Esta es la tercera vez que, como tema monográfico, la Nefrología está presente en la Revista.En una primera ocasión hicimos una revisión del tratamiento, en un conjunto de la Insuficiencia Renal Crónica y en la segunda pasamos revista a una serie de procesos que en su evolución iban a condicionar consecuencias, tanto funcionales como patológicas, en el riñón.Siguiendo en esta linea, nos ha parecido interesante dedicar este tercer tema fundamentalmente a las glomerulopatias primitivas. Una de las dificultades, que como estudiantes de medicina hemos tenido muchos, ha sido la de clasificar las glomerulonefritis y de esta forma poder organizar nuestro propio esquema mental. Por ello hemos dedicado el primer trabajo a estudiar la relación anatomoclínica, para lo cual hemos seguido una clasificación que nos parece suficientemente clara y amplia al mismo tiempo . Para un mejor entendimiento de las glomerulopatías, será necesario conocer las bases inmunopatológicas en que se 215
We investigated whether modification of collagen type I turnover is related to the long-term response to cardiac resynchronization therapy (CRT). Methods and Results: Serum carboxy-terminal propeptide of procollagen type I or PICP (a marker of collagen type I synthesis), carboxy-terminal telopeptide of collagen type I or CITP (a marker of collagen type I degradation), matrix metalloproteinase (MMP)-1, -2, -9 and tissue inhibitor of MMP (TIMP)-1, were measured in 54 patients (35 responders) at baseline and after 1 year of CRT. At baseline, PICP and the ratio PICP: CITP were higher (p < 0.01) in responders than in nonresponders. At 1-year, both PICP (p < 0.005) and the ratio PICP:CITP (p < 0.05) decreased in responders, while increased in nonresponders (p < 0.005 and p < 0.05, respectively). MMP-1 (p < 0.05), MMP-9 (p < 0.005), and the ratio MMP-1:TIMP-1 (p < 0.01) increased, while TIMP-1 decreased (p < 0.005) in responders, but remained unchanged in nonresponders. The ratio PICP:CITP correlated inversely with ejection fraction (r = -0.501, p < 0.01) and directly with left ventricular end-diastolic diameter (r = 0.376, p < 0.05) in responders after CRT. Direct correlations were found between MMP-1, and -9 and ejection fraction (r = 0.315, p < 0.05, r = 0.516, p < 0.01) in responders after CRT. Conclusions The ability of CRT to modify collagen type I turnover (i.e. decreasing synthesis and increasing degradation) is associated with its long-term response.
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