RESUMEN
INTRODUCTION: Doppler ultrasound (US) has become the primary imaging technique for the evaluation of renal transplants. It provides information about the intrarenal resistance index (RI). A high RI is seen in every form of graft dysfunction. In this article, we review the utility of sonography, particularly the intrarenal RI measured early after renal transplant, as a predictor of acute and chronic clinical outcome in patients. RESULTS: RI is a valuable marker to determine graft function and related vascular complications. It reveals a strong correlation with serum creatinine levels measured days after transplant. Its elevation is typical for acute tubular necrosis and can be used to predict its duration. An RI >1 (absent end-diastolic flow) seen in the first weeks after transplant is associated with impaired renal graft recovery. In addition, it is an early predictor of chronic allograft nephropathy (even correlated with biopsy results), which will allow a change in therapy. CONCLUSIONS: RI measured serially in the early period after kidney transplantation is a valuable marker for determining renal graft function. It is also useful for demonstrating various types of graft dysfunction; however, it cannot differentiate between them. In recent studies, extrarenal factors in kidney transplantation (eg, recipient's age) may significantly influence RI in the recipient, demonstrating that RI depends on the vascular characteristics of the recipient and not on the graft itself.
Asunto(s)
Funcionamiento Retardado del Injerto/diagnóstico por imagen , Rechazo de Injerto/diagnóstico por imagen , Trasplante de Riñón , Riñón/diagnóstico por imagen , Ultrasonografía Doppler , Funcionamiento Retardado del Injerto/fisiopatología , Rechazo de Injerto/fisiopatología , Supervivencia de Injerto/fisiología , Humanos , Riñón/fisiopatología , Necrosis Tubular Aguda/diagnóstico por imagen , Necrosis Tubular Aguda/etiología , Necrosis Tubular Aguda/fisiopatología , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatologíaRESUMEN
BACKGROUND: New-onset diabetes after renal transplantation (NODAT) is one of the most frequent metabolic complications after transplantation; it is present in â¼25% of kidney transplant recipients, increasing their cardiovascular risk and inducing graft damage. The medical approach of this entity is still a matter of controversy, so our aim was to review the evidence available and offer a practical approach for diagnosis, treatment, and follow-up. METHODS: A systematic review of the literature in the Medline, Embase, Cochrane, and Lilacs databases was carried out with the use of the terms "Diabetes Mellitus," "Kidney Transplantation," "Drug Therapy," "Prognosis," "Therapeutics," and "Risk Factors." Randomized controlled trials, meta-analyses, and observational studies were included. RESULTS: The main risk factors were elevated body mass index, family history of diabetes, recipient >60 years old, hepatitis C virus infection, and treatment with tacrolimus/corticosteroids or sirolimus. Some small studies suggest that thiazolidinediones, sulfonylureas, glinides, and dipeptidyl peptidase 4 inhibitors could be useful in the treatment of the disease. NODAT constitutes a prognostic factor for the renal transplant. Although there is a higher risk of developing diabetes in kidney transplant recipients than in the general population, both populations share the same diagnostic criteria. CONCLUSIONS: There is no consensus on the treatment regimen for these patients. It is necessary to review the diagnostic criteria and the screening methods for NODAT, given the higher susceptibility of kidney transplant recipients to develop this entity; therefore, an earlier intervention could be implemented to decrease the negative effects that this disease has on the kidney graft and the recipient.
Asunto(s)
Diabetes Mellitus Tipo 2/etiología , Trasplante de Riñón , Complicaciones Posoperatorias/etiología , Adulto , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Factores de RiesgoRESUMEN
INTRODUCTION: Currently in the medical literature there is controversy about the role and effects of renal transplantation (RTx) on the sexual functioning of patients with terminal chronic renal disease (TCRD). There is no clear evidence of the real impact of RTx on sexual functioning in these patients. This article makes a brief summary of the literature, describing the most important clinical concepts, evaluates results, and compares the impact of renal transplantation on sexual function before and after the procedure. MATERIAL AND METHODS: Medline and the Embase database were consulted; Medical Subject Headings used were "Kidney Failure, Chronic," "Kidney Transplantation," "Sexual Dysfunction," "Pleasure," "Sexual Behavior," and "Quality of Life." Search was limited to articles within the last 15 years. RESULTS: Sexual dysfunction affects almost 87% of male and 60% to 80% of female patients; 40% to 78% of male patients with RTx report a sense of improvement on global sexual function, 25% to 30% of female patients of reproductive age with RTx report improvement in sexual performance and decreasing of menstrual cycle alterations. Fewer than 10% of patients receiving an RTx reported a decrease of sexual satisfaction. DISCUSSION: Despite controversy, reviewed results show significant improvement of sexual functioning after receiving an RTx. Those who report no improvement of sexual functioning may have conditions attributable to implicit characteristics of TCRD (age, neuroendocrine/metabolic problems) and/or RTx (immunosuppressive therapy). RTx improves sexual functioning by improving sexual desire and overall sexual satisfaction. CONCLUSION: Identified determinants associated with improvement of sexual functioning are decreased prolactin serum level, age younger than 45 years, and onset of dialysis less than 6 months.
