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1.
U: the Caribbean health digest ; (5): 40-43, April-June 2009. ilus
Artigo em Inglês | MedCarib | ID: med-17865

RESUMO

You might not guess it, but the kidneys are as vital to human life as is the heart. They filter toxins out of our blood. If these toxins were allowed to accumulate even for a very short time, they would kill us quite quickly. Even the normal minerals we expect to find in a healthy body can be deadly in the wrong amounts. Potassium, for example, can stop the heart from beating if it is allowed to accumulate. The kidneys are, therefore, essential to our very existance. The heart pumps the blood; the kidneys keep it clean. Of all the organs, the kidneys are placed in a most protected location to prevent damage from trauma of any sort. They lie on the large muscles of the back and are cushioned from behind by these layers of very developed tissues. Above, and in front, the lower ribs guard them like fingers of a hand. And in case that were not enough protection, a well developed pad of fat envelopes the organs like bubble wrap around a fragile package. Most people have a matching pair of bean-shaped kidneys - but not everyone does. Some individuals are born with only one kidney; some lose a kidney from trauma, surgery of diseased states, or destruction from kidney stones which are not properly treated early enough. All these individuals can still live a perfectly normal life, have children and do almost everything except take part in contact sports for obvious safety reasons, to avoid damage to their precious, sole remaining kidney.


Assuntos
Transplante de Rim , Insuficiência Renal , Rim , Nefropatias , Falência Renal Crônica
2.
West Indian med. j ; 47(2): 54-8, Jun. 1998.
Artigo em Inglês | MedCarib | ID: med-1801

RESUMO

We have reviewed our delivery of highly sophisticated medical therapy, haemodialysis and renal transplantation in a Caribbean setting. The purpose has been to reflect local outcomes in relation to mortality and survival, but comparisons with a vastly larger database have been attempted. Such comparisons are extremely difficult due to methodological differences and the fact that facilities contributing to that database vary considerably with regard to patient age, gender, ethnicity and comorbidity. Nonetheless, the crude data available provide important justification for the existence of regular haemodialysis and its adjunctive therapy of renal transplantation in the Caribbean.(AU)


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/estatística & dados numéricos , Transplante de Rim/estatística & dados numéricos , Nefropatias/mortalidade , Barbados , Avaliação de Resultados em Cuidados de Saúde , Resultado do Tratamento , Taxa de Sobrevida
3.
West Indian med. j ; 47(suppl. 2): 49, Apr. 1998.
Artigo em Inglês | MedCarib | ID: med-1835

RESUMO

The results of 10 living donor (LRD) renal transplants performed in Barbados during the period 1987 to 1997 are reported. The donors were four mothers, three fathers, two brothers and an uncle. The six female and four male recipients were 14 to 36 years of age. Four recipients displayed delayed graft function (DFG), ie, failure to produce more than 1.0 L of urine in the first 24 hours and/or failure to reduce plasma creatinine by more than 50 percent in the first 48 post-operative hours. Two of these grafts were lost due to thrombosis of the allograft anastomisis; one patient successfully resumed haemodialysis therapy following transplant nephrectomy but the other died from the respiratory distress syndrome three days after transplantation. Of the remaining two patients with DGF, one showed impaired function at one year and subsequently lost the allograft at ten years post-transplantation from chronic rejection, the other has "normal" renal function five year post-transplantation. One other patient died in the early post-operative period, from a cerebral haemorrhage due to uncontrolled hypertension. Five of the allografts were functioning five years after transplantation (mean plasma creatinine = 169.2 umols/l); one has a plasma creatinine of 112 umols/l at one year and another has a plasma creatinine of 300 umols/l eight months after transplantation. This experience shows that the infrastructure to support LRD renal transplants is established in Barbados and can be used to supplement renal replacement initiatives in Barbados and in neighbouring Eastern Caribbean states.(AU)


Assuntos
Adolescente , Adulto , Humanos , Transplante de Rim/mortalidade , Transplante de Rim/estatística & dados numéricos , Barbados
4.
West Indian med. j ; 44(2): 74-6, June 1995.
Artigo em Inglês | MedCarib | ID: med-6562

RESUMO

Three case reports of cytomegalovirus (CMV) disease in seronegative renal transplant recipients of seropositive donor kidneys are presented. Clinicians need to have a high index of suspicion for CMV disease in such patients. Early diagnosis and treatment are essential to decrease morbidity and mortalitiy. Prophylaxis with antiviral and/or CMV-hyperimmunoglobulin may decrease the incidence of serious infection (AU)


Assuntos
Relatos de Casos , Humanos , Masculino , Feminino , Adolescente , Adulto , Transplante de Rim/efeitos adversos , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/tratamento farmacológico , Terapia de Imunossupressão/efeitos adversos , Rejeição de Enxerto
5.
Am J Nephrol ; 14(3): 226-9, 1994.
Artigo em Inglês | MedCarib | ID: med-7979

RESUMO

A 42 year old man with chronic renal failure and homograft transplantation developed adult T-cell lymphoma in one native kidney. The role of transfusion in the acquisition of human T-lymphotropic virus type 1 and its role in the early development of adult T cell lymphoma, particularly on the background of chronic immunosuppression, are discussed. To our knowledge, this is the first such case. (AU)


