___________________________________________________

ARIELA BENIGNI (ITALIA): The role of endothelin in renal disease progression

NORBERT BRAUN AND TEUT RISLER (Alemania): The Role of Immunoadsorption in Clinical Nephrology

LUIS CARRERAS (ESPAÑA): Síndrome hemolítico urémico en el adulto

ALBERTO M. CASTELAO (ESPAÑA): Lipid metabolism abnormalities in diabetic nephropathy patients and their management

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Session Start: Thu Feb 23 22:01:05 2000
[22:08] (JBover) buenas noches Luis
[22:09] (jgonzalez) buenas noches
[22:10] (JBover) welcome ariela!
[22:11] (JBover) Dr CARRERAS let me introduce you to A. Benigni from BERGAMO
[22:12] (JBover) hola welcome FER
[22:12] (JBover) Ariela ...you may try writing in the little space below this screen
[22:12] (abenigni) I am ready to start chatting, hello j
[22:14] (JBover) FER let me introduce you to DR ARIELA BENINGNI from Bergamo, Italy
[22:14] (JBover) abenigni Dr CARRERAS will participate also tonight with his experience in hemolitic uremic syndrome
[22:15] (JBover) Dr Braun from germany also promised his presence
[22:15] (abenigni) I will connect with you again within ten minutes
[22:15] (JBover) and Dr CASTELAO is just entering
[22:15] (JBover) ok ARIELA
[22:15] (JBover) we will start then
[22:16] (JBover) hola pedro
[22:16] (perico) hola jordi
[22:17] (perico) buenas noches a todos
[22:17] (JBover) CAstelao esta INTENTANDO entrar
[22:17] (JBover) y ya tenemos aqui al Dr Luis CArreras
[22:17] (perico) encantado
[22:18] (JBover) perico ------> Dr Carreras
[22:18] (JBover) Dr CArreras ----> Dr Abaigar
[22:18] (LCarreras) Encantado, Perico
[22:20] (JBover) Pedro amc es ALberto MArtinez CAstelao
[22:20] (LCarreras) Saludos, Alberto
[22:20] (amc) Luis saludos
[22:26] (perico) de todas formas ya hemos pasado el tiempo de cortesía, no?
[22:26] (JBover) los días anteriores fuimos mas puntuales
[22:27] (amc) Jordi: podríamos acompañarla?
[22:27] (JBover) ariela YA estuvo aqui...dijo que se conectaba en 10 minutos..le deben quedar dos
[22:28] (JBover) y el presidente????
[22:28] (JBover) el presidente igual no encontró un cyber-café!
[22:28] (JBover) GERARDO!!!!!! estaba preguntando por ti!
[22:29] (perico) entrará un poco más tarde
[22:29] (amc) Saludos Geardo
[22:29] (JBover) Gerardo....tu decides......ariela estuvo y dijo que se reconectaba en 10 minutos..llevamos 15
[22:29] (JBover) esperamos? o damos paso al Dr CArreras???
[22:30] (JBover) amc= Alberto MArtinez Castelao
[22:30] (amc) Dime
[22:30] (LCarreras) Por mí como queráis. pero me gusta esperar a Ariela..
[22:30] (perico) yo creo que podemos comenzar
[22:30] (amc) OK
[22:30] (JBover) pues bien.....
[22:31] (JBover) empezamos con el Dr Carreras siguiendo el programa entonces
[22:31] * JBover tiene el placer de presentaros al dr Luis CArreras
[22:31] (JBover) Jefe Clinico de Nefrología Clínica del Hospital de Bellvitge en Barcelona
[22:31] (LCarreras) Gracias por estos sentidos aplausos
[22:31] (JBover) Luis le damos la palabra a Ariela...es una señora!
[22:32] (MJesus) ciao Ariela! Buona sera!
