Microalbuminuria e insuficiencia renal en la infección crónica por el virus de la hepatitis C / Microalbuminuria and renal insufficiency in chronic hepatitis C virus infection

Introducción La infección crónica por el virus de la hepatitis C (VHC) se ha asociado a enfermedad glomerular, que se manifiesta mediante proteinuria con o sin disfunción renal. Método Estudio observacional analítico transversal con 120 pacientes infectados por el VHC y 145 controles VHC-negativos para determinar la prevalencia de daño renal asociada al VHC y su relación con factores de riesgo. Se recogieron datos de la historia clínica y anamnesis y se realizaron al menos 3 análisis de sangre y orina en un año. La insuficiencia renal se definió por un filtrado glomerular estimado inferior a 60ml/min/1,73 m2 y/o una microalbuminuria superior a 20mg/l o un índice microalbuminuria/creatinina mayor de 30 μg/mg. Resultados La prevalencia de microalbuminuria e insuficiencia renal se estimó en el 19,3 y 11,7% en los VHC-positivos vs el 10,5 y 0,7% en los VHC-negativos (p = 0,04), respectivamente. El 26,1% de los pacientes VHC-positivos tenía algún signos de daño renal vs el 11,8% de los VHC-negativos (p = 0,003). La infección por el VHC se asoció de forma independiente y significativa con la probabilidad de deterioro de la función renal. La prevalencia de microalbuminuria e insuficiencia renal se incrementó progresivamente con el aumento de edad. Conclusión Los pacientes VHC-positivos presentan una alta prevalencia de microalbuminuria e insuficiencia renal en comparación con sujetos VHC-negativos. El riesgo de insuficiencia renal asociado al VHC es independiente en presencia de otros factores predisponentes como hipertensión arterial y diabetes (AU)

Introduction Chronic hepatitis C virus (HCV) infection is associated with glomerular disease, which is manifested by proteinuria with or without renal dysfunction. Method To determine the prevalence of HCV-associated renal injury and associated risk factors, we performed an observational, analytic, cross-sectional study of 120 HCV-positive patients and 145 HCV-negative controls. Data were gathered from medical records and history-taking and at least three blood and urine analyses were performed over a 1-year period. Renal insufficiency was defined as an estimated glomerular filtration rate of less than 60ml/min/1.73 m2 and/or microalbuminuria of more than 20mg/l or a microalbumin/creatinine ratio higher than 30 mcg/mg. Results The prevalence of microalbuminuria and renal insufficiency was 19.3% and 11.7% in HCV-positive patients versus 10.5% and 0.7% in HCV-negative controls (p 0.04), respectively. A total of 26.1% of HCV-positive patients had signs of renal injury compared with 11.8% of HCV-negative controls (p 0.003). HCV infection was independently and significantly associated with the probability of worsening of renal function. The prevalence of microalbuminuria and renal insufficiency progressively increased with greater age. Conclusion HCV-positive patients show a high prevalence of microalbuminuria and renal insufficiency compared with HCV-negative individuals. The risk of HCV-associated renal insufficiency is independent of the presence of other predisposing factors such hypertension and diabetes (AU)

[Microalbuminuria and renal insufficiency in chronic hepatitis C virus infection]. / Microalbuminuria e insuficiencia renal en la infección crónica por el virus de la hepatitis C.

INTRODUCTION: Chronic hepatitis C virus (HCV) infection is associated with glomerular disease, which is manifested by proteinuria with or without renal dysfunction. METHOD: To determine the prevalence of HCV-associated renal injury and associated risk factors, we performed an observational, analytic, cross-sectional study of 120 HCV-positive patients and 145 HCV-negative controls. Data were gathered from medical records and history-taking and at least three blood and urine analyses were performed over a 1-year period. Renal insufficiency was defined as an estimated glomerular filtration rate of less than 60ml/min/1.73 m2 and/or microalbuminuria of more than 20mg/l or a microalbumin/creatinine ratio higher than 30 mcg/mg. RESULTS: The prevalence of microalbuminuria and renal insufficiency was 19.3% and 11.7% in HCV-positive patients versus 10.5% and 0.7% in HCV-negative controls (p 0.04), respectively. A total of 26.1% of HCV-positive patients had signs of renal injury compared with 11.8% of HCV-negative controls (p 0.003). HCV infection was independently and significantly associated with the probability of worsening of renal function. The prevalence of microalbuminuria and renal insufficiency progressively increased with greater age. CONCLUSION: HCV-positive patients show a high prevalence of microalbuminuria and renal insufficiency compared with HCV-negative individuals. The risk of HCV-associated renal insufficiency is independent of the presence of other predisposing factors such hypertension and diabetes.

