RESUMEN
Existing approaches for infection risk stratification in kidney transplant recipients are suboptimal. Here, we aimed to develop and validate a weighted score integrating non-pathogen-specific immune parameters and clinical variables to predict the occurrence of post-transplant infectious complications. To this end, we retrospectively analyzed a single-center derivation cohort of 410 patients undergoing kidney transplantation in 2008-2013 in Madrid. Peripheral blood lymphocyte subpopulations, serum immunoglobulin and complement levels were measured at one-month post-transplant. The primary and secondary outcomes were overall and bacterial infection through month six. A point score was derived from a logistic regression model and prospectively applied on a validation cohort of 522 patients undergoing kidney transplantation at 16 centers throughout Spain in 2014-2015. The SIMPLICITY score consisted of the following variables measured at month one after transplantation: C3 level, CD4+ T-cell count, CD8+ T-cell count, IgG level, glomerular filtration rate, recipient age, and infection within the first month. The discrimination capacity in the derivation and validation cohorts was good for overall (areas under the receiver operating curve of 0.774 and 0.730) and bacterial infection (0.767 and 0.734, respectively). The cumulative incidence of overall infection significantly increased across risk categories in the derivation (low-risk 13.7%; intermediate-risk, 35.9%; high-risk 77.6%) and validation datasets (10.2%, 28.9% and 50.4%, respectively). Thus, the SIMPLICITY score, based on easily available immune parameters, allows for stratification of kidney transplant recipients at month one according to their expected risk of subsequent infection.
Asunto(s)
Trasplante de Riñón , Humanos , Trasplante de Riñón/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , España/epidemiología , Receptores de TrasplantesAsunto(s)
Delftia acidovorans , Trasplante de Riñón , Pielonefritis , Humanos , Pielonefritis/etiología , Pielonefritis/microbiología , Enfermedad Aguda , Infecciones por Bacterias Gramnegativas/etiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/microbiología , Femenino , Persona de Mediana Edad , MasculinoRESUMEN
INTRODUCTION: Information is available regarding the prevalence and incidence of positive microbiological serology results both in the general population and in patients on haemodialysis in Spain. Nevertheless, little information is known regarding patients with diabetes attended in external nephrology consultations. OBJECTIVE: To evaluate the percentage of patients with positive serology results for hepatitis B and C, Human Immunodeficiency Virus (HIV), and syphilis in the initial assessment of patients referred to diabetic nephropathy external consultations. PATIENTS AND METHOD: Retrospective study of 500 patients assessed over the course of 5 years with the diagnosis of diabetic nephropathy originating in external consultations and for which hepatitis B, C, HIV, and syphilis serology had been requested. RESULTS: With regard to hepatitis B virus, 0.4% of patients had chronic hepatitis B, 10.2% had overcome the hepatitis and were in recovery, and 4.2% had received the hepatitis B vaccine. As for hepatitis C, 2.4% of the patients studied had antibodies against hepatitis C. With regard to syphilis, 0.8% of patients had positive serological results. No patients had positive HIV serology results. CONCLUSIONS: Despite major methodological limitations, this would be the first study to evaluate the microbiological serology of diabetic nephropathy patients treated in external consultations.
Asunto(s)
Anticuerpos Antibacterianos/sangre , Anticuerpos Antivirales/sangre , Nefropatías Diabéticas/sangre , VIH/inmunología , Hepacivirus/inmunología , Virus de la Hepatitis B/inmunología , Treponema pallidum/inmunología , Serodiagnóstico del SIDA , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nefrología , Derivación y Consulta , Estudios Retrospectivos , Sífilis , Serodiagnóstico de la Sífilis , Adulto JovenRESUMEN
Although clinical presentation of fibrillary glomerulonephritis is similar to most forms of glomerulonephritis, it is usually difficult to make the diagnosis. Clinical manifestations include proteinuria, microscopic haematuria, nephrotic syndrome, and impairment of renal function. A diagnosis of fibrillary glomerulonephritis is only confirmed by renal biopsy and it must comprise electronmicroscopy-verified ultrastructural findings. We report four cases between 45-50 years old with documented type 2 diabetes mellitus (T2DM) and arterial hypertension. All patients were found to have fibrils on kidney biopsy. The differential diagnosis of fibrils in the setting of diabetes mellitus is also discussed.
