array:21 [
  "pii" => "X2013251412002221"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Aug.11645"
  "estado" => "S300"
  "fechaPublicacion" => "2012-11-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2012;32:824-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 6226
    "formatos" => array:3 [
      "EPUB" => 319
      "HTML" => 5222
      "PDF" => 685
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699512002224"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Aug.11645"
      "estado" => "S300"
      "fechaPublicacion" => "2012-11-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2012;32:824-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 12828
        "formatos" => array:3 [
          "EPUB" => 302
          "HTML" => 11835
          "PDF" => 691
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "titulo" => "Ateroembolia de colesterol y tratamiento combinado con esteroides e iloprost"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "824"
            "paginaFinal" => "828"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Cholesterol atheroembolism and combined treatment with steroids and iloprost"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "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" => "11645_19759_34803_es_11645_f1.jpg"
                "Alto" => 295
                "Ancho" => 600
                "Tamanyo" => 86110
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Evolución de la función renal"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Angel Manuel Sevillano Prieto, Ángel M. Sevillano-Prieto, Eduardo Hernández Martínez, Eduardo Hernández-Martínez, Jara Caro Espada, Jara Caro-Espada, Maria Molina Gomez, María Molina-Gómez, Eduardo Gutiérrez Martínez, Eduardo Gutiérrez-Martínez, Enrique Morales Ruiz, Enrique Morales-Ruiz, Ester Gonzalez Monte, Ester González-Monte, Manuel Praga Terente, Manuel Praga-Terente"
            "autores" => array:16 [
              0 => array:2 [
                "nombre" => "Angel Manuel"
                "apellidos" => "Sevillano Prieto"
              ]
              1 => array:2 [
                "nombre" => "Ángel M."
                "apellidos" => "Sevillano-Prieto"
              ]
              2 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "Hernández Martínez"
              ]
              3 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "Hernández-Martínez"
              ]
              4 => array:2 [
                "nombre" => "Jara"
                "apellidos" => "Caro Espada"
              ]
              5 => array:2 [
                "nombre" => "Jara"
                "apellidos" => "Caro-Espada"
              ]
              6 => array:2 [
                "nombre" => "Maria"
                "apellidos" => "Molina Gomez"
              ]
              7 => array:2 [
                "nombre" => "María"
                "apellidos" => "Molina-Gómez"
              ]
              8 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "Gutiérrez Martínez"
              ]
              9 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "Gutiérrez-Martínez"
              ]
              10 => array:2 [
                "nombre" => "Enrique"
                "apellidos" => "Morales Ruiz"
              ]
              11 => array:2 [
                "nombre" => "Enrique"
                "apellidos" => "Morales-Ruiz"
              ]
              12 => array:2 [
                "nombre" => "Ester"
                "apellidos" => "Gonzalez Monte"
              ]
              13 => array:2 [
                "nombre" => "Ester"
                "apellidos" => "González-Monte"
              ]
              14 => array:2 [
                "nombre" => "Manuel"
                "apellidos" => "Praga Terente"
              ]
              15 => array:2 [
                "nombre" => "Manuel"
                "apellidos" => "Praga-Terente"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251412002221"
          "doi" => "10.3265/Nefrologia.pre2012.Aug.11645"
          "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/X2013251412002221?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512002224?idApp=UINPBA000064"
      "url" => "/02116995/0000003200000006/v0_201502091338/X0211699512002224/v0_201502091339/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251412002213"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jul.11532"
    "estado" => "S300"
    "fechaPublicacion" => "2012-11-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:829-34"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5128
      "formatos" => array:3 [
        "EPUB" => 291
        "HTML" => 4168
        "PDF" => 669
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "A successful clinical case of encapsulating peritoneal sclerosis ' surgical management using enterolysis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "829"
          "paginaFinal" => "834"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Éxito en caso clínico de esclerosis peritoneal encapsulante: tratamiento quirúrgico mediante enterólisis"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11532_16025_31058_en_t111532_copia.jpg"
              "Alto" => 771
              "Ancho" => 2172
              "Tamanyo" => 551125
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Potential biomarkers for monitoring membrane injury"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => " Diálise Peritoneal dos C.H.U.C, Patrícia Neto"
          "autores" => array:2 [
            0 => array:1 [
              "apellidos" => "Diálise Peritoneal dos C.H.U.C"
            ]
            1 => array:2 [
              "nombre" => "Patrícia"
              "apellidos" => "Neto"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512002216"
        "doi" => "10.3265/Nefrologia.pre2012.Jul.11532"
        "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/X0211699512002216?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002213?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000006/v0_201502091602/X2013251412002213/v0_201502091603/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X201325141200223X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Sep.11631"
    "estado" => "S300"
    "fechaPublicacion" => "2012-11-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:819-23"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 6590
      "formatos" => array:3 [
        "EPUB" => 288
        "HTML" => 5629
        "PDF" => 673
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "acute renal failure predictors in elderly patients with chronic kidney disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "819"
          "paginaFinal" => "823"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Factores predictores de fracaso renal agudo en ancianos con enfermedad renal crónica"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11631_16025_38375_en_t111631_copia.jpg"
              "Alto" => 772
              "Ancho" => 2177
              "Tamanyo" => 632306
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Comparison of the sociodemographic characteristics, parameters of renal function, haematocrit, and comorbidity during the baseline period between elderly patients with and without at least one episode of acute renal failure during a 36-month monitoring pe"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "MANUEL HERAS, Manuel Heras, MARIA JOSE FERNANDEZ-REYES, M. José Fernández-Reyes, MARIA TERESA GUERRERO, M. Teresa Guerrero, ROSA SANCHEZ, Rosa Sánchez, ANGELICA MUÑOZ, Angélica Muñoz, ALVARO MOLINA, Álvaro Molina, MARIA ASTRID RODRIGUEZ, M. Astrid Rodríguez"
          "autores" => array:14 [
            0 => array:2 [
              "nombre" => "MANUEL"
              "apellidos" => "HERAS"
            ]
            1 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Heras"
            ]
            2 => array:2 [
              "nombre" => "MARIA JOSE"
              "apellidos" => "FERNANDEZ-REYES"
            ]
            3 => array:2 [
              "nombre" => "M. José"
              "apellidos" => "Fernández-Reyes"
            ]
            4 => array:2 [
              "nombre" => "MARIA TERESA"
              "apellidos" => "GUERRERO"
            ]
            5 => array:2 [
              "nombre" => "M. Teresa"
              "apellidos" => "Guerrero"
            ]
            6 => array:2 [
              "nombre" => "ROSA"
              "apellidos" => "SANCHEZ"
            ]
            7 => array:2 [
              "nombre" => "Rosa"
              "apellidos" => "Sánchez"
            ]
            8 => array:2 [
              "nombre" => "ANGELICA"
              "apellidos" => "MUÑOZ"
            ]
            9 => array:2 [
              "nombre" => "Angélica"
              "apellidos" => "Muñoz"
            ]
            10 => array:2 [
              "nombre" => "ALVARO"
              "apellidos" => "MOLINA"
            ]
