Dosificación de vancomicina en pacientes en hemodiálisis / No disponible

Dado el amplio uso de vancomicina en hemodiálisis (HD) es necesario adecuar la dosificación a las actuales membranas de diálisis, asegurando niveles óptimos. Objetivo: Valorar si, en HD, tras 1 gramo intravenoso (IV) los niveles plasmáticos de vancomicina se encuentran en rango terapéutico. Material y métodos: Estudio de cohorte transversal que incluye 28 pacientes en HD 3 veces/semana tratados con vancomicina entre el 15/2/2006 y el 14/2/2007. Sead ministró 1 gramo IV durante la última hora de HD, determinando niveles antes y después de la sesión siguiente(preHD1, postHD1) y antes de la 2ª sesión siguiente(preHD2). Resultados: De los 28 pacientes, 5 presentaban 3determinaciones y 5 presentaban 2 y el resto 1. De las 43muestras, 19 eran hombres (44,2%) y 24 mujeres (55,8%),con edad media 70 ± 8,4 años. La dosis de 1 gramo correspondía a > 15 mg/kg en 31 pacientes (72,1%) y < 15 mg/kgen 12 (27,9%). El 44,2% utilizaban polietersulfona de alta permeabilidad (PES-AP), 7% eval, 32,5% polietersulfona de media-baja permeabilidad (PES-BP) y 16,3% poliacrilonitrilo. El nivel medio preHD1 fue 7,06 mcg/ml, 7,5 mcg/mlpara la dosis > 15 mg/kg y 6 mcg/ml para < 15 mg/kg (p <0,05). El 16,3% presentó niveles por debajo del rango terapéutico, siendo 6,45% para una dosis > 15 mg/kg frente a 41,67% para la dosis < 15 mg/kg. Respecto a los dializadores, los niveles más bajos se observaron con PES-AP (5,95 mcg/ml) y los más elevados con PES-BP (7,27 mcg/ml) (p no significativa). Ningún paciente con PES-BP se encontró en rango infraterapéutico, frente a 31,58% con PES-AP (p = 0,07). Los valores postHD1 y preHD2 se encontraban en niveles subóptimos, tanto la media como los que recibían > 15 mg/kg y < 15 mg/kg, y en todos los dializadores. Conclusiones: La administración de 1 gramo IV de vancomicina cada 5-7 días no es adecuado para pacientes en HD, sobre todo cuando se utilizan membranas de alto flujo. Mientras no se actualizan las pautas de dosificación es necesario monitorizar los niveles prediálisis del fármaco para evitar concentraciones infraterapéuticas (AU)

Vancomycin is widely used in haemodialysis (HD) patients for treating infections of vascular access due to St. Aureus. To avoid subtherapeutic levels it is important to know the adequate dosing in patients undergoing haemodialysis with high flux membranes. Objective: The aim of this study was to evaluate whether HD patients treated with 1 g intravenous (IV) vancomycin reached optimum plasma levels. Material and methods: In a crossover design we studied 28 chronic HD patients, 3 times a week, treated with vancomycin between 15/2/2006 and 14/2/2007. Antibiotic wasgiven at dose of 1 g during the last hour of dialysis session. Plasma levels of vancomycin were measured immediately before next HD (preHD1) and after (postHD1), and prior to the beginning of the second next session (preHD2). We evaluated age, sex, dry height, week Kt/V and the type of membrane used. Results: Of 28 patients, 5 were analysed 3 times, 2 were analysed twice and 9 were analysed once. There were 43 samples, 19 men (44.2%) and 24 women (55.8%), with a mean age of 70 ± 8,4 years. 1 g dose is equivalent to > 15 mg/kg in 31 patients (72.1%) and < 15 mg/kg in 12 (27.9%). The type of membrane used was high flux polyetersulfone (PES-AP) (44.2%), eval (7%), medium-low polyetersulfone (PES-BP) (32.5%) and polyacrylonitrile (16.3%). PreHD1 mean concentration results for the total population was 7.06 mg/ml, being 16.3% bellow optimum levels. There were not difference between patients treated with dose > 15 mg/kg (7.5 mg/ml) and < 15 mg/kg (6 m/ml). When the dose administered was > 15 mg/kg, 6.45% results were subtherapeutic, whereas if the dose was < 15 mg/kg, 41.67% values were bellow optimum levels (p < 0.05). With regard to the dialyzers used, the lowest concentrations were observed with PES-AP (5.95 mg/ml) and the highest values were observed with PES-BP (7.27 mg/ml) (p no significance). No patient using PESBP versus 31.58% patients using PES-AP showed suboptimum values (p = 0,07). All postHD1 and preHD2 results were in subtherapeutic range (mean values, dose > and < 15 mg/kg and all types of membrane). Conclusions: Based on the above results, the vancomycin dosing schedule of 1 g IV every 5-7 days is not recommended for patients undergoing haemodialysis with high flux membranes. Since there are not guidelines for handling this antibiotic in these patients our findings suggest that it may be necessary to monitorize predialysis plasma levels to avoid subtherapeutic values (AU)

