Revista de la Sociedad Ecuatoriana de Nefrología, Diálisis y Trasplante
REV SEN is the biannual publication of the Ecuadorian Society of Nephrology, Dialysis, and Transplantation. The aim of the publication is to the field related to nephrology, its procedures, replacement treatments for kidney function, and kidney transplantation. REV SEN is published semi-annually and is reviewed by blinded peers.
Sociedad Ecuatoriana de Nefrología, Diálisis y Trasplante
Some Observations on Hypertension and the Kidney.
The author warns about the worrying tendency to underestimate the control of high blood pressure (hypertension) in patients with kidney disease, in favor of other analytical parameters. He emphasizes that blood pressure measurements taken in the doctor's office are often unreliable due to the "white coat effect" and limited technical expertise. Although ambulatory blood pressure monitoring (ABPM) is useful for assessing nighttime blood pressure, it has limitations, including insurance coverage restrictions, costs, and discomfort that disrupts sleep. To overcome this medical "comfort zone," the author proposes strict guidelines for accurate measurement: Protocol: Sit with back support, feet flat on the floor, right arm completely bare, at heart level, at rest, and without talking. Measurements taken while lying down are unreliable. Device: Avoid mercury and uncalibrated aneroid sphygmomanometers. Validated digital upper-arm blood pressure monitors are recommended, with cuffs appropriate to the arm size (or universal cuffs) to avoid overestimating readings. As a primary solution, home blood pressure monitoring (HBPM) performed by the patient is promoted. This method is as effective as ambulatory blood pressure monitoring (ABPM) but offers the advantage of reflecting daily life, allowing unlimited repetitions, and fostering patient engagement with their condition. Given the lack of strict consensus, the author suggests a 5-day protocol (with 3 daily readings before meals), discarding the first two days and averaging the remaining readings to ensure a reliable diagnosis.
Copyright (c) 2026 Cristian Krämer (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Epidemiological profile of glomerulopathies in adults
Introduction: This cross-sectional study aims to determine the prevalence of different types of glomerulopathy among patients aged 18 years or older who underwent renal biopsy at the Metropolitan Hospital of Quito from January 2019 to August 2024. Materials and methods: Reports of renal biopsies performed between January 2019 and August 2024 were reviewed. All adult patients aged 18 years or older who underwent a renal biopsy during this period were included. Histological diagnoses were classified according to the World Health Organization (WHO) classification, and their overall prevalence was evaluated, as well as their prevalence by gender and age. Results: A total of 168 renal biopsies were analyzed, revealing a gender distribution of 58.33% male and 41.67% female, with a mean age of 46.81 ± 16.79 years. The most frequent glomerulopathy was focal segmental glomerulosclerosis (FSGS), with a prevalence of 22.49% across all age groups. Other common diagnoses included IgA nephropathy and membranous glomerulonephritis, both with a prevalence of 13.1%. Among those under 40 years of age, lupus nephritis was the most prevalent at 22.54%, whereas among those over 65 years of age, FSGS was the most prevalent at 31.25%. Additionally, lupus nephritis (27.14%) was more prevalent in women compared to men, who presented with focal segmental glomerulosclerosis (25.56%). Conclusions: Primary glomerulopathies are the third leading cause of chronic kidney disease worldwide. These conditions are potentially treatable if diagnosed early, which can prevent their progression and the subsequent need for dialysis. This study provides valuable information on the distribution and prevalence of glomerulopathies, which is essential for improving diagnosis and treatment in our setting.
Copyright (c) 2026 Andrea Portilla, Washington Osorio , Alex Siza Duarte, Andrés Arteaga-Arellano, Francisco Xavier Castro Vega, María Elena Urresta Avila, Fernando Jimenez, Verónica Remache (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Late-onset systemic lupus erythematosus with leukocytoclastic vasculitis, hypertension, myocarditis, and lupus nephritis
Introduction: Systemic lupus erythematosus is a systemic autoimmune disease that can affect multiple organs, including vascular structures, although this involvement is uncommon. Leukocytoclastic vasculitis is a rare form of small-vessel vasculitis characterized by inflammation of dermal venules and manifests clinically as palpable purpura. Its association with myocarditis, hypertension, and lupus nephritis is uncommon and presents a diagnostic and therapeutic challenge. Case Report: We present the case of a 53-year-old female patient who consulted for purpuric lesions on her lower extremities, pretibial edema, and joint symptoms. Her condition was complicated by severe hypertension, myocarditis, and lupus nephritis. Skin and kidney biopsies confirmed the diagnoses of leukocytoclastic vasculitis and lupus nephritis, respectively. Outcome: The patient was treated with intravenous methylprednisolone, followed by prednisolone, with significant improvement in clinical manifestations and laboratory parameters. Conclusion: This case highlights the diverse presentations of SLE, particularly its association with leukocytoclastic vasculitis, a rare but relevant manifestation. Early management with immunosuppressants led to a favorable clinical outcome. This report underscores the importance of suspecting SLE in patients with atypical vasculitis and of adopting a multidisciplinary approach to achieve timely diagnosis and treatment.
Copyright (c) 2026 Jorge Rico Fontalvo, Gustavo Aroca Martinez, Valentina Pérez Jiménez, María De Los Ángeles Vélez Verbel, Andrés Cadena Bonfanti, Luis Castillo Parodi, Antonio Iglesias Gamarra, Diana M Perea Rojas, Carlos Guido Musso, Rodrigo Daza Arnedo (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Impact of needle bevel position during venipuncture on functional outcomes in hemodialysis patients
Introduction: The position of the needle bevel during arteriovenous access cannulation for hemodialysis may influence pain, bleeding, and procedural efficiency; however, existing evidence remains inconsistent. The aim of this research was to assess the potential effect of needle bevel position on hemostasis time, pain intensity, and the occurrence of complications, as well as on delivered dialysis dose and extracorporeal circuit pressures. Materials and Methods: This was a randomized, controlled, monocentric crossover study conducted between June and July 2025 in a private clinic in Ecuador. Patients with autologous arteriovenous fistulas in use for more than three months were included. Each patient served as their own control. The study duration was four weeks, with two weeks assigned to each bevel position. Descriptive and inferential statistical analyses were performed. Results: A total of 136 patients were included (3264 punctures), of whom 62.5% were male. No significant differences were observed in arterial (9.92 vs. 9.85 min) or venous (10.38 vs. 10.32 min) hemostasis times, nor in pain scores (1.73 vs. 1.87), according to bevel position. Likewise, no differences were found in delivered dialysis dose (1.82 vs. 1.80) or extracorporeal circuit pressures. Bleeding at the time of puncture was lower when the bevel was positioned downward (12.7% vs. 18.6%; P=0.001). Conclusions: Needle bevel position does not affect hemostasis time, pain perception, delivered dialysis dose, or extracorporeal circuit pressures. However, a downward bevel position is associated with reduced bleeding during puncture.
Copyright (c) 2026 Fernanda Criollo, Katty Victoria de la Cruz Angulo, Raymed Antonio Bacallao Méndez, José Antonio Dorta Díaz, Mariant Borges Colina , Narcisa Verónica Sánchez Ruiz (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Ultrasonographic assessment of venous congestion - VExUS
Doppler of the hepatic vein with a monophasic pulsatile pattern with systolic inversion, compatible with elevation of right atrial pressure and with significant systemic venous congestion. - inversion or marked decrease in the systolic wave. - Diastolic predominance. - Retrograde flow episodes. - Very pulsatile morphology. - great variability with the cardiac cycle. In practical terms: S < D S reverse.
Copyright (c) 2025 Washington Xavier Osorio Chuquitarco (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Evaluation and short-term impact of functional renal reserve in extended criteria vs. healthy donors
Introduction: In the face of the growing demand for organs, the use of donors with extended criteria requires precise methods to assess their post-nephrectomy safety. This study evaluates functional renal reserve (RFR) in healthy donors and in donors with extended criteria, comparing the oral protein load test with Doppler-derived variation in the intraparenchymal renal resistance index (VIRRI). We analyze whether VIRRI, a non-invasive technique based on vascular autoregulation under abdominal pressure, can replace complex methods for predicting renal compensatory capacity. Materials and methods: An observational and prospective study was conducted in two transplant centers with 32 adult donors (eGFR >80 ml/min/1.73 m²). Functional renal reserve (RFR) was compared using two methods: oral protein loading (1.2 g/kg) with creatinine clearance, and the intraparenchymal renal resistive index (VIRRI) variation test by Doppler ultrasound under abdominal mechanical stress. Statistical analysis included Student's t-tests, Pearson correlation and Mann-Whitney U, considering significance with p < 0.05 and 95% confidence intervals. Results: We included 32 participants (27 with extended criteria; 5 healthy). Donors with extended criteria had higher age, weight, BMI, glucose, and LDL (P < 0.05). Although baseline eGFR was similar between groups (109 mL/min), functional renal reserve was significantly lower in the extended criteria group (39.3 ± 33.7 vs. 87.2 ± 71 mL/min; P < 0.05). No statistically significant correlation was found between the protein load measurement and the VIRRI test (R2 = 0.054). Conclusions: Donors with extended criteria have a significantly lower RRF despite a normal baseline eGFR. Aging and metabolic alterations erode renal compensatory capacity, a phenomenon that conventional static assessments fail to detect. The lack of correlation among the evaluated methods underscores the need for dynamic protocols. Integrating RRF into donor selection optimizes risk stratification, thereby ensuring greater graft viability and longevity in kidney transplantation.
Variation in the intraparen-chymal renal resistance index
Copyright (c) 2025 Jesús Daniel Lima Lucero, Lucía Monserrat Pérez Navarro, Rafael Valdez Ortiz (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Determinants of access to health services, out-of-Pocket expenditures, and therapeutic adherence in patients with diabetes mellitus
Introduction: Type 2 diabetes mellitus (T2DM) is a global epidemic that unevenly affects low- and middle-income countries, where structural factors and financial barriers greatly limit access to effective medical care. In Ecuador, this condition is the fourth leading cause of death, and service coverage is limited. The goal of this research was to identify the factors influencing access to health services, the effect of out-of-pocket costs, and levels of treatment adherence among diabetic patients treated in the metropolitan district of Quito in 2024. Materials and methods: An observational, prospective, cross-sectional study was conducted at the "Fray Bartolomé de Las Casas" health center. The sample was probabilistic, consisting of adults diagnosed with diabetes. A survey validated by experts (Aiken's V 0.81) and with acceptable internal consistency (Cronbach's alpha 0.782) was used for data collection. The instrument assessed sociodemographic, economic (including consultation, drug, and transportation expenses), and operational access variables. Statistical analysis included inferential tests such as the chi-square test and the calculation of the Odds Ratio (OR). Results: a total of 95 patients were analyzed. Perceived worsening of health is significantly linked to social security affiliation (OR 2.77; P=0.0258) and the unavailability of institutional medicines (OR 2.86; P=0.0347). The average monthly expenditure on drugs was $82.19 USD, indicating that spending more than $50 USD per month is a critical risk factor for loss of adherence (OR 2.81; P=0.0211). An accessibility paradox was evident: patients who report clinical stability tend to navigate the system by compensating for public shortages with their own resources, while social security users associate saturation and bureaucracy with a decline in their condition. Conclusion: The stability of the diabetic patient in this context relies less on biological factors and more on the individual's financial ability to compensate for the shortcomings of the public system. The inefficiency of the social security system and the high out-of-pocket medication costs are the primary factors behind perceived health decline and low adherence.
Copyright (c) 2025 María Catherine Orrico Fernández, Giovanni Wladimir Rojas Velasco, José Esteban Costa Gil (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Chyloperitoneum secondary to calcium channel blockers in a peritoneal dialysis patient
Introduction: Hypertension is one of the most prevalent diseases worldwide, particularly in patients with end-stage renal disease undergoing renal replacement therapy. Antihypertensive treatment in this group typically involves pharmacological combinations including calcium channel blockers; although effective, these may be associated with adverse effects such as chyloperitoneum. Case report: We present the case of a 45-year-old female with a history of hypertension and stage V chronic kidney disease on continuous ambulatory peritoneal dialysis. Following adjustments to her antihypertensive regimen, lercanidipine was added in combination with valsartan. Subsequently, she presented thick, cloudy, and low-volume effluent. High triglyceride levels were identified in the peritoneal fluid sample. The drug was discontinued, resulting in clinical improvement over the following days. Discussion: Chyloperitoneum is a rare clinical entity, with an estimated incidence of up to 1 in 20,000 cases, characterized by the accumulation of milky peritoneal fluid with triglyceride levels exceeding 200 mg/dL. Its pathogenesis is linked to lymphatic drainage dysfunction, which can be exacerbated by calcium channel blockers such as lercanidipine, which increase lymphatic pressure via vasodilation. Unlike infectious peritonitis, this condition lacks inflammatory criteria or positive cultures, as evidenced in our patient (triglycerides: 264 mg/dL). Fundamental management consists of immediate discontinuation of the offending drug, typically resulting in clinical and analytical resolution within 24 to 72 hours. Conclusion: Chyloperitoneum induced by calcium channel blockers is an infrequent entity, often misdiagnosed as peritonitis. Definitive diagnosis through biochemical and cellular analysis of the peritoneal fluid enables resolution upon drug withdrawal. Correct identification avoids invasive procedures, unnecessary treatments, and additional costs, ensuring efficient and safe clinical management for the patient.
Copyright (c) 2025 Hugo Oswaldo Ortega Duran , Cesar Octavio Toral Chacón, Diego Fernando Argudo Sánchez , Manuel Alejandro Ugalde Noritz, Adriana Cordero (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Etiology of stage 5 chronic kidney disease
Introduction: Chronic kidney disease (CKD) is a catastrophic condition and a public health problem in Ecuador. The present study aims to determine the prevalence of etiologies of stage 5 chronic kidney disease among patients in the city of Cuenca's public dialysis network in March 2018. Materials and methods: A cross-sectional multicenter study was conducted. Data were collected from 458 patients using a questionnaire. Tabulation and statistical analysis were performed in Microsoft Office Excel 2016. The results were presented in simple distribution tables. Results: The distribution according to sex was 50.44% men and 49.46% women. The mean age was 58.47 ±13.59 years. The etiologies were: Diabetes Mellitus (41.92%), Arterial Hypertension (34.06%), Unknown Etiology (11.57%), Unrelated Glomerulopathies (3.06%), Obstructive Uropathy (2.4%), and the remaining pathologies (6.99%). Conclusions: The main etiologies of stage 5 CKD were Diabetes Mellitus and Arterial Hypertension.
Copyright (c) 2025 Gabriel Alejandro Cepeda Flores, Dana Isabel Reyes Encalada, César Toral Chacón, Carla Marina Salgado Castillo (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Infectious complications in hospitalized patients with chronic kidney disease on renal replacement therapy
Introduction: The second cause of mortality in patients with chronic kidney disease is infections, among which the presence of devices such as catheters is a risk factor. This study examines the factors contributing to catheter-related infections among patients with CKD on the Colombian Caribbean Coast. Methods: The present observational study was conducted at the Clínica de la Costa (Barranquilla, Colombia) from 2019 to 2024. Records of patients on hemodialysis or peritoneal dialysis hospitalized for infections associated with the renal replacement device, with microbiological confirmation by positive culture, were included. The sample was divided into two groups based on hospital outcome: living and deceased. Sociodemographic, clinical, microbiological, and management variables were collected. Percentages are compared with the Chi-square test and the Odds ratio. Results: A total of 78 cases were analyzed, of which 38 were from the hemodialysis program and 40 from the peritoneal dialysis program; in-hospital mortality was 25.6% (n=20). No statistically significant differences were found in age, sex, or chronic comorbidities, such as hypertension or diabetes, between the groups of survivors and deaths. A history of previous infection and neurological disease was identified as a critical risk factor, increasing the probability of death almost fourfold (OR: 3,714; 95%CI: 1,037-13,309; P=0.036). The fatal outcome was closely linked to septic shock and admission to the ICU, which were present in 100% of the deceased (P < 0.001). Microbiologically, methicillin-resistant S. aureus was the main predictor of mortality, present in 50% of deaths with a significantly higher risk than other pathogens (OR: 117; P=0.0014). No significant association was observed between the type of access device or dialysis modality and patient death. Conclusion: Survival on renal replacement therapy depends on strict microbiological surveillance and personalization of preventive care in cognitively compromised patients, allowing early intervention before irreversible organ dysfunction sets in.
