RESUMEN
Kidney transplant is the best treatment option for patients with end-stage renal disease. It reduces mortality and improves the quality of life. However, kidney transplant presents medical and surgical complications, and one of the most common is the posttransplant lymphocele. Lymphocele complication has an incidence of up to 20% and presents with variable clinical symptoms, which are directly associated with the size and compression effect on the adjacent organs. There are reported risk factors that favor the appearance of lymphocele. Despite known factors, there are more relevant factors (male sex, deceased donor, and corticosteroids) to carry out a stricter follow-up. The treatment of lymphoceles can vary according to the severity of the symptoms, characteristics of the collection, and the patient's clinical status. Despite the high recurrence, percutaneous intervention is the initial approach in this condition. If percutaneous aspiration, drainage, and sclerotherapy are unsuccessful, then open or laparoscopic fenestration can be performed; laparoscopy is the standard of treatment since it is highly effective and has few adverse effects.
Asunto(s)
Fallo Renal Crónico , Trasplante de Riñón , Laparoscopía , Linfocele , Humanos , Masculino , Trasplante de Riñón/efectos adversos , Linfocele/diagnóstico por imagen , Linfocele/etiología , Calidad de Vida , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/cirugía , Drenaje/efectos adversos , Algoritmos , Laparoscopía/efectos adversos , Complicaciones Posoperatorias/terapia , Complicaciones Posoperatorias/cirugíaRESUMEN
Despite its rare frequency, a pleuroperitoneal communication is a well-documented complication for patients on peritoneal dialysis. It occurs in ~2% of continuous ambulatory peritoneal dialysis, with uncertain incidence for those on automated peritoneal dialysis. We report a case of a 30-year-old female patient with end-stage kidney disease with sudden dyspnea 2 days after starting automated peritoneal dialysis. Her chest x-ray revealed a significant pleural effusion on the right side. A thoracocentesis was performed, with a pleural glucose/plasma glucose of 1.08. Additionally, a computed tomography scan revealed a pleuroperitoneal communication upon dialysate infusion added with media contrast. A pleural-to-serum glucose gradient of greater than 50 mg/dL may indicate the diagnosis of a pleuroperitoneal communication in patients on peritoneal dialysis. Current literature also indicates that a pleural-to-serum glucose ratio above 1.0 may provide a more sensitive analysis. This case highlights the diagnosis process for this complication, with both laboratory and image findings corroborating the clinical hypotheses of a pleuroperitoneal communication in a patient on automated peritoneal dialysis.
Asunto(s)
Hidrotórax , Fallo Renal Crónico , Diálisis Peritoneal Ambulatoria Continua , Diálisis Peritoneal , Humanos , Femenino , Adulto , Hidrotórax/etiología , Diálisis Peritoneal/efectos adversos , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/terapia , Fallo Renal Crónico/complicaciones , GlucosaRESUMEN
BACKGROUND: Kidney transplant programs have variable thresholds to accept obese candidates. This study aimed to examine trends and the social context of obesity among United States dialysis patients and implications for kidney transplant access. METHODS: We performed a retrospective cohort study of 1 084 816 adults who initiated dialysis between January 2007 and December 2016 using the United States Renal Data System data. We estimated national body mass index (BMI) trends and 1-y cumulative incidence of waitlisting and death without waitlisting by BMI category (<18.5 kg/m 2 , ≥18.5 and <25 kg/m 2 [normal weight], ≥25 and <30 kg/m 2 [overweight], ≥30 and <35 kg/m 2 [class 1 obesity], ≥35 and <40 kg/m 2 [class 2 obesity], and ≥40 kg/m 2 [class 3 obesity]). We then used Fine-Gray subdistribution hazard regression models to examine associations between BMI category and 1-y waitlisting with death as a competing risk and tested for effect modification by End Stage Renal Disease (ESRD) network, patient characteristics, and neighborhood social deprivation index. RESULTS: The median age was 65 (interquartile range 54-75) y, 43% were female, and 27% were non-Hispanic Black. From 2007 to 2016, the adjusted prevalence of class 1 obesity or higher increased from 31.9% to 38.2%. Class 2 and 3 obesity but not class 1 obesity were associated with lower waitlisting rates relative to normal BMI, especially for younger individuals, women, those of Asian race, or those living in less disadvantaged neighborhoods ( pinteraction < 0.001 for all). CONCLUSIONS: Obesity prevalence is rising among US incident dialysis patients. Relative to normal BMI, waitlisting rates with class 2 and 3 obesity were lower and varied substantially by region, patient characteristics, and socioeconomic context.
