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Biomedical subjects

J Luño

Publications and source records attributed to J Luño.

At least 19 recordsLinked to original sources
PubMed2006

[Prolonged acute renal failure and severe polyradiculopathy in ethylene glycol intoxication].

Ethylene glycol intoxication involves acute renal failure and severe metabolic acidosis. Prolonged renal insufficiency can occur but terminal chronic renal failure has been reported in very few cases. We describe a patient who after ingestion of 920 ml of ethylene glycol developed prolonged acute renal failure needing hemodialysis for 37 days and then he partly recovered renal function. The patient developed a severe sensitive-motor and autonomic polyradiculopathy.

Acute Kidney Injury↗
PubMed2005

[Renin-angiotensin system in diabetic nephropathy].

The importance of the renin angiotensin system (RAS) in the development and progression of the diabetic nephropathy is confirmed with the recent demonstration that the development of nephropathy in the diabetic patients can be avoided by blockers of the RAS. For that reason, the promotion of preventive programs for the detection of microalbuminuria, from the early phases of the diabetes is needed. Control of blood pressure, of glucose and lipids are needed. If microalbuminuria is present, the administration of a blocker of RAS, even in the presence of normal blood pressure can prevent the progression to diabetic nephropathy. The main objective to prevent the development and progression of nephropathy in the diabetic patients, as well as the cardiovascular risk, is a strict control of the PA.

Albuminuria↗
PubMed2005

[Pharmacogenetics of angiotensin system in non diabetic nephropathy].

BACKGROUND: Genetic variability could contribute to the response to pharmacological treatment in patients with nephropathy. In albuminuric diabetic patients the renoprotective effect of angiotensin I-converting enzyme (ACE) inhibition should be lower among homozygotes for the deletion allele (DD) compared to II-homozygotes. METHODS: A total of 71 non-diabetic chronic nephropathy patients were treated with losartan (n = 37) or amlodipine (n = 34). Blood pressure and proteinuria were determined before and after the treatment, and changes in the mean values were statistically compared. Patients were genotyped for the ACE-I/D, angiotensin I receptor type 1 (AGTR1)-1166 A/C, and angiotensinogen (AGT)-M235T polymorphims, and the reduction of blood pressure and proteinuria between the different genotypes were compared. RESULTS: The reduction in systolic or diastolic blood pressure was not found to be different between the ACE-I/D or AGT-M/T genotypes in patients treated with losartan or amlodipine. In patients treated with losartan, we found a significantly higher reduction of diastolic blood pressure in AGTR1-AA patients compared to AC patients (p = 0,0024). We did not find differences in proteinuria-reduction between the different genotypes in patients treated with losartan or amlodipine. CONCLUSIONS: Our data show that the effects of losartan and amlodipine on the absolute mean reduction of blood pressure and proteinuria in non-diabetic nephropathy patients are similar between the different ACE or AGT genotypes. Although based on a small number of patients, the AGTR1-AA genotype was associated with a significantly higher reduction in diastolic blood pressure among losartan-treated patients. Additional studies are necessary to refute or confirm this association.

Adult↗
PubMed2005

[Evaluation of efficacy of darbepoetin alfa administered once monthly as treatment of anemia in predialysis patients with chronic kidney disease].

BACKGROUND: Darbepoetin alfa has demonstrated its efficacy when is administered subcutaneously once-weekly and once every 2 weeks as treatment of anemia in patients with chronic kidney disease (CKD). The aim of this study is to assess the efficacy of subcutaneus darbepoetin alfa administered once monthly in patients with progressive CKD who maintained stable levels of Hb treated on once every other week dosing. METHODS: Patients included in the study maintained hemoglobin (Hb) > 11 g/dl and were receiving darbepoetin alfa once every other week during at least 4 months. We studied a frequency interval dose change: once every other week frequency was converted to once monthly at equivalent dose. The study completers were 12 patients over the third month and 7 at the end of one year evaluation period. RESULTS: A statistic significant decrease in Hb and hematocrit (Hto) was observed over the third month, although all patients maintain Hb levels higher than 11 g/dl. At the same time it was appreciated a statistic significant increased on creatinine (Cr) and parathyroid hormone levels (PTH). At the end of one year evaluation period no differences were observed in any of variables. CONCLUSION: Darbepoetin alfa administered once monthly is an efficacious option as treatment of anemia for patientes with CKD. With a dose of 1 mcg/kg/month, all patientes maintain Hb > 11 g/dl.

