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Los varones con enfermedad renal crónica cursan a menudo con deficiencia en testosterona. Se desconoce si el déficit de testosterona que acompaña a la pérdida de función renal se asocia con el tipo de tratamiento sustitutivo de la función renal. Métodos: El estudio de corte transversal incluyó 79 varones prevalentes en diálisis, 43 en hemodiálisis (HD) y 36 en diálisis peritoneal (DP). Con una edad media de 69 años, el 31,6% eran diabéticos. Se evaluaron los niveles de testosterona endógena (inmunoluminiscencia: N 3-10,5ng/ml), marcadores nutricionales/inflamatorios, marcadores de metabolismo óseo mineral, anemia, tipo de técnica y permanencia. La composición corporal fue estimada mediante bioimpedancia vectorial y espectroscópica. Se considera déficit de testosterona cuando los niveles son inferiores a 3ng/ml. Resultados: Los niveles de testosterona medios fueron 8,81±6,61ng/ml. El 39,5% de los pacientes en HD y el 5,6% de los de DP presentaban déficit de testosterona. Los niveles de testosterona se correlacionaron directamente con el tipo de técnica, HD (rho Spearman 0,366; p < 0,001) y el tiempo de permanencia (Rho −0,412; p=0,036) en el análisis univariante y solo con la técnica de HD en el multivariante. No se encontraron otras correlaciones significativas. Conclusiones: Los niveles circulantes de testosterona en hombres en diálisis se asocian de manera independiente con la técnica de HD. Se puede concluir que, en la reducción de testosterona que acompaña de manera natural a la pérdida de masa muscular e inflamación, se asocia un nuevo factor que es la técnica dialítica. Se necesitan estudios para elucidar si la técnica per se favorece la eliminación de testosterona (AU)

Testosterone deficiency is a prevalent condition in male patients with chronic kidney disease. However, it is not known whether the type of renal replacement therapy has an impact on testosterone deficiency that accompanies loss of renal function. Methods: The cross-sectional study enrolled 79 prevalent male patients on dialysis; 43 on haemodialysis (HD) and 36 on peritoneal dialysis (PD). The median age was 69 years and 31.6% were diabetics. Endogenous testosterone levels were measured by immunoluminescence assay (normal range 3-10.5ng/ml), while nutritional/inflammatory markers, bone and mineral metabolism markers, anaemia, type of dialysis technique and time on dialysis were also assessed. Body composition was evaluated by bioimpedance vector analysis and bioimpedance spectroscopy. Testosterone deficiency was defined as levels below 3ng/ml. Results: Mean testosterone levels were 8.81±6.61ng/ml. Testosterone deficiency affected 39.5% of HD patients and only 5.6% of PD patients. In the univariate analysis, testosterone levels were directly correlated with type of dialysis technique (HD) (Rho Spearman 0.366; P<.001) and time on dialysis (Rho −0.412; P=.036) and only with the HD technique in the multivariate analysis. No other significant correlations were found. Conclusions: Circulating testosterone levels in men on dialysis were independently associated with HD technique. It can be concluded that a new factor —namely the dialysis technique— may be associated with falling testosterone levels and the associated loss of muscle mass and inflammation. Further studies are needed to establish whether the dialysis technique itself triggers testosterone elimination (AU)

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Testosterone deficiency is a prevalent condition in male patients with chronic kidney disease. However, it is not known whether the type of renal replacement therapy has an impact on testosterone deficiency that accompanies loss of renal function. METHODS: The cross-sectional study enrolled 79 prevalent male patients on dialysis; 43 on haemodialysis (HD) and 36 on peritoneal dialysis (PD). The median age was 69 years and 31.6% were diabetics. Endogenous testosterone levels were measured by immunoluminescence assay (normal range 3-10.5ng/ml), while nutritional/inflammatory markers, bone and mineral metabolism markers, anaemia, type of dialysis technique and time on dialysis were also assessed. Body composition was evaluated by bioimpedance vector analysis and bioimpedance spectroscopy. Testosterone deficiency was defined as levels below 3ng/ml. RESULTS: Mean testosterone levels were 8.81±6.61ng/ml. Testosterone deficiency affected 39.5% of HD patients and only 5.6% of PD patients. In the univariate analysis, testosterone levels were directly correlated with type of dialysis technique (HD) (Rho Spearman 0.366; P<.001) and time on dialysis (Rho -0.412; P=.036) and only with the HD technique in the multivariate analysis. No other significant correlations were found. CONCLUSIONS: Circulating testosterone levels in men on dialysis were independently associated with HD technique. It can be concluded that a new factor -namely the dialysis technique- may be associated with falling testosterone levels and the associated loss of muscle mass and inflammation. Further studies are needed to establish whether the dialysis technique itself triggers testosterone elimination.