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Fallo Renal Crónico/cirugía , Trasplante de Riñón , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Psicológicas/etiología , Femenino , Humanos , Fallo Renal Crónico/complicaciones , Masculino , Calidad de Vida , Resultado del TratamientoRESUMEN
INTRODUCTION: Kidney transplantation (KT) increases fertility in patients with chronic kidney disease (CKD); their pregnancies are considered of high risk because of higher incidence of complications. The objective of this study was to propose, based on current concepts, an algorithm for preconception and perinatal care of KT recipients with a desire for parity. MATERIALS AND METHODS: We searched for literature published within the last 10 years related to pregnancy and KT. Based on the results, we developed an algorithm for the approach to preconception/perinatal care of these patients. RESULTS: Preconception care begins with pre-KT study of women of childbearing age, continues with contraception, and ends with the proper selection of candidates; an exhaustive study of health condition, function of renal graft, and infections that may affect the fetus is required; fetotoxic drugs must be suspended, immunosuppression must be based in corticosteroids, azathioprine, and tacrolimus or cyclosporine. Once conception is achieved, prenatal care should be done by a multidisciplinary team; follow-up of graft function and maternal-fetal health must be strict. Pregnancy has no deleterious effect on graft function; pelvic localization of graft does not contraindicate vaginal delivery; breastfeeding is indicated if immunosuppressive levels in the newborn are low. CONCLUSIONS: KT returns the possibility of motherhood to women with CKD. Proper selection and optimal care of patients determines success in maternal, fetal, and graft results.
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Técnicas de Apoyo para la Decisión , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Atención Perinatal/métodos , Atención Preconceptiva/métodos , Complicaciones del Embarazo/prevención & control , Algoritmos , Femenino , Humanos , Recién Nacido , Embarazo , Complicaciones del Embarazo/etiologíaRESUMEN
Urinary tract infection (UTI), including bacteriuria, cystitis, and pyelonephritis, is the most common infectious complication after kidney transplantation (KTx). Over the past few years, many medical groups assumed this pathological process to be a "benign" disease in kidney transplant recipients (KTxR). However, increased medical and scientific advances in knowledge and management of KTx complications have raised questions about UTI as a pathological process that decreases and worsens kidney allograft function and survival. This review sought to clarify diagnostic criteria, as well as to describe factors associated with UTI in KTxR that expose its effects on the allograft. We sought to show the uncertainty of important topics within the field of UTI among kidney allograft recipients and to propose a practical clinical approach to KTxRs with UTI.
Asunto(s)
Trasplante de Riñón , Infecciones Urinarias/diagnóstico , Humanos , Infecciones Urinarias/etiología , Infecciones Urinarias/terapiaRESUMEN
Kidney transplantation has become the best treatment for children with chronic kidney disease (CKD). In recent times, knowledge concerning the effect of CKD and kidney transplantation over the normal growth rate has increased; now it is known that 40% of children with CKD do not reach the expected height for age. Growth retardation has been associated with the type of nephropathy, metabolic and endocrine disorders that are secondary to kidney disease, immunosuppressive therapy with glucocorticoids, and suboptimal function of renal allograft. Nowadays, we know better the role of the growth hormone/insulin-like growth factor 1 axis in growth retardation we can see it in children with CKD or recipients of renal allograft. Several studies have shown that administration of recombinant growth hormone (rhGH) has a positive effect on the longitudinal growth of children and teenagers who have received a kidney transplant. On the other hand, there have been reported side effects associated with using rhGH; however, these are not statistically significant. In this article, we show a small review about growth in children with CKD and/or recipients of renal allografts the growth pattern of three children who were known by the Transplant Group of National University of Colombia, and the results obtained with the use of rhGH in one of these cases. We want to show the possibility of achieving a secure use of rhGH in children with CKD and its use as a therapeutic option for treating the growth retardation in children with kidney transplantation, and set out the need of typifying the growth pattern of Colombian children with CKD and/or who are recipients of renal allografts through multicenter studies to propose and analyze the inclusion of rhGH in the therapeutic scheme of Colombian children with these two medical conditions. rhGH could be a useful tool for treating children with CKD or kidney transplantation who have not reached the expected longitudinal growth for age. However, it is necessary to know the growth pattern standards for Colombian children with CKD or kidney transplant in Bogotá-Colombia to include the rhGH in clinical protocols for treatment of these patients.