Peritonitis bacteriana espontánea como forma de presentación de síndrome nefrótico idiopático en un adulto de raza negra / Spontaneous bacterial peritonitis as form of presentation of idiopathic nephrotic syndrome in an adult black race

La peritonitis bacteriana espontánea es una complicación grave y observada a menudo en el síndrome nefrótico infantil. Sin embargo, en los adultos, pese a ser frecuentemente descrita en los textos de nefrología, es una complicación rara. En la revisión realizada sólo 16 casos están publicados con este tipo de complicación en adultos, y no hay ninguno descrito posterior al año 2000. A continuación exponemos el caso de un varón de 25 años, procedente de Senegal, con peritonitis bacteriana espontánea, fracaso renal agudo y coagulopatía por desnutrición como forma de presentación de un síndrome nefrótico florido. Además a través del caso aportado se discuten distintos aspectos de la epidemiología y del manejo de estos pacientes así como las últimas publicaciones sobre las opciones de tratamiento de la glomerulopatía responsable del cuadro

Spontaneous bacterial peritonitis is a serious and frequent complication in childhood nephrotic syndrome. However, this type of complication is very rare in adult nephrotic patients. In the review realized only 15 cases are published with this complication, and none of them after the year 2000. Later we expose the case of a male of 25 years old, proceeding of senegal, with spontaneous bacterial peritonitis, acute renal failure and coagulopatia for malnutrition as form of presentation of a nephrotic syndrome flowery. Besides across the contributed case different aspects of the epidemiology and of the managing of these patients are discussed as well as the last publications on the options of treatment of the glomerulopatia responsible of the clinical symptoms

[Spontaneous bacterial peritonitis as form of presentation of idiophatic nephrotic syndrome in a black adult]. / Peritonitis bacteriana espontánea como forma de presentación de síndrome nefrótico idiopático en un adulto de raza negra.

Spontaneous bacterial peritonitis is a serious and frequent complication in childhood nephrotic syndrome. However, this type of complication is very rare in adult nephrotic patients. In the review realized only 15 cases are published with this complication, and none of them after the year 2000. Later we expose the case of a male of 25 years old, proceeding of senegal, with spontaneous bacterial peritonitis, acute renal failure and coagulopatia for malnutrition as form of presentation of a nephrotic syndrome flowery. Besides across the contributed case different aspects of the epidemiology and of the managing of these patients are discussed as well as the last publications on the options of treatment of the glomerulopatia responsible of the clinical symptoms.

Our nine-year experience with the self-locating catheter: comparison of malfunction rate with other Tenckhoff catheter variants.

OBJECTIVE: To evaluate catheter-related complications among self-locating and other variants of Tenckhoff catheters. PATIENTS AND METHODS: We studied all self-locating catheters implanted in our hospitals from May/97 to Dec/05. We extended the follow-up to Jun/05. We collected demographic data, causes of catheter withdrawal and dropping of PD. We studied data about technique and catheter related complications. RESULTS: We included 328 catheters in 285 patients. There were 258 self-locating, 55 straight and 15 curled. There was a higher rate of catheter withdrawal due to malfunction in patients with straight or pig-tail catheters than in self-locating ones (log-rank, p < 0.001). CONCLUSION: In our patients, self-locating catheters have a lower malfunction rate than other variants of Tenckhoff catheters.

Iron deficiency--an underrecognized problem in nonanemic and erythrocytic kidney transplant recipients: risks and effects of ACEI and of iron treatment.

The state of iron deposits in long-term kidney graft recipients is not well-known. Angiotensin enzyme inhibitors (ACEIs) reduce hematocrit levels in patients with posttransplant erythrocytosis (PTE), but their action on iron deposits has not been sufficiently evaluated. We designed this study to investigate the prevalence of iron deficiency among patients without anemia, the efficacy of ACEI treatment and its influence on iron deposits, and the risks of iron treatment in patients with symptomatic iron deficiency but no anemia. One hundred thirty eight patients were included if they had a kidney transplant for more than a year, with good renal function, with no anemia, and with neither iron nor rHuEpo, ARA, or ACEI treatment. One hundred seventeen had a normal Ht (group 1) and 21 had PTE (group 2). Iron deficiency was found in 73 (62.4%) group 1 patients and in 10 (47%) group 2 patients. Two group 1 patients with symptoms of iron deficiency were treated with oral iron. Their symptoms disappeared, but one developed PTE. Enalapril treatment decreased Ht levels in PTE but not in control patients. Furthermore, this drug increased iron deposits in PTE and controls with a baseline iron deficiency. We conclude that there is a high prevalence of iron deficiency in long-term transplanted patients without anemia. Furthermore, iron treatment must be carefully administered because of the risk of PTE. Enalapril treatment decreased Ht levels in PTE but not in control patients and increased iron deposits in patients with baseline iron deficiency.

