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1

Gideon, Alexander y European Organization for Nuclear Research., eds. Polarization at LEP. Geneva: CERN, European Organization for Nuclear Research, 1988.

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2

Nicolas, Rey, ed. LKP: Guadeloupe : le mouvement des 44 jours. Paris: Syllepse, 2010.

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3

G, Altarelli, Kleiss Ronald y Verzegnassi Claudio, eds. Z physics at LEP 1. Geneva: CERN, European Organization for Nuclear Research, 1989.

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4

author, Kaulanjan-Diamant Axelle, ed. Abécédaire LKP: Clés analytiques et critiques du mouvement : enquête journalistique, analyse sociologique. Matoury, Guyane: Ibis Rouge Éditions, 2012.

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5

Praag, Philip, ed. Political Science and Changing Politics. NL Amsterdam: Amsterdam University Press, 2017. http://dx.doi.org/10.5117/9789462987487.

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Politics is about conflict, struggle, decision-making, power and influence. But not every conflict and not every situation in which power is exercised is widely regarded as politics. A football coach who decides to leave a player on the bench because he has given him a bit of lip, is exerting power, and there is conflict here, too. However, few people would consider this a political issue. The same applies to a mother who quarrels with her adolescent daughter about going to a house party, a schoolteacher who gives a student detention, and so on. But if we were to limit our understanding of politics to official decisions that are taken by governments, in parliaments or on municipal councils, we would fail to recognise the political meaning of trade unions, lobbyists, protest groups, corporations and other more-or-less organised groups that influence collective decision-making.
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6

Moseley, V. J. "Jon", Andreas Lampropoulos, Eftychia Apostolidi y Christos Giarlelis. Characteristic Seismic Failures of Buildings. Editado por Stephanos E. Dritsos. Zurich, Switzerland: International Association for Bridge and Structural Engineering (IABSE), 2019. http://dx.doi.org/10.2749/sed016.

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<p>Earthquakes can cause considerable fatalities, injuries and financial loss. The forces of nature cannot be blamed, as the problem lies with the structures in seismic regions that may not have been designed or constructed to a sufficient degree to resist earthquake actions or they may have design flaws. This Structural Engineering Document (SED) concerns reinforced concrete and masonry buildings together with geotechnical aspects and presents in a concise and practical way the state of the art of current understanding of building failures due to earthquakes. It classifies the different types of seismic failure, explains the reasons for each failure, describes good practices to avoid such failures and also describes seismic retrofitting/upgrading procedures for pre-earthquake strengthening and post-earthquake repair and/or strengthening techniques for deficient buildings. Carefully selected photographs and diagrams illustrate the different failure types. This document could be considered as quite unique, as this is the first time such material concerning characteristic seismic failures of buildings has been presented together in one single document. It is intended to be a valuable educational reference textbook aimed at all levels of experience of engineers. It provides background information, ideas, guidance and reassurance to engineers in earthquake regions faced with the task of building a safer future for the public and to protect lives. <p> <iframe width="560" height="315" src="https://www.youtube-nocookie.com/embed/Oddi3VTtxCM" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>
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7

Fernandez, Elizabeth. Debiry Innovations Ltd. Manufacturers of Protein Fabric. Lulu Press, Inc., 2009.

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8

Wang, David Derwoei. The role of Epstein-Barr virus latent infection membrane protein (LMP) in cell transformation. 1988.

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9

How to Plan for Long-Term Care: Protect Your Family with a Smart LTC Plan. Plan Ahead, Inc., 2014.

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10

Simple LTC Solution: How to Protect Your Life's Savings with a Long-Term Care Partnership Program. Independently Published, 2018.

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11

How to Plan for Long-Term Care : Protect Your Family and Your Legacy: Create a Smart LTC Plan. Plan Ahead, Inc., 2012.

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12

Hesse, Lautaro Daniel. Estudio del impacto de la ausencia de Kir6.2/K-ATP en la regeneración hepática posterior a una hepatectomía parcial. Teseo, 2022. http://dx.doi.org/10.55778/ts878848969.

