was read the article
array:21 [ "pii" => "X2013251409004689" "issn" => "20132514" "doi" => "10.3265/Nefrologia.2009.29.3.5085.en.full" "estado" => "S300" "fechaPublicacion" => "2009-06-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2009;29:266-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4308 "formatos" => array:3 [ "EPUB" => 260 "HTML" => 3472 "PDF" => 576 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699509004681" "issn" => "02116995" "doi" => "10.3265/Nefrologia.2009.29.3.5085.en.full" "estado" => "S300" "fechaPublicacion" => "2009-06-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2009;29:266-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 9560 "formatos" => array:3 [ "EPUB" => 242 "HTML" => 7964 "PDF" => 1354 ] ] "es" => array:11 [ "idiomaDefecto" => true "titulo" => "Cirugía bariátrica en pacientes con glomeruloesclerosis focal y segmentaria secundaria a obesidad" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "266" "paginaFinal" => "269" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Bariatric surgery in patients with focal segmental glomerulosclerosis secondary to obesity" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Ramírez, S. Mezzano, Leopoldo Ardiles, D. Carpio, J. Mukdsi" "autores" => array:5 [ 0 => array:2 [ "Iniciales" => "J." "apellidos" => "Ramírez" ] 1 => array:2 [ "Iniciales" => "S." "apellidos" => "Mezzano" ] 2 => array:2 [ "nombre" => "Leopoldo" "apellidos" => "Ardiles" ] 3 => array:2 [ "Iniciales" => "D." "apellidos" => "Carpio" ] 4 => array:2 [ "Iniciales" => "J." "apellidos" => "Mukdsi" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251409004689" "doi" => "10.3265/Nefrologia.2009.29.3.5085.en.full" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409004689?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509004681?idApp=UINPBA000064" "url" => "/02116995/0000002900000003/v0_201502091409/X0211699509004681/v0_201502091409/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X201325140900471X" "issn" => "20132514" "doi" => "10.3265/Nefrologia.2009.29.3.5241.en.full" "estado" => "S300" "fechaPublicacion" => "2009-06-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2009;29:270-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3004 "formatos" => array:3 [ "EPUB" => 250 "HTML" => 2331 "PDF" => 423 ] ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "Independent Clinical Research in Spain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "270" "paginaFinal" => "271" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Investigación Clínica Independiente en España" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Josep M. Cruzado" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Josep M." "apellidos" => "Cruzado" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699509004712" "doi" => "10.3265/Nefrologia.2009.29.3.5241.en.full" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509004712?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325140900471X?idApp=UINPBA000064" "url" => "/20132514/0000002900000003/v0_201502091629/X201325140900471X/v0_201502091629/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251409004670" "issn" => "20132514" "doi" => "10.3265/Nefrologia.2009.29.3.5285.en.full" "estado" => "S300" "fechaPublicacion" => "2009-06-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2009;29:263-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4142 "formatos" => array:3 [ "EPUB" => 221 "HTML" => 3422 "PDF" => 499 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Scintigraphy of the intraperitoneal cavity using technetium 99m as a diagnostic technique for diaphragmatic leaks in peritoneal dialysis: regarding two cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "263" "paginaFinal" => "265" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La gammagrafía con Tc99m intraperitoneal como técnica diagnóstica de fugas diafragmáticas en pacientes en diálisis peritoneal: a propósito de dos casos." ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "17818078_f1_p264.jpg" "Alto" => 502 "Ancho" => 399 "Tamanyo" => 19514 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I Gil Carballeira, Rosa Ramos Sánchez, M Antonia Azancot, J Bartolomé Espinosa, M Vilaplana Moltó, J Camps Domènech" "autores" => array:6 [ 0 => array:2 [ "Iniciales" => "I" "apellidos" => "Gil Carballeira" ] 1 => array:2 [ "nombre" => "Rosa" "apellidos" => "Ramos Sánchez" ] 2 => array:2 [ "nombre" => "M Antonia" "apellidos" => "Azancot" ] 3 => array:2 [ "Iniciales" => "J" "apellidos" => "Bartolomé Espinosa" ] 4 => array:2 [ "Iniciales" => "M" "apellidos" => "Vilaplana Moltó" ] 5 => array:2 [ "Iniciales" => "J" "apellidos" => "Camps Domènech" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699509004673" "doi" => "10.3265/Nefrologia.2009.29.3.5285.en.full" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509004673?