[Vancomycin dosing in hemodialysis patients]. / Dosificación de vancomicina en pacientes en hemodiálisis.

UNLABELLED: Vancomycin is widely used in haemodialysis (HD) patients for treating infections of vascular access due to St. Aureus. To avoid subtherapeutic levels it is important to know the adequate dosing in patients undergoing haemodialysis with high flux membranes. OBJECTIVE: The aim of this study was to evaluate whether HD patients treated with 1 g intravenous (IV) vancomycin reached optimum plasma levels. MATERIAL AND METHODS: In a crossover design we studied 28 chronic HD patients, 3 times a week, treated with vancomycin between 15/2/2006 and 14/2/2007. Antibiotic was given at dose of 1 g during the last hour of dialysis session. Plasma levels of vancomycin were measured immediately before next HD (preHD1) and after (postHD1), and prior to the beginning of the second next session (preHD2). We evaluated age, sex, dry height, week Kt/V and the type of membrane used. RESULTS: Of 28 patients, 5 were analysed 3 times, 2 were analysed twice and 9 were analysed once . There were 43 samples, 19 men (44,2%) and 24 women (55,8%), with a mean age of 70 +/- 8,4 years. 1 g dose is equivalent to > 15 mg/kg in 31 patients (72,1%) and < 15 mg/kg in 12 (27,9%). The type of membrane used was high flux polyetersulfone (PES-AP) (44,2%), eval (7%), medium-low polyetersulfone (PES-BP) (32,5%) and polyacrylonitrile (16,3%). PreHD1 mean concentration results for the total population was 7,06 mg/ml, being 16,3% bellow optimum levels. There were not difference between patients treated with dose > 15 mg/kg (7,5 mg/ml) and < 15 mg/kg (6 m/ml). When the dose administered was > 15 mg/kg, 6,45% results were subtherapeutic, whereas if the dose was < 15 mg/kg, 41,67% values were bellow optimum levels (p<0,05). With regard to the dialyzers used, the lowest concentrations were observed with PES-AP (5,95 mg/ml) and the highest values were observed with PES-BP (7,27 mg/ml) (p no significance). No patient using PES-BP versus 31,58% patients using PES-AP showed suboptimum values (p> or =0,07). All postHD1 and preHD2 results were in subtherapeutic range (mean values, dose > and < 15 mg/kg and all types of membrane). CONCLUSIONS: Based on the above results, the vancomycin dosing schedule of 1 g IV every 5-7 days is not recommended for patients undergoing haemodialysis with high flux membranes. Since there are not guidelines for handling this antibiotic in these patients our findings suggest that it may be necessary to monitorize predialysis plasma levels to avoid subtherapeutic values.

[Telemedicine applied to Nephrology. Another form of consultation]. / Telemedicina aplicada a la nefrología. Otra forma de consulta.