Nuevas técnicas para extraer prótesis biliares metálicas recubiertas impactadas / New techniques to extract impacted partially covered metallic biliary stents

Uno de los problemas que aparecen en las prótesis metálicas de vía biliar es su dificultad para retirarlas, sobre todo si han pasado meses o han migrado. Para eso se han usado varios métodos a fin de poder extraer las prótesis biliares metálicas, tanto las recubiertas como las no recubiertas, con diferente eficacia.Se describen 2 nuevas formas para poder extraer prótesis parcialmente recubiertas que presentan migración proximal y se han impactado en el área papilar y el colédoco distal. Una prótesis se extrajo mediante papilectomía y la otra con balón de dilatación con colangiografía retrógrada endoscópica; para esto, se usó un duodenoscopio. En ambos casos se pudieron retirar las prótesis sin complicaciones graves para los enfermos y con un buen resultado para el calibre final de la estenosis(AU)

One of the problems affecting metallic biliary stents is the difficulty of removing them, especially after a period of months or if they have migrated. Several approaches have been used to remove both covered and uncovered stents, although with different degrees of effectiveness.We report two new approaches to removing partially covered stents that migrated proximally and that impacted in the papillary area and distal common bile duct. One stent was removed by papillectomy and the other by using duodenoscopy-guided controlled radial expansion balloon dilation. In both cases, the stents were removed without severe complications for the patient, leaving a good caliber in the stenosis(AU)

[New techniques to extract impacted partially covered metallic biliary stents]. / Nuevas técnicas para extraer prótesis biliares metálicas recubiertas impactadas.

One of the problems affecting metallic biliary stents is the difficulty of removing them, especially after a period of months or if they have migrated. Several approaches have been used to remove both covered and uncovered stents, although with different degrees of effectiveness. We report two new approaches to removing partially covered stents that migrated proximally and that impacted in the papillary area and distal common bile duct. One stent was removed by papillectomy and the other by using duodenoscopy-guided controlled radial expansion balloon dilation. In both cases, the stents were removed without severe complications for the patient, leaving a good caliber in the stenosis.

[Effect of Helicobacter pylori eradication on iron deficiency anemia of unknown origin]. / Efecto de la erradicación de Helicobacter pylori en la anemia ferropénica de origen incierto.

UNLABELLED: Iron deficiency anemia of unknown origin is a frequent cause of anemia in which etiological diagnosis is often not achieved, despite currently available diagnostic techniques. Recent studies suggest that, in the absence of digestive tract lesions, Helicobacter pylori infection could be the cause of iron deficiency anemia, due to the alterations produced in gastric iron absorption. OBJECTIVES: To evaluate whether H. pylori eradication resolves iron deficiency anemia and removes the need for oral iron administration. PATIENTS AND METHODS: We performed an observational descriptive study in patients with iron deficiency anemia refractory to treatment with oral iron administration and with out causes that could explain their anemia. Gastroscopy, ileocolonoscopy, intestinal transit study and/or endoscopic capsule were performed. Female patients also underwent gynecological study. All patients were H. pylori-positive and standard eradication therapy was administered until elimination was achieved. The patients were followed-up for a minimum of 3 months after H. pylori eradication and the need for oral iron intake after eradication was evaluated. RESULTS: Ten patients, aged 53+/-8.2 years, were included. Hemoglobin (Hbg) before treatment was 10.06+/-0.53 mg/dl, mean corpuscular volume (MCV) was 75.43+/-6.02 fl and ferritin was 6.1+/-3.28 ng/ml. Eradication therapy was administered until elimination of H. pylori. The mean time before disappearance of anemia was 4.5 months. Laboratory parameters after treatment were as follows: Hgb 12.86+/-0.75 mg/dl, MCV 85.02+/-4.8 fl and ferritin 28+/-22.19 ng/dl. CONCLUSIONS: In the absence of lesions that could explain iron deficiency anemia, this disease can be related to H. pylori infection. Eradication of this infection is closely followed by disappearance of anemia and ferropenia.

