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Objetivo: Determinar la frecuencia, la evolución clínica, el tratamiento y el desenlace de la lesión renal aguda (LRA) en pacientes embarazadas con preeclampsia severa (PS) menores de 20años de edad. Material y método: Estudio observacional, transversal, retrospectivo y analítico en una serie de 23 pacientes embarazadas menores de 20años de edad con PS atendidas en la UCI de un hospital de alta especialidad de la ciudad de México durante los años 2018 y 2019. Se consultaron los expedientes para conocer la frecuencia de enfermas que desarrollaron LRA (creatinina sérica ≥1,1mg/dl), complicaciones, diuresis, tratamiento con fármacos, terapia de reemplazo, desenlace (recuperación, hemodiálisis) y mortalidad. Los resultados se compararon con los de enfermas de la serie que no presentaron LRA. Se utilizó estadística descriptiva, prueba U de Mann Whitney y prueba exacta de Fisher con el programa SPSS versión 20. Resultados: Veintidós enfermas tenían riñones nativos y una portaba injerto renal. La frecuencia de pacientes con LRA fue del 43,47% (n=10) con media de la creatinina sérica de 1,59±0,63mg/dl (límites 1,1 a 3,2) y diuresis de 0,91±0,74ml/kg/h. Las 23 enfermas recibieron furosemida como fármaco individual intravenoso (60,87%; n=14) o posterior a la infusión de solución NaCl 0,9% (39,13%; n=9). La LRA se recuperó en el 39,13% (n=9) y se precisó hemodiálisis en la paciente trasplantada (4,34%), con muerte materna del 0%. Conclusiones: La frecuencia de LRA fue elevada, con un solo caso que requirió hemodiálisis, sin mortalidad materna. El uso irrestricto de furosemida en todos los casos resultó relevante.(AU)

Objective: To determine the frequency, clinical course, treatment and outcome of acute kidney injury (AKI) in pregnant patients under 20years of age with severe preeclampsia (SP). Material and method: Observational, cross-sectional, retrospective and analytical study in a series of 23 pregnant patients under 20years of age with SP attended in the Intensive Care Unit (ICU) of a high specialty hospital in Mexico City during the years 2018 and 2019. Records were consulted to determine the frequency of patients that developed AKI (serum creatinine ≥1.1mg/dL), complications, diuresis, drug treatment, replacement therapy, outcome (recovery, haemodialysis), and mortality. The results were compared with those of the patients in the series that did not present with an AKI. Descriptive statistics, Mann Whitney U test and Fisher's exact test, using SPSS version 20, were used. Results: Twenty-two patients had native kidneys and one had a kidney graft. The frequency of patients with AKI was 43.47% (n=10) with mean serum creatinine 1.59±0.63mg/dL (range 1.1 to 3.2) and urine volume 0.91±0.74ml/kg/hour. All 23 patients received furosemide, as an individual drug intravenously 60.87% (n=14), and 39.13% (n=9) after the infusion of 0.9% NaCl solution. AKI recovered in 39.13% (n=9), and haemodialysis was performed in the transplanted patient (4.34%), with 0% maternal death. Conclusions: The frequency of AKI was high with only one case requiring haemodialysis, and no maternal mortality. The unrestricted use of furosemide in all cases was relevant.(AU)

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BACKGROUND: Cardiovascular disease (CVD) is the second major cause of death in kidney-transplanted children. Cardiovascular risk factors (CVRF) prevalence after transplant may increase. The effect of immunosuppressive therapy has not been fully studied in children. The objective of the study was to measure and compare CVRF prevalence in kidney-transplanted children, depending of immunosuppressive therapy. METHODS: The study was an observational, transversal, retrospective, comparative study of pediatric patients transplanted at UMAE Hospital General Centro Medico La Raza. All patients were treated with prednisone and mycophenolic acid and any of cyclosporine, tacrolimus, or sirolimus. Demographic, clinical, and biochemical variables and immunosuppressive therapy were evaluated. We used analysis of variance, χ(2), and Fisher tests with the SPSS 18.0 statistical program. RESULTS: One hundred fifteen patients were studied. Sixty-five (56.5%) were male, and median age was 18.5 ± 2.3 years. Seventy-eight (67.2%) were transplanted from a living related donor. Prevalence of anemia and nephrotic proteinuria was significantly less in patients treated with tacrolimus. Those treated with cyclosporine had a significantly greater prevalence of increased LDL-cholesterol, increased serum phosphorus, and increased calcium-phosphorus. Those treated with tacrolimus had lower, not significant, prevalence of hypertension, hyperuricemia, hypoalbuminemia, hypercholesterolemia, hypertriglyceridemia, and low serum HDL-cholesterol than those treated with sirolimus and cyclosporine. In multivariate analysis, patients treated with cyclosporine had significantly more probability of increased phosphorus (OR, 10.65; 95% CI, 2.75-41.16, P = .001) and calcium-phosphorus (OR, 37.94; 95% CI, 3.45-416.17, P = .003) than those treated with tacrolimus. CONCLUSIONS: Patients treated with tacrolimus had less prevalence of CVRF than those treated with cyclosporine or sirolimus. Tacrolimus is the best immunosuppressive option to diminish CVRF in children after kidney transplantation.

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