Asunto(s)
Fallo Renal Crónico , Diálisis Renal , Adulto , Humanos , Estados Unidos/epidemiología , Femenino , Anciano , Masculino , Diálisis Renal/efectos adversos , Estudios Retrospectivos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/cirugía , Índice de Masa Corporal , Obesidad/epidemiología , Medio SocialRESUMEN
BACKGROUND: In the last decade, kidney donation has been recognized as a risk factor for end-stage renal disease (ESRD). ESRD risk calculators have been recently perfected in North American populations. In Mexico, the rates of overweight, obesity, and diabetes mellitus (DM) are among the highest worldwide; nevertheless, most kidney transplants are obtained from living donors. This study aims to describe the risk profile for chronic kidney disease (CKD) development in kidney donors in a highly active transplant center in Central Mexico. METHODS: We conducted a retrospective, observational, descriptive cohort study of kidney donors followed at the Hospital Centenario Miguel Hidalgo (CHMH). We used the pretransplant CKD risk calculator at 15 years and over a lifetime (www.transplantmodels.com/esrdrisk). Aside from the calculator of kidney failure risk, we also used the calculator for postdonation CKD risk (www.transplantmodels.com/donesrd/). Factors associated with a glomerular filtration rate (GFR) <60 mL/min were evaluated by univariate and multivariate analysis. RESULTS: The study included 543 donors. The average follow-up period was 1.7 years (±2.7) with a median of 0.7 years (interquartile range, 0.2-2.1). The average predicted risk for ESRD development at 15 years was 0.08% (±0.1); 25.6% had a risk >0.1%, and only 1 patient had a risk >1%. The lifetime ESRD risk was 0.62% (±0.5); 15% had a risk >1%, and the greatest risk was 3.5%. The median of patients at risk of developing postdonation ESRD was 1 in 10,000 donors (0.6-1.5) at 5 years, 5.7 in 10,000 donors (3.5-8.8) at 10 years, 15 in 10,000 donors (9.1-23.2) at 15 years, and 31 in 10,000 donors (18.9-47.7) at 20 years. During the follow-up period, 52 patients developed a GFR of <60 mL/min. Both risk estimation formulas were significantly associated with a GFR of <60 mL/min. Among the individual factors, the GFR (hazard ratio 0.96, 95% confidence interval 0.94-0.97, P < .001) and the urinary albumin to creatinine ratio (hazard ratio 1.009, 95% confidence interval 1.005-1.01, P < .001) remained statistically significant. CONCLUSION: The risk of ESRD in kidney donors in Aguascalientes, Mexico, is similar to that described in the United States. Risk calculators are an indispensable decision-making tool to better understand kidney donors in our milieu.
Asunto(s)
Fallo Renal Crónico , Insuficiencia Renal Crónica , Humanos , Estados Unidos , Estudios Retrospectivos , Nefrectomía/efectos adversos , Estudios de Cohortes , México/epidemiología , Donadores Vivos , Riñón , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/etiología , Tasa de Filtración Glomerular , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/etiología , Factores de RiesgoRESUMEN
BACKGROUND: Remote patient monitoring (RPM) programs in automated peritoneal dialysis (APD) allow clinical teams to be aware of many aspects and events of the therapy that occur in the home. The present study evaluated the association between RPM use and APD technique failure. METHODS: A retrospective, multicentre, observational cohort study of 558 prevalent adult APD patients included between 1 October 2016 and 30 June 2017 with follow-up until 30 June 2018 at Renal Therapy Services network in Colombia. Patients were divided into two cohorts based on the RPM use: APD-RPM (n = 148) and APD-without RPM (n = 410). Sociodemographic and clinical characteristics of all patients were summarized descriptively. A propensity score was used to create a pseudo-population in which the baseline covariates were well balanced. The association of RPM with technique failure was estimated adjusting for the competing events death and kidney transplant. RESULTS: Five hundred fifty-eight patients were analyzed. 26.5% had APD-RPM. In the matched sample comprising 148 APD-RPM and 148 APD-without RPM patients, we observed a lower technique failure rate of 0.08 [0.05-0.15] episodes per patient-year in APD-RPM versus 0.18 [0.12-0.26] in APD-without RPM cohort; incidence rate ratio = 0.45 95% confidence interval: [0.22-0.91], p-value = 0.03. CONCLUSIONS: The use of an RPM program in APD patients may be associated with a lower technique failure rate. More extensive and interventional studies are needed to confirm its potential benefits and to measure other patient-centered outcomes.
