Asunto(s)
Amiloidosis/etiología , Diálisis Renal/efectos adversos , Amiloidosis/diagnóstico por imagen , Amiloidosis/metabolismo , Enfermedades Óseas/diagnóstico por imagen , Enfermedades Óseas/etiología , Enfermedades Óseas/metabolismo , Humanos , Artropatías/diagnóstico por imagen , Artropatías/etiología , Artropatías/metabolismo , Radiografía , Microglobulina beta-2/metabolismoRESUMEN
A 56-year-old woman with scleroderma developed rapidly progressive glomerulonephritis with epithelial crescents associated with hemoptysis after 27 months of D-penicillamine therapy and a cumulative dose of 1,200 g. Renal failure necessitated 5 hemodialysis sessions. D-penicillamine was withdrawn and glucocorticoids combined with azathioprine were given with good recovery of renal function. The 9 other reported cases of D-penicillamine induced rapidly progressive glomerulonephritis have been reviewed. This syndrome is potentially life-threatening: the 5 untreated patients died, whereas 5 patients given immunosuppressive therapy are alive.
Asunto(s)
Glomerulonefritis/inducido químicamente , Penicilamina/efectos adversos , Esclerodermia Sistémica/tratamiento farmacológico , Biopsia , Femenino , Glomerulonefritis/patología , Hemoptisis/inducido químicamente , Humanos , Glomérulos Renales/patología , Microscopía Electrónica , Persona de Mediana Edad , Penicilamina/uso terapéuticoAsunto(s)
Amiloidosis/complicaciones , Artritis/etiología , Adulto , Anciano , Amiloidosis/clasificación , Amiloidosis/epidemiología , Artritis/epidemiología , Fiebre Mediterránea Familiar/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mieloma Múltiple/complicaciones , Microglobulina beta-2/análisisRESUMEN
We have reviewed 27 diabetic patients treated between 1971 and 1981 by haemodialysis and/or by transplantation. Overall patient survival is 43 per cent at five years (vs 78 per cent in non-diabetics of similar age). Two year patient survival is identical (73%) with haemodialysis and after transplantation. One year graft survival is 55 per cent. Progression of extrarenal diabetic complications is similar in haemodialysis and after transplantation. Recurrence of diabetic glomerulosclerosis was documented in two grafts. Haemodialysis thus offers a suitable alternative for diabetic patients who cannot be transplanted.
Asunto(s)
Nefropatías Diabéticas/terapia , Fallo Renal Crónico/terapia , Trasplante de Riñón , Diálisis Renal , Adolescente , Adulto , Nefropatías Diabéticas/mortalidad , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Fallo Renal Crónico/mortalidad , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
The respective merits of hemodialysis (HD) and transplantation (TP) in the treatment of 25 patients with diabetic renal failure are analyzed. Overall patient survival whatever the method of treatment is 72% at one year and 50% at 4 years. One year survival is 67% for patients treated only by HD and 81% after TP. This difference results in part from the fact that early death after the initiation of therapy occurs usually during HD prior to TP. Death results mainly from cardiovascular disease (6/7 deaths) in HD and from infectious complications (5/9 deaths) after TP. Taken together with death, rejection of 11/19 grafts reduces graft survival to 56% at one year and 33% at 2 years. Progression of cardiovascular, ocular and neurologic complications is similar whatever the mode of treatment. Recurrence of diabetic renal disease was documented in the graft of one patient. All patients with a 2 year survival (6 grafted, 1 dialyzed) have an excellent rehabilitation. Altogether both methods of treatment appear satisfactory. The initial pessimism regarding the outcome of HD treatment appears unwarranted. Unfortunately, both HD and TP remain marred by a greater number of complications in diabetic than in non-diabetic patients. Initiation of therapy at an earlier stage of the disease and better control of the diabetes might further improve results.
Asunto(s)
Nefropatías Diabéticas/terapia , Fallo Renal Crónico/terapia , Trasplante de Riñón , Diálisis Renal , Adulto , Nefropatías Diabéticas/mortalidad , Nefropatías Diabéticas/cirugía , Femenino , Supervivencia de Injerto , Humanos , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/cirugía , Masculino , Persona de Mediana EdadRESUMEN
Two men with Wegener's disease began immunosuppressive treatment during severe renal insufficiency. Despite an initial temporary remission new lesions appeared and renal failure progressed. Haemodialysis was started, cytotoxic drugs were stopped, and steroid dosage was reduced. All extrarenal manifestations of the disease remitted, however, suggesting a favourable effect of either the immunosuppression induced by terminal renal failure or the haemodialysis itself. Renal transplantation was then undertaken in both patients. Thirteen and 55 months after the operations respectively renal function was satisfactory and no signs of reactivation of Wegener's disease had appeared. These results show that whatever the activity of Wegener's disease and its initial response to immunosuppressive agents, dialysis and transplantation are fully warranted once irreversible renal failure is established.
Asunto(s)
Granulomatosis con Poliangitis/terapia , Trasplante de Riñón , Diálisis Renal , Adulto , Azatioprina/uso terapéutico , Ciclofosfamida/uso terapéutico , Granulomatosis con Poliangitis/complicaciones , Humanos , Fallo Renal Crónico/etiología , Fallo Renal Crónico/terapia , Masculino , Prednisona/uso terapéutico , Trasplante HomólogoRESUMEN
Since there is no widely used method of reducing the severity of massive digoxin intoxication, the capacity of hemoperfusion with coated, activated charcoal to remove digoxin was evaluated in a case of suicidal digoxin ingestion (25 mg). Seven hours after ingestion the digoxin plasma level was equal to 8.9 ng/ml. This was decreased to 4.5 ng/ml after 6 hr hemoperfusion. The amount of digoxin adsorbed by the column represents 4.8% of the absorbed dose. At a blood flow rate of 170 ml/min, the mean digoxin clearance by hemoperfusion was 44.5 +/- 26.9 ml/min. From these results we conclude that charcoal hemoperfusion in acute digoxin intoxication is of little value.