UNLABELLED: In 2004, according to socio- demographic criteria and to the improvement in the welfare quality, we incorporated to the portfolio of services of our section a work tool that meant a novel technology; the "telemedicine". The Objective has been to asses the utility of telemedicine in the follow- up of the renal patients, bringing the consultation of nephrology closer to the patient's home as well as the relationship between two welfare levels. MATERIAL AND METHOD: Retrospective and descriptive study of the patients with renal pathology treated in the consultation of telenephrology at our hospital in a period of time of 27 months (November 2004-January 2007). Such study is carried out in primary care centers of our sanitary area (4 centers). The general practician (G.P) starts up the system by elaborating a document of derivation to the consultation of "telenephrology". All this information is included in a computerized data base that arrives via "Intranet" at the Hospital. From the consultation of Telenephrology the question is answered in real- time and through a system of videoconference. RESULTS: A total of 105 first consultations have been made. 52 men and 53 women between 18 and 94 years of age. The diagnoses made in the consultation of Telenephrology have been: HTA (essential and secondary): 90 (85.7%). IRC: 61 (58%). Diabetic Nefropathy: 17 (16%). Renal Polycystic: 3 (2.8%). Urinary Lithiasis: 2 (1.9%). Congenital malformations: 1 (0.95%). Obstructive Nefropathy: 1 (0.95%). Chronic Glomerulonephritis: 6 (5.7%). Urinary infection: 1 (0.95%). Absence of renal pathology: 5 (4.8%). Some of the diagnoses coincide in several patients. The causes of the IRC have been Nephroangioesclerosis: 33. Diabetic Nefropathy: 14. Not drafted: 8. Disease to glomerular: 2. Urinary Lithiasis: 2. Renal Polycystic: 1. Ischemic Nephropathy: 1. 82 out of the 90 patients with HTA had essential arterial hypertension and 8 suffered from secondary HTA. The causes of this were: 5 HTA of parenquimatous renal origin. 2 vasculorrenal HTA and one with a primary hyperaldosteronism. The associated factors of risk to the observed HTA have been: Dyslipemia: 29. Diabetes méllitus: 29. Hyperuricemia: 11. Obesity: 12. CONCLUSION: The telecare in nephrology is possible promoting also the approach between two welfare levels, without a decrease in the quality of assistance. That way, we can get a lower number of hospital visits and, subsequently, a saving in sanitary transport as well as in hospital consultations.

[Hypertension high resolution consultation. A year of experience]. / Consulta de alta resolución (CAR) de HTA: experiencia de un año.

By High Resolution Consultation (HRC) we mean an ambulatory process of assistance fulfilled in a single day, by which treatment and diagnosis are established after all complementary tests have been carried out. Once diagnosed, the patient is discharged and resent to the doctor who had previously remitted him/ her. In the Cáceres sanitary area, with distances longer than 100- 120 km. and precarious local road communications, the introduction of hypertension (HTA) HRC has brought along important savings of sanitary and economical resources and it is perceived by the user as highly satisfactory. We have carried out an observational one- year study of our HCR HTA, in which 90 patients have been evaluated, out of which 74.4% came from primary assistance and 25.6% from specialized assistance. Once diagnosed, 61 patients were discharged and sent to receive primary assistance and 29 were kept in our outpatient nephrology consultation, justified by severe and/ or rebellious HTA in 11 cases and by renal failure in 16 cases; two of these patients are still being tested. Taking into account that in a traditional consultation a patient would need two or three visits and one or two days for complementary tests, our HTA HRC (by which patients are tested and diagnosed in a single day), brings along savings of one or two consultations and two to four relocations for new consultations and diagnostic explorations. In one year of HTA- HRC with 90 patients, we have saved from 212 to 302 consultations and from 302 to 604 relocations in comparison to the traditional organization and we have thus generated from 100 to 150 places for first appointments.

Consulta de alta resolución (CAR) de HTA: experiencia de un año / High-resolution consultation for hypertension. A one-year experience

