Guía clínica española del acceso vascular para hemodiálisis / Spanish clinical guidelines on vascular access for haemodialysis

El acceso vascular para hemodiálisis es esencial para el enfermo renal tanto por su morbimortalidad asociada como por su repercusión en la calidad de vida. El proceso que va desde la creación y mantenimiento del acceso vascular hasta el tratamiento de sus complicaciones constituye un reto para la toma de decisiones debido a la complejidad de la patología existente y a la diversidad de especialidades involucradas. Con el fin de conseguir un abordaje consensuado, el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV), que incluye expertos de las cinco sociedades científicas implicadas (nefrología [S.E.N.], cirugía vascular [SEACV], radiología vascular e intervencionista [SERAM-SERVEI], enfermedades infecciosas [SEIMC] y enfermería nefrológica [SEDEN]), con el soporte metodológico del Centro Cochrane Iberoamericano, ha realizado una actualización de la Guía del Acceso Vascular para Hemodiálisis publicada en 2005. Esta guía mantiene una estructura similar, revisando la evidencia sin renunciar a la vertiente docente, pero se aportan como novedades, por un lado, la metodología en su elaboración, siguiendo las directrices del sistema GRADE con el objetivo de traducir esta revisión sistemática de la evidencia en recomendaciones que faciliten la toma de decisiones en la práctica clínica habitual y, por otro, el establecimiento de indicadores de calidad que permitan monitorizar la calidad asistencial.

Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support.

[Renal failure stages as predictors of mortality following acute coronary syndrome]. / El grado de insuficiencia renal como predictor de mortalidad tras un síndrome coronario agudo.

INTRODUCTION: renal glomerular filtration rate on hospital admission in patients presented with an acute coronary syndrome as a predictor for mortality. PATIENTS AND METHODS: The study analysed 290 patients admitted on hospital with an acute coronary syndrome during one year (2003). Renal function was estimated using the renal glomerular filtration rate by the MDRD formula. Patients were stratified in three groups: patients with a GFR > or = 60 ml/min/1,73 m2; n = 186, patients with GFR < 60 or > 30; n = 93 and patients with GFR < 30; n = 11. RESULTS: 66.6% of patients were males and 66.5% were older than 65 years old. 54.5% suffered from hypertension and 39% were diabetics. All patients with GFR < 30 ml/min had an acute coronary syndrome without elevation of ST segment. They were the oldest with a major proportion of previous cardiovascular events as cerebrovascular disease, peripheral vascular disease or myocardial infarction. Diagnostic procedures and treatments were less administered in patients with GFR < 30 ml/min. Although in the univariate analysis demonstrated that hospital mortality was related to GFR < 30 ml/min, sex, ageing, Killip > 1, ventricular function and cTnT elevation, only GFR < 30 ml/min, ageing, heart failure and ventricular dysfunction persisted significant in the multivariate analysis. Hospital mortality was 27.3% in patients with GFR < 30 ml/min, 7.5% in patients with GFR between 30-60 ml/min and 3.8% in patients with a GFR > or = 60 ml/min. Mortality after two years follow up was 27.3% in patients with GFR < 30 ml/min, 20.4% in patients with GFR between 30-60 ml/min and 10.2% in patients with a GFR > or = 60 ml/min. Mortality (hospital mortality and after two years of follow up) was increased in patients with GFR< 30 ml/min, ageing, heart failure and diabetes after adjusted for other prognostic factors. CONCLUSIONS: A reduced glomerular filtration rate is an independent risk factor for mortality in patients with an acute coronary syndrome. Estimation of the renal glomerular filtration rate might be used as prognostic value in these patients.