[22:32] (JBover) Dra Benigni welcome
[22:32] (LCarreras) Naturalmente
[22:32] (amc) Wellcome Ariela
[22:32] (JBover) Welcome ariela...we were aiting for you
[22:32] (abenigni) hello everybody
[22:32] * JBover introduces to ARiela Benigni
[22:33] (JBover) As you all know...Dr Benigni is gonna talk today about endotehelin-1 and renal disease progression
[22:33] (JBover) She is working at the MArio Negri's Institute in bergamo, Italy
[22:33] (JBover) and, despite we have all read her conference, .....
[22:33] (JBover) perhaps it would be nice to have a summary from her
[22:33] (JBover) Dr Benigni????
[22:34] (JBover) ***************
[22:34] (abenigni) OK
[22:35] (JBover) Dr Benigni..could you please provide us a summary about your conference???
[22:35] (abenigni) Some experimental evidence are available that endothelin plays a role in progressive renal diseases
[22:36] (abenigni) in that endothelin synthesis/expression is increased in the kidney in proteinuric progressive nephropathies
[22:38] (JBover) pre-clinical observations convincingly document a role of ET-1 in progressive renal disease
[22:38] (abenigni) Furthermore, the recent availabilty of ET receptor antagonists lend to demonstrate that endothelin is a profibrotic agent and is responsible of interstitial damage
[22:39] (JBover) studies with endothelin receptor antagonists indicate that these compounds, while having a modest antiproteinuric effect, effectively prevent renal fibrosis.
[22:40] (JBover) Dr Benigni...what is the molecular pathway linking endothelin and renal scarring????
[22:41] (abenigni) yes, ET receptor antagonists have a modest anti hypertensive as well as antiproteinuric effect, while they are effective in reducing tubulointerstitial damage
[22:42] (amc) Dr Benigni: Are there experiences in the use of anti ET agents in human beings
[22:42] (abenigni) I believe that ET overexpression in the kidney derives from a toxic effect of proteins on proximal tuibuli
[22:43] (abenigni) unfortunately data on human beings are scanty with ET receptoe antagonists. The Companies do not invest in chronic long term studies
[22:43] (JBover) are you suggesting that their antibibrotic action is just related to their anti-proteinuric effect? is there no link between endothelin and TGF-Beta for instance??
[22:44] (JBover) antibibrotic=antiFibrotic :-)
[22:45] (abenigni) no, we demonstrated that protein overload induces ET overexpression in proximal tubuli and ET is mostly released towaqrds the interstitium where iot can exert its fibrotic action
[22:46] (abenigni) et overexpression is a consequence of proteinuria not a cause
[22:46] (JBover) is ET fibrotic by itself?
[22:47] (JBover) is there a sinergistic action between ACEI or AIIR blockers and ETR antagonists???
[22:48] (abenigni) yes, it induces fibroblast proliferation and ECM accumulation, but we cannot exclude a role for ET induced TGF B synthesis
[22:48] (abenigni) a sinergistic action on what?
[22:48] (JBover) on reducing proteinuria
[22:49] (JBover) a sinergistic action between endothelin receptor antagonists and ACEI or AII recxeptor blockers
[22:49] (abenigni) no, ET receptor anatgonists had a mild proteinuria lowering effect
[22:50] * JBover wonders if there are any further questions
[22:50] (abenigni) ACEI or AII blockers reduce proteinuria and reduce protein induced ET synthesis and ET receptor antagonist antagonize the effect of ET
[22:51] (JBover) I felt a bit dissapointed when I read that it is difficult that they could be commecially available....not even for the treatment of hypertension????
[22:51] (RJ_Bosch) is there any role of PAN on endothelin action on proteinuria
[22:52] (abenigni) could you spell PAN?
[22:52] (RJ_Bosch) sorry PAF
[22:53] (abenigni) my comment was related to renal disease progression, there are data in hypertensive patients but the effect was modest and the compounds are toxic
[22:54] (JBover) ooooooooooooo I didnt know about that toxicity
[22:54] (abenigni) yes, liver toxicity
[22:55] (JBover) do you have any experience on the use of these compounds in experimental renal transplantation???