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409004670?idApp=UINPBA000064" "url" => "/20132514/0000002900000003/v0_201502091629/X2013251409004670/v0_201502091629/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Bariatric surgery in patients with focal segmental glomerulosclerosis secondary to obesity" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "266" "paginaFinal" => "269" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "J. Ramírez, S. Mezzano, Leopoldo Ardiles, D. Carpio, J. Mukdsi" "autores" => array:5 [ 0 => array:3 [ "Iniciales" => "J." "apellidos" => "Ramírez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "S." "apellidos" => "Mezzano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:4 [ "nombre" => "Leopoldo" "apellidos" => "Ardiles" "email" => array:1 [ 0 => "lardiles@uach.cl" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "D." "apellidos" => "Carpio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 4 => array:3 [ "Iniciales" => "J." "apellidos" => "Mukdsi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Nefrología, Instituto de Medicina. Facultad de Medicina. Universidad Austral de Chile, Valdivia, Valdivia, Chile, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => " nstituto de Anatomía, Histología y Patología. Facultad de Medicina. Universidad Austral de Chile, Valdivia, Valdivia, Chile, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Becado, Sociedad Internacional de Nefrología, Valdivia, Valdivia, Chile, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cirugía bariátrica en pacientes con glomeruloesclerosis focal y segmentaria secundaria a obesidad" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "17918078_f1_p267.jpg" "Alto" => 301 "Ancho" => 823 "Tamanyo" => 34018 ] ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">Obesity, defined as a Body Mass Index (BMI) ≥ 30, has become a worldwide health issue of epidemic proportions. In the United States, its prevalence reached 65% in 2003 and as a disease it is becoming increasingly relevant in developing countries like Chile, where a National Health Survey in 2003 indicated a prevalence of 23%. This condition is associated with other cardiovascular risk factors like high blood pressure, insulin resistance/type 2 diabetes mellitus, dyslipidaemia and coronary heart disease and can lead to progressive renal failure.</p><p class="elsevierStylePara">The first descriptions of nephropathy associated with obesity were published 30 years ago, being followed by numerous reports of kidney disease in obese subjects without diabetes.</p><p class="elsevierStylePara">Nephrotic syndrome associated with obesity has been described as a glomerulopathy that presents variable proteinuria. Occasionally nephrotic range proteinuria is present, but without the full blown nephrotic syndrome<span class="elsevierStyleSup">1</span>, and with histopathological findings of FSGS. Diferences with the primary form of FSGS involves less foot process effacement of podocytes, perihilar predominance and the presence of glomerulomegaly. It progresses naturally into renal failure in half of cases<span class="elsevierStyleSup">2</span> if left untreated.</p><p class="elsevierStylePara">Taking into consideration the fact that developing countries are experiencing the epidemic spread of chronic kidney failure and that this could increase due to the concomitant raise in obesity incidence, we have decided to communicate two cases of FSGS affecting young obese males who were not diabetics, and who, following bariatric surgery experienced a significant remission of proteinuria in one case and total disappearance of the condition in another, which made it possible to reduce or suspend antiproteinuric treatment.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CLINICAL CASES</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case 1</span></p><p class="elsevierStylePara">This case involves a male patient who was obese from the age of 17, with some type 2 diabetic (DM2) relatives on his father’s side and who was taking atorvastatin for mild hyperlipidaemia. During a routine check-up at 19 years of age, the patient weighed 102kg (BMI 36.6), proteinuria was 3.8g/day, and there were no abnormalities in the urine sediment. Fasting glycaemia, albumin, thyroid profile and lipid levels were normal, blood pressure was 140/75, blood creatinine was 1.4mg/dl and the serology was negative for systemic diseases that could potentially affect the kidneys.