Assuntos
Adulto , Masculino , Humanos , Transplante de Rim , Transfusão de Sangue/efeitos adversos , Hospedeiro Imunocomprometido , Leucemia-Linfoma de Células T do Adulto/transmissão , Cadáver , Rim/patologia , Insuficiência Renal Crônica/cirurgia , Terapia de Imunossupressão
6.
West Indian med. j ; 42(suppl.2): 5, July 1993.
Artigo em Inglês | MedCarib | ID: med-5515

RESUMO

The renal replacement options in ERSD are (1) Haemodialysis (HD) in hospital or at home; (2) Peritoneal Dialysis: intermittent (IPD), continuous ambulatory (CAPD), continuous cyclic (machine) (CCPD); (3) Renal transplantation: living donor kidney and cadaver donor kidney and (4) Haemofiltration. Since 1979, there has been a phenomenal growth in the number of patients on chronic peritoneal dialysis, increasing from 2,000 patients worldwide to over 75,000 in 1992. This accounts for 14 per cent of patients on dialysis worldwide. The percentage of patients on CAPD is 6 percent in Japan, 51 percent in the United Kingdom and 93 percent in Mexico. CAPD is the cheapest form of dialysis in Europe and Canada and as cheap as home haemodialysis in the USA. In the USA, 1 in 3 new patients commenced on CAPD is diabetic. Data from the United States Renal Data System (USRDS) show that for primary renal disease in the non-diabetic, survival on CAPD is as good as haemodialysis. In the diabetics younger than 50 years, survival on CAPD is better than HD, but, over 50 years, there is no difference in survival. This applies for both Blacks and Whites. There are advantages for CAPD for diabetic patients when compared to HD. There is rapid establishment as with home therapy, training usually taking about three weeks; a partner is not essential; there are fewer hypotensive episodes and there is minimal stress on the cardiovascular system. One of the main disadvantages is peritonitis. Other less common problems are obstruction of the peritoneal catheter, tunnel infections and peritoneal thickening, leading to loss of peritoneal membrane surface. The main symptoms and signs of peritonitis are cloudly dialysate fluid, fever, abdominal pain and tenderness. Major improvements in the type of catheter, the type of giving sets and aseptic techniques have led to reduced incidence of peritonitis and patient mortality. The use of Erythropoietin in Patients with Chronic Renal Failure - Erythropoietin is normally produced in the peritubular interstitial cells of the kidneys. About 10 percent is produced in the liver, and there are no pre-formed stores of erythropoietin. Hypoxia increases de novo production of erythropoietin. It recruits and maintains the survival of the erythroid progenitor cells and promotes their maturation. The main condition in which erythropoietin is deficient is chronic renal failure, but it has also been found deficient in patients with cancer, chronic inflammations and chronic infections. Erythropoietin has been produced by genetic engineering, and its major indication is for the treatment of anaemia of chronic renal failure patients on haemodialysis, CAPD and also for predialysis patients (AU)


Assuntos
Humanos , Diabetes Mellitus/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Diálise Peritoneal Ambulatorial Contínua , Eritropoetina/uso terapêutico , Transplante de Rim/métodos , Hemodiálise no Domicílio , Peritonite , Hipóxia , Anemia
7.
West Indian med. j ; 38(Suppl. 1): 40, April 1989.
Artigo em Inglês | MedCarib | ID: med-5673

RESUMO

In establishing a renal transplant service in the Bahamas, a review of the availability of suitable cadaveric organ donors in the Intensive Care Unit (ICU) was carried out over the period January, 1988 to October, 1988. Clinical criteria for suitable organ donation and brain deaths were applied to all patients who died in the ICU. Over the nine-month period, 351 patients were admitted to the ICU and 107 died; 8 of 107 deaths fulfilled the criteria for cadaveric organ donation. All suitable victims succumbed to head inury. The mean age was 27 years with 6 to 8 deaths occuring within 4 days of admission. Issues affecting donor procurement rate in major transplant centres are not applicable in the centralized stem under study where all patients requiring critical care are referred to the ICU. It is concluded that cadaveric organ donation alone is inadequate to fulfill the criteria for cadaveric organ donation. All suitable victims succumbed to head injury. The mean age was 27 years with 6 to 8 deaths occuring within 4 days of admission. Issues affecting donor procurement rate in major transplant centres are not applicable in the centralized stem under study where all patients requiring critical care are referred to the ICU. It is concluded that cadaveric organ donation alone is inadequate to fulfill the organ demand for renal transplantation. In the Bahamas a policy of using living related donor organs whenever possible is favoured. Casual observation of road traffic and ICU mortalities fosters an erroneous assumption of potential donor organs (AU)


Assuntos
Humanos , Adulto , Transplante de Rim , Doadores de Tecidos , Unidades de Terapia Intensiva , Morte Encefálica , Bahamas
8.
West Indian med. j ; 37(Suppl. 2): 36, Nov. 1988.
Artigo em Inglês | MedCarib | ID: med-5820

