Michelle López Luzardo

La acidosis metabólica subclínica resultante de una carga ácida de la dieta  constituye un factor de riesgo para diversas patologías. Objetivo: Determinar si los pacientes ingresados en el Centro Médico Docente La Trinidad logran modificar el contenido ácido de la dieta que consumen durante su hospitalización, mediante una  Intervención Educativa (IE). Métodos: se analizó la Carga Ácida Potencia Renal (CAPR) de las dietas completa (C), de protección gástrica (PG), hiposódica (H) y para diabéticos (D). Se identificaron las preferencias de los pacientes en cuanto a alimentos ácidos y alcalinos antes y después de la IE. Resultados: La CAPR (mEq/día) antes y después de la IE fue: <0: 9 vs 26 pacientes; 0-20: 11 vs 21; >20: 40 vs 13. Después de la IE 49 (81,6%) pacientes disminuyeron la CAPR  de su dieta y 11 (18,4%) la aumentaron (p<0,0001). El promedio de la CAPR para todas dietas antes vs después de la IE fue de 29,35 vs 4,60 (p<0,0001): dieta C 27,67 vs 2,43; dieta de PG ...

High protein intake produces an increase in net acid excretion, which in turn leads to an increase in urinary calcium. Effects of diet in urinary acid and calcium excretion depend not only on the protein content, but also may be modified by other constituents such as potassium and alkali equivalents of bicarbonate present in fruits and vegetables. Diets deficient in these potassium bases increase the acid load imposed by proteins. In conse- quence, diets with a high protein intake or poor in fruits and vegetables produce a low-grade systemic metabolic acidosis which exerts deleterious effects on the body, including growth retardation in children, decreased muscle and bone mass in adults, and kidney stone formation. This review intends to summarize the present evidence in relation to the effects of high protein diets in different organs and systems including hydroelectrolytic and acid base metabolism, bone metabolism, renal and endocrine function. Particular aspects that may exert a ...

High protein intake produces an increase in net acid excretion, which in turn leads to an increase in urinary calcium. Effects of diet in urinary acid and calcium excretion depend not only on the protein content, but also may be modified by other constituents such as potassium and alkali equivalents of bicarbonate present in fruits and vegetables. Diets deficient in these potassium bases increase the acid load imposed by proteins. In consequence, diets with a high protein intake or poor in fruits and vegetables produce a low-grade systemic metabolic acidosis which exerts deleterious effects on the body, including growth retardation in children, decreased muscle and bone mass in adults, and kidney stone formation. This review intends to summarize the present evidence in relation to the effects of high protein diets in different organs and systems including hydroelectrolytic and acid base metabolism, bone metabolism, renal and endocrine function. Particular aspects that may exert a sp...

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Our aim was to determine and analyze the dietary PRAL and food composition pattern in apparently healthy children from 1 to 6 years of age. Parents of 52 children were selected by convenience, in an outpatient clinic of healthy children. Dietary quality and pattern was assessed by 24 hour recall and food frequency questionnaire. We focused on the intake of macronutrients and food groups, such as meats, dairy, fruits and vegetables. Nutrient intake was compared with national and international recommendations. PRAL was determined according to the method described by Remer and Manz. Descriptive statistics and correlations were applied. Dietary intake of proteins, milk and meat was high, while fruits and vegetables intake was low. PRAL was positive in 92% of the children and correlated (p<0.05) with intake of energy, proteins, fat, meat and dairy products. Protein intake was above 2.5 g/kg/day in 46.2% of the children. Food groups with the highest unbalance were meat and dairy produc...

La decisión de hospitalizar o no un niño con Infección Urinaria (IU) no debe sustentarse de forma exclusiva en el diagnóstico de pielonefritis aguda, ya que estudios recientes han mostrado que en los pacientes con buen estado general y, sin antecedentes de uropatía importante, el tratamiento ambulatorio con antibióticos por vía oral es eficaz y seguro. Por ello, la decisión de ingreso se debe basar fundamentalmente en la valoración de la situación clínica del paciente y el riesgo estimado de complicaciones generales. En esta revisión se evalúa la eficacia y seguridad de los antibióticos que se utilizan para tratar pielonefritis aguda en niños que requieren ser hospitalizados, se especifican los agentes antibióticos óptimos, así como la vía de administración y la duración del tratamiento adecuadas para este grupo de pacientes. Asimismo, se revisan los aspectos particulares de la IU en el neonato, debido a las características especiales del sistema inmune en este grupo de edad.

Calcium oxalate crystal growth inhibitor (CGI) was isolated from human urine in monomeric form (14,000 daltons). Antibody was elicited and purified to monospecificity by affinity chromatography. Tamm-Horsfall protein was isolated from human urine and an antibody to Tamm-Horsfall protein compared to anti-CGI. The anti-CGI reacted with its antigen on immunodiffusion, by ELISA and by Western Blotting of polyacrylamide gel electrophoresis-separated antigen. Immunofluorescent localization of CGI was found in distal renal tubules. This was precisely the localization of Tamm-Horsfall protein. Isolated Tamm-Horsfall protein was found to bind CGI which could only be partially removed with EDTA. While anti-CGI is suitable to assay CGI in human urine by ELISA techniques, it will also detect CGI that is complexed to THP. While the CGI found in human urine possesses 90% of the urinary macromolecular crystal growth inhibitor activity, THP is without effect on crystal growth, in spite of bound CGI. The balance between free CGI and that bound to Tamm-Horsfall protein may be important in the overall balance of urinary macromolecules that affect calcium oxalate nephrolithiasis.

Resumo: Se presentan los resultados de un estudio multicéntrico sobre IRC en niños, con participación de las principales Unidades de Nefrología Pediátrica del país. Del análisis de 174 pacientes, manejados entre 1.979 y 1.986, se establecieron las siguientes ...

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Archeological findings give profound evidence that humans have suffered from kidney and bladder stones for centuries. Bladder stones were more prevalent during older ages, but kidney stones became more prevalent during the past 100 years, at least in the more developed countries. Also, treatment options and conservative measures, as well as ‘surgical’ interventions have also been known for a long time. Our current preventive measures are definitively comparable to those of our predecessors. Stone removal, first lithotomy for bladder stones, followed by transurethral methods, was definitively painful and had severe side effects. Then, as now, the incidence of urolithiasis in a given population was dependent on the geographic area, racial distribution, socio-economic status and dietary habits. Changes in the latter factors during the past decades have affected the incidence and also the site and chemical composition of calculi, with calcium oxalate stones being now the most prevalent. Major differences in frequency of other constituents, particularly uric acid and struvite, reflect eating habits and infection risk factors specific to certain populations. Extensive epidemiological observations have emphasized the importance of nutritional factors in the pathogenesis of urolithiasis, and specific dietary advice is, nowadays, often the most appropriate for prevention and treatment of urolithiasis.