 0.3, p = 0.003), and BMI before transplantation (OR 0.9, p = 0.017). The different evolution of weight did not influence the final situation of the graft. The BMI at one year did influence as a continuous variable (HR 1.3, p = 0.003), and obesity, with a worse evolution (HR 7.0, p = 0.025). CONCLUSIONS: Although not all patients gain weight after kidney transplantation, the different evolution of weight does not influence graft survival.

Effect of weight change after renal transplantation on outcomes of graft survival. / Efecto del cambio en el peso tras el trasplante renal en la supervivencia del injerto.

BACKGROUND AND OBJECTIVE: After kidney transplantation, there is an overall increase in weight, which may increase the risk of chronic kidney disease (CKD) and graft loss. But, not all patients gain weight, and the impact on the graft of this different evolution has not been well studied. The objective was to determine the causes of this different evolution and its effect on the graft. PATIENTS AND METHODS: Retrospective single-center cohort study of 201 patients followed up after transplantation, analyzing the determinants of the variation in weight at one year using logistic regression, and its effect on graft survival at the end of follow-up using Cox regression. RESULTS: Globally, there was an average weight gain of 4.5kg in the first year, but 26.6% lost weight. 37.2% increased their BMI, while 9.5% decreased it. The determinants of the different evolution of weight were age (OR for every 10 years: 0.6, P=.002), previous dialysis modality (ref. hemodialysis) (OR 0.3, P=.003), and BMI before transplantation (OR 0.9, P=.017). The different evolution of weight did not influence the final situation of the graft. The BMI at one year did influence as a continuous variable (HR 1.3, P=.003), and obesity, with a worse evolution (HR 7.0, P=.025). CONCLUSIONS: Although not all patients gain weight after kidney transplantation, the different evolution of weight does not influence graft survival.

Nuevos aspectos en la vigilancia epidemiológica con relación a las enfermedades virales en hemodiálisis / New aspects in epidemiological surveillance in relation to viral diseases in hemodialysis

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Association between serum uric acid and carotid disease in patients with atherosclerotic acute ischemic stroke.

AIM: The role of serum uric acid in ischemic stroke is controversial. On the one hand, it has a role as neuroprotectant in acute phase, but on the other hand, it may promote atherosclerosis in carotid arteries. Our aim is to investigate the association of serum uric acid levels at admission of acute ischemic stroke patients with carotid disease. METHODS: Cross-sectional study of patients admitted due to acute ischemic stroke. Clinical and laboratory variables were recorded. The carotid disease was defined based on the findings of carotid echography intima to media thickness and stenosis. Patients were grouped according to these findings. Robust statistical methods were applied into analysis. RESULTS: A total of 245 patients were recruited through a stroke registry. Their values of serum uric acid were related to both carotid intima to media thickness and stenosis showing a positive relationship between serum uric acid levels and intima to media thickness by Pearson correlation ( p < 0.05). Similarly, after adjusting for all potential confounders, eGFR, glucose, age and serum uric acid levels, (OR 1.26 (95% CI 1.04 -1.52, p»0.01), were identified as independent predictors for having a intima to media thickness ≥1 mm. Similarly, by grouping patients in tertiles of the serum uric acid distribution, we found a predominantly greater carotid disease in the tertile with the highest levels of serum uric acid ( p < 0.005). CONCLUSION: Our study supports the hypotheses that serum uric acid levels have different roles in the case of ischemic stroke. Its effects on the vascular wall contribute to the development of atherosclerosis and carotid disease.

Eritropoyetina, insuficiencia renal crónica y cáncer / Erythropoietin, chronic renal failure and cancer

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Guías de hipertensión: Muchas y mal avenidas / Hypertension guidelines: Too many and discordant

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[Erythropoiesis-stimulating agents in congestive heart failure patients]. / Uso de agentes estimuladores de la eritropoyesis en pacientes con insuficiencia cardiaca congestiva.

