Luis Alberto Evangelista-Carrillo

Bioelectrical impedance permits the measurement of variables related to morbidity and mortality in cardiac surgery patients. The preoperative phase angle (PhA) is one of the variables associated with increased mortality, prolonged duration of invasive mechanical ventilation, and prolonged hospital stay. However, its relationship with acute kidney injury (AKI) is unknown. A prospective cohort study measured the PhA 24 hours before surgery, and the standardized phase angle (SPhA) was calculated from data from the reference population. The incidence and severity of AKI were determined over 7 days after surgery. Multivariate analysis was performed to determine the relationships between PhA or SPhA and the incidence and severity of AKI after cardiac surgery. A total of 120 patients were recruited. The incidence of AKI during the 7 days after cardiac surgery was 37%, 70% of which were classified as Kidney Disease Improving Global Outcomes (KDIGO) 1, 19% as KDIGO 2, and 11% as KDIGO 3. SPhA > −0.54 was associated with a lower incidence of AKI at 21% and lower AKI KDIGO 1 at 8% (2/24 patients) than SPhA ≤ −0.54 was associated with an AKI incidence of 40% ( P = .072) and AKI KDIGO 1 incidence of 30% (29/96 patients) ( P = .029). There were no differences in the incidence of AKI classified as KDIGO 2–3. According to the multivariate analysis, an SPhA > −0.54 was a protective factor (RR 0.254, CI 0.074–0.870, P = .029). A high SPhA (>−0.54) serves as a protective factor against AKI, particularly against AKI classified as KDIGO 1.

Key Clinical Message: We present a case of a 23‐year‐old male who developed thrombotic microangiopathy associated with the induction dose of tacrolimus. Get an early diagnosis and give timely treatment of thrombotic microangiopathy is essential to improve the prognosis of the kidney transplant.

Evidence supporting a starting dose of 2 g/day of mycophenolate mofetil (MMF) in combination with tacrolimus (TAC) for renal transplantation (RT) is still limited, but maintaining a dose of vs 2 g of MMF. A prospective cohort study was performed with a 12-month follow-up of recipients of RT from living donors with low (1.5 g/day) or standard (2 g/day) doses of MMF. The association between adverse effects and complications and doses of MMF was examined using Cox proportional hazard models, and survival free of AR, infectious diseases, and noninfectious complications was evaluated using the Kaplan–Meier test. At the end of the follow-up, the incidence of infectious diseases was 52% versus 50% (P = .71) and AR was 5% versus 5% (P = .86), respectively. The survival rate free of gastrointestinal (GI) complications requiring medical attention was higher in the low-dose group than in the standard-dose dose (88% vs 45%, respectively; P < .001). The use of 1.5 g/day of MMF confers a reduction in GI complications without an increase in infectious diseases or the risk of AR.