Se entiende como consulta de alta resolución (CAR) el proceso asistencial ambulatorio realizado en una sola jornada, en el que se establece el diagnóstico y tratamiento, después de realizar la pruebas complementarias. Una vez valorado el paciente es dado de alta y enviado nuevamente al médico que lo remitió. En el área sanitaria de Cáceres, con distancias superiores a los 100-120 km y una red viaria comarcal precaria la implantación de la CAR-HTA ha supuesto un importante ahorro de recursos sanitarios y económicos y es percibida por el usuario cómo altamente satisfactoria. Hemos realizado un estudio observacional de un año de nuestra CAR de HTA, en la que han sido valorados90 pacientes, de los cuales el 74,4% procedían de atención primaria y el 25,6% de especializada. Una vez valorados61 pacientes fueron dados de alta y derivados a atención primaria y 29 pacientes permanecieron en la consulta de Nefrología, justificado por HTA severa y/o rebelde en 11 casos y por afectación renal en otros 16 casos, dos están pendientes de pruebas. En relación con una consulta clásica en la que los pacientes necesitan 2 ó 3 consultas y 1ó 2 días más para pruebas complementarias la CAR de HTA, en la que los pacientes son vistos en un solo día, supone un ahorro de 1 ó 2 consultas y 2 ó 4 desplazamientos para consultas y pruebas. En un año de CAR-HTA con 90pacientes vistos, de los cuales 61 fueron dados de alta ha habido un ahorro de 212 ó 302 consultas y 302 ó 604 desplazamientos en comparación con la consulta clásica y la generación de 100-150 «huecos» para primeras visitas (AU)

By High Resolution Consultation (HRC) we mean an ambulatory process of assistance fulfilled in a single day, by which treatment and diagnosis are established after all complementary tests have been carried out. Once diagnosed, the patient is discharged and resent to the doctor who had previously remitted him/ her. In the Cáceres sanitary area, with distances longer than 100-120 km and precarious local road communications, the introduction of hypertension (HTA) HRC has brought along important savings of sanitary and economical resources and it is perceived by the user as highly satisfactory. We have carried out an observational one year study of our HCR-HTA, in which 90 patients have been evaluated, out of which 74.4% came from primary assistance and25.6% from specialized assistance. Once diagnosed, 61 patients were discharged and sent to receive primary assistance and 29were kept in our outpatient nephrology consultation, justified by severe and/ or rebellious HTA in 11 cases and by renal failure in16 cases; two of these patients are still being tested. Taking into account that in a traditional consultation a patient would need two or three visits and one or two days for complementary tests, our HTA-HRC (by which patients are tested and diagnosed in a single day), brings along savings of one or two consultations and two to four relocations for new consultations and diagnostic explorations. In one year of HTA-HRC with 90 patients, we have saved from 212 to 302 consultations and from 302 to 604 relocations in comparison to the traditional organization and we have thus generated from 100 to 150 places for first appointments (AU)

Nuestra experiencia en el hiperaldosteronismo primario / Our experience in primary hiperaldos dosteronism

Objetivo: Analizar las formas de presentación, características clínicas, diagnóstico y tratamiento de los pacientes diagnosticados de hiperaldosteronismo primario (HA1º) en la consulta externa de nefrología desde su apertura. Método: Se realizó un estudio retrospectivo revisando todas las historias clínicas de pacientes diagnosticados de HA1º desde 1981-2005. Resultados: Se diagnosticaron un total de 35 pacientes con una edad media de 50 años con predominio de varones (82%). El motivo principal de inicio de estudio de HA1º fue la hipertensión arterial (HTA) rebelde, seguido de hipertensión más hipopotasemia(34%). Dieciséis casos eran adenomas (7 adenomas clásicos y 9 renino-dependientes) y 14 hiperplasias (10 hiperplasias bilaterales y 4 hiperplasias adrenales primarias). Cinco casos fueron excluidos del estudio por encontrarse en el momento de realización del estudio pendientes de pruebas complementarias. Para diagnóstico de localización la prueba que mostró más concordancia con el diagnóstico final fue la gammgrafía I-131colesterol seguida de la RMN y la TAC. En 8 casos se realizó muestreo venoso suprarrenal. Fueron intervenidos 10 de los 16 adenomas con resultado de normalización de cifras tensionales sin tratamiento en el 60% de ellos. El resto de los casos se encuentran en tratamiento con espironolactona con adecuado control tensional. El efecto adverso más frecuente fue la ginecomastia. Conclusión: En contra de lo publicado en la literatura, en nuestra serie observamos un claro predominio de varones. Obtuvimos una similar incidencia de adenomas e hiperplasias. La forma de presentación más frecuente fue la hipertensión arterial rebelde al tratamiento. La opción quirúrgica de los adenomas no significa un resultado curativo, pero sí un mejor controlde las cifras tensionales con menos fármacos y una disminución de los niveles de aldosterona con el consiguiente descenso de la toxicidad miocárdica y vascular (AU)