[22:55] (JBover) in models of Chronic transplant nephropathy???
[22:56] (abenigni) i am not aware of studies with PAF receptor antagonists looking at ET
[22:56] *** Braun (jirc@a11a-23.dialin.msh.de) has joined #cin2000
[22:57] (RJ_Bosch) Ok, thanks
[22:58] (JBover) do you have any experience on the use of these compounds in experimental renal transplantation???
[22:58] (JBover) ) in models of Chronic transplant nephropathy???
[22:58] * JBover looks at the audience to know if there is a LAST question
[22:58] (abenigni) data are available from a german group of ET RA efficacy in chronic rejection, we have experience in CsA nephrotocity in rat and man in which ET is increased in the kidney, but no experience with ETRA
[22:59] (JBover) interesting
[23:00] * JBover wonders if there are any further questions
[23:00] (JBover) are there any questions???
[23:00] (JBover) well.....
[23:01] (JBover) I would greatly appreciate to Dr benigni heer presence and support to this novel venue
[23:01] (abenigni) thank you to you, dr Bover
[23:01] (JBover) We are all really thankful for your support and excelency of your conference
[23:02] (abenigni) to the next chat
[23:02] (JBover) and we are looking forward to your presence in the future again
[23:02] (JBover) COME TO SEE us from time to time!
[23:02] (abenigni) ok, I will do my best to join you thank you for inviting me
[23:03] (gerardo) thanks ariela
[23:03] (JBover) welll....next speaker will be DR NORBERT BRAUN
[23:03] (JBover) Norbert Braun is a clinical nephrologist
[23:04] (JBover) involved in research on extracorporeal treatments
[23:04] (JBover) mainly INMUNOADSORPTION
[23:04] (JBover) as you all know....
[23:04] (JBover) immunoadsortion is a tool for eliminating ...
[23:05] (JBover) substances from the plasma such as immunoglobulins, lipids or fibrinogen
[23:05] (JBover) Dr Norbert Braun will talk about his experience
[23:06] (JBover) Dr Braun is coming from...
[23:06] (JBover) Sektion Nieren- und Hochdruckkrankheiten of the Universitätsklinikum Tübingen, Germany
[23:06] (JBover) Welcome Dr Braun!!!!!!!!!!
[23:07] (JBover) Dr Braun ..could you please give us a summary about your conference???
[23:07] *** speaker (mjcoma@prim-hgy.hgy.es) has joined #cin2000
[23:08] (Braun) Hello Dr. Bover, thank you for inviting me to this online chat. I am form Tübingen, Germany
[23:08] (speaker) The Role of Immunoadsorption in Clinical Nephrology
[23:08] (speaker) Norbert Braun and Teut Risler
[23:08] (speaker) General Considerations
[23:09] (speaker) Extracorporeal immunoadsorption is known for about twenty years but has only recently
[23:09] (Braun) I am doing research on immunoadsorption for about 10 years, now.
[23:09] (speaker) attracted attention by the physicians because plasmapheresis failed to prove its
[23:09] (speaker) effectiveness in many autoimmune diseases. Thus, research focused on other tools for the
[23:09] (speaker) elimination of pathogenic antibodies and circulating immune complexes. This article
[23:09] (speaker) summarises the results of clinical investigations in this field focusing on immunoadsorption
[23:09] (speaker) in certain autoimmune and renal diseases.
[23:09] (Braun) May I put an interesting point to the forum?
[23:09] (speaker) Immunoadsorption is capable to eliminate huge amounts of immunoglobulins from the
[23:10] (MJesus) Dr. Braun..... yes!
[23:10] (JBover) GREAT!!!!!!!
[23:10] (JBover) let's do it Dr Braun!!!!!!!
[23:10] (Braun) Dr Benigni stated that ET1 is an important mediator for progression in renal disease. It seems to be correlated to the level of proteinuria.
