Enfermedad por citomegalovirus en los pacientes inmunodeprimidos por glomerulonefritis necrosante pauciinmune / Cytomegalovirus disease in immunosuppressed patients with necrotizing pauci-immune glomerulonephritis

Introducción: La afectación renal por glomerulonefritis necrosante pauciinmune (GNPI) asociada a vasculitis de pequeño vaso requiere tratamiento inmunodepresor, cuyos efectos secundarios incluyen un mayor riesgo de procesos infecciosos, como la enfermedad por citomegalovirus (CMV), aunque no hay recomendaciones sobre su manejo en las guías de práctica clínica (GPC).ObjetivoEstudiar la incidencia de enfermedad por CMV y sus determinantes.Pacientes y métodosPacientes con diagnóstico histológico de GNPI en los últimos 10 años, determinando la carga viral de CMV y analizando los determinantes de su concurrencia.ResultadosSe realizaron 44 biopsias durante el periodo de estudio. Del total, 11 pacientes (25%) desarrollaron enfermedad por CMV; todos habían recibido tratamiento inmunodepresor. Cuatro (30,8%) fallecieron durante el ingreso. Los factores determinantes de la enfermedad fueron la edad (por cada 10 años OR: 3,0, IC 95%: 1,0 a 8,9, p = 0,012) y la albúmina (por cada g/L OR: 0,8, IC 95%: 0,6 a 1,0, p = 0,012).ConclusionesLa incidencia de enfermedad por CMV en pacientes inmunodeprimidos por GNPI es alta, con alta mortalidad. Sería necesario incluir estrategias en las GPC para prevenir su desarrollo. (AU)

Introduction: Renal involvement due to necrotizing pauci-immune glomerulonephritis (PIGN) associated with small vessel vasculitis requires the use of immunosuppressive. Associated side effects include an increased risk of infectious processes, such as cytomegalovirus (CMV) disease; therefore, there are no recommendations on its management in the various clinical practice guidelines (CPG).ObjectiveTo study the incidence of CMV disease and its determinants.Patients and methodsPatients with histological diagnosis of necrotizing pauci-immune glomerulonephritis in the last 10 years, who were determined the viral load of CMV, analyzing the determinants of its occurrence.ResultsForty-four biopsies were performed during the study period. Eleven patients (25%) developed CMV disease; all had received immunosuppressive treatment. Four (30.8%) died during admission. The determinants of CMV disease were age (for every 10 years OR: 3.0, 95% CI: 1.0-8.9, p = 0.012), and plasma albumin (for each g/L OR: 0.8, 95% CI: 0.6-1.0, p = 0.012).ConclusionsThe incidence of CMV disease in immunocompromised patients due to PIGN is high, with high mortality. It would be necessary to include strategies in the CPGs to prevent it. (AU)

[Cytomegalovirus disease in immunosuppressed patients with necrotizing pauci-immune glomerulonephritis]. / Enfermedad por citomegalovirus en los pacientes inmunodeprimidos por glomerulonefritis necrosante pauciinmune.

INTRODUCTION: Renal involvement due to necrotizing pauci-immune glomerulonephritis (PIGN) associated with small vessel vasculitis requires the use of immunosuppressive. Associated side effects include an increased risk of infectious processes, such as cytomegalovirus (CMV) disease; therefore, there are no recommendations on its management in the various clinical practice guidelines (CPG). OBJECTIVE: To study the incidence of CMV disease and its determinants. PATIENTS AND METHODS: Patients with histological diagnosis of necrotizing pauci-immune glomerulonephritis in the last 10 years, who were determined the viral load of CMV, analyzing the determinants of its occurrence. RESULTS: Forty-four biopsies were performed during the study period. Eleven patients (25%) developed CMV disease; all had received immunosuppressive treatment. Four (30.8%) died during admission. The determinants of CMV disease were age (for every 10 years OR: 3.0, 95% CI: 1.0-8.9, p = 0.012), and plasma albumin (for each g/L OR: 0.8, 95% CI: 0.6-1.0, p = 0.012). CONCLUSIONS: The incidence of CMV disease in immunocompromised patients due to PIGN is high, with high mortality. It would be necessary to include strategies in the CPGs to prevent it.