Aims: The aim of this paper is to analyze the ways of appearance, clinical characteristics, diagnosis and treatment related to patients suffering from primary hyperaldosteronism (HA1º) in external nephrology consultation since their opening. Methodology: A retrospective study was carried out, checking out all HA1º diagnosed patients of clinicalrecords from 1981-2005. Results: 35 patients were diagnosed,with an average age of 50 and a predominance of men (82%). The main reason for starting the HA1º study was persistent hypertension; other reasons were hypertension and hypopotassemia (34%). Sixteen of the cases were adenomas (7 classic adenomas and 9 renin-dependents) and fourteen of them were hyperplasia (10 bilateral hyperplasias and 4 primary adrenals hyperplasia). Five cases were excluded because they were waiting for complementary tests. For location diagnosis, gammagrafía I-131cholesterol was the test showing more agreement with final diagnosis, and then RMN and TAC. In eight of the cases, an adrenal vein sampling was made. Ten of sixteen adenomas suffered a surgery performance. The result showed standardization of tensional levels, without any treatment in 60% of the cases. The rest of them are currently treated with spironolactone under an appropriate tensionalcontrol. Gynecomastia was the most usual adverse effect found. Conclusion: Contrary to other published papers, we found out a male predominance in our database. A similar incidence of adenomas e hyperplasias was obtained. The most usual way of appearance was persistent hypertension to treatment. Adenomas surgery does not implyhealing results, though it achieves a better tensional levels control, using less drugs and diminishing aldosterone levels. It implies a descent in myocardic and vascular toxicity (AU)

[Our experience in primary hyperaldosteronism]. / Nuestra experiencia en el hiperaldosteronismo primario.

UNLABELLED: The aim of this paper is to analyze the ways of appearance, clinical characteristics, diagnosis and treatment related to patients suffering from primary hyperaldosteronism (HA1 masculine) in external nephrology consultation since their opening. METHODOLOGY: a retrospective study was carried out, checking out all HA1 masculine diagnosed patients of clinical records from 1981-2005. RESULTS: 35 patients were diagnosed, with an average age of 50 and a predominance of men (82%). The main reason for starting the HA1 masculine study was persistent hypertension; other reasons were hypertension and hypopotassemia (34%). Sixteen of the cases were adenomas (7 classic adenomas and 9 renin-dependents) and fourteen of them were hyperplasia (10 bilateral hyperplasias and 4 primary adrenals hyperplasia). Five cases were excluded because they were waiting for complementary tests. For location diagnosis, gammagrafía I131cholesterol was the test showing more agreement with final diagnosis, and then RMN and TAC. In eight of the cases, an adrenal vein sampling was made. Ten of sixteen adenomas suffered a surgery performance. The result showed standardization of tensional levels, without any treatment in 60% of the cases. The rest of them are currently treated with spironolactone under an appropriate tensional control. Gynecomastia was the most usual adverse effect found. CONCLUSION: Contrary to other published papers, we found out a male predominance in our database. A similar incidence of adenomas e hyperplasias was obtained. The most usual way of appearance was persistent hypertension to treatment. Adenomas surgery does not imply healing results, though it achieves a better tensional levels control, using less drugs and diminishing aldosterone levels. It implies a descent in myocardic and vascular toxicity.

[The start of renal replacement therapy in a Spanish department]. / Comienzo de tratamiento renal sustitutivo en la provincia de Cáceres.

