Analysis of Kidney Donation and Its Relationship With Graft Failure of the Recipient at 1 Year.

INTRODUCTION: Currently, the shortage of organs available for kidney transplantation and a change in donors' and recipients' profiles (elderly, with cardiovascular risk, donors after cardiac death), it is becoming necessary to assess grafts from expanded-criteria donors (ECD) in order to have methods that allow us to predict viability and graft survival. OBJECTIVE: The aim of this study was to analyze the different methods of renal donor assessment (estimated glomerular filtration rate [eGFR], preimplantation biopsy, and Kidney Donor Profile Index [KDPI] score) as predictors of graft survival and renal function of our recipient at 1 year. METHODS: We performed a descriptive and retrospective study of 183 deceased donor kidney transplantations performed at our center between 2011 and 2015. We calculated the KDPI scores, donor eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration Formula equation, and biopsies were evaluated using Banff classification. RESULTS: ECDs comprised 59.60%, 93% of donors had an eGFR ≥ 60 mL/min/1.73 m2, and 41% presented with a KDPI score ≥ 90%. The most frequent range in the biopsy score was 0-3. The 1-year graft survival rate was 86.90%. Factors that negatively influenced graft survival were donor/recipient age, ECD, KDPI, and cold ischemia time (CIT). CONCLUSION: Prolonged CIT and KDPI ≥ 90% were donor variables that were related to graft failure at 1 year in our center.

Kidney transplantation with organs from donors after circulatory death type 3: a prospective multicentric Spanish study (GEODAS 3).

To increase the number of kidney donors, new strategies are needed such as living donor programs, expanded criteria donors, or donors after circulatory death (DCD) kidney transplantation programs. The GEODAS group has started an observational, prospective, multicenter clinical study, collecting data from all DCD type-3 kidney transplantations performed in seven Spanish hospitals from January 2012 to January 2014. The preliminary results have shown a delayed graft function of 40.4% and graft survival of 93.7% with a nadir creatinine of 1.3 mg/dL. From all 33 potential donors included in the study, 32 were effective and 63 kidney grafts were transplanted with a utilization rate of 98.5%. Creatinine evolution (median [range]) was in the first month: 2.1 [0.6-5.6]; third month: 1.6 [0.8, 4.2]; first year: 1.6 [0.9-2.2]. These results are similar to kidney transplantation from donors after brain death as shown in the literature, especially in the graft and recipient survival rates. In addition, the controlled programs are easier and less expensive than uncontrolled DCD programs with a higher rate of graft use.

Molecular mechanisms by which white tea prevents oxidative stress.

The flavonoid content of tea (Camellia sinensis) has beneficial properties in the prevention of diseases. However, the mechanisms by which white tea can protect against oxidative stress remain unclear. To shed light on this issue, rats were given distilled water (controls), 0.15 mg/day (dose 1) or 0.45 mg/day (dose 2) of solid tea extract/kg body weight for 12 months. All the animals received an injection of adriamycin (ADR; 10 mg/kg body weight), except half of the control group, which were given an injection of saline solution. The expression of the nuclear factor, E2-related factor 2 (Nrf2), NAD(P)H:quinone oxidoreductase 1 (Nqo1), glutathione S-transferase (Gst), haem oxygenase-1 (Ho1), catalase (Cat), superoxide dismutase (Sod) and glutathione reductase (Gr) in liver was analysed by real-time PCR, and the activity of catalase (CAT), superoxide dismutase (SOD) and glutathione reductase (GR) was measured spectrophotometrically. ADR significantly increased the expression of Nrf2, Gst, Nqo1, Ho1, Cat, Sod and Gr with respect to the control levels and also increased the activity of CAT, SOD and GR. The intake of white tea increased in a higher degree the expression of Nrf2, Gst, Nqo1 and Ho1 in the tea + ADR group compared with the control group and C + ADR group. In addition, tea + ADR groups decreased the expression and activity of CAT, SOD and GR in a dose-dependent manner.

Nutrition and prevalence of undernutrition assessed by different diagnostic criteria in nursing homes for elderly people.