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La vuelta a diálisis tras fallo de trasplante renal (TX) es una situación cada vez más frecuente. En la vuelta a diálisis tras TX fallido suele darse una situación clínica similar o peor a la de los pacientes nuevos en hemodiálisis o diálisis peritoneal (DP). Aunque existen bastantes estudios sobre la situación clínica de los pacientes que vuelven a DP tras períodos largos con TX funcionante, no hay apenas información sobre la evolución de un subgrupo de pacientes que vuelven a DP tras fallo de TX a los pocos días o semanas de su realización. Objetivo: Evaluar si un corto período de tiempo con TX subóptimo y tratamientos/medidas agresivas pueden influir en la permeabilidad de membrana, la situación clínica y la eficacia dialítica al volver a DP. Pacientes y métodos: En 9 pacientes (53,5 ± 15,4 años, 5 hombres, 4 mujeres) procedentes de DP con fallo precoz de TX y vuelta a DP (25 ± 23 días, rango 10-64) de los cinco últimos años, se estudian datos analíticos de inflamación, nutrición, función renal, permeabilidad y eficacia de DP, en cuatro momentos de la evolución: previo al TX, inmediatamente a la vuelta a DP, al primer mes y al tercer mes de DP. Resultados: No se detectan diferencias significativas en la evolución de los parámetros de nutrición e inflamación. La diuresis desciende de forma significativa del volumen previo al trasplante al de la vuelta a DP y al primer mes en DP (p = 0,032), manteniéndose en niveles reducidos a los tres meses en DP. La UF se reduce de 1407 a 951 ml/día (p = 0,022) y de 314 a 260 ml/4 h (p = 0,018) en el test de equilibrio peritoneal al tercer mes en DP, sin cambios en el cociente dializado/plasma de creatinina. Kt/V y aclaramiento semanal de creatinina descienden ligeramente, manteniéndose en niveles adecuados de eficacia. Conclusiones: En esta pequeña muestra de pacientes que vuelven a DP tras fallo precoz de TX, no parece que las medidas que comporta el manejo de un injerto en riesgo en un corto espacio de tiempo afecten de forma importante a parámetros clínicos y de permeabilidad o eficacia peritoneal

The return to dialysis after kidney transplant (TX) failure is increasingly common. On returning to dialysis after TX failure, there is usually a similar or worse clinical situation than in patients who are on haemodialysis or peritoneal dialysis (PD) for the first time. Although there are several studies on the clinical situation of patients who return to PD after long periods with a functioning TX, there is hardly any information on the progression of a patient subgroup returning to PD after TX failure a few days or weeks after transplantation. Objective: Assess whether a short period of time on suboptimal TX and aggressive treatment/measures may influence membrane permeability, the clinical situation and dialysis efficacy on returning to PD. Patients and method: In 9 patients (53.5±15.4 years of age, 5 males and 4 females) who had previously been on PD before early TX failure and had returned to PD (25±23 days, range 10-64) over the last five years, we studied laboratory data including inflammation, nutrition, kidney function, permeability and PD efficacy, at four points during progression: before TX, immediately after returning to PD and after one month and three months on PD. Results: We did not detect significant differences in the progression of nutrition and inflammation parameters.Diuresis decreased significantly from pre-TX volume to diuresis on return to PD and after one month on PD (p=.032), remaining at low levels after three months on PD. UF decreased from 1407 to 951ml/day (p=.022) and from 314 to 260ml/4h (p=.018) in the peritoneal equilibration test after three months on PD, without changes being observed in the creatinine dialysate/plasma ratio. Kt/V and weekly creatinine clearance decreased slightly and remained at adequate efficacy levels. Conclusions: In this small sample of patients, who returned to PD after early TX failure, it does not appear that the measures involved in managing a graft at risk over a short period of time have a major effect on clinical parameters and permeability or peritoneal efficacy

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UNLABELLED: The return to dialysis after kidney transplant (TX) failure is increasingly common. On returning to dialysis after TX failure, there is usually a similar or worse clinical situation than in patients who are on haemodialysis or peritoneal dialysis (PD) for the first time. Although there are several studies on the clinical situation of patients who return to PD after long periods with a functioning TX, there is hardly any information on the progression of a patient subgroup returning to PD after TX failure a few days or weeks after transplantation. OBJECTIVE: Assess whether a short period of time on suboptimal TX and aggressive treatment/measures may influence membrane permeability, the clinical situation and dialysis efficacy on returning to PD. PATIENTS AND METHOD: In 9 patients (53.5 ± 15.4 years of age, 5 males and 4 females) who had previously been on PD before early TX failure and had returned to PD (25 ± 23 days, range 10-64) over the last five years, we studied laboratory data including inflammation, nutrition, kidney function, permeability and PD efficacy, at four points during progression: before TX, immediately after returning to PD and after one month and three months on PD. RESULTS: We did not detect significant differences in the progression of nutrition and inflammation parameters. Diuresis decreased significantly from pre-TX volume to diuresis on return to PD and after one month on PD (p=.032), remaining at low levels after three months on PD. UF decreased from 1407 to 951 ml/day (p=.022) and from 314 to 260 ml/4h (p=.018) in the peritoneal equilibration test after three months on PD, without changes being observed in the creatinine dialysate/plasma ratio. Kt/V and weekly creatinine clearance decreased slightly and remained at adequate efficacy levels. CONCLUSIONS: In this small sample of patients, who returned to PD after early TX failure, it does not appear that the measures involved in managing a graft at risk over a short period of time have a major effect on clinical parameters and permeability or peritoneal efficacy.

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La psoriasis es una enfermedad cutánea con afectación sistémica, cuyo daño tisular se considera inmunomediado y que en la actualidad se trata eficazmente con etanercept. El daño renal de esta patología no está completamente aclarado en la literatura. Presentamos un caso de glomerulonefritis membranosa con depósitos de C1q que posteriormente desarrolló psoriasis. En este artículo hacemos una revisión de la posible asociación entre estas patologías y la respuesta a esta molécula biológica (AU)

Psoriasis is a cutaneous disease with systemic involvement. Tisular damage is consider to be immunomediated, and actually is being effectively treated with Etanercept. Kidney damage of this patological condition is not completely clarified in the literature. We present a case of Membranous Nephropathy with C1q deposits that subsequently developed psoriasis. In this article we make a review of a possible association between these diseases and the respose to that biological molecule (AU)

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Psoriasis is a cutaneous disease with systemic involvement. Tissue damage is considered to be immune-mediated, and etanercept currently provides effective treatment. Kidney injury arising from this condition has not yet been fully explained in the literature. We present a case of membranous nephropathy with C1q deposits followed by development of psoriasis. In this article we will review the possible association between these conditions and the response to this biological molecule.

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