            11 => array:2 [
              "nombre" => "Álvaro"
              "apellidos" => "Molina"
            ]
            12 => array:2 [
              "nombre" => "MARIA ASTRID"
              "apellidos" => "RODRIGUEZ"
            ]
            13 => array:2 [
              "nombre" => "M. Astrid"
              "apellidos" => "Rodríguez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512002232"
        "doi" => "10.3265/Nefrologia.pre2012.Sep.11631"
        "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/X0211699512002232?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141200223X?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000006/v0_201502091602/X201325141200223X/v0_201502091603/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Cholesterol atheroembolism and combined treatment with steroids and iloprost"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "824"
        "paginaFinal" => "828"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Angel Manuel Sevillano Prieto, Ángel M. Sevillano-Prieto, Eduardo Hernández Martínez, Eduardo Hernández-Martínez, Jara Caro Espada, Jara Caro-Espada, Maria Molina Gomez, María Molina-Gómez, Eduardo Gutiérrez Martínez, Eduardo Gutiérrez-Martínez, Enrique Morales Ruiz, Enrique Morales-Ruiz, Ester Gonzalez Monte, Ester González-Monte, Manuel Praga Terente, Manuel Praga-Terente"
        "autores" => array:16 [
          0 => array:4 [
            "nombre" => "Angel Manuel"
            "apellidos" => "Sevillano Prieto"
            "email" => array:1 [
              0 => "sevillano.am@gmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "&#193;ngel M&#46;"
            "apellidos" => "Sevillano-Prieto"
            "email" => array:1 [
              0 => "sevillano&#46;am&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "Hern&#225;ndez Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "Hern&#225;ndez-Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Jara"
            "apellidos" => "Caro Espada"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Jara"
            "apellidos" => "Caro-Espada"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Maria"
            "apellidos" => "Molina Gomez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Mar&#237;a"
            "apellidos" => "Molina-G&#243;mez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "Guti&#233;rrez Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "Guti&#233;rrez-Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "Enrique"
            "apellidos" => "Morales Ruiz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          11 => array:3 [
            "nombre" => "Enrique"
            "apellidos" => "Morales-Ruiz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          12 => array:3 [
            "nombre" => "Ester"
            "apellidos" => "Gonzalez Monte"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          13 => array:3 [
            "nombre" => "Ester"
            "apellidos" => "Gonz&#225;lez-Monte"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          14 => array:3 [
            "nombre" => "Manuel"
            "apellidos" => "Praga Terente"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          15 => array:3 [
            "nombre" => "Manuel"
            "apellidos" => "Praga-Terente"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España, Spain, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Ateroembolia de colesterol y tratamiento combinado con esteroides e iloprost"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11645_16025_38053_en_f111645_copia.jpg"
            "Alto" => 1035
            "Ancho" => 2114
            "Tamanyo" => 340967
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Evolution of renal function"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Cholesterol atheroembolism &#40;CAE&#41; is a disease with a poor prognosis&#46; The pathogenesis of this disease is based on the impact of cholesterol crystals derived from atheromatous plaques in small vessels&#46;<span class="elsevierStyleSup">1</span> In recent years&#44; the incidence of CAE has increased as the result of a burgeoning population of individuals that are particularly susceptible to this disease &#40;elderly patients&#44; those with diabetes&#44; hypertension&#44; and dyslipidaemia&#41; in addition to a greater frequency of triggering factors &#40;endovascular procedures&#44; anti-coagulation treatment&#41;&#46;<span class="elsevierStyleSup">2</span> CAE produces important rates of morbidity and mortality&#44; which increase when the kidneys are also involved&#46; Renal function is recovered following this disease in only 25&#37; of cases&#46;<span class="elsevierStyleSup">1&#44;2</span></p><p class="elsevierStylePara">The management of CAE is a complicated task due to the lack of unified treatment criteria in the medical literature&#46; It does appear that these patients benefit from a strict control of cardiovascular risk factors in order to prevent the development of this disease&#46;<span class="elsevierStyleSup">3&#44;4</span> However&#44; there is no agreement regarding the measures to take when the disease has already been triggered&#46; Several articles exist in the medical literature suggesting various treatment regimens&#44; although no definitive results have been shown either to refute or support these recommendations&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">In this article&#44; we present the case of a patient with CAE with peripheral vascular and renal involvement who benefited from combined treatment with steroids and prostaglandin analogues &#40;iloprost&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CASE REPORT</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Our patient was a 71-year old female who sought treatment in the nephrology department at our hospital due to an acute deterioration in renal function&#46; The patient&#8217;s relevant background included&#58; arterial hypertension &#40;on treatment with enalapril&#41;&#44; dyslipidaemia&#44; tobacco use&#44; and grade IIA peripheral vascular disease&#44; with Doppler-ultrasound tests indicative of a significant stenosis in the left femoral artery&#46; Basal renal function was normal&#46;</p><p class="elsevierStylePara">In December 2012&#44; the patient underwent an arteriography for peripheral vascular disease&#44; which led to a balloon angioplasty of the superficial femoral artery of the left leg&#44; with 2 stents implanted&#46; After 24 hours&#44; the patient was administered Adiro<span class="elsevierStyleSup">&#174;</span> and low molecular weight heparin &#40;LMWH&#41; and discharged from the hospital&#46; Serum creatinine &#40;Crs&#41; at this moment was 1&#46;26mg&#47;dl&#46;</p><p class="elsevierStylePara">Ten days later&#44; the patient went to the emergency department due to rectal bleeding with no haemodynamic instability &#40;blood pressure&#58; 127&#47;83mm Hg&#41;&#46; Laboratory analysis revealed Hb&#58; 9&#46;8g&#47;dl&#44; 8000 leukocytes&#47;mm<span class="elsevierStyleSup">3</span>&#44; and 17&#37; eosinophils &#40;1400&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#46; Crs was 4&#46;3mg&#47;dl&#46; During the patient&#8217;s stay in the emergency department&#44; treatment with LMWH and enalapril was suspended and volume expansion therapy was started&#46; A colonoscopy was also performed that revealed colonic ulcers indicative of ischaemia&#46; No further rectal bleeding occurred in the following 24 hours&#44; and Crs decreased to 3&#46;42mg&#47;dl&#46; The patient was discharged to her home with a referral to the nephrology department&#44; where she sought further treatment 15 days later&#46;</p><p class="elsevierStylePara">On her visit to the nephrology department&#44; the patient had a Crs of 4&#46;44mg&#47;dl&#44; acidosis&#44; and hyperkalaemia&#44; which motivated her hospitalisation&#46; Upon evaluation&#44; the patient reported the appearance of painful purple-coloured lesions on the toes and soles of both feet&#46; These lesions appeared 10 days after the endovascular procedure and had worsened with time&#46; A biochemical analysis revealed that the eosinophilia continued&#44; and no improvements could be seen in renal function&#46; A urinary sediment analysis revealed isolated leukocytes with no red blood cells&#46; A dilated fundus examination was normal&#44; and a Doppler-ultrasound showed the kidneys to have normal size and good cortical-medullary differentiation&#44; a non-dilated urinary tract&#44; and an absence of stenoses in the renal arteries&#46;</p><p class="elsevierStylePara">Given the patient&#8217;s history of endovascular manipulation&#44; clinical symptoms&#44; and biochemical parameters&#44; we suspected the presence of CAE with renal involvement &#40;known as atheroembolic renal disease &#91;AERD&#93;&#41;&#46; The diagnosis was confirmed with a cutaneous biopsy of the purple lesions on the