Anti-Glutathione S Transferase T1 Antibodies After Renal Transplant and Their Impact on Graft Outcome.

OBJECTIVES: Anti-glutathione S transferase T1 (GSTT1) antibodies, a type of non-HLA antibody, have been associated with chronic hepatic graft rejection. Despite the presence of this enzyme in the kidney, there are not enough studies on the development of anti-GSTT1 antibodies and their impact on renal grafts. Our objective was to evaluate the presence of anti-GSTT1 antibodies after renal transplant and their impact on graft outcomes. MATERIALS AND METHODS: We conducted an ambispective cohort study. We performed real-time polymerase chain reaction to screen for GSTT1 alleles in 293 recipients and their donors. In null GSTT1 (GSTT1*0) genotype recipients of GSTT1-positive donors, the presence of anti-GSTT1 antibodies was evaluated using indirect immunofluorescence and Luminex assays, and their effects on graft function were evaluated. The median follow-up period was 54.3 months. RESULTS: Of the 293 patients studied, 42 recipients (14.4%) with GSTT1-positive donors did not have the GSTT1 allele (GSTT1-positive donor/GSTT1*0 recipient). Using Luminex assay, we detected antibodies in 16 patients (38.1%), 12 of which were already present at the time of transplant. Of these cases, 37.5% with antibodies had undergone a previous renal transplant. Using indirect immunofluorescence, we found that only 12 patients tested positive, 4 at the time of transplant. Antibody presence did not effect graft glomerular filtration rates or graft loss at 1 year, at 2 years, or end of follow-up. CONCLUSIONS: The presence of anti-GSTT1 antibodies is frequent in renal transplant GSTT1*0 recipients of GSTT1-positive donors but has no effects on graft outcome.

Efecto del cambio en el peso tras el trasplante renal en la supervivencia del injerto / Effect of weight change after renal transplantation on outcomes of graft survival

Antecedentes y objetivo: Tras el trasplante renal se produce de manera global un incremento del peso pudiendo aumentar el riesgo de enfermedad renal crónica (ERC) y de pérdida del injerto. Pero no todos los pacientes ganan peso, y la repercusión sobre el injerto de esta diferente evolución, no está bien estudiado. El objetivo fue determinar las causas de esta diferente evolución y su efecto sobre el injerto. Pacientes y métodos: Estudio de cohortes retrospectivo unicéntrico de 201 pacientes seguidos tras el trasplante, analizando los determinantes de la variación del peso al año mediante regresión logística, y su efecto sobre la pérdida del injerto al final del seguimiento mediante regresión de Cox. Resultados: Globalmente se produjo durante el primer año un aumento de peso de 4,5kg de media, pero un 26,6% perdieron peso. El 37,2% aumentó su índice de masa corporal (IMC), mientras que el 9,5% lo disminuyó. Los determinantes de la diferente evolución del peso fueron la edad (OR por cada 10 años: 0,6; p=0,002), la modalidad de diálisis previa (ref. hemodiálisis) (OR: 0,3; p=0,003) y el IMC previo al trasplante (OR: 0,9; p=0,003). La diferente evolución del peso no influyó en la pérdida del injerto. Sí influyeron el IMC al año como variable continua (HR: 1,3; p=0,003) y la obesidad, con peor evolución (HR: 7,0; p=0,025). Conclusiones: Aunque no todos los pacientes ganan peso tras el trasplante renal, la diferente evolución del peso no influye en la supervivencia del injerto. (AU)

Background and objective: After kidney transplantation, there is an overall increase in weight, which may increase the risk of chronic kidney disease (CKD) and graft loss. But, not all patients gain weight, and the impact on the graft of this different evolution has not been well studied. The objective was to determine the causes of this different evolution and its effect on the graft. Patients and methods: Retrospective single-center cohort study of 201 patients followed up after transplantation, analyzing the determinants of the variation in weight at one year using logistic regression, and its effect on graft survival at the end of follow-up using Cox regression. Results: Globally, there was an average weight gain of 4.5kg in the first year, but 26.6% lost weight. 37.2% increased their BMI, while 9.5% decreased it. The determinants of the different evolution of weight were age (OR for every 10 years: 0.6, P=.002), previous dialysis modality (ref. hemodialysis) (OR 0.3, P=.003), and BMI before transplantation (OR 0.9, P=.017). The different evolution of weight did not influence the final situation of the graft. The BMI at one year did influence as a continuous variable (HR 1.3, P=.003), and obesity, with a worse evolution (HR 7.0, P=.025). Conclusions: Although not all patients gain weight after kidney transplantation, the different evolution of weight does not influence graft survival. (AU)

Effect of weight change after renal transplantation on outcomes of graft survival.