Influence of angiotensin-converting enzyme polymorphism gene, IGF-1, and other factors in the response rate of hematocrit to enalapril treatment in patients with posttransplant erythrocytosis.

A significant relationship between hematocrit values and serum parameters such as the insulin like growth factor (IGF-1) and calcium was observed in patients with posttransplant erythrocytosis (PTE). Since angiotensin-converting enzyme inhibitors (ACEI) decrease hematocrit (Ht) levels in these patients, ACE genotype should play an important role. We designed this study to investigate whether ACE genotype or baseline concentrations of IGF-1, IGF-blood binding protein 3 (BP3), growth hormone (GH), or Ca influenced the response of Ht to ACEI treatment. Twenty-one kidney graft recipients with PTE were treated with enalapril (2.5 to 5 mg/d) for 1 year. IGF-1, BP3, GH, Ca, and Ht were determined before as well as 15, 30, 90, 180, and 365 days after enalapril treatment. ACE polymorphism was also determined. Enalapril treatment significantly decreased Ht levels. Only IGF-1 baseline levels showed a positive correlation to the decreased Ht (P < .025). ACE genotype as determined in 18 patients, showed no correlation with the response to enalapril. Patients with ACE genotype II showed a tendency to an earlier display of PTE. We conclude that low doses of enalapril decrease Ht levels in PTE patients; that PTE begins earlier in patients with II ACE genotype; and that only IGF-1 baseline levels influence the Ht decrease after treatment. These observations suggest that ACEI decrease the Ht via an inhibitory effect on IGF-1, which has a stimulary effect on erythropoiesis.

Informe de diálisis y trasplante correspondiente al año 2002 de la Sociedad Española de Nefrología y Registros Autonómicos / The year 2002 Spanish Nephrology Society Report on Dialysis and Transplantation and Autonomic Registries

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Lower malfunction rate with self-locating catheters.

OBJECTIVE: We analyzed malfunction rates (obstruction, omental wrapping, displacement) and catheter survival for self-locating catheters as compared with other Tenckhoff catheter designs. PATIENTS AND METHODS: We conducted our survey at two centers, prospectively studying all self-locating catheters implanted from May 1997 to October 2000 and used for peritoneal dialysis (PD). Tenckhoff catheters of other designs used previously in our units were used as the control group. We analyzed removal causes and catheter survival. RESULTS: We studied 173 catheters (105 self-locating catheters, 53 straight catheters, and 15 coiled catheters) implanted in 139 patients (43% of them women) with a mean age of 53 +/- 14 years. The analysis of catheter removal showed that 3 of 105 self-locating catheters, 3 of 15 coiled catheters, and 17 of 53 straight catheters were removed owing to malfunction (chi2: p = 0.0000). Kaplan-Meier curves showed that the bulk of removals for malfunction occurred within the first 3 months after PD start. The group of self-locating catheters showed better survival (log-rank: p = 0.0009). Other causes for catheter removal included peritonitis (n = 22), exit-site infection alone (n = 4), and end of PD treatment (n = 66). No significant differences were seen in the annual peritonitis rate (straight-tip: 0.955 +/- 2.315 episodes annually; coiled-tip: 0.651 +/- 0.864 episodes annually; self-locating: 0.720 +/- 1.417 episodes annually; t-test: p > 0.400). No gut or bladder perforations were observed. CONCLUSION: In our survey, self-locating catheters were associated with better survival and fewer removals for malfunction than were Tenckhoff catheters of other designs.