Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 9 de 9
Filtrar
1.
Nephrol Dial Transplant ; 31(1): 64-72, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26289418

RESUMEN

BACKGROUND: Light chain myeloma cast nephropathy (MCN) is the major cause of renal failure in multiple myeloma and strongly impacts patient survival. The role of kidney biopsy in the management of MCN is unclear. METHODS: Renal pathological findings were retrospectively studied in 70 patients with multiple myeloma and MCN. Patients were categorized according to the achievement or not of renal response, as defined by estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m(2) and/or dialysis independence at 3 months. RESULTS: Thirty-two patients (46%) achieved a renal response. In the whole study population, the following parameters differed significantly between patients with and without renal response, respectively: baseline median eGFR (13.3 versus 9.3 mL/min/1.73 m(2), P = 0.017), Acute Kidney Injury Network Stage 3 (68.8 versus 92.1%, P = 0.019), haematological response rate (94 versus 34%, P < 0.0001), median percentage of free light chain (FLC) reduction at Day 21 (92 versus 24%, P = 0.006) and median number of casts/10 fields (14 versus 25, P = 0.005). The extent of interstitial fibrosis and tubular atrophy was similar. In multivariate analysis, only FLC reduction at Day 21 was significantly associated with renal response. However, when considering only the subgroup of haematological responders, both median number of casts [odds ratio (OR) = 0.93, 95% confidence interval (95% CI): 0.88-0.98, P = 0.01] and extent of tubular atrophy (OR = 0.03, 95% CI: 0.00-0.52, P = 0.02) were independent predictors of renal response. CONCLUSIONS: In MCN, the presence of numerous casts and diffuse tubular atrophy is associated with poor renal prognosis. These data suggest that additional strategies to reduce FLC burden should be considered in patients with extensive cast formation.


Asunto(s)
Lesión Renal Aguda/diagnóstico , Mieloma Múltiple/patología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/terapia , Anciano , Biopsia/efectos adversos , Femenino , Tasa de Filtración Glomerular , Humanos , Estimación de Kaplan-Meier , Riñón/patología , Riñón/fisiopatología , Masculino , Persona de Mediana Edad , Mieloma Múltiple/complicaciones , Mieloma Múltiple/mortalidad , Mieloma Múltiple/terapia , Análisis Multivariante , Pronóstico , Diálisis Renal , Estudios Retrospectivos , Resultado del Tratamiento
3.
Clin Nephrol ; 78(4): 316-21, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22981033

RESUMEN

The association of Fanconi syndrome (FS) and chronic kidney disease (CKD) has been rarely described during the course of paroxysmal nocturnal hemoglobinuria (PNH). We report 2 patients with PNH and CKD associated with proximal tubule dysfunction, which manifested as full-blown FS in one case. In both patients, abnormal iron load within the kidneys was demonstrated by magnetic resonance imaging, which correlated with diffuse and numerous hemosiderin inclusions within proximal tubular cells. After 12 months, eculizumab treatment resulted in significant decrease in the kidney iron load in both cases. Glomerular filtration rate improved in one case and was stabilized in the other, in whom pretreatment kidney biopsy had shown severe extensive interstitial fibrosis. However, symptoms of proximal tubular dysfunction persisted in both patients. These data suggest that hemosiderin deposition in proximal tubules is probably an important mechanism involved in the development of FS, an under recognized and early manifestation of CKD in PNH. Prolonged treatment with eculizumab may improve long-term renal function in PNH patients with CKD.


Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Síndrome de Fanconi/etiología , Hemoglobinuria Paroxística/complicaciones , Enfermedades Renales/etiología , Anciano , Enfermedad Crónica , Femenino , Hemoglobinuria Paroxística/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad
5.
Nephrol Dial Transplant ; 24(9): 2866-71, 2009 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-19389864

RESUMEN

BACKGROUND: The proportion of diabetic patients undergoing haemodialysis is rapidly increasing. Glucose control among such patients is difficult to assess. We aimed to evaluate the clinical performance of a continuous glucose monitoring system (CGMS) in type 2 diabetic patients on chronic haemodialysis. METHODS: We used a 4-day CGMS to monitor glucose levels in 19 haemodialysed type 2 diabetic patients (HD T2) including 2 days with and 2 days without dialysis session, and 39 non-HD T2 in a double-centre study. RESULTS: The glucose concentration according to the glucose meter and CGMS were correlated in HD T2 patients (r = 0.90, P < 0.0001) and in non-HD T2 patients (r = 0.81, P < 0.0001). The relative absolute difference (RAD) between glucose determined by a glucose meter and glucose determined by the CGMS did not differ between HD T2 and non-HD T2 patients (9.2 +/- 10.5 vs. 8.2 +/- 7.6%; P = 0.165). Glycated haemoglobin (A1c) and mean glucose concentration were strongly correlated in non-HD T2 patients (r = 0.71; P < 0.0001) but weakly correlated in HD T2 patients (r = 0.47; P = 0.042). Fructosamine was correlated with the mean glucose concentration in non-HD T2 (r = 0.67; P < 0.0001) but not in HD T2 patients (r = 0.04; P = 0.88). CONCLUSION: CGM is a validated marker of glycaemic control in HD diabetic patients. This tool showed that A1c and fructosamine, despite being good markers of glycaemic control in non-HD diabetic patients, are of poor value in HD diabetic patients.


Asunto(s)
Automonitorización de la Glucosa Sanguínea , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/terapia , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/terapia , Diálisis Renal , Anciano , Glucemia/análisis , Automonitorización de la Glucosa Sanguínea/estadística & datos numéricos , Femenino , Fructosamina/sangre , Hemoglobina Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad
6.
NDT Plus ; 1(5): 379-80, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25983947
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA