Glomerulopatí del trasplante. Resultados clínicos y seguimiento de casos.

OBJECTIVE: We describe the evolution of graft function in patients with transplant glomerulopathy measure by levels of serum creatinine, proteinuria and estimated glomerular filtration rate. METHOD: Cross-sectional study conducted in the Regional General Hospital No. 46 IMSS. Included patients with kidney allograft and diagnosis of renal biopsy of transplant glomerulopathy grafting between January 1, 2006 to April 31, 2013 serum creatinine, proteinuria and estimated glomerular filtration rate at diagnosis, 6, 12 and 24 was recorded months. The results are shown with numbers, percentages and standard deviations. RESULTS: 42 patients were included. At 6 months of diagnosis, 14% decline in graft function and 7.1% graft loss. At 12 months, 17.9% graft loss, and at 24 months 36.3% had chronic graft dysfunction and graft loss as return to dialysis. CONCLUSIONS: Evolution in our patients seems to be better to other series of cases reported in the literature.

[Epidemiology of glomerular disease in adults: a database review]. / Epidemiología de la enfermedad glomerular en adultos. Revisión de una base de datos.

INTRODUCTION: Glomerular disease is among the top ten leading causes of death in Mexico. AIM: To assess the frequency of glomerulopathy in western Mexico in a Regional Hospital belonging of the Instituto Mexicano Del Seguro Social. METHODS: Single hospital center retrospective analysis. We reviewed all native kidney biopsies between January 2003 and December 2011, in patients more than 16 years old, to establish clinical features, presentation, and histological report. RESULTS: A total of 163 reports were analyzed; patients with a mean age of 32.6 ± 13.3 years, 55% female, 24% had systemic arterial hypertension, and 10% with a family history of chronic renal failure. The most frequent types of primary glomerulonephritis were focal segmental glomerulosclerosis (FSGS) in 47% of cases, followed by membranous nephropathy in 15%. The most frequent types of secondary glomerulonephritis were lupus nephritis in 14%, followed by diabetic nephropathy in 4% and amyloidosis in 1.2%. CONCLUSION: Focal segmental glomerulosclerosis is the most frequent type of glomerulopathy in our population; we observed a minor percentage of Inmunoglobulin A (IgA) nephropathy compared with worldwide reports. This information is a contribution to the understanding of the prevalence of glomerulopathy in western Mexico.

[Frequency of peritoneal transport in a population of the Hospital General Regional No. 46, Instituto Mexicano del Seguro Social]. / Frecuencia de los tipos de transporte peritoneal en la población del Hospital General Regional N.º 46 del Instituto Mexicano del Seguro Social.

BACKGROUND: The peritoneal equilibration test (PET) is a common test used in the adequacy of peritoneal dialysis (PD). AIM: To determine the frequency of presentation of different types of peritoneal transport in patients on PD ranking with Twardowski, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) and Hospital de Especialidades del Instituto Mexicano del Seguro Social Centro Médico Nacional de Occidente (IMSS-HE, CMNO) and establish themselves. METHODS: Descriptive and transversal study. Included with PET on PD patients between April 2011 to September 2012; any gender, 16 years or older, in DP minimum of 4 weeks. PEP performed standardized bags of 2.5%. RESULTS: Performed 235 PET. We can classify peritoneal transport with Twardowski in high (H) 34%, high average (HA) 37%, low average (LA) 25%, and low (L) 4% peritoneal transport rates. INCMNSZ percentages H was 34%, HA 32%, LA 23%, and L 11%; using the CMNO HE was H 26%, HA 31%, LA 31%, and L 12%. From our data, the percentage of patients with H was 22%, HA 33%, LA 32%, and L13%. CONCLUSION: Classifying patients according to type of transport with Twardowski will under-diagnose the low and overestimate high transport, and can alter survival forecasts.

Screening for kidney disease on World Kidney Day in Jalisco, Mexico.

BACKGROUND: In 2006, the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF) introduced World Kidney Day, to educate the public about the importance of chronic kidney disease (CKD) and its early detection. This prospective study examined the diagnostic yield of screening for CKD in poor neighborhoods in Guadalajara, Mexico, on World Kidney Day. METHODS: On World Kidney Day in 2006 and 2007, 2 screening stations were set up in Guadalajara, with a 2-week promotion period beforehand in the local media. Individuals who were aware that they had CKD and those <18 years of age were excluded. Data were prospectively collected by the staff of the screening programs using a standard form; all participants provided blood and urine specimens for serum creatinine assays and dipstick urinalysis. RESULTS: We studied 634 participants, of whom approximately 24% had proteinuria, 35% had hematuria and 6.4% had an estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2. Overall, the number needed to screen (NNS) to detect 1 new case of eGFR <60 ml/min per 1.73 m2 was 16 (95% confidence interval [95% CI], 12-22), varying from as low as 5 (95% CI, 4-8) in participants >60 years of age, to as high as 84 (95% CI, 35 to >200) in people aged 18 to 40 years. CONCLUSIONS: Proteinuria and eGFR <60 ml/min per 1.73 m2 were frequently detected among participants in community-based screening carried out on World Kidney Day in the state of Jalisco, Mexico, especially in people over 40 years old. Our data indicate that screening on World Kidney Day may be useful for identifying Jalisco residents with CKD, and suggest that trials of targeted screening and intervention are feasible and warranted.

Disparities in renal care in Jalisco, Mexico.

End-stage renal disease represents a serious public health problem in Mexico. Close to 9% of the Mexican population has chronic kidney disease (CKD) and 40,000 patients are on dialysis. However, the fragmentation of our health care system has resulted in unequal access to renal replacement therapy. In addition, poor patients in Jalisco with kidney failure have very advanced disease at the time of dialysis initiation, suggesting lack of access to predialysis care. To address these issues, a number of strategies have been implemented. Among them a renal replacement therapy program for which the cost of treatment is shared by government, patients, industry, and charitable organizations; the implementation of a state-funded hemodialysis program that provides free dialysis for the poor; the establishment of a university-sponsored residency program in nephrology and a postgraduate training in nephrology nursing; and a screening program for early detection and control of CKD. In conclusion, access to renal care is unequal. The extension of the Seguro Popular to cover end-stage renal disease treatment nationwide and the implementation of community screening programs for the detection and control of CKD offers an opportunity to correct the existing disparities in renal care in Jalisco and perhaps in other regions of Mexico.