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<p>Comprender los mecanismos que rigen la regeneración hepática es crucial para el manejo apropiado de los procesos regenerativos y el desarrollo de nuevas terapias en situaciones donde es necesario recuperar la masa hepática perdida. Se plantea la siguiente pregunta: ¿Existe alguna relación entre la expresión de Kir6.2 y la regeneración hepática posterior a una hepatectomía parcial (HP)? Se utilizaron ratones de las cepas C57BL/6 (WT, <i>wild-type</i>) como animales control, y ratones <i>knockout</i> para Kir6.2 (Kir-/-), los cuales fueron sometidos a HP de dos tercios. La regeneración hepática posterior a la hepatectomía se evaluó a diferentes tiempos que representan las distintas fases de la regeneración. Se determinó el índice peso hígado/peso corporal (PH/PC). Se determinó el perfil de las transaminasas séricas. Se detectó el antígeno nuclear de proliferación celular (PCNA) y ciclina D1. Se estableció el índice apoptótico mediante la determinación entre la proteína Bax y las proteínas antiapoptóticas Bcl-2/Bcl-xL. En conclusión, la ausencia de la proteína Kir6.2 tiene un impacto negativo en la proliferación que se produce luego de la resección de una parte de la masa hepática. En los ratones carentes de Kir6.2 la regeneración también puede verse comprometida por una mayor tasa de apoptosis. El presente estudio proporciona, por primera vez, evidencias claras de que la proteína Kir6.2 participa en el fenómeno regenerativo luego de una HP de dos tercios en ratones.</p>
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13

Ferro, Charles J. y Khai Ping Ng. Recommendations for management of high renal risk chronic kidney disease. Editado por David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0099.

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Poorer renal function is associated with increasing morbidity and mortality. In the wider population this is mainly as a consequence of cardiovascular disease. Renal patients are more likely to progress to end-stage renal disease, but also have high cardiovascular risk. Aiming to reduce both progression of renal impairment and cardiovascular disease are not contradictory. Focusing on the management of high-risk patients with proteinuria and reduced glomerular filtration rates, it is recommended that blood pressure should be kept below 140/90, or 130/80 if proteinuria is > 1 g/24 h (protein:creatinine ratio (PCR) >100 mg/mmol or 0.9 g/g). These targets may be modified according to age and other factors. Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor antagonists should form part of the therapy for patients with proteinuria > 0.5 g/24 h (PCR > 50 mg/mmol or 0.45 g/g). Use of ACEIs or angiotensin receptor blockers in patients with lower levels of proteinuria may be indicated in some patient groups even in the absence of hypertension, notably in diabetic nephropathy. Evidence that other agents that reduce proteinuria bring additional benefits is weak at present. The best studies of ‘dual-blockade’ with various combinations of ACEIs, ARBs, and renin inhibitors have shown additional hazard with little evidence of additional benefit. Hyperlipidaemia—regardless of lipid levels, statin therapy is indicated in secondary cardiovascular prevention, and in primary prevention where cardiovascular risk is high, noting that current risk estimation tools do not adequately account for the increased risk of patients with CKD. There is not substantial evidence that lipid lowering therapy impacts on average rates of loss of GFR in progressive CKD. Non-drug lifestyle interventions to reduce cardiovascular risk, including stopping smoking, are important for all. Acidosis—in more advanced CKD it is justified to treat acidosis with oral sodium bicarbonate. Diet—sodium restriction to < 100 mmol/day (6 g/day) and avoidance of excessive dietary protein are justified in early to moderate CKD. Recommendations to limit levels of protein to 0.8 g/kg body weight are suggested by some, but additional protective effects of this are likely to be slight in patients who are otherwise well managed. Low-protein diets may carry some risk. Lower-protein diets may however be used to prevent symptoms in advanced CKD not treated by dialysis.
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14

Wiklund, Olov y Jan Borén. Pathogenesis of atherosclerosis: lipid metabolism. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198755777.003.0011.

