Experience and Utility of the Protocol Kidney Biopsy in the First Year of Kidney Transplantation.

BACKGROUND: Protocol kidney biopsy (PKB) in kidney transplant is a useful tool for graft monitoring because the subclinical detection of histologic lesions helps to modulate immunosuppression. We analyze our experience. METHODS: We performed a descriptive study that analyzed the PKB results at the fourth to sixth month and the first year post transplant of patients with kidney transplant followed in our hospital between January 2015 and June 2021. RESULTS: A total of 100 patients and 134 biopsy results were included, of which 71 were obtained between the fourth and sixth month and 63 at the first year. The mean age was 57.8 years, and 66% were men. Unknown etiology was the most common underlying kidney disease (31%), followed by diabetes mellitus (15%) and polycystic kidney disease (14%). A total of 80% had panel-reactive antibody < 50%. Induction therapy consisted of thymoglobulin (51%) and basiliximab (49%), and maintenance therapy consisted of corticosteroids and tacrolimus (100%), mycophenolate mofetil (82%), and mammalian target of rapamycin inhibitor (18%). Of the total of the PKB results (n = 134), 19 episodes of subclinical rejection (14%) and 10 with borderline changes (7.4%) were observed. Regarding other findings, there were cases of nephrocalcinosis (4.4%), immunoglobulin A nephropathy (2.2%), and BK nephropathy (1.5%). The PKB brought about a change in the therapeutic attitude in 45 cases (33%) of the total number of biopsies, the most frequent change being the administration of boluses of methylprednisolone (12.6%) and the change to mammalian target of rapamycin inhibitor (8.9%). CONCLUSIONS: In our experience, PKB is a useful tool for monitoring and evaluating histologic changes without clinical expression in the kidney graft, allowing us to adapt the treatment during the first year of kidney transplant.

Regional differences in the prevalence of someg lomerulopathies on the Canary Islands

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[Characteristics of the diabetic patients referred for the first time to the nephrologist]. / Características de los pacientes diabéticos referidos por primera vez a las consultas de atención especializada de Nefrología.

BACKGROUND: Diabetic nephropathy (DN) has become the main cause of end-stage renal disease. In our country, this problem is specially relevant in Canary Islands, where DN is the cause of renal failure in 39% of patients included in dialysis programs. The importance of this situation and the relevance of an adequate referral to the nephrologist, prompt us to study the characteristics of diabetic patients referrred to our outpatient clinic. SUBJECTS AND METHODS: One-hundred and fifty patients with diabetes consecutively referred to the outpatient nephrology clinic at the Hospital Universitario Nuestra Señora de Candelaria were included in the study. We analysed demographic and epidemiologic characteristics, therapeutic strategies, as well as serum and urine biochemical parameters. RESULTS: Ninety-eight percent of patients suffered from type 2 diabetes, and 90% were referred by the primary physician. Renal insufficiency and proteinuria were the main causes of referral (48% and 30.6%, respectively). Overweight or obesity were present in 82.6% of patients, 97% were hypertensive and 92.6% presented dyslipidemia. Medical history of cardiovascular disease was present 16% of patients. Two-thirds of patients had a creatinine clearance below 60 ml/min. One-third of patients did not receive therapy with blockers of the renin-angiotensin system, and only 37% were treated with statins. CONCLUSIONS: An elevated percentage of diabetic patients referred to nephrologist did not reach the recommended therapeutic goals. These findings prompt us to reflect on the therapeutic approach in these patients and the referral to the nephrologist.

Desfibrilador automático implantable en pacientes en hemodiálisis / Automatic implantable cardioverter defibrillator in hemodialysis patients

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Características de los paciente diabéticos referidos por primera vez a las consultas de atención especializada de Nefrología / Characteristics of the diabetic patients referred for the first time to the nephrologist

Introducción: La nefropatía diabética (ND) se ha convertido en la primera causa de insuficiencia renal crónica en nuestro país. Esta patología es especialmente relevante en las Islas Canarias, donde el porcentaje de pacientes en programas de diálisis con ND como enfermedad de base era a 31 de diciembre de 2005 del 39%. Dada la importancia de esta situación, y la trascendencia que en los últimos años ha cobrado la problemática relacionada con la remisión de los pacientes con enfermedad renal a los servicios de Nefrología, el objetivo del presente estudio ha sido analizar las características de la población diabética que es derivada a las unidades de atención especializada de Nefrología. Pacientes y Métodos: Estudio de los 150 primeros pacientes diabéticos que, a partir de octubre de 2001, fueron remitidos de forma consecutiva a las consultas de Nefrología del Hospital Universitario Nuestra Señora de Candelaria de Santa Cruz de Tenerife. Se realizó una historia clínica y exploración física completas, se recogieron datos relativos a las pautas terapéuticas, se realizó una analítica de sangre y orina de 24 horas. Resultados: El 98% de los pacientes eran diabéticos tipo 2, y en el 90% de los casos fueron remitidos por su médico de Atención Primaria. La presencia de insuficiencia renal y de proteinuria fueron los dos motivos más frecuentes de derivación (48% y 30,6%, respectivamente). El 82,6% de los pacientes presentaba sobrepeso u obesidad, el 88% hipertensión arterial y el 92,6% dislipemia. Un 16% de los pacientes 6% presentaba algún antecedente de enfermedad cardiovascular. Dos tercios de los pacientes presentaban un aclaramiento de creatinina inferior a 60 ml/min. Un tercio de los pacientes no recibían tratamiento con bloqueadores del sistema renina-angiotensina, y sólo un 37% estaban tratados con estatinas. Conclusiones: Un elevado porcentaje de los pacientes diabéticos remitidos a los Servicios de Nefrología no presenta un cumplimiento adecuado de los objetivos terapéuticos. Es preciso reflexionar sobre la actitud terapéutica en estos pacientes y su remisión al nefrólogo

Background: Diabetic nephropathy (DN) has become the main cause of endstage renal disease. In our country, this problem is specially relevant in Canary Islands, where DN is the cause of renal failure in 39% of patients included in dialysis programs. The importance of this situation and the relevance of an adequate referral to the nephrologist, prompt us to study the characteristics of diabetic patients refered to our outpatient clinic. Subjects and methods: One-hundred and fifty patients with diabetes consecutively referred to the outpatient nephrology clinic at the Hospital Universitario Nuestra Señora de Candelaria were included in the study. We analysed demographic and epidemiologic characteristics, therapeutic strategies, as well as serum and urine biochemical parameters. Results: Ninety-eight percent of patients suffered from type 2 diabetes, and 90% were referred by the primary physician. Renal insufficiency and proteinuria were the main causes of referral (48% and 30.6%, respectively). Overweight or obesity were present in 82.6% of patients, 97% were hypertensive and 92.6% presented dyslipidemia. Medical history of cardiovascular disease was present 16% of patients. Two-thirds of patients had a creatinine clearance below 60 ml/min. One-third of patients did not receive therapy with blockers of the renin-angiotensin system, and only 37% were treated with statins. Conclusions: An elevated percentage of diabetic patients referred to nephrologist did not reach the recommended therapeutic goals. These findings prompt us to reflect on the therapeutic approach in these patients and the referral to the nephrologist

Acceso vascular central para hemodiálisis y disfonía / No disponible

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