patient&#8217;s feet&#44; in which we observed the intravascular cholesterol crystals typical of this disease&#46;</p><p class="elsevierStylePara">Given the progressive worsening of renal function &#40;maximum Crs of 5&#46;58mg&#47;dl&#41; and cutaneous lesions&#44; we decided to start treatment with iloprost &#40;2ng&#47;kg&#47;min during 12 hours per day for 14 days&#41;&#44; steroids &#40;1mg&#47;kg&#47;day for one week&#44; followed by a decreasing treatment regimen until complete removal after 3 months&#41; and high doses of statins &#40;atorvastatin at 80mg&#47;24h&#41;&#46;</p><p class="elsevierStylePara">Two days after starting treatment&#44; the patient experienced a progressive improvement in the cutaneous lesions that allowed for reducing the dose of analgesia&#46; This prescription also produced an improvement in renal function&#44; which started one week after starting treatment&#46; Given the good evolution of the patient&#8217;s condition&#44; she was discharged to her home one month after hospitalisation&#46; Crs upon discharge was 2&#46;99mg&#47;dl&#44; and 3 months after hospitalisation&#44; Crs was down to 1&#46;9mg&#47;dl &#40;Figure 1&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">CAE is a systemic disease that produces high rates of morbidity and mortality&#46; It can affect any organ system throughout the body&#44; with the most commonly affected organs being the kidneys&#44; gastrointestinal tract&#44; and the skin&#46; CAE produces a mortality rate after one year that ranges between 30&#37; and 80&#37;&#44; according to studies&#46; When CAE produces renal involvement &#40;AERD&#41;&#44; the progression of the disease tends to be quite severe&#44; necessitating dialysis in 40&#37; of cases&#46; Only 25&#37; of these patients eventually recover renal function&#46;<span class="elsevierStyleSup">3-4</span> The differential diagnosis of this disease also includes several different entities&#44; such as contrast-induced nephropathy and immunoallergic interstitial nephritis&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">Two different treatment protocols exist for patients with CAE&#46; The first is designed to avoid the reappearance of CAE by controlling cardiovascular risk factors &#40;blood pressure and atheromatous plaques&#41; and avoiding exposure of the patient to factors that could trigger symptoms &#40;anti-coagulants&#44; endovascular interventions&#41;&#46; The other type of treatment attempts to reduce the level of ischaemia produced in affected organs in order to improve their functioning&#46; Drugs in this second treatment type include steroids and prostaglandin analogues&#46;<span class="elsevierStyleSup">6</span></p><p class="elsevierStylePara">Several studies have shown that preventative measures reduce the mortality of patients with CAE&#46;<span class="elsevierStyleSup">2&#44;4</span> However&#44; the use of specific treatment measures to combat the disease continues to be the subject of much debate&#46;</p><p class="elsevierStylePara">The pathogenesis of CAE is based on the release of cholesterol crystals from atheromatous plaques that accumulate and obstruct small vessels&#44; producing ischaemic damage in various organs of the body&#46; A histopathological analysis reveals an important inflammatory component in the form of a reaction to the cholesterol crystals as foreign bodies&#46; This inflammatory component also contributes to the vascular obstruction that produces ischaemia&#46;<span class="elsevierStyleSup">1&#44;2</span> Through steroid treatment&#44; we attempt to improve the inflammatory component of the embolism by increasing distal blood flow to the vascular obstruction and reducing ischaemic damage&#46; Experimentally&#44; this mechanism has not been demonstrated <span class="elsevierStyleItalic">in vivo</span>&#46; In studies published of cases treated with steroids&#44; arguments have been presented both in favour and against this treatment alternative for improving renal function&#46; For example&#44; in a study involving three Spanish hospitals &#40;Hospital Parc Taul&#237; de Sabadell&#44; Hospital de Ciudad Real and Hospital 12 de octubre&#41;&#44;<span class="elsevierStyleSup">7</span> which examined 45 cases of CAE&#44; no beneficial effects were observed from steroid use&#46; However&#44; the overall trend in studies published on this disease appears to be improved symptoms of skin and gastrointestinal ischaemia in patients treated with steroids&#46;<span class="elsevierStyleSup">8-10</span></p><p class="elsevierStylePara">Recently&#44; prostaglandin analogues &#40;iloprost&#41; have been added to the treatment arsenal against CAE&#46; These drugs have important vasodilatory and anti-platelet activity&#44; making them ideal for use in various diseases with ischaemic components&#44; with good results&#46;<span class="elsevierStyleSup">11</span> Iloprost was first used for the treatment of CAE with cutaneous lesions in 1995&#46; Treatment was effective&#44; with improvements observed in cutaneous lesions and pain&#46;<span class="elsevierStyleSup">12</span> Since then&#44; six cases have been published in which iloprost was used to treat CAE&#46;<span class="elsevierStyleSup">13-15 </span>In all of these&#44; clear improvements were observed in terms of cutaneous lesions and pain&#44; and 50&#37; of the patients also enjoyed an improvement of renal function&#46; In almost all of these cases&#44; combined treatment was administered with iloprost and steroids &#40;Table 1&#41;<span class="elsevierStyleSup">&#46;11-14</span></p><p class="elsevierStylePara">Our patient had CAE with important renal&#44; cutaneous&#44; and gastrointestinal involvement&#46; After reviewing the pertinent medical literature&#44; and in light of the poor evolution of the patient&#8217;s condition&#44; we decided to apply combined therapy with steroids and iloprost&#46; After starting treatment&#44; we observed clear improvements in the cutaneous lesions and pain&#44; with reduced requirements for analgesic prescriptions&#46; Additionally&#44; renal function&#44; which until this point had suffered progressive deterioration&#44; started to improve 48 hours following the start of treatment&#46; Currently&#44; the patient&#8217;s Crs is 1&#46;9mg&#47;dl&#46;</p><p class="elsevierStylePara">Our case reflects the experiences of other case reports and provides a certain level of optimism for the use of combined therapy with steroids and iloprost&#46;</p><p class="elsevierStylePara">Combined therapy does not produce a recovery of renal function in all patients&#44; but it does improve extra-renal symptoms&#44; which are often the most important drivers of the prognosis in these patients&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">One very important factor in the response of CAE to treatment is the moment in which treatment is started&#46; Given the pathogenesis of the disease&#44; it is essential to start treatment as soon as possible&#46; If delayed&#44; the affected parenchyma suffers an even greater degree of damage and the probability of recovered function decreases&#46; This parameter has not been evaluated in any studies to date&#44; and may improve the rate of recovery of renal function in these patients&#46;</p><p class="elsevierStylePara">No studies involving the combined treatment of this condition with steroids and iloprost have described important adverse effects&#46; In all of these&#44; the steroids used were at low doses and for short periods of times&#46;</p><p class="elsevierStylePara">The aforementioned arguments along with an absence of other treatment alternatives leads us to suggest that combined treatment with steroids and iloprost should be considered for the treatment of patients with CAE and organ damage&#46; This therapy should be started as soon as possible in order to optimise results&#46; This should also be confirmed through the application of prospective and randomised clinical studies&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors state that they have no potential conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11645&#95;16025&#95;38053&#95;en&#95;f111645&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11645_16025_38053_en_f111645_copia.jpg" alt="Evolution of renal function"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Evolution of renal function</p><p class="elsevierStylePara"><a href="grande&#47;11645&#95;16025&#95;38054&#95;en&#95;t111645&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11645_16025_38054_en_t111645_copia.jpg" alt="Review of the use of iloprost in cases of cholesterol atheroembolism"></img></a></p><p class="elsevierStylePara">Table 1&#46; Review of the use of iloprost in cases of cholesterol atheroembolism</p>"
    "pdfFichero" => "P1-E544-S3766-A11645-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:3 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437185"
          "palabras" => array:1 [