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Lipids are carried in plasma as microparticles, lipoproteins, composed of a core of hydrophobic lipids and a surface of amphipathic lipids. In addition, the particles carry proteins (i.e. apolipoproteins). The proteins have key functions in the metabolism as receptor ligands, enzymes or activators. Lipoproteins are classified based on density into: chylomicrons, VLDL, IDL, LDL, and HDL. Retention of apoB-containing lipoproteins (LDL, IDL, and VLDL) in the arterial intima is the initiating event in the development of atherosclerosis. Retention is mediated by binding of apoB to structural proteoglycans in the intima. Increased plasma concentration of apoB-containing lipoproteins is the main risk factor for atherosclerotic cardiovascular disease (CVD) and the causative role of LDL has been demonstrated in several studies. Lp(a) is a subclass of LDL and elevated Lp(a) is an independent risk-factor, primarily genetically mediated. Genetic data support that high Lp(a) causes atherosclerosis. Elevated triglycerides in plasma are associated with increased risk for CVD. Whether triglycerides directly induce atherogenesis is still unclear, but current data strongly support that remnant particles from triglyceride-rich lipoproteins are causal. HDL are lipoproteins that have been considered to be important for reversed cholesterol transport. Low HDL is a strong risk-factor for CVD. However, the causative role of HDL is debated and intervention studies to raise HDL have not been successful. Reduction of LDL is the main target for prevention and treatment, using drugs that inhibit the enzyme HMG-CoA reductase, i.e. statins. Other drugs for LDL reduction and to modify other lipoproteins may further reduce risk, and new therapeutic targets are explored.
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15

Twisk, Jos y Isabel Ferreira. Physical activity, physical fitness, and cardiovascular health. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199232482.003.0025.

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The incidence of morbidity and mortality related to CVD is rather low in a paediatric population. Studies investigating the relationship between physical activity, physical fitness, and cardiovascular health in children and adolescents are therefore mostly limited to CVD risk factors as outcome measures. For this reason, this chapter will focus on the association of physical activity and physical fitness with CVD risk factors in children and adolescents. These risk factors can be divided into the so-called traditional CVD risk factors; that is, lipoproteins [total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides (TG)], blood pressure, body fatness, and diabetes, and ‘new’ CVD risk factors; that is, other lipoproteins [lipoprotein(a) (Lp(a)), apolipoprotein (apo)B, and apoA-1], coagulation and inflammation markers [fibrinogen, C-reactive protein (CRP)], homocysteine, and heart rate variability.
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16

Skiba, Grzegorz. Fizjologiczne, żywieniowe i genetyczne uwarunkowania właściwości kości rosnących świń. The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, 2020. http://dx.doi.org/10.22358/mono_gs_2020.