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No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Nódulo Pulmonar Solitario/diagnóstico por imagen , Nódulo Pulmonar Solitario/microbiología , Trasplante de Riñón/efectos adversos , Criptococosis/diagnóstico por imagen , Criptococosis/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Persona de Mediana Edad , Anciano , Fotoféresis/métodos , Rechazo de Injerto/terapia , Trasplante de Riñón/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Creatinina/sangre , Resultado del Tratamiento , Reproducibilidad de los ResultadosAsunto(s)
Alopurinol/farmacología , Nefropatías Diabéticas/tratamiento farmacológico , Cese del Hábito de Fumar , Fumar/epidemiología , Acetilcolina/química , Alopurinol/química , Alopurinol/uso terapéutico , Benzazepinas/química , Química Encefálica/efectos de los fármacos , Bupropión/química , Causalidad , Comorbilidad , Nefropatías Diabéticas/epidemiología , Nefropatías Diabéticas/psicología , Humanos , Hipoxantina/metabolismo , Estructura Molecular , Nicotina/química , Agonistas Nicotínicos/química , Quinoxalinas/química , Cese del Hábito de Fumar/psicología , Relación Estructura-Actividad , Vareniclina , Xantina Oxidasa/antagonistas & inhibidoresRESUMEN
Antecedentes: En España hay datos sobre prevalencia e incidencia de serologías microbiológicas positivas tanto en la población general como en pacientes en hemodiálisis. Sin embargo, se conocen pocos datos sobre los pacientes con diabetes atendidos en consulta externa de Nefrología. Objetivo: Valorar el porcentaje de pacientes con serologías positivas para hepatitis B y C, virus de inmunodeficiencia humana (VIH) y sífilis en la valoración inicial de los pacientes remitidos para estudio a la consulta externa de nefropatía diabética. Pacientes y métodos: Estudio retrospectivo de las serologías solicitadas con el diagnóstico de nefropatía diabética con origen en consultas externas de 500 pacientes valorados durante 5 años a los que se les había solicitado serologías de la hepatitis B, C, VIH y sífilis. Resultados: Respecto al virus de la hepatitis B, el 0,4 % de los pacientes tenían hepatitis B crónica, el 10,2 % había pasado la hepatitis y estaban curados y el 4,2 % había recibido la vacuna de la hepatitis B. En cuanto a la hepatitis C, el 2,4 % de los pacientes estudiados tenían anticuerpos frente hepatitis C. Respecto a la sífilis, el 0,8 % de los pacientes tenían serologías positivas. Ningún paciente presentó serologías positivas para VIH. Conclusiones: Si bien con grandes limitaciones metodológicas, este sería el primer estudio donde se revisan las serologías microbiológicas de pacientes con nefropatía diabética atendidos en consulta externa (AU)
Introduction: Information is available regarding the prevalence and incidence of positive microbiological serology results both in the general population and in patients on haemodialysis in Spain. Nevertheless, little information is known regarding patients with diabetes attended in external nephrology consultations. Objective: To evaluate the percentage of patients with positive serology results for hepatitis B and C, Human Immunodeficiency Virus (HIV), and syphilis in the initial assessment of patients referred to diabetic nephropathy external consultations. Patients and method: Retrospective study of 500 patients assessed over the course of 5 years with the diagnosis of diabetic nephropathy originating in external consultations and for which hepatitis B, C, HIV, and syphilis serology had been requested. Results: With regard to hepatitis B virus, 0.4% of patients had chronic hepatitis B, 10.2% had overcome the hepatitis and were in recovery, and 4.2% had received the hepatitis B vaccine. As for hepatitis C, 2.4% of the patients studied had antibodies against hepatitis C. With regard to syphilis, 0.8% of patients had positive serological results. No patients had positive HIV serology results. Conclusions: Despite major methodological limitations, this would be the first study to evaluate the microbiological serology of diabetic nephropathy patients treated in external consultations (AU)
Asunto(s)
Humanos , Nefropatías Diabéticas/microbiología , Pruebas Serológicas/métodos , Complicaciones de la Diabetes/microbiología , Serodiagnóstico del SIDA/métodos , Hepatitis B Crónica/sangre , Hepatitis C Crónica/sangre , Serodiagnóstico de la Sífilis/métodosAsunto(s)
Hipernatremia/etiología , Insuficiencia Renal/complicaciones , Anciano , Femenino , Humanos , SedRESUMEN
No disponible