Revista de nefrología y terapéutica

Introducción: Este estudio se realizó para buscar correlación clínico-histológica durante la nefritis lúpica.
Pacientes y método: Fue un estudio retrospectivo y analítico, realizado durante un período de 10 años desde el 1 de enero de 2007 hasta el 31 de diciembre de 2016 en el departamento de nefrología del Hospital Aristide Le Dantec en Dakar. Los parámetros histológicos se cruzaron con datos demográficos, clínicos y biológicos para buscar correlación clínico-biológica e histológica.
Resultados: En un total de 93 pacientes negros con lupus, se incluyeron 64, lo que da una prevalencia hospitalaria del 69%. La edad media de los pacientes fue de 31,97 ± 10,44 años. Hubo 81% de mujeres y 19% de hombres con una proporción de sexos de 0,23. La existencia de hipertensión e insuficiencia renal se correlacionó con la presencia de una
clase proliferativa. La fibrosis intersticial se correlacionó con la insuficiencia renal. Se encontró una correlación estadísticamente significativa entre la presencia de infiltración intersticial y la existencia de insuficiencia renal y leucocituria. La endarteritis fibrosa se correlacionó con insuficiencia renal e hipertensión. La arteriosclerosis se asoció con hipertensión.
Conclusión: Las clases proliferativas, la fibrosis intersticial, la infiltración intersticial y las lesiones vasculares crónicas se correlacionaron con manifestaciones clínico-biológicas graves. Se necesitan estudios multicéntricos que respalden estos resultados.

Background: Chronic kidney disease (CKD) is characterized by unfavorable cardiac and vascular remodeling. The study aimed at evaluating effects of 6-month supplementation with omega-3 on blood pressure, left ventricular geometry and function, and arterial properties in patients with CKD 1-3.

Methods: Six-month supplementation with omega-3 acids (2 g/day) was completed in 87 CKD patients, and in 27 individuals without CKD, hypertension or overt cardiovascular disease. At baseline and after supplementation, an echocardiographic examination was performed, evaluating left ventricular mass index (LVMI), left ventricular relative wall thickness (RWT), and ejection fraction (EF). Ultrasound imaging of the common carotid artery with intima media thickness (IMT), aortic pulse wave velocity measurement (PWV) and 24-hour blood pressure monitoring (ABPM) were performed. Serum concentration of omega-3 acids: eicosapentaenoic (EPA), docosahexaenoic (DHA), and alpha linolenic (ALA) was determined using gas chromatography.

Results: After six-month omega-3 supplementation, ALA concentration increased in CKD patients and in reference group, while EPA and DHA did not change. PWV and IMT values did not change significantly. Posterior wall thickness (PWd) (p=0.018) and RWT decreased (p=0.035), while LVMI and EF did not change in CKD group. ABPM did not change.

Conclusion: Supplementation with omega-3 acid resulted in beneficial left ventricular remodeling, despite the absence of changes in ABPM and arterial properties.

Trial registration: The study was registered in Clinical Trials.gov. Identifier: NCT 02147002.

Keto acids is widely used in dialysis patients with end-stage renal disease, which can effectively correct hypocalcemia, reduce blood PTH as well as blood phosphorus, and elevate blood albumin. Keto acids have a very low incidence of side effects. So far, no cases of Keto acids-induced severe hypercalcemia had been reported. The authors here present a case of continuous ambulatory peritoneal dialysis (CAPD) patient who repeatedly developed severe hypercalcemia accompanied by consciousness disturbance due to daily low-dose keto acids administration. In this case, common causes of hypercalcemia were excluded by thorough physical examination and investigations. The blood calcium concentration of this patient had reached 3.83 mmol/L, belonging to severe hypercalcemia, and the clinical manifestations of cognitive disorder required urgent treatment. After the suspension of keto acids, the serum calcium concentration returned to normal, and the peritoneal dialysis scheme resumed as normal after discharge, which could still maintain the normal calcium concentration. When the patient took the medicine again, severe hypercalcemia occurred as expected. After drug withdrawal, blood calcium backed to normal level, and blood phosphorus increased, which further confirmed that calcium and phosphorus metabolism disorder was closely related to the use of keto acids. This case here indicate that close monitoring of blood calcium, phosphorus and other indicators are needed, in order to prevent potential risk of hypercalcemia which would endanger the safety of patient's life.