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Renal hyperfiltration (RHF) is a prevalent phenomenon in critically ill patients characterized by augmented renal clearance (ARC) and increased of elimination of renally eliminated medications. Multiple risk factors had been described and potential mechanisms may contribute to the occurrence of this condition. RHF and ARC are associated with the risk of suboptimal exposure to antibiotics increasing the risk of treatment failure and unfavorable patient outcomes. The current review discusses the available evidence related to the RHF phenomenon, including definition, epidemiology, risk factors, pathophysiology, pharmacokinetic variability, and considerations for optimizing the dosage of antibiotics in critically ill patients.

Even when people with diabetes mellitus (DM) meet their cholesterol goals, they still face a higher risk of heart and blood vessel problems. One major reason is a particle called lipoprotein(a), or Lp(a), which is similar to LDL cholesterol. Raised levels of Lp(a) are inherited rather than caused by lifestyle. Lp(a) can build up in the body and make it easier for blood clots to form because it closely resembles a protein called plasminogen, reducing its ability to form plasmin that dissolves blood clots. At the same time, chemical changes like oxidation and glycation can make blood vessels more inflamed, adding to the risk. Elevated concentrations of Lp(a) (>30 mg/dL; 75 nmol/L), and particularly >50 mg/dL (125 nmol/L), are independently associated with coronary artery disease, ischemic stroke, diabetic nephropathy, retinopathy, and neuropathy. Conventional lipid-lowering therapies exert neutral or modest effects on Lp(a), in contrast to RNA-based targeted agents (antisense oligonucleotides and siRNA [Small Interfering RNA]), which achieve reductions of 70–95% and show consistent results in Phase 2 clinical trials. In this review, we bring together findings from laboratory research and clinical studies, and highlight why it is important to measure Lp(a) levels—at least once in a person’s life, and especially in those with diabetes—to help doctors better assess risk and plan more effective treatments. In diabetic populations, the adaptation of Lp(a)-targeted therapies could redefine the management of residual risk and improve both cardiovascular and microvascular outcomes.

Lung-protective ventilation and other experimental conditions raise arterial carbon dioxide tension (PaCO2) and alter pH. Short-term benefits are reported in non-infectious settings, whereas infection and/or prolonged exposure are typically harmful. This scoping review systematically maps immune-mediated effects of hypercapnia on innate immunity and alveolar epithelial repair. Scoping review per Levac et al. and PRISMA Extension for Scoping Reviews (Open Science Framework protocol: 10.17605/OSF.IO/WV85T; post hoc). We searched original preclinical studies (in vivo/in vitro) in PubMed, Web of Science, ScienceDirect, Cochrane Reviews, and SciELO (2008–2023). PaCO2 (mmHg) was prioritized; %Fraction of inspired Carbon Dioxide (%FiCO2) was recorded when PaCO2 was unavailable; pH was classified as buffered/unbuffered. Data were organized by context, PaCO2, and exposure duration; synthesis used heat maps (0–120 h) and a narrative description for >120 h. Mechanistic axes extracted the following: NF-κB (canonical/non-canonical), Bcl-2/Bcl-xL–Beclin-1/autophagy, AMPK/PKA/CaMKKβ/ERK1/2 and ENaC/Na,K-ATPase trafficking, Wnt/β-catenin in AT2 cells, and miR-183/IDH2/ATP. Thirty-five studies met the inclusion criteria. In non-infectious models, a “protective window” emerged, with moderate PaCO2 and brief exposure (65–95 mmHg; ≤4–6 h), featuring NF-κB attenuation and preserved epithelial ion transport. In infectious models and/or with prolonged exposure or higher PaCO2, harmful signals predominated: reduced phagocytosis/autophagy (Bcl-2/Bcl-xL–Beclin-1 axis), AMPK/PKA/ERK1/2-mediated internalization of ENaC/Na,K-ATPase, depressed β-catenin signaling in AT2 cells, impaired alveolar fluid clearance, and increased bacterial burden. Chronic exposures (>120 h) reinforced injury. Hypercapnia is a context-, dose-, time-, and pH-dependent double-edged modulator. The safe window is narrow; standardized, parallel reporting of PaCO2 and pH—with explicit comparisons of buffered vs. unbuffered hypercapnia—is essential to guide clinical translation.

Background: Alterations in the acid-base balance are studied in all medical specialties. Although most cases derive from a preexisting pathology, they can also manifest themselves in a primary context. The proper identification of the acid-base disorder allows the pathological process to be characterized. The correct interpretation of the blood gasometry as a technique for monitoring the ventilatory status, oxygenation and acid-base balance of a patient requires the integration of various physicochemical approaches in order to specify a diagnosis, quantify a therapeutic response, and monitor the severity or the progression of a pathological process. Material & Method: A literature review was conducted in the PubMed, Scopus and Science Direct databases. The articles were selected according to the title and the abstract and sorted by topics relevant by pathophysiology, divergences, clinical approach, diagnosis, and management. Results: A guide the clinical correlation of the critical patient with the blood gasometry parameters to characterize the acid-base disorder through the proposition of a diagnostic algorithm. Conclusion: The incorporation of the three theories in a diagnostic algorithm facilitates a greater understanding of the pathophysiological mechanisms and allows us to identify a more precise therapeutic objective to correct the underlying disorder in the different clinical contexts of the patient.

