Diabetes mellitus is a chronic disorder that affects predominantly the carbohydrate metabolism, but also the biotransformation of proteins and fat. Many intra-and extracellular metabolic mechanisms are impaired which leads to structural changes in the vascular wall and the heart muscle. This eventually causes their functional deterioration and the end result is clinical manifestation of macrovascular incidents or heart failure. People with perturbations of the glucose metabolism (impaired fasting glucose, impaired glucose tolerance and insulin resistance) are also with a higher risk of cardiovascular diseases, even before the diagnosis of diabetes. Nowadays we have a cheap, easy and non-invasive method for early diagnosis of cardiovascular disorders, way before their clinical manifestation, and that is the ultrasound methodology. The echocardiography is a valuable technique for the detection of changes in the myocardial structure and its contractility. The tissue Doppler ultrasound is a more precise method that can detect the slightest aberrations in the heart muscle function, that could not be seen with the conventional echocardiography. Subclinical atherosclerotic changes can be determined with a Doppler scan of the big arteries (carotids, renal arteries), and the subsequent calculation of their resistive index and of the intima-media thickness. There are a lot of studies in this fi eld which show that the structural and functional impairment could be diagnosed in diabetic patients without any complaints and with otherwise healthy hearts. This means that these diagnostic methods should be used in the routine clinical examination of every diabetic individual in order to predict and possibly prevent major cardiovascular events and severe heart failure.

In December 2019 a newly described single-stranded coronavirus, later named SARS-CoV-2, started its expansion around the world and subsequently caused a global pandemic, affecting the lives of millions of people worldwide. SARS-CoV-2 can bind multiple receptors on different cells and thus invade many target organs, including the respiratory and gastrointestinal mucous membranes, lungs, central nervous system, heart, etc. This virus can affect the kidney tissue both directly and as a consequence of other organ involvement or of the treatment administered, causing acute kidney injury and leaving long term squeals that worsen the prognosis. We describe three patients with acute kidney injury and subsequent acute renal failure at the background of coronaviral infection.

Background:The significance of asymptomatic hyperuricemia (AH) continues to be debated. At the population level, asymptomatic hyperuricemia is associated with multiple comorbidities, including hypertension, coronary artery disease, diabetes and chronic kidney disease.1Objectives:To investigate the impact of asymptomatic hyperuricemia on renal functional and structural parameters in comparison with symptomatic gout.Methods:The subjects included in the study were divided into two groups - 46 patients with asymptomatic hyperuricemia and 18 diagnosed with gout according to ACR/EULAR 2015 criteria.2 For renal function assessment urine analysis, albuminuria, estimated glomerular filtration rate (eGFR) based on Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation were used. Diagnostic ultrasound as well as renal biopsy were performed to evaluate structural and histological kidney changes. Statistical analysis was performed using SPSS 22.0 software (SPSS Inc, Chicago, USA).Results:There were no significant differences between the two groups on serum uric acid levels, albuminuria, and eGFR. However, erythrocyturia (p=0.047) and nephrolithiasis (p<0.001) prevailed significantly in patients with gout, 66.7% and 61.1% respectively. We did not find any histological differences between the two groups regarding the number of affected glomeruli, tubular atrophy and percentage of interstitial fibrosis based on light microscopy scans.Conclusion:Our results indicate that patients with AH need renal screening since both AH and gout show similar kidney changes. Further research is needed to elucidate the role of early treatment with xanthine oxidase inhibitor for asymptomatic hyperuricemia as prevention of complications such as erythrocyturia and nephrolithiasis.References:[1]Yip K, Cohen RE, Pillinger MH. Asymptomatic hyperuricemia: is it really asymptomatic? CurrOpin Rheumatology 2020; 32(1):71-79 doi: 10.1097/BOR.0000000000000679.[2]Neogi T, Jansen TL, Dalbeth N et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatogy 2015;67(10):2557-68. doi: 10.1002/art.39254.Disclosure of Interests:None declared.