Although some cases of tubular dysfunction (TD) associated with nephrotic syndrome have been described, the incidence and the characteristics of this complication remain unknown. We investigated the presence of TD (renal glycosuria, aminoaciduria, metabolic acidosis with normal anion gap, hypouricaemia, and throughout hypophosphataemia) in 36 patients with nephrotic syndrome. Ten patients (group 1) showed glycosuria at some time during the course of their illness, ranging from 2.5 to 11.2 g/24 h. In addition, seven of them had metabolic acidosis with normal anion gap, five aminoaciduria, and two hypouricaemia. Membranous glomerulonephritis was the most frequent aetiology in group 1 patients (7 of 10). Proteinuria and serum creatinine (SCr) were significantly higher in group 1 patients than in the 26 remaining patients without TD (group 2): 10.2 +/- 3.7 versus 6.7 +/- 2.9 g/24 h (P less than 0.01) and 3.2 +/- 1.9 versus 1.6 +/- 0.9 mg/dl (P less than 0.05) respectively. The appearance of TD coincided with a clear worsening of renal function in most of group 1 patients. In addition, at the end of follow-up, SCr had increased from 3.2 +/- 1.9 to 5.6 +/- 3.3 mg/dl (P less than 0.05) in this group. In contrast, SCr did not show significant changes in group 2 (1.6 +/- 0.9 versus 2.1 +/- 2.2 mg/dl). In conclusion, a significant proportion (27.7%) of patients with nephrotic syndrome present TD data at some moment of their course; the appearance of this complication appears to be a sign of poor prognosis.
Chronic lower extremity ulcers (CLEUs) have a high prevalence and are difficult to treat due to their various aetiologies. The aim of this study is to evaluate the results achieved in treating CLEUs using an Erbium: YAG (Er:YAG) laser with RecoSMA technology. This laser emits thousands of microbeams of energy causing superficial epidermal ablation and a separation of dermal fibres due to a mechanical-acoustic and resonance effect. The evaluation of the results achieved was carried out by questionnaires completed by 18 patients enrolled in the study. Histological studies and photographs taken before each session (16 sessions in total) were analysed to visually monitor the clinical progress. The analyses were carried out with the help of computer software. The results after 16 treatment sessions showed the complete healing of ulcers or a decrease in their initial area of at least 55% in over 65% of the patients treated. The Student's t-test and Fisher's exact test were used for statistical analysis. The Er:YAG laser and RecoSMA technology ablates few epidermal cell layers, producing a mechanical-acoustic effect with resonance action leading to tissue regeneration mechanisms. This technology offers an effective and safe alternative for treating CLEUs.
ResumenLas úlceras crónicas de los miembros inferiores (UCMI) tienen una elevada prevalencia, etiología diversa y son de difícil curación. El objetivo del presente estudio es evaluar los resultados alcanzados en su curación mediante el empleo de un láser de Erbium:YAG con tecnología RecoSMA. Este láser y sistema de tecnología emite energía en forma de miles de microhaces induciendo microablación de la epidermis y actuación en las células de la dermis por efecto mecánico-acústico.Tratamos con irradiación semanal 17 pacientes durante 3 meses. La evaluación de resultados se realizó mediante cuestionarios y correlación clínica e histológica, realizando fotografías antes de cada sesión de tratamiento (12 en total), y su correspondiente análisis con asistencia de un programa informático.Los resultados mostraron curación completa, o reducción del área de las úlceras en aproximadamente el 50% de su superficie inicial en más del 50% de los pacientes. En el estudio estadístico empleamos t de Student y test exacto de Fisher y obtuvimos resultados estadísticamente significativos, con p<0,05.El láser de Er:YAG y la tecnología RecoSMA basada en ópticas que convierten el haz del láser en miles de microhaces no solamente se absorbe en la superficie del tejido, sino que penetra en la dermis y, por mecanismo mecánico-acústico, produce efectos de resonancia eficaces para producir regeneración tisular. Su empleo en las UCMI de difícil solución es una alternativa de tratamiento eficaz y seguro.Palabras clave Úlceras, Ulceras crónicas miembros inferiores, Láser Erbium,YAG, Tecnología RecoSMA.
Nivel de evidencia científica 4
AbstractChronic lower extremity ulcers (CLEU) have a high prevalence, present various aetiologies and are difficult to heal. The aim of the present study is to evaluate the results achieved in healing CLEU using an Erbium:YAG with RecoSMA technology. This laser emits energy in thousands of microbeams causing superficial epidermal ablation by thermal effect, and a limited cell membrane destruction in dermis due to a mechanical-acoustic effect.Evaluation of results achieved was carried out in 17 patients enrolled in the study by questionnaires, histologies and clinical visual correlation of progress by photographs taken before each session (12 session in total), which were analyzed with the help of a computer program.Results after 12 treatment sessions showed complete healing of ulcers or a decrease of their initial area in at least 50% in more than 50% of patients treated. The t Student test and Fishers´ exact test were used for the statistical analysis noticing that results obtained were statistically significant with p<0,05.The Er:YAG laser and RecoSMA technology, based on a system of optics which converts the laser beam in thousands of microbeams, it is not only absorbed in the tissue surface, but penetrates in the dermis. The acoustic-mechanical mechanism produces effective resonance effects to achieve tissue regeneration. This technology used on difficult CLEU offers an effective and safe treatment alternative.
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