RESUMEN
UNLABELLED: Experience with early corticosteroid withdrawal (CSWD) in renal transplant recipients with focal segmental glomerulosclerosis (FSGS) has not been previously reported. Since corticosteroids are used to treat primary FSGS, concern exists as to whether early CSWD regimens will be associated with an increased risk of FSGS recurrence posttransplant. The purpose of the present study was to evaluate the results of early CSWD in FSGS recipients and compare these results to a historic control group of FSGS patients who underwent renal transplantation under corticosteroid-based immunosuppression. METHODS: Forty-three patients with FSGS underwent renal transplantation with early CSWD. Results in these patients were compared to FSGS patients that underwent renal transplantation with chronic corticosteroid therapy. All rejection episodes were biopsy proven with grading by Banff criteria. Statistical analyses included Student's t test and chi square tests. RESULTS: Results in 43 patients with a median follow-up of 569 days were analyzed and compared to control patients. There was no significant difference in recurrent FSGS, time to recurrence, or graft loss. CONCLUSION: CSWD does not increase risk for recurrence of FSGS. These observations indicate that ECSW can be achieved in FSGS patients, thereby affording them the benefits of steroid elimination.
Asunto(s)
Corticoesteroides/uso terapéutico , Glomeruloesclerosis Focal y Segmentaria/patología , Trasplante de Riñón/patología , Corticoesteroides/administración & dosificación , Adulto , Creatinina/sangre , Esquema de Medicación , Estudios de Seguimiento , Glomeruloesclerosis Focal y Segmentaria/epidemiología , Humanos , Persona de Mediana Edad , Recurrencia , Factores de Riesgo , Factores de Tiempo , Insuficiencia del TratamientoRESUMEN
Behavioral syndromes that occur in patients with aphasic disorders without localizing neurologic signs may appear strikingly similar to psychiatric disorders. In the absence of abnormal physical findings, the predominance of psychiatric symptoms, such as avoidance/withdrawal, irritability/hostility, paranoia, or depression, can lead the busy primary care clinician and the unsuspecting psychiatrist away from an organic diagnosis. Through review of selected literature and case presentations, we provide guidelines for evaluating and correctly identifying aphasic disorders masked by complex behavioral syndromes.