Asunto(s)
Fallo Renal Crónico , Diálisis Peritoneal , Adulto , Estudios de Cohortes , Femenino , Humanos , Incidencia , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/terapia , Masculino , Monitoreo Fisiológico/métodos , Diálisis Peritoneal/métodos , Estudios RetrospectivosRESUMEN
OBJECTIVE: To analyze the content of the diagnostic proposition risk of excessive fluid volume in patients undergoing hemodialysis. METHOD: Content validity study, with 48 judges who assessed the content of the diagnostic proposition risk of excessive fluid volume, using an electronic data collection instrument. The judges' answers were analyzed through the calculation of the Content Validity Index and the T test. RESULTS: The risk of excessive fluid volume was considered adequate, containing 23 risk factors: increased sodium concentration in the dialysate; missing hemodialysis sessions; insufficient water; low self-efficacy for fluid restriction; deficient knowledge; altered body mass index; excessive intake of fluids, proteins and sodium; lower kt/v index; inadequate removal of fluids in hemodialysis; thirst; xerostomia; older people; comorbidities; renal function decline; decreased urinary volume; inflammatory status; hospitalization; low serum level of albumin and lymphocytes, and high level of phosphorus; and use of antihypertensive drugs. CONCLUSION: The content of the diagnostic proposition risk of excessive fluid volume was considered adequate by the judges.
Asunto(s)
Insuficiencia Cardíaca , Fallo Renal Crónico , Desequilibrio Hidroelectrolítico , Anciano , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/terapia , Diálisis Renal , Sodio , SedRESUMEN
Although the clearance of low-molecular weight toxins is modulated by dialysis dose, the relationship between dialysis adequacy and middle systemic inflammatory mediators is often overlooked. Thus, the relationship between dialysis adequacy, pro- and anti-inflammatory cytokines and chemokines in hemodialysis (HD) patients was investigated. Forty-eight HD patients (19 women and 25 men) were investigated. Age, body mass index, time in HD, nutritional status, Kt/V and blood biochemical parameters was similar in patients of both sexes (P > 0.05). Thus, patients were stratified by dialysis adequacy measured by Kt/V method (adequate Kt/V ≥ 1.2). Post-HD urea, creatinine, cytokines (IFN-γ, IL-4 and IL-10) and chemokines (CCL-2, CCL-5, CXCL-8 and CXCL-10) were higher in patients with Kt/V < 1.2 (P < 0.05). Kt/V exhibited significant correlation with CXCL-10/IP-10 serum levels. Positive correlation between creatinine with IFN-γ, CCL-2/MCP-1, and CXCL-10/IP-10, and negative correlation with IL-10 was identified in patients with Kt/V < 1.2 (P < 0.05). In patients with Kt/V ≥ 1.2, only IL-10 was positively and CXCL-10/IP-10 negatively correlated with creatinine levels (P < 0.05). Kt/V and creatinine levels exhibited variable predictive value (Kt/V = 27% to 37%, creatinine = 29% to 47%) to explain cytokines and chemokines circulating levels in patients with adequate and inadequate dialysis dose. Taken together, our findings provide evidence that in addition to modulating uremic toxins levels, such as urea and creatinine, dialysis dose is associated with circulating levels of inflammatory mediators. Thus, low Kt/V results and creatinine accumulation are potential indicators of the systemic inflammatory stress determined by up-regulation of proinflammatory cytokines and chemokines, and downregulation of anti-inflammatory cytokines.
