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1.
Am J Transplant ; 17(1): 201-209, 2017 01.
Artículo en Inglés | MEDLINE | ID: mdl-27272414

RESUMEN

Acute renal rejection is a major risk factor for chronic allograft dysfunction and long-term graft loss. We performed a genome-wide association study to detect loci associated with biopsy-proven acute T cell-mediated rejection occurring in the first year after renal transplantation. In a discovery cohort of 4127 European renal allograft recipients transplanted in eight European centers, we used a DNA pooling approach to compare 275 cases and 503 controls. In an independent replication cohort of 2765 patients transplanted in two European countries, we identified 313 cases and 531 controls, in whom we genotyped individually the most significant single nucleotide polymorphisms (SNPs) from the discovery cohort. In the discovery cohort, we found five candidate loci tagged by a number of contiguous SNPs (more than five) that was never reached in iterative in silico permutations of our experimental data. In the replication cohort, two loci remained significantly associated with acute rejection in both univariate and multivariate analysis. One locus encompasses PTPRO, coding for a receptor-type tyrosine kinase essential for B cell receptor signaling. The other locus involves ciliary gene CCDC67, in line with the emerging concept of a shared building design between the immune synapse and the primary cilium.


Asunto(s)
Rechazo de Injerto/diagnóstico , Fallo Renal Crónico/cirugía , Trasplante de Riñón/efectos adversos , Proteínas Asociadas a Microtúbulos/genética , Polimorfismo de Nucleótido Simple , Proteínas Tirosina Fosfatasas Clase 3 Similares a Receptores/genética , Proteínas Supresoras de Tumor/genética , Enfermedad Aguda , Adulto , Estudios de Casos y Controles , Femenino , Marcadores Genéticos , Estudio de Asociación del Genoma Completo , Rechazo de Injerto/etiología , Rechazo de Injerto/genética , Humanos , Masculino , Persona de Mediana Edad , Pronóstico
2.
Am J Transplant ; 15(8): 2211-4, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25808194

RESUMEN

The KDIGO guidelines propose a new approach to diagnose chronic kidney disease (CKD) based on estimated glomerular filtration rate (GFR). In patients with a GFR value comprised between 45 and 59 mL/min/1.73 m(2) as estimated by the CKD-EPI creatinine equation (eGFRcreat ), it is suggested to confirm the diagnosis with a second estimation using the CKD-EPI cystatin C-based equations (eGFRcys /eGFRcreat-cys) . We sought to determine whether this new diagnostic strategy might extend to kidney transplant recipients (KTR) and help to identify those with decreased GFR. In 670 KTR for whom a measured GFR was available, we simulated the detection of CKD using the two-steps approach recommended by the guidelines in comparison to the conventional approach relying on creatinine equation. One hundred forty-five patients with no albuminuria had eGFRcreat between 45 and 59 mL/min/1.73 m(2) . Among them, 23% had inulin clearance over 60 mL/min/1.73 m(2) and were thus incorrectly classified as CKD patients. When applying the Kidney Disease: Improving Global Outcomes (KDIGO) strategy, 138 patients were confirmed as having a GFR below 60 mL/min with eGFRcreat-cys . However, 21% of them were misclassified in reference to measured GFR. Our data do no not support the use of cystatin C as a confirmatory test of stage 3 A CKD in KTR.


Asunto(s)
Cistatina C/sangre , Trasplante de Riñón , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
3.
Am J Transplant ; 15(11): 2991-4, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26095663

RESUMEN

Kidney transplantation originating from the hepatic artery has not previously been reported. Herein, we report a third kidney transplantation with the common hepatic artery as inflow. A 62-year-old male with chronic renal failure due to polycystic kidney disease was proposed to a third kidney transplantation. CT-scan showed diffuse calcification of the aorto-iliac axis and the splenic artery. The common hepatic artery was the only artery suitable for anastomosis and as such was chosen as the inflow for retransplantation. The operation was performed through a right subcostal laparotomy. A saphenous bypass was interposed between the common hepatic artery and the graft, then the renal vein was anastomosed to the suprarenal inferior vena cava. Duration of warm ischemia was 27 min. Postoperative course was complicated with delayed graft function of 17 days and pulmonary infection. Patient was discharged at day 30. With a follow-up of 40 months, serum creatinine level and eGFR are, respectively, 191 µmol/L and 32 mL/min. Hepato-renal bypass technique can be used in kidney retransplantation when patient anatomy is not compatible with other classical options.