Contexto: la injuria renal aguda asociada al uso de medios de contraste yodados (IRA-ACI) es un desorden iatrogénico con potenciales implicaciones en morbilidad y mortalidad, motivo de preocupación en los servicios de imágenes médicas. Los últimos años han marcado cambios importantes en la concepción que poseemos sobre esta entidad desde una definición más precisa, verdadera incidencia, factores de riesgo y escalas predictivas, hasta el impacto real de algunas estrategias para su prevención. Objetivo: generar recomendaciones basadas en la evidencia para el uso de medios de contraste yodados en pacientes sometidos a procedimientos radiológicos diagnósticos o terapéuticos, mediante de un consenso de expertos. Metodología: a partir de la formulación de preguntas de investigación relacionadas con la injuria renal aguda asociada al uso medios de contraste yodados, se realiza la búsqueda de evidencia en Pubmed, Embase y Scopus entre enero del 2013 y agosto del 2022. Los artículos se seleccionaron por medio de una revisión sistemática y a través de la metodología de consenso Delphi modificado. Los documentos fueron analizados usando instrumentos que evalúan la calidad de su evidencia. Resultados: se formularon 22 recomendaciones para el manejo de pacientes que requieren la administración de medios de contraste yodados. Un panel de 11 expertos, entre los que se contó con 4 nefrólogos, 4 radiólogos, 1 nefrólogo pediatra y 2 epidemiólogos, participaron de forma activa en la elaboración del consenso, con un total de cinco sesiones virtuales y 15 horas de trabajo. Conclusiones: el término injuria renal aguda asociada al uso de medios de contraste yodados (IRA-ACI) debe usarse idealmente y abandonar otras definiciones que infieren una causalidad manifiesta; con relación a su incidencia, los datos recientes demuestran que ha sido sobreestimada en la literatura y percibida de forma exagerada por el personal del área de la salud, de igual forma, solo una baja tasa de filtración glomerular estimada (TFGe) se considera como un factor de riesgo independiente para el desarrollo de IRA-ACI. Finalmente, respecto a su prevención, únicamente la hidratación ha mostrado un potencial beneficio como medida nefroprotectora. Background: Contrast-Associated Acute Kidney Injury (CA-AKI) is an iatrogenic disorder with potential implications for morbidity and mortality, a matter of concern in medical imaging services. In recent years, significant changes have been made in our understanding of this condition, from a more precise definition, real incidence, risk factors, and predictive scales, to the actual impact of certain prevention strategies. Purpose: To generate evidence-based recommendations about the use of iodinated contrast media in patients undergoing diagnostic and/or therapeutic radiological procedures, through expert consensus. Methodology: Based on the formulation of research questions related to Contrast-Associated Acute Kidney Injury, evidence was searched in Pubmed, Embase, and Scopus from January 2013 to August 2022. Articles were selected through a systematic review and a modified Delphi consensus methodology. The documents were assessed using instruments that evaluate quality of their evidence. Results: A total of 22 recommendations were formulated for the management of patients requiring administration of iodinated contrast media. An expert panel consisting of 11 members, including 4 nephrologists, 4 radiologists, 1 pediatric nephrologist, and 2 epidemiologists, actively participated in the consensus development. The process involved 5 virtual sessions and 15 hours of work. Conclusions: The term "Contrast-Associated Acute Kidney Injury" (CA-AKI) should ideally be used and other definitions implying a clear causality should be abandoned. Regarding its incidence, recent data show that it has been overestimated in the literature and perceived exaggeratedly by healthcare personnel. Similarly, only a low estimated glomerular filtration rate (eGFR) is considered an independent risk factor for the development of CA-AKI. Finally, in terms of prevention, hydration alone has shown potential benefits as a nephroprotective measure.

Background: The evidence supporting a starting dose of 2 g/day of mycophenolate mofetil (MMF) in combination with tacrolimus (TAC) in renal transplant (RT) is still limited but maintaining the dose of less than 2g could result in worse clinical outcomes in terms of acute rejection (AR). Research Question: This study’s aim was to determine the association between AR, infectious and non-infectious complications after RT with the dose of 1.5g vs . 2g of MMF. Design: A prospective cohort was performed with a 12-month follow-up in recipients of RT from living donors with low doses of MMF (1.5 g/day) or use of standard dosage (2 g/day). The association between adverse effects and complications and doses of MMF were examined in Cox proportional hazard models and survival free of AR, infectious diseases, and non-infectious complications was evaluated by the Kaplan-Meier test. Results: At the end of the follow-up, the incidence of infectious diseases was 52% vs . 50% ( p =0.71) and AR was 5% vs . 5% ( p =0.86), respectively. Survival free of GI complications requiring medical attention was higher in the low dose group compared to the standard dose (88% vs . 45%, respectively; p <0.001). Discussion: The use of 1.5 g/day of MMF is safe in Mexican population with RT from living donors without increasing the risk of AR, and it confers a reduction of adverse events.