Asunto(s)
Quimiocina CXCL10/sangre , Creatinina/sangre , Inflamación/sangre , Interleucina-10/sangre , Fallo Renal Crónico/terapia , Diálisis Renal , Uremia/terapia , Adulto , Anciano , Biomarcadores/sangre , Femenino , Humanos , Inflamación/diagnóstico , Fallo Renal Crónico/sangre , Fallo Renal Crónico/diagnóstico , Masculino , Persona de Mediana Edad , Diálisis Renal/efectos adversos , Resultado del Tratamiento , Uremia/sangre , Uremia/diagnóstico , Adulto JovenRESUMEN
OBJECTIVES: Arteriovenous fistulas primary patency at one-year occurs in 43-85% of the patients with end-stage renal disease. The diagnosis attributable to end-stage renal disease has been suggested to impact arteriovenous fistulas outcomes. The objective was to compare primary patency at one week, 1, 3, 6, and 12 months of follow-ups, among systemic lupus erythematosus patients and two control groups; additionally, we evaluated the impact of systemic lupus erythematosus to predict early patency loss. METHODS: A retrospective review of charts from arteriovenous fistulas created between 2008 and 2017 was performed. One-hundred thirty-four patients were identified and classified according to end-stage renal disease attributable diagnosis as: systemic lupus erythematosus cases (N = 14), control-group-1 (91 patients with primarily diabetes and hypertension), and control-group-2 (29 patients with idiopathic end-stage renal disease). A case-control matched design (1:2:1) was proposed. Logistic regression analysis and Kaplan-Meier curves were used. Institutional Review Board approval was obtained. RESULTS: More systemic lupus erythematosus patients lost primary patency at 3 (28.6%) and 12 months (71.4%) than patients from control-groups-1 (vs. 3.6% and 35.7%, respectively) and -2 (vs. 0% and 14.3%, respectively), (p ≤ 0.011 for both). Days of primary patency survival were shorter in systemic lupus erythematosus patients (p = 0.003). Systemic lupus erythematosus diagnosis was the only factor associated with early patency loss, HR: 3.141, 95%CI: 1.161-8.493 (systemic lupus erythematosus diagnosis vs. control-group-1) and HR: 12.582, 95%CI: 1.582-100.035 (systemic lupus erythematosus diagnosis vs. control-group-2). CONCLUSIONS: Diagnosis attributable to end-stage renal disease has a major impact on arteriovenous fistula outcomes in patients. Systemic lupus erythematosus patients have an increased risk of arteriovenous fistulas patency loss within the first six months of follow-up. Patients with idiopathic end-stage renal disease had an excellent one year arteriovenous fistula patency survival.
Asunto(s)
Derivación Arteriovenosa Quirúrgica , Fallo Renal Crónico/terapia , Lupus Eritematoso Sistémico/complicaciones , Nefritis Lúpica/terapia , Diálisis Renal , Adolescente , Adulto , Derivación Arteriovenosa Quirúrgica/efectos adversos , Femenino , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/fisiopatología , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/etiología , Lupus Eritematoso Sistémico/diagnóstico , Nefritis Lúpica/diagnóstico , Nefritis Lúpica/etiología , Masculino , Persona de Mediana Edad , Diálisis Renal/efectos adversos , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Adulto JovenRESUMEN
BACKGROUND: A kidney transplant candidate's social network serves as a pool of potential living donors. Sex and racial differences in network size, network strength, and living donor requests may contribute to disparities in living donor kidney transplantation. METHODS: In this multicenter cross-sectional study, we performed an egocentric network analysis via a telephone survey of 132 waitlisted candidates (53% female and 69% Black) to identify demographic and network factors associated with requesting living kidney donations. RESULTS: Female participants made requests to more network members than male participants: incidence rate ratio (IRR) 1.95, 95% confidence interval (CI) [1.24-3.06], P < 0.01. Black participants tended to make more requests than whites (IRR 1.65, 95% CI [0.99-2.73], P = 0.05). The number of requests increased with the size of the network (IRR 1.09, 95% CI [1.02-1.16], P = 0.01); however, network size did not differ by sex or race. Network members who provided greater instrumental support to the candidates were most likely to receive a request: odds ratio 1.39, 95% CI [1.08-1.78], P = 0.01. CONCLUSIONS: Transplant candidates' networks vary in size and in the number of requests made to the members. Previously observed racial and sex disparities in living donor kidney transplantation do not appear to be related to network size or to living donation requests, but rather to the network members themselves. Future living donor interventions should focus on the network members and be tailored to their relationship with the candidate.
