S Tallon

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.

Clinical and Analytical Findings in Gitelman’s Syndrome Associated with Homozygosity for the c.1925 G>A SLC12A3 Mutation

Background: Gitelman’s syndrome (GS) is caused by mutations in the SLC12A3. Most of the mutations are rare, making it difficult to establish a genotype-phenotype correlation. Although GS is a recessive disorder, some patients also have an affected parent, suggesting a dominant inheritance. Methods: We sequenced the 26 coding exons of SLC12A3 in a family in which the proband and her father had a late onset GS. We obtained cDNA of the 2 patients and analyzed the effect of a mutation on pre-mRNA splicing. Results: The 2 patients were homozygous for a nucleotide change in the last nucleotide of exon 15: c.1925 G>A. The mother was a heterozygous carrier for this putative mutation. Amplification of cDNA with primers for exons 14–17 was negative, suggesting that this mutation affected the splicing and promoted mRNA degradation through nonsense-mediated decay. Conclusions: We report a family with 2 patients with late onset GS and homozygous for a mutation in the last nucleotide of exon 15. Our study shows that homozygosity for this mutation resulted in a significant loss of normal SLC12A3 transcript.

Glomerulopatía C3: una nueva entidad basada en el complemento

C3 glomerulopathy is a new, recently described entity that has changed the perspective, treatment and classification of a number of glomerular diseases. It encompasses 2 similar but clearly differentiated pathologies -the dense-deposit disease and C3 glomerulonephritis itself. The alternative complement pathway plays a fundamental role in its pathogenesis and, specifically, the mutations and defects in its regulatory factors (mainly factor H and factor I), as well as the presence of acquired autoantibodies (C3 nephritic factor), which generates an unbridled activation of the system, and ultimately, a deposit of its products at the glomerular level. Its poor prognosis and onset in young populations makes the detailed study of new therapeutic alternatives for this disease essential. Recently eculizumab, an anti-C5 antibody, has demonstrated effectiveness in the treatment of these patients.

HYPERTENSION AND VASCULAR RISK IN VERY ELDERLY: PP.19.214

Objectives: The prevalence of hypertension (HT) in >65 years is high, however people >80 years represent one of the most forgotten, despite the high prevalence of HT. Our objective was to determine the clinical characteristics of the population >80 years who attended our consultation. Methods: Cross-sectional study, during 2009, which included patients >65 years. We studied: demographic parameters, cardiovascular risk factors (CRF), target organ damage (TOD) and comorbidity. Statistical analyses of qualitative variables are in percentages and frequencies, numerical in standard deviation; comparison of categorical variables using X2 test and for continuous T-student test. A p value <0.05 was considered significant. Results: There was 307 patients >80 years and 418 between 65–80 years. In patients >80 years, 61.2% were men, 84.7% had hypertension, 57% CKD (GFR <60 ml/min/1,73m2), 28% cardiopathy, 13% stroke, 49.5% had at least 1 TOD, 67% had 3 or more CRF, and Charlson index was 8.97 ± 2.07. Comparing these patients with 65–80 years, we find no differences for sex, HT, smoking, diabetes and peripheral vascular disease. Patients >80 years had less obesity (p:0.0004; OR:0.57 CI95%: 0.41–0.78), dyslipidemia (p:0.00002, OR:0.53 CI95%: 0.39–0.71), however had a high prevalence of cardiopathy (cardiac insufficiency, myocardial infarction, LVH) (p:0.0002, OR:1.9 CI95%: 1.35–2.76), stroke (p:0.008, OR:1.93 CI95%: 1.17–3.18), CKD (p:0.00001, OR:2.33 CI95%: 1.72–3.15), presence at least 1 TOD (p:0.00001, OR:2.07, CI95%: 1.52–2.80). The BMI is lower (p:0.0003), but had a high number of TOD, CRF and Charlson I. (p:0.00001). Conclusions: HT is very prevalent in our population. Compared to the classic group of > 65 years they have a great number of CRF and TOD. While the magnitude of risk tends to be lower after 65 years, the absolute risk is greater because the CRF are more prevalent and frequently associated with increasing age, which has a multiplier effect. Studies are needed to selectively target this age group while existing information is variable and inconsistent.