</p><p class="elsevierStylePara">A kidney biopsy obtained 10 glomeruli, one was generally sclerotic and one of the others showed segmental sclerosis, significant hyalinosis and adherence to Bowman’s capsule which was perihilar in location (figure 3a); moderate interstitial fibrosis and tubular atrophy affecting the sclerotic glomerulus and efferent arteriolar hyalinosis were observed. The Electron Microcope (EM) revealed foot process effacement of podocytes with microvillous transformation and segmental changes in the Glomerular Basement Membrane (GBM), mainly in the paramesangial area, without any electron-dense deposits or tubulo-reticular inclusions. The immunofluorescence assay (IFA) only showed unspecific traces of IgM and C3. It was concluded that the patient presented the perihilar variant of FSGS.</p><p class="elsevierStylePara">Antiproteinuric treatment with 20mg/day of lisinopril and 160mg/day of valsartan induced a moderate reduction in proteinuria to 1.5g/day. Efforts to lose body weight through exercise and diet were ineffective and open gastric bypass surgery was performed 17 months later which resulted in a weight loss of 80kg and the significant remission of proteinuria, which made it possible to reduce the dose of lisinopril to 5mg/day, suspend valsartan and atorvastatine treatment altogether and maintain renal function (blood creatinine 1.4mg/dl) after 58 months of follow up (figures 1a and 2a).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case 2</span></p><p class="elsevierStylePara">This case involves a male patient who was obese from the age of 20. On examination, hypothyroidism and hyperlipidaemia were detected (total cholesterol 351mg/dl, HDL 49mg/dl and LDL 280mg/dl), both were quickly treated with thyroid hormone replacement therapy but there was no change in weight. One uncle had been diagnosed with DM2. During a routine check-up at 35 years of age the patient weighed 124kg (BMI 41.4), proteinuria was 7.14g/day, and there were no abnormalities in the urine sediment. Thyroid hormone levels were normal, blood pressure was normal (130/80mmHg), fasting glycaemia and albumin were normal and blood creatinine was 1.27mg/dl. The serology was also normal.</p><p class="elsevierStylePara">The kidney biopsy showed 16 glomeruli; two were generally sclerotic, three showed segmental sclerosis which was perihilar in location and adherence to Bowman’s capsule; the rest were about 50% larger in size. There was moderate interstitial fibrosis, tubular atrophy (figure 3b), interstitial lymphocyte infiltration and mild intimal fibrosis with moderate arteriolar hyalinosis. The EM revealed foot process effacement of podocytes (figure 3c), segmental changes in the GBM without electro-dense deposits or tubulo-reticular inclusions. The IFAdid not provide any additional information and it was concluded that patient presented the perihilar variant of focal glomerulosclerosis and glomerulomegaly.</p><p class="elsevierStylePara">Treatment with 10mg/day of fosinopril was administered which resulted in a reduction in proteinuria to 1.0g/day, without any change in weight despite modifying the patient’s diet for 17 months. Subsequently, open gastric bypass surgery was performed which resulted in a significant reduction in weight (85kg). His proteinuria disappeared, which made it possible to suspend all treatment with ACE inhibitors. Kidney function remained stable, with blood creatinine at 1.0mg/dl, after 35 months of observation (figures 1b and 2b).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">Our two cases graphically illustrate the most typical glomerular disease associated with severe obesity and the positive response to the effective reduction in weight that was the result of bariatric surgery. Although it is clear that our patients reduced protein excretion after the use of RASblocking agents, the high initial levels of proteinuria and the failure of measures to reduce weight prompted the decision to perform bariatric surgery. In this respect, the beneficial effects of RAS-blocking agents could potentially have been lost if the obesity was not radically dealt with.