IntroductionTreatable traits are a cornerstone of personalized (precision) medicine. Arterial carbon dioxide tension (PaCO2) is a fundamental measure in acute respiratory failure. We aimed to determine whether PaCO2 can be considered a treatable trait in patients with acute respiratory failure.MethodsWe performed an electronic search to identify studies addressing hypercapnia and hypocapnia as clinically actionable features in respiratory insufficiency, including their prognostic value and role as potential treatment targets. A systematic snowball approach (backward and forward citation tracking) was applied to capture additional relevant articles. Evidence was synthesized narratively to contextualize findings within the conceptual framework of PaCO2 as a treatable trait.ResultsPaCO2 supports classification of acute respiratory failure as hypercapnic or non-hypercapnic, informs prognosis, and helps define non-invasive management with high-flow nasal cannula or non-invasive ventilation. In intubated patients, PaCO2 contributes to monitoring ventilatory strategies such as lung-protective ventilation and prone positioning, and it helps interpret outcome-relevant variables such as ventilatory ratio and mechanical power. Across the peri-extubation period, PaCO2 is associated with clinically meaningful outcomes before, during, and after ventilator weaning and can guide selection of post-extubation non-invasive support to reduce reintubation risk.DiscussionPaCO2 may be considered a treatable trait across the pre-intubation, invasively ventilated, and post-extubation phases of acute respiratory failure. Further research is needed to define clinically actionable limits and targets in relevant patient subgroups, including safety margins in relation to pH and exposure time.

Se torna evidente el compromiso del sistema respiratorio y digestivo en los pacientes infectados por el nuevo coronavirus emergente. No obstante, también puede existir compromiso de otros sistemas importantes, como lo es el sistema renal. Se hace imprescindible que el clínico no olvide que los pacientes renales muchas veces concomitan con enfermedades cardiovasculares, ya que en ambas patologías se torna sombrío el pronóstico de la enfermedad infecto-contagiosa causada por el nuevo coronavirus. Aún no existen fármacos efectivos y aprobados para enfrentar este virus. Hoy día se presume el posible efecto benéfico de los antipalúdicos (hidroxicloroquina y cloroquina) en el tratamiento de pacientes infectados por el virus. Se espera que a través de las propiedades antivirales que exhiben estos fármacos, se mejore el pronóstico y la mortalidad asociada a esta enfermedad. Para ello se adelantan un número considerable de ensayos que escudriñan y discuten su utilidad en la patología de interés actual.

Aunque en la actualidad la lesión renal aguda en mujeres embarazadas es una complicación poco común, esta se correlaciona con peores desenlaces maternos y fetales. Sus causas son múltiples y varían según el trimestre de presentación. Los cambios fisiológicos renales durante el embarazo hacen que los criterios diagnósticos de lesión renal aguda en la población general no sean fácilmente extrapolables a las pacientes obstétricas, por lo que la sospecha temprana y eltratamiento oportuno son fundamentales para evitar la progresión del daño renal y sus complicaciones sistémicas asociadas, incluidas las metabólicas, urémicas e hidroelectrolíticas.

Aunque en la actualidad la lesión renal aguda en mujeres embarazadas es una complicación poco común, esta se correlaciona con peores desenlaces maternos y fetales. Sus causas son múltiples y varían según el trimestre de presentación. Los cambios fisiológicos renales durante el embarazo hacen que los criterios diagnósticos de lesión renal aguda en la población general no sean fácilmente extrapolables a las pacientes obstétricas, por lo que la sospecha temprana y eltratamiento oportuno son fundamentales para evitar la progresión del daño renal y sus complicaciones sistémicas asociadas, incluidas las metabólicas, urémicas e hidroelectrolíticas.

Resumen Aunque es evidente el compromiso de los sistemas respiratorio y digestivo en los pacientes infectados por el nuevo coronavirus (SARS-CoV-2), también puede existir compromiso de otros sistemas importantes, como lo es el sistema renal. En este sentido, se hace imprescindible que el clínico no olvide que los pacientes renales muchas veces concomitan con enfermedades cardiovasculares, ya que en ambas patologías se torna sombrío el pronóstico de la enfermedad infectocontagiosa causada por este nuevo coronavirus. Aún no existen fármacos efectivos y aprobados para enfrentar este virus, pero se presume el posible efecto benéfico de los antimaláricos (hidroxicloroquina y cloroquina) y se espera que a través de las propiedades antivirales que exhiben estos fármacos se mejore el pronóstico y la mortalidad asociada a la enfermedad; al respecto se adelantan un número considerable de ensayos que escudriñan y discuten la viabilidad de este tratamiento. En el presente artículo se realiza una revisión narrativa de la evidencia científica disponible hasta el 15 de abril de 2020 en las bases de datos acerca del uso de este grupo de fármacos contra la COVID-19.