BACKGROUND: Undernutrition is the state produced by the intake of insufficient energy, macronutrients or micronutrients. The present study aimed to assess the prevalence of undernutrition using 10 different diagnostic criteria described in the literature and to assess its association with energy intake in an institutionalised elderly population. METHODS: The cross-sectional study included 213 subjects, aged 65-96 years (135 women and 78 men), who lived in seven nursing homes in the province of Murcia, on the Mediterranean coast of Spain. Dietary intake and anthropometric and biochemical parameters were assessed, and 10 different diagnostic criteria, taken from studies of elderly subjects similar to our population, were applied. RESULTS: The mean dietary intakes appeared to cover the recommended dietary intake for a Spanish elderly population. However, only 58.2% of the studied subjects consumed 100% of the recommended dietary intake and 15.5% of the subjects had an energy intake below 80% of the recommended dietary intake. Depending on the criteria used for the diagnosis, the proportion of patients with undernutrition varied between 2% and 57%. When the relationship between undernourishment, as defined by the different methods and intake deficiency, was assessed, a statistically significant relationship was only found for five of the 10 diagnostic criteria assessed. CONCLUSIONS: Research needs to focus on the development and evaluation of specific nutritional assessment tools for application to older people aiming to improve the detection of those suffering (or who are at risk of suffering) undernutrition.

[Development of a current version of a software application for research and practice in human nutrition (GRUNUMUR 2.0)]. / Desarrollo de una versión actualizada de una aplicación informática para investigación y práctica en nutrición humana (GRUNUMUR 2.0).

The aim of this paper is the description of a new version of the software application GRUNUMUR, a useful tool for human nutrition studies designed by the Nutrition Research Group from the Murcia University. Similar to the first, this second version offers the possibility to address different types of study: dietary habits (24 h recall, 7-days dietary record and Food Frequency Questionnaire), epidemiological, anthropometrical and clinical studies. The new version, called GRUNUMUR 2.0, compatible with the first one, has an online help system for all functions of the application, providing the user tasks, allows safe storage of a virtually unlimited number of results, in an orderly and organized way, you can retrieve it when required, through a system of backups and scheduled maintenance and unattended (tasks performed by a server), another advantage is its total accessibility, both from the university intranet (www.um.es) and from the internet, it works via Web Browser (http://senver.inf.um.es/esen), and finally, allows data to be exported to Excel for further processing with other applications as well as publishing reports in PDF, to deliver study participants if necessary. The new version has been validated by comparing the extracted results with those obtained from the other software with no significant differences for any of the variables analyzed. The application GRUNUMUR 2.0 is a tool improved, useful and reliable for addressing human nutrition studies.

[Renal cell carcinoma metastatic to the duodenum and Vater ampulla: report of two cases]. / Metástasis de cáncer renal a duodeno y ámpula de Vater; informe de dos casos.

These two cases of metastatic renal cell carcinoma to the duodenum, adds to the limited experience reported in the literature. Both patients initially presented with upper gastrointestinal bleeding years after they had a nephrectomy. After an extensive diagnostic work-up, they were both submitted to a classic pancreaticoduodenectomy (Whipple's procedure). Only the final histopathological report revealed the diagnosis. Basic recommendations on diagnosis and treatment are discussed in this article and a review of the literature is given.

[Prevalence of malnutrition and influence of oral nutritional supplementation on nutritional status in institutionalized elderly]. / Prevalencia de desnutrición e influencia de la suplementación nutricional oral sobre el estado nutricional en ancianos institucionalizados.

BACKGROUND: Nutritional supplementation might be an effective strategy for improving the nutritional status and the quality of life of institutionalized fragile elderly. OBJECTIVES: The prevalence of malnutrition and its relation with disease, and the influence of dietary supplementation by means of oral formulas on the nutritional status of elderly nursing home residents were assessed. METHODS: Two studies were carried out, one a cross-sectional survey in 31 subjects and the other a longitudinal-sectional survey in 19 subjects, both groups living in a public nursing home in the city of Murcia (SE Spain). Body mass index (BMI), serum albumin concentration (ALB) and geriatric nutritional risk index (GNRI) were assessed as markers of potential malnutrition. Illnesses were ascertained from medical records. RESULTS AND DISCUSSION: The prevalence of malnutrition of the total collective was high (39%), and especially in the fragile subjects (50%). The administration of oral nutritional supplements in the usual diet for 12 months significantly increased ALB and GNRI, and had no effect on body weigh and BMI. Jointly, these effects decreased the in the number of subjects at high nutritional risk and increased the number of subjects with a low or zero risk of malnutrition. CONCLUSION: The administration of oral nutritional supplements in the usual diet of this elderly collective is an effective clinical strategy in nutritional therapy.