Aged↗
PubMed2002

[Renal and cardiovascular protection associated to antihypertensive treatment in the elderly].

The incidence of arterial hypertension increases with age in such a way that by the age of 60 the incidence is greater than 50% in men and women. This increase is particularly relevant if we consider the changes in systolic blood pressure (increase) and diastolic blood pressure (decrease) in relation to age and as a consequence in the reduction of vascular compliance which is common in men and women over the age of 60. These disorders are associated to artheriosclerosis and the corresponding increase in pulse pressure. It is for these reasons that the most common form of hypertension is isolated systolic hypertension (SBP > 140 mmHg and SBP < 90 mmHg), which represents 50% of hypertensive patients in the elderly population. Isolated systolic hypertension is also associated to an increase in cardiovascular disease (MI, stroke), increasing the risk of mortality four times. In elderly people, hypertension and isolated systolic hypertension are risk factors that can be managed. Today there is sufficient evidence from clinical trials that show a clear benefit in the reduction of the cardiovascular and renal risk associated to the antihypertensive treatment in the elderly, at least when the blood pressure is greater than 160/90 mmHg. The target blood pressure figures to control in the elderly person, probably below 160/90 mmHg, still need to be determined.

Aged↗
PubMed2001

Prevalence of hypertension in renal disease.

BACKGROUND: Hypertension (HTN) is very frequent in patients with renal disease and its prevalence increases as renal failure progresses. METHODS: We studied the prevalence of HTN in 1921 patients with different nephropathies. Patients on dialysis and renal transplant patients were not included in the study. HTN was defined as SBP>140 and/or DBP>90 mmHg, or requiring antihypertensive therapy. RESULTS: The prevalence of HTN in the total group of patients with renal diseases was 60.5%, but this prevalence varied widely depending upon the type of underlying nephropathy. The prevalence of HTN was practically universal in patients with renal vascular disease (93%) and in patients with established diabetic nephropathy (87%), and 74% of the patients with polycystic kidney disease, 63% of the patients with chronic pyelonephritis and 54% of the patients diagnosed with glomerulonephritis were hypertensive. The prevalence of HTN in patients with renal insufficiency (80%) is significantly higher than that in patients without renal insufficiency (43% P<0.001). In a multiple logistic regression analysis, the independent risk factors defining HTN in renal patients were: renal failure, age, the presence of diabetes, hypertriglyceridaemia and proteinuria. Antihypertensive treatment consisted of diet alone in 4% of the patients, one drug in 45%, two drugs in 36%, three medications in 13% and more than three drugs in 2.5%. The angiotensin-converting enzyme (ACE) inhibitors were the most frequently prescribed drug (39% of the patients treated in monotherapy) followed by calcium channel blockers (27%), diuretics (18%) and beta-blockers (9%). The most common combined therapy was a diuretic plus an ACE inhibitor. The percentage of patients with BP controlled according to current recommendations for renal patients (BP<130/85) was very low; SBP in only 49% and DBP in 24%. Control of both was only achieved in 10% of the patients. CONCLUSIONS: There is a high prevalence of HTN in renal patients, which depends on the type of nephropathy and the degree of renal failure. Other independent risk factors for HTN in patients with renal disease are: advanced age, the presence of diabetes, hypertriglyceridaemia and the severity of proteinuria. BP control in renal patients is quite poor and should be improved to reduce progression of the renal disease.

Blood Pressure↗
PubMed2001

Effect of strict blood pressure control on proteinuria in renal patients treated with different antihypertensive drugs.