Asunto(s)
Fallo Renal Crónico/cirugía , Trasplante de Riñón , Donadores Vivos/provisión & distribución , Red Social , Apoyo Social , Listas de Espera , Adulto , Familia , Femenino , Amigos , Humanos , Relaciones Interpersonales , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/psicología , Masculino , Persona de Mediana Edad , Factores Raciales , Estudios Retrospectivos , Factores SexualesRESUMEN
End-stage renal disease (ESRD) has an incidence of 5.5 to 9 pmp, and a prevalence of 23 to 65 pmp in children under 15 years of age. Chronic peritoneal dialysis (PD) represents the most widely used renal replacement therapy in children before kidney transplantation. There are two PD modalities, the manual one (CAPD) and the automated one (APD). The choice is based on the peritoneum characteristics, evaluated through the peritoneal equilibrium test (PET), which divides patients into high transporters (rapid exchange membrane), high average, low average, and low transporters (slow exchange membrane). This test basically evaluates the solutes transport rate, and the MiniPET has been added which evaluates peritoneal free water transport. The amount of dialysis (Kt/V), which represents the dose of dialysis administered also must be evaluated to assure a minimal value of 1.7 related to morbidity and mortality. These parameters should be evaluated periodically to ad just the PD and whenever suspected an inadequate clearance or ultrafiltration. The objective of this review is to provide basic concepts on peritoneal transport physiology, PD modalities, free water transport and peritoneal solute transport evaluation, and the dialysis dose to be applied according to the patient's needs, as well as reviewing the correction mechanisms and procedure adjustment whenever required.
Asunto(s)
Fallo Renal Crónico/terapia , Diálisis Peritoneal/métodos , Niño , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/fisiopatología , Pediatría , Resultado del TratamientoRESUMEN
Resumen: La enfermedad renal crónica terminal (ERCT) tiene una incidencia de 5,5 a 9 ppm, y una prevalencia de 23 a 65 ppm en menores de 15 años. La diálisis peritoneal (DP) crónica representa en pediatría la terapia de reemplazo renal más usada, previo al trasplante renal. Existen 2 tipos de DP crónicas, manual (DPCA) y automatizada (DPA), cuya elección se basa en las características del peritoneo eva luado mediante el test de equilibrio peritoneal (PET), que divide a los pacientes en transportadores altos (intercambio rápido), promedio alto, promedio bajo, y bajos (intercambio lento). Este test eva lúa básicamente el transporte de solutos, al cual se ha sumado el MiniPET, que evalúa el transporte peritoneal de agua libre. Se debe igualmente determinar la cuantía de diálisis (Kt/V), que representa la dosis de diálisis aplicada, con un valor mínimo sugerido de 1,7, relacionado a la morbimortalidad. Estos parámetros deben ser evaluados periódicamente para ajustar la DP, y cada vez que se sospeche una depuración o ultrafiltración inadecuadas. El objetivo de esta revisión es entregar conceptos bási cos sobre fisiología del transporte peritoneal, modalidades de DP, evaluación del transporte de agua y solutos peritoneal, y el cálculo de la dosis de diálisis para una diálisis ajustada a las necesidades de cada paciente, como también revisar los mecanismos de corrección y ajuste del procedimiento cada vez que se requiera.
