Libman-Sacks endocarditis and severe aortic regurgitation in a patient with systemic lupus erythematosus in peritoneal dialysis
Endocarditis de Libman-Sacks e insuficiencia aórtica grave en un paciente con lupus eritematoso sistémico en diálisis peritoneal
Read
11821
Timeswas read the article
2524
Total PDF
9297
Total HTML
Share statistics
array:21 [ "pii" => "X2013251411052365" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.Jun.10939" "estado" => "S300" "fechaPublicacion" => "2011-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2011;31:619-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5710 "formatos" => array:3 [ "EPUB" => 313 "HTML" => 4828 "PDF" => 569 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699511052368" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2011.Jun.10939" "estado" => "S300" "fechaPublicacion" => "2011-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2011;31:619-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 13997 "formatos" => array:3 [ "EPUB" => 276 "HTML" => 13144 "PDF" => 577 ] ] "es" => array:10 [ "idiomaDefecto" => true "titulo" => "Endocarditis de Libman-Sacks e insuficiencia aórtica grave en un paciente con lupus eritematoso sistémico en diálisis peritoneal" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "619" "paginaFinal" => "621" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Libman-Sacks endocarditis and severe aortic regurgitation in a patient with systemic lupus erythematosus in peritoneal dialysis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10939_108_16445_es_10939_f1.jpg" "Alto" => 345 "Ancho" => 326 "Tamanyo" => 122738 ] ] "descripcion" => array:1 [ "es" => "Insuficiencia aórtica masiva." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Y. Barreiro Delgado, I. García Méndez, N. Martín Alemany, J. Calabia Martínez, M. Morales Fornos, M. Fuertes, M. Vallès Prats" "autores" => array:7 [ 0 => array:2 [ "Iniciales" => "Y." "apellidos" => "Barreiro Delgado" ] 1 => array:2 [ "Iniciales" => "I." "apellidos" => "García Méndez" ] 2 => array:2 [ "Iniciales" => "N." "apellidos" => "Martín Alemany" ] 3 => array:2 [ "Iniciales" => "J." "apellidos" => "Calabia Martínez" ] 4 => array:2 [ "Iniciales" => "M." "apellidos" => "Morales Fornos" ] 5 => array:2 [ "Iniciales" => "M." "apellidos" => "Fuertes" ] 6 => array:2 [ "Iniciales" => "M." "apellidos" => "Vallès Prats" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251411052365" "doi" => "10.3265/Nefrologia.pre2011.Jun.10939" "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/X2013251411052365?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511052368?idApp=UINPBA000064" "url" => "/02116995/0000003100000005/v0_201502091408/X0211699511052368/v0_201502091409/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X2013251411052357" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.Jun.10941" "estado" => "S300" "fechaPublicacion" => "2011-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2011;31:621-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 13516 "formatos" => array:3 [ "EPUB" => 346 "HTML" => 12336 "PDF" => 834 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Intravascular haemolysis and renal failure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "621" "paginaFinal" => "622" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemólisis intravascular y fracaso renal" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10941_108_21740_en_f1.10941.jpg" "Alto" => 292 "Ancho" => 600 "Tamanyo" => 94454 ] ] "descripcion" => array:1 [ "en" => "Comparing LDH evolution in two patients." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Rosado Rubio, P. Fraile Gómez, P. García Cosmes, R. Díez Bandera, C. González Álvarez" "autores" => array:5 [ 0 => array:2 [ "Iniciales" => "C." "apellidos" => "Rosado Rubio" ] 1 => array:2 [ "Iniciales" => "P." "apellidos" => "Fraile Gómez" ] 2 => array:2 [ "Iniciales" => "P." "apellidos" => "García Cosmes" ] 3 => array:2 [ "Iniciales" => "R." "apellidos" => "Díez Bandera" ] 4 => array:2 [ "Iniciales" => "C." "apellidos" => "González Álvarez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X021169951105235X" "doi" => "10.3265/Nefrologia.pre2011.Jun.10941" "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/X021169951105235X?