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Introducción: La Diabetes Mellitus (DM) es una enfermedad inflamatoria sistémica de alta prevalencia e incidencia a nivel mundial. Dentro de las complicaciones crónicas, la enfermedad renal diabética es una de las más frecuentes y que marca el pronóstico. Objetivos: El objetivo de este artículo es hacer una revisión actualizada de la enfermedad renal diabética, a la luz de los cambios en los paradigmas que se han generado en los últimos años con respecto a sus nuevas definiciones, el papel de la inflamación en su desarrollo, la gestión del riesgo cardiovascular y los nuevos tratamientos. La enfermedad renal diabética puede presentarse en aproximadamente el 30-50% de la población con diabetes mellitus tipo 1 o 2 alrededor del mundo. En la patogénesis y progresión de esta condición se distinguen tres ejes fundamentales el hemodinámico, metabólico e inflamatorio. Es importante siempre hacer gestión del riesgo cardiovascular. El diagnóstico se debe hacer con el cálculo de la tasa de filtrado glomerular y la relación albuminuria / creatinuria en muestra ocasional. Los objetivos en el tratamiento deben ser: el control metabólico, reducir o enlentecer la progresión de la enfermedad renal y disminuir los desenlaces cardiovasculares. Conclusión: El tratamiento de la ERD debe ser holístico, desde intervenciones no farmacológicas, como la modificación de los estilos de vida, hasta los nuevos medicamentos como el uso de inhibidores SGLT-2, Agonistas del receptor GLP-1 y el uso antagonistas selectivos del receptor mineralocorticoide como finerenona. El futuro es promisorio.

Introduction: Diabetes mellitus (DM) is a systemic inflammatory disease of high prevalence and incidence worldwide. Among the chronic complications, diabetic kidney disease is one of the most frequent and determines the prognosis. Objectives: The objective of this article is to make an updated review of diabetic kidney disease, in light of the changes in the paradigms that have been generated in recent years concerning to the new definitions, the role of inflammation-causing disease, cardiovascular risk management, and the new treatments. Diabetic kidney disease can present in approximately 30-50% of the population with diabetes mellitus type 1 or 2 around the world. In the pathogenesis and progression of this condition, three fundamental axes are distinguished: the hemodynamic, the metabolic, and the inflammatory. It is important to manage cardiovascular risk. The diagnosis must be made by calculating the glomerular filtration rate and the albuminuria/creatinuria ratio in a random urine sample. The objectives of the treatment should be: metabolic control, reduce or slow the progression of kidney disease and improve cardiovascular outcomes. Conclusion: The treatment of diabetic kidney disease should be holistic, from non-pharmacological interventions, such as lifestyle changes, to new medications such as the use of SGLT-2 inhibitors, GLP-1 receptor agonists, and the use of selective mineralocorticoid receptor antagonists such as finerenone. The future is promising.

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Background: The multi-slice computerized tomography (MSCT) is a medical imaging modality that has been used to determine the size and location of the stomach cancer. Additionally, MSCT is considered the best modality for the staging of gastric cancer. One way to assess the type 2 cancer of stomach is by detecting the pathological structure with an image segmentation approach. The tumor segmentation of MSCT gastric cancer images enables the diagnosis of the disease condition, for a given patient, without using an invasive method as surgical intervention. Methods: This approach consists of three stages. The initial stage, an image enhancement, consists of a method for correcting non homogeneities present in the background of MSCT images. Then, a segmentation stage using a clustering method allows to obtain the adenocarcinoma morphology. In the third stage, the pathology region is reconstructed and then visualized with a three-dimensional (3-D) computer graphics procedure based on marching cubes algorithm. In order to validate the segmentations, the Dice score is used as a metric function useful for comparing the segmentations obtained using the proposed method with respect to ground truth volumes traced by a clinician. Results: A total of 8 datasets available for patients diagnosed, from the cancer data collection of the project, Cancer Genome Atlas Stomach Adenocarcinoma (TCGASTAD) is considered in this research. The volume of the type 2 stomach tumor is estimated from the 3-D shape computationally segmented from the each dataset. These 3-D shapes are computationally reconstructed and then used to assess the morphopathology macroscopic features of this cancer. Conclusions: The segmentations obtained are useful for assessing qualitatively and quantitatively the stomach type 2 cancer. In addition, this type of segmentation allows the development of computational models that allow the planning of virtual surgical processes related to type 2 cancer.

