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Percutaneous peritoneal dialysis catheter (PDC) insertion for continuous ambulatory peritoneal dialysis (CAPD) entails a higher risk of complications such as bowel injury, vascular injury, and catheter migration compared to the surgical insertions. We conducted a comparative analysis of two techniques of peritoneal entry for PDC insertion by Seldinger technique. We performed a retrospective review of 426 percutaneously inserted PDCs in nonobese naïve abdomens for CAPD at two tertiary care teaching hospitals in India over 6 years. Comparison of various mechanical complications, and short-term catheter survival was done between use of introducer needle (Group "I") and spring-loaded pneumoperitoneum (Veress) needle (Group "V"). Group "I" to "V" patient ratio was 277:149. Group "I" had heavier patients (p = 0.03) whereas "V" group had a dominance of diabetes (p = 0.009) and prior hemodialysis patients (p = 0.03). At 3 months, the odds of mechanical complications (OR = 0.27, p = 0.004), PDC migration (OR = 0.18, p = 0.02), and omental wrapping (OR = 0.13, p = 0.04) were less in "V" group. No bowel injury occurred with Veress needle use. At 6 months, "V" group had higher odds of event-free sustained PDC tip position (OR = 0.39, p = 0.003), and catheter survival (p = 0.03), and the cumulative events were lesser too (p = 0.002). Refractory peritonitis and deaths with functioning catheter were comparable between both the groups. In this first-of-its-kind study, spring-loaded Veress pneumoperitoneum needle use was safer, entrusted sustained PDC tip position in pelvis, and had a better catheter survival compared to use of introducer needle for peritoneal entry in percutaneously inserted PDCs. These findings should be confirmed by a randomized controlled study.
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Catéteres de Permanencia/efectos adversos , Intestinos/lesiones , Agujas , Diálisis Peritoneal Ambulatoria Continua/instrumentación , Diálisis Peritoneal Ambulatoria Continua/métodos , Femenino , Humanos , India , Masculino , Persona de Mediana Edad , Neumoperitoneo , Estudios RetrospectivosRESUMEN
INTRODUCTION: Peritoneal dialysis catheter (PDC) placement for chronic kidney disease (CKD) amongst overweight and obese patients is difficult owing to deeper operating field. Literature being discordant on survival and complications in this patient subset, we attempted to analyse this research question in Indian population. MATERIALS AND METHODS: We retrospectively analysed PDC inserted by nephrologist using surgical minilaparotomy for survivals and complications amongst 'overweight and obese' cohort ('O') at two tertiary care government hospitals in India, and compared results with normo-weight cohort ('N'), with 12-36 months follow-up. RESULTS: 245 PDCs were inserted by surgical minilaparotomy and 'N' to 'O' ratio was 169:76. 'O' group were more rural residing (P = 0.003) and post-abdominal surgery (P = 0.008) patients. The 1, 2, and 3-year death censored catheter survival rate was 98.6%, 95.8%, and 88.2% respectively in 'O' group, and 97.6%, 94.5% and 91.8% in 'N' group respectively (P = 0.52). Patient survival (P = 0.63), mechanical complications (P = 0.09) and infective complications (P = 0.93) were comparable despite technically challenging surgery in 'O' group. Refractory peritonitis related PDC removal was comparable (P = 0.54). Prior haemodialysis or catheter related blood stream infections or diabetes were non-contributory to results. CONCLUSIONS: Catheter survival and patient survival amongst obese and overweight CAPD patients was non-inferior to normal weight patients. Mechanical, and infective complications were comparable despite technically challenging abdominal terrain in 'O' group. The overall CAPD performance was good amongst obese and overweight.
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BACKGROUND: Infectious disorders are a major cause of concern in renal transplant recipients (RTRs) leading to considerable morbidity and mortality. We studied the profile and outcomes of infectious disorders in a cohort of RTR. MATERIALS AND METHODS: In this prospective, observational study, we evaluated all RTR who presented with the features of infection. We also included asymptomatic patients with microbiological evidence of infection. We excluded patients with acute rejection, drug toxicity, and malignancy. Descriptive statistics were used to analyze the results. RESULTS: The study population (n = 45, 35 male and 10 female) had a mean age of 35.5 ± 10.4 years and follow-up after transplant was 2.1 ± 1.7 years. Urinary tract infection (UTI, n = 15) is the most common infection followed by tuberculosis (TB, n = 8), cytomegalovirus (n = 6), candidiasis (n = 7), and hepatitis (n = 11). Miscellaneous infections such as cryptosporidiosis and pneumocystis were seen in 10 patients. Simultaneous infections with two organisms were seen in 7 patients. Four patients succumbed to multiorgan dysfunction following sepsis, another 4 patients developed chronic graft dysfunction, while the remaining 35 RTR had a good graft function. CONCLUSION: Infectious complications are very common in the posttransplant period including UTI and TB. Further large scale studies are required to identify the potential risk factors leading to infections in RTR.