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052357?idApp=UINPBA000064" "url" => "/20132514/0000003100000005/v0_201502091634/X2013251411052357/v0_201502091634/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251411052373" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.Jun.10934" "estado" => "S300" "fechaPublicacion" => "2011-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2011;31:618-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4911 "formatos" => array:3 [ "EPUB" => 282 "HTML" => 4069 "PDF" => 560 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Role of acute tubular necrosis with blood cast during endocapillary proliferative glomerulonephritis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "618" "paginaFinal" => "619" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papel de la necrosis tubular aguda por cilindros hemáticos en la glomerulonefritis proliferativa endocapilar" ] ] "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" => "10934_108_21734_en_f110934.jpg" "Alto" => 234 "Ancho" => 600 "Tamanyo" => 226052 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.D. Sánchez de la Nieta, L. González, E. Olazo, S. Anaya, M. Arrambarri, A. Romera, C. Vozmediano, I. Ferreras, F. Rivera" "autores" => array:9 [ 0 => array:2 [ "Iniciales" => "M.D." "apellidos" => "Sánchez de la Nieta" ] 1 => array:2 [ "Iniciales" => "L." "apellidos" => "González" ] 2 => array:2 [ "Iniciales" => "E." "apellidos" => "Olazo" ] 3 => array:2 [ "Iniciales" => "S." "apellidos" => "Anaya" ] 4 => array:2 [ "Iniciales" => "M." "apellidos" => "Arrambarri" ] 5 => array:2 [ "Iniciales" => "A." "apellidos" => "Romera" ] 6 => array:2 [ "Iniciales" => "C." "apellidos" => "Vozmediano" ] 7 => array:2 [ "Iniciales" => "I." "apellidos" => "Ferreras" ] 8 => array:2 [ "Iniciales" => "F." "apellidos" => "Rivera" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699511052376" "doi" => "10.3265/Nefrologia.pre2011.Jun.10934" "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/X0211699511052376?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052373?idApp=UINPBA000064" "url" => "/20132514/0000003100000005/v0_201502091634/X2013251411052373/v0_201502091634/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Libman-Sacks endocarditis and severe aortic regurgitation in a patient with systemic lupus erythematosus in peritoneal dialysis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "619" "paginaFinal" => "621" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Y. Barreiro Delgado, I. García Méndez, N. Martín Alemany, J. Calabia Martínez, M. Morales Fornos, M. Fuertes, M. Vallès Prats" "autores" => array:7 [ 0 => array:4 [ "Iniciales" => "Y." "apellidos" => "Barreiro Delgado" "email" => array:1 [ 0 => "yai_1980@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "I." "apellidos" => "García Méndez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "Iniciales" => "N." "apellidos" => "Martín Alemany" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "J." "apellidos" => "Calabia Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "Iniciales" => "M." "apellidos" => "Morales Fornos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 5 => array:3 [ "Iniciales" => "M." "apellidos" => "Fuertes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 6 => array:3 [ "Iniciales" => "M." "apellidos" => "Vallès Prats" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Nefrología, Hospital Josep Trueta, Girona, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => " Unidad de Nefrología, Hospital Josep Trueta, Girona, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Unidad de Cardiología, Hospital Josep Trueta, Girona, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Endocarditis de Libman-Sacks e insuficiencia aórtica grave en un paciente con lupus eritematoso sistémico en diálisis peritoneal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10939_108_21737_en_f1.10939.jpg" "Alto" => 467 "Ancho" => 600 "Tamanyo" => 203514 ] ] "descripcion" => array:1 [ "en" => "Massive aortic regurgitation." ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor, </span></p><p class="elsevierStylePara">Libman-Sacks endocarditis is the most classic heart disorder associated with systemic lupus erythematosus (SLE) and is a serious cause of morbidity and mortality. For some patients undergoing peritoneal dialysis (PD) lupic activity markers remain positive after having started treatment, with accompanying clinical symptoms, especially serositis or vasculitis.</p><p class="elsevierStylePara">We present the case of a 46-year-old female, affected by advanced type IV lupus nephropathy, undergoing a PD programme since February 2009. Since then, she has presented with positive markers. She was suffering flare on her skin and joints, and received sodium mycophenolate at a dosage of 180mg and prednisone at 5mg daily. She is on the waiting list for a kidney transplant. The only PD complication that she experienced was an episode of peritonitis, in June of the same year.</p><p class="elsevierStylePara">She was admitted because of dyspnoea and general progressive discomfort, which had lasted for 15 days. During the last days she had chest pain in the left hemithorax, which increased when she breathed deeply and improved relatively in anteversion. She did not have a fever or any other clinical symptoms.</p><p class="elsevierStylePara">In the physical examination, a diastolic murmur was found in the aortic area, which extended to the carotids, with a significant pericardial friction, but there were no signs of heart failure. The rest of physical examination was normal.</p><p class="elsevierStylePara">The biochemical tests found: leukocytes: *21.3K/µl (4.4-11.3), band cells: 3%, neutrophils: * 92.0% (50-70), lymphocytes: * 3.0% (25-40), C-reactive protein (CRP): * 17.73mg/dl (0.1-0.5), procalcitonin: * 4.84ng/ml (<0.5). Antinuclear antibodies (indirect immunofluorescence [IIF]): 320-640 u arb (0-80), anti-DNA antibodies (enzyme immuno-assay): 1.3ml (<10IU/ml), anti-DNA antibodies (IIF): 80-640 u arb (0-80), cardiolipin antibodies (IgG): 3.5IU GPL/ml, IgM: 2.5IU GPL/ml (negatives), C3: 118mg/dl (79-152), C4: 24.4mg/dl (16-38), urea 127, creatinine: 8.46mg/dl; haemoglobin (Hb): 9.6g/dl, haemocrit: 29%. Cephalin time test: 27.9/30 seconds (29-31s), positive lupus anticoagulant.</p><p class="elsevierStylePara">A cardiac ultrasound was performed, showing massive aortic regurgitation (AR) with a preserved left ventricular ejection fraction (LVEF) (69%). Three vegetations were found in the aortic valve, and the largest one measured 20mm. A pericardial haemorrhage was also observed without signs of heart block or thrombi (Figures 1 and 2).</p><p class="elsevierStylePara">All of the blood and serum cultures were negative. Chest, abdominal and cranial computed tomography (CT) did not show any significant changes.</p><p class="elsevierStylePara">Daily dialysis was indicated given the evidence of pericarditis and the uraemic evidence. With the diagnosis of endocarditis and awaiting the haemocultures, treatment with empirical antibiotics was started with vancomycin + ceftazidime + gentamicin. Given the suspicion of lupus activity, the prednisone dose was increased to 60mg/24 hours and the sodium mycophenolate dose to 180mg/12 hours.</p><p class="elsevierStylePara">After eight days of treatment, a control echocardiogram was performed which showed that the pericardial leakage had reduced and that the severe AR was persistent, with an image of swaying vegetation. Lastly, blood cultures were negative.</p><p class="elsevierStylePara">Given the severity of AI, it was decided that the valve should be repaired surgically, and a mechanical prosthesis placed. The anatomopathological diagnosis of the valvular piece informed of an aortic endocarditis with no evidence of microorganisms (Libman-Sacks endocarditis). On the pericardium a fibrinous chronic pericarditis was observed.