            0 => "Ateroembolia de colesterol"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437187"
          "palabras" => array:1 [
            0 => "Esteroides"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437189"
          "palabras" => array:1 [
            0 => "Prostaglandina"
          ]
        ]
      ]
      "en" => array:3 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437186"
          "palabras" => array:1 [
            0 => "Cholesterol atheroembolic"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437188"
          "palabras" => array:1 [
            0 => "Steroids"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437190"
          "palabras" => array:1 [
            0 => "Prostaglandine"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara">La ateroembolia de colesterol &#40;AEC&#41; es una enfermedad sist&#233;mica cuya incidencia ha aumentado en las &#250;ltimas d&#233;cadas y que presenta una elevada morbimortalidad&#46; En el momento actual se desconocen cu&#225;les son las alternativas terap&#233;uticas m&#225;s efectivas en esta entidad&#46; En este art&#237;culo presentamos el caso de una paciente diagnosticada de AEC con afectaci&#243;n cut&#225;nea&#44; intestinal y renal&#44; que present&#243; una buena evoluci&#243;n tras el inicio de terapia combinada con esteroides y an&#225;logos de las prostaglandinas&#46; A pesar de que no existen estudios concluyentes&#44; sugerimos esta alternativa para el manejo de AEC con afectaci&#243;n org&#225;nica&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara">Cholesterol atheroembolism &#40;CAE&#41; is a systemic disorder whose incidence has increased in recent decades and that presents high morbidity and mortality&#46; Although several therapeutic alternatives have been reported&#44; there is no consensus about the best treatment for this disease&#46; In this paper we report the case of a patient with CAE with skin&#44; bowel and kidney involvement who presented a good response to combined therapy with steroids and prostaglandin analogues&#46; Although there are no conclusive studies&#44; we recommend this therapeutic alternative in the management of CAE with organic failure&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11645_16025_38053_en_f111645_copia.jpg"
            "Alto" => 1035
            "Ancho" => 2114
            "Tamanyo" => 340967
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Evolution of renal function"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11645_16025_38054_en_t111645_copia.jpg"
            "Alto" => 2004
            "Ancho" => 2168
            "Tamanyo" => 952833
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Review of the use of iloprost in cases of cholesterol atheroembolism"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Meyrier A. Cholesterol crystal embolism: Diagnosis and Treatment. Kidney Int 2006;69:1308-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16614719" 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" => "Scolari F, Ravani P. Atheroembolic renal disease. Lancet 2010;375:1650-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20381857" 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" => "Fine MJ, Kapoor W, Falaga V. Cholesterol crystal embolization: A review of 221 cases in the English literature. Angiology 1987;42:769-84."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Belenfant X, Meyrier A, Jacquot C. Supportive treatment improves survival in multivisceral cholesterol crystal embolism. Am J Kidney Dis 1999;33:840-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10213638" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673611612154"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Espejo B, Herrero JC, Torres A, Martínez A, Gutiérrez E, Morales E, et al. Nefritis intersticial inmunoalérgica vs ateroembolismo de colesterol.\u{A0}Características diferenciales. Nefrologia 2003;2:25-30."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Venturelli C, Jeannin G, Sottini L, Dallera N, Scolari F, Venturelli C. Cholesterol crystal embolism (atheroembolism). Heart Int 2006;2:155. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21977265" 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" => "Gutiérrez-Solís E, Morales E, Rodríguez Jornet A, Andreu FJ, Rivera F, Vozmediano C, et al. Atheroembolic renal disease; analysis of clinical and therapeutic factors that influence its progression. Nefrologia 2010;30:317-23. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20414329" 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" => "Lye WC, Cheah JS, Sinniah R. Renal cholesterol embolic disease. Case report and review of the literature. Am J Nephrol 1993;13:489-93. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8141186" 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" => "Nakahama H, Sakaguchi K. Small doses oral corticosteroids treatment rapidly improved renal function in a patient with an acute aggravation of a chronic renal failure due to cholesterol embolism. Nephrol Dial Transplant 2001;16:872-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11274298" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Takahashi T, Konta T, Nishida W, Igarashi A, Ichikawa K, Kubota I. Renal cholesterol embolic disease effectively treated with steroid pulse therapy. Intern Med 2003;42:1206-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Belch JJ, McKay A, McArdle B, Leiberman P, Pollock JG, Lowe GD, et al. Epoprostenol (prostacyclin) and severe arterial disease. Lancet 1983;1:315-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2893136" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Radauceanu A, Avignon A, Ribstein J, Monnier L. Use of a prostacyclin analogue in cholesterol crystal embolism. Diabet Med 1998;15:262-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9545130" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Elinav E, Chajek\u{AD}Shaul T, Stern M. Improvement in cholesterol emboli syndrome after iloprost therapy. BMJ 2002;324:268-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11823357" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rodríguez Gómez MA, Heras M, Molina Ordas A, Fernández-Reyes MJ, Sánchez R, Álvarez-Ude F. Clinical response to Iloprost treatment in a patient with cholesterol ateroembolic renal disease. Nefrologia 2009;29:494-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19820771" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Grenader T, Lifschitz M, Shavit L. Iloprost in embolic renal failure. Mt Sinai J Med 2005;72:339-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16184298" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003200000006/v0_201502091602/X2013251412002221/v0_201502091603/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/20132514/0000003200000006/v0_201502091602/X2013251412002221/v0_201502091603/en/P1-E544-S3766-A11645-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002221?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Cholesterol atheroembolism and combined treatment with steroids and iloprost
Ateroembolia de colesterol y tratamiento combinado con esteroides e iloprost
Angel Manuel Sevillano Prietoa, Ángel M. Sevillano-Prietob, Eduardo Hernández Martíneza, Eduardo Hernández-Martínezb, Jara Caro Espadaa, Jara Caro-Espadab, Maria Molina Gomeza, María Molina-Gómezb, Eduardo Gutiérrez Martíneza, Eduardo Gutiérrez-Martínezb, Enrique Morales Ruiza, Enrique Morales-Ruizb, Ester Gonzalez Montea, Ester González-Monteb, Manuel Praga Terentea, Manuel Praga-Terenteb
a Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España, Spain,
b Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid,
Read
11012
Times
was read the article
2481
Total PDF
8531
Total HTML
Share statistics
 array:21 [
  "pii" => "X2013251412002221"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Aug.11645"
  "estado" => "S300"
  "fechaPublicacion" => "2012-11-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:824-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 6226
    "formatos" => array:3 [
      "EPUB" => 319
      "HTML" => 5222
      "PDF" => 685
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699512002224"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Aug.11645"
      "estado" => "S300"
      "fechaPublicacion" => "2012-11-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2012;32:824-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 12828
        "formatos" => array:3 [
          "EPUB" => 302
          "HTML" => 11835
          "PDF" => 691
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "titulo" => "Ateroembolia de colesterol y tratamiento combinado con esteroides e iloprost"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "824"
