Impact of simultaneous pancreas-kidney transplantation: patients' perspectives.

BACKGROUND: Few qualitative studies of simultaneous pancreas-kidney transplantation (SPK Tx) have been published. The aims of this study were to explore from the perspective of patients, the experience of living with diabetes mellitus type 1 (T1DM), suffering from complications, and undergoing SPK Tx with good outcome; and to determine the impact of SPK Tx on patients and their social and cultural environment. METHODS: We performed a focused ethnographic study. Twenty patients were interviewed. Data were analyzed using content analysis and constant comparison following the method proposed by Miles and Huberman. RESULTS: A functioning SPK Tx allowed renal replacement therapy and insulin to be discontinued. To describe their new situation, patients used words and phrases such as "miracle", "being reborn" or "coming back to life". Although the complications of T1DM, its surgery and treatment, and associated psychological problems did not disappear after SPK Tx, these were minimized when compared with the pretransplantation situation. CONCLUSION: For patients, SPK Tx represents a recovery of their health and autonomy despite remaining problems associated with the complications of T1DM and SPK Tx. The understanding of patients' existential framework and their experience of disease are key factors for planning new intervention and improvement strategies.

[The monitoring of dialysis dose by ionic dialysance-based Kt reveals less dialysis adequacy than the Kt/V(UREA)-based measurement in critically ill patients with acute renal failure]. / La medida de la dosis de diálisis mediante Kt por dialisancia iónica revela una menor adecuación que la medida por Kt/V(UREA) en la insificiencia renal aguda de pacientes críticos.

INTRODUCTION: Measurement of dialysis dose by methods based on urea kinetics (Kt/VUREA) are hardly applicable to critical ill patients with acute renal failure (ARF). However, it is the base of the ADQI consensus recommendation for the target minimum dose. OBJECTIVE: To evaluate the usefulness of the real-time measurement of delivered dialysis dose (Kt) by means of the ionic dialysance (KtID) in the critically ill patient and to compare adequacy of dialysis dose between KtID and traditional Kt/V(UREA). MATERIAL AND METHODS: Prospective observational study in 17 critically ill patients with ARF requiring acute hemodialysis with a predefined prescription for the study (51 measures). RESULTS: The mean delivered Kt/V(UREA) was 1.19 +/- 0.14, with 59% of the sessions with values equal or above the ADQI recommendation. On the contrary, the mean KtID values obtained was 37.6 +/- 1 l, with only 29.4% of the sessions being equal or greater than the recommended values. CONCLUSIONS: Dialysis dose monitoring by means of KtID reveals a lower degree of adequacy as compared to the traditional Kt/V(UREA) method. The dynamic character of KtID monitoring can allow the adaptation of each dialysis session ("K" and/or "t") in order to achieve the recommended dose.

[Hodgkin's disease complicated with autoimmune thrombocytopenic purpura and a nephrotic syndrome due to deposition of circulating immunocomplexes (author's transl)]. / Enfermedad de Hodgkin complicada con púrpura trombopénica autoimmune y síndrome nefrótico por depósito de immunocomplejos circulantes.

This report deals with a case of Hodgkin's disease presenting during its evolution with autoimmune thrombocytopenic purpura and a nephrotic syndrome with extramembranous glomerulonephritis. The histopathological study of renal tissue demonstrated the presence of IgG and the C3 fraction of complement in the extramembranous deposits. The same type of immunoglobulins and C3 existed in the serum as circulating immunocomplexes, suggesting that the glomerulonephritis was due to the deposition of such immunocomplexes in the glomerular membrane. A review of the literature discloses 32 cases of autoimmune thrombocytopenic purpura associated to Hodgkin's lymphoma, and 47 cases of Hodgkin's lymphoma associated to the nephrotic syndrome. However, the association of both complications in the same patient with lymphoma has been heretofore unreported. The possible etiopathogenic mechanisms of these autoimmune complications and its pathological features are discussed along with the response to treatment. Generally the activity of such disorders parallels that of the lymphoma, thus making them potentially useful parameters to appraise lymphomatous activity.