Ricardo Heguilen - Academia.edu (original) (raw)

Papers by Ricardo Heguilen

Nephrology Dialysis Transplantation

bedside thoracic ultrasound for counting B-lines and abdominal ultrasound for assessment of IVC d... more bedside thoracic ultrasound for counting B-lines and abdominal ultrasound for assessment of IVC diameter and IVC respiratory collapse. RESULTS: Acute kidney injury was diagnosed in 33 (53%) patients with ADHF. 23 (70%) patients had stage 1, 9 (27%)-stage 2, and 1 (3%)-stage 3 of AKI. There were not patients needing replacement kidney therapy. Patients with ADHF and AKI during the first day of hospitalization had larger IVC diameter (18.965.4 mm vs. 14.765.3 mm, resp., p=0.04) and respiratory IVC collapse was significantly lower (7.264.7 mm vs. 12.464.7 mm, resp., p=0.01). Subsequently, during the 7th day of therapy in patients with AKI the value of collapse of IVC became lower compared with patients without AKI (5.565.3 mm vs. 13.169.2 mm, resp., p=0.04). Cutoff point for predicting AKI was 8.7 mm for IVC collapse (under the curves of 0.77; sensitivity 73%, specificity 69%). The study showed no interaction between the count of pulmonary B-lines and the risk of AKI. CONCLUSIONS: Study showed that AKI affected 53% of patients with ADHF. Kidney dysfunction is associated with venous congestion. There was no interaction between the count of pulmonary B-lines and the risk of AKI in patients with ADHF, but increasing IVC diameter and reducing respiratory IVC collapse is associated with AKI development in patients with ADHF.

Medicina, 2017

The main aim of the study was to determine the prevalence of vascular calcifications in patients ... more The main aim of the study was to determine the prevalence of vascular calcifications in patients with chronic kidney disease on dialysis in our population assessed by X-ray. The secondary objectives were to determine the cardiovascular risk factors associated with the presence of vascular calcifications and to evaluate the complementary use of the echocardiogram in a cross-sectional, observational, multicentric study. We included patients with chronic kidney disease on dialysis, age =18 years with at least 3 months of renal replacement therapy in 8 dialysis centres in Argentina. The degree of vascular calcification was determined using Adragao and Kauppila scores. The presence of valvular calcifications was established through a trans-thoracic doppler echocardiogram. Univariate and multivariate analysis were undertaken, considering the degree of vascular calcification as the dependent variable; 443 adult patients were evaluated at 8 centres across 5 provinces in Argentina. The preva...

Clinical Kidney Journal, 2016

Background: Sevelamer has been associated with less progression of vascular calcifications. This ... more Background: Sevelamer has been associated with less progression of vascular calcifications. This effect could be due to a reduction in serum phosphate levels but also to other additive effects. Magnesium has been also shown to prevent vascular calcification but the effect of sevelamer on serum magnesium levels has not been thoroughly evaluated. Our aim was to analyze whether the use of sevelamer reducesthe riskof hypomagnesemia in hemodialysis (HD)-requiring end-stage renal disease patients. Methods: All prevalent patients from the dialysis unit of the Hospital Italiano de Buenos Aires as of 1 June 2015 were evaluated. They were on three times per week bicarbonate/citrate-buffered HD. They were not receiving phosphate binders or magnesiumcontaining drugs. The average of three successive monthly magnesium serum levels was considered as the baseline magnesium concentration. Sevelamer carbonate use was retrieved from the patient's clinical records. Results: One hundred and fifty-one patients were included. A large proportion of individuals were on proton pump inhibitors (PPIs) (66%) and more than 50% were using sevelamer carbonate. Serum magnesium levels were significantly higher in those receiving sevelamer compared with those who did not (2.05 ± 0.3 versus 1.8 ± 0.4 mg/dL; P < 0.05). A larger proportion of individuals receiving sevelamer were among those with normal serum magnesium (P = 0.02), while among those with hypomagnesemia, a larger proportion were on PPIs. In the multivariate model including the use of PPIs, sevelamer carbonate resulted in an independent protective factor for hypomagnesemia (odds ratio: 0.44; 95% confidence interval: 0.21-0.87). Conclusions: Hemodialysis patients receiving sevelamer show higher serum magnesium levels and a reduced risk of hypomagnesemia. This effect remains even after adjustment for PPI use. This effect could contribute to the still controversial superiority of sevelamer in preventing vascular calcifications.