Asunto(s)
Arteria Hepática/cirugía , Fallo Renal Crónico/cirugía , Trasplante de Riñón/métodos , Enfermedades Renales Poliquísticas/complicaciones , Vena Safena/cirugía , Anastomosis Quirúrgica/métodos , Estudios de Seguimiento , Tasa de Filtración Glomerular , Supervivencia de Injerto , Humanos , Riñón/irrigación sanguínea , Fallo Renal Crónico/etiología , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Enfermedades Renales Poliquísticas/diagnóstico , Enfermedades Renales Poliquísticas/cirugía , Circulación Renal/fisiología , Reoperación/estadística & datos numéricos , Medición de Riesgo , Factores de Tiempo , Resultado del Tratamiento
4.
Am J Transplant ; 13(3): 695-706, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23311466

RESUMEN

The slope of GFR associates with an increased risk for death in patients with native CKD but whether a similar association exists in kidney transplantation is not known. We studied an inception cohort of 488 kidney transplant recipients (mean follow-up of 12 ± 4 years) for whom GFR was longitudinally measured by inulin clearance (mGFR) at 1 year and then every 5 years. Association of mGFR at 1 year posttransplant and GFR slope after the first year with all-cause mortality was studied with a Cox regression model and a Fine and Gray competing risk model. While in Crude analysis, the mGFR value at 1 year posttransplant and the rate of mGFR decline were both associated with a higher risk of all-cause mortality, only the slope of mGFR remained a significant and strong predictor of death in multivariate analysis. Factors independently associated with a more rapid mGFR decline were feminine gender, higher HLA mismatch, retransplantation, longer duration of transplantation, CMV infection during the first year and higher rate of proteinuria. Our data suggest that the rate of renal graft function decline after 1 year is a strong predictor of all-cause mortality in kidney transplantation.


Asunto(s)
Rechazo de Injerto/mortalidad , Supervivencia de Injerto/fisiología , Enfermedades Renales/patología , Trasplante de Riñón/mortalidad , Adulto , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Humanos , Enfermedades Renales/mortalidad , Enfermedades Renales/cirugía , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Tasa de Supervivencia , Factores de Tiempo
5.
Transplant Proc ; 41(2): 672-3, 2009 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-19328953

RESUMEN

Occurrence of cancer after renal transplantation remains a major problem, and the second cause of death. We performed a retrospective analysis of first cancer, first skin cancer, and first organ cancer (including posttransplant lymphoproliferative disease [PTLD]) among 1265 cases from 1979 to 2006. The occurrence of cancer was clearly a time-dependent event justifiying the use of Kaplan-Meier survival and Cox regression methods. The 10-year cumulative incidences of first cancer, first skin cancer, and first organ cancer were 24.6%, 14.5%, and 14.5%, respectively. Recipient age was a major, independent risk factor for the 3 endpoints with a 6% increased relative risk for each year increment (P < .0001). Female gender was also a major, independent risk factor, but only for skin cancer (P = .0002). We could not demonstrate any difference between the immunosuppressive drugs used for induction or maintenance therapy, especially between antithymocyte globulin (ATG) vs anti-CD25, cyclosporine vs tacrolimus, and azathioprine vs mycophenolate mofetil. Large cohorts are needed with strict stratifications for recipient age and gender to detect any difference, if any, among the drugs.


