IgA nephropathy is the most common glomerulopathy, characterized by immune complex deposits in the glomeruli causing renal damage. It is associated with genetic predisposition and abnormal immune responses. We present the case of a 15-year-old adolescent with glomerular hematuria and acute renal deterioration following a viral illness and exposure toNSAIDs and iodinated contrast. Renal biopsy revealed IgA nephropathy and acute tubulointerstitial nephritis (ATIN) witheosinophilia. She received methylprednisolone pulses, achieving renal recovery. This case highlights the importance of distinguishing acute complications in patients with IgA nephropathy to ensure timely and appropriate management. IgA nephropathy and interstitial nephritis are connected through inflammatory mechanisms in the kidney. Although IgA nephropathyprimarily affects the glomeruli with different histologic patterns, in this case we found interstitial inflammation exacerbatingdamage and accelerating the deterioration of renal function. This highlights the importance of addressing all the mechanismof acute kidney injury to prevent progression to end-stage renal disease.
Arteriovenous fistulas (AVFs) with hemodynamic compromise represent an uncommon complication of percutaneous renal biopsy in native kidneys. In most cases, these fistulas are asymptomatic and self-limiting. However, on certain occasions, depending on their size, they may impair renal perfusion and lead to hemodynamic alterations. We report the case of a 61-year-old female patient who required embolization of the right renal artery due to a high-flow arteriovenous fistula (AVF-HF) associated with a pseudoaneurysm, presenting with gross hematuria and hemodynamic decompensation following a percutaneous renal biopsy.
Introduction: Idiopathic nephrotic syndrome (INS) in children may present frequent relapses or steroid dependence, with a risk of corticosteroid toxicity. In this context, rituximab (RTX) and mycophenolate mofetil (MMF) were used as alternative therapeutic options. Materials and methods: A prospective observational cohort study was conducted in a pediatric nephrology unit in the Autonomous City of Buenos Aires, including 12 patients with steroid-dependent nephrotic syndrome (SDNS) who received sequential treatment with RTX and MMF. Results: Of the 12 patients treated with RTX, 4 achieved sustained remission. The remaining 8 had fewer than 2 relapses per year but required potentially toxic steroid doses; therefore, after a mean period of 13 months post-RTX, MMF was added. All patients remained in remission until the end of the study. The cumulative steroid dose (CSD) pre-RTX was 5335 mg/m2 and post-RTX was 2024 mg/m2 (p = 0.001). Finally, the mean CSD with MMF was 1378 mg/m2 (Wilcoxon test: T = 3.5, p = 0.005). In the 10 patients who experienced at least one relapse, the mean CD20 lymphocyte count one month after RTX was 3.7 cells/mm3, and at relapse it was 26 cells/mm3 (CD20–proteinuria correlation coefficient: 0.54). Observed adverse effects were minimal and reversible. Conclusion: Sequential therapy with RTX and MMF may be an option for patients with primary steroid-dependent nephrotic syndrome.
Urogenital tuberculosis is the most common extrapulmonary form. Although considered rare, it accounts for up to 30% of cases. It predominates in males and is associated with immunosuppressive conditions. Its clinical presentation is usually insidious and nonspecific, which often delays diagnosis. However, in advanced stages, it can cause serious complications, affecting the prognosis. Objective: To describe one of the clinical presentations of renal tuberculosis. Materials and Methods: We present a case of renal tuberculosis in an immunocompetent patient, which manifested as a renal abscess. Results: The patient required drainage of the renal abscess and antituberculosis antibiotic treatment. Conclusion: This case highlights the importance of considering renal tuberculosis as a differential diagnosis, even in immunocompetent patients with renal abscesses of unclear etiology.
Objective: Chronic kidney disease of nontraditional cause (CKDnt) is a significant concern in Mesoamerica and South Asia. Despite research progress, its causes remain unclear and disease burden high. The international workshop was convened to evaluate current evidence and guide public health strategies. Materials and methods: The Fourth International Workshop on CKDnt was held in 2024 and organized by the Consortium for the Epidemic of Nephropathy in Central America and Mexico (CENCAM), in collaboration with the Executive Secretariat of the Council of Ministers of Health of Central America and the Dominican Republic (SE-COMISCA), the Latin American Society of Nephrology and Hypertension (SLANH), the Central American Program for Health, Work and Environment (SALTRA), and the Spanish Agency for International Development Cooperation (AECID). The objective was to provide evidence-based support for the program “Strategy for the Prevention, Mitigation, and Control of CKDnt in Central America and the Dominican Republic”. Results: Participants numbered 165, most from Mesoamerica. Workshop discussions were centered around: (1) the causes of CKDnt, (2) methodological research approaches, and (3) strategies for application of findings. Conclusions: Addressing CKDnt requires coordinated, evidence-based actions at both regional and international levels.
Objective: To assess the current status of chronic kidney disease (CKD) in the nutritional context and generate recommendations for the medical and nutritional management of patients with CKD in Central America and the Caribbean. Material and methods: Expert meetings (nephrologists, nutritionists, internists, and nutritionists) were held virtually and in person during 2022 and 2024. International guidelines on nutrition in CKD were reviewed, considering the country-specific situational assessment, nutritional diagnosis and intervention, and management recommendations. Results: A lack of data on the prevalence and incidence of CKD and its nutritional complications in the region was identified. Recommendations were developed for nutritional screening, evaluation, diagnosis, and intervention at different stages of CKD and renal replacement therapy, including guidelines on dietary prescription, meal plans, nutritional education, and follow-up. Conclusions: This document provides a regional expert consensus to standardize nutritional management of CKD patients in Central America and the Caribbean, highlighting the importance of individualized treatment and the need for a multidisciplinary approach. Its unique feature lies in the adaptation of international guidelines to the specific characteristics of the region.
Objective: To implement a tool for collecting the opinions of nephrologists regarding accesibility to renal care in Latin America. Material and methods: A survey comprising 52 questions/4 dimensions (health coverage; care setting; access to diagnostic/therapeutic technology; renal replacement characteristics) was distributed online (to selected nephrologists/18 countries); certainty per dimension was assessed and correlated with socioeconomic variables using Microsoft Excel® (descriptive) and JASP® (probabilistic). Results: Over 94 responses (mean = 5.2/country) the mean certainty was 3.93/5 points (lower for human resources, higher for regulations and access to technologies in private subsector). Public healthcare funding predominates (65%), coexisting with cross-coverage; availability of professionals were divergent between countries (lower in the public subsector); 70% reported integrated nephrology guidelines (many under development), the registries show asymmetric evolution (37% consolidated, 19% unregistered), 50% cited renal care programs, and 53% reported current transplant laws; diagnostic/therapeutic technology (even basic) was less available in the public sector, correlating with lower economic development and healthcare spending; the private sector does not adequately meet the remaining demand. Conclusions: Obtaining validated information from nephrologists is crucial, to provide decision-makers with concrete elements to develop public policies on kidney health. The developed tool is replicable and scalable for new, more representative and specific studies in different subregions or countries.