Copyright (c) 2025 Gustavo Aroca Martínez, Valentina Perez, Diana Perea, Andrés Cadena Bonfanti, Joanny Judith Sarmiento, María Raad Sarabia, Rodrigo Daza Arnedo, Jorge Rico Fontalvo (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Self-determination in health, as a psychological factor influencing observational survival and symptom perception in patients in hemodialysis programs
Introduction: Self-determination in Health (SDH), defined as a patient's inherent ability to make informed and active decisions about their health care, is a modifiable psychological factor that correlates with motivation, proactive behavior, and improved physical health outcomes. In the context of hemodialysis (HD) therapy, SDH promotes functional autonomy and active patient engagement, even in the face of vulnerability; by contrast, its absence is associated with decision delegation and deterioration in health. The study hypothesizes that patients in hemodialysis programs with higher SDH will have a lower perception of symptoms and a longer survival. Methods: This observational, case-control study was carried out in 14 hemodialysis units in Ecuador from May to June 2025. Patients aged 18 years or older who were enrolled in hemodialysis programs were included. Two groups were formed: one with patients without SDH and the other with patients with SDH. The variables studied included age, duration of hemodialysis treatment, self-determination in health, adherence to treatment, labor integration, physical dependence, acceptance of kidney disease, and scores on "The Dialysis Symptom Index." A 1:1 propensity score matching (PSM) was performed between the groups based on age, sex, and presence of type 2 diabetes mellitus. The means were compared using Student's t-test, while proportions were compared using Chi-squared tests. An observational survival analysis was also conducted, examining the length of stay in the hemodialysis unit up to the date of the survey. Results: 180 patients without SDH and 184 with SDH were analyzed. Age was similar in both groups (57.9 ± 13.7 years vs. 58.0 ± 11.8 years, P = 0.938). The proportion of men was similar in both groups (51.1% vs. 51.6%; P=0.921). The prevalence of type 2 diabetes mellitus was comparable between the groups (48.3% vs. 47.3%; P=0.841). The group without SDH had a higher rate of physical dependence (53.3%) compared to the group with SDH (25.5%) (P < 0.001). Adherence was greater in the group with SDH (51.6%) than in the group without SDH (36.7%; P < 0.001). Work activity was more common among the group with SDH (38.0%) compared to 12.2% among the group without SDH (12.2%; P < 0.001). The group with SDH showed lower symptom intensity (–25.82%) than the group without SDH (P<0.001). Increased survival was observed in the SDH group, with 29.5 months versus 36.08 months in the non-SDH group (χ2, Log-Rank 7.71, P<0.005). Conclusions: Patients with SDH exhibited longer survival, significantly higher treatment adherence, and less physical dependence. Additionally, self-determination was associated with a reduction in the severity of perceived symptoms, including pain and psychological symptoms such as worry and sadness, across 18 of the 34 assessed. These findings demonstrate that SDH is not just a psychological concept but also a therapeutic goal that impacts survival. Randomized intervention studies in SDH are necessary.
Copyright (c) 2025 Franklin Mora-Bravo, Paulina Cruz, Marcia Pozo, Diego Vimos, Alfonso Silva, Marisol Perez, Washington Osorio, Rafael Becerra Guerra , Nelson Rojas, Guillermina Blum, Gustavo Guevara, Rosalina Lituma, Wilmer Sanango, Santiago Silva, Oscar Ron, Victor Ortega, Elizabeth Gonzalez, Marlon Rivilla, Yamilka Rodriguez, Juan Paz, Estefania Leon, Adriana Cabrera, Maria Chediak, Byron Saa, Karol Vacacela, Gustavo Coello, Maria Cajas (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Unusual ureteral stenosis in an immunosuppressed patient
Introduction: Genitourinary tuberculosis (GUTB) is one of the most insidious forms of extrapulmonary tuberculosis. In patients living with HIV, progression toward structural complications can be severe, even under stable immunological control. This report aims to analyze the clinical course of GUTB leading to end-stage renal disease (ESRD) secondary to obstructive nephropathy. Case Report: A 45-year-old male patient with a 15-year history of HIV (undetectable viral load and CD4+ > 250 cells/mm³) and a recent history of successfully treated pulmonary tuberculosis. He presented with a 3-month history of dysuria and progressive decrease in urinary volume, evolving into acute urinary retention. Imaging revealed Grade IV bilateral hydronephrosis and segmental ureteral stenosis. Laboratory tests showed critical impairment of renal function (initial creatinine of 3 mg/dL, progressing to 19.27 mg/dL, and urea of 284 mg/dL). Urine culture confirmed the presence of Mycobacterium tuberculosis. Outcome: Despite the initiation of antitubercular treatment and bladder decompression, the patient developed severe uremic symptoms. The severity of the bilateral obstructive nephropathy resulted in irreversible renal damage (Stage V), requiring the initiation of chronic renal replacement therapy (dialysis). Surgical resolution was not feasible due to the extent of the fibrosis. Conclusion: Genitourinary tuberculosis can cause accelerated end-stage renal failure due to obstructive nephropathy, even in patients with controlled HIV and successful antitubercular treatment. Irreversible ureteral fibrosis demands early urological monitoring to detect strictures before functional damage becomes permanent and requires chronic dialysis.