BEING OLD IS LIKE TO HAVE MORE VASCULAR RISK?: PP.19.233

Objective: The prevalence of hypertension (HT) in the Spanish population over 60 years is 65%. Guadalajara has an average age of the highest in Spain, so we decided to study the presence of different cardiovascular risk factor (CRF) and the prevalence of target organ damage (TOD). Methods: We registered patients in nephrology consult in 2009. Recording the sex, weight, height, BMI, CRF, TOD (myocardial infarction, heart failure, coronary ischemia, stroke and/or significant impairment of renal function (GFR <60 ml/min/1, 73m2)) and comorbidity (Charlson I.). Statistical analysis was performed using SPSS 17, we use for qualitative variables chi square, for quantitative Student t test. A p value <0.05 was considered statistically significant. Results: There have been 1272 patients, 730 patients >65 years, of which 41.8% are women, BMI was 29.15 ± 4.59, mean age 78.24 ± 6,69, Charlson 3.48 ± 1.99. In patients >65 years have seen a greater percentage of CVR like HT (p = 0.00001, OR:4.11 95% [3,15–5,31]), dyslipidemia (p = 0.014, OR:1.32 IC95% [1,06–1,667]), diabetes (p = 0.00008, OR 2.537 95% [1,93–3,33]), although lower to smoke (p = 0.00001 OR:0.48, 95% [0,38–0,61]), higher percentage TOD with significant decrease in GFR (p = 0, 00001; OR:5,87 95% [4,34–7,49]), cardiac lesion (p = 0.00002, OR:5.89 95% [3,74–9,28]), stroke (p = 0.00009, OR:3.30 95% [1,89–5,75]), peripheral vascular disease (p = 0.001, OR:3.00 95% [1,53–5,86]). In addition patients >65 years have a higher BMI (p = 0.011, 95% CI -1.348 to 0.176), number of CRF (p = 0.00001, 95% CI -1.143 to 0.866), and Charlson I. (p = 0.00001, 95% CI -2.060 to 1.645). (Table 01 and 02). Conclusions: Our study shows that a very high percentage of patients older than 65 have HT, dyslipidemia, diabetes, overweight, the existence of a high prevalence of TOD or subclinic mainly cardiovascular and renal injury than 65 years. Therefore we believe that due to the progressive aging of our population we must undertake more preventive level control on the different factors of CRF. Figure 1. No caption available. Figure 2. No caption available.

REDUCTION OF RENAL MASS AND CARDIOVASCULAR RISK FACTORS: PP.9.378

Objective: In patients with renal mass reduction (RMR), the evolution of renal function and vascular risk associated causes controversies. It is possible that the RMR is due to hypertension. The aim of our study was to evaluate the presence of hypertension, cardiovascular risk factors (CRF), target organ damage (TOD) and chronic kidney disease (CKD) in a population of single kidney. Methods: We evaluate patients in the nephrology clinic during 2009. Recording was made for sex, weight, height, BMI, CRF, TOD (myocardial infarction, heart failure, coronary ischemia, stroke and CKD (GFR <60 ml/min/1, 73m2)) and comorbidity (Charlson Index). Statistical analysis was performed using SPSS 17. A p value <0.05 was considered statistically significant. Results: A total of 107 patients with RMR was recorded, 22 (20.6%) had unilateral renal agenesis, 34 (31.8%) acquired unilateral renal atrophy and 51 (47.7%) surgical nephrectomy. 45.8% women, BMI was 29.50 ± 5.48, mean age 68.71 ± 17.72. A high percentage of hypertension 64,49%, 42.06% obesity, dyslipidemia 38.32%, 28.97% TOD, and 37 (34.6%) patients had CKD, Charlson index was 2.6 ± 1.7. When comparing the presence of CRF and TOD there are a significant difference between renal atrophy or nephrectomy versus renal agenesis in hypertension (p = 0.0003, OR:5.7 95% CI:2,0–15,9) and CKD (p = 0.024, OR:4.22 95% CI:1,1–15, 3), number of CRF (p:0.027; 95% CI:1,2–0,07) and Charlson I. (p = 0.009, 95% CI: -2,1–0,3), there were no differences between renal atrophy with nephrectomy. Conclusions: There are a large percentage of patients with hypertension, dyslipidemia and at least one TOD or CKD. There is an increased risk of hypertension and CKD in patients who have been nephrectomised or have functional renal atrophy being different in unilateral renal agenesis. Therefore we should do a better control of CRF with particular significance in the above mentioned factors, also must conduct more studies to know the developments and implications arising from the decrease in renal mass. Figure 1. No caption available.

