Our findings suggest that patients with uncontrolled secondary hyperparathyroidism may benefit from PEIT if they present with very high basal PTH levels and/or big nodule size.

Summary Persistent hyperparathyroidism is frequent in postrenal transplant patients. Percutaneous ethanol injection therapy (PEIT) is an alternative for treatment of patients with secondary hyperparathyroidism but it was not described in postrenal transplant patients. We report our experience with PEIT to control hyperparathyroidism in the post‐transplant period. We performed PEIT under ultrasonographic guidance and local anesthesia in eight patients because of persistent secondary hyperparathyroidism after renal transplantation. Indications for PEIT were: high intact parathyroid hormone (iPTH) levels with hypercalcemia, hypophosphatemia, osteopenia and/or bone pain. All patients had at least one visible parathyroid nodule by ultrasonography. Biochemical assays were performed immediately before PEIT, between 1 and 7 days after last PEIT, and a mean of 8.0 ± 2.8 months after PEIT. Serum iPTH and calcium levels decreased significantly after treatment and remained unchanged until final control. Serum iPTH decreased from 286.9 ± 107.2 to 154.6 ± 42.2 pg/ml (P < 0.01) after PEIT (percentual reduction 36.5 ± 9.5%). This response was significantly correlated to total ethanol volume used (r: 0.94, P < 0.0001). Hypercalcemia disappeared in six of eight patients treated. Only minor complications were registered. There were no changes in renal function related to the treatment. Our findings show that PEIT is a useful and safe alternative for patients with persistent post‐transplant secondary hyperparathyroidism.

We evaluated the efficacy of percutaneous ethanol injection therapy (PEIT) as a therapeutic option for recurrence of secondary hyperparathyroidism after subtotal parathyroidectomy in ESRD patients. Six patients underwent PEIT. A mean of 1.3 ± 0.8 ethanol injections was performed. Nodular volume was 1.5 ± 1.7 cm3, and 2.8 ± 2.8 cm3 of ethanol was injected per patient. After ethanol injection PTH decreased significantly (1897 ± 754 to 549 ± 863 pg/mL (P < .01)). There was also a reduction in serum calcium, phosphorus and calcium-phosphorus product. A positive and significant correlation was found between nodular volume with ethanol injected and time from parathyroidectomy. Only one patient required hospitalization due to severe hypocalcaemia. In other two cases, local discomfort and temporary mild dysphonia were registered. PEIT is an effective treatment to control recurrences of secondary hyperparathyroidism postsubtotal parathyroidectomy.

Background:Currently, there are no biomarkers to predict respiratory worsening in patients with Coronavirus infectious disease, 2019 (COVID- 19) pneumonia.Objectives:We aimed to determine the prognostic value of Krebs von de Lungen-6 circulating serum levels (sKL-6) predicting COVID- 19 evolving trends.Methods:We prospectively analyzed the clinical and laboratory characteristics of 375 COVID- 19 patients with mild lung disease on admission. sKL-6 was obtained in all patients at baseline and compared among patients with respiratory worsening.Results:45.1% of patients developed respiratory worsening during hospitalization. Baseline sKL-6 levels were higher in patients who had respiratory worsening (median [IQR] 303 [209-449] vs. 285.5 [15.8-5724], P=0.068). The best sKL-6 cut-off point was 408 U/mL (area under the curve 0.55; 33% sensitivity, 79% specificity). Independent predictors of respiratory worsening were sKL-6 serum levels, age >51 years, time hospitalized, and dyspnea on admission. Patients with baseline sKL-6 ≥ 408 U/mL had a 39% higher risk of developing respiratory aggravation seven days after admission. In patients with serial determinations, sKL-6 was also higher in those who subsequently worsened (median [IQR] 330 [219-460] vs 290.5 [193-396]; p<0.02).Conclusion:sKL-6 has a low sensibility to predict respiratory worsening in patients with mild COVID-19 pneumonia. Baseline sKL-6 ≥ 408 U/mL is associated to a higher risk of respiratory worsening. sKL-6 levels are not useful as a screening tool to stratify patients on admission but further research is needed to investigate if serial determinations of sKL-6 may be of prognostic use.References:[1]Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. 5.[2]Tian W, Jiang W, Yao J, Nicholson CJ, Li RH, Sigurslid HH, et al. Predictors of mortality in hospitalized COVID-19 patients: A systematic review and meta-analysis. J Med Virol. 2020.[3]Wang D, Li R, Wang J, Jiang Q, Gao C, Yang J, et al. Correlation analysis between disease severity and clinical and biochemical characteristics of 143 cases of COVID-19 in Wuhan, China: a descriptive study. BMC Infect Dis. 2020;20(1):519.Disclosure of Interests:None declared.