Copyright (c) 2025 ROBERTO GUTIERREZ, Pedro Gutiérrez Gómez, Sofía Gutiérrez Gómez, Alex Gutiérrez Gómez (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Sociodemographic, clinical, and laboratory profile of patients with early- versus late-onset systemic lupus erythematosus
Introduction: Late-onset systemic lupus erythematosus (SLE) is a rare form of the disease, characterized by atypical clinical manifestations and a higher burden of comorbidities, which makes it challenging to diagnose and manage on time. The objective of this study was to compare the sociodemographic, clinical, and paraclinical characteristics, as well as the therapeutic outcomes, of patients with early- and late-onset SLE in a reference center in the Colombian Caribbean. Methods: Observational, descriptive, and cross-sectional study, based on the review of medical records from the RENELUP database (2010–2024). Patients aged ≥18 years who met the 2019 EULAR/ACR criteria were included. Chi-square, Fisher's, and Student's T tests were applied. Results: A total of 282 patients were analyzed: 235 (83%) with early SLE and 47 (17%) with late SLE. Females predominated (89% and 81%, respectively). Late SLE had higher proteinuria (2,900 vs 662 mg/24h; P<0.001) and lower HDL (41 vs 48 mg/dl; P=0.038). There were no significant differences in remission or mortality, although mortality was higher in late SLE (20.7% vs 10.1%). Conclusion: Patients with late SLE had a lower frequency of typical clinical manifestations, including mucocutaneous, joint, and hematological involvement. In terms of renal involvement, patients with late SLE had a higher burden of proteinuria, with no statistically significant differences in mortality or remission rate.
Copyright (c) 2025 Gustavo Aroca Martínez, Valentina Perez, Maria Raad, Diana Perea, Carlos Guido, Santos Depine, Jorge Perez, Juan Perez, Maria Aroca, Andres Cadena, Joanny Sarmiento, Valmore Bermudez, Rodrigo Daza-Arnedo , Jorge Rico-Fontalvo, Antonio Iglesias (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Risk association between hypocomplementemia and the development of lupus nephritis
Introduction: Systemic lupus erythematosus (SLE) activity is monitored by complement levels C3, C4, and CH50. The present study aimed to investigate the association between hypocomplementemia and the development of lupus nephropathy (LN) in patients with SLE, to determine whether hypocomplementemia is a predisposing factor. Methods: The present observational, case-control study was conducted at the Eugenio Espejo Hospital in Quito, Ecuador, from 2009 to 2014. Records of patients diagnosed with SLE were included. Two groups were formed: the first with lupus nephropathy and the second without lupus nephropathy. The variables included demographic and clinical data, hypocomplementemia status, C3 and C4 levels, 24-hour proteinuria, serum creatinine, and serum urea. The strength of association between hypocomplementaemia and renal involvement in patients with SLE was summarized by odds ratios (ORs) and their 95% confidence intervals (CIs). Results: A total of 134 patients were included. There were 52 cases and 82 controls. Hypocomplementemia is associated with the risk of developing lupus nephritis (OR=11.1; 95% CI 4.9-25.2, P <0.05). These results were maintained with sex-adjusted models (OR=11.2; 95% CI 4.9-25.7, P <0.05), and by age and sex (OR=11.5; 95% CI 5.0-26.7; P <0.05). Patients with extremely low C3 values had a 4-fold increased risk of developing LN, while those with extremely low C4 values had an 8-fold increased risk. Conclusions: There is a strong risk association between hypocomplementemia and the development of lupus nephritis in patients with SLE.
Copyright (c) 2025 Dr. Xavier Villota Acosta, Dra. Desiré Torres Morales, Oswaldo Alcocer, Enrique Gea (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
ANCA-Positive late-onset lupus and diffuse alveolar hemorrhage: Overlap or new clinical entity?
Introduction: Systemic lupus erythematosus (SLE) usually occurs in young people and manifests acutely, whereas in late cases (over 50 years of age), it is rare and insidious. The co-presence with neutrophil cytoplasmic antibodies (ANCA), characteristic of most vasculitis, is rare and leads to worse clinical outcomes. Clinical case: A 65-year-old man diagnosed with SLE for 4 years, with mild skin and joint symptoms. In the last 3 months, he presented with asthenia, adynamia, cough with hemoptysis, edema of the lower limbs, and proteinuria in the nephrotic range. Chest CT showed alveolar occupation with a ground glass pattern; Bronchoscopy showed diffuse alveolar hemorrhage. Renal biopsy reported class IV lupus nephritis, diffuse extracapillary proliferation, and grade I interstitial fibrosis. The diagnosis of lung-renal syndrome is considered. Conclusion: the concomitance between these autoimmune pathologies is unusual; there is a late-onset overlap syndrome between lupus nephritis and MPO-ANCA pauciimmune glomerulonephritis. In turn, as it presents more aggressive evolutions, it requires greater renal replacement therapy, plasmapheresis, and tumor necrosis factor inhibitors.
Copyright (c) 2025 Francisco Javier Vega Perez, José Lucas Daza, Maria Alejandra Falla Macias, Juan Camilo García Peralta, Manuela Alejandra Olarte Osma, Vanessa Villavicencio, Verónica Piedad Remache Otañez, Aldrin Diogenes Sosa Alvarado (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Nephrotic syndrome as an atypical presentation of polymyositis
Introduction: Polymyositis is an autoimmune idiopathic myopathy characterized by collagen disorders and mainly affects the proximal muscles and lungs. Its onset is subacute and evolves over weeks. It is more prevalent in women than in men. Renal manifestations are uncommon; when present, the most common include acute tubular necrosis secondary to hemoglobinuria and myoglobinuria associated with acute rhabdomyolysis. In addition, symptoms such as dysphagia and dyspnea may occur. Case report: We report the case of a 40-year-old female patient with a history of dermatitis herpetiformis and hyperprolactinemia, who consulted for a one-month clinical picture, characterized by fever, anasarca, muscle weakness, significant proteinuria and pericardial effusion. Electromyography showed findings compatible with inflammatory myopathy and muscle biopsy confirmed the diagnosis of polymyositis. Renal biopsy showed an increase in the mesangial matrix with immunofluorescence IgM deposits, compatible with mesangial glomerulopathy. The patient was treated with corticosteroid pulses and presented a favorable clinical evolution. Discussion: Renal involvement in patients with polymyositis (PM) is uncommon and is usually limited to tubular damage secondary to rhabdomyolysis or glomerulopathies, such as focal segmental glomerulosclerosis or tubulo-interstitial nephritis. The occurrence of a nephrotic syndrome in this setting requires a detailed etiologic evaluation. In the case presented, the renal biopsy showed IgM-associated mesangial nephropathy, a rare and still controversial entity that has been discussed as a variant of disease characterized by minimal changes or FSGS. The literature reports few cases of PM-associated glomerulopathies, with a predominance of membranous glomerulonephritis or immunocomplexes. The pathophysiology may involve common immune mechanisms, including CD8+ T-cell activation and cytokine-mediated glomerular damage. Conclusions: Complete remission of nephrotic syndrome after immunosuppressive treatment targeting PM suggests a possible shared immune-mediated origin.
Copyright (c) 2025 Dr Jose Lucas Daza, Salma Yulieth Yasno Lopez, Nicole Cifuentes Peralta , Stefania Macias Villermo, Elba Villavicencio (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Kidney transplantation is the renal replacement therapy that provides the best survival rates. The main issues are related to the presence of unidentified or untreated humoral and cellular rejection, which reduce graft survival. Significant progress is being made in this area of research.
Copyright (c) 2025 SLANH (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Over the past five years, understanding metabolism related to managing type 2 diabetes mellitus and nephropathy has reached a level not seen in decades. The introduction of sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 (GLP-1) agonists, and selective nonsteroidal mineralocorticoid receptor antagonists (Finerenone) offers physicians new tools for nephroprotection programs. We present the posters from the conference.
Sex influences hemoglobin, muscle mass, vascular development, and prognostic outcomes in chronic kidney disease. We present the conference posters.
Chronic kidney disease (CKD) is a global health problem with a dismal prognosis in pediatrics, with a significant impact in adulthood. Epidemiological data show between 55 and 60 diagnoses per million people under 18 years of age, with 1% of the entire population suffering from end-stage renal disease. It is characterized by the accumulation of uremic toxins, requiring urgent palliative treatment.
Patients hospitalized with COVID-19 are at increased risk of acute kidney injury (AKI; incidence 0.5–80%), which contributes to increased morbidity and mortality. There are limited data on the long-term (more than 12 months) effect of COVID-19-associated AKI on kidney function, especially in populations with a prevalent chronic kidney disease, such as ours.
Problems related to aging and renal decline include loss of muscle mass in older adults, drug toxicity in patients on multiple medications, and the challenge of determining when to start renal replacement therapy. We showcase the top posters from the conference.
1.º puesto: epidemiologia renal Gustavo Aroca Martínez, et al. Estudio: Enfermedad renal crónica en poblaciones vulnerables, afrodescendientes, indígenas y agrícolas en América Latina. 2.º Puesto: Epidemiologia renal Henry González Torres, et al. Estudio: Supervivencia renal en glomerulopatías primarias: un estudio retrospectivo de 15 años en el Caribe colombiano. 3.º Puesto: Epidemiologia renal José María Mora Gutierrez, et al. Estudio: Riesgo renal y cardiovascular oculto en población joven: resultados de un programa de cribado en pacientes ambulatorios aparentemente sanos. 1.º Puesto: Glomerulopatías Raúl Junior Gonzales Navarro, et al. Estudio: Glomerulopatías primarias 2006-2015 en Lima -Perú. 2.º Puesto: Glomerulopatías Iván Rosero, et al. Estudio: Mapa nefropatológico del austro del Ecuador. 3.º Puesto: Glomerulopatías Lucas Daza, et al. Estudio: Importancia clínica de la positividad de ANCA en la nefritis lúpica en pacientes hispanos. 