</p><p class="elsevierStylePara">At present, two months after heart surgery, the patient has returned to the PD programme, with no clinical signs of lupus activity, maintaining positive immunological markers and undergoing treatment with sodium mycophenolate at a dose of 180mg/12 hours and prednisone at a dose of 50mg/24 hours.</p><p class="elsevierStylePara"><a href="grande/10939_108_21737_en_f1.10939.jpg" class="elsevierStyleCrossRefs"><img src="10939_108_21737_en_f1.10939.jpg" alt="Massive aortic regurgitation."></img></a></p><p class="elsevierStylePara">Figure 1. Massive aortic regurgitation.</p><p class="elsevierStylePara"><a href="grande/10939_108_21738_en_f2.109392.jpg" class="elsevierStyleCrossRefs"><img src="10939_108_21738_en_f2.109392.jpg" alt="Large vegetation adhered to the right coronary sigmoid"></img></a></p><p class="elsevierStylePara">Figure 2. Large vegetation adhered to the right coronary sigmoid</p>" "pdfFichero" => "P1-E524-S3359-A10939-EN.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10939_108_21737_en_f1.10939.jpg" "Alto" => 467 "Ancho" => 600 "Tamanyo" => 203514 ] ] "descripcion" => array:1 [ "en" => "Massive aortic regurgitation." ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10939_108_21738_en_f2.109392.jpg" "Alto" => 475 "Ancho" => 600 "Tamanyo" => 175439 ] ] "descripcion" => array:1 [ "en" => "Large vegetation adhered to the right coronary sigmoid" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "1.\u{A0}Bouma W,\u{A0}Klinkengerg TJ,\u{A0}Van der Horst ICC,\u{A0}Wijdh-den Hamer IJ,\u{A0}Erasmus ME,\u{A0}Bijl M, et al. Mitral valve surgery for mitral regurgitation caused by Libman-Sacks endocarditis: a report of four cases and a systemic review of literature.\u{A0}J Cardiothor Surg 2010;5:1-13." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Roldan CA, Shively BK, Lau CC, Gurule FT, Smith EA, Crawford MH. Systemic lupus erythematus valve disease by transesophageal echocardiography and role of antifosfolipidid antibodies. J Am Coll Cardiol 1992;20:1127-34. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1341885" 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" => "Moyssakis I,\u{A0}Tektonidou MG, Vasillous A,\u{A0}Samarkos M,\u{A0}Votteas V,\u{A0}Moutsopoulos HM. Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution.\u{A0}Am J Med 2007;120:636-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17602939" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0735109711046158" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Grzegorzewska AE, Leander M. Lymphocyte subsets in the course of continuos ambulatory peritoneal dialysis. Perit Dial 2001;17:10-4." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Young Suck Goo, Hyeon Cheon Park, Hooon Young Choi.\u{A0}The evolution of lupus activity among patients with end- stage renal disease secondary to lupus nephritis. Yonsei Med J 2004;45(2):199-206. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15118989" 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" => "Chih-Chia Liang, Chiu-Ching Huang, I-Kuan Wang, Chiz-Tzung, Kuan-Hsing Chen, Cheng-Hao Weng, et al. Impact of renal survival on the course and outcome of systemic lupus erythemayosus patients treated with chronic peritoneal dialysis. Ther Apher Dial 2009;14:35-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20438518" 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" => "Yui Pong\u{A0}Siu, Kay Tai Leung, Matthew Ka Hang Tong, Tze Hoi Kwan, Chi Chiu Mok. Clinical outcomes of systemic lupus erythematosus patients undergoing continous ambulatory peritoneal dialysis. Nephrol Dial Transplant 2005;20:2797-802. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16204302" 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" => "Szeto CC, Li PK. Reactivation of systemic lupus erythematosus after end-stage renal disease. J Rheumatol 1998;25:1520-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9712094" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003100000005/v0_201502091634/X2013251411052365/v0_201502091634/en/main.assets" "Apartado" => array:4 [ "identificador" => "35437" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000005/v0_201502091634/X2013251411052365/v0_201502091634/en/P1-E524-S3359-A10939-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052365?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 6 | 16 |