European Journal of Rheumatology, 2016

The presence of distal extremity pain in children and adolescents usually triggers the search of ... more The presence of distal extremity pain in children and adolescents usually triggers the search of rheumatologic diseases without considering non-rheumatologic causes of joint pain. Approaching distal extremity pain with a complete differential diagnosis, including non-rheumatologic entities, may hasten diagnosis, thus decreasing cost and aiding in earlier initiation of appropriate therapy. To present a case of a patient who after years of work up of arthralgia, which was actually attributed to rheumatologic causes, had an inherited metabolic disease. A 32-year-old male presented to the clinic with complaints of distal pain in his four limbs, predominantly in the hands, since he was 8 years. After 6 years of consultation in various pediatric centers, he was diagnosed with growing pains. At the age of 15 years, laboratory investigations began targeting rheumatologic causes of his symptomatology, and after 9 years, the diagnosis of chronic kidney disease of unknown etiology was made. Because of the constellation of signs and symptoms and his family history, an analysis of α-galactosidase A enzyme activity was conducted and Fabry disease was confirmed. Rheumatologists and immunologists may be the first encounter patients with Fabry disease. Thus, if Fabry disease is not considered at the differential diagnosis, an opportunity is missed for early initiation of a therapy.

Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia

Background: Estimating the dialysis dose is a requirement commonly used to assess the quality of ... more Background: Estimating the dialysis dose is a requirement commonly used to assess the quality of renal replacement therapy (RRT) in patients with chronic kidney disease (CKD). In patients with acute kidney injury (AKI), this value is not always evaluated and it has been estimated that the prescribed dose is seldom obtained. Reports addressing this issue in AKI individuals are scarce and most have not included an adequate number of patients or treatments, nor were patients treated with extended therapies. Kt values obtained by the ionic dialysance method have been validated for the evaluation of the dialysis dose and it has also been shown that, compared with Kt/V, this is the most sensitive strategy for revealing inadequate dialysis treatment in critically ill AKI individuals. The main aim of this study was to assess the difference between the prescribed and the administered dialysis dose in critically ill AKI patients, and to evaluate what factors determine this gap using Kt values...

Background / Purpose: Fabry disease (FD) is an X-linked recessive inborn error of glycosphingolip... more Background / Purpose: Fabry disease (FD) is an X-linked recessive inborn error of glycosphingolipid metabolism caused by the deficient activity of the αgalactosidase A (αgal A). Although diagnosis is often delayed or missed, progressive renal failure with proteinuria and the need for dialysis or transplantation are prominent features.Enzyme replacement therapy (ERT) in all males with Fabry disease (including those with end-stage renal disease) and female carriers with substantial disease manifestations should be initiated as early as possible. As urinary protein excretion is strongly associated with renal disease progression in men and women with FD, we report the clinical and renal outcome of 21 FD patients receiving ERT who were followed up for a period of up to 8 years. Main conclusion: Regression models of the eGFR slope indicated that UP/Cr is the most important indicator of renal disease progression in adult Fabry patients. ERT is the only disease-specific therapy currently av...

Clinical genetics, Jan 26, 2015

We describe the results of the multidisciplinary evaluation in patients with Fabry disease and th... more We describe the results of the multidisciplinary evaluation in patients with Fabry disease and the same genetic mutation and their outcomes using different approved ERT. We measured baseline data and serial results of neuropathic pain assessment and renal, cardiac and cerebrovascular functioning. Pain scale showed improvement in all male cases treated with agalsidasa beta. A mild improvement was detected in agalsidasa alfa treated patients after one year with posterior increase. During the agalsidase beta shortage two male patients were switched to agalsidasa alfa, after one year both cases presented an increase in scale values. Renal evolution showed a tendency towards a decrease in proteinuria in patients using agalsidase beta and worsening with agalsidase alfa. We found improvement in two females using agalsidase beta and no changes in the other cases regarding cardiac functioning. Brain MRI showed increase of white matter lesions in 4 patients. Improvement and stabilization in n...

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Medicina cutánea ibero-latino-americana, 1989

Itching is the dermatologic symptom more often found in patients with chronic renal failure. We h... more Itching is the dermatologic symptom more often found in patients with chronic renal failure. We have studied 80 patients with end-stage renal disease; itching was present in 56.3% of the cases. We didn't detected in this study any correlation between itching, long term hemodialysis, high calcium, phosphorus, alkaline phosphatase or phosphocalcic product levels. We have seen: 1. Those patients with itching were older than the rest. 2. Itching was important in those patients with residual diuresis less than 500 ml/day (p greater than 0.01). 3. Those men without itching had higher hematocrit levels (p greater than 0.01). 4. Histologic findings on optic and electronic microscopy were more frequent in patients who presented this symptom.