Asunto(s)
Trasplante de Riñón/efectos adversos , Neoplasias/epidemiología , Cadáver , Estudios de Cohortes , Femenino , Humanos , Inmunosupresores/uso terapéutico , Incidencia , Trasplante de Riñón/inmunología , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Prednisolona/uso terapéutico , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Cutáneas/epidemiología , Donantes de Tejidos
6.
Transplantation ; 50(6): 969-73, 1990 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-2256169

RESUMEN

We investigated natural-killer cells in 81 renal transplant recipients (RTR) in order to define what kind of in vivo prophylactic immunosuppression could be responsible of the impairment of these NK cells. Cell-surface phenotyping was performed by direct immunofluorescence with Leu7 (CD57), Leu11 (CD16), and Leu19 (CD56) antibodies, in one- and two-color stainings. Functional properties were analyzed with freshly isolated nonadherent mononuclear cells (NK activity) and after in vitro activation with r-IL-2 (LAK activity), in cytotoxicity assays using K562 and Daudi tumor lines as specific targets. A flow cytometry technique using carboxy-Fluorodiacetate was applied to monitor the cytotoxicity of NK cells. Our data emphasize the already known deficiency of NK cells: both NK subsets (CD16+ and/or CD56+) and NK activity were decreased in RTR. Moreover, we demonstrated that the in vitro IL-2-induced LAK cytotoxicity was also diminished in RTR. NK cells and functions were normal in RTR treated with cyclosporine only, decreased in RTR treated with both cyclosporine and azathioprine, and at the lowest level in RTR treated with azathioprine without cyclosporine. A multivariate statistical analysis found a negative linear regression between the doses of azathioprine and the number of functions of NK cells, confirming that azathioprine was responsible for the deficiency of NK cells in our RTR.


Asunto(s)
Inmunosupresores/administración & dosificación , Trasplante de Riñón , Células Asesinas Activadas por Linfocinas/inmunología , Células Asesinas Naturales/inmunología , Corticoesteroides/administración & dosificación , Adulto , Antígenos CD/análisis , Azatioprina/administración & dosificación , Ciclosporinas/administración & dosificación , Citotoxicidad Inmunológica , Humanos , Persona de Mediana Edad
7.
Transplantation ; 72(6): 1050-5, 2001 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-11579299

RESUMEN

BACKGROUND: The aim of this study was to compare the efficacy and safety of induction treatment with antithymocyte globulins (ATG) followed by tacrolimus therapy with immediate tacrolimus therapy in renal transplant recipients. METHODS: This 12-month, open, prospective study was conducted in 15 centers in France and 1 center in Belgium; 309 patients were randomized to receive either induction therapy with ATG (n=151) followed by initiation of tacrolimus on day 9 or immediate tacrolimus-based triple therapy (n=158). In both study arms, the initial daily tacrolimus dose was 0.2 mg/kg. Steroid boluses were given in the first 2 days and tapered thereafter from 20 mg/day to 5 mg/day. Azathioprine was administered at 1-2 mg/kg per day. RESULTS: At month 12, biopsy-confirmed acute rejections were reported for 15.2% (induction) and 30.4% (noninduction) of patients (P=0.001). The incidence of steroid-sensitive acute rejections was 7.9% (induction) and 22.2% (noninduction)(P=0.001). Steroid-resistant acute rejections were reported for 8.6% (induction) and 8.9% (noninduction) of patients. A total of nine patients died. Patient survival and graft survival at month 12 was similar in both treatment groups (97.4% vs. 96.8% and 92.1% vs. 91.1%, respectively). Statistically significant differences in the incidence of adverse events were found for cytomegalovirus (CMV) infection (induction, 32.5% vs. noninduction, 19.0%, P=0.009), leukopenia (37.3% vs. 9.5%, P<0.001), fever (25.2% vs. 10.1%, P=0.001), herpes simplex (17.9% vs. 5.7%, P=0.001), and thrombocytopenia (11.3% vs. 3.2%, P=0.007). In the induction group, serum sickness was observed in 10.6% of patients. The incidence of new onset diabetes mellitus was 3.4% (induction) and 4.5% (noninduction). CONCLUSION: Low incidences of acute rejection were found in both treatment arms. Induction treatment with ATG has the advantage of a lower incidence of acute rejection, but it significantly increases adverse events, particularly CMV infection.