| 2024 October | 70 | 30 | 100 |
| 2024 September | 84 | 29 | 113 |
| 2024 August | 88 | 71 | 159 |
| 2024 July | 70 | 26 | 96 |
| 2024 June | 92 | 58 | 150 |
| 2024 May | 94 | 46 | 140 |
| 2024 April | 68 | 43 | 111 |
| 2024 March | 82 | 30 | 112 |
| 2024 February | 74 | 46 | 120 |
| 2024 January | 82 | 26 | 108 |
| 2023 December | 49 | 31 | 80 |
| 2023 November | 55 | 31 | 86 |
| 2023 October | 64 | 26 | 90 |
| 2023 September | 63 | 42 | 105 |
| 2023 August | 74 | 34 | 108 |
| 2023 July | 94 | 43 | 137 |
| 2023 June | 98 | 30 | 128 |
| 2023 May | 102 | 42 | 144 |
| 2023 April | 61 | 28 | 89 |
| 2023 March | 63 | 30 | 93 |
| 2023 February | 78 | 24 | 102 |
| 2023 January | 74 | 30 | 104 |
| 2022 December | 76 | 32 | 108 |
| 2022 November | 80 | 40 | 120 |
| 2022 October | 69 | 47 | 116 |
| 2022 September | 58 | 48 | 106 |
| 2022 August | 71 | 37 | 108 |
| 2022 July | 69 | 40 | 109 |
| 2022 June | 91 | 33 | 124 |
| 2022 May | 119 | 39 | 158 |
| 2022 April | 86 | 60 | 146 |
| 2022 March | 99 | 52 | 151 |
| 2022 February | 104 | 42 | 146 |
| 2022 January | 114 | 37 | 151 |
| 2021 December | 103 | 45 | 148 |
| 2021 November | 75 | 53 | 128 |
| 2021 October | 84 | 46 | 130 |
| 2021 September | 78 | 49 | 127 |
| 2021 August | 103 | 35 | 138 |
| 2021 July | 66 | 39 | 105 |
| 2021 June | 101 | 33 | 134 |
| 2021 May | 94 | 46 | 140 |
| 2021 April | 177 | 66 | 243 |
| 2021 March | 161 | 34 | 195 |
| 2021 February | 88 | 19 | 107 |
| 2021 January | 54 | 21 | 75 |
| 2020 December | 52 | 19 | 71 |
| 2020 November | 55 | 13 | 68 |
| 2020 October | 46 | 20 | 66 |
| 2020 September | 37 | 16 | 53 |
| 2020 August | 50 | 13 | 63 |
| 2020 July | 54 | 8 | 62 |
| 2020 June | 53 | 11 | 64 |
| 2020 May | 82 | 16 | 98 |
| 2020 April | 49 | 18 | 67 |
| 2020 March | 56 | 14 | 70 |
| 2020 February | 63 | 23 | 86 |
| 2020 January | 71 | 19 | 90 |
| 2019 December | 71 | 33 | 104 |
| 2019 November | 78 | 18 | 96 |
| 2019 October | 51 | 14 | 65 |
| 2019 September | 59 | 21 | 80 |
| 2019 August | 53 | 17 | 70 |
| 2019 July | 55 | 24 | 79 |
| 2019 June | 58 | 13 | 71 |
| 2019 May | 97 | 23 | 120 |
| 2019 April | 112 | 39 | 151 |
| 2019 March | 54 | 17 | 71 |
| 2019 February | 40 | 18 | 58 |
| 2019 January | 47 | 10 | 57 |
| 2018 December | 168 | 43 | 211 |
| 2018 November | 182 | 17 | 199 |
| 2018 October | 159 | 13 | 172 |
| 2018 September | 121 | 14 | 135 |
| 2018 August | 73 | 17 | 90 |
| 2018 July | 87 | 14 | 101 |
| 2018 June | 79 | 16 | 95 |
| 2018 May | 85 | 16 | 101 |
| 2018 April | 90 | 7 | 97 |
| 2018 March | 91 | 11 | 102 |
| 2018 February | 87 | 1 | 88 |
| 2018 January | 104 | 8 | 112 |
| 2017 December | 88 | 9 | 97 |
| 2017 November | 56 | 6 | 62 |
| 2017 October | 52 | 8 | 60 |
| 2017 September | 41 | 4 | 45 |
| 2017 August | 39 | 6 | 45 |
| 2017 July | 42 | 7 | 49 |
| 2017 June | 49 | 3 | 52 |
| 2017 May | 81 | 13 | 94 |
| 2017 April | 53 | 8 | 61 |
| 2017 March | 43 | 11 | 54 |
| 2017 February | 109 | 7 | 116 |
| 2017 January | 36 | 7 | 43 |
| 2016 December | 55 | 7 | 62 |
| 2016 November | 82 | 8 | 90 |
| 2016 October | 137 | 6 | 143 |
| 2016 September | 208 | 1 | 209 |
| 2016 August | 186 | 4 | 190 |
| 2016 July | 143 | 0 | 143 |
| 2016 June | 128 | 0 | 128 |
| 2016 May | 102 | 0 | 102 |
| 2016 April | 81 | 0 | 81 |
| 2016 March | 82 | 0 | 82 |
| 2016 February | 104 | 0 | 104 |
| 2016 January | 88 | 0 | 88 |
| 2015 December | 102 | 0 | 102 |
| 2015 November | 69 | 0 | 69 |
| 2015 October | 62 | 0 | 62 |
| 2015 September | 68 | 0 | 68 |
| 2015 August | 63 | 0 | 63 |
| 2015 July | 65 | 0 | 65 |
| 2015 June | 50 | 0 | 50 |
| 2015 May | 50 | 0 | 50 |
| 2015 April | 5 | 0 | 5 |
Show all