Abstract: End-stage renal disease (ESRD) has an incidence of 5.5 to 9 pmp, and a prevalence of 23 to 65 pmp in children under 15 years of age. Chronic peritoneal dialysis (PD) represents the most widely used renal replacement therapy in children before kidney transplantation. There are two PD modalities, the manual one (CAPD) and the automated one (APD). The choice is based on the peritoneum characteristics, evaluated through the peritoneal equilibrium test (PET), which divides patients into high transporters (rapid exchange membrane), high average, low average, and low transporters (slow exchange membrane). This test basically evaluates the solutes transport rate, and the MiniPET has been added which evaluates peritoneal free water transport. The amount of dialysis (Kt/V), which represents the dose of dialysis administered also must be evaluated to assure a minimal value of 1.7 related to morbidity and mortality. These parameters should be evaluated periodically to ad just the PD and whenever suspected an inadequate clearance or ultrafiltration. The objective of this review is to provide basic concepts on peritoneal transport physiology, PD modalities, free water transport and peritoneal solute transport evaluation, and the dialysis dose to be applied according to the patient's needs, as well as reviewing the correction mechanisms and procedure adjustment whenever required.
Asunto(s)
Humanos , Niño , Diálisis Peritoneal/métodos , Fallo Renal Crónico/terapia , Pediatría , Resultado del Tratamiento , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/fisiopatologíaRESUMEN
Chronic kidney disease is a significant problem of public health worldwide, and up to 60% of patients start dialysis in an unplanned manner without a definitive dialysis access. Recently, peritoneal dialysis (PD) has emerged as an alternative to unplanned chronic dialytic method, and the world collective experience shows that PD can be an efficient, safe, and cost-effective alternative with comparable outcomes to the planned PD and urgent-start hemodialysis (HD). More importantly, as compared to urgent-start HD using a central venous catheter, urgent-start PD has significantly fewer incidences of catheter-related bloodstream infections, dialysis-related mechanical complications, and need for dialysis catheter reinsertions during the initial time of the therapy. An integrative review was conducted on PD urgent start compared to HD urgent start and to planned PD, identifying its potential advantages and limitations. Literature search was performed within multiple databases, and observational studies on clinical experience with urgent PD were reviewed and appraised.
Asunto(s)
Servicios Médicos de Urgencia , Hallazgos Incidentales , Diálisis Peritoneal , Terapia de Reemplazo Renal , Brasil , Toma de Decisiones Clínicas , Países en Desarrollo , Manejo de la Enfermedad , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/terapia , Diálisis Peritoneal/métodos , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/terapia , Terapia de Reemplazo Renal/métodosRESUMEN
BACKGROUND: Urinary parameters, anti-dsDNA antibodies and complement tests were explored in patients with childhood-Systemic Lupus Erythematosus (cSLE) early-onset lupus nephritis (ELN) from a large multicenter cohort study. METHODS: Clinical and laboratory features of cSLE cases with kidney involvement at presentation, were reviewed. Disease activity parameters including SLEDAI-2 K scores and major organ involvement at onset and follow up, with accrued damage scored by SLICC-DI, during last follow up, were compared with those without kidney involvement. Autoantibodies, renal function and complement tests were determined by standard methods. Subjects were grouped by presence or absence of ELN. RESULTS: Out of the 846 subjects enrolled, mean age 11.6 (SD 3.6) years; 427 (50.5%) had ELN. There was no significant difference in the ELN proportion, according to onset age, but ELN frequency was significantly higher in non-Caucasians (p = 0.03). Hematuria, pyuria, urine casts, 24-h proteinuria and arterial hypertension at baseline, all had significant association with ELN outcome (p < 0.001). With a similar follow up time, there were significantly higher SLICC-DI damage scores during last follow up visit (p = 0.004) and also higher death rates (p < 0.0001) in those with ELN. Low C3 (chi-square test, p = 0.01), but not C3 levels associated significantly with ELN. High anti-dsDNA antibody levels were associated with ELN (p < 0.0001), but anti-Sm, anti-RNP, anti-Ro, anti-La antibodies were not associated. Low C4, C4 levels, low CH50 and CH50 values had no significant association. High erythrocyte sedimentation rate (ESR) was associated with the absence of ELN (p = 0.02). CONCLUSION: The frequency of ELN was 50%, resulting in higher morbidity and mortality compared to those without ELN. The urinary parameters, positive anti-dsDNA and low C3 are reliable for discriminating ELN.