Asunto(s)
Suero Antilinfocítico/uso terapéutico , Inmunosupresores/uso terapéutico , Trasplante de Riñón , Tacrolimus/uso terapéutico , Adulto , Resistencia a Medicamentos , Femenino , Rechazo de Injerto/tratamiento farmacológico , Rechazo de Injerto/epidemiología , Rechazo de Injerto/prevención & control , Supervivencia de Injerto , Humanos , Inmunosupresores/efectos adversos , Incidencia , Riñón/fisiopatología , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Esteroides/uso terapéutico , Tacrolimus/efectos adversos
8.
Am J Kidney Dis ; 37(4): 720-7, 2001 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-11273871

RESUMEN

Experimental evidence suggests a role for obesity in the formation and progression of some glomerular lesions, but data for human glomerulonephritis are lacking. In a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA) nephropathy, we assessed whether the presence of an elevated body mass index (BMI >/= 25 kg/m(2)) at the time of the first renal biopsy (RB1) correlated with clinical data at RB1 (24-hour proteinuria, arterial hypertension, and renal function), pathological data (global optical score [GOS] with detailed pathological indices), and clinical progression to both arterial hypertension and chronic renal failure (CRF). In both univariate and multivariate analyses, the presence of an elevated BMI at RB1 was significantly associated with the severity of pathological renal lesions (GOS and vascular, tubular, and interstitial indices). Hypertension-free survival was significantly less in overweight patients (P: < 0.0001) compared with those with normal weight. In a Cox regression analysis for hypertension-free survival including 24-hour proteinuria greater than 1 g, GOS, and metabolic parameters, only elevated BMI and GOS were independent factors for the development of arterial hypertension. CRF-free survival was also significantly less in patients with an excessive BMI. In a multivariate Cox regression analysis for CRF-free survival, hypertension, GOS, and BMI at RB1 were independent risk factors for CRF. In IgA nephropathy, excessive body weight and/or BMI are underestimated predictive factors for the development of arterial hypertension and, ultimately, CRF.


Asunto(s)
Peso Corporal , Glomerulonefritis por IGA/diagnóstico , Obesidad/diagnóstico , Adulto , Edad de Inicio , Índice de Masa Corporal , Comorbilidad , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Glomerulonefritis por IGA/epidemiología , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/epidemiología , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Proteinuria/diagnóstico , Proteinuria/epidemiología , Factores de Riesgo
9.
Chest ; 102(5): 1436-40, 1992 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-1330447

RESUMEN

In unresectable non-small cell lung cancer (NSCLC) with a patent mainstem bronchus, some studies of obstructive tumors, showed (1) a poor role for irradiation in obtaining efficient debulking and (2) an interest in preliminary laser treatment in these patients. Cryotherapy is another method to obtain debulking. Moreover, several studies showed that cryotherapy would increase the radiosensitivity of a tumor. We performed a preliminary protocol combining successively initial cryotherapy followed by irradiation in inoperable NSCLC (either for local or functional contraindications). Thirty-eight patients were included and treated first by cryotherapy performed under general anesthesia and then with external irradiation in a curative intent. The efficiency of cryotherapy assessed on bronchoscopy was found to be volume-efficient (VE) in 26 of the 38 patients and non-volume-efficient (NVE) in the other 12 patients. After irradiation in the VE group, 17 of the 26 patients had no bronchial residual tumor (NRT). In contrast, all of the patients in the NVE group had a bronchial residual tumor (RT). Survival in the VE group (median, 397 days) was significantly higher than the survival of the NVE group (median, 144 days). Survival was found to be independent of the surgical contraindication (local or functional). The best survival was associated both with the efficiency of the initial debulking (VE) by cryotherapy and with the local control (NRT) induced by the irradiation (median, 560 days). Local control was obtained in 65 percent (17/26) of the cases in the VE group and was never observed in the NVE group. In our study the VE group's local control is better than the 35 percent usually reported after irradiation alone. These results argue for the efficient potentiation of irradiation by cryotherapy.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Criocirugía , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/cirugía , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Terapia Combinada , Criocirugía/efectos adversos , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Tasa de Supervivencia
10.
Clin Nephrol ; 34(2): 45-51, 1990 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-2225552