[23:10] (JBover) yes ......
[23:11] (Braun) There are a few published case series about immunoadsorption in patients with FSGS.
[23:11] (JBover) what's the point?????
[23:12] (Braun) Okay
[23:13] (Braun) In brief immunoadsorption is known to eliminate huge amounts of immunoglobulins from the circulation of the patient.
[23:13] (amc) Dr Braun: Do you meant that IA can remove ET?
[23:14] (JBover) but it will remove much more than ET.....how can it be implemented more specific???
[23:15] (MJesus) Dr. Braun is leave by lag
[23:15] (MJesus) el Dr. Braun ha perdido la conexion
[23:16] (Braun) Dr Jesus, I am still there and trying to keep up with the conference.
[23:16] (JBover) great!!!!!
[23:16] (MJesus) you have no response to ping! .... perhaps, a firewall ?
[23:17] (Braun) Now, what I would like to answer is whether immunoadsorption although more specific than plasmapheresis is a specific or an unspecific immunological tool?
[23:18] (JBover) GREAT POINT!!!!!!
[23:18] (JBover) go on , please
[23:18] (Braun) Our own results show that effective elimination of IgG below detection limit reduces proteinuria in FSGS patients but relapses are quite regularily seen.
[23:19] (Braun) On the other hand, there are patients with FSGS who do not respond to this treatment at all.
[23:20] (JBover) was that done with IMMUNOADSORPTION ONLY or they realpsed despite the use of concomitant drugs?
[23:20] (JBover) realpsed=relapsed
[23:20] (Braun) Patients with recurrent FSGS in their transplant had concommitant treatment.
[23:21] (Braun) Our patients with FSGS in their own kidneys did not receive immunosuppressants.
[23:21] (Braun) This might indicate that there are two distinct entities of FSGS.
[23:21] (JBover) then it is not surprising that they relapsed...what about combinig immunoadsorption with drugs to reduce the production of Ig????
[23:22] (Braun) We have done that as well as others.
[23:22] (JBover) or to reduce the production of "FSGS permeability factor"????
[23:23] (JBover) weren't the results any better???
[23:23] (Braun) If the patient was already treated conventionally, let's say with cyclophosphamide, this treatment doesn't prevent relapse.
[23:23] (gerardo) alguien me traduce?
[23:23] (gerardo) los trabajsos que dice el dr.Braun son randomizados?
[23:23] (Braun) In accordance with Dantal, we use intermittent immunoadsorption to maintain remission. Cytotoxic treatment is of not much help in this condition.
[23:24] (Braun) We as well as the group of Savin, Los Angelos, tried to identify the proteinuric factor.
[23:24] (Braun) As you know there is only weak evidence for its existance.
[23:25] (JBover) Intermitent???? could you be more specific???? once every.......
[23:25] (JBover) tell us about THE COST
[23:25] (RJ_Bosch) do you randomize your patients
[23:25] (MJesus) Dr. Braun, gerardo ask you about the randomization of the patients
[23:26] (Braun) Treatment consists of treatment every day for the first week, then every second day for the next two or three weeks, and once when remission was obtained. once every week.
[23:26] (Braun) Costs: Immunoadsorption onto protein A sepharose costs about 10,000 Euros.
[23:27] * JBover repeats the question about randomization
[23:27] (JBover) who asked Dr Torres (gerardo)
[23:27] (Braun) This covers treatment of about 100 l plasma.
[23:27] (JBover) How does this cost compare with plasmapheresis????
[23:28] (JBover) there were two last questions Dr Braun
[23:31] (RJ_Bosch) ok
[23:31] (JBover) dr Braun......two last questions since we have to move on....
[23:32] (JBover) Dr Gerardo Torres asked if you randomized any treatment
[23:32] (Braun) Okay.
[23:32] (JBover) and the final question will be......how does that cost compare with plasmapheresis????
