RESUMO
BACKGROUND: Antiplatelet therapy is common in patients on the waiting list for kidney transplantation. OBJECTIVE: To evaluate the incidence of post-operative bleeding in patients with antiplatelet therapy undergoing kidney transplantation and analyze the impact on the outcome. METHODS: We studied all patients with concomitant antiplatelet therapy undergoing kidney transplantation in our center from January 2007 to June 2012. Data were collected by chart review. Univariate and multivariate logistic regression and Cox proportional hazard model were used to identify risk factors for the long-term outcome. RESULTS: Of 744 kidney transplant recipients during the study period, 161 received oral antiplatelet therapy and were included in the study. One-third of the patients demonstrated signs of bleeding, half of which requiring surgical treatment. Coronary artery disease, deceased donor kidney transplantation, and dual antiplatelet medication were independent risk factors for post-operative bleeding. One-year allograft survival was significantly better in the non-bleeding group (91.4% vs 75.9%, p=0.023). Multivariable analysis found that post-operative bleeding, recipient age, and biopsy-proven rejection were independent risk factors for graft survival. Recipient age and biopsy-proven rejection were also identified as independent risk factors for patient survival. CONCLUSION: This analysis indicated a high risk for post-operative bleeding in renal transplant patients under antiplatelet therapy. The associated negative effect on allograft survival underscored the need to reduce any risk factors for post-operative bleeding.
RESUMO
Acute kidney injury (AKI) is a clinical syndrome occurring in the context of multiple and diverse disease entities. Although the term AKI implies renal damage as well as functional impairment or a combination of both, diagnosis is solely based on the functional parameters serum creatinine and urine output. Independent of the underlying disease and even assuming full recovery of renal function, AKI is associated with increased morbidity and mortality not only during the acute situation, but also long term. Awareness of the individual risk profile of each patient and the variety of causes and clinical manifestations of AKI is pivotal for prophylaxis, diagnosis, and therapy. The complexity of the clinical syndrome in the context of sepsis, solid organ transplantation, malignancy, and autoimmune diseases requires differentiated diagnostic and therapeutic approaches and interdisciplinary care.
Assuntos
Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/terapia , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/terapia , Testes de Função Renal/métodos , Transplante de Rim/métodos , Medicina Baseada em Evidências , Alemanha , Humanos , Síndrome , Resultado do TratamentoRESUMO
BACKGROUND: End-stage liver disease is associated with complex alterations in hemostasis. Whereas prognosis is essentially affected by life-threatening bleeding complications in some patients, others, especially those with cholestatic liver diseases, suffer from thromboembolic complications. Standard laboratory values (SLVS; prothrombin time, activated partial thrombin time, platelet count) cannot sufficiently reflect the altered balance of pro- and anticoagulatory factors. Moreover, a couple of studies indicated that SLVS are not able to predict bleeding complications in patients with acute liver failure or decompensated liver cirrhosis. DIAGNOSIS AND THERAPY: Use of bed-side coagulation diagnostics such as thrombelastometry/-graphy, detection of thrombocyte function by multiple electrode aggregometry and selective measurement of single factors allows a targeted and causal therapy of hepatic coagulopathies especially in the context of bleeding complications or surgical interventions. In recent years, coagulation management guided by these new devices has contributed to a reduction in transfusion of allogenic blood products, which may be associated with undesirable side effects. DISCUSSION: The current review summarizes the complex pathophysiological alterations of hemostasis associated with advanced liver insufficiency and discusses recent upcoming diagnostics and coagulation management in this patient cohort.
Assuntos
Cuidados Críticos/métodos , Hemorragia/etiologia , Hemorragia/terapia , Falência Hepática/complicações , Falência Hepática/terapia , Tromboembolia/etiologia , Tromboembolia/terapia , Testes de Coagulação Sanguínea , Hemorragia/diagnóstico , Hepatite C Crônica/complicações , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/terapia , Humanos , Falência Hepática/diagnóstico , Transplante de Fígado , Testes Imediatos , Prognóstico , Fatores de Risco , Tromboembolia/diagnósticoAssuntos
Injúria Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Angiografia Coronária , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/terapia , Codificação Clínica , Comportamento Cooperativo , Creatinina/sangue , Diagnóstico por Computador , Diagnóstico Precoce , Intervenção Médica Precoce , Alemanha , Fidelidade a Diretrizes , Humanos , Unidades de Terapia Intensiva , Comunicação Interdisciplinar , Falência Renal Crônica/diagnóstico , Prognóstico , SoftwareAssuntos
Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/terapia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/urina , Biomarcadores/urina , Creatinina/sangue , Diagnóstico Precoce , Medicina Baseada em Evidências , Taxa de Filtração Glomerular/fisiologia , Humanos , Proteínas de Ligação a Fator de Crescimento Semelhante a Insulina/urina , Valor Preditivo dos Testes , Terapia de Substituição Renal , Fatores de Risco , Inibidor Tecidual de Metaloproteinase-2/urina , Ácido Úrico/sangueAssuntos
Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/terapia , Proteínas de Fase Aguda , Interleucina-18 , Lipocalinas , Proteínas Proto-Oncogênicas , Injúria Renal Aguda/tratamento farmacológico , Injúria Renal Aguda/etiologia , Proteínas de Fase Aguda/urina , Anticorpos Monoclonais Humanizados/uso terapêutico , Anticoagulantes/uso terapêutico , Biomarcadores/sangue , Biomarcadores/urina , Ácido Cítrico/uso terapêutico , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/patologia , Síndrome Hemolítico-Urêmica/complicações , Síndrome Hemolítico-Urêmica/terapia , Humanos , Interleucina-18/sangue , Interleucina-18/urina , Lipocalina-2 , Lipocalinas/sangue , Lipocalinas/urina , Proteínas Proto-Oncogênicas/sangue , Proteínas Proto-Oncogênicas/urina , Diálise Renal , Escherichia coli Shiga ToxigênicaRESUMO
New guidelines of the "Kidney Disease: Improving Global Outcome" (KDIGO) working group standardize the definition of acute kidney injury (AKI) and acute kidney disease (AKD) allowing the assessment of prognosis and efficacy of prophylactic and therapeutic measures in different patient cohorts. The degree of severity and the duration of acute kidney injury are critical factors for the development of chronic kidney disease and mortality. The achievement of optimal fluid volumes is a cornerstone in the treatment during the early phase of AKI, while volume overload should be avoided in the late phase of established AKI. Recently employed biomarkers are promising for the early detection and prognosis of AKI, but cannot yet be used as routine tests. Microscopic urinalysis, a very old and cost-effective diagnostic measure, provides valuable informations about the severity and the course of AKI.