1.º Puesto: Hemodiálisis. Daniela Ponce, et al. Estudio:Peritoneal dialysis Vs Hemodiafiltration for elderly patients over 75 years with com CKD stage 5D: a prospective cohort study. 2.º Puesto: Hemodiálisis. Franklin Mora Bravo, et al. Estudio: Efecto del aumento progresivo del flujo extracorpóreo (Qb) en el control del fósforo en pacientes en hemodiafiltración. 3.º Puesto: Hemodiálisis. Marcos Javier Romero Vazquez, et al. Estudio: Impacto de la quelación de hierro con deferasirox en la longitud de los telómeros y estrés oxidativo en pacientes en hemodiálisis: un estudio aleatorizado. 1.º Puesto: Hipertensión. José María Mora Gutierrez, et al. Estudio: Impacto del Deterioro Renal en la Fibrosis e Inflamación Cardíaca en Pacientes con Enfermedad Renal Diabética en Estadio 3: Perspectivas desde la RM Cardíaca y Biomarcadores Sanguíneos. 2.º Puesto: Hipertensión. Ileana Holst Schumacher, et al. Estudio: Hipertensión arterial en un grupo de niños y adoslecentes costarricences. 3.º Puesto: Hipertensión. Julio Andrés Franco Vivas, et al. Estudio: Relación entre la función diastólica del ventrículo izquierdo y el índice de sensibilidad a la sal. 1.º Puesto: injuria renal aguda. Alejandro Martínez Gallardo González, et al. Estudio: Injuria renal aguda con hipernatremia y ventos adversos renales mayores. 2.º Puesto: injuria renal aguda. Alejandro Martínez Gallardo González, et al. Estudio: Tratamiento con inhibidores SGLT2 durante insuficiencia renal aguda y su asociación con eventos adversos renales mayores. 3.º Puesto: injuria renal aguda. Diego Argudo, et al. Estudio: Efecto del uso de contraste yodado intravenoso en la función renal: Análisis retrospectivo en pacientes hospitalizados en un hospital de segundo nivel. 1.º Puesto: Nefrogeriatría. Pamela Soto Santillán, et al. Estudio: Evaluación nutricional y aplicación de SARC F en pacientes con enfermedad renal crónica en hemodiálisis. 2.º Puesto: Nefrogeriatría. Andy Corral, et al. Estudio: Beneficios y seguridad de Inhibidores del SGLT2 en octogenarios, nonagenarios y centenarios. 3.º Puesto: Nefrogeriatría. Josué Román Cab Paat, et al. Estudio: Evaluación geriátrica integral de pacientes con enfermedad renal crónica en hemodiálisis. 1.º Puesto: covid & Enfermedad renal. Tania Lizbeth Jiménez Sánchez, et al. Estudio: La lesión renal aguda asociada a Covid-19, aún en grado leve-moderado, se asocia con peor función renal a largo plazo. 2.º Puesto: Nefropediatría. Andrea Lucía García Díaz, et al. Estudio: Tratamiento de albuminuria persistente en adolescentes. Estudio de cohorte prospectiva del programa de tamizaje de ERC en Aguascalientes. 3.º Puesto: Nefropediatría. Mariana Kamariski, et al. Estudio: Experiencia en el manejo de lesión renal aguda pediátrica con terapias lentas continuas. 1.º Puesto: Riñón/diabetes/metabolismo. Luis Toro, et al. Estudio: Efectos metabólicos y renales del uso de agonistas del receptor de GLP-1 en pacientes con diabetes tipo 2 en Chile. 2.º Puesto: Riñón/diabetes/metabolismo. María Isabel Ramos García, et al. Estudio: Asociación entre metabolismo mineral e infección por virus de hepatitis C en pacientes con ERC en hemodiálisis. 3.º Puesto: Riñón/diabetes/metabolismo. Jorge Rico Fontalvo, et al. Estudio: Eficacia y seguridad de Finerenona en pacientes con ERC asociada a diabetes tipo 2. 1.º Puesto: trasplante. Luis Agustín Camacho Murillo, et al. Estudio: El tratamiento de 1ra línea en pacientes con Rechazo Crónico Activo, mediado por anticuerpos, confiere una supervivencia del injerto renal y glomerulopatía postrasplante similar a la de pacientes sin lesiones crónicas. 2.º Puesto: trasplante. Andrea Zapata Arango, et al. Estudio: Prevalencia de neoplasias en adultos con trasplante renal: datos del Registro Nacional de Salud Colombiano entre 2019 – 2023. 3.º Puesto: trasplante. Andriana Margarita Lituma Orellana, et al. Estudio: Experiencia de trasplante renal ABO incompatible en Argentina. 1.º Puesto: Accesos vasculares e intervencionismo. Darío Reinoso y Favio Carrera, et al. Estudio: Diagnóstico de Accesos Vasculares disfuncionales por flebotac con técnica modificada. 2.º Puesto: Accesos vasculares e intervencionismo. Ethel Acabal, et al. Estudio: Implementación del programa nacional del acceso con fistula arteriovenosa en Guatemala. 3.º Puesto: Accesos vasculares e intervencionismo. Yadira Mariaca Ortiz, et al. Estudio: ¿La obesidad incrementa el riesgo de complicaciones en biopsia renal percutánea? Estudio observacional. 1.º Puesto: electrolitos. Andrey Narvaez, et al. Estudio: Hiponatremia en la Enfermedad Renal Crónica en Nicaragua: Una Realidad Silenciosa desde la Práctica Clínica. 2.º Puesto: electrolitos. Giovanna Arrocha, et al. Estudio: Alteraciones del metabolismo Óseo-Mineral en pacientes con ERC. Un estudio observacional de centro único. 3.º Puesto: electrolitos. Richard Palomeque Larriva, et al. Estudio: Alteraciones metabólicas en pacientes pediátricos con litiasis renal del departamento de nefrología en el Hospital Infantil de México de enero de 2017 a diciembre de 2020. 1.º Puesto: enfermedad renal crónica. Diego Osmany Chamba Pineda, et al. Estudio: Utilidad de T1 mapping en pacientes con enfermedad renal crónica terminal para determinar fibrosis miocárdica. 2.º Puesto: enfermedad renal crónica Pamela Morales, et al. Estudio: El ángulo de fase: un marcador sensible a los cambios en la composición corporal inducidos por la ultrafiltración y la hipervolemia en pacientes en hemodiafiltración. Un estudio observacional de centro único. 