[23:33] (RJ_Bosch) do you have experience in different nephropaties like RPGN
[23:33] (Braun) We tried to set up a randomized controlled trial in treatment resistant FSGS two years ago (German Glomerulonephritis Study Group).
[23:33] (Braun) If you treat patients with about 3 plasmavolumes per treatment using plasmapheresis, immunoadsorption is cheaper after the 3rd or 4th treatment session.
[23:34] (Braun) We have experience with lupus nephritis, too.
[23:34] (Braun) We also treated Goodpasture syndrome.
[23:34] (JBover) I think that your contribution is great Dr Braun
[23:35] (Braun) The clincial results in severe lupus nephritis are quite promising and the manuscript was sent to NDT about half a year ago (now in revision).
[23:35] (JBover) Many people are not aware yet of this possibility and we have to face sometimes patients with very diffcicult approaches and I think that Immunoadsorption becomes an additional tool we may use
[23:35] (Braun) Thank you Dr Bover
[23:36] (MJesus) dr. braun.... thank you!!
[23:36] (JBover) definitely a multicentric trial is guaranteed......problem is how many centers have that economical possibility???
[23:36] (JBover) Thank you very much Dr Braun..we will be looking forward to read that manuscript and we all have an important contact to keep on being informed
[23:36] (Braun) Within the German Glomerulonephritis Study Group currently 14 centres are participating.
[23:37] * JBover will present now Dr Luis CArreras
[23:37] (JBover) Dr Braun...we will play Dr Carreras Conference but it is in Spanish......
[23:38] (JBover) you may stay for the discussion
[23:38] (JBover) since HUS has also some interesting points to make for immunoadsorption
[23:38] (Braun) Certainly, I will stay for a while to follow the discussion.
[23:38] (JBover) Dr Carreras is the Head of CLinical Nephrology of Princeps d'Espanya Hospital in barcelona
[23:38] (JBover) He has a vast experience in HUS
[23:39] (JBover) and he has even a very unique experience on familiar HUS in the adulthood
[23:39] (JBover) he will summarized it in his presentation
[23:39] (JBover) Dr Carreras WELCOME!!!!!!!
[23:39] (LCarreras) Thank you, Jordi
[23:40] (JBover) RESUMEN FINAL SOBRE SHU EN EL ADULTO
[23:40] (JBover) La relación entre SHU y PTT se reafirma ante el hallazgo de manifestaciones extrarrenales en 17 pacientes.
[23:40] (JBover) Se trata de un problema multifactorial
[23:40] (JBover) en el que nuestra experiencia nos permite incidir sobre los aspectos genéticos.
[23:40] (JBover) Parece obvia la predisposición genética de una amplia familia reseñada en la conferencia presentada.
[23:40] (JBover) Se trata de seis casos confirmados, ampliamente separados en el tiempo lo que descarta un problema epidémico, y un séptimo posible lo ratifican.
[23:41] (JBover) Sin embargo, no se ha podido probar su relación con el haplotipo involucrado
[23:41] (JBover) ni con el descenso del complemento hallado en sus miembros.
[23:41] (JBover) La normalidad del factor H en casi todos ellos discrepa de lo expuesto hasta ahora en la literatura.
[23:41] (JBover) Tampoco el estudio de los otros tres grupos familiares
[23:41] (JBover) con afectación de dos miembros en cada uno
[23:41] (JBover) ha aportado datos esclarecedores.
[23:41] (JBover) Es necesario estudiar el papel de otros moduladores del complemento,
[23:41] (JBover) como el factor I y de las alteraciones en la degradación del factor de von Willebrand
[23:41] (JBover) que parecen más evidentes en la PTT.
[23:42] (JBover) En un intento de hallar factores pronósticos
[23:42] (JBover) el examen anatomopatológico nos ha permitido relacionar la severidad de la insuficiencia renal
[23:42] (JBover) con la isquemia glomerular y con la MAT yuxtaglomerular.