VASCULAR RISK AND HYPOTHYROIDISM: PP.15.71

Objective: Hypothyroidism (HYP) is one of the most common chronic disorders. Guadalajara remains like one of the areas with highest prevalence in Spain. Previous studies show strong evidence that HYP (even subclinical) confers increased cardiovascular risk (CVR). Our aim was to determine the relationship between HYP and the prevalence of vascular risk. Design and Method: Cross sectional descriptive study conducted in 2009 in Guadalajara Hospital. We have evaluated the presence of HYP and their relationship with CVR, comorbidity and renal insufficiency. Statistical analysis was making with SPSS 17 and we use percentages, chi square, and Student test. A p value <0.05 was considered statistically significant. Results: There were 1272 patients, 42.75% were women, mean age was 65.92 ± 17.58 years, BMI 28.85 ± 5.18 and Charlson index 2.7 ± 2.05. Patients with HYP were 150 (11.8%). In HYP patients we observe a significant relationship with female gender (p = 0.00002, OR: 3.06 [95% CI 2.13 to 4.39]), smoking (p = 0.00008; OR 0.44 [95% CI 0.29 to 0.67]), dyslipidemia (p = 0.00001, OR 1.89 [95% CI 1.31 to 2.65]), significant deterioration of renal function (GFR <60 ml/min/1, 72m2) (p = 0.0004, OR 1.68 [95% CI 1.17 to 2.42]) and comorbidity (p = 0.003, 95 % -0.532 to 0.178). (Table 01 AND 02). Figure 1. No caption available. Figure 2. No caption available. Conclusions: These findings indicate a high percentage of HYP in nephrology clinic of our hospital. The HYP is clearly related to sex (female), degree of comorbidity, dyslipidemia, diabetes and renal failure, being the last three vascular risk factors of great importance. On the other hand in a manner consistent with other work could have a lower prevalence of HYP in patients who smoke. Future studies should determine the real role of vascular risk in patients with HYP.

AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE AND HYPERTENSION: PP.30.182

Objective: Autosomal polycystic kidney disease (APKD) is a common hereditary renal disease with an incidence of 1/1.000 people, its associated with development of hypertension and chronic kidney disease (CKD), both important cardiovascular risk factors (CRF). We considered this study to see the relationship between hypertension, CRF and CKD in APKD. Methods: The study was conducted in the Guadalajaras Hospital during 2009. Recording was made for sex, weight, height, BMI, CRF, target organ damage (TOD) (myocardial infarction, heart failure, coronary ischemia, stroke and CKD (GFR < 60 ml/min/1, 73m2), comorbidity (Charlson Index). The statistical analysis was carried out by percentages, qualitative variables by chi square and quantitative by Student t test. A p value <0.05 was considered statistically significant. Results: There have been 56 patients with APKD, hypertension was confirmed in 32 (57.1%), 55.4% women, BMI was 27.02 ± 4.08, mean age was 52.82 ± 18.91 and CKD in 9 (16.1%), 16.1% had TOD. The presence of hypertension was related to age >55 years in males and >65 in women (p = 0.009), but there were no significant differences in other CRF such as dyslipidemia, smoking, impaired fasting glucose, dyslipidemia, obesity, diabetes mellitus or metabolic syndrome, although hypertensive patients had more CKD this was not significant (p = 0.063). On the other hand the risk of TOD (p = 0.036, OR: 7.6 [95% CI 0,88–66,2]), age (p:0.007, 95% CI −23.3 to −3.8) and Charlson I. (p = 0.0001, 95% CI −2.50 to −1.01) was higher in hypertensive patients. (Table 01 and 02). Figure 1. No caption available. Conclusions: We note a high prevalence of hypertension in patients with APKD. The hypertension in patients with APKD is associated with the presence of TOD, more comorbidity and age, and its important that eight of nine patients with CKD were hypertensive. Further studies should be conducted to determine the actual role of APKD in the presence of reno-cardiovascular damage, on the other side as there is no specific treatment for APKD, its important an adequate control of hypertension.