BACKGROUND: Early nephrological referral and planned start of dialysis are associated with better prognosis after the beginning of renal replacement therapy (RRT). The aim of our study was to analyse patient clinical and analytic characteristics at the time of initiating dialysis and to evaluate if morbimortality was affected by planned start. PATIENTS AND METHODS: We performed a retrospective study of all patients commencing RRT in a Spanish Hospital of The National Health System over two years (2003-2004). A total of 117 patients (47 female and 70 male) were included. We carried out a retrospective analysis of the demographic characteristics, patients' clinical and analytic conditions at the time of starting dialysis and hospitalization days and mortality in six months after starting dialysis. Patients were classified as planned (P) or unplanned (NP), depending on whether the first dialysis was planned or an emergency. RESULTS: Sixty five patients (56.4%) started dialysis in a planned group while 52 (43.6%) were unplanned. In the former group, 83.1% of the patients had a vascular or peritoneal access available when starting RRT, whereas in the later group only the 3.8% had it. Planned dialysis initiation was associated with a high level of serum haemoglobin, haematocrit, calcium and albumin (p < 0.001), and a low level of serum urea, creatinine (p < 0.001) and phosphate (p < 0.05). More patients of the unplanned group were admitted at hospital at the initiation of dialysis (90.4% vs. 6.1%) and during the first 6 months (48% vs. 15.3%). The period of hospitalization was longer for the unplanned group (23.6 days vs 3 days) (p < 0.001). The 6-month-mortality was lower in the planned group (4.6% vs. 11.5%), whitout statistical difference. CONCLUSIONS: Planned dialysis initiation is associated with better clinical and metabolical conditions, greater probability of a vascular or peritoneal access availability and lower rate of hospitalization and mortality within 6 months after starting RRT

Comienzo de tratamiento renal sustitutivo en la provincia de Cáceres / The start of renal replacement therapy in a spanish department

Introducción: La derivación precoz al nefrólogo y el inicio programado de diálisisse asocian a un mejor pronóstico tras el comienzo del tratamiento renal sustitutivo(TRS). El objetivo de nuestro estudio fue analizar las características clínicasy analíticas de los pacientes al comienzo de diálisis y valorar si el inicioprogramado influía en la morbi-mortalidad a los 6 meses.Pacientes y métodos: Estudio retrospectivo que incluye los 117 pacientes queiniciaron TRS en nuestra provincia en los años 2003-2004 (47 mujeres y 70 varones).Se revisaron las características demográficas, los datos clínicos y analíticosal inicio, los ingresos hospitalarios y la mortalidad a los 6 meses. Los pacientes sedividieron en programados (P) y no programados (NP) dependiendo si la primeradiálisis se realizó en situación de urgencia (NP) o si pudo ser diferida en eltiempo más de 24 horas (P).Resultados: Sesenta y cinco pacientes comenzaron TRS de forma programada(56,4%) y 52 de forma no programada (43,6%). Los pacientes P presentaban accesovascular o peritoneal útil en un porcentaje mayor (83,1% vs 3,8%). El inicioprogramado de diálisis se asoció a un nivel más elevado de hemoglobina, hematocrito,calcio y albúmina (p < 0,001), y a una tasa más baja de urea, creatinina(p < 0,001) y fósforo (p < 0,05). Un menor número de pacientes del grupo P requirieroningreso al inicio de TRS (6,1% vs 90,4%), y también entre el 2° y el6° meses (15,3% vs 48%). Los días de hospitalización fueron significativamenteinferiores en el grupo programado (3 vs 23,6) (p < 0,001). Aunque no hubo diferenciasestadísticamente significativas, la mortalidad a los 6 meses fue menor enel grupo programado (4,6% vs 11,5%).Conclusiones: El inicio programado de diálisis se asocia a una mejor situaciónclínico-metabólica, una mayor probabilidad de acceso útil y un menor número dehospitalizaciones y tasa de mortalidad en los 6 meses posteriores

