Preservación de la función renal residual en diálisis peritoneal mediante bloqueo del receptor de angiotensina / No disponible

La conservación de la Función Renal Residual (FRR) tras el inicio de la diálisis peritoneal (DP) es esencial, tanto para la supervivencia del paciente como para la de la técnica. Los métodos de nefroprotección de eficacia probada en la insuficiencia renal crónica podrían mantener su eficaciatras el inicio de la diálisis. Este estudio demuestra que elcandesartán a dosis entre 16 y 32 mg/día es bien tolerado en pacientes normotensos en DP, y que reduce la progresión de la insuficiencia renal desde 8 mL/min/año en el período prediálisis hasta 2 mL/min/año tras iniciar la DP. La proteinuria también se reduce a la mitad al final del primer año, sin que se aprecien efectos perjudiciales sobre el control de la anemia. Concluimos que el bloqueo del receptor de angiotensina debe mantenerse tras el inicio de la DP, con independencia del control tensional, a fin de reducir el deterioro de la FRR en estos pacientes (AU)

Preservation of residual renal function (RRF) after the start of peritoneal dialysis (PD) is essential for both patient and technique survival. Nephroprotection methods of proven efficacy in chronicrenal failure may maintain their efficacy after the start of dialysis. This study shows that candesartan, at doses ranging from 16and 32 mg/day, is well tolerated in normotensive patients on PD and reduces progression of renal failure from 8 mL/min/year in the pre-dialysis period to 2 mL/min/year after PD start. Proteinuriais also decreased to a half at the end of the first year, with no harmful effects seen on anemia control. It is concluded that angiotensin receptor blockade should be maintained after the start of PD, irrespective of blood pressure control, in order to reduce RRF impairment in these patients (AU)

[Preservation of residual renal function in peritoneal dialysis by angiotensin receptor blockade]. / Preservación de la función renal residual en diálisis peritoneal mediante bloqueo del receptor de angiotensina.

Preservation of residual renal function (RRF) after the start of peritoneal dialysis (PD) is essential for both patient and technique survival. Nephroprotection methods of proven efficacy in chronic renal failure may maintain their efficacy after the start of dialysis. This study shows that candesartan, at doses ranging from 16 and 32 mg/day, is well tolerated in normotensive patients on PD and reduces progression of renal failure from 8 mL/min/year in the pre-dialysis period to 2 mL/min/year after PD start. Proteinuria is also decreased to a half at the end of the first year, with no harmful effects seen on anemia control. It is concluded that angiotensin receptor blockade should be maintained after the start of PD, irrespective of blood pressure control, in order to reduce RRF impairment in these patients.

Association of idiopathic retroperitoneal fibrosis, rapidly progressive glomerulonephritis and antiproteinase 3 antineutrophil cytoplasmic antibodies (anti PR3-ANCA).

We report a case of idiopathic retroperitoneal fibrosis and rapidly progressive glomerulonephritis with serum antiproteinase 3 antineutrophil cytoplasmic antibodies (anti-PR3-ANCA), without clinical or histological signs of Wegener's granulomatosis, in a 46-year-old man. Our case and previously reported cases showing the same association support the hypothesis that the association is not fortuitous, but reflects a common immunological mechanism.

[Dialysis and transplant. Spain in 2005]. / Informe de Situación de Diálisis y Trasplante en España, 2005.

In 2005, renal replace treatment (dialysis and transplant) was necessary for about 40,000 people, without being known the number accurate and either their basic characteristics, such as: time in treatment, modality or treatment changes. The presented data cover the 76% of the Spanish population and are the result of the cooperation among technicians of registries, nephrologists and transplant coordinations. 4,125 people started RRT in 2005, the total estimated acceptance rate for renal replacement therapy in adults in Spain was 126 pmp and regarding other European countries it locates us in an intermediate area. The incidence rate seems to keep stable in the last years although there were some differences among communities (from 104 pmp in Castile and Leon to 186 pmp in Canary Islands). Diabetes Mellitus is the most diagnosed cause of renal failure in 2005, more than 20% of patients, followed by vascular diseases. The estimated prevalence of renal replacement therapy in Spain at the end of 2005 was 903 pmp, with important variations among communities (from 806 pmp in Cantabria to 1056 pmp in Valencia Region). The 47% of prevalent RRT patients had a functioning transplant. Mortality on haemodialysis and peritoneal dialysis was 13.7% and 10.8% respectively. Mortality on transplant was 1.3%, one of the lowest values registered so far. Mortality on renal replacement therapy was around 5% among patients from 45 to 64 years, 11% between 65 and 74 years and 19% among the patients older than 75 years.

[Pulmonary infection caused by Rhodococcus equi in a renal transplant recipient]. / Infección pulmonar por Rhodococcus equi en un trasplantado renal.

Rhodococcus equi is a primarily pathogen in animals and it has only rarely been seen in immunocompromised humans. We describe our experience with an HIV-negative patient with a functioning renal graft under cyclosporin-azathioprine-prednisone therapy. The patient died after a two months recurrent multifocal pneumonia. The cultures from sputum and blood were negatives but R. equi was isolated from lungs in the necropsy. Most of the 41 cases we had found in the literature had AIDS or HIV infection. Six cases had a kidney graft under azathioprine-prednisone therapy. Rhodococcus equi infection may be missed in some instances due to incomplete or improper identification of the organism, that grows well in aerobic media but is usually regarded as a component of normal flora or as a contaminant. The ability of R. equi to persist in and eventually to destroy macrophages is the basis of its pathogenicity. It also explains the clinical resistance to antibiotics without intracellular activity. Rhodococcus equi infection must be suspected in immunocompromised patients with recurrent pneumonia. Correct identification and combined therapy with lipophilic antibiotics that penetrate the macrophages are necessary to prevent the high mortality of this infection.