RESUMEN
BACKGROUND: Iron overload can affect cardiac structure and function by the production of free radicals in addition to iron deposits in heart muscle. The purpose of this study was to compare traditional and non-traditional cardiovascular risk factors (CVRF) in children and adolescents on renal replacement with and without iron overload. Also, we evaluated the relationships between iron overload and left ventricular mass (LVM). METHODS: First, in a cross-sectional study, we evaluated traditional and non-traditional CVRF in 143 children and adolescents, 48 on peritoneal dialysis (PD), 53 on hemodialysis (HD) and 42 after renal transplantation according to iron overload. In a second phase with a case-control study, we measured LVM in 12 case patients and 12 matched controls. RESULTS: Iron overload was identified in 15 patients (10.5%), 11 in HD and 4 in PD (P = 0.002). The group with iron overload had lower body mass index (17 versus 19; P = 0.01), total cholesterol (132 versus 165 mg/dL; P = 0.03) and hemoglobin (8.5 versus 10.6 g/dL; P = 0.003) but higher interleukin (IL)-6 levels (4.8 versus 3.6 ng/L; P = 0.04) and hypertension diagnosis (79 versus 48%; P < 0.001) than those without iron overload. Ferritin showed a positive correlation with C-reactive protein (CRP) and IL-6 levels. In a subgroup of 24 patients (12 with and 12 without iron overload), LVM was not different. However, ferritin levels showed a borderline positive correlation (r = 0.44, P = 0.05) with LVM. CONCLUSION: Children and adolescents with iron overload show more CVRFs, especially if they received replacement therapy with HD. Ferritin is related to CRP and IL-6 levels.
Asunto(s)
Enfermedades Cardiovasculares/etiología , Sobrecarga de Hierro/etiología , Fallo Renal Crónico/complicaciones , Trasplante de Riñón , Diálisis Renal/efectos adversos , Adolescente , Proteína C-Reactiva/metabolismo , Estudios de Casos y Controles , Niño , Preescolar , Estudios Transversales , Femenino , Ferritinas/sangre , Humanos , Interleucina-6/sangre , Fallo Renal Crónico/terapia , Masculino , Pronóstico , Factores de RiesgoRESUMEN
Recent studies considered that an increase in sympathetic activity (SA) may be responsible for left ventricular hypertrophy (LVH). Before and after renal transplantation (RT), we evaluated changes on left ventricular mass (LVM) and SA in 40 end-stage renal disease patients between 8 and 35 years old. Hypertension (95.0% vs. 71.0%; p=0.005), use of combined antihypertensive drugs (57.5% vs. 30.0%; p=0.01), and LVH (77.5% vs. 52.5%; p=0.01) significantly decreased after RT whereas low-to-high frequency ratio (LF/HF), which represents SA, increased (3.1 vs. 5.3; p=0.0001). However, LVM regressors (with decrease on LVM index more than 20%) showed a trend of lower change on LF/HF ratio (1.6 vs. 2.4; p= 0.09) than nonregressors. Living-donor graft, baseline LVM, use of antihypertensive drugs, lower change on LF/HF ratio, and lower systolic blood pressure levels were associated with LVM regression in the simple correlation analysis. However, in the logistic regression analysis, only baseline LVM and donor type remained in the model (R(2)=0.35; p=0.0003). Thus, LVH decreased after RT and was related to baseline LVM and living-donor type. However, it is possible that the higher persistence of LVH after RT could be explained at least in part by increase in heart sympathetic activity and use of immunosuppressors.