Clinical and Experimental Nephrology, 2012

The occurrence of contrast-induced acute kidney injury (CIAKI) has paralleled the increased numbe... more The occurrence of contrast-induced acute kidney injury (CIAKI) has paralleled the increased number of diagnostic interventions requiring radiographic contrast media (CM). Several strategies aimed at preventing renal injury following iodine have been carried out over the last several years. The aim of this study was to evaluate the impact of three different strategies aimed at preventing CIAKI in patients with renal dysfunction (serum creatinine &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1.25 mg/dl or estimated creatinine clearance &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;45 ml/min) receiving low osmolar CM for diagnostic-therapeutic procedures. Candidates received 154 mmol NaHCO3 solution (B0) at a rate of 3 ml/kg/h from at least 2 h before the procedure and at 1 ml/kg/h during and for the next 6-12 h; the same schedule plus N-acethyl-cysteine (NAC) 600 mg twice daily the day before and the day of the procedure (BN) or NAC as above plus 154 mmol NaCl solution at a rate of 3 ml/kg/h from at least 2 h before the procedure and at 1 ml/kg/h during and for the next 6-12 h (SN). Serum creatinine (SCr) was measured at baseline and on days 2 or occasionally 3 after CM. The main outcome measure was the occurrence of CIAKI, defined as a ≥25% increase in SCr within 2-3 days of CM. The three groups were similar with regard to age, gender distribution, weight, baseline serum levels of creatinine, sodium, potassium, urate and estimated creatinine clearance. A larger proportion of individuals received ACEIs/ARAs in the BN group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), but in the SN group, more patients declared a past history of acute myocardial infarction or had high blood pressure, and few displayed mild-moderate left ventricular dysfunction (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). CIAKI occurred in 24/123 (19.5%) assessable patients (15/42 in the B0 group, 3/43 in the BN group and 6/38 in the SN group; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Thus, 15/42 patients who did not receive NAC developed CIAKI in contrast to 9/81 who did (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Multivariate logistic regression models showed that the use of NAC was the unique factor associated with a statistically significant influence for the occurrence of CIAKI (OR: 0.18; 95% CI: 0.04-0.72; p = 0.016). The results from this study show that: (1) the occurrence of CIAKI after low-osmolar CM administration is similar to that reported worldwide. (2) NAC-based renoprotective measures are superior for the prevention of CIAKI in patients with previous renal dysfunction. (3) They also demonstrate that bicarbonate expansion alone has limited value in preventing CIAKI. For those individuals at risk, combination prophylaxis including volume expansion plus NAC should be recommended to reduce the chance of overt kidney injury following CM administration.

International Journal of Pediatric Otorhinolaryngology, 2005

Streptococcus pneumoniae (Sp) and Haemophilus influenzae (Hi) are the leading bacterial cause of ... more Streptococcus pneumoniae (Sp) and Haemophilus influenzae (Hi) are the leading bacterial cause of acute otitis media (AOM), having the nasopharynx (NP) as their reservoir. In October 2001 we began a prospective, multicenter, randomized, evaluator blind study, comparing the efficacy of amoxicillin-sulbactam (Ax/S) and amoxicillin-clavulanic acid (Ax/C) for the treatment of non-recurrent AOM (nr-AOM). Both antimicrobial susceptibility (AS) to Ax/S and Ax/C from Sp and Hi carried by study children (aged 6-48 months with nr-AOM) and, clinical outcome after treatment with high dose of either Ax/C (7:1) or Ax/S (4:1) (amoxicillin dose: 80 mg/(kg day), b.i.d. for 10 days) were assessed. Nasal cultures (NCs) were taken at Day 0. Follow-up NCs, were done only for Sp carriers. On final analysis 247/289 pts (85.5%) were fully evaluable (120 Ax/S and 127 Ax/C). NP carriage rate of Hi and Sp at Day 0 was 32.2% (93/289 pts) and 28.7% (83/289 pts), respectively. Persistent Sp carriage was detected only in 2 pts. Hi betalactamase positive rate was 13% (12/93). MICs for Ax/S and Ax/C were identical when tested against Sp and Hi isolates (range 0.

renal.org.ar

RESUMEN El embarazo ocurre con cierta frecuencia en mujeres portadoras de insuficiencia renal cró... more RESUMEN El embarazo ocurre con cierta frecuencia en mujeres portadoras de insuficiencia renal crónica (IRC) aun en aquellas en terapia de reemplazo renal (TTR). El objetivo de este análisis retrospectivo es comunicar la experiencia de 13 años de un ...

Rev. nefrol. diálisis …, 1993

Resumo: La CaMgATPasa es una enzima involucrada en los movimientos de calcio a través de las memb... more Resumo: La CaMgATPasa es una enzima involucrada en los movimientos de calcio a través de las membranas biológicas. Nosotros testeamos la actividad de dicha enzima en membranas de eritrocitos de 17 pacientes hipercalciúricos y la comparamos con 8 ...