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Background: Insulin resistance (IR) is a metabolic disorder related to atherosclerosis. Its measurement is of great importance not only as a marker of diabetes but also for cardiovascular disease. The aim of this research study was to evaluate the relationship between various IR indices and coronary risk in an adult population from Maracaibo city, Venezuela. Methods: The Maracaibo City Metabolic Syndrome Prevalence Study is a descriptive, cross-sectional study with random and multi-stage sampling. In this sub study, 1272 individuals of both genders were selected with the measurement of basal insulin and coronary risk according to the Framingham-Wilson formula calibrated for our population. The insulin resistance indices evaluated were HOMA2-IR, triglycerides and glucose index (TyG) and triglycerides/HDL ratio (TG/HDL). The predictive capacity and association between each index and the coronary risk event in 10 years were determined. Results: Of the evaluated population, 55.2% were female, 34.8% had a coronary risk ≥5% in 10 years, with the TG/HDL and TyG indices showing the highest AUC 0.712 (0.681-0.743) and 0.707 (0.675-0.739), respectively; compared to HOMA2-IR. Both were also the indices most associated with increased coronary risk, especially TG/HDL ≥3 with a higher association [OR = 2.83 (1.74-4.61); p<0.01] after multivariable adjustment. Conclusions: TyG (≥4.5) and TG/HDL (≥3) indices showed a great predictive capacity of higher coronary risk, with being TG/HDL more associated even after adjusting for abdominal obesity and hs-CRP. Therefore, these represent useful tools for determining IR.

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INTRODUCTION: Subclinical hypothyroidism (ScH) is an endocrine alteration that is related to cardiovascular risk factors, including those categorized as components of the Metabolic Syndrome (MS). However, findings in prior reports regarding an association between these alterations are inconsistent. The purpose of this study was to determine the relationship between both entities in adult subjects from Maracaibo City, Venezuela. MATERIALS AND METHODS: The Maracaibo City Metabolic Syndrome Prevalence Study is a descriptive, cross-sectional study with random and multistage sampling. In this substudy, 391 individuals of both genders were selected and TSH, free T3, and free T4 tests were performed as well as a complete lipid profile, fasting glycaemia, and insulin blood values. ScH was defined according to the National Health and Nutrition Examination Survey (NHANES) criteria: high TSH (≥4.12mUI/L) and normal free T4 (0.9-1,9 ng/dL) in subjects without personal history of thyroid disease. MS components were defined according to IDF/AHA/NHLBI/WHF/IAS/IASO-2009 criteria. A multiple logistic regression analysis was used to assess the relationship between MS components and ScH diagnosis. RESULTS: Of the evaluated population, 10.5% (n=41) was diagnosed with ScH, with a higher prevalence in women (female: 13.6% versus male: 7.7%; χ2=3.56, p=0.05). Likewise, 56.1% (n=23) of the subjects with ScH were diagnosed with MS (χ2=4.85; p=0.03), being hyperglycemia the main associated criterion (χ2=11.7; p=0.001). In multivariable analysis, it was observed that the relationship was exclusive with the presence of type 2 diabetes mellitus (T2DM) OR: 3.22 (1.14-9.14); p=0.03. CONCLUSION: The relationship between ScH and MS in our population is dependent on the presence of hyperglycemia, specifically T2DM diagnosis, findings that vary from those previously reported in Latin American subjects.

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Background: In 1980, Reuben Andresen observed that in certain individuals, obesity did not increase mortality, introducing an atypical phenotype called "healthy obese". Other studies reported that 10-15 % of lean individuals presented insulin resistance, hyperglycemia and dyslipidemia. The objective of this study was to evaluate biochemical and clinical characteristics of metabolic phenotypes in Maracaibo city. Methods: A descriptive, cross-sectional study with a randomized multistage sampling was performed including 1226 non diabetic individuals from both sexes. For phenotype definition, the subjects were first classified according to their BMI into Normal-Weight, Overweight and Obese; then divided in metabolically healthy and unhealthy using a two-step analysis cluster. To evaluate the relationship with coronary risk, a multiple logistic regression model was performed. Results: In the studied population, 5.2% (n=64) corresponded to unhealthy lean subjects, and 17.4% (n=217) to healthy obese subjects. Metabolically unhealthy normal-weight (MUNW) phenotype was found in males in 53.3% in contrast to 51.3% of metabolically unhealthy obese (MUO) phenotype found in females. An association between metabolically unhealthy phenotypes and a higher risk of a coronary event was found, especially for obese individuals (MHO: OR=1.85 CI95%: 1.11-3.09; p=0.02 and MUO: OR=2.09 CI95%: 1.34-3.28; p<0.01). Conclusion: Individuals with atypical metabolic phenotypes exist in Maracaibo city. Related factors may include insulin resistance, basal glucose levels, and triglycerides levels. Lastly, cardiovascular risk exhibited by healthy obese individuals should be classified in categories of major coronary risk related to lean subjects.