Contexto: la procalcitonina (PCT) podría ser útil en la evaluación de la función del injerto renal (IR) en el postrasplante inmediato, ya que sus niveles se incrementan posterior a la elevación de citocinas inflamatorias (IL-6, TNF-?) durante eventos de disfunción renal. Objetivo: determinar la asociación de la PCT sérica con la función del injerto renal en el periodo postrasplante inmediato. Metodología: cohorte retrospectiva de septiembre del 2018 a abril del 2019 en la División de Nefrología y Trasplantes, del Centro Médico Nacional de Occidente (CMNO), del Instituto Mexicano del Seguro Social (IMSS). Se incluyeron 62 receptores de trasplante renal de donante vivo (DV) y fallecido (DF) con determinación de PCT en los primeros 7 días del TR y el registro de eventos de disfunción temprana del injerto (DTI), fueron comparados con pacientes sin DTI (sDTI). Resultados: los receptores con DTI presentaron niveles más altos de PCT (13,90, 3,90, 1,22 ng/mL) comparado con el grupo sin DTI (0,32, 0,31 y 0,22 ng/ml) en los días 1, 3 y 5 respectivamente; p < 0,05. Conclusiones: la PCT es un marcador biológico asociado a DTI en el postrasplante renal inmediato.

Introducción: La enfermedad renal crónica avanzada (ERCA) puede impactar notablemente lacalidad de vida relacionada con la salud (CVRS) de las personas que la padecen. Además, la per-cepción sobre lo amenazante que es esta enfermedad para su vida puede impactar notablementela salud física y emocional de los pacientes. Objetivos: Valorar la CVRS y la percepción de amenaza de la enfermedad en pacientes con ERCAy evaluar las asociaciones entre las variables de estudio. Materiales y métodos: Estudio transversal realizado en 70 pacientes (80 % varones) de entre 38y 88 años (M=68,88; DT=9,98) mediante dos instrumentos: el cuestionario de calidad de vida enenfermedad renal versión abreviada (KDOQL- SF36) y el cuestionario de percepción de amenaza de enfermedad (BIPQ). Se realizó un análisis descriptivo de los datos mediante el programaestadístico SPSS 26.0 y usando los estadísticos pruebast,dde Cohen y correlaciones de Pearson. Resultados: Los participantes mostraron una gran afectación de su CVRS y una percepción ne-gativa de la enfermedad, siendo los peores indicadores los encontrados en mujeres. Una peorpercepción de la enfermedad se asoció con mayor afectación de la CVRS Conclusiones: La percepción de los pacientes sobre su salud puede afectar la adherencia terapéutica,por lo que es necesario implementar programas de intervención que incidan en ella y favorezcan lasalud física y mental de los pacientes.

Biologic education plays an important role in understanding the living systems and ecosystems that it does not surround in the context of a zoonotic-like epidemic such as SARS-CoV-2 may have an important role for self-care in patients with kidney disease that they are a population at high risk according to epidemiological data. That is why the present work aims to describe the association between education in biological science in patients with kidney disease in the context of a covid-19 epidemic. Biological science education is an important component subject to self-care so that many patients with kidney disease allowing them to understand, the importance of having a better adhere to the therapeutic regimen, dietary regimen and in the specific case of the epidemic by COVID -19 may allow them to take preventive measures to avoid their exposure to the pathogen. La educación en ciencias biológicas juega un papel importante a la hora de entender los sistemas vivos y ecosistemas que no rodea en contexto de una epidemia de tipo Zoonótico como SARS-CoV-2 y cumple un papel importante para el autocuidado en pacientes con enfermedad renal que son una población en alto riesgo según datos epidemiológicos. El presente trabajo pretende describir la asociación entre la educación en ciencia biológica. La educación en ciencias biológicas es un componente importante supeditado a el autocuidado para que muchos pacientes con enfermedad renal permitiendo que éste pueda entender, la importancia de tener una mejor adhieren a él régimen terapéutico, régimen alimenticio y en el caso puntual de la epidemia por COVID-19 puede permitir que ellos tomen las medidas preventivas que eviten su exposición al patógeno.