<span class="elsevierStyleSup">2</span> The protracted remission following the effective weight loss confirms the importance of obesity in the pathogenesis of this condition. It is clear that a control kidney biopsy would have been useful in order to identify histological changes that associated with remission; however this possibility was ruled out for ethical reasons.</p><p class="elsevierStylePara">The physiopathological analysis of kidney disease associated with obesity is well supported with experimental examples of obese rats that present early podocyte damage and macrophage infiltration associated with hyperlipidaemia and hyperglycaemia, which precedes the development of glomerulosclerosis and tubulo-interstitial damage. Cases of spontaneous obesity in rhesus monkeys develop into full blown metabolic syndrome with progressive weight gain, followed by a sustained increase in blood insulin without hyperglycaemia, and finally leads to significant hyperglycaemia and a drop in insulin levels.<span class="elsevierStyleSup">3</span> Both our patients had a family history of DM2 but did not present it themselves, and although unfortunately we did not record insulin levels, they never presented hyperglycaemia when fasting plasma glucose tests were carried out on several occasions. Furthermore, the hyperlipidemia in one of the patients quickly normalized after thyroid hormone replacement and the same occurred in the other following the weight loss, making possible to eliminate statins.</p><p class="elsevierStylePara">The pathogenic mechanisms of renal damage associated with obesity are related to the adverse effects of the body adapting to the increase in the excretory load, salt retention and the direct or indirect effects of hyperinsulinaemia/insulin resistance and renal lipotoxicity. Haemodynamic changes are very important given that an increase in intraglomerular pressure associated with hyperinsulinaemia has been observed in experimental conditions and that obese patients without DM2 present greater glomerular filtration compared with control subjects with a normal BMI.<span class="elsevierStyleSup">4</span> The pathogenic role of RAS and the therapeutic use of RAS- blockers is significant because an increase in BMI is associated with an augment in vascular sensitivity to angiotensin II, which is confirmed by the regression of intraglomerular hypertension and structural damage after using ACE inhibitors.<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">The importance of fatty tissue has also been evaluated since adipocytes not only act as an energy store but also they secrete hormones, cytokines and growth factors for the systemic vascular and renal bed, including renin, angiotensinogen, IL-6, leptin, PAI-1, adiponectin and TGFbeta. This is how animals with overexpression of angiotensin II in adipocytes develop hypertension which directly or indirectly affects the kidney. Leptin, a peptide produced by fatty tissue reduces food intake and increases sympathetic nerve activity in both thermogenic and non-thermogenic tissue and is considered an anti-obesity hormone. However, for reasons that have not yet been clarified, it has been observed that obese subjects develop a resistance to the satiety and loss of weight induced by leptine, conserving the sympathetic outflow to non-thermogenic tissues like the kidney, heart and adrenals. Therefore, leptine may modify the production of nitric oxide and induce sodium retention, systemic vasoconstriction and hypertension.<span class="elsevierStyleSup">6</span></p><p class="elsevierStylePara">At present, the management of nephropathy associated with obesity focuses on the use of antiproteinuric agents, with ACE inhibitors and angiotensin II receptor blockers being the most commonly used treatments, which also improve insulin sensitivity and protect the kidneys and cardiovascular system. Statins, metformin and PPARg have also been tested. Notwithstanding the foregoing, the only reduction in body weight has been effective in reducing proteinuria<span class="elsevierStyleSup">7</span>. Bariatric surgery is considered a viable method for achieving it, involving a reasonable risk, and has already been suggested for the management of proteinuria in obese diabetic patients<span class="elsevierStyleSup">8</span> and other glomerulopathies. Therefore, it should form part of the therapeutic arsenal for treating renal diseases associated with obesity<span class="elsevierStyleSup">9</span> when the weight loss objective cannot be reached using conventional medical treatments or when the degree of proteinuria does not allow a long wait.