            "paginaFinal" => "828"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Cholesterol atheroembolism and combined treatment with steroids and iloprost"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "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 Espa&#241;a"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "11645_19759_34803_es_11645_f1.jpg"
                "Alto" => 295
                "Ancho" => 600
                "Tamanyo" => 86110
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Evoluci&#243;n de la funci&#243;n renal"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Angel Manuel Sevillano Prieto, &#193;ngel M&#46; Sevillano-Prieto, Eduardo Hern&#225;ndez Mart&#237;nez, Eduardo Hern&#225;ndez-Mart&#237;nez, Jara Caro Espada, Jara Caro-Espada, Maria Molina Gomez, Mar&#237;a Molina-G&#243;mez, Eduardo Guti&#233;rrez Mart&#237;nez, Eduardo Guti&#233;rrez-Mart&#237;nez, Enrique Morales Ruiz, Enrique Morales-Ruiz, Ester Gonzalez Monte, Ester Gonz&#225;lez-Monte, Manuel Praga Terente, Manuel Praga-Terente"
            "autores" => array:16 [
              0 => array:2 [
                "nombre" => "Angel Manuel"
                "apellidos" => "Sevillano Prieto"
              ]
              1 => array:2 [
                "nombre" => "&#193;ngel M&#46;"
                "apellidos" => "Sevillano-Prieto"
              ]
              2 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "Hern&#225;ndez Mart&#237;nez"
              ]
              3 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "Hern&#225;ndez-Mart&#237;nez"
              ]
              4 => array:2 [
                "nombre" => "Jara"
                "apellidos" => "Caro Espada"
              ]
              5 => array:2 [
                "nombre" => "Jara"
                "apellidos" => "Caro-Espada"
              ]
              6 => array:2 [
                "nombre" => "Maria"
                "apellidos" => "Molina Gomez"
              ]
              7 => array:2 [
                "nombre" => "Mar&#237;a"
                "apellidos" => "Molina-G&#243;mez"
              ]
              8 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "Guti&#233;rrez Mart&#237;nez"
              ]
              9 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "Guti&#233;rrez-Mart&#237;nez"
              ]
              10 => array:2 [
                "nombre" => "Enrique"
                "apellidos" => "Morales Ruiz"
              ]
              11 => array:2 [
                "nombre" => "Enrique"
                "apellidos" => "Morales-Ruiz"
              ]
              12 => array:2 [
                "nombre" => "Ester"
                "apellidos" => "Gonzalez Monte"
              ]
              13 => array:2 [
                "nombre" => "Ester"
                "apellidos" => "Gonz&#225;lez-Monte"
              ]
              14 => array:2 [
                "nombre" => "Manuel"
                "apellidos" => "Praga Terente"
              ]
              15 => array:2 [
                "nombre" => "Manuel"
                "apellidos" => "Praga-Terente"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251412002221"
          "doi" => "10.3265/Nefrologia.pre2012.Aug.11645"
          "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/X2013251412002221?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512002224?idApp=UINPBA000064"
      "url" => "/02116995/0000003200000006/v0_201502091338/X0211699512002224/v0_201502091339/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251412002213"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jul.11532"
    "estado" => "S300"
    "fechaPublicacion" => "2012-11-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:829-34"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5128
      "formatos" => array:3 [
        "EPUB" => 291
        "HTML" => 4168
        "PDF" => 669
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "A successful clinical case of encapsulating peritoneal sclerosis &#39; surgical management using enterolysis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "829"
          "paginaFinal" => "834"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "&#201;xito en caso cl&#237;nico de esclerosis peritoneal encapsulante&#58; tratamiento quir&#250;rgico mediante enter&#243;lisis"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11532_16025_31058_en_t111532_copia.jpg"
              "Alto" => 771
              "Ancho" => 2172
              "Tamanyo" => 551125
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Potential biomarkers for monitoring membrane injury"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => " Di&#225;lise Peritoneal dos C&#46;H&#46;U&#46;C, Patr&#237;cia Neto"
          "autores" => array:2 [
            0 => array:1 [
              "apellidos" => "Di&#225;lise Peritoneal dos C&#46;H&#46;U&#46;C"
            ]
            1 => array:2 [
              "nombre" => "Patr&#237;cia"
              "apellidos" => "Neto"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512002216"
        "doi" => "10.3265/Nefrologia.pre2012.Jul.11532"
        "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/X0211699512002216?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002213?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000006/v0_201502091602/X2013251412002213/v0_201502091603/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X201325141200223X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Sep.11631"
    "estado" => "S300"
    "fechaPublicacion" => "2012-11-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:819-23"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 6590
      "formatos" => array:3 [
        "EPUB" => 288
        "HTML" => 5629
        "PDF" => 673
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "acute renal failure predictors in elderly patients with chronic kidney disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "819"
          "paginaFinal" => "823"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Factores predictores de fracaso renal agudo en ancianos con enfermedad renal cr&#243;nica"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11631_16025_38375_en_t111631_copia.jpg"
              "Alto" => 772
              "Ancho" => 2177
              "Tamanyo" => 632306
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Comparison of the sociodemographic characteristics&#44; parameters of renal function&#44; haematocrit&#44; and comorbidity during the baseline period between elderly patients with and without at least one episode of acute renal failure during a 36-month monitoring pe"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "MANUEL HERAS, Manuel Heras, MARIA JOSE FERNANDEZ-REYES, M&#46; Jos&#233; Fern&#225;ndez-Reyes, MARIA TERESA GUERRERO, M&#46; Teresa Guerrero, ROSA SANCHEZ, Rosa S&#225;nchez, ANGELICA MU&#209;OZ, Ang&#233;lica Mu&#241;oz, ALVARO MOLINA, &#193;lvaro Molina, MARIA ASTRID RODRIGUEZ, M&#46; Astrid Rodr&#237;guez"
          "autores" => array:14 [
            0 => array:2 [
              "nombre" => "MANUEL"
              "apellidos" => "HERAS"
            ]
            1 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Heras"
            ]
            2 => array:2 [
              "nombre" => "MARIA JOSE"
              "apellidos" => "FERNANDEZ-REYES"
            ]
            3 => array:2 [
              "nombre" => "M&#46; Jos&#233;"
              "apellidos" => "Fern&#225;ndez-Reyes"
            ]
            4 => array:2 [
              "nombre" => "MARIA TERESA"
              "apellidos" => "GUERRERO"
            ]
            5 => array:2 [
              "nombre" => "M&#46; Teresa"
              "apellidos" => "Guerrero"
            ]
            6 => array:2 [
              "nombre" => "ROSA"
              "apellidos" => "SANCHEZ"
            ]
            7 => array:2 [
              "nombre" => "Rosa"
              "apellidos" => "S&#225;nchez"
            ]
            8 => array:2 [
              "nombre" => "ANGELICA"
              "apellidos" => "MU&#209;OZ"
            ]
            9 => array:2 [
              "nombre" => "Ang&#233;lica"
              "apellidos" => "Mu&#241;oz"
            ]
            10 => array:2 [
              "nombre" => "ALVARO"
              "apellidos" => "MOLINA"
            ]
            11 => array:2 [
              "nombre" => "&#193;lvaro"
              "apellidos" => "Molina"
            ]
            12 => array:2 [
              "nombre" => "MARIA ASTRID"
              "apellidos" => "RODRIGUEZ"
            ]
            13 => array:2 [
              "nombre" => "M&#46; Astrid"
              "apellidos" => "Rodr&#237;guez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512002232"
        "doi" => "10.3265/Nefrologia.pre2012.Sep.11631"
        "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/X0211699512002232?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141200223X?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000006/v0_201502091602/X201325141200223X/v0_201502091603/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Cholesterol atheroembolism and combined treatment with steroids and iloprost"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "824"
