RESUMEN
Focal segmental glomerular sclerosis (FSGS) is 1 of the primary causes of nephrotic syndrome in both pediatric and adult patients, which can lead to end-stage kidney disease. Recurrence of FSGS after kidney transplantation significantly increases allograft loss, leading to morbidity and mortality. Currently, there are no consensus guidelines for identifying those patients who are at risk for recurrence or for the management of recurrent FSGS. Our work group performed a literature search on PubMed/Medline, Embase, and Cochrane, and recommendations were proposed and graded for strength of evidence. Of the 614 initially identified studies, 221 were found suitable to formulate consensus guidelines for recurrent FSGS. These guidelines focus on the definition, epidemiology, risk factors, pathogenesis, and management of recurrent FSGS. We conclude that additional studies are required to strengthen the recommendations proposed in this review.
Asunto(s)
Glomeruloesclerosis Focal y Segmentaria , Trasplante de Riñón , Síndrome Nefrótico , Adulto , Humanos , Niño , Glomeruloesclerosis Focal y Segmentaria/diagnóstico , Glomeruloesclerosis Focal y Segmentaria/epidemiología , Glomeruloesclerosis Focal y Segmentaria/etiología , Esclerosis/complicaciones , Trasplante de Riñón/efectos adversos , Trasplante Homólogo/efectos adversos , Síndrome Nefrótico/diagnóstico , Síndrome Nefrótico/etiología , Síndrome Nefrótico/terapia , Recurrencia , PlasmaféresisRESUMEN
INTRODUCTION: Arteriovenous fistulas (AVF) are the preferred choice for vascular access in hemodialysis. We aim to identify factors that may contribute to AVF failure. METHODS: Data regarding AVF survival were collected from 441 patients. All AVFs were either radial or brachial, of the end-to-side variety. Parameters studied were age, gender, diabetes mellitus, hypertension prior to end-stage kidney disease (ESKD), site of fistula, blood flow rate, venous pressure, dialysis vintage and frequency, needle gauge used during dialysis, year of fistula creation, and details of fistula failure. FINDINGS: The 6-month, 1-year and 2-year AVF survival rates were 98.41%, 95.01%, and 89.57%. Failure rates were 17.2%, 5.5%, 26.8%, and 14.4% for dominant radial, non-dominant radial, dominant brachial and non-dominant brachial respectively (P < 0.001). Using a larger needle size had better AVF survival rate (P < 0.05). All other factors had no significant correlation with AVF failure. CONCLUSION: There were no statistically significant differences in AVF patency with respect to gender, age, blood flow rate, presence of diabetes mellitus or systemic hypertension. A distally placed AVF in the nondominant arm had the best survival rate. Using a larger needle size, specifically 15G during dialysis, was associated with lowest AVF failure.