RESUMEN
OBJECTIVES: In this study, we compared the effects of an individualized physical activity program on lifestyle, metabolic profile, body composition, and quality of life in kidney transplant recipients and patients with chronic kidney disease. MATERIALS AND METHODS: Our study included 24 kidney transplant recipients and 15 patients with chronic kidney disease at stage 3/4. Body composition (impedance spectroscopy) and habitual physical activity (accelerometry) assessed at baseline were used to prepare the individualized physical activity program. Participants received repeated training, which was supervised during the first 2 weeks, followed by short message service reminders. Measurements were repeated after 1 and 3 months. RESULTS: Time spent daily on physical activity and total energy expenditure increased in kidney transplant recipients (from 126 ± 87 to 200 ± 132 min/day [P = .001] and from 1.73 ± 0.37 to 2.24 ± 0.59 cal/min [P < .001]) and in patients with chronic kidney disease (from 79 ± 78 to 109 ± 114 min/day [P < .001] and from 1.5 ± 0.5 to 1.92 ± 0.47 cal/min [P < .001]). Adipose mass (40.8 ± 11.5 vs 38.5 ± 10.3 kg; P = .01), total body water (38.1 ± 9.1 vs 37.3 ± 9.7 L; P = .01), and fat tissue index (14.3 ± 3.7 vs 13.5 ± 3.1 kg/m2; P = .009) decreased significantly only in kidney transplant recipients. Body cell mass decreased in patients with chronic kidney disease. Significant changes of estimated glomerular filtration rates were observed in kidney transplant recipients. CONCLUSIONS: Increased physical activity achieved through structured exercise programs induced beneficial effects on metabolic profile and body composition in patients with chronic kidney disease, with even greater benefits in kidney transplant recipients.
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Composición Corporal , Terapia por Ejercicio/métodos , Ejercicio Físico , Hábitos , Trasplante de Riñón , Insuficiencia Renal Crónica/terapia , Receptores de Trasplantes , Actigrafía , Adiposidad , Adulto , Espectroscopía Dieléctrica , Metabolismo Energético , Femenino , Estado de Salud , Estilo de Vida Saludable , Humanos , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Sistemas Recordatorios , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/psicología , Conducta de Reducción del Riesgo , Encuestas y Cuestionarios , Envío de Mensajes de Texto , Factores de Tiempo , Receptores de Trasplantes/psicología , Resultado del Tratamiento , Pérdida de PesoRESUMEN
CONTEXT: The pathophysiology of calcium-phosphate disturbances in diabetic (DM) kidney disease differs from that in non-DM chronic kidney disease (CKD). OBJECTIVE: We compared the effect of a 6-day high-phosphate diet on serum fibroblast growth factor-23 (FGF-23) and other parameters of calcium-phosphate metabolism in DM and non-DM CKD patients. DESIGN AND SETTING: This was a prospective interventional study in a research center setting. PARTICIPANTS, INTERVENTION, AND MEASURES: Twenty-six nondialysis patients with stages 3-5 CKD and albuminuria less than 300 mg/g creatinine were recruited from February 2011 to November 2012 (15 DM, 11 non-DM). All patients received a high-phosphate diet (1800 mg/d) for 6 days. At baseline, day 3, and day 7 serum FGF-23, PTH, Ca, P, 25-hydroxyvitamin D, 1,25 dihydroxyvitamin D, monocyte chemoattractant protein-1, and calcium and phosphate urine excretion were measured. RESULTS: In DM CKD patients, serum calcium was lower on days 3 and 7 vs baseline (P < .01, respectively), and in non-DM patients, it was unchanged. Serum phosphorus increased significantly only in non-DM patients on days 3 and 7 vs baseline (P < 0.01, respectively). Serum PTH was higher in the DM group on day 7 vs baseline (P = .04). Plasma 25-hydroxyvitamin D, 1,25 dihydroxyvitamin D, and serum monocyte chemoattractant protein-1 were unchanged in both groups. Serum FGF-23 increased in DM patients, from baseline to day 3 (58.1 ± 52.7 and 91.6 ± 71.1 pg/mL, P = .001) but later tended to decrease. In non-DM patients, there was a steady increase of FGF-23 between baseline and day 7 (75 ± 84.3 to 176 ± 197 pg/mL, P = .04). Urine phosphate excretion was significantly higher on day 7 in DM patients only (P < .05). CONCLUSIONS: PTH seems to play the major role in the regulation of phosphate excretion in DM CKD. The role of FGF-23 in phosphate disposal in DM CKD remains debatable.