Efecto de la erradicación de Helicobacter pylori en la anemia ferropénica de origen incierto / Effect of Helicobacter pylori eradication on iron deficiency anemia of unknown origin

La anemia ferropénica (AF) de origen incierto es una causa frecuente de ferropenia. A pesar de las técnicas disponibles en la actualidad, no se llega a establecer su diagnóstico etiológico. Recientes estudios sugieren que la infección por Helicobacter pylori podría ser causa de AF en ausencia de lesiones del tracto digestivo, debido a la alteración que se produce en la absorción gástrica de hierro. Objetivos: Evaluar si la eliminación de H. pylori consigue la desaparición de la AF y suprime la necesidad del consumo de hierro oral. Pacientes y métodos: Estudio observacional descriptivo, en el que se han incluido pacientes con AF refractaria al tratamiento con hierro oral y sin causas que la justifiquen. Se realizó una gastroscopia, una ileocolonoscopia, un tránsito intestinal y/o una cápsula endoscópica, así como un estudio ginecológico a las mujeres. Todos los pacientes presentaban H. pylori positivo, por lo que se realizó un tratamiento erradicador estándar hasta su eliminación. Se hizo un seguimiento mínimo de 3 meses tras la eliminación de H. pylori y se valoraron las necesidades de hierro oral tras la erradicación. Resultados: Se incluyó a 10 pacientes con una media ± desviación estándar de edad de 53 ± 8,2 años. La hemoglobina (Hb) antes del tratamiento era de 10,06 ± 0,53 mg/dl, el volumen corpuscular medio (VCM) de 75,43 ± 6,02 fl y la ferritina de 6,1 ± 3,28 ng/ml. Se llevó a cabo un tratamiento erradicador hasta la desaparición de H. pylori. El tiempo medio hasta la desaparición de la anemia fue de 4,5 meses. Los parámetros analíticos tras el tratamiento fueron: Hb 12,86 ± 0,75 mg/dl, VCM 85,02 ± 4,8 fl y ferritina 28 ± 22,19 ng/dl. Conclusiones: La AF de origen incierto, en ausencia de lesiones que la justifiquen, puede relacionarse con la infección por H. pylori. La eliminación de esta infección se sigue a corto plazo con la desaparición de la anemia y de la ferropenia

Iron deficiency anemia of unknown origin is a frequent cause of anemia in which etiological diagnosis is often not achieved, despite currently available diagnostic techniques. Recent studies suggest that, in the absence of digestive tract lesions, Helicobacter pylori infection could be the cause of iron deficiency anemia, due to the alterations produced in gastric iron absorption. Objectives: To evaluate whether H. pylori eradication resolves iron deficiency anemia and removes the need for oral iron administration. Patients and methods: We performed an observational descriptive study in patients with iron deficiency anemia refractory to treatment with oral iron administration and with out causes that could explain their anemia. Gastroscopy, ileocolonoscopy, intestinal transit study and/or endoscopic capsule were performed. Female patients also underwent gynecological study. All patients were H. pylori-positive and standard eradication therapy was administered until elimination was achieved. The patients were followed-up for a minimum of 3 months after H. pylori eradication and the need for oral iron intake after eradication was evaluated. Results: Ten patients, aged 53 ± 8.2 years, were included. Hemoglobin (Hbg) before treatment was 10.06 ± 0.53 mg/dl, mean corpuscular volume (MCV) was 75.43 ± 6.02 fl and ferritin was 6.1 ± 3.28 ng/ml. Eradication therapy was administered until elimination of H. pylori. The mean time before disappearance of anemia was 4.5 months. Laboratory parameters after treatment were as follows: Hgb 12.86 ± 0.75 mg/dl, MCV 85.02 ± 4.8 fl and ferritin 28 ± 22.19 ng/dl. Conclusions: In the absence of lesions that could explain iron deficiency anemia, this disease can be related to H. pylori infection. Eradication of this infection is closely followed by disappearance of anemia and ferropenia (AU)

Efficacy of rifabutin-based triple therapy in Helicobacter pylori infected patients after two standard treatments.

BACKGROUND AND AIM: Even with the current most effective treatment regimens for Helicobacter pylori infection, a considerable number of patients will be resistant to eradication. The aim of the present study was to evaluate the H. pylori eradication rate in patients resistant to standard therapies when treated with a triple therapy of pantoprazole, rifabutin and amoxicillin. METHODS: Ninety-two consecutive patients diagnosed with H. pylori infection resistant to two previous treatment regimens were treated with pantoprazole, rifabutin and amoxicillin for 10 days. The persistence or eradication of H. pylori was determined by a 13C-urea breath test performed 4 weeks after the treatment. RESULTS: Per protocol eradication was achieved in 62.2% of patients and the intention-to-treat eradication was 60.8%. Only two patients were excluded for adverse events related to the treatment. CONCLUSIONS: The eradication rate is acceptable as a third-line therapy, particularly in centers with high cure rate for first line therapy. Another important value of this study is the good tolerance for the treatment observed in our patients. It is possible that rifabutin-based triple therapy may be of use in hospital centers that do not have disposable culture and susceptibility methods against H. pylori.

Neumatosis colónica y síndrome del intestino irritable, ¿un nexo de unión? / Pneumatosis cystoides intestinalis and irritable

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