Background: Early nephrological referral and planned start of dialysis are associatedwith better prognosis after the beginning of renal replacement therapy (RRT). The aim of our study was to analyse patient clinical and analytic characteristicsat the time of initiating dialysis and to evaluate if morbimortality was affected byplanned start.Patients and methods: We performed a retrospective study of all patients commencingRRT in a Spanish Hospital of The National Health System over two years(2003-2004). A total of 117 patients (47 female and 70 male) were included. Wecarried out a retrospective analysis of the demographic characteristics, patients’ clinicaland analytic conditions at the time of starting dialysis and hospitalizationdays and mortality in six months after starting dialysis. Patients were classified asplanned (P) or unplanned (NP), depending on whether the first dialysis was plannedor an emergency.Results: Sixty five patients (56.4%) started dialysis in a planned group while 52(43.6%) were unplanned. In the former group, 83.1% of the patients had a vascularor peritoneal access available when starting RRT, whereas in the later grouponly the 3.8% had it. Planned dialysis initiation was associated with a high levelof serum haemoglobin, haematocrit, calcium and albumin (p < 0.001), and a lowlevel of serum urea, creatinine (p < 0.001) and phosphate (p < 0.05). More patientsof the unplanned group were admitted at hospital at the initiation of dialysis(90.4% vs 6.1%) and during the first 6 months (48% vs 15.3%). The periodof hospitalization was longer for the unplanned group (23.6 days vs 3 days) (p <0.001). The 6-months-mortality was lower in the planned group (4.6% vs 11.5%),whitout statistical difference.Conclusions: Planned dialysis initiation is associated with better clinical and metabolicalconditions, greater probability of a vascular or peritoneal access availabilityand lower rate of hospitalization and mortality within 6 months after starting RRT

Inicio de diálisis en una provincia española / No disponible

No disponible

Síndrome hemolítico urémico, descenso de C3 y ANCA positivos / No disponible

No disponible

Nefropatía membranosa y espondilitis anquilopoyética

No disponible

[Renal histological lesions in patients with type II diabetes mellitus]. / Lesiones histológicas renales en pacientes con diabetes mellitus tipo II.

Diabetic glomerulosclerosis is the most frequent cause of renal disease in patients with type II diabetes mellitus (DM), sometimes accompanied by vascular lesions. However, other glomerular pathologies are important in these patients. The aim of this study was to evaluate the prevalence of non-diabetic nephropathy (NDN) in selected patients with type II DM, and to identify clinical markers that may predict its presence in this population. We reviewed 20 renal biopsies performed on twenty patients with type II DM. Nine of them showed diabetic nephropathy (DN) (45%), whereas eleven showed NDN (55%): 1 IgA nephropathy, 3 vasculitis and 7 membranous nephropathy. We found no differences between the two groups with regard to sex, duration of DM, insulin therapy, glycosylated haemoglobin, proteinuria, presence of nephrotic syndrome, hypertension, serum IgA level or renal size. The NDN group had haematuria in 63.6%, whereas the patients with NDN had it in 44.4% (NS). Body mass index was higher in NDN patients (30 +/- 6.7 vs 22 +/- 2.9; p < 0.01), The same was true for creatinine clearance (82.2 +/- 51.4 ml/m vs 40.4 +/- 19.6 ml/m; p < 0.05). The age at the moment of diagnosis was higher in ND patients (67 +/- 11.2 vs 54.3 +/- 4.6; p < 0.05). The 3 patients who had diabetic retinopathy were found to have DN on renal biopsy (diagnostic specificity = 100%), although 66.7% of the patients with diabetic glomerulopathy had no retinopathy. We conclude that patients with type II DM with renal findings suggesting non-diabetic renal disease frequently it have NDN, and a renal biopsy must be performed. The presence of retinopathy has a predictive value of 100% in predicting DN, therefore its existence may make this diagnostic procedure unneccesary.

Lesiones histológicas renales en pacientes con diabetes mellitus tipo II / Renal histologic lesions in patients with type II DM