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Resumo A causa mais comum e muitas vezes ignorado de hipertensão secundária e resistente é a doença renal parenquimatosa, cuja prevalência está crescendo. Quando se tenha esgotado a terapia anti-hipertensiva oral, podem ser usadas outras medidas não farmacológicas como a embolização de artérias renais, que visa diminuir o estímulo simpático, o estado hiperreninêmico e ativação do sistema renina angiotensina aldosterona que estão aumentados na doença renal crônica. Reportamos o caso de uma mulher com doença renal crônica e em terapia de substituição renal, com mínimo de diurese residual e hipertensão arterial resistente, submetida à embolização de artérias renais com a finalidade de conseguir um melhor controle dos valores da pressão arterial e diminuir o nómero de medicamentos anti-hipertensivos. Com este procedimento, consegue-se os objetivos propostos, além de uma melhor adesão ao manejo médico e menor probabilidade de internações hospitalares por crise hipertensiva.Pouco existe na literatura sobre a embolização de artérias renais em pacientes em terapia dialítica; no entanto, é possível que uma função renal residual mínima possa levar a estados de hiperatividade simpática e altos níveis de renina circulantes, que pode gerar hipertensão arterial resistente; é aqui onde a embolização de artérias renais teria sua maior utilidade.

Resumen La causa médica más común y con frecuencia ignorada de hipertensión arterial secundaria y resistente es la enfermedad renal parenquimatosa, cuya prevalencia viene en aumento. Cuando se ha agotado la terapia antihipertensiva oral se pueden utilizar otras medidas no farmacológicas que buscan frenar la contribución del riñón a la hipertensión, esto es mediante la disminución del estímulo simpático, el estado hiperreninémico y la activación del eje renina angiotensina aldosterona que se encuentran aumentados en la enfermedad renal crónica, mediante herramientas poco usadas pero útiles para este fin como lo es la embolización de las arterias renales. Realizamos el reporte de un caso de embolización de arterias renales en una mujer con enfermedad renal crónica y en terapia de reemplazo renal, con mínima diuresis residual e hipertensión arterial resistente, en quien se buscaba como objetivo primario un mejor control en las cifras de presión arterial y como objetivo secundario la disminución del número de medicamentos antihipertensivos a utilizar. Se logró no solo la mejoría en las cifras tensionales y la disminución de los medicamentos antihipertensivos, sino también una mejor posibilidad de adherencia al manejo médico a futuro, con menor nómero de recaídas por crisis hipertensiva. Poco existe en la literatura actual acerca de la embolización de arterias renales en pacientes en terapia dialítica; sin embargo, es factible que una mínima función renal residual pueda llevar a estados de hiperactividad simpática y altos niveles de renina circulante, que puedan generar escenarios de hipertensión arterial resistente; es aquí en donde la embolización de arterias renales tendría su mayor utilidad.

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OBJECTIVE: This research aims to apply the definition proposed by the Acute Kidney Injury Network (AKIN) research group to assess the incidence, risk factors, and outcomes in acute kidney injury (AKI) patients admitted at the intensive care unit (ICU). DESIGN: This is a retrospective cohort study. Patients who were admitted to the ICU from January 1, 2003 to December 31, 2004 were studied. INTERVENTIONS: Medical records of all patients were reviewed. Demographic information, diagnoses, risk factors for AKI, laboratory data, urinary output, frequency and days of exposure to mechanical ventilation, ICU and hospital stay, and outcomes were recorded. MEASUREMENTS AND MAIN RESULTS: A total of 794 patients were studied. There were 39.8% of patients who presented AKI (stage 1: 13.9%, stage 2: 12%, stage 3: 13.9%). The variables that were associated with the presence of AKI in the multivariable analysis were as follows: sepsis (odds ratio [OR], 5.29; 95% confidence interval [CI], 3.36-8.33), heart failure (OR, 3.01; 95% CI, 1.59-5.67), vasopressor use (OR, 1.89; 95% CI, 1.26-2.83), and age (ß = 1.02; 95% CI, 1.01-1.03). The mean hospital stay increased with renal commitment: patients without AKI, 10.9 days; AKIN stage 1, 17.8; AKIN stage 2, 21.1; and AKIN stage 3, 22.1 days (P < .0001). Mortality rate increased as more advanced the AKI stage was (no AKI, 7.3%; AKI 1, 16.4%; AKI 2, 34.7%; and AKIN 3, 45.5%; P < .0001). CONCLUSIONS: All of the result indicators--stay days in ICU, hospital stay days, frequency and days of mechanical ventilation, and mortality--considerably increased with more acute AKI stage. The most important risk factor of AKI was the sepsis.

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La enfermedad renal cronica (ERC), se define como un proceso fisiopatológico de etiología múltiple, que produce pérdida progresiva e inexorable del numero funcional de nefronas, con la posibilidad de dar lugar a una condición denominada Insuficiencia Renal Cronica (IRC), la cual, a su vez, conduce al paciente a depender permanentemente de una terapia de reemplazo renal...