Dietary intake and iron status of institutionalized elderly people: relationship with different factors.

OBJECTIVES: Aims of the study were to investigate iron status in institutionalized elderly subjects and to determine its association with different factors including: age, gender, body mass index, dietary intake, consumption of iron supplements, functional status and disease. DESIGN: A cross-sectional study. SETTING: Seven public nursing homes. PARTICIPANTS: 252 subjects, aged 65-96 years. MEASUREMENTS: Food intake was assessed by a 4-day weighed-food record. Iron status indices were measured. Barthel' s Index was used to evaluate functional status. Illnesses were ascertained from medical records. RESULTS: Anemia was found in 25.4% of subjects studied. Average dietary intakes fulfilled the amounts of Recommended Dietary Intake for Spanish elderly population, except for folate. A substantial percentage of subjects exhibited folate dietary deficit (89.2%). Mean (SD) BMI was 27.8 (6.4) kg/m2, and functional status 78.1 (26.5). Taking into account hematocrit, red blood cell count and serum iron concentration values, poor iron status was significantly more common in men (59.4, 61.4 and 16.8%, respectively) than in women (36.4, 36.4 and 6.0%, respectively). Hemoglobin concentration was positively associated with the energy and nutrient dietary intake, and negatively with age, BMI and functional status. CONCLUSIONS: Based on World Health Organization criteria, anemia was found in 25.4% of elderly subjects studied. Iron deficiency seems to be the main cause of anemia, and chronic disease the second cause of anemia. Dietary intake is not one of the principal causes of anemia in the study population, except for folate intake.

[Strategies for improving nutritional value of the meals offered by public nursing homes for the elderly]. / Estrategias para mejorar el valor nutricional de los menús ofertados en residencias públicas para personas mayores.

BACKGROUND: In developed countries, elderly people are considered a group of high risk for possible nutritional imbalances, particularly if they are institutionalized. OBJECTIVES: In the present study, the nutritional value of the meals offered by public nursing homes for the elderly in province of Murcia (Spain) was assessed, to compare the results with Spanish recommendations and to propose possible strategies for improving the nutritional status of the residents. METHODS: We studied 252 meals offered by six nursing homes, evaluating the energy and macronutrient contents, caloric profile, fat quality and cholesterol and fiber contents. The results were compared with Spanish recommendations for elderly people, and recommendations for a balanced and Mediterranean diet. RESULTS AND DISCUSSION: The average energy content of the meals widely fulfilled the amounts of Recommended Dietary Intake for the elderly population. The caloric profile was adequate as regards proteins, low in carbohydrates and high in lipids. The fat quality was adequate, the cholesterol content was higher and the fiber content lower that the recommended amounts. CONCLUSIONS: Among possible strategies to improve the nutritional value of the meals, could be a reduction in the fat and cholesterol contents and an increase in carbohydrate and fiber contents, by replacing some red meat dishes by legumes, bread and refined cereals by wholemeal foods, and fat full dairy products by low fat equivalents.

Sarcomatoid renal cell carcinoma in a renal transplant recipient.

The incidence of transplanted kidneys derived from elderly donors is increasing because of the larger waiting lists and greater age of patients with end-stage renal failure. Compared with young donors, one of the problems is the heightened risk of neoplasm transmission. We report 2 cases of kidney recipients, both of whom developed a sarcomatoid renal cell carcinoma after receiving a kidney transplant from the same 68-year-old male donor, who did not show signs of a neoplasm on a previous abdominal ultrasound or a pretransplant biopsy. The first recipient was a 66-year-old woman who developed a kidney mass with several urologic obstructive complications, tumor dissemination, and death at 9 months after kidney transplantation. The second recipient was a 48-year-old asymptomatic man with normal renal function, who was studied after the results of the first recipient, revealing another renal tumor. Transplant nephrectomy was performed and a peritoneal implant was resected. The patient is alive without evidence of a neoplasm after 18 months. Herein we have discussed the mechanisms of neoplasm transmission in kidney transplantation and possible strategies for its prevention and treatment.