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Bones are multifunctional passive organs of movement that supports soft tissue and directly attached muscles. They also protect internal organs and are a reserve of calcium, phosphorus and magnesium. Each bone is covered with periosteum, and the adjacent bone surfaces are covered by articular cartilage. Histologically, the bone is an organ composed of many different tissues. The main component is bone tissue (cortical and spongy) composed of a set of bone cells and intercellular substance (mineral and organic), it also contains fat, hematopoietic (bone marrow) and cartilaginous tissue. Bones are a tissue that even in adult life retains the ability to change shape and structure depending on changes in their mechanical and hormonal environment, as well as self-renewal and repair capabilities. This process is called bone turnover. The basic processes of bone turnover are: • bone modeling (incessantly changes in bone shape during individual growth) following resorption and tissue formation at various locations (e.g. bone marrow formation) to increase mass and skeletal morphology. This process occurs in the bones of growing individuals and stops after reaching puberty • bone remodeling (processes involve in maintaining bone tissue by resorbing and replacing old bone tissue with new tissue in the same place, e.g. repairing micro fractures). It is a process involving the removal and internal remodeling of existing bone and is responsible for maintaining tissue mass and architecture of mature bones. Bone turnover is regulated by two types of transformation: • osteoclastogenesis, i.e. formation of cells responsible for bone resorption • osteoblastogenesis, i.e. formation of cells responsible for bone formation (bone matrix synthesis and mineralization) Bone maturity can be defined as the completion of basic structural development and mineralization leading to maximum mass and optimal mechanical strength. The highest rate of increase in pig bone mass is observed in the first twelve weeks after birth. This period of growth is considered crucial for optimizing the growth of the skeleton of pigs, because the degree of bone mineralization in later life stages (adulthood) depends largely on the amount of bone minerals accumulated in the early stages of their growth. The development of the technique allows to determine the condition of the skeletal system (or individual bones) in living animals by methods used in human medicine, or after their slaughter. For in vivo determination of bone properties, Abstract 10 double energy X-ray absorptiometry or computed tomography scanning techniques are used. Both methods allow the quantification of mineral content and bone mineral density. The most important property from a practical point of view is the bone’s bending strength, which is directly determined by the maximum bending force. The most important factors affecting bone strength are: • age (growth period), • gender and the associated hormonal balance, • genotype and modification of genes responsible for bone growth • chemical composition of the body (protein and fat content, and the proportion between these components), • physical activity and related bone load, • nutritional factors: – protein intake influencing synthesis of organic matrix of bone, – content of minerals in the feed (CA, P, Zn, Ca/P, Mg, Mn, Na, Cl, K, Cu ratio) influencing synthesis of the inorganic matrix of bone, – mineral/protein ratio in the diet (Ca/protein, P/protein, Zn/protein) – feed energy concentration, – energy source (content of saturated fatty acids - SFA, content of polyun saturated fatty acids - PUFA, in particular ALA, EPA, DPA, DHA), – feed additives, in particular: enzymes (e.g. phytase releasing of minerals bounded in phytin complexes), probiotics and prebiotics (e.g. inulin improving the function of the digestive tract by increasing absorption of nutrients), – vitamin content that regulate metabolism and biochemical changes occurring in bone tissue (e.g. vitamin D3, B6, C and K). This study was based on the results of research experiments from available literature, and studies on growing pigs carried out at the Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences. The tests were performed in total on 300 pigs of Duroc, Pietrain, Puławska breeds, line 990 and hybrids (Great White × Duroc, Great White × Landrace), PIC pigs, slaughtered at different body weight during the growth period from 15 to 130 kg. Bones for biomechanical tests were collected after slaughter from each pig. Their length, mass and volume were determined. Based on these measurements, the specific weight (density, g/cm3) was calculated. Then each bone was cut in the middle of the shaft and the outer and inner diameters were measured both horizontally and vertically. Based on these measurements, the following indicators were calculated: • cortical thickness, • cortical surface, • cortical index. Abstract 11 Bone strength was tested by a three-point bending test. The obtained data enabled the determination of: • bending force (the magnitude of the maximum force at which disintegration and disruption of bone structure occurs), • strength (the amount of maximum force needed to break/crack of bone), • stiffness (quotient of the force acting on the bone and the amount of displacement occurring under the influence of this force). Investigation of changes in physical and biomechanical features of bones during growth was performed on pigs of the synthetic 990 line growing from 15 to 130 kg body weight. The animals were slaughtered successively at a body weight of 15, 30, 40, 50, 70, 90, 110 and 130 kg. After slaughter, the following bones were separated from the right half-carcass: humerus, 3rd and 4th metatarsal bone, femur, tibia and fibula as well as 3rd and 4th metatarsal bone. The features of bones were determined using methods described in the methodology. Describing bone growth with the Gompertz equation, it was found that the earliest slowdown of bone growth curve was observed for metacarpal and metatarsal bones. This means that these bones matured the most quickly. The established data also indicate that the rib is the slowest maturing bone. The femur, humerus, tibia and fibula were between the values of these features for the metatarsal, metacarpal and rib bones. The rate of increase in bone mass and length differed significantly between