Renal failure stages as predictors of mortality following acute coronary syndrome

Introducción: determinar el filtrado glomerular al ingreso como predictor de mortalidad tras un Síndrome Coronario Agudo (SCA). Pacientes y método: se analizaron 290 pacientes que ingresaron por SCA durante el año 2003. Se valoró la función renal al ingreso mediante la fórmula de estimación del Filtrado Glomerular (FG) MDRD. Se estratificaron en tres grupos: pacientes con FG ≥60 ml/min/1,73 m2; n = 186, pacientes con FG <60 y >_30; n = 93 y pacientes con FG <30; n = 11. Resultados: todos los pacientes con FG <30 ml/min presentaron un SCA sin elevación del segmento ST, los cuales eran de edad más avanzada con mayor prevalencia de eventos cardiovasculares previos (accidente vascular cerebral, de arteriopatía periférica, y de infarto de miocardio). La realización de pruebas diagnósticas fue menor. La mortalidad hospitalaria fue del 27,3% en los pacientes con FG <30 ml/min, 7,5% en los pacientes con FG entre 30 y 60 ml/min, y del 3,8% en los pacientes con FG ≥60 ml/min. Tras dos años de seguimiento, la mortalidad fue del 27,3% en los pacientes con FG <30 ml/min, del 20,4% en los pacientes con FG entre 30 y 60 ml/min, y del 10,2% con FG ≥60 ml/min. Al ajustar por otras variables pronósticas, los pacientes con FG <30 ml/min presentaron una mayor mortalidad tanto durante el ingreso como en el seguimiento a dos años. Conclusiones: la reducción del FG es un factor de riesgo independiente de mortalidad tras un SCA. El uso de las fórmulas de estimación del FG en el seguimiento de dichos pacientes tiene valor pronóstico (AU)

Introducción: determinar el filtrado glomerular al ingreso como predictor de mortalidad tras un Síndrome Coronario Agudo (SCA). Pacientes y método: se analizaron 290 pacientes que ingresaron por SCA durante el año 2003. Se valoró la función renal al ingreso mediante la fórmula de estimación del Filtrado Glomerular (FG) MDRD. Se estratificaron en tres grupos : pacientes con FG >_60 ml/min/1,73 m2; n = 186, pacientes con FG <60 y >_30; n = 93 y pacientes con FG <30; n =11. Resultados: todos los pacientes con FG <30 ml/min presentaron un SCA sin elevación del segmento ST, los cuales eran de edad más avanzada con mayor prevalenc ia de eventos cardiovasculares previos (accidente vascular cerebral , de arteriopatía periérica, y de infarto de miocardio) . La realización de pruebas diagnósticas fue menor. La mortalidad hospitalaria fue del27,3% en los pacientes con FG <30 ml/min, 7,5% en los pacientes con FG entre 30 y 60 ml /min, y del 3,8% en los pacientes con FG >_60 ml/min. Tras dos años de seguimiento, la mortalidad fue del 27,3% en los pacientes con FG <30 ml/min, del 20,4% en los pacientes con FG entre 30 y 60 ml /min, y del 10,2% con FG >_60ml /min. Al ajustar por otras variables pronósticas , los pacientes con FG <30 ml /min presentaron una mayor mortalidad tanto durante el ingreso como en el seguimiento a dos años . Conclusiones : la reducción del FG es un factor de riesgo independiente de mortalidad tras un SCA. El uso de las fórmulas de estimación del FG en el seguimiento de dichos pacientes tiene valor pronóstico (AU)

Experiencia en el uso de prótesis vasculares de poliuretanurea tipo Vectra en una unidad de hemodiálisis / Use of vascular polyurethane-urea prosthesis of the of the vectra type in a hemodialysis unit

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Enfermedad de Graves, hipotiroidismofarmacológico y síndrome nefrótico por enfermedad de cambios mínimos / Graves disease, drug-related hypothyroidism, and nephrotic syndrome due to minimal changes disease

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[Peritoneal implants in patients affected by chronic renal failure in hemodialysis programme]. / Implantes peritoneales en pacientes con insuficiencia renal crónica en programa de hemodiálisis.

The presence of peritoneal implants detected by computered axial tomography (CT) is usually related to mesothelial primary neoformative processes or, more frequently to peritoneal metastasis or peritoneal carcinomatosis. Although the higher prevalence of neoplastic processes in the chronic renal failure population, the association of peritoneal implants and constitutional syndrome is not always correlated to peritoneal carcinomatosis. We present the case of two patients with chronic renal failure in hemodialysis programme, with abdominal insidious clinical, constitutional syndrome and similar peritoneal implants seen by CAT: the histologic analysis of peritoneal implants gave the definitive diagnostic of secondary amyloidosis and peritoneal tuberculosis respectively.