Congestive heart failure is a disease of high incidence and prevalence in the elderly. Anemia is associated with an increased mortality in these patients. This article reviews the cumulated evidence about the use of erythropoiesis-stimulating agents in congestive heart failure patients. Although some improvement in quality of life has been shown, it has not been found any decrement on mortality and, as a result, together with the high drug cost, it is not recommended the use of this kind of drugs in heart failure patients.

Control de la dislipemia y uso de hipolipemiantes en Extremadura: resultados del estudio de Control de Factores de riesgo de Extremadura (Estudio COFRE) / Lipid control and cholesterol lowering drugs use in Extremadura. Results from the Control of Risk Factors in Extremadura Study (COFRE Study)

Objetivo. Evaluar la prevalencia de dislipemia, su grado de control y el uso de hipolipemiantes en atención primaria en Extremadura. Diseño y métodos. Se ha recogido la presencia y el control de los factores de riesgo cardiovascular en una muestra de 1.022 pacientes visitados de forma consecutiva en consulta que presentaban al menos un factor de riesgo cardiovascular; de ellos se aceptaron 988 pacientes para el análisis estadístico. Los pacientes se han dividido según los objetivos de control de las cifras de lipoproteínas de baja densidad (LDL) en función de su riesgo cardiovascular, estimado según los criterios del III Panel de Expertos para Adultos. Resultados. El colesterol total y la fracción de LDL eran más bajos cuanto mayor era el riesgo cardiovascular estimado del individuo (p < 0,001). Por el contrario, las concentraciones de triglicéridos aumentaban significativamente de forma proporcional al riesgo cardiovascular de los pacientes. Para los pacientes de riesgo bajo el 69,2% de los individuos estaban controlados, mientras que en el grupo de riesgo moderado solamente el 42,6% tenía colesterol unido a LDL < 130 mg/dl. En cuanto a los pacientes de riesgo elevado, el 22,9 y el 7,1% de los pacientes de riesgo muy elevado estaban controlados. El 48,4% de la muestra global de pacientes estaba recibiendo tratamiento con estatinas, y su uso era más frecuente cuanto mayor era el riesgo estimado. El fármaco más usado era la atorvastatina (45,6%). A pesar del mal control, las dosis medias utilizadas eran bajas. Conclusiones. El control de la dislipemia sigue siendo bajo, especialmente en los pacientes de riesgo alto y muy alto, a pesar de que sus concentraciones de lípidos son inferiores a la población de riesgo menor. El uso mayor de fármacos hipolipemiantes en grupos de riesgo mayor indica un cuidado mayor de estos pacientes, aunque no se alcancen los objetivos deseados; este hecho parece relacionado con el uso de dosis inferiores a las necesarias (AU)

Objective. our study aimed to assess the prevalence and the control of dyslipemia, as well as the use of cholesterol lowering in primary care settings in Extremadura. Patients and methods. It was recorded the prevalence and control of cardiovascular risk factors in a sample of 1022 patients consecutively seen in primary care office who have at least one cardiovascular risk factor. From them, 988 were available for statistical analysis. the patients were split into the cardiovascular risk categories of AtP-III. Results. total cholesterol and LDL fraction were as lower as higher was the patients¿ estimated cardiovascular risk (p < 0.001). Contrariwise, triglycerides concentrations were higher in higher risk groups. women have higher hDL-cholesterol and lower triglycerides levels than men. 69.2% of low risk patients were controlled meanwhile 42.6% of medium risk patients have LDL cholesterol < 130 mg/dl. high and very high risk groups showed respectively 22.9% and 7.1% of controlled patients. 48.4% of patients were taking statins. the most used drug was atovastatin (45.6%). In spite of low control rates mean dosages of drugs were low. Conclusions. the study shows a poor control of dyslipemia specially in high and very high risk patients in spite of lower lipid levels when compared to lower risk population. the more frequent use of cholesterol lowering drugs in high risk subjects suggest an intensified care although selected targets are not reached; these results seems to be related to low dosage of this kind of drugs (AU)