[23:42] (JBover) Pero no existía una aparente relación entre deterioro funcional
[23:42] (JBover) y MAT glomerular.
[23:42] (JBover) Eran escasas las lesiones en arterias interlobulillares.
[23:43] (JBover) La evolución, si bien su gravedad es manifiesta,
[23:43] (JBover) ha sido variable.
[23:43] (JBover) De los ocho pacientes que recuperaron función renal,
[23:43] (JBover) tres habían presentado un SHU posparto,
[23:43] (JBover) que tradicionalmente se asocia con mejor pronóstico,
[23:43] (JBover) y su satisfactoria evolución se alcanzó exclusivamente con tratamiento conservador, hemodiálisis.
[23:43] (JBover) Si bien su bajo número impide precisar ningún dato,
[23:43] (JBover) si cabe señalar que, en conjunto eran pacientes jóvenes, 18- 34 años,
[23:43] (JBover) excepto uno de 66
[23:44] (JBover) y su creatinina inicial era relativamente menor que la del resto,
[23:44] (JBover) entre 140 y 529 mmol/l,
[23:44] (JBover) de modo que cinco de ellos no requirieron hemodiálisis.
[23:44] (JBover) Contrasta todo ello con las elevadas cifras de creatinina (118- 1673 mmol/l, X= 661 ± 437mmol/l)
[23:44] (JBover) o los requerimientos de diálisis que inicialmente presentaban los pacientes
[23:44] (JBover) que no obtuvieron remisión del proceso.
[23:44] (JBover) Los resultados de los diversos tratamientos ensayados no han sido satisfactorios.
[23:45] (JBover) Aunque la plasmaféresis se ha mostrado más eficaz
[23:45] (JBover) que la exclusiva administración de plasma fresco
[23:45] (JBover) en su acción sobre la hemólisis,
[23:45] (JBover) no ha impedido la aparición de recidivas ni la progresión hacia la insuficiencia renal.
[23:45] (JBover) La administración de prednisona en once pacientes,
[23:45] (JBover) misoprostol en 14 y dosis masivas de vitamina E en tres o vincristina en uno,
[23:45] (JBover) no permite establecer ninguna relación con la evolución del proceso.
[23:45] (JBover) El trasplante renal sigue siendo una opción de alto riesgo
[23:46] (JBover) por sus frecuentes recidivas.
[23:46] (JBover) La introducción de micofenolato mofetil parece, por el momento,
[23:46] (JBover) la más adecuada de las opciones.
[23:46] (JBover) MUchisimas gracais Dr Carreras
[23:47] (JBover) Thank you very much Dr Carreras
[23:47] (LCarreras) Gracias otra vez
[23:47] (JBover) plas plas plas plas
[23:47] (RJ_Bosch) muy interesante, muchas gracias
[23:47] (MJesus) muchas gracias !!
[23:48] (JBover) Dr Carreras.....hay algun lugar para la IMMUNOADSORCION en el SHU????
[23:48] (JBover) is there any role for immunoadsorption for the treatment of HUS????
[23:48] (LCarreras) No la hemos empleado. Supongo que los resultados serían paralelos a los de la plasmaféresis
[23:49] (amc) Luis: has revisado cuántos casos en la literatura están tratados con [23:50] (JBover) Dr Braun pregunta.....
[23:50] (LCarreras) Creo que ninguno. Sólo digo que el trasplante, en estos pacientes, parece ir mejor con myc
[23:50] (Braun) What is meant by plasmapheresis looks better than fresh frozen plasma? Substitution of fresh frozen plasma is a general accepted treatment concept and many nephrologists think that this is accually the effective treatment.
[23:50] (JBover) Dr Braun pregunta......que quisiste decir con que la plasmaferesis parece mejor que plasma fresco????
