Alexandra Esteves

Obesity represents a serious and growing disease worldwide. The pathophysiological changes secondary to chronic inflammation lead to the development of diseases that increase the morbidity and mortality of individuals. Chronic kidney disease (CKD) is a condition with deleterious effects that acts bidirectionally with obesity. From approximately 20% to 30% of individuals share phenotypes of CKD and obesity, increasing their cardiovascular risk and the risk of other complications. Obesity and CKD form a vicious cycle in which inflammation is the central axis of multiorgan damage. Despite increasing the risk of cardiac and renal mortality, CKD progresses in relation to body mass index and albuminuria. Nowadays, the implementation of the new medications aimed at mitigating the peak of inflammation is becoming a cornerstone of treatments for obesity, diabetes, cardiovascular diseases, and renal disease.

Obesity represents a serious and growing disease worldwide. The pathophysiological changes secondary to chronic inflammation led to the development of diseases that increase the morbidity and mortality of individuals. Chronic kidney disease (CKD) is a condition with deleterious effects that acts bidirectionally with obesity. Approximately 20% to 30% of individuals share phenotypes of CKD and obesity, increasing their cardiovascular risk and the risk of other complications. Obesity and CKD form a vicious cycle in which inflammation is the central axis of multiorgan damage. Despite increasing the risk of cardiac and renal mortality, CKD progresses in relation to body mass index and albuminuria. Nowadays, the implementation of the new medications aimed at mitigating the peak of inflammation are becoming as cornerstone treatments for obesity, diabetes, cardiovascular diseases, and renal disease.

Peritoneal dialysis effluent should be clear and any changes in aspect require further investigation. We report a case of a spontaneous milky white effluent (chyloperitoneum) associated with calcium channel blockers in a peritoneal dialysis patient. Our case is a 43-year-old man that presents with milky white peritoneal dialysis effluent 9 days after starting peritoneal dialysis. He didn't have any other complaints and he wasn't prescribed any new medications. In the effluent sample we found high triglycerides (1.8 mmol/L) thus confirming the chyloperitoneum. We suspended lercanidipine and within a few days the peritoneal dialysis effluent was clear. Currently the patient is well adjusted to the technique and had no further episodes of chyloperitoneum.

Hematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for patients with hematologic malignancies and certain solid tumors and nonmalignant hematologic conditions. Both AKI and CKD occur commonly after HSCT and are associated with significant morbidity and mortality. AKI and CKD in this setting may result from direct effects of the transplant or be caused by pretransplant bone marrow conditioning regimens and/or nephrotoxic agents administered in the post-transplant period. In this article, we review the epidemiology, risk factors, etiologies, pathophysiology, diagnosis, prevention, and treatment of post-HSCT AKI and CKD, with special attention to recent advances in this fast-moving and evolving field.

An arteriovenous fistula is the preferred vascular access option for hemodialysis patients. However, complications, such as high-output heart failure and upper limb edema due to central vein stenosis, may arise. We describe a case of a 65-year-old kidney transplant patient with severe edema in the left arm due to central vein stenosis and ipsilateral umerocephalic arteriovenous fistula. He was a previous hemodialysis patient and received his kidney transplant in 2015. This patient had an eight-month waiting list to undergo surgical ligation of the arteriovenous fistula. Since his quality of life was decaying, we decided to perform a peripheral vascular embolization with Amplatzer® vascular plugs (Abbott, Green Oaks, IL). After a two-month follow-up, the arm edema was significantly reduced, and no immediate complications were reported. This case highlights that the Amplatzer® vascular plug is a safe and effective alternative for arteriovenous fistula embolization in patients with arm edema due to central vein stenosis.