Journal of Laboratory and Clinical Medicine, 2001

Nephrology Dialysis Transplantation, 2005

Background. Hyperkalaemia is common in patients with advanced renal disease. In this double-blind... more Background. Hyperkalaemia is common in patients with advanced renal disease. In this double-blind, randomized, three-sequence, crossover study, we compared the effect of three dialysate bicarbonate concentrations ([HCO 3 À ]) on the kinetics of serum potassium (K þ) reduction during a conventional haemodialysis (HD) session in chronic HD patients. Methods. We studied eight stable HD patients. The choice of dialysate [HCO 3 À ] followed a previously assigned treatment protocol and the [HCO 3 À ] used were low bicarbonate (LB; 27 mmol/l), standard bicarbonate (SB; 35 mmol/l) and high bicarbonate (HB; 39 mmol/l). Polysulphone dialysers and automated machines provided blood flow rates of 300 ml/min and dialysis flow rates of 500 ml/min for each HD session. Blood samples were drawn at 0 (baseline), 15, 30, 60 and 240 min from the arterial extracorporeal line to assess blood gases and serum electrolytes. In three of the eight patients, we measured serum K þ 1 h post-dialysis as well as K þ removal by the dialysis. The same procedures were followed until the completion of the three arms of the study, with a 1 week interval between each experimental arm.

Nephrology, 2007

Background: The renal reserve (RR), assessed after an oral protein challenge or the intravenous a... more Background: The renal reserve (RR), assessed after an oral protein challenge or the intravenous administration of amino acids, is still present in healthy pregnant women (NP), although resting glomerular filtration rate (GFR) and renal plasma flow (RPF) increase progressively throughout normal gestation. No studies have addressed this issue in hypertensive gravidas; the aim of this trial was to evaluate renal response to an acute protein load (PL) in NP and pregnant women with borderline hypertension (HP). Methods: Five NP, eight HP and eight healthy non-pregnant women (CG) were evaluated. After fasting overnight, all subjects received an oral water load (20 mL/kg of body weight), the urinary output was then replaced orally with equal volumes of water. After two 30 min periods, an 80 g PL was provided. Creatinine clearance (CCr) was measured every 30 min from 1 h before and for 4 h following PL. Participants remained recumbent during the study, bladder emptiness was assessed by ultrasound immediately after each micturition. Baseline CCr was taken as the average of two 30 min periods before PL and peak CCr as the maximal CCr recorded thereafter. Results: The groups were similar with regard to age, weight or gestation age.

Nephrology, 2006

Background: Hyperhomocysteinaemia is an independent risk factor for cardiovascular disease with a... more Background: Hyperhomocysteinaemia is an independent risk factor for cardiovascular disease with a remarkable prevalence in patients with chronic renal failure (CRF). Low doses of folic acid (FA) with or without vitamin B6 and B12 has been shown to effectively reduce plasma homocysteine (Hcy). The aim of this study was to compare the short-term effects of two different oral doses of FA (5 vs 15 mg/d) on plasma Hcy levels in subjects suffering from moderate-severe CRF. Methods: A double-blind, double-dummy, comparative, two-stage randomised study was performed. Seventeen patients aged 45-71 years, with glomerular filtration rates between 15.4-50 mL/min 1.73/m 2 were randomly assigned to receive FA 5 mg/d (FA-5, n: 8) or FA 15 mg/d (FA-15, n: 9) for 30 days. At the end of this 30-day double-blind period, all the participants were placed on FA 5 mg/d (open period), for 5 additional months. Both groups were also supplemented with vitamins B1, B6 and B12 throughout the trial. Blood samples were drawn at 0, 15, 30, 90 and 180 days to assess Hcy, complete blood count (CBC) and sequential multichannel analysis (SMA). Chest X-ray and a 12-lead electrocardiogram (ECG) were also performed.

Journal of Cardiovascular Pharmacology, 1995

Endothelin (2, 5, and 10 pmol/kg/min) was infused into the renal artery of conscious dogs, produc... more Endothelin (2, 5, and 10 pmol/kg/min) was infused into the renal artery of conscious dogs, producing graded and progressive reductions in renal blood flow (RBF) without initial vasodilatation, parallel reductions in glomerular filtration rate (GFR), and reduced Na+ excretion, but little change in urine flow. Pretreatment of the dogs with either ibuprofen (20 mg/kg orally) or aspirin (30 mg/kg p.o.) did not significantly alter the effects of endothelin (5 pmol/kg/min) on RBF, GFR, or Na+ excretion. However, endothelin caused antidiuresis in these cyclooxygenase-inhibited dogs, indicating that the effects of endothelin on water reabsorption were prostanoid mediated. Treatment with captopril (1.5 mg/kg + 0.5 mg/kg/h) did not significantly alter any of the responses to endothelin. The local effects of endothelin in the kidneys of conscious dogs were vasoconstriction and reduced Na+ excretion which were not mediated or modified by either angiotensin II or prostanoids.

International Journal of Gynecology & Obstetrics, 2000