The increase in the prevalence of diabetes mellitus (DM) and the secondary kidney damage produces diabetic nephropathy (DN). Early nephropathy is defined as the presence of microalbuminuria (30–300 mg/day), including normal glomerular filtration rate (GFR) or a mildly decreased GFR (60–89 mL/min/1.73 m2), with or without overt nephropathy. The earliest change caused by DN is hyperfiltration with proteinuria. The acceptable excretion rate of albumin in urine is <30 mg/day. Albuminuria represents the excretion of >300 mg/day. Chronic kidney disease (CKD) is characterized by abnormalities in renal function that persist for >3 months with health implications. Alterations in the redox state in DN are caused by the persistent state of hyperglycemia and the increase in advanced glycation end products (AGEs) with ability to affect the renin-angiotensin system and the transforming growth factor-beta (TGF-β), producing chronic inflammation and glomerular and tubular hypertrophy and favoring the appearance of oxidative stress. In DN imbalance between prooxidant/antioxidant processes exists with an increase in reactive oxygen species (ROS). The overproduction of ROS diminishes expression of the antioxidant enzymes (manganese superoxide dismutase, glutathione peroxidase, and catalase). The early detection of CKD secondary to DN and the timely identification of patients would permit decreasing its impact on health.

No abstract

Minimization in immunosuppression could contribute to the appearance the donor-specific HLA antibodies (DSA) and graft failure. The objective was to compare the incidence of DSA in renal transplantation (RT) in recipients with immunosuppression with and without steroids. A prospective cohort from March 1st, 2013 to March 1st, 2014 and follow-up (1 year), ended in March 2015, was performed in living donor renal transplant (LDRT) recipients with immunosuppression and early steroid withdrawal (ESW) and compared with a control cohort (CC) of patients with steroid-sustained immunosuppression. All patients were negative cross-matched and for DSA pre-transplant. The regression model was used to associate the development of DSA antibodies and acute rejection (AR) in subjects with immunosuppressive regimens with and without steroids. Seventy-seven patients were included (30 ESW and 47 CC). The positivity of DSA class I (13% vs 2%; P < 0.05) and class II (17% vs 4%, P = 0.06) antibodies were higher in ESW versus CC. The ESW tended to predict DSA class II (RR 5.7; CI (0.93–34.5, P = 0.06). T-cell mediated rejection presented in 80% of patients with DSA class I ( P = 0.07), and 86% with DSA II ( P = 0.03), and was associated with DSA class II, (RR 7.23; CI (1.2–44), P = 0.03). ESW could favor the positivity of DSA. A most strictly monitoring the DSA is necessary for the early stages of the transplant to clarify the relationship between T-cell mediated rejection and DSA.

DMCs for dialysis procedures were higher in APD than in CAPD, but the difference was not statistically significant. In both APD and CAPD, 90% of costs were attributable to the dialysis procedure, hospitalizations, and medications. In a multivariate analysis, no independent variable significantly predicted a higher DMC.

México es uno de los países con mayor uso de diálisis peritoneal (DP) en el mundo. Los resultados de la DP (morbimortalidad, tasa de peritonitis y supervivencia de la técnica) en México son comparables a los de otros países (1).El panel de expertos de la International Society of Renal Nutrition and Metabolism (ISRNM) propuso el término de "desgaste proteico energético" (DPE) como aquel estado que presenta un descenso tanto de los depósitos proteicos como de las reservas energéticas (esto es, una pérdida de músculo y de grasa) debido a las múltiples alteraciones nutricionales y catabólicas que ocurren en la enfermedad renal crónica2,3. Estas alteraciones incluyen: disminución en la ingestión calórico-proteica, condiciones co-mórbidas, trastornos endocrinos, aumento en la producción de citoquinas inflamatorias, toxinas urémicas, acidosis metabólica y pérdida de nutrientes durante la terapia de reemplazo renal, etc (2, 3).El término DPE es el que mejor define los síndromes relacionados al desgaste muscular, malnutrición e inflamación que ocurren en esta condición. La caquexia ocurre con poca frecuencia en la enfermedad renal y es la forma más severa de DPE, ya que este último puede referirse a grados leves de depleción de masa proteica y energética2. Por este motivo, nos ha parecido oportuno exponer los datos recientes sobre el DPE en nuestro país, para así, implementar las estrategias adecuadas para abordarlo.La prevalencia de DPE ha sido reportada en un amplio rango que va del 49-92% en la población tanto prevalente (casos ya existentes en DP) como incidente (casos nuevos en DP) en los distintos programas de DP en México (tabla 1) (4-8). Los pacientes sin seguridad social son los que presentan mayor DPE (5,7,8). Este es un grave problema debido a que el DPE se asocia con mortalidad en estos pacientes (9).