BACKGROUND: The severity of proteinuria is the main predictive factor in the progression of renal failure in chronic nephropathies. Therefore, action aimed at reducing proteinuria should be a priority in the treatment of these patients. Various antihypertensive drugs, in particular the angiotensin-converting enzyme inhibitors (ACEIs), have a greater antiproteinuric effect, although it is difficult to establish whether this is due only to their effect on arterial blood pressure (BP) or to other mechanisms associated with blockade of the renin-angiotensin system (RAS). METHODS: The evolution of proteinuria after two successive treatment periods was studied prospectively for 2 years in 22 patients with chronic glomerulonephritis. In period I, which lasted for 12 months, BP was strictly controlled (<125/75 mmHg) and the patients received random and double-blind treatment with a beta-blocker (betaB), atenolol; a non-dihydropyridine calcium channel blocker (CCB), verapamil; an ACEI, trandolapril; or a fixed combination of the latter two. In period II, all of the patients received treatment openly for an additional 12 months with a fixed combination of verapamil+trandolapril at half the dose of the preceding period, to obtain conventional control of BP at <140/90 mmHG: RESULTS: The mean level for basal SBP/DBP was 136+/-14/86+/-7 mmHg, which decreased in period I to 121+/-15/76+/-8 mmHg (P=0.01) and to 124+/-5/78 +/-8 mmHg (P<0.05) at 6 and 12 months of treatment, respectively. There were no differences in the BP reached in the four therapy groups; however, proteinuria only decreased in the patients treated with trandolapril alone or in combination with verapamil. In period II, BP levels rose to 134+/-10/84+/-8 mmHg (P<0.05); this increase in BP was accompanied by an increase in proteinuria in those patients who had received the ACEI alone or in combination in the previous period, while in patients previously treated with a betaB or a CCB, proteinuria decreased, in spite of the increase in BP. CONCLUSIONS: With equal BP control, treatment with the ACEI trandolapril alone, or in combination with a CCB, has a greater antiproteinuric effect than that obtained with other antihypertensive drugs, but this effect is attenuated if BP is not strictly controlled.

Adrenergic beta-Antagonists↗
PubMed1998

Renal vascular disease in the elderly.

The aging of Western societies is causing a progressive increase in the number of patients over 65 starting dialysis. The EDTA Registry shows that in 1995 this section of the population represented nearly 45% of patients under dialysis, and the percentage is even higher in the USRDS at 48%, 20% of whom are over 75. These changes have not only been quantitative, but have also modified the causes of end-stage renal disease (ESRD). Diabetic nephropathy (DN) and renal vascular disease (RVD) account for more than 50% of all these causes, reaching 66% according to the latest USRDS calculations. According to these numbers, RVD represents 29% of all causes, the incidence varying with the age group, and has become the main cause of ESRD in the elderly (38% of all cases). Until a few years ago, RVD was synonymous with hypertension, but as the population ages, the range of diseases in this group is increasing. The main RVDs that cause ESRD in the elderly are: hypertensive RVD (nephrosclerosis), atheromatous RVD (either as ischemic atherosclerotic nephropathy or as atheroembolism), and acute occlusion of renal arteries (either bilateral or unilateral in single-kidney patients). The diagnosis of nephrosclerosis in the absence of histological confirmation is a presumed clinical diagnosis, made in most cases by exclusion, and is therefore clearly overestimated. On the other hand, atheromatous RVD is an underdiagnosed disease that is often overlooked. The prevalence, natural history, diagnosis and prognosis are discussed in this report.

Aged↗
PubMed1998

Effects of antihypertensive therapy on progression of diabetic nephropathy.

There is a clear relationship between hypertension and the microvascular complications of diabetes. Genetic predisposition to hypertension has been correlated to the risk of diabetic nephropathy in type I diabetes, and hypertension is a well known risk factor for developing nephropathy in patients with type II diabetes. Multiple studies have emphasized the importance of hypertension on renal disease progression, and blood pressure control with conventional antihypertensive drugs slows the rate of renal function loss in diabetic nephropathy. Furthermore, evidence of the role of renin-angiotensin system (RAS) on progression of renal damage has focused much interest on the therapeutic action of the RAS blockade. In patients with type I diabetes, blocking the RAS with angiotensin converting enzyme (ACE) inhibitors prevents progression from microalbuminuria to overt nephropathy, and in overt nephropathy decreases the gradual loss of renal function beyond its blood pressure lowering effect. Less clinical information is available in type II diabetic nephropathy, but our experience and some recent studies suggest that ACE inhibitors also have a renoprotective action in type II diabetes. The role of calcium channel blockers in diabetic nephropathy is not clear. Several short-term studies with the first generation dihydropyridine calcium antagonists showed a lower effect on urinary albumin excretion and a more rapid progression to renal failure than with ACE inhibitors. However, other calcium channel blockers, particularly of the non-dihydropyridine type, have been shown to have a beneficial effect on diabetic nephropathy, decreasing proteinuria and slowing progression.

Antihypertensive Agents↗