Implantes peritoneales en pacientes con insuficiencia renal crónica en programa dehemodiálisis / Peritoneal implants in patients affected by chronic renal failure in hemodialysis programme

La presencia de implantes peritoneales detectados por tomografía axial computerizada(TAC) suele estar asociada a procesos neoformativos primarios del mesotelioo, más frecuentemente, a metástasis peritoneales o carcinomatosis peritoneal.A pesar de la mayor prevalencia de procesos neoplásicos en la poblaciónafecta de insuficiencia renal crónica, la asociación de implantes peritoneales y síndromeconstitucional no siempre se correlaciona con carcinomatosis peritoneal.Presentamos dos pacientes con insuficiencia renal crónica en programa de hemodiálisis,con clínica insidiosa abdominal, síndrome constitucional e implantesperitoneales de similares características visualizados por TAC. El análisis histológicode los implantes peritoneales permitió el diagnóstico definitivo de amiloidosissecundaria y tuberculosis peritoneal respectivamente

The presence of peritoneal implants detected by computered axial tomography(CT) is usually related to mesothelial primary neoformative processes or, more frequentlyto peritoneal metastasis or peritoneal carcinomatosis. Although the higherprevalence of neoplastic processes in the chronic renal failure population, the associationof peritoneal implants and constitutional syndrome is not always correlatedto peritoneal carcinomatosis. We present the case of two patients with chronicrenal failure in hemodialysis programme, with abdominal insidious clinical,constitutional syndrome and similar peritoneal implants seen by CAT: the histologicanalysis of peritoneal implants gave the definitive diagnostic of secondary amyloidosisand peritoneal tuberculosis respectively

New strategy for the stereoselective synthesis of fluorinated beta-amino acids.

Racemic and chiral nonracemic alpha-substituted and alpha-unsubstituted beta-fluoroalkyl beta-amino acid derivatives 6 and 9 have been synthesized in two steps starting from fluorinated imidoyl chlorides 1 and ester enolates. This approach is based on the chemical reduction of previously obtained gamma-fluorinated beta-enamino esters 4 by using ZnI(2)/NaBH(4) in a nonchelated aprotic medium (dry CH(2)Cl(2)) as the reducing agent. A metal-chelated six-membered model has been suggested to explain the stereochemical outcome of the reduction reaction. The process takes place with high yields and with moderate to good diastereoselectivity. The best results related to diastereoselective reduction of chiral beta-enamino esters 4 were provided by the use of (-)-8-phenylmenthol as a chiral auxiliary.

Neurotoxicidad post-primera dosis de valaciclovir vía oral en una paciente en hemodiálisis

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Fracaso renal agudo como forma de presentación clínica de linfoma de Burkitt renal en un paciente HIV positivo / Burkitt’s lymphoma in an hiv positive patient presenting with acute renal failure

El linfoma de Burkitt es un tumor frecuentemente asociado a situaciones de inmunodepresión como puede ser leucemia aguda linfoblástica (L3) o infecciones por el virus de la inmunodeficiencia humana (VIH). La incidencia de la afectación renal es variable (34-62%), respondiendo a diferentes etiologías. Presentamos un caso de fracaso renal agudo en un paciente con linfoma de Burkitt con infiltración renal e infectado por el virus de la inmunodeficiencia humana (AU)

Burkitt’s lymphoma is a tumour often associated with low immunity as acutelymphoblastic leukaemia (l3) or infection by the human immunodeficiency virus(HIV). The incidence of renal affection is variable (34-62%) and there are different aetiologies. We present a case of acute renal failure in a patient with a Burkitt’s lymphoma and renal infiltration, and infected by the human immunodeficiency virus (AU)

Enantioselective syntheses of dopaminergic (R)- and (S)-benzyltetrahydroisoquinolines.

Optically pure (1S,R)- and (1R,S)-benzyltetrahydroisoquinolines (BTHIQs), 12a,b as the major diastereomers, were prepared by stereoselective reduction of the isoquinolinium salt possessing (R)- and (S)-phenylglycinol as the chiral auxiliary, respectively. The absolute configurations of (1S,R)-13a hydrochloride (O-debenzoylated derivative from 12a) and (1R,S)-12b diastereomers were unambiguously determined by single-crystal X-ray analysis. Reductive removal of the chiral auxiliary group, subsequent N-propylation, and cleavage of the methylenedioxy group furnished the optically active catecholamines (1S)-16a and (1R)-16b in good overall yield. We have separately prepared for the first time pairs of dopaminergic 1-BTHIQs enantiomers through a classical methodology in asymmetric synthesis. The (1S)-enantiomers (14a-16a) bind to D1 and D2 dopamine receptors with affinities 5-15 times higher than those of the corresponding (1R)-enantiomers (14b-16b). Moreover, (1S)-14a inhibits [3H]dopamine uptake with high affinity. It appears that synthesis and testing of (S)-enantiomers of BTHIQ are very important for the search for new active drugs at dopamine receptors.

The first acetimine gold(I) and gold(III) complexes and the first acetonine complexes.

Ketimino(phosphino)gold(I) complexes of the type [Au[NR=C(Me)R']L]X (X = ClO4, R = H, L = PPh3, R'=Me (la), Et (2a); L=PAr3 (Ar=C6H4OMe-4), R'=Me (1b), Et (2b); L=PPh3, R=R'=Me (3); X= CF3SO3 (OTf), L=PPh3, R=R'=Me (3'); R=Ar, R'=Me (4)) have been prepared from [Au(acac)L] (acac = acetyl acetonate) and ammonium salts [RNH3]X dissolved in the appropriate ketone MeC(O)R'. Complexes [Au(NH=CMe2)2]X (X = C1O4 (6), OTf (6')) were obtained from solutions of [Au(NH3)2]X in acetone. The reaction of 6 with PPN[AuCl2] or with PhICl2 gave [AuCl(NH=CMe2)] (7) or [AuCI2(NH=CMe2)2]ClO4 (8), respectively. Complex 7 was oxidized with PhICl2 to give [AuCl3(NH=CMe2)] (9). The reaction of [AuCl(tht)] (tht = tetrahydrothiophene), NaClO4, and ammonia in acetone gave [Au(acetonine)2]ClO4 (10) (acetonine = 2,2,4,4,6-pentamethyl-2,3,4,5-tetrahydropyrimidine) which reacted with PPh3 or with PPN[AuCl2] to give [Au(PPh3)(acetonine)]ClO4 (11) or [AuCl(acetonine)] (12), respectively. Complex 11 reacts with [Au(PPh3)(Me2CO)]ClO4 to give [(AuPPh3)2(mu-acetonine)](ClO4)2 (13). The reaction of AgClO4 with acetonine gave [Ag(acetonine)(OClO3)] (14). The crystal structures of [Au(NH2Ar)(PPh3)]OTf (5), 6' and 10 have been determined.

[Acute kidney failure as the clinical presenting form of renal Burkitt's lymphoma in an HIV-positive patient]. / Fracaso renal agudo como forma de presentación clínica de linfoma de Burkitt renal en un paciente HIV positivo.

Burkitt's lymphoma is a tumour often associated with low immunity as acute lymphoblastic leukaemia (l3) or infection by the human immunodeficiency virus (HIV). The incidence of renal affection is variable (34-62%) and there are different aetiologies. We present a case of acute renal failure in a patient with a Burkitt's lymphoma and renal infiltration, and infected by the human immunodeficiency virus.

1-Chloro-1,1-difluoro-N-(4-methoxyphenyl)-3-(pyrrolidin-2-ylidene)propan-2-imine.

In the title compound, C(14)H(15)ClF(2)N(2)O, the Z configuration has been confirmed. The molecular structure shows an intramolecular N-H.N hydrogen bond [H.N 2.04 (6), N.N 2.709 (6) A and N-H.N 124 (5) degrees ]. This interaction could be responsible for the Z configuration.

Synthesis, reactivity, and X-ray crystallographic characterization of mono-, di-, and tetranuclear palladium(II)-metalated species.