[23:51] (JBover) Dr Braun comenta que la sustitucion con plasma fresco esta aceptado y muchos nefrologos creen que es el tratameinto mas efectivo
[23:51] (JBover) incluso por encima de la plasmaferesis
[23:51] (LCarreras) Para nosotros el resultado final no ha sido maravilloso. Pero, con plasmaféresis se observa una evidente reducción de la hemólisis
[23:51] (JBover) Any comment about that??
[23:51] (gerardo) plasma fresco o plasmaféresis es lo mismo, es cuestion de cantidad
[23:52] (LCarreras) No vista bajo plasma fresco
[23:52] (Braun) I know of several large case series where immunoadsorption was used in chemotherapy associated HUS with much success. There is no case report on familiar or idiopathic HUS regarding immunoadsorption.
[23:53] (LCarreras) No, en plasmaféresis podemos llevarnos algunos factores existentes en el plasma del paciente. Agregantes plaquetares, por ejemplo
[23:53] (JBover) Dr Braun afirma que conoce una larga serie de casos en que SHU asociado a quimioterapia en que se uso inmunoadsorcion con exito!!!. Pero no conoce casos familiares con inmunoadsorcion
[23:54] (LCarreras) De acuerdo
[23:54] (gerardo) Luis pero tambien podemos introducir mayor cantidad de otros
[23:54] (gerardo) factores
[23:55] (JBover) Gerardo.....cuanta cantidad de plasma poneis vosotros?????
[23:55] (LCarreras) En cierto modo, pese a los riesgos, es lo que se busca. Proporcionar factores de los que carece
[23:55] (LCarreras) Alrededpr de 1.5 l
[23:56] (gerardo) nosotros ponemos 2-3 litos de ppl
[23:56] (LCarreras) Y también seroalbúmina
[23:56] (gerardo) sin sero albumina
[23:56] (JBover) gerardo..haceis plasmaferésis o solo plasma fresco???
[23:56] (gerardo) genealment plasmaféresis
[23:57] (LCarreras) Hemos hecho ambas cosas. En casos graves, por supuesto, plasmaféresis
[23:57] (JBover) (Braun) I agree that there might be an advantage in stopping haemolysis if plasmpheresis is applied to these patients. this might be improtant if anti-endothel cell antibodies are involved in this condition. Did they measure any auto-antibodies?
[23:57] (JBover) El Dr braun dice que esta de acuerdo en que....
[23:57] (LCarreras) No, dr. Braun
[23:57] (JBover) la plasmaferesis puede suponer una ventaja para parar la hemolisis. Puede ser especialemnte importante si....
[23:58] (JBover) hay anticuerpos antiendoteliales ...LOS MEDIS????
[23:58] (LCarreras) No, ya decía que no
[23:58] (gerardo) no
[23:59] (JBover) alguna expereiencia con sustitucion con CRIOPRECIPITADOS????
[23:59] (JBover) Please ask about any experience with cryoprecipitated plasma substitution.
[23:59] (LCarreras) no, no tenemos
[23:59] (gerardo) Ninguna
[0:00] (JBover) what about you Dr Braun????
[0:00] (JBover) do you have any expereince with cryoprecipitate d plasma substitution.
[0:01] (Braun) Currently, the CGTS is performing a randomized trial testing cryoprecipitated plasma against plasmapheresis.
[0:01] (JBover) we will be looking forward to it as well
[0:01] (JBover) well, ladies and gentlemen....
[0:02] (JBover) THANK YOU VERY MUCH DR CARRERAS
[0:02] (LCarreras) Gracies, Jordi. Thank you.
[0:02] (JBover) we shall move on to our last invited guest..Dr ALberto Castelao
[0:02] (Braun) The study has been continued for about 3 years now and we have included about 12 patients.
[0:03] (JBover) Dr Alberto Castealo is the HEad of HEmodialysis in Principes d'Espanya Hospital Barcelona
[0:03] (JBover) He has a vast expereince in Diabetic patients as well
[0:03] (JBover) He is specially interested in control of hyperlipidemia in patients with renal failure
[0:04] (JBover) and today he is presenting his experience in the treatment of hyperlipidemia in diabetic patients
[0:04] (JBover) Welcome Dr Castealo
[0:04] (amc) Thank you, Jordi
[0:04] (JBover) thanks for coming Dr castealo
[0:04] (JBover) CASTELAO now it is spelled properly!