RESUMEN

In order to improve our possibility of establishing a long-term prognosis in IgA nephritis, 73 patients out of a cohort of 282, followed over a mean period of 12 years at the same institution for an IgA nephritis, had a prospective second renal biopsy 5 years later. For all biopsies (RB1 and RB2), we developed a quantitative scoring for all elementary lesions with a glomerular, an interstitial, a tubular and a vascular index. The sum of these 4 indexes gave a global optical score (GOS). Pathological improvement on light microscopy (delta GOS less than or equal to -2) was noticed only in 3 patients (4%), stability (-2 less than delta GOS less than +2) in 30 patients (41%), mild deterioration (+2 less than or equal to GOS less than 5) in 23 patients (32%) and major progression (delta GOS greater than or equal to 5) in 17 patients (23%). We observed no pathological remission, even in the 14 patients with complete clinical remission. The pathological progression was characterized by an increase in all elementary lesions, mainly the tubulo-interstitial and vascular ones. By immunofluorescence mesangial IgA deposits remained stable with no disappearance; however, the number and intensity of vascular C3 deposits were significantly greater on RB2. Chronic renal failure (serum creatinine greater than 1.5 mg/dl) correlated best with major pathological progression and mainly with the progression of extraglomerular lesions. IgA nephritis is a slowly progressive disease with no pathological remission, and its evolution is characterized by progression of extraglomerular lesions, mainly vascular, which might play a major role in the ultimate development of chronic renal failure.


Asunto(s)
Glomerulonefritis por IGA/patología , Adolescente , Adulto , Biopsia , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Mesangio Glomerular/patología , Glomerulonefritis por IGA/mortalidad , Humanos , Masculino , Microscopía Fluorescente , Persona de Mediana Edad , Pronóstico , Análisis de Regresión
11.
Ann Biol Clin (Paris) ; 48(9): 631-6, 1990.
Artículo en Francés | MEDLINE | ID: mdl-2099114

RESUMEN

In order to define the best appraisal of Natural Killer cells, the authors performed a dual study, including both phenotypes and functional activities, and all the analyses were achieved with flow cytometric techniques. Results were applied to renal transplantation. Among the numerous clusters of differenciation, only CD16 and CD56 appeared to be well correlated with the functional properties of Natural Killer cells, and especially for CD3- cells. On the other hand, CD57 should no longer be considered as a NK marker. Functional properties of Natural Killer cells were evaluated by cytotoxicity assays of peripheral lymphocytes against K562 and Daudi tumor cells, either spontaneously, or after a 3-day activation with Interleukin 2 (LAK). The authors use carboxyfluoro-diacetate to label viable cells and avoid radioisotopes. They confirm the Natural Killer cells deficiency in renal transplant recipients, and show that this impairment also involves the LAK cytotoxicity. Azathioprine appeared to be responsible of such deficiency. During viral infections, Natural Killer cells raised and reached the normal values, while they were incapable of any response to fight against cancer. They suggest that the Natural Killer deficiency could explain the high incidence of malignancies during renal transplantation.


Asunto(s)
Trasplante de Riñón/inmunología , Células Asesinas Naturales/inmunología , Adulto , Azatioprina/farmacología , Citometría de Flujo , Humanos , Interleucina-2/inmunología , Fallo Renal Crónico/inmunología , Células Asesinas Naturales/efectos de los fármacos , Persona de Mediana Edad , Fenotipo
12.
Presse Med ; 21(41): 1957-60, 1992 Dec 02.
Artículo en Francés | MEDLINE | ID: mdl-1294950

RESUMEN

We conducted a dual study of phenotype and function of natural killer cells (NK) using flow cytometry, this study being applied to renal transplantation. The CD 16 and CD 56 clusters correlated well with NK cytotoxicity, especially for CD 3 lymphocytes, whereas CD 57 should no longer be considered a NK marker. NK activity was determined on K 562 or Daudi cells, either spontaneously or after in vitro activation with r-interleukin 2 (LAK). Cytotoxicity was analyzed after labeling of target cells by carboxyfluoro-diacetate and measured by flow cytometry. We found that in renal transplant recipients NK cells were deficient in numbers and functions and showed that LAK activity was also diminished. Azathioprine appeared to be the main immunosuppressant impairing NK cells. Viral infections increased the numbers and functions of NK cells, whereas during malignancies they remain as low as in uncomplicated recipients. NK cells deficiency might be involved in the high incidence of de novo malignancies in renal transplant recipients.