The reactivity of the tetranuclear metallated palladium compound (Pd[mu 2-(C6H4)PPh2]Br)4 (1) with different ligands has been investigated with the aim of evaluating the influence of the entering ligand on the nature of the reaction products. The results confirmed the ability of the ligand [(C6H4)PPh2]- to expand a bridging [mu 2-] or a chelating [eta 2-] coordination mode, depending on the auxiliary ligands present in the complex. Bulky phosphines stabilize mononuclear species of formula (Pd[eta 2-(C6H4)PPh2]Br[P]), with a four-atom metallocycle, while small phosphines give dinuclear compounds. The molecular structures of three different metalated palladium compounds have been determined by single-crystal X-ray crystallography; the tetranuclear (Pd[mu 2-(C6H4)PPh2]Cl)4 (2), the dinuclear(Pd[mu 2-(C6H4)PPh2]Br[PMe3])2 (3), and the mononuclear (Pd[eta 2-(C6H4)PPh2]Br[PCBr]), (PCBr = P(o-BrC6H4)Ph2) (9) were obtained, the first one by halogen exchange reaction and the others by frame degradation of 1.

Gold(I) Complexes with N-Donor Ligands. 2.(1) Reactions of Ammonium Salts with [Au(acac-kappaC(2))(PR(3))] To Give [Au(NH(3))L](+), [(AuL)(2)(&mgr;(2)-NH(2))](+), [(AuL)(4)(&mgr;(4)-N)](+), or [(AuL)(3)(&mgr;(3)-O)](+). A New and Facile Synthesis of [Au(NH(3))(2)](+) Salts. Crystal Structure of [{AuP(C(6)H(4)OMe-4)(3)}(3)(&mgr;(3)-O)]CF(3)SO(3).

The complexes [Au(acac-kappaC(2))(PR(3))] (acac = acetylacetonate, R = Ph, C(6)H(4)OMe-4) react with (NH(4))ClO(4) to give amminegold(I), [Au(NH(3))(PR(3))]ClO(4), amidogold(I), [(AuPR(3))(2)(&mgr;(2)-NH(2))]ClO(4), or nitridogold(I), [(AuPR(3))(4)(&mgr;(4)-N)]ClO(4), complexes, depending on the reaction conditions. Similarly, [Au(acac-kappaC(2))(PPh(3))] reacts with (NH(3)R')OTf (OTf = CF(3)SO(3)) (1:1) or with [H(3)N(CH(2))(2)NH(2)]OTf (1:1) to give (amine)gold(I) complexes [Au(NH(2)R')(PPh(3))]OTf (R' = Me, C(6)H(4)NO(2)-4) or [(AuPPh(3))(2){&mgr;(2)-H(2)N(CH(2))(2)NH(2)}](OTf)(2), respectively. The ammonium salts (NH(2)R'(2))OTf (R' = Et, Ph) react with [Au(acac-kappaC(2))(PR(3))] (R = Ph, C(6)H(4)OMe-4) (1:2) to give, after hydrolysis, the oxonium salts [(AuPR(3))(3)(&mgr;(3)-O)]OTf (R = Ph, C(6)H(4)OMe-4). When NH(3) is bubbled through a solution of [AuCl(tht)] (tht = tetrahydrothiophene), the complex [Au(NH(3))(2)]Cl precipitates. Addition of [Au(NH(3))(2)]Cl to a solution of AgClO(4) or TlOTf leads to the isolation of [Au(NH(3))(2)]ClO(4) or [Au(NH(3))(2)]OTf, respectively. The crystal structure of [(AuPR(3))(3)(&mgr;(3)-O)]OTf.Me(2)CO (R = C(6)H(4)OMe-4) has been determined: triclinic, space group P&onemacr;, a = 14.884(3) Å, b = 15.828(3) Å, c = 16.061(3) Å, alpha = 83.39(3) degrees, beta = 86.28(3) degrees, gamma = 65.54(3) degrees, R1 (wR2) = 0.0370 (0.0788). The [(AuPR(3))(3)(&mgr;(3)-O)](+) cation shows an essentially trigonal pyramidal array of three gold atoms and one oxygen atom with O-Au-P bond angles of ca. 175 degrees and Au.Au contacts in the range 2.9585(7)-3.0505(14) Å. These cations are linked into centrosymmetric dimers through two short Au.Au [2.9585(7), 3.0919(9) Å] contacts. The gold atoms of the dimer form a six-membered ring with a chair conformation.