Secondary amyloidosis associated with histiocytosis X.

We report a 34-year-old man diagnosed with Langerhans cell histiocytosis (LCH) or histiocytosis X in 1980. He had multiple focal osseous lesions, difficult control of the disease activity and was treated many times with chemo- and radiotherapy for symptomatic control. His kidney disease started 20 years after the diagnosis with progressive renal failure and increasing non-nephrotic proteinuria, coinciding with two flares of LCH. A percutaneous renal biopsy demonstrated amyloidosis. There is only one case described in the amyloidosis literature associated with LCH.

[Giant adrenal myelolipoma: hypertension, renal failure and spontaneous rupture]. / Mielolipoma suprarrenal gigante: hipertensión, insuficiencia renal y rotura espontánea.

Adrenal myelolipoma is a rare, benign, slow-growing tumor composed of adipose tissue and hematopoietic elements. It is usually diagnosed incidentally, although there are reports of patients with symptoms and descriptions of retroperitoneal hemorrhage due to rupture of large tumors. The condition has been associated with obesity, high blood pressure and adrenal dysfunction. We present a patient with retroperitoneal hemorrhage due to spontaneous rupture of a myelolipoma, hypertension, and renal failure secondary to nephroangiosclerosis.

In vivo dc and ac measurements at acupuncture points in healthy and unhealthy people.

OBJECTIVES: The aim of this work was to compare in vivo measurements of direct current (dc) and alternating current (ac) obtained from acupuncture points in Ukrainian and Mexican residents. METHODS: Measurements were made using the method of Voll. The participants were 43 healthy Ukrainian and 71 healthy Mexican residents aged between 20 and 30 years, as well as 24 Mexican patients with a clinical diagnosis of rheumatoid arthritis and 14 patients with a clinical diagnosis of allergy. RESULTS: The results showed that dc measurements are not directly applicable to different populations. Thus, the dc resistance of the acupuncture points in the Mexican participants was 4-5 times larger than in the Ukrainians. In contrast, the capacitance of the two groups did not differ by more than 25%. CONCLUSIONS: Impedance measurements from acupuncture points can be used as an efficient and prompt non-invasive method for diagnostic purposes.

[Embolization of non-functioning renal allograft: efficacy and control of systemic inflammation]. / Embolización del injerto renal no funcionante: eficacia y control del estado inflamatorio crónico.

BACKGROUND: The graft intolerance syndrome (fever, pain, haematuria) may lead to a chronic inflammatory disease, with cardiovascular repercussion. Nephrectomy is considered the classical treatment of these cases but nowadays renal vascular embolization has been suggested as a possible alternative treatment. The present study concerns seven cases trated with renal vascular embolization in our hospital summarizing data of graft intolerance syndrome and the chronic inflammatory disease. MATERIAL AND METHODS: Between january 2000 and december 2003 seven renal vascular embolization were performed in nonfunctioning renal allograft. The procedure was made with calibrated particles of 300-500micron. Data about complications related to the technique the same as analitic inflammatory parameters before and after treatment (CRP, ferritin, serum albumin, hemoglobin, erythropoietin) were registered. RESULTS: The patients were two men and five women, with median age of 39,7 +/- 8,8 years. The period beween the dialysis and the embolization was of 10,0 +/-8,2 months. Comparing the perion of admission in the hospital due to nephrectomy which was of 17,86+/-4,41 days, the period because of embolization was shorter, being 8,14 +/- 4,53 days. All analitic parameters studied, clearly improved after embolization with decrease of ferritin and CRP, increase of albumin and better hemoglobin level with lower erythropoietin dose. In five of the seven patients there was no renal captation with CT or gammagraphy. Four patients presented a postembolization syndrome, but no other important complication was registered. Neither reembolization nor renal nephrectomy was neccesary in any of the seven cases. CONCLUSION: Percutaneous renal embolization is a simple, easy, safety and effective technique that must be considered as an alternative treatment to nephrectomy, resolving the chronic inflammatory disease secondary to the graft intolerance syndrome.