La glomeruloesclerosis diabética es la causa más frecuente de afectación renal en pacientes con diabetes mellitus (DM) tipo II, muchas veces con lesiones vasculares. Sin embargo, no es despreciable la importancia de otras patologías glomerulares. El objetivo de este estudio ha sido evaluar la prevalencia de nefropatía no diabética (NND) en biopsias renales realizadas en pacientes seleccionados afectos de DM, e identificar marcadores clínicos que pueden predecir su presencia en esta población.Revisamos 20 biopsias realizadas a otros tantos pacientes con DM tipo II. Los criterios para su indicación fueron la ausencia de retinopatía, presencia de hematuria, insuficiencia renal de aparición reciente, inexplicada o de rápida progresión, proteinuria de comienzo brusco y DM de corta evolución (inferior a 3 años). De los 20 casos, nueve correspondieron a nefropatías diabéticas (ND) (45 por ciento) y 11 a NND (55 por ciento). Entre éstos, hubo una nefropatía IgA, 7 glomerulonefritis membranosas y 3 vasculitis. No encontramos diferencias en cuanto al sexo, tiempo de evolución de DM, insulinoterapia, HbA1c, proteinuria, presencia de síndrome nefrótico, HTA, valor de IgA sérica o tamaño renal. El grupo de la NND presentó microhematuria en el 63,6 por ciento frente al 44,4 por ciento de los pacientes con ND (NS).El índice de masa corporal fue más elevado en los pacientes con NND (30 ñ 6,7 vs 22 ñ 2,9; p < 0,01), al igual que el CCr (82,2 ñ 51,4 ml/m vs 40,4 ñ 19,6 ml/m; p < 0,05), Aquéllos con ND tenían una edad más avanzada (67 ñ 11,2 vs 54,3 ñ 4,6; p < 0,05).Los 3 pacientes que mostraron retinopatía presentaron una ND en la biopsia renal (especificidad diagnóstica del 100 por ciento), aunque el 66,7 por ciento de los pacientes con glomeruloesclerosis diabética carecían de retinopatía.Podemos concluir que los pacientes con DM tipo II con signos clínicos de enfermedad renal no diabética, tales como insuficiencia renal de reciente comienzo o de rápida evolución, proteinuria de inicio brusco, presencia de sintomatología sistémica, ANCA positivo o sedimento patológico, presentan una incidencia de ésta lo suficientemente elevada como para justificar la realización de una biopsia renal. Aunque el número de pacientes es escaso, la presencia de retinopatía tiene un valor predictivo del 100 por ciento para la ND, por lo que su existencia podría obviar esta prueba diagnóstica. (AU)

Fracaso renal agudo debido a intoxicación por paracetamol / Acute renal failure secondary to paracetamol intoxication

La intoxicación por paracetamol se manifiesta clásicamente por hepatotoxicidad, siendo la insuficiencia renal un evento inusual, sobre todo en ausencia de daño hepático fulminante o alteraciones hemodinámicas severas. Presentamos el caso de una mujer de 22 años que, tras la ingestión de 11,5gramos de acetaminofén presentó un fracaso renal agudo. El curso clínico y los datos de laboratorio apoyaron el diagnóstico de necrosis tubular aguda. La paciente precisó hemodiálisis, pero la recuperación de la función renal fue completa. Revisamos el metabolismo del paracetamol y las posibles causas de fallo renal en los casos de ingesta masiva de dicho fármaco (AU)

Paracetamol poisoning is manifested by hepatotoxicity, but acute renal failureis very rare, especially when there is no fulminant hepatic damage with encephalopathy or severe haemodynamic alterations. We present here the case of a 22-year-old woman who presented with acuterenal failure after the ingestion of 11.5 g of acetaminophen. The clinical course and laboratory data were consistent with tubular necrosis. The patient required hemodialysis, but finally renal function returned to normal. The acetaminophen pharmacology and the differential diagnosis of acute azotemia in paracetamol overdosage are reviewed (AU)

[Remission of nephrotic syndrome caused by renal amyloidosis secondary to pulmonary tuberculosis after tuberculostatic treatment]. / Remisión de síndrome nefrótico por amiloidosis renal secundaria a tuberculosis pulmonar tras tratamiento tuberculostático.

Secondary systemic amyloidosis is a frequent complication in several chronic infectious and inflammatory states. Although initially amyloidosis was described in association with long-standing syphilis and tuberculosis, with the introduction of antiboitic and antituberculous therapy, rheumatoid arthritis is now the commonest cause of this illness. We present here the case of a 16 year-old woman, who was diagnosed one month ealier with pulmonary tuberculosis. She developed a nephrotic syndrome and her kidney biopsy confirmed the presence of amyloid. Treatment of the tuberculosis was accompanied by clinical remission of the nephrotic syndrome two years later.