[0:04] (amc) OK
[0:04] (MJesus) Welcome Dr Castelao
[0:04] (JBover) could you give us a summary on your work????
[0:05] (amc) I think is too late. So in 2 minutes
[0:05] (amc) Atherosclerosis is tle leading cause of mortality
[0:05] (amc) in diabetic patients.
[0:05] (amc) We have studied 98 type 2 DM patients
[0:06] (amc) mean age 63 year olñd.
[0:06] (amc) The patients were divided into 4 groups:
[0:06] (amc) G-I ( n=13). Hypercholesterolñemic DM patients (>6.25 mmol/l), treated with fibric acid derivatives.
[0:07] (amc) G-II: (n=52=) Hyperchol. patients treated with statins.
[0:07] (amc) G-III Hypercholest patients not treated with lipid-loewering drrugs
[0:08] (amc) G-IV: control group: normocholesterol. paytinets (n=13).
[0:08] (amc) Cardiovascular events: 46% G.I; 33% G-II;
[0:11] (JBover) algun angloparlante???
[0:12] (amc0) Jordi: can I continue
[0:12] (JBover) you sure can
[0:12] (SCigarran) Me too
[0:13] (amc0) Mortality was 23% in G-I, 19% in G-II
[0:13] (amc0) 25% in G.-III and 31% in G.-IVC
[0:13] (amc0) In summary (para no cansar)
[0:13] (amc0) 1. Goals of current guidelines are very f
[0:14] (amc0) dificult to achieve in DM patients
[0:14] (amc0) 2. Lipoproteins in DM patienst are atherogenic even with normal plasma levels
[0:14] (amc0) 3. In these patients is manxdatory
[0:14] (amc0) to establish combined measures in order to
[0:15] (amc0) stop micro and macroangio¡pathy
[0:15] (amc0) to preserve CV status
[0:15] (amc0) and also to detect D Nephropathy in heearly stages
[0:15] (amc0) trying to avoid atherosclerosis and DN
[0:16] (amc0) finsih
[0:16] (JBover) GREAT WORK!!!!!!
[0:16] (JBover) creo que podemos hablar en español si lo deseais
[0:16] (amc0) Todos a dormir
[0:16] (JBover) noir...do you speak spanish????
[0:16] (JBover) Braun antes de irse dijo......
[0:16] (JBover) (Braun) Okay, I think the time is over. It was nice chatting with you (despite some problems in the beginning). You might tell Dr Castelao, that I read his article and was very impressed about this excellent work. Have a good night.
[0:17] (amc0) Thank Jordi
[0:17] (JBover) alguna pregunta para el Dr Castelao????
[0:17] (JBover) podrias recordarnos la DOSIS y QUE ESTATINA USASTE???
[0:17] (amc0) it is time to go to bed
[0:18] (MJesus) yes, d'accord
[0:18] (amc0) Statins: lova(20-40mg), sinva (10-20), pravas (20-40), fluvas (20-40) atorv 10-20
[0:19] (JBover) cual es el GOAL de colesterol???
[0:19] (JBover) te riges por colesterol total o LDL???
[0:19] (amc0) En DM less than 4.2 mmol/l
[0:20] (amc0) Col total. Para LDL < 2.70 mmol/l
[0:20] (JBover) alguna pregunta más????
[0:20] (gerardo) gracias a todos y hasta mañana. Llevamos mas de 2 horas
[0:21] (amc0) Hasta mañana
[0:21] (JBover) hasta mañana a todos
[0:21] (JBover) gracias ALBERTO!!!!
[0:21] (JBover) gracias por tu paciencia!!!!!!
[0:21] (amc0) gracias a ti .Jordi