Asunto(s)
Trasplante de Riñón/métodos , Células Asesinas Naturales/fisiología , Corticoesteroides/farmacología , Corticoesteroides/uso terapéutico , Azatioprina/farmacología , Azatioprina/uso terapéutico , Ciclosporina/farmacología , Ciclosporina/uso terapéutico , Humanos , Técnicas In Vitro , Fallo Renal Crónico/fisiopatología , Células Asesinas Activadas por Linfocinas/efectos de los fármacos , Células Asesinas Activadas por Linfocinas/fisiología , Células Asesinas Naturales/efectos de los fármacos , Fenotipo
13.
Presse Med ; 20(19): 891-5, 1991 May 18.
Artículo en Francés | MEDLINE | ID: mdl-1829186

RESUMEN

Oncological complications were studied in 420 renal transplantations performed in 389 patients. Seven patients with a history of neoplasia were transplanted, and 2 tumours were transmitted by the graft. However, the main problem was that of de novo tumours induced by immunosuppression: 26 patients developed such tumours which resulted in death for 7 of them. The risk of tumour seems to be relatively selective. Seven lymphoproliferative syndromes, 6 Kaposi's sarcomas and 4 spinocellular epitheliomas were observed and together accounted for 65.3 percent of de novo tumours. Excessive immunosuppression could be blamed in only one third of the patients. On the other hand, some geographical and/or ethnic factors seemed to facilitate tumour development, and infections with viruses of the herpes group were found in 76 percent of these subjects.


Asunto(s)
Inmunosupresores/efectos adversos , Trasplante de Riñón/efectos adversos , Paraproteinemias/etiología , Sarcoma de Kaposi/etiología , Neoplasias Cutáneas/etiología , Adulto , Carcinoma/etiología , Femenino , Estudios de Seguimiento , Humanos , Tolerancia Inmunológica , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Neoplasias/cirugía , Paraproteinemias/cirugía , Virosis/etiología
14.
Presse Med ; 20(1): 21-4, 1991.
Artículo en Francés | MEDLINE | ID: mdl-1829814

RESUMEN

In a series of 296 patients treated in our centre by dialysis and/or renal transplantation over the last 15 years, the actuarial survival rates at 5, 10 and 15 years were 79, 68 and 57 percent respectively. Comparing the influence on survival of each of these two treatments separately should avoid two methodological biases represented by the sequential risk due to the succession of treatments and by different pretherapeutic situations. We therefore analysed these patients' survivals by the unbiased Mantel-Byar method, using a comparison of multiple survival factors (Cox's technique). We showed that treatment was an independent factor of survival and that transplantation had a more beneficial effect than dialysis. However, these replacement techniques seem to have less influence on survival than the pretherapeutic situations.


Asunto(s)
Fallo Renal Crónico/mortalidad , Trasplante de Riñón/métodos , Diálisis Renal/métodos , Análisis Actuarial , Adulto , Factores de Edad , Anciano , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad
15.
Rev Prat ; 41(24): 2419-23, 1991 Nov 15.
Artículo en Francés | MEDLINE | ID: mdl-1803452

RESUMEN

Primary IgA nephritis is the most frequent nephritis and represent half of the glomerular diseases. Its incidence is 2,7/10(5) inhabitants. The diagnosis is established on a renal biopsy, which shows typical IgA mesangial deposits: granular, predominant, and diffuse. A central pathogenic role is played by the IgA immune system, both from the mucosa and the bone marrow. The long term prognosis should no longer be considered as mild because, after 20 years of evolution, 1/3 of the patients are going into chronic renal failure, and 1/6 into end-stage renal disease. It is essential to delineate the risk factors predicting ultimate evolution towards chronic failure, to select patients who may benefit from aggressive treatment, such as high doses steroids. For all patients, it is essential to have a regular clinical and biological check up, and an adequate control of arterial hypertension, in order to avoid or delay progression.


Asunto(s)
Glomerulonefritis por IGA , Glomerulonefritis por IGA/diagnóstico , Glomerulonefritis por IGA/etiología , Glomerulonefritis por IGA/inmunología , Glomerulonefritis por IGA/terapia , Humanos , Vasculitis por IgA/complicaciones , Cirrosis Hepática Alcohólica/complicaciones
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