        "paginaFinal" => "828"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Angel Manuel Sevillano Prieto, &#193;ngel M&#46; Sevillano-Prieto, Eduardo Hern&#225;ndez Mart&#237;nez, Eduardo Hern&#225;ndez-Mart&#237;nez, Jara Caro Espada, Jara Caro-Espada, Maria Molina Gomez, Mar&#237;a Molina-G&#243;mez, Eduardo Guti&#233;rrez Mart&#237;nez, Eduardo Guti&#233;rrez-Mart&#237;nez, Enrique Morales Ruiz, Enrique Morales-Ruiz, Ester Gonzalez Monte, Ester Gonz&#225;lez-Monte, Manuel Praga Terente, Manuel Praga-Terente"
        "autores" => array:16 [
          0 => array:4 [
            "nombre" => "Angel Manuel"
            "apellidos" => "Sevillano Prieto"
            "email" => array:1 [
              0 => "sevillano&#46;am&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "&#193;ngel M&#46;"
            "apellidos" => "Sevillano-Prieto"
            "email" => array:1 [
              0 => "sevillano&#46;am&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "Hern&#225;ndez Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "Hern&#225;ndez-Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Jara"
            "apellidos" => "Caro Espada"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Jara"
            "apellidos" => "Caro-Espada"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Maria"
            "apellidos" => "Molina Gomez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Mar&#237;a"
            "apellidos" => "Molina-G&#243;mez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "Guti&#233;rrez Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "Guti&#233;rrez-Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "Enrique"
            "apellidos" => "Morales Ruiz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          11 => array:3 [
            "nombre" => "Enrique"
            "apellidos" => "Morales-Ruiz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          12 => array:3 [
            "nombre" => "Ester"
            "apellidos" => "Gonzalez Monte"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          13 => array:3 [
            "nombre" => "Ester"
            "apellidos" => "Gonz&#225;lez-Monte"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          14 => array:3 [
            "nombre" => "Manuel"
            "apellidos" => "Praga Terente"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          15 => array:3 [
            "nombre" => "Manuel"
            "apellidos" => "Praga-Terente"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España, Spain, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Ateroembolia de colesterol y tratamiento combinado con esteroides e iloprost"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11645_16025_38053_en_f111645_copia.jpg"
            "Alto" => 1035
            "Ancho" => 2114
            "Tamanyo" => 340967
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Evolution of renal function"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Cholesterol atheroembolism &#40;CAE&#41; is a disease with a poor prognosis&#46; The pathogenesis of this disease is based on the impact of cholesterol crystals derived from atheromatous plaques in small vessels&#46;<span class="elsevierStyleSup">1</span> In recent years&#44; the incidence of CAE has increased as the result of a burgeoning population of individuals that are particularly susceptible to this disease &#40;elderly patients&#44; those with diabetes&#44; hypertension&#44; and dyslipidaemia&#41; in addition to a greater frequency of triggering factors &#40;endovascular procedures&#44; anti-coagulation treatment&#41;&#46;<span class="elsevierStyleSup">2</span> CAE produces important rates of morbidity and mortality&#44; which increase when the kidneys are also involved&#46; Renal function is recovered following this disease in only 25&#37; of cases&#46;<span class="elsevierStyleSup">1&#44;2</span></p><p class="elsevierStylePara">The management of CAE is a complicated task due to the lack of unified treatment criteria in the medical literature&#46; It does appear that these patients benefit from a strict control of cardiovascular risk factors in order to prevent the development of this disease&#46;<span class="elsevierStyleSup">3&#44;4</span> However&#44; there is no agreement regarding the measures to take when the disease has already been triggered&#46; Several articles exist in the medical literature suggesting various treatment regimens&#44; although no definitive results have been shown either to refute or support these recommendations&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">In this article&#44; we present the case of a patient with CAE with peripheral vascular and renal involvement who benefited from combined treatment with steroids and prostaglandin analogues &#40;iloprost&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CASE REPORT</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Our patient was a 71-year old female who sought treatment in the nephrology department at our hospital due to an acute deterioration in renal function&#46; The patient&#8217;s relevant background included&#58; arterial hypertension &#40;on treatment with enalapril&#41;&#44; dyslipidaemia&#44; tobacco use&#44; and grade IIA peripheral vascular disease&#44; with Doppler-ultrasound tests indicative of a significant stenosis in the left femoral artery&#46; Basal renal function was normal&#46;</p><p class="elsevierStylePara">In December 2012&#44; the patient underwent an arteriography for peripheral vascular disease&#44; which led to a balloon angioplasty of the superficial femoral artery of the left leg&#44; with 2 stents implanted&#46; After 24 hours&#44; the patient was administered Adiro<span class="elsevierStyleSup">&#174;</span> and low molecular weight heparin &#40;LMWH&#41; and discharged from the hospital&#46; Serum creatinine &#40;Crs&#41; at this moment was 1&#46;26mg&#47;dl&#46;</p><p class="elsevierStylePara">Ten days later&#44; the patient went to the emergency department due to rectal bleeding with no haemodynamic instability &#40;blood pressure&#58; 127&#47;83mm Hg&#41;&#46; Laboratory analysis revealed Hb&#58; 9&#46;8g&#47;dl&#44; 8000 leukocytes&#47;mm<span class="elsevierStyleSup">3</span>&#44; and 17&#37; eosinophils &#40;1400&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#46; Crs was 4&#46;3mg&#47;dl&#46; During the patient&#8217;s stay in the emergency department&#44; treatment with LMWH and enalapril was suspended and volume expansion therapy was started&#46; A colonoscopy was also performed that revealed colonic ulcers indicative of ischaemia&#46; No further rectal bleeding occurred in the following 24 hours&#44; and Crs decreased to 3&#46;42mg&#47;dl&#46; The patient was discharged to her home with a referral to the nephrology department&#44; where she sought further treatment 15 days later&#46;</p><p class="elsevierStylePara">On her visit to the nephrology department&#44; the patient had a Crs of 4&#46;44mg&#47;dl&#44; acidosis&#44; and hyperkalaemia&#44; which motivated her hospitalisation&#46; Upon evaluation&#44; the patient reported the appearance of painful purple-coloured lesions on the toes and soles of both feet&#46; These lesions appeared 10 days after the endovascular procedure and had worsened with time&#46; A biochemical analysis revealed that the eosinophilia continued&#44; and no improvements could be seen in renal function&#46; A urinary sediment analysis revealed isolated leukocytes with no red blood cells&#46; A dilated fundus examination was normal&#44; and a Doppler-ultrasound showed the kidneys to have normal size and good cortical-medullary differentiation&#44; a non-dilated urinary tract&#44; and an absence of stenoses in the renal arteries&#46;</p><p class="elsevierStylePara">Given the patient&#8217;s history of endovascular manipulation&#44; clinical symptoms&#44; and biochemical parameters&#44; we suspected the presence of CAE with renal involvement &#40;known as atheroembolic renal disease &#91;AERD&#93;&#41;&#46; The diagnosis was confirmed with a cutaneous biopsy of the purple lesions on the patient&#8217;s feet&#44; in which we observed the intravascular cholesterol crystals typical of this disease&#46;</p><p class="elsevierStylePara">Given the progressive worsening of renal function &#40;maximum Crs of 5&#46;58mg&#47;dl&#41; and cutaneous lesions&#44; we decided to start treatment with iloprost &#40;2ng&#47;kg&#47;min during 12 hours per day for 14 days&#41;&#44; steroids &#40;1mg&#47;kg&#47;day for one week&#44; followed by a decreasing treatment regimen until complete removal after 3 months&#41; and high doses of statins &#40;atorvastatin at 80mg&#47;24h&#41;&#46;</p><p class="elsevierStylePara">Two days after starting treatment&#44; the patient experienced a progressive