3.º Puesto: enfermedad renal crónica Rosalina de Lourdes Lituma, et al. Estudio: Herramienta de Evaluación de Síntomas para la Práctica Clínica en Pacientes Dializados: Un Cuestionario Basado en Consenso (Score de Guayaquil). 1.º Puesto: Trasplante (CASOS) Giuseppe Ayala, et al. Caso: Estenosis crítica de la arteria renal como causa reversible de disfunción del injerto. 2.º Puesto: Trasplante (CASOS) Marcela Ibañez, et al. Caso: Embolización de pseudoaneurisma en injerto renal como terapia de salvamento endovascular. 1.º Puesto: Pediatría (CASOS) Mariana Kamariski, et al. Caso: Purificación sanguínea extracorpórea en un niño con Loxocelismo Cutáneo-Visceral grave. 2.º Puesto: Pediatría (CASOS) Franklin Loachamin Chicaiza, et al. Caso: Microangiopatía trombótica por rotavirus. 1.º Puesto: injuria renal aguda (CASOS) Andrés Burak , et al. Caso: Síndrome Urémico Hemolítico atípico secundario a infección por dengue. 2.º Puesto: injuria renal aguda (CASOS) Maiko Alejandro Tavera Díaz, et al. Caso: Terapias extracorpóreas guiadas por fenotipos en Sepsis. 3.º Puesto: injuria renal aguda (CASOS) Diana Vargas, et al. Caso: Tormenta autoinmune asociada a inmunoterapia en paciente con cáncer de pulmón. 1.º Puesto: glomerulopatía (CASOS) Juan Enrique Rodríguez Mori, et al. Caso: Deficiencia de Lecitina colesterol acil transferasa, con hallazgo de “Cuerpos de Zebra” en enfermedad de Fabry. 1.º Puesto: Hemodiálisis. Mayte Fuentes, et al. Caso: Bacteriemia por Staphylococcus aureus con compromiso tiroideo en paciente en hemodiálisis.
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Hypertension and cardiovascular complications, original articles.
Arterial hypertension in patients with chronic kidney disease shows a paradoxical pattern compared to the general population. The best survival outcomes are seen in patients with systolic hypertension over 160 mmHg, while the highest mortality rates occur in those with pressures below 120 mmHg. These paradoxical findings may be linked to body composition, muscle mass index, and the ratio of effective circulating blood volume to muscle mass index. The original articles on hypertension from the conference are included.
Hypertension and Cardiovascular Complications
High blood pressure is one of the main modifiable risk factors for the development of cardiovascular complications, such as heart failure, coronary artery disease, stroke, and chronic kidney disease. Several clinical cases have shown that inadequate blood pressure control is associated with increased morbidity and mortality and progressive target organ deterioration. Analysis of these clinical scenarios highlights the need for timely diagnosis, accurate risk stratification, and the implementation of combination therapies to optimize prognosis. Furthermore, the importance of a comprehensive and multidisciplinary approach, as well as ongoing monitoring, is emphasized to prevent complications and improve the quality of life of patients with high blood pressure.
Hemodialysis, Peritoneal Dialysis and Nutrition
Hemodialysis has advanced this decade: hemodiafiltration has shown improved survival and better outcomes in controlling cardiovascular symptoms, phosphorus levels, pruritus, and reducing the use of erythropoietin. The enhanced bone marrow response is partly due to the necessity of ultrapure water as part of hemodiafiltration treatment, which has been required in the "On-Line" system—a pending task in hemodialysis. The significance of these communications is that HDF results in fewer outpatient symptoms for patients compared to HD. Another study compares peritoneal dialysis and HDF in patients over 75 years old, showing a substantial difference with HDF associated with lower mortality. Another study examines quality of life in HDF versus HD, which is notably better with HDF. Additionally, a study measures the removal of B2 microglobulin comparing HDF and expanded HD, again favoring HDF. We present the best posters from the congress.
Acute kidney injury reflects systemic dysfunction caused by injury in patients admitted to intensive care. The primary causes are sepsis and poisoning. The best posters feature original articles on topics such as iron levels, hyponatremia, mortality, and contrast media use in acute kidney injury.
Pediatric nephrology is a subspecialty of pediatric medicine that focuses on diagnosing, treating, and monitoring kidney and urinary tract diseases in children and teens. Pediatric nephrologists manage conditions like urinary tract infections, kidney stones, inherited kidney disorders, kidney failure, and high blood pressure, working with other specialists to deliver comprehensive care to kids with kidney health issues.
Pediatric nephrology is a subspecialty of pediatric medicine that focuses on diagnosing, treating, and monitoring kidney and urinary tract diseases in children and adolescents. Pediatric nephrologists manage conditions like urinary tract infections, kidney stones, inherited kidney disorders, kidney failure, and high blood pressure, collaborating with other specialists to provide comprehensive care for children with kidney health issues.
Acute renal failure indicates systemic dysfunction in response to injury in patients admitted to intensive care. The primary causes are sepsis and poisoning. This conference will discuss cases of acute renal failure caused by new nephrotoxic agents such as tenofovir, tirzepatide, oxaliplatin, and warfarin.