Estimados editores, Reportamos el caso clínico de una paciente de sexo femenino de 47 años, que consultó por dolor lumbar izquierdo progresivo de seis meses de evolución y un episodio de hematuria macroscópica. Tenía antecedentes personales de hipertensión arterial (HTA) de un año de evolución. Al examen físico, presentó dolor a la puño percusión lumbar izquierda. En el laboratorio, hemoglobina y función renal normales, orina con microalbuminuria.Se le realizó ecografía abdominal (►Fig. 1), que evidenció riñones de tamaño levemente aumentados, con aumento difuso de la ecogenicidad cortical, y en ambos senos renales dilataciones quísticas multitabicadas, de paredes finas, bien definidas. Se decidió complementar estudio con Uro-Tomografía Computada (TC) (►Fig. 2), donde se objetivaron riñones de tamaño levemente aumentado a expensas de numerosos quistes peri-pélvicos bilaterales, de paredes finas, bien definidas, que producen compresión extrínseca del sistema colector, con dilatación proximal secundaria.Por persistencia de la lumbalgia izquierda, pese al tratamiento analgésico inicial, se le realizó drenaje y alcoholización de los quistes peri-pélvicos renales izquierdos. El líquido claro se analizó, y se obtuvieron 57 células a predominio linfocitario, con cultivos negativos.La paciente presentó mejoría clínica. En el control a los tres meses con Uro-TC, se evidenció franca reducción volumétrica de los quistes peri-pélvicos izquierdos y menor dilatación del sistema excretor (►Fig. 3).La linfangiectasia renal, también conocida como linfangiomatosis renal, linfangioma renal, e higroma renal, es un trastorno benigno y poco frecuente. 1-3 Puede ser congénito o adquirido. 1,4 Habitualmente es bilateral (90%) y excepcionalmente está localizado sólo en un sector del riñón. Afecta a ambos sexos por igual y puede diagnosticarse a cualquier edad. 1,4,5 Se han reportado algunos casos de asociación familiar. 6,7 Poco se conoce sobre su prevalencia, etiopatogenia e historia natural. 2 Normalmente, el drenaje linfático del riñón, la cápsula renal y los tejidos perirrenales se intercomunican a través de varios troncos linfáticos localizados en el interior del seno renal. Ellos drenan en los ganglios linfáticos paraaórticos, paracavales e interaortocavos. En la linfangiectasia renal, se cree que se presenta una malformación en el desarrollo y alteración en el drenaje de los linfáticos y, en consecuencia, dilatación y ectasia del sistema linfático perirrenal, peripélvico e intrarrenal con la formación de quistes. 3,5,7 La mayoría de las veces es asintomática. 3,4,7 Dentro de los síntomas más frecuentes se encuentran: dolor abdominal, hematuria, proteinuria, fiebre, anorexia, pérdida de peso, HTA, masa palpable en flancos, distensión abdominal, ascitis, edema de extremidades inferiores, eritrocitosis y, excepcionalmente, quiluria. 4 Habitualmente, la función renal es normal, pero hay casos publicados con insuficiencia renal por la compresión del parénquima renal. 1,2,4 La ultrasonografía evidencia colecciones peripiélicas, perirren...