improvement in the cutaneous lesions that allowed for reducing the dose of analgesia&#46; This prescription also produced an improvement in renal function&#44; which started one week after starting treatment&#46; Given the good evolution of the patient&#8217;s condition&#44; she was discharged to her home one month after hospitalisation&#46; Crs upon discharge was 2&#46;99mg&#47;dl&#44; and 3 months after hospitalisation&#44; Crs was down to 1&#46;9mg&#47;dl &#40;Figure 1&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">CAE is a systemic disease that produces high rates of morbidity and mortality&#46; It can affect any organ system throughout the body&#44; with the most commonly affected organs being the kidneys&#44; gastrointestinal tract&#44; and the skin&#46; CAE produces a mortality rate after one year that ranges between 30&#37; and 80&#37;&#44; according to studies&#46; When CAE produces renal involvement &#40;AERD&#41;&#44; the progression of the disease tends to be quite severe&#44; necessitating dialysis in 40&#37; of cases&#46; Only 25&#37; of these patients eventually recover renal function&#46;<span class="elsevierStyleSup">3-4</span> The differential diagnosis of this disease also includes several different entities&#44; such as contrast-induced nephropathy and immunoallergic interstitial nephritis&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">Two different treatment protocols exist for patients with CAE&#46; The first is designed to avoid the reappearance of CAE by controlling cardiovascular risk factors &#40;blood pressure and atheromatous plaques&#41; and avoiding exposure of the patient to factors that could trigger symptoms &#40;anti-coagulants&#44; endovascular interventions&#41;&#46; The other type of treatment attempts to reduce the level of ischaemia produced in affected organs in order to improve their functioning&#46; Drugs in this second treatment type include steroids and prostaglandin analogues&#46;<span class="elsevierStyleSup">6</span></p><p class="elsevierStylePara">Several studies have shown that preventative measures reduce the mortality of patients with CAE&#46;<span class="elsevierStyleSup">2&#44;4</span> However&#44; the use of specific treatment measures to combat the disease continues to be the subject of much debate&#46;</p><p class="elsevierStylePara">The pathogenesis of CAE is based on the release of cholesterol crystals from atheromatous plaques that accumulate and obstruct small vessels&#44; producing ischaemic damage in various organs of the body&#46; A histopathological analysis reveals an important inflammatory component in the form of a reaction to the cholesterol crystals as foreign bodies&#46; This inflammatory component also contributes to the vascular obstruction that produces ischaemia&#46;<span class="elsevierStyleSup">1&#44;2</span> Through steroid treatment&#44; we attempt to improve the inflammatory component of the embolism by increasing distal blood flow to the vascular obstruction and reducing ischaemic damage&#46; Experimentally&#44; this mechanism has not been demonstrated <span class="elsevierStyleItalic">in vivo</span>&#46; In studies published of cases treated with steroids&#44; arguments have been presented both in favour and against this treatment alternative for improving renal function&#46; For example&#44; in a study involving three Spanish hospitals &#40;Hospital Parc Taul&#237; de Sabadell&#44; Hospital de Ciudad Real and Hospital 12 de octubre&#41;&#44;<span class="elsevierStyleSup">7</span> which examined 45 cases of CAE&#44; no beneficial effects were observed from steroid use&#46; However&#44; the overall trend in studies published on this disease appears to be improved symptoms of skin and gastrointestinal ischaemia in patients treated with steroids&#46;<span class="elsevierStyleSup">8-10</span></p><p class="elsevierStylePara">Recently&#44; prostaglandin analogues &#40;iloprost&#41; have been added to the treatment arsenal against CAE&#46; These drugs have important vasodilatory and anti-platelet activity&#44; making them ideal for use in various diseases with ischaemic components&#44; with good results&#46;<span class="elsevierStyleSup">11</span> Iloprost was first used for the treatment of CAE with cutaneous lesions in 1995&#46; Treatment was effective&#44; with improvements observed in cutaneous lesions and pain&#46;<span class="elsevierStyleSup">12</span> Since then&#44; six cases have been published in which iloprost was used to treat CAE&#46;<span class="elsevierStyleSup">13-15 </span>In all of these&#44; clear improvements were observed in terms of cutaneous lesions and pain&#44; and 50&#37; of the patients also enjoyed an improvement of renal function&#46; In almost all of these cases&#44; combined treatment was administered with iloprost and steroids &#40;Table 1&#41;<span class="elsevierStyleSup">&#46;11-14</span></p><p class="elsevierStylePara">Our patient had CAE with important renal&#44; cutaneous&#44; and gastrointestinal involvement&#46; After reviewing the pertinent medical literature&#44; and in light of the poor evolution of the patient&#8217;s condition&#44; we decided to apply combined therapy with steroids and iloprost&#46; After starting treatment&#44; we observed clear improvements in the cutaneous lesions and pain&#44; with reduced requirements for analgesic prescriptions&#46; Additionally&#44; renal function&#44; which until this point had suffered progressive deterioration&#44; started to improve 48 hours following the start of treatment&#46; Currently&#44; the patient&#8217;s Crs is 1&#46;9mg&#47;dl&#46;</p><p class="elsevierStylePara">Our case reflects the experiences of other case reports and provides a certain level of optimism for the use of combined therapy with steroids and iloprost&#46;</p><p class="elsevierStylePara">Combined therapy does not produce a recovery of renal function in all patients&#44; but it does improve extra-renal symptoms&#44; which are often the most important drivers of the prognosis in these patients&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">One very important factor in the response of CAE to treatment is the moment in which treatment is started&#46; Given the pathogenesis of the disease&#44; it is essential to start treatment as soon as possible&#46; If delayed&#44; the affected parenchyma suffers an even greater degree of damage and the probability of recovered function decreases&#46; This parameter has not been evaluated in any studies to date&#44; and may improve the rate of recovery of renal function in these patients&#46;</p><p class="elsevierStylePara">No studies involving the combined treatment of this condition with steroids and iloprost have described important adverse effects&#46; In all of these&#44; the steroids used were at low doses and for short periods of times&#46;</p><p class="elsevierStylePara">The aforementioned arguments along with an absence of other treatment alternatives leads us to suggest that combined treatment with steroids and iloprost should be considered for the treatment of patients with CAE and organ damage&#46; This therapy should be started as soon as possible in order to optimise results&#46; This should also be confirmed through the application of prospective and randomised clinical studies&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors state that they have no potential conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11645&#95;16025&#95;38053&#95;en&#95;f111645&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11645_16025_38053_en_f111645_copia.jpg" alt="Evolution of renal function"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Evolution of renal function</p><p class="elsevierStylePara"><a href="grande&#47;11645&#95;16025&#95;38054&#95;en&#95;t111645&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11645_16025_38054_en_t111645_copia.jpg" alt="Review of the use of iloprost in cases of cholesterol atheroembolism"></img></a></p><p class="elsevierStylePara">Table 1&#46; Review of the use of iloprost in cases of cholesterol atheroembolism</p>"
    "pdfFichero" => "P1-E544-S3766-A11645-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:3 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437185"
          "palabras" => array:1 [
            0 => "Ateroembolia de colesterol"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437187"
          "palabras" => array:1 [
            0 => "Esteroides"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437189"
          "palabras" => array:1 [
            0 => "Prostaglandina"
          ]
        ]
      ]
      "en" => array:3 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437186"
          "palabras" => array:1 [
            0 => "Cholesterol atheroembolic"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437188"
          "palabras" => array:1 [
            0 => "Steroids"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437190"
