RESUMEN
Among the causes of the nephrotic syndrome in renal allografts, minimal change disease is a rarity with only few cases described in the medical literature. Most cases described have occurred early in the post-transplant course. There is no established treatment for the condition but prognosis is favorable. We describe a case of minimal change disease that developed 8 years after a successful transplantation of a renal allograft in a middle-aged woman. The nephrotic syndrome was accompanied by deterioration of allograft function. Treatment with mycophenolate mofetil was successful in inducing remission and stabilizing allograft function.
Asunto(s)
Fallo Renal Crónico/cirugía , Trasplante de Riñón/patología , Nefrosis Lipoidea/patología , Biopsia , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Inmunosupresores/uso terapéutico , Glomérulos Renales/patología , Persona de Mediana Edad , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapéutico , Nefrosis Lipoidea/sangre , Nefrosis Lipoidea/tratamiento farmacológico , Profármacos , Inducción de Remisión/métodos , Factores de Tiempo , Trasplante HomólogoRESUMEN
AIM: Anaemia is a major complication of advancing chronic kidney disease (CKD) and is amenable to treatment with epoetin. In order to manage the large number of CKD patients, it is essential that much of the care take place in primary care practices. METHODS: We describe a programme to treat anaemia with epoetin beta (EPO), using a simple referral and management protocol, by general practitioners remotely supported by a nephrologist and nurse coordinator team. RESULTS: Data for 79 patients treated between May 2005 and May 2007 was analysed. Patients were treated with stepwise alterations of EPO dose, beginning with 4000 units/week, and were followed up for a mean of 11 months (range 3-25). The mean age was 73 years and 91% were of Caucasian origin. Sixty-seven per cent had stage 4 CKD and 27% were at stage 3. Mean haemoglobin increased from 92.9 (standard deviation (SD) 7.1) to 118.5 (SD 11.7) g/L (P < 0.01). More than 75% achieved Hb of 110 g/L or more by the fifth month of therapy. Mean starting dose of EPO was 58.8 (SD 25.0) and increased to 79.9 (SD 55.6) units/kg/week (P < 0.01). Mean serum ferritin decreased (P = 0.05), but transferrin saturation was not significantly altered. Estimated glomerular filtration rate remained stable. There was non-significant elevation of systolic and diastolic blood pressure during treatment. CONCLUSION: The study demonstrates that treatment of anaemia with EPO can be successfully accomplished in primary care setting by general practitioners without the need for many patients to attend a nephrology clinic.