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Diabetes Mellitus Tipo 2/complicaciones , Nefropatías Diabéticas/sangre , Dieta/efectos adversos , Factores de Crecimiento de Fibroblastos/sangre , Riñón/fisiopatología , Fosfatos/efectos adversos , Insuficiencia Renal Crónica/complicaciones , Anciano , Biomarcadores/sangre , Biomarcadores/orina , Calcio/sangre , Calcio/orina , Nefropatías Diabéticas/fisiopatología , Nefropatías Diabéticas/orina , Regulación hacia Abajo , Femenino , Factor-23 de Crecimiento de Fibroblastos , Humanos , Masculino , Persona de Mediana Edad , Hormona Paratiroidea/sangre , Hormona Paratiroidea/metabolismo , Fosfatos/orina , Fósforo/efectos adversos , Fósforo/sangre , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/orina , Índice de Severidad de la Enfermedad , Factores de Tiempo , Regulación hacia ArribaRESUMEN
BACKGROUND: Transplant renal artery stenosis (TRAS) is a serious vascular complication due to non-specific clinical manifestations, causing serious diagnostic difficulties. Contrast-enhanced ultrasound (CE-US) can complement standard sonographic examination in evaluation of TRAS. MATERIAL AND METHODS: Standard ultrasound B presentation, extended with color Doppler assessment of the flow spectrum and CE-US, was carried out in the early postoperative period in a group of 180 patients who underwent kidney transplantation. In CE-US analysis, the maximum contrast agent perfusion to the cortex and renal pyramids was evaluated. In 15 patients with sonographically diagnosed TRAS, magnetic resonance angiography and computer tomography angiography were performed to confirm the diagnosis. RESULTS: In patients with TRAS, significantly longer time of contrast agent (CE) inflow was observed in comparison to patients without perfusion disturbances (3.47 s vs. 1.5 s, p<0.000 for cortex; 6.01 vs. 2.09 s for pyramids, p<0.000). The rate of CE inflow was strongly positively correlated with severity of stenosis assessed on the basis of CTA/MRA examination (R=0.97 for cortex and 0.9 for pyramids; p<0.001). Six months after kidney transplantation, patients with a history of TRAS had significantly higher serum creatinine level than recipients with normal renal artery blood flow (1.76 mg/dL vs. 1.53 mg/dl, p<0.02). Estimated GFR was decreased to 35.9 ml/min vs. 46.5 ml/min, respectively (p<0.05). CONCLUSIONS: Contrast-enhanced ultrasound allows for quick and non-invasive assessment of parenchymal kidney graft perfusion. It enables confirmation of TRAS diagnosis in the early postoperative period and helps assess the degree of stenosis.
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Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Obstrucción de la Arteria Renal/diagnóstico por imagen , Obstrucción de la Arteria Renal/etiología , Adulto , Anciano , Medios de Contraste , Femenino , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Periodo Posoperatorio , Arteria Renal/diagnóstico por imagen , Arteria Renal/trasplante , Obstrucción de la Arteria Renal/diagnóstico , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler en Color , Adulto JovenRESUMEN
Acute pancreatitis is a disease with significant mortality. Hypertriglyceridemia (HTG) is the third most common etiological factor of this disorder after alcohol and gall-stones. The authors presented a case of 42-years old caucasian female who was hospitalized due to recurrence of acute pancreatitis. She had been diagnosed with HTG. She had earlier seven episodes of acute pancreatitis. Endoscopic papillotomy and conservatory treatment didn't change her complaints and she was consented for surgery. Exclusion of distal part of bile duct was performed. The common bile duct was anastomosed side-to-side to the 70 cm long Roux loop of the jejunum with the ligation of the distal part of the common bile duct. Following the surgery authors observed normalization of amylase, lipase, leukocytosis and CRP levels. During six months after procedure patient didn't have any new episode of pancreatitis. Exclusion of distal part of bile duct may be a useful tool in surgical treatment of recurrent acute hypertriglyceridemia-induced pancreatitis.
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Anastomosis en-Y de Roux , Conductos Biliares/cirugía , Hipertrigliceridemia/complicaciones , Pancreatitis Crónica/etiología , Pancreatitis Crónica/cirugía , Adulto , Femenino , Humanos , Resultado del TratamientoRESUMEN
BACKGROUND: Neurological complications are quite frequent in patients after solid organ transplantation, mostly affecting the central nervous system, and less frequently the peripheral nerves. Guillain-Barré syndrome (GBS), a reactive autoimmune disease of the nervous tissue, is the most common cause of acute polyneuropathy in adults following a viral or bacterial infection. GBS has been also linked to neurotoxic adverse effects of calcineurin inhibitors. This syndrome occurs relatively frequently in patients after bone marrow transplantation, but has been a rare complication in solid organ transplant recipients. Epstein-Barr virus (EBV) infection is relatively common in transplant recipients and in some cases may lead to neurological complications. CASE REPORT: In this report we present an interesting case of a patient who developed GBS in the course of EBV infection 1 year after kidney transplantation. CONCLUSIONS: In patients with rapid development of polyneuropathy after transplantation, Guillain-Barré syndrome should be excluded.