[Nephropathia caused by hantavirus puumala: a case report]. / Nefropatía por hantavirus puumala: a propósito de un caso.

We present a patient from Germany with Hantavirus infection, admitted in the Emergency room of our hospital, with fever, thrombocytopenia, acute renal failure, oliguria, mild proteinuria and hematuria. Percutaneous renal biopsy revealed an acute interstitial nephritis without medulla haemorrhages. The virus infection confirmation was made by detection of IgM against Hantavirus Puumala. This infection should be considered in patients with thrombocytopenia, fever and acute renal failure, over all if they are from North and Central Europe.

Adiposity and dietary intake in cardiovascular risk in an obese population from a Mediterranean area.

The aim of the study was to determine the particular relevance of android fat distribution and dietary intake in cardiovascular risk in an obese Mediterranean population with high intake of monounsaturated fatty acids (MUFA) and to compare the findings with those from normal-weight subjects. For the study, 193 subjects aged 25-60 were selected: 118 obese (BMI > or = 27 kg/m2), and 75 normal-weight (BMI < 25 kg/m2). Cardiovascular risk factors including hypertension, dyslipidaemia, glucose intolerance and insulin resistance were assessed. Nutrient intake and body fat distribution were determined. Results show that MUFA were highly consumed in the total population (21% of total energy). The obese population was normolipidemic and normoinsulinemic. However, cardiovascular risk factors (CVRF) were significantly higher than in normal-weight (P < 0.05). Obese subjects derived a greater percentage of their energy intake from total fat and lower from carbohydrates and saturated fats (P < 0.05). BMI and waist-hip ratio positively correlated with fat percentage of total energy intake and with MUFA (g/100 g fatty acids) in men, indicating that the excess of fat intake in obesity is due to a larger consumption of olive oil. CVRF were significantly and positively associated to waist circumference and WHR, both in obese and in normal-weight subjects. In conclusion, not only obesity but also android fat in normal-weight subjects are important factors in cardiovascular disease even in the Mediterranean population, with a high intake of MUFA, where these factors seem to be more relevant to cardiovascular risk than dietary composition.

[Multivalent informatics application for studies of the nutritional status of the population. Assessment of food intake]. / Una aplicación informática multivalente para estudios del estado nutricional de grupos de población. Valoración de la ingesta alimentaria.

The aim of the study is the presentation and validation of a computer program, GRUNUMUR, designed for nutritional evaluation studies in great population groups, and to describe some of the results obtained after the application of this working tool. This program includes he following types of studies: a) dietary study; b) food habits study; c) anthropometric study and d) clinical study. The main advantage of GRUNUMUR is the possibility of being periodically actualized without any important software knowledge, and to be opened to the introduction of new data bases. The software program GRUNUMUR Is one more of the multiple programs described in the literature. However, once validated, this tool has the particularity of being developed after an important experience in the nutritional field and only with a scientific purpose. The result is a reliable tool, which facilitates nutrition research.

[Primary amyloidosis associated to severe factor X deficiency]. / Amiloidosis primaria (AL) asociada a déficit severo de factor X.

Amyloidosis is a systemic disease characterized by generalized deposition of beta-organized proteic fibrillar material with green birefringence under polarized light, in different tissues and organs, the most frequent kidney, liver and heart, with important clinical repercussion. Primary or AL amyloidosis is the most common subtype of amyloidosis (1), confirmed by biopsy-proved amyloid deposition in abdominal fat pad, rectum, kidney or liver, if necessary, in which fragments of monoclonal light chains are deposited. Cases with factor X (Stuart factor) of coagulation deficiency associated are described, due to adsorption of this factor to amyloid fibrills. Normally, evolution is fatal, with only few months of survival. We report a case of primary amyloidosis with nephrotic syndrome, severe factor X deficiency (without bleeding complications), possible heart affection and short-term good response to chemotherapic treatment.