Rotura renal no traumática. Posoperatorio de transplante renal. A propósito de un caso. / Non-traumatic kidney rupture. Kidney transplant postoperative period. A case report

Se presenta el caso de un paciente de 40 años de edad, que desarrolla una rotura del injerto renal a los 5 días del postoperatorio de trasplante renal con donante cadavérico en nuestra Institución. Se discuten los factores de riesgo para esta complicación, las causas más frecuentes en el trasplante renal, el diagnóstico y el manejo actual de esta grave complicación.

The case of a 40 year old male patient with a rupture of the kidney graft after 5 days of a kidney transplant from a cadaveric donor is presented. Common risk factors for this complication, frequent causes in kidney transplant, diagnosis, and current management of this serious complication are discussed

H1N1 influenza A virus-associated acute lung injury: response to combination oseltamivir and prolonged corticosteroid treatment.

PURPOSE: During the 2009 H1N1 influenza A virus pandemic, a minority of patients developed rapidly progressive pneumonia leading to acute lung injury (ALI)-acute respiratory distress syndrome (ARDS). A recent meta-analysis provides support for prolonged corticosteroid treatment in ALI-ARDS. We prospectively evaluated the response to oseltamivir and prolonged corticosteroid treatment in patients with ALI-ARDS and suspected H1N1 influenza. METHODS: From June 24 through 12 July 2009, 13 patients with suspected H1N1 pneumonia and ALI-ARDS were admitted to the intensive care unit (ICU) of a tertiary care hospital. H1N1 influenza was confirmed with real-time reverse transcriptase-polymerase chain reaction assay in eight patients. Oseltamivir and corticosteroid treatment were initiated concomitantly at ICU admission; those with severe ARDS received methylprednisolone (1 mg/kg/day), and others received hydrocortisone (300 mg/day) for a duration of 21 +/- 6 days. RESULTS: Patients with and without confirmed H1N1 influenza had similar disease severity at presentation and a comparable response to treatment. By day 7 of treatment, patients experienced a significant improvement in lung injury and multiple organ dysfunction scores (P < 0.001). Twelve patients (92%) improved lung function, were extubated, and discharged alive from the ICU. Hospital length of stay and mortality were 18.7 +/- 9.6 days and 15%, respectively. Survivors were discharged home without oxygen supplementation. CONCLUSIONS: In ARDS patients, with and without confirmed H1N1 influenza, prolonged low-to-moderate dose corticosteroid treatment was well tolerated and associated with significant improvement in lung injury and multiple organ dysfunction scores and a low hospital mortality. These findings provide the rationale for developing a randomized trial.