the examined bones, but in all cases it was lower (coefficient b <1) than the growth rate of the whole body of the animal. The fastest growth rate was estimated for the rib mass (coefficient b = 0.93). Among the long bones, the humerus (coefficient b = 0.81) was characterized by the fastest rate of weight gain, however femur the smallest (coefficient b = 0.71). The lowest rate of bone mass increase was observed in the foot bones, with the metacarpal bones having a slightly higher value of coefficient b than the metatarsal bones (0.67 vs 0.62). The third bone had a lower growth rate than the fourth bone, regardless of whether they were metatarsal or metacarpal. The value of the bending force increased as the animals grew. Regardless of the growth point tested, the highest values were observed for the humerus, tibia and femur, smaller for the metatarsal and metacarpal bone, and the lowest for the fibula and rib. The rate of change in the value of this indicator increased at a similar rate as the body weight changes of the animals in the case of the fibula and the fourth metacarpal bone (b value = 0.98), and more slowly in the case of the metatarsal bone, the third metacarpal bone, and the tibia bone (values of the b ratio 0.81–0.85), and the slowest femur, humerus and rib (value of b = 0.60–0.66). Bone stiffness increased as animals grew. Regardless of the growth point tested, the highest values were observed for the humerus, tibia and femur, smaller for the metatarsal and metacarpal bone, and the lowest for the fibula and rib. Abstract 12 The rate of change in the value of this indicator changed at a faster rate than the increase in weight of pigs in the case of metacarpal and metatarsal bones (coefficient b = 1.01–1.22), slightly slower in the case of fibula (coefficient b = 0.92), definitely slower in the case of the tibia (b = 0.73), ribs (b = 0.66), femur (b = 0.59) and humerus (b = 0.50). Bone strength increased as animals grew. Regardless of the growth point tested, bone strength was as follows femur > tibia > humerus > 4 metacarpal> 3 metacarpal> 3 metatarsal > 4 metatarsal > rib> fibula. The rate of increase in strength of all examined bones was greater than the rate of weight gain of pigs (value of the coefficient b = 2.04–3.26). As the animals grew, the bone density increased. However, the growth rate of this indicator for the majority of bones was slower than the rate of weight gain (the value of the coefficient b ranged from 0.37 – humerus to 0.84 – fibula). The exception was the rib, whose density increased at a similar pace increasing the body weight of animals (value of the coefficient b = 0.97). The study on the influence of the breed and the feeding intensity on bone characteristics (physical and biomechanical) was performed on pigs of the breeds Duroc, Pietrain, and synthetic 990 during a growth period of 15 to 70 kg body weight. Animals were fed ad libitum or dosed system. After slaughter at a body weight of 70 kg, three bones were taken from the right half-carcass: femur, three metatarsal, and three metacarpal and subjected to the determinations described in the methodology. The weight of bones of animals fed aa libitum was significantly lower than in pigs fed restrictively All bones of Duroc breed were significantly heavier and longer than Pietrain and 990 pig bones. The average values of bending force for the examined bones took the following order: III metatarsal bone (63.5 kg) <III metacarpal bone (77.9 kg) <femur (271.5 kg). The feeding system and breed of pigs had no significant effect on the value of this indicator. The average values of the bones strength took the following order: III metatarsal bone (92.6 kg) <III metacarpal (107.2 kg) <femur (353.1 kg). Feeding intensity and breed of animals had no significant effect on the value of this feature of the bones tested. The average bone density took the following order: femur (1.23 g/cm3) <III metatarsal bone (1.26 g/cm3) <III metacarpal bone (1.34 g / cm3). The density of bones of animals fed aa libitum was higher (P<0.01) than in animals fed with a dosing system. The density of examined bones within the breeds took the following order: Pietrain race> line 990> Duroc race. The differences between the “extreme” breeds were: 7.2% (III metatarsal bone), 8.3% (III metacarpal bone), 8.4% (femur). Abstract 13 The average bone stiffness took the following order: III metatarsal bone (35.1 kg/mm) <III metacarpus (41.5 kg/mm) <femur (60.5 kg/mm). This indicator did not differ between the groups of pigs fed at different intensity, except for the metacarpal bone, which was more stiffer in pigs fed aa libitum (P<0.05). The femur of animals fed ad libitum showed a tendency (P<0.09) to be more stiffer and a force of 4.5 kg required for its displacement by 1 mm. Breed differences in stiffness were found for the femur (P <0.05) and III metacarpal bone (P <0.05). For femur, the highest value of this indicator was found in Pietrain pigs (64.5 kg/mm), lower in pigs of 990 line (61.6 kg/mm) and the lowest in Duroc pigs (55.3 kg/mm). In turn, the 3rd metacarpal bone of Duroc and Pietrain pigs had similar stiffness (39.0 and 40.0 kg/mm respectively) and was smaller than that of line 990 pigs (45.4 kg/mm). The thickness of the cortical bone layer took the following order: III metatarsal bone (2.25 mm) <III metacarpal bone (2.41 mm) <femur (5.12 mm). The feeding system did not affect this indicator. Breed differences (P <0.05) for this trait were found only for the femur bone: Duroc (5.42 mm)> line 990 (5.13 mm)> Pietrain (4.81 mm). The cross sectional area of the examined bones was arranged in the following order: III metatarsal bone (84 mm2) <III metacarpal bone (90 mm2) <femur (286 mm2). The feeding system had no effect on the value of this bone trait, with the exception of the femur, which in animals fed the dosing system was 4.7% higher (P<0.05) than in pigs fed ad libitum. Breed differences (P<0.01) in the coross sectional area were found only in femur and III metatarsal bone. The value of this indicator was the highest in Duroc pigs, lower in 990 animals and the lowest in Pietrain pigs. The cortical index of individual bones was in the following order: III metatarsal bone (31.86) <III metacarpal bone (33.86) <femur (44.75). However, its value did not significantly depend on the intensity of feeding or the breed of pigs.
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17