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10-30% of dialysis population awaiting renal transplantation is sensitized. Present desensitization protocols use intravenous immune globulins, rituximab, and plasmapheresis in various combinations; however, these regimens are unaffordable by many in developing countries. We tried desensitization with mycophenolate mofetil and plasmapheresis. Methods. Patients with high PRA titre (> or =50%) or positive crossmatch (>10%) were treated with MMF for a month before proposed transplant and were given five sittings of plasmapheresis. Results. 11 of 12 patients had normalization of PRA/crossmatch with this regimen and were successfully transplanted. One patient lost the graft due to graft vein thrombosis, and two patients died within three months after transplant due to septicemia and pulmonary embolism, respectively, with a functioning graft. No patient, including the two who died, developed clinical rejection over a mean follow-up of 10 months (range 1-16 months). Mean serum creatinine at last follow up was 1.1 mg/dL (range 0.9-1.3 mg/dL). Conclusions. Though the number of patients studied is small, we feel that highly sensitized patients awaiting living donor renal transplant should be tried on this simple and cost-effective regime before transplant. The more aggressive and expensive approaches incorporating IVIg and rituximab should be used only if this relatively low-cost regime is unsuccessful.
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Desensibilización Inmunológica/métodos , Trasplante de Riñón/inmunología , Ácido Micofenólico/análogos & derivados , Plasmaféresis/métodos , Inmunología del Trasplante , Adulto , Estudios de Cohortes , Terapia Combinada , Ahorro de Costo , Análisis Costo-Beneficio , Desensibilización Inmunológica/economía , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Rechazo de Injerto , Supervivencia de Injerto , Prueba de Histocompatibilidad , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/cirugía , Trasplante de Riñón/métodos , Trasplante de Riñón/mortalidad , Donadores Vivos , Masculino , Persona de Mediana Edad , Ácido Micofenólico/administración & dosificación , Cuidados Preoperatorios , Resultado del Tratamiento , Listas de Espera , Adulto JovenRESUMEN
A living-unrelated renal transplant recipient presented with a history of fever with chills and rigors for 3 days. Clinically, the cause of the fever could not be localized. During a hospital stay of 72 hours, the patient developed sore throat, laryngeal stridor and acute myocardial infarction. A post-mortem revealed disseminated mucormycosis involving the larynx, heart, intestines, brain and the transplanted kidney.
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Trasplante de Riñón/efectos adversos , Enfermedades de la Laringe/etiología , Mucormicosis/complicaciones , Infarto del Miocardio/etiología , Ruidos Respiratorios/etiología , Adulto , Humanos , MasculinoRESUMEN
Uremic hemorrhagic pericarditis occurs much less frequently in acute than in chronic renal failure, but when it does, it is a potentially fatal complication. The possibility of hemorrhagic pericarditis and cardiac tamponade should be considered in patients with acute renal failure and acute hemodynamic instability. This study reports a case of falciparum malaria complicated by acute renal failure that developed fatal cardiac tamponade in the recovery phase of acute renal failure.
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Lesión Renal Aguda/complicaciones , Taponamiento Cardíaco/etiología , Malaria Falciparum/complicaciones , Lesión Renal Aguda/parasitología , Lesión Renal Aguda/terapia , Taponamiento Cardíaco/parasitología , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Pericarditis/etiología , Diálisis Renal , Uremia/etiologíaRESUMEN
Renal cortical nephrocalcinosis is a rare condition in which there is calcification within the renal parenchyma. This article reports a 33-year-old patient who developed acute renal failure following multiple injuries leading to hemorrhagic shock. His renal failure improved gradually, though he required dialysis support for two months. Serial ultrasounds showed a progressive decrease in renal size, and a radiograph of the abdomen showed speckled calcification in both renal areas. A CT scan of abdomen showed diffuse cortical calcification involving the entire right kidney and upper half of the left kidney.