          "palabras" => array:1 [
            0 => "Prostaglandine"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara">La ateroembolia de colesterol &#40;AEC&#41; es una enfermedad sist&#233;mica cuya incidencia ha aumentado en las &#250;ltimas d&#233;cadas y que presenta una elevada morbimortalidad&#46; En el momento actual se desconocen cu&#225;les son las alternativas terap&#233;uticas m&#225;s efectivas en esta entidad&#46; En este art&#237;culo presentamos el caso de una paciente diagnosticada de AEC con afectaci&#243;n cut&#225;nea&#44; intestinal y renal&#44; que present&#243; una buena evoluci&#243;n tras el inicio de terapia combinada con esteroides y an&#225;logos de las prostaglandinas&#46; A pesar de que no existen estudios concluyentes&#44; sugerimos esta alternativa para el manejo de AEC con afectaci&#243;n org&#225;nica&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara">Cholesterol atheroembolism &#40;CAE&#41; is a systemic disorder whose incidence has increased in recent decades and that presents high morbidity and mortality&#46; Although several therapeutic alternatives have been reported&#44; there is no consensus about the best treatment for this disease&#46; In this paper we report the case of a patient with CAE with skin&#44; bowel and kidney involvement who presented a good response to combined therapy with steroids and prostaglandin analogues&#46; Although there are no conclusive studies&#44; we recommend this therapeutic alternative in the management of CAE with organic failure&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11645_16025_38053_en_f111645_copia.jpg"
            "Alto" => 1035
            "Ancho" => 2114
            "Tamanyo" => 340967
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Evolution of renal function"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11645_16025_38054_en_t111645_copia.jpg"
            "Alto" => 2004
            "Ancho" => 2168
            "Tamanyo" => 952833
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Review of the use of iloprost in cases of cholesterol atheroembolism"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Meyrier A. Cholesterol crystal embolism: Diagnosis and Treatment. Kidney Int 2006;69:1308-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16614719" 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" => "Scolari F, Ravani P. Atheroembolic renal disease. Lancet 2010;375:1650-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20381857" 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" => "Fine MJ, Kapoor W, Falaga V. Cholesterol crystal embolization: A review of 221 cases in the English literature. Angiology 1987;42:769-84."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Belenfant X, Meyrier A, Jacquot C. Supportive treatment improves survival in multivisceral cholesterol crystal embolism. Am J Kidney Dis 1999;33:840-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10213638" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673611612154"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Espejo B, Herrero JC, Torres A, Martínez A, Gutiérrez E, Morales E, et al. Nefritis intersticial inmunoalérgica vs ateroembolismo de colesterol.\u{A0}Características diferenciales. Nefrologia 2003;2:25-30."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Venturelli C, Jeannin G, Sottini L, Dallera N, Scolari F, Venturelli C. Cholesterol crystal embolism (atheroembolism). Heart Int 2006;2:155. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21977265" 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" => "Gutiérrez-Solís E, Morales E, Rodríguez Jornet A, Andreu FJ, Rivera F, Vozmediano C, et al. Atheroembolic renal disease; analysis of clinical and therapeutic factors that influence its progression. Nefrologia 2010;30:317-23. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20414329" 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" => "Lye WC, Cheah JS, Sinniah R. Renal cholesterol embolic disease. Case report and review of the literature. Am J Nephrol 1993;13:489-93. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8141186" 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" => "Nakahama H, Sakaguchi K. Small doses oral corticosteroids treatment rapidly improved renal function in a patient with an acute aggravation of a chronic renal failure due to cholesterol embolism. Nephrol Dial Transplant 2001;16:872-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11274298" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Takahashi T, Konta T, Nishida W, Igarashi A, Ichikawa K, Kubota I. Renal cholesterol embolic disease effectively treated with steroid pulse therapy. Intern Med 2003;42:1206-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Belch JJ, McKay A, McArdle B, Leiberman P, Pollock JG, Lowe GD, et al. Epoprostenol (prostacyclin) and severe arterial disease. Lancet 1983;1:315-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2893136" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Radauceanu A, Avignon A, Ribstein J, Monnier L. Use of a prostacyclin analogue in cholesterol crystal embolism. Diabet Med 1998;15:262-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9545130" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Elinav E, Chajek\u{AD}Shaul T, Stern M. Improvement in cholesterol emboli syndrome after iloprost therapy. BMJ 2002;324:268-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11823357" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rodríguez Gómez MA, Heras M, Molina Ordas A, Fernández-Reyes MJ, Sánchez R, Álvarez-Ude F. Clinical response to Iloprost treatment in a patient with cholesterol ateroembolic renal disease. Nefrologia 2009;29:494-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19820771" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Grenader T, Lifschitz M, Shavit L. Iloprost in embolic renal failure. Mt Sinai J Med 2005;72:339-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16184298" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003200000006/v0_201502091602/X2013251412002221/v0_201502091603/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/20132514/0000003200000006/v0_201502091602/X2013251412002221/v0_201502091603/en/P1-E544-S3766-A11645-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002221?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 7 10 17
2024 October 60 31 91
2024 September 68 23 91
2024 August 84 62 146
2024 July 61 25 86
2024 June 76 51 127
2024 May 76 43 119
2024 April 61 42 103
2024 March 48 21 69
2024 February 48 33 81
2024 January 38 28 66
2023 December 23 23 46
2023 November 47 39 86
2023 October 41 26 67
2023 September 26 33 59
2023 August 43 19 62
2023 July 47 34 81
2023 June 47 19 66
2023 May 67 32 99
2023 April 26 18 44
2023 March 66 32 98
2023 February 38 18 56
2023 January 35 32 67
2022 December 57 27 84
2022 November 51 42 93
2022 October 70 57 127
2022 September 46 36 82
2022 August 65 51 116
2022 July 35 45 80
2022 June 45 35 80
2022 May 86 36 122
2022 April 72 51 123
2022 March 75 48 123
2022 February 97 43 140
2022 January 81 24 105
2021 December 106 43 149
2021 November 60 44 104
2021 October 64 50 114
2021 September 48 36 84
2021 August 54 43 97
2021 July 39 42 81
2021 June 44 18 62
2021 May 84 47 131
2021 April 143 43 186
2021 March 84 41 125
2021 February 79 26 105
2021 January 67 20 87
2020 December 31 17 48
2020 November 49 15 64
2020 October 41 20 61
2020 September 52 17 69
2020 August 38 11 49
2020 July 57 13 70
2020 June 59 10 69
2020 May 61 10 71
2020 April 56 19 75
2020 March 60 9 69
2020 February 56 23 79
2020 January 76 23 99
2019 December 79 17 96
2019 November 76 15 91
2019 October 683 10 693
2019 September 36 20 56
2019 August 24 11 35
2019 July 51 22 73
2019 June 40 12 52
2019 May 42 15 57
2019 April 111 41 152
2019 March 37 20 57
2019 February 45 19 64
2019 January 51 26 77
2018 December 93 45 138
2018 November 94 14 108
2018 October 93 18 111
2018 September 85 17 102
2018 August 54 11 65
2018 July 50 14 64
2018 June 62 11 73
2018 May 64 13 77
2018 April 51 7 58
2018 March 56 10 66
2018 February 53 8 61
2018 January 59 7 66
2017 December 65 14 79
2017 November 64 10 74
2017 October 43 9 52
2017 September 51 15 66
2017 August 47 21 68
2017 July 58 19 77
2017 June 70 11 81
2017 May 63 16 79
2017 April 87 17 104
2017 March 59 17 76
2017 February 56 23 79
2017 January 35 20 55
2016 December 76 6 82
2016 November 73 9 82
2016 October 115 9 124
2016 September 159 10 169
2016 August 221 6 227
2016 July 209 17 226
2016 June 147 0 147
2016 May 151 0 151
2016 April 146 0 146
2016 March 86 0 86
2016 February 125 0 125
2016 January 119 0 119
2015 December 142 0 142
2015 November 94 0 94
2015 October 100 0 100
2015 September 92 0 92
2015 August 84 0 84
2015 July 85 0 85
2015 June 34 0 34
2015 May 60 0 60
2015 April 5 0 5
Show all

Follow this link to access the full text of the article

Idiomas
Nefrología (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?