Jalan, Rajiv y Banwari Agarwal. Extracorporeal liver support devices in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0198.

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Liver failure is common and carries high morbidity and mortality. Liver transplantation (LT) is the only definitive treatment available performed as an emergency in acute liver failure and electively for chronic liver disease. In the last 50 years, a number of extracorporeal liver support devices and modifications have emerged , some of them purely mechanical in nature aimed at detoxification, while others are cell based systems possessing bio-transformational capability. Mechanical devices are mainly based on albumin dialysis, albumin being a key transporter protein that is severely deficient and irreversibly destroyed in liver diseases. Despite a sound scientific rationale and good safety profile, none of the currently available devices have shown enough promise to be incorporated in routine clinical practice, their use being limited to specific clinical situations. This chapter describes currently available devices, their operational characteristics, current evidence of their utility and limitation, and the future developments in the field of extracorporeal liver support.
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18

Salmi-Niklander, Kirsti, Sofia Laine, Päivi Salmesvuori, Ulla Savolainen y Riikka Taavetti, eds. Friction, Fragmentation, and Diversity. Amsterdam University Press, 2021. http://dx.doi.org/10.1017/9789048553853.

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This collection focuses on difficult memories and diverse identities related to conflicts and localized politics of memories. The contemporary and history-oriented case studies discuss politicized memories and pasts, the frictions of justice and reconciliation, and the diversity and fragmentation of difficult memories. <i>Friction, Fragmentation, and Diversity: Localized Politics of European Memories</i> brings together methodological discussions from oral history research, cultural memory studies and the study of contemporary protest movements. The politicization of memories is analyzed in various contexts, ranging from everyday interaction and diverse cultural representations to politics of the archive and politics as legal processes. The politicization of memories takes place on multiple analytical levels: those inherent to the sources; the ways in which the collections are utilized, archived, or presented; and in the re-evaluation of existing research.
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19

Adani and the War over Coal. NewSouth, Incorporated, 2018.

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20

Beresford, Quentin. Adani and the War over Coal. NewSouth, Incorporated, 2018.

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21

Beresford, Quentin. Adani and the War over Coal. ReadHowYouWant.com, Limited, 2019.

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22

Daudon, Michel y Paul Jungers. Uric acid stones. Editado por Mark E. De Broe. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0202_update_001.

