Revista médica de Chile
-
Revista médica de Chile · May 2024
Multicenter Study[Tacrolimus in Difficult to Treat Proteinuria Associated with Lupus Nephritis. Experience of 3 Centers].
The management of proteinuria in patients with lupus nephritis represents a challenge for the specialist. Recently, Calcineurin Inhibitors have been positioned as an effective alternative in these patients, but their use is not widespread in our country. We report the experience of three centers in this regard. ⋯ Tacrolimus alone or in combination with Mycophenolate is a safe and effective alternative in the management of Lupus nephritis-associated proteinuria.
-
Revista médica de Chile · May 2024
Case Reports[Paroxysmal Nocturnal Hemoglobinuria: A Rare but Treatable Cause of Acute Kidney Injury. Case Report].
Early recognition of acute kidney injury is essential to prevent progression to chronic kidney disease. We present the case of a 19-year-old man with multiple emergency department visits for fatigue, abdominal pain, and intermittent dark urine. Upon admission, he had pancytopenia with elements suggestive of hemolysis and acute kidney injury. ⋯ The diagnosis of PNH was confirmed by flow cytometry. He was treated with prednisone, anticoagulation, iron, and folic acid supplementation. He progressed with a favorable clinical and laboratory response.
-
Revista médica de Chile · May 2024
Case Reports[Uremic Leontiasis Ossea: A Challenge in End-Stage Chronic Kidney Disease. About a Case].
Uremic leontiasis ossia (ULO) is a rare manifestation of renal osteodystrophy in) patients with end-stage chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPTH). It occurs due to increased osteoclastic activity secondary to high plasmatic parathyroid hormone (PTH) levels. This leads to bone deformation with thickening and massive enlargement of the cranial vault, resulting in a leonine face appearance. Imaging such as CT scans of the head and neck can reveal bone remodeling, which aids in diagnosing ULO in patients with elevated PTH. Treatment requires a multidisciplinary approach, including medical management of SHPTH, parathyroidectomy, and osteoplasty under a maxillofacial surgery specialist to correct anatomical abnormalities. ⋯ ULO is a rare disease and poses a diagnostic challenge. Early recognition of clinical features of ULO and elevated PTH levels in end-stage CKD patients is essential for a prompt diagnosis and appropriate treatment to avoid the consequences of ULO.
-
Revista médica de Chile · May 2024
[Association of the 5HTTLPR/rs25531 Genetic Variant with Depression in a Cohort of Primary Care Patients].
Serotonin plays a central role in mood regulation and the development of depressive disorders. The serotonin transporter, the primary regulator of serotonin levels, presents genetic variants that affect its functionality. ⋯ In this study, 5HTTLPR/rs25531 polymorphisms, independent of the bi- or tri-allelic analysis performed, did not prove to be risk factors for depression. In turn, we corroborated that female sex and childhood traumatic events are associated with an increased risk of developing a major depressive episode.
-
Revista médica de Chile · May 2024
[Experience in Implementing an Integrated Cardiometabolic Practice Unit in a Private Healthcare Provider: A Value-Based Care Model].
Cardiovascular diseases, in addition to being a health problem for Chile, ranking as the second leading cause of death, also impose a significant economic burden on the country. Aiming to reduce these diseases' health and economic impact, we decided to structure a Cardiometabolic Integrated Practice Unit (UPI) at the FUSAT Clinical Hospital. Unlike the current organization of healthcare systems in Chile, a UPI is structured throughout the entire cycle of care (from promotion and prevention to rehabilitation), with a multidisciplinary team (both clinical and administrative) organized around closely related medical conditions or a set of health conditions. ⋯ After 6 months of collaborative work, we successfully implemented the UPI at the FUSAT Clinical Hospital. This achievement demonstrates that projects of this nature can be carried out through a defined organization and governance, a strategic definition and prioritization of objectives, and an adaptation of the methodology to the local reality. The successful implementation of the UPI inspires confidence in its potential impact on healthcare in Chile.