J.R. Rodríguez-Palomares

Papel del nefrólogo en la acidosis láctica grave por metformina

Metformin is an antihyperglycemic agent commonly used in diabetic patients. It is very effective and is able to reduce the plasma glucose and HbA1C. However, in some patients, specially those with comorbidities, metformin can provoke severe lactic acidosis with high morbimortality. Treatment of the lactic acidosis induced by metformin is based on the use of supportive general measures; in severe cases, procedures of extrarrenal purification like hemodialysis or continuous hemodiafiltration have been successfully used.

Glomerulonefritis extracapilar y lepra: una asociación infrecuente

eprosy is a chronic disease caused by the intracellular bacilus Mycobacterium leprae, which primarily affects the skin and eripheral nerves.1 The clinical picture is variable; there are aucibacillary forms with few lesions (tuberculoid leprosy), nd multibacillary forms with numerous lesions (lepromaous leprosy), which occurs in patients with impaired cellular mmunity.2 The presence of extracapillary glomerulonephritis ith leprosy is rare, and here we describe the case of a patient ith both diseases. This was a 79-year-old man diagnosed of leprosy at age 32, ith both neurological and cutaneous involvement. He was dmitted in March 2011 with oedema, haematuria, and worsning of renal function. On examination, he was noted to have eonine facies, loss of eyebrows, and a saddle nose. His skin as rough with xerostomia and thickening, and there were rythematous macules on the limbs. BP was 168/104. Venous ressure was elevated, and there were bibasal crepitations and eripheral oedema. There was reduced sensibility to touching nd pain in the limbs. Blood test revealed a haemoglobin of 11.9 g/dL, leukocytes 660/mm3, platelets 173,000/mm3, creatinine 2.31 mg/dL, and rea 93 mg/dL. Transaminases, LDH, CK, cholesterol, triglyceides, HDL, and LDL, were normal. Urinary sediment had >100 ed blood cells per field (90% dysmorphic), with a 24 h proteinria of 1.3 g. Serology was negative for HIV, hepatitis B and C irus. ANA, ANCA, and anti-glomerular basement membrane ntibodies were negative, and C3 and C4 were normal. Chest -ray showed vascular redistribution and a left-sided pleual effusion. Abdominal ultrasound showed kidneys of normal ize with increased cortical echogenicity with no other abnoralities.

Cómo debemos analizar y describir la mortalidad de nuestros pacientes: Experiencia del Grupo Centro Diálisis Peritoneal

INTRODUCTION There are different strategies to analyse mortality in peritoneal dialysis (PD) with different definitions for case, event, time at risk, and statistical tests. A common method for the different registries would enable proper comparison to better understand the actual differences in mortality of our patients. METHODS We review and describe the analysis strategies of regional, national and international registries. We include actuarial survival, Kaplan-Meier (KM) and competitive risk (CR) analyses. We apply different approaches to the same database (GCDP), which show apparent differences with each method. RESULTS A total of 1,890 incident patients in PD from 2003-2013 were included (55 years; men 64.2%), with initial RRF of 7ml/min; 25% had diabetes and a Charlson index of 3 [2-4]; 261 patients died, 380 changed to haemodialysis (HD) and 682 received a transplant. Annual mortality rates varied up to 20% in relative numbers (6.4 vs. 5.2%) depending on the system applied. The estimated probability of mortality measured by CR progressively differs from the KM over the years: 3.6 vs. 4.0% the first year, then 9.0 vs. 11.9%, 15.6 vs. 28.3%, and 18.5 vs. 43.3% the following years. CONCLUSIONS Although each method may be correct in themselves and express different approaches, the final impression left on the reader is a number that under/overestimates mortality. The CR model better expresses the reality of PD, where the number of patients lost to follow-up (transplant, transfer to HD) it is 4 times more than deceased patients and only a quarter remain on PD at the end of follow up.