RESUMO

Long-term haemodialysis at the University Hospital of the West Indies, Jamaica, started in 1971 with the training of patients with end-stage renal failure for self-treatment in their own homes. There was no Government Health Insurance or other third party funding for this treatment and, regrettably, patients whose financial and social circumstances did not allow home-dialysis treatment perished from terminal uraemia. Elsewhere in the Caribbean, notably in San Fernando and Port-of-Spain in Trinidad and Tobago, attempts were also being made to introduce dialysis therapy. Again, there was little encouragement in the way of funding from traditional health care sources. The majority of Jamaicans coming to end-stage renal failure did so as the result of benign or malignant nephrosclerosis and the majority of these were from the lower socioeconomic strata of the society. To overcome their relative disadvantagement, dialysis programmes were initiated, first at the Kingston Public Hospital (circa 1972) and subsequently at the University Hospital (1974), to prepare patients with end-stage renal failure for renal transplantation. By September 1980 twenty-five cadaver renal transplants had been performed on patients from these two sources. All patients transplanted in Jamaica have received cadaver transplants. On June 14, 1987 the first successful living-related donor renal transplant in the Commonwealth Caribbean was performed in Barbados. A few months later four similar operations were performed in San Fernando. Dialysis facilities now exist in the Bahamas, Barbados, Bermuda, Jamaica and Trinidad and Tobago. The future holds the prospect of co-operation between these centres and the provision of renal transplantation services for a greater number of West Indian nationals (AU)


Assuntos
Humanos , Diálise Renal , Hemodiálise no Domicílio/economia , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Transplante de Rim , Atenção à Saúde/economia , Jamaica/epidemiologia
10.
Carib Med J ; 49(1/2): 41-2, 1988.
Artigo em Inglês | MedCarib | ID: med-4514
13.
West Indian med. j ; 22(3): 152, Sept. 1973.
Artigo em Inglês | MedCarib | ID: med-6177

RESUMO

In August, 1970, a renal transplant was performed at the Kingston Public Hospital in Jamaica. The patient lived for 21 days, dying suddenly from a complication of the operation but with normal renal function. At the time over 2,000 such operations had been done in the world, yet this was the first in the British Caribbean. Our second renal transplant was done in May, 1972. The patient is still alive and well with normal renal function. The reasons for our regional tardiness in this exciting field of surgery are closely associated with the problems we are encountering with our tranplant programme in Jamaica. A well-run chronic haemodialysis programme with a resident nephrologist must be available to keep the potential recipients alive and relatively fit while awaiting transplantation. With only 2 major hospitals and a poor inter-hospital transplant system, cadaver donors are relatively scarce. A high percentage of potential cadaver donors are lost because of uneducated and superstitious relatives declining consent. The small pool of recipients makes it difficult to obtain a good tissue match. Despite the above, the nephro-urological unit at the Kingston Public Hospital in association with the nephrologists at the University Hospital of the West Indies are now embarking on an active transplant programme (AU)


Assuntos
Humanos , Transplante de Rim , Jamaica
15.
BMC public health ; 10(266): [1-9], 21 May 2010. tab
Artigo em Inglês | MedCarib | ID: med-17503

RESUMO

Background: Black minority ethnic groups in the UK have relatively low rates of deceased donation and report a higher prevalence of beliefs that are regarded as barriers to donation. However there is little data from migrants' countries of origin. This paper examines community attitudes to deceased kidney donation in Barbados and compares the findings with a survey conducted in a disadvantaged multi-ethnic area of south London. Methods: Questionnaires were administered at four public health centres in Barbados and at three private general practices. Adjusted odds ratios were calculated to compare attitudinal responses with a prior survey of 328 Caribbean and 808 White respondents in south London. Results: Questionnaires were completed by 327 respondents in Barbados (93% response); 42% men and 58% women, with a mean age of 40.4 years (SD 12.6). The main religious groups were Anglican (29%) and Pentecostal (24%). Educational levels ranged from 18% not completing 5th form to 12% with university education. Attitudes to the notion of organ donation were favourable, with 73% willing to donate their kidneys after their death and only 5% definitely against this. Most preferred an opt-in system of donation. Responses to nine attitudinal questions identified 18% as having no concerns and 9% as having 4 or more concerns. The highest level of concern (43%) was for lack of confidence that medical teams would try as hard to save the life of a person who has agreed to donate organs. There was no significant association between age, gender, education or religion and attitudinal barriers, but greater knowledge of donation had some positive effect on attitudes. Comparison of attitudes to donation in south London and Barbados (adjusting for gender, age, level of education, employment status) indicated that a significantly higher proportion of the south London Caribbean respondents identified attitudinal barriers to donation. Community attitudes in Barbados are favourable to deceased donation based on a system of informed consent. Comparison with south London data supports the hypothesis that the relatively high prevalence of negative attitudes to deceased donation among disadvantaged ethnic minorities in high income countries may reflect feelings of marginalisation and lack of belonging.


Assuntos
Humanos , Transplante de Rim , Rim , Grupos Minoritários , Barbados , Reino Unido , Região do Caribe
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