<span class="elsevierStyleSup">10</span></p><p class="elsevierStylePara"><a href="grande/17918078_f1_p267.jpg" class="elsevierStyleCrossRefs"><img src="17918078_f1_p267.jpg"></img></a></p><p class="elsevierStylePara">Figure 1. </p><p class="elsevierStylePara"><a href="grande/17918078_f2_p268.jpg" class="elsevierStyleCrossRefs"><img src="17918078_f2_p268.jpg"></img></a></p><p class="elsevierStylePara">Figure 2. </p><p class="elsevierStylePara"><a href="grande/17918078_f3_p268.jpg" class="elsevierStyleCrossRefs"><img src="17918078_f3_p268.jpg"></img></a></p><p class="elsevierStylePara">Figure 3. </p>" "pdfFichero" => "P-E-S-A179-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:4 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440089" "palabras" => array:1 [ 0 => "Cirugía bariátrica" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440091" "palabras" => array:1 [ 0 => "IECA" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440093" "palabras" => array:1 [ 0 => "Glomeruloesclerosis" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440095" "palabras" => array:1 [ 0 => "Obesidad" ] ] ] "en" => array:4 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440090" "palabras" => array:1 [ 0 => "Bariatric surgery" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440092" "palabras" => array:1 [ 0 => "ACEI" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440094" "palabras" => array:1 [ 0 => "Glomerulosclerosis" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440096" "palabras" => array:1 [ 0 => "Obesity" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara">Se presentan dos casos de proteinuria en jóvenes obesos no diabéticos, con histología de Glomeruloesclerosis Focal y Segmentaria (GFS). La efectiva reducción de peso corporal mediante cirugía bariátrica se siguió de una remisión sostenida de la proteinuria, permitiendo una significativa reducción o suspensión de las dosis de fármacos bloqueadores del sistema renina-angiotensina.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara">2 cases of proteinuria in obese non-diabetic young males, both corresponding to focal segmental glomerulosclerosis are presented. Effective reduction of body weight by bariatric surgery was followed by sustained remission of proteinuria allowing significant reduction or total removal of blockers of the reninangiotensin-system.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "17918078_f1_p267.jpg" "Alto" => 301 "Ancho" => 823 "Tamanyo" => 34018 ] ] ] 1 => array:7 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "17918078_f2_p268.jpg" "Alto" => 342 "Ancho" => 823 "Tamanyo" => 33595 ] ] ] 2 => array:7 [ "identificador" => "fig3" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "17918078_f3_p268.jpg" "Alto" => 232 "Ancho" => 823 "Tamanyo" => 41313 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Praga M, Morales E, Herrero JC, et al. Absence of hypoalbuminemia despite massive proteinuria in focal segmental glomerulosclerosis secondary to hyperfiltration. Am J Kidney Dis 1999;33:52-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9915267" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Praga M, Hernández E, Morales E, et al. Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis. Nephrol Dial Transplant 2001;16:1790-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11522860" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bagby SP. Obesity-initiated metabolic syndrome and the kidney: a recipe for chronic kidney disease? J Am Soc Nephrol 2004;15:2775-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15504931" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Chagnac A, Weinstein T, Korzets A, Ramadan E, Hirsch J, Gafter U. Glomerular hemodynamics in severe obesity. Am J Physiol Renal Physiol 2000;278:F817-F822. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10807594" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Abrass CK. Overview: obesity: what does it have to do with kidney disease? J Am Soc Nephrol 2004;15:2768-72. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15504929" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bravo PE, Morse S, Borne DM, Aguilar EA, Reisin E. Leptin and hypertension in obesity. Vasc Health Risk Manag 2006;2:163-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17319461" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Weisinger JR, Kempson RL, Eldridge FL, Swenson RS. The nephrotic syndrome: a complication of massive obesity. Ann Intern Med 1974;81:440-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/4416380" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Izzedine H, Coupaye M, Reach I, Deray G. Gastric bypass and resolution of proteinuria in an obese diabetic patient. Diabet Med 2005;22:1761-2. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16401325" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Fowler SM, Kon V, Ma L, Richards WO, Fogo AB, Hunley TE. Obesity-related focal and segmental glomerulosclerosis: normalization of proteinuria in an adolescent after bariatric surgery. Pediatr Nephrol 2008." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Praga M. Obesity-a neglected culprit in renal disease. Nephrol Dial Transplant 2002;17:1157-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12105233" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000002900000003/v0_201502091629/X2013251409004689/v0_201502091629/en/main.assets" "Apartado" => array:4 [ "identificador" => "35422" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000003/v0_201502091629/X2013251409004689/v0_201502091629/en/P-E-S-A179-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409004689?idApp=UINPBA000064" ]
Year/Month | Html | Total | |
---|---|---|---|
2024 November | 6 | 9 | 15 |
2024 October | 65 | 43 | 108 |
2024 September | 87 | 23 | 110 |
2024 August | 85 | 51 | 136 |
2024 July | 59 | 33 | 92 |
2024 June | 72 | 34 | 106 |
2024 May | 61 | 32 | 93 |
2024 April | 54 | 22 | 76 |
2024 March | 40 | 20 | 60 |
2024 February | 49 | 35 | 84 |
2024 January | 56 | 34 | 90 |
2023 December | 42 | 23 | 65 |
2023 November | 46 | 27 | 73 |
2023 October | 48 | 43 | 91 |
2023 September | 68 | 28 | 96 |
2023 August | 74 | 23 | 97 |
2023 July | 69 | 25 | 94 |
2023 June | 64 | 21 | 85 |
2023 May | 69 | 29 | 98 |
2023 April | 43 | 14 | 57 |
2023 March | 50 | 23 | 73 |
2023 February | 45 | 23 | 68 |
2023 January | 45 | 25 | 70 |
2022 December | 48 | 35 | 83 |
2022 November | 63 | 29 | 92 |
2022 October | 75 | 45 | 120 |
2022 September | 54 | 24 | 78 |
2022 August | 60 | 42 | 102 |
2022 July | 45 | 47 | 92 |
2022 June | 45 | 19 | 64 |
2022 May | 38 | 35 | 73 |
2022 April | 53 | 43 | 96 |
2022 March | 62 | 47 | 109 |
2022 February | 42 | 36 | 78 |
2022 January | 55 | 26 | 81 |
2021 December | 71 | 29 | 100 |
2021 November | 45 | 40 | 85 |
2021 October | 47 | 38 | 85 |
2021 September | 60 | 36 | 96 |
2021 August | 65 | 22 | 87 |
2021 July | 76 | 40 | 116 |
2021 June | 52 | 11 | 63 |
2021 May | 75 | 26 | 101 |
2021 April | 114 | 40 | 154 |
2021 March | 88 | 26 | 114 |
2021 February | 73 | 19 | 92 |
2021 January | 47 | 18 | 65 |
2020 December | 34 | 10 | 44 |
2020 November | 41 | 10 | 51 |
2020 October | 19 | 8 | 27 |
2020 September | 37 | 4 | 41 |
2020 August | 55 | 12 | 67 |
2020 July | 51 | 9 | 60 |
2020 June | 40 | 24 | 64 |
2020 May | 56 | 11 | 67 |
2020 April | 40 | 11 | 51 |
2020 March | 41 | 13 | 54 |
2020 February | 81 | 23 | 104 |
2020 January | 75 | 20 | 95 |
2019 December | 52 | 22 | 74 |
2019 November | 56 | 28 | 84 |
2019 October | 25 | 8 | 33 |
2019 September | 59 | 14 | 73 |
2019 August | 53 | 11 | 64 |
2019 July | 69 | 17 | 86 |
2019 June | 49 | 10 | 59 |
2019 May | 37 | 6 | 43 |
2019 April | 81 | 30 | 111 |
2019 March | 48 | 16 | 64 |
2019 February | 21 | 18 | 39 |
2019 January | 42 | 19 | 61 |
2018 December | 75 | 30 | 105 |
2018 November | 74 | 10 | 84 |
2018 October | 92 | 17 | 109 |
2018 September | 56 | 12 | 68 |
2018 August | 27 | 12 | 39 |
2018 July | 39 | 10 | 49 |
2018 June | 29 | 6 | 35 |
2018 May | 54 | 13 | 67 |
2018 April | 41 | 9 | 50 |
2018 March | 39 | 7 | 46 |
2018 February | 33 | 9 | 42 |
2018 January | 40 | 5 | 45 |
2017 December | 38 | 10 | 48 |
2017 November | 44 | 8 | 52 |
2017 October | 34 | 7 | 41 |
2017 September | 33 | 9 | 42 |
2017 August | 40 | 19 | 59 |
2017 July | 26 | 10 | 36 |
2017 June | 47 | 10 | 57 |
2017 May | 56 | 11 | 67 |
2017 April | 44 | 14 | 58 |
2017 March | 34 | 9 | 43 |
2017 February | 35 | 8 | 43 |
2017 January | 31 | 11 | 42 |
2016 December | 52 | 11 | 63 |
2016 November | 63 | 11 | 74 |
2016 October | 86 | 13 | 99 |
2016 September | 131 | 12 | 143 |
2016 August | 151 | 8 | 159 |
2016 July | 159 | 24 | 183 |
2016 June | 115 | 0 | 115 |
2016 May | 87 | 0 | 87 |
2016 April | 91 | 0 | 91 |
2016 March | 62 | 0 | 62 |
2016 February | 87 | 0 | 87 |
2016 January | 84 | 0 | 84 |
2015 December | 113 | 0 | 113 |
2015 November | 64 | 0 | 64 |
2015 October | 73 | 0 | 73 |
2015 September | 64 | 0 | 64 |
2015 August | 68 | 0 | 68 |
2015 July | 49 | 0 | 49 |
2015 June | 37 | 0 | 37 |
2015 May | 53 | 0 | 53 |
2015 April | 5 | 0 | 5 |