Asunto(s)
Ventrículos Cardíacos/patología , Corazón/inervación , Hipertrofia Ventricular Izquierda/patología , Trasplante de Riñón , Complicaciones Posoperatorias , Sistema Nervioso Simpático/fisiología , Adolescente , Adulto , Antihipertensivos/uso terapéutico , Niño , Estudios de Cohortes , Ecocardiografía , Femenino , Corazón/fisiopatología , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/diagnóstico , Hipertrofia Ventricular Izquierda/etiología , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Fallo Renal Crónico/cirugía , Donadores Vivos , Modelos Logísticos , Masculino , Sistema Nervioso Simpático/efectos de los fármacosRESUMEN
In patients with renal anemia, iron therapy can be administered intermittently or regularly at a low dose. We performed a randomized clinical trial in pediatric patients with end-stage renal failure on hemodialysis and absolute or functional iron deficiency. The study group received maintenance iron therapy according to the ferritin serum levels and the control group received intermittent 10-weekly doses. Success was defined as stabilization of ferritin levels between 100 and 800 microg/l and transferrin saturation (TSAT) between 20% and 50%, in addition to an increase in the hemoglobin level. The major reason for exclusion was iron overload. The study group received 6 mg/kg per month of parenteral iron [95% confidence interval (CI) 3.3-8.8] and the control group 14.4 mg/kg per month (95% CI 12-16.8) ( P<0.001). After 4 months of treatment, ferritin levels increased to 66 microg/l (95% CI 69-200) in the study group and to 334 microg/l (95% CI 145-522) in the control group ( P=0.009). Maintenance therapy and intermittent weekly doses were successful in 73% and 38%, respectively. After 3 months of treatment, hemoglobin levels increased to 10 g/dl, with no difference between the groups. However, in the control group the increase in hemoglobin levels was unsustained, and 3 patients needed transfusion. Patients in the control group had a higher risk of iron overload than patients in the study group (70% vs. 19%). Thus, the regimen based on assessment of serum ferritin levels was more efficient than the intermittent regimen because it increased and maintained the hemoglobin levels with lower iron doses and a lower risk of iron overload.
Asunto(s)
Anemia Ferropénica/tratamiento farmacológico , Anemia Ferropénica/etiología , Hierro/administración & dosificación , Hierro/sangre , Fallo Renal Crónico/complicaciones , Adolescente , Niño , Esquema de Medicación , Femenino , Ferritinas/sangre , Hemoglobinas/metabolismo , Humanos , Inyecciones Intravenosas , Masculino , Transferrina/metabolismo , Resultado del TratamientoRESUMEN
Se revisaron los expedientes clínicos de todos los niños con transplantes de riñon en el Hospital de Ginecopediatría, Centro Médico Nacioanl en León, Guanajuato, a partir del inicio del programa de transplante. Entre junio de 1989 y marzo de 1993 se han realizado trasplantes a 19 niños, trece hombres y seis mujeres. Las edades han variado entre cinco y 16 años. La etiología de enfermedad renal terminal identificada con mayor frecuencia fue glomerulonefritis crónica. Al momento del transplante 17 pacientes se encontraban en programas de diálisis peritoneal y dos en hemodiálisis. En 13 niños el órgano se obtuvo de donador vivo y en seis de cadáver. Después de un seguimiento de tres a 44 meses con media de 19, la tasa de sobrevida de pacientes es de 84.2 por ciento, y la de órganos de 63.2 por ciento. El trasplante es una alternativa de tratamiento que requiere de la integración de un equipo multidisciplinario con experiencia en la atención del paciente en edad pediátrica. Los resultados iniciales en este hospital parecen alentadores
Asunto(s)
Humanos , Preescolar , Niño , Adolescente , Donantes de Tejidos/clasificación , Trasplante de Riñón/efectos adversos , Glomerulonefritis/complicaciones , Enfermedades Renales/fisiopatología , Diálisis Peritoneal Ambulatoria Continua , Diálisis Renal , Insuficiencia Renal Crónica/etiologíaRESUMEN
Se presenta el caso de una paciente de 14 años de edad con diagnóstico de teratoma quístico mixto del tipo II del cóccix. Se mencionan el protocolo de diagnóstico y la técnica quirúrgica que se recomienda en la actualidad, lo mismo que algunos aspectos de interés para el tratamiento de estos tumores.