Asunto(s)
Lupus Eritematoso Sistémico/complicaciones , Nefritis Lúpica/etiología , Lesión Renal Aguda/diagnóstico , Adolescente , Edad de Inicio , Anticuerpos Antinucleares/análisis , Biomarcadores , Biopsia , Sedimentación Sanguínea , Brasil/etnología , Niño , Preescolar , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Glomerulonefritis/diagnóstico , Glomerulonefritis/etiología , Hematuria/diagnóstico , Humanos , Hipertensión/diagnóstico , Lactante , Recién Nacido , Riñón/patología , Fallo Renal Crónico/diagnóstico , Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/inmunología , Lupus Eritematoso Sistémico/orina , Nefritis Lúpica/sangre , Nefritis Lúpica/diagnóstico , Nefritis Lúpica/inmunología , Masculino , Proteinuria/diagnóstico , Piuria/diagnósticoRESUMEN
BACKGROUND: An arteriovenous fistula (AVF) is the preferred vascular access for long-term hemodialysis. The main disadvantage of AVF is the rate of nonmaturation or unsuccessful use for hemodialysis (FUHD). We described our findings in AVF creation and possible risk factors associated with FUHD. METHODS: This is a retrospective study of AVFs during a 6-year period. Variables collected at the time of creation were demographics, comorbidities, replacement therapy, preoperative laboratory tests, and estimated 6-month mortality on hemodialysis. All AVFs were created in the upper arms. Outcomes were FUHD, cannulation failure, and cumulative survival. Univariate and multivariate analyses were performed to find possible risk factors for FUHD. RESULTS: AVFs were created in 78 patients. Average age was 36.3 years, and 74.4% were male. Mean body mass index was 24.5 kg/m2. The most common etiologies were glomerulopathy (53.6%) and diabetes mellitus (13.4%). Estimated six-month mortality was 4.2%. One patient underwent AVF before hemodialysis (mean dialysis time 2.2 years). Nineteen AVFs were considered FUHD (23.2%). Cannulation failure was 15.9%. AVF 1-year and 3-year survival was 67.8% and 63.5%, respectively. FUHD had higher estimated six-month mortality on hemodialysis, shorter prothrombin time, and lower serum albumin level than successful AVF (univariate analysis) (P < 0.05) Short prothrombin time and albumin were confirmed for FUHD (multivariate analysis). A 3.3-gr/dL serum albumin cutoff point (area under the curve, 0.715; receiver operating characteristic) (P < 0.05) was determined for FUHD. CONCLUSIONS: The population referred for AVF creation possesses different characteristics in our center. Good AVF outcomes can be achieved. Preoperative serum albumin level and prothrombin time could be the possible risk factors associated with unsuccessful AVF use.
Asunto(s)
Derivación Arteriovenosa Quirúrgica/efectos adversos , Fallo Renal Crónico/terapia , Diálisis Renal , Adulto , Anciano , Derivación Arteriovenosa Quirúrgica/mortalidad , Biomarcadores/sangre , Coagulación Sanguínea , Femenino , Humanos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/mortalidad , Masculino , México , Persona de Mediana Edad , Tiempo de Protrombina , Diálisis Renal/efectos adversos , Diálisis Renal/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Albúmina Sérica Humana/metabolismo , Factores de Tiempo , Insuficiencia del Tratamiento , Adulto JovenRESUMEN
Patients with end-stage renal disease (ESRD) whether on dialysis therapy (DT) or who received a kidney transplant (KT) have previously shown unfavorable surgical outcomes. Little is known about the comparative efficacy and durability of lower extremity bypass (LEB) in those patients. The Vascular Quality Initiative database was explored to identify DT or KT recipients (2003-2016) who had LEB. We included 1,714 bypass procedures; DT: 1,512 (88.2%). Primary patency (PP) at 2 year was comparable between KT and DT groups (PP [95% confidence interval {CI}]: 77.0% [69.7%-82.8%] vs. 80.5% [77.8%-82.9%]; P = 0.212), and the risk-adjusted hazard was similar (adjusted hazard ratio [aHR] [95% CI]: 0.89 [0.61-1.30]; P = 0.540). Amputation-free survival (AFS) at 2 year was more favorable in KT group (AFS [95% CI]: 73.1% [66.3%-78.8%] vs. 48.0% [45.4%-50.6%]; P < 0.001), (aHR [95% CI]: 2.29 [1.62-3.23]; P < 0.001). Patients on DT exhibited a higher risk of mortality than KT recipients (aHR [95% CI]: 2.94 [2.07-4.17]; P < 0.001). This study demonstrated superior limb outcomes in KT recipients than patients on DT after LEB. Despite the comparable PP, the risk of amputation or death was doubled in patients on DT compared with KT recipients. Because both groups were similar in several baseline characteristics, the difference in outcome is likely driven by the positive effect of KT on the physiological milieu of these patients.