Chronic Kidney Disease, is defined as a pathophysiologic process with multiple etiologies, that produces a progressive and ineludible lost ofthe number of functional nephrones, with the possibility ofgiving place to a condition called Chronic Renal Failure, which itself drives the patient to permanent1y depend on Renal Replacement Therapy...

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La Enfermedad Renal Crónica (ERC) se define como un proceso fisiopatológico de etiología múltiple que produce pérdida progresiva e inexorable del número funcional de nefronas, con la posibilidad de dar lugar a una condición denominada Insuficiencia Renal Crónica (IRC), la cual a su vez, conduce al paciente a depender permanentemente de una terapia de reemplazo renal. La ERC se define como: daño renal por ≥ 3 meses, definida por daño estructural o funcional con o sin disminución de la Rata de Filtración Glomerular (RFG), manifestada por anormalidades patológicas o marcadores de daño renal y por RFG < 60 m.l/min/1.73m2 por ≥ 3 meses, con o sin marcadores de daño renal; este es el parámetro que determina el estadío de la enfermedad renal (estadío 1- 5). Para el 2002 y basados en las estimaciones realizadas en la población norteamericana, aproximadamente ocho millones de personas presentaban una RFG menor a 60rnl/min/1.73m2 , lo cual corresponde a una enfermedad renal en estadío 3 o mayor. En números absolutos, la población con IRC en edades comprendidas entre los 45 y 64 años continúa creciendo y la incidencia total desde 1981 se ha cuadruplicado (de 82 a 334 por millón de habitantes). Sin importar la enfermedad renal subyacente (enfermedad primaria o secundaria), la progresión de la ERC deriva en un punto común, caracterizado por glomérulos escleróticos no funcionales, atrofia tubular y fibrosis intersticial, con la acumulación de "toxinas urémicas". Sin embargo, después de 150 años de ser descritas por vez primera, continúa siendo elusiva su adecuada caracterización. La ERC se acompaña de condiciones comórbidas como síndrome anémico, síndrome malnutrición-inflamación, acidemia/acidosis metabólica, dislipidemia, y enfermedad ósea que incrementan la morbi-mortalidad fundamentalmente de origen cardiovascular en este grupo de pacientes...

Chronic Kidney Disease is defined as a pathophysiologic process with multiple etiologies that produces a progressive and ineludible lost of the number of functional nephrones, with the possibility of giving place to a condition called Chronic Renal Failure, which itself drives the patient ro permanently depend on Renal Replacement Therapy. Chronic Renal disease is defined as: renal damage lasting 3 or more months, defined as structural or functional damage with or without decline in Glomerular filtration Rate (GFR), evidenced by pathological abnormalities or renal damage markers or GFR < 60ml/min/1.73 73m2 lasting 3 or more months, with or without renal damage markers. This is the parameter that establishes the stage of renal disease.In 2002 based on the estimates carried out in the North American population, approximately eight million people had a GFR < 60ml/min/1.73 111 2, which corresponds to a Renal Disease at least in Stage 3. In absolute numbers, the population with CRF between ages of 45 and 64 keeps growing and the total incidence since 1981 is four times bigger (82 to 334 per million habitants). Regardless of the underlying renal disease (primary or secondary), the progression of Chronic RenalDisease ends in a common point, characterized by sclerotic and non-functioning glomeruli, tubular atrophyand interstitial fibrosis, with the accumulation of «uremic toxins¼. Even though, after 150 years of being described for the first time, its adequate characterization is still elusive. Chronic Renal Disease has some associated conditions like anemic syndrome, malnutrition-inflammation syndrome, metabolic acidosis, dyslipidemia and bone disease that increases the morbimonality mainly cardiovascular morbilmortality, in this group of patients...

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A las pacientes gestantes, además de las causas comunes de falla renal aguda encontradas en la población general, se suman las enfermedades propias de su estado. En caso de llegar a darse esta situación, el pronóstico generalmente es bueno, con recuperación completa de la función renal, si se diagnostica y se trata a tiempo. El manejo con terapia de reemplazo renal usualmente es transitorio, mientras se resuelve su enfermedad de base y se termina la gestación. Presentanlos el caso de una mujer embarazada con antecedente de síndrome HELLP y abluptw placentae que presentó falla renal aguda y necesitó terapia de reemplazo renal transitoriamente.

In addition to the same causes of acute renal failure as the general population, pregnant women adjoin those diseases associated with pregnancy. If this happens, the overall prognosis is good and recovery of renal function is complete, this if it is early diagnosed and treated. Management with renal replacement therapy is used as a bridge until the cause of renal dysfunetion is treated and pregnancy has concluded.We present a case of a pregnant patient with HELLP syndrome and Abruptio placentae who suffered acute renal failure and required temporal renal replacement therapy.

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