RESUMEN
Regional citrate anticoagulation of the extracorporeal circuits (CRA) experienced considerable growth over the past decade. This development is partly explained by the significant progresses made in the field of bioengineering. These allow a secure administration of citrate, while an increasing availability of ionized calcium measurement at the bedside allows reactivity in monitoring the treatment. An increasing severity of the medical condition of patients requiring blood purification treatment gives more contrast to the profile of patient who may benefit from a CRA. If some methods of renal replacement therapy are well suited to this mode of anticoagulation, others are, to date, only at the stage of development and are applied under close medical supervision.
Asunto(s)
Anticoagulantes/administración & dosificación , Ácido Cítrico/administración & dosificación , Terapia de Reemplazo Renal/métodos , Humanos , Infusiones Intralesiones , Riñones Artificiales , Modelos Biológicos , Diálisis Renal/métodos , Diálisis Renal/estadística & datos numéricos , Terapia de Reemplazo Renal/estadística & datos numéricos , Espera VigilanteAsunto(s)
Lesión Renal Aguda/etiología , Enfermedad por Anticuerpos Antimembrana Basal Glomerular , Disnea/etiología , Glomerulonefritis/etiología , Hemoptisis/etiología , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/complicaciones , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/diagnóstico , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/diagnóstico por imagen , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/tratamiento farmacológico , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Ciclofosfamida/administración & dosificación , Ciclofosfamida/uso terapéutico , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Hematuria/etiología , Humanos , Masculino , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Prednisona/administración & dosificación , Prednisona/uso terapéutico , Radiografía Torácica , Cese del Hábito de Fumar , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: Though currently asymptomatic, a sickle cell trait can be responsible for renal abnormalities with macroscopic hematuria. METHODS: Ten patients were admitted to our department with gross hematuria in sickle trait. RESULTS: Six blacks men and four blacks women, aged from 17 to 53 years, had recurrent episodes of gross hematuria with clots in five patients with lumbar pain in four patients. Duration of gross hematuria varied from two weeks to two years. Imaging findings were normal. Urinary concentration ability was abnormally low in all patients but none had an impairement of the ability to dilute the urine or tubular dysfunction. Resolution of hematuria was obtained by abundant and alkaline hydratation in three patients. In six patients, aminocaproic acid was successfully employed, with a complete (3/6) or partial (3/6) efficiency. In one last patient, oral urea permitted a partial improvement. CONCLUSION: Combination of chemical and physical factors in renal medullary of sickle cell trait are responsible for gross hematuria and impaired capacity to concentrate the urine. A cautious care must still be given to make this association a diagnostic of exclusion. Clinical is usually benign. When resting and alkaline hydration are not sufficient to resolve hematuria, antifibrinolytic agents such as aprotinin, oral urea, urologic technical are sometimes necessary.