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Uric acid (UA) stones are typically red-orange and often appear as sand/ gravel though they may be large. They are totally radiolucent. They account for about 10% of all kidney stones in most countries, and up to 20% in some populations. It is twice as frequent in males, prevalence increases with age, and it is two to three times higher in patients with type 2 diabetes or with features of the metabolic syndrome. Factors that induce the formation of UA stones are a low urine volume, hyperuricosuria, and, more importantly, a permanently low urine pH (< 5). Indeed, below its pKa of 5.35 at 37°C, UA is in non-dissociated form, whose solubility is at best 100 mg/L, whereas urinary UA excretion normally exceeds 600 mg/day and may exceed 1g/day.Because UA solubility increases up to approximately 500 mg/L at urine pH > 6, urine alkalinization, with a target pH of 6.5–7, is the cornerstone of medical treatment. This most often allows dissolution of existing stones and prevention of recurrent stone formation so that urological intervention is infrequently needed. The preferred agent for alkalinization is potassium citrate (30–60 mEq/day in divided doses), because potassium urate is twice more soluble than sodium urate. However, in patients with poor gastric tolerance to potassium citrate or contraindication to potassium supplements, sodium bicarbonate is an acceptable alternative. Limitation of animal proteins, purine-rich foods (including beer), alcoholic drinks and acidified beverages (sodas) are useful measures, together with large fluid intake (> 2–2.5 L/day). Allopurinol may be indicated in cases of symptomatic hyperuricaemia. Regular observance of alkalinisation, with periodic controls of urine pH by the patient, is needed to prevent the rapid formation of UA stones. Patients affected by UANL, especially if overweight, should be evaluated for type 2 diabetes or glucose intolerance and managed accordingly.
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23

Hall, Andrew y Shamima Rahman. Mitochondrial diseases and the kidney. Editado por Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0340.

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Mitochondrial disease can affect any organ in the body including the kidney. As increasing numbers of patients with mitochondrial disease are either surviving beyond childhood or being diagnosed in adulthood, it is important for all nephrologists to have some understanding of the common renal complications that can occur in these individuals. Mitochondrial proteins are encoded by either mitochondrial or nuclear DNA (mtDNA and nDNA, respectively); therefore, disease causing mutations may be inherited maternally (mtDNA) or autosomally (nDNA), or can arise spontaneously. The commonest renal phenotype in mitochondrial disease is proximal tubulopathy (Fanconi syndrome in the severest cases); however, as all regions of the nephron can be affected, from the glomerulus to the collecting duct, patients may also present with proteinuria, decreased glomerular filtration rate, nephrotic syndrome, water and electrolyte disorders, and renal tubular acidosis. Understanding of the relationship between underlying genotype and clinical phenotype remains incomplete in mitochondrial disease. Proximal tubulopathy typically occurs in children with severe multisystem disease due to mtDNA deletion or mutations in nDNA affecting mitochondrial function. In contrast, glomerular disease (focal segmental glomerulosclerosis) has been reported more commonly in adults, mainly in association with the m.3243A<G point mutation. Co-enzyme Q10 (CoQ10) deficiency has been particularly associated with podocyte dysfunction and nephrotic syndrome in children. Underlying mitochondrial disease should be considered as a potential cause of unexplained renal dysfunction; clinical clues include lack of response to conventional therapy, abnormal mitochondrial morphology on kidney biopsy, involvement of other organs (e.g. diabetes, cardiomyopathy, and deafness) and a maternal family history, although none of these features are specific. The diagnostic approach involves acquiring tissue (typically skeletal muscle) for histological analysis, mtDNA screening and oxidative phosphorylation (OXPHOS) complex function tests. A number of nDNA mutations causing mitochondrial disease have now been identified and can also be screened for if clinically indicated. Management of mitochondrial disease requires a multidisciplinary approach, and treatment is largely supportive as there are currently very few evidence-based interventions. Electrolyte deficiencies should be corrected in patients with urinary wasting due to tubulopathy, and CoQ10 supplementation may be of benefit in individuals with CoQ10 deficiency. Nephrotic syndrome in mitochondrial disease is not typically responsive to steroid therapy. Transplantation has been performed in patients with end-stage kidney disease; however, immunosuppressive agents such as steroids and tacrolimus should be used with care given the high incidence of diabetes in mitochondrial disease.
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