Asunto(s)
Implantación de Prótesis Vascular , Fallo Renal Crónico/terapia , Trasplante de Riñón , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/cirugía , Diálisis Renal , Vena Safena/trasplante , Anciano , Amputación Quirúrgica , Implantación de Prótesis Vascular/efectos adversos , Bases de Datos Factuales , Femenino , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/fisiopatología , Trasplante de Riñón/efectos adversos , Recuperación del Miembro , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Supervivencia sin Progresión , Diálisis Renal/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Grado de Desobstrucción VascularRESUMEN
El objetivo propuesto es reordenar los conocimientos sobre el síndrome hemolítico urémico en los pediatras, que se enfrentan al manejo de pacientes con esta enfermedad en los servicios de urgencia, hospitalización y unidades de cuidado intensivo. Actualmente se considera una enfermedad rara o emergente. El 90 por ciento de los casos es causado, fundamentalmente, por una infección entérica con Escherichia coli productora de toxina Shiga. La infección en humanos está provocada por el consumo de carne contaminada poco cocida, leche no pasteurizada o productos lácteos, agua, fruta y vegetales. El período de incubación, después de la ingestión de estos productos, es de 1 a 10 días. El diagnóstico del síndrome se basa en la presencia de pródromo diarreico asociado a anemia hemolítica microangiopática, trombocitopenia y daño renal agudo, elementos que caracterizan la enfermedad. La trombocitopenia puede ser transitoria y no detectada en los exámenes de laboratorio. Un recuento de plaquetas > 150 000 pudiera ser un marcador indirecto de resolución del proceso microangiopático. Clínicamente suele iniciarse con dolor abdominal, diarrea y desarrollo entre los 4-10 días de fracaso renal agudo. El tratamiento actual de los pacientes con el síndrome es de sostén, aunque se está usando el anticuerpo monoclonal recombinante Eculizumab, también, las terapias de recambio plasmático como tratamiento de primera línea tan pronto como se realice el diagnóstico. El síndrome urémico hemolítico es una de las causas principales de falla renal aguda en niños. Su diagnóstico y tratamiento precoz y oportuno son la clave para prevenir las complicaciones de esta entidad(AU)
The proposed objective is to reorder the knowledge on haemolytic uremic syndrome´s management in pediatricians that have to face the care of patients suffering this disease in emergency services, hospitalization and intensive care units. Nowadays, it is considered a rare or emerging disease. In 90 percent of the cases, it is caused mainly by an enteric infection with Escherichia coli which produces Shiga toxine. The infection in humans is provoqued by consumption of raw contamined meat, non-pasteurized milk or dairy products, water, fruits or vegetables. Incubation period after ingestion is of 1 to 10 days. The syndrome's diagnostic is based in the presence of diarrheic prodome associated to microangiopathic hemolytic anemia; thrombocytopenia and acute renal damage which are elements that characterize the disease. Thrombocytopenia can be transitory and not detected in laboratory tests. Platelets count> 150 000 could be an indirect marker of resolution in the microagniopathic process. Clinically speaking, it normally starts with abdominal pain, diarrhea and evolution in 4 to 10 days of acute renal damage. The current treatment for patients witht the syndrome is supportive treatment although it is also used the recombinant monoclonal antibody called Eculizumab; and also plasma recharge therapies as a front line treatment as soon as the diagnostic has been made. Hemolytic uremic syndrome is one of the main causes of acute renal failure in children. Its diagnostic and early and timely treatment are the key to prevent complications of this entity(AU)