BACKGROUND AND OBJECTIVE: After kidney transplantation, there is an overall increase in weight, which may increase the risk of chronic kidney disease (CKD) and graft loss. But, not all patients gain weight, and the impact on the graft of this different evolution has not been well studied. The objective was to determine the causes of this different evolution and its effect on the graft. PATIENTS AND METHODS: Retrospective single-center cohort study of 201 patients followed up after transplantation, analyzing the determinants of the variation in weight at one year using logistic regression, and its effect on graft survival at the end of follow-up using Cox regression. RESULTS: Globally, there was an average weight gain of 4.5 kg in the first year, but 26.6% lost weight. 37.2% increased their BMI, while 9.5% decreased it. The determinants of the different evolution of weight were age (OR for every 10 years: 0.6, p = 0.002), previous dialysis modality (ref. hemodialysis) (OR 0.3, p = 0.003), and BMI before transplantation (OR 0.9, p = 0.017). The different evolution of weight did not influence the final situation of the graft. The BMI at one year did influence as a continuous variable (HR 1.3, p = 0.003), and obesity, with a worse evolution (HR 7.0, p = 0.025). CONCLUSIONS: Although not all patients gain weight after kidney transplantation, the different evolution of weight does not influence graft survival.

Effect of weight change after renal transplantation on outcomes of graft survival. / Efecto del cambio en el peso tras el trasplante renal en la supervivencia del injerto.

BACKGROUND AND OBJECTIVE: After kidney transplantation, there is an overall increase in weight, which may increase the risk of chronic kidney disease (CKD) and graft loss. But, not all patients gain weight, and the impact on the graft of this different evolution has not been well studied. The objective was to determine the causes of this different evolution and its effect on the graft. PATIENTS AND METHODS: Retrospective single-center cohort study of 201 patients followed up after transplantation, analyzing the determinants of the variation in weight at one year using logistic regression, and its effect on graft survival at the end of follow-up using Cox regression. RESULTS: Globally, there was an average weight gain of 4.5kg in the first year, but 26.6% lost weight. 37.2% increased their BMI, while 9.5% decreased it. The determinants of the different evolution of weight were age (OR for every 10 years: 0.6, P=.002), previous dialysis modality (ref. hemodialysis) (OR 0.3, P=.003), and BMI before transplantation (OR 0.9, P=.017). The different evolution of weight did not influence the final situation of the graft. The BMI at one year did influence as a continuous variable (HR 1.3, P=.003), and obesity, with a worse evolution (HR 7.0, P=.025). CONCLUSIONS: Although not all patients gain weight after kidney transplantation, the different evolution of weight does not influence graft survival.

Insuficiencia renal aguda secundaria a poliarteritis nudosa / Acute kidney failure due to polyarteritis nodosa

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Incidencia de bacteriemiaen pacientes portadoresde catéter permanente tunelizadopara hemodiálisis / Incidence of bacteriaemia in patients with permanent tunnelled haemodialysis catheters

La bacteriemia relacionada con el catéter es una de las principales complicaciones aumentando el riesgo de pérdida del catéter o incluso la muerte del paciente. La utilización de sellado de las luces del catéter con antibióticos o el empleo de mupirocin atópica en el orificio de salida del catéter ha demostrado disminuir la incidencia de bacteriemia; sin embargo, un manejo lo más aséptico posible del catéter es la principal herramienta para disminuir esta incidencia. Objetivo: evaluar la tasa de incidencia de bacteriemias en pacientes portadores de catéter tunelizado sin la utilización de sellado con antibióticos ni la utilización de mupirocina haciendo especial hincapié en la asepsia durante la manipulación. Se incluyeron todos los pacientes portadores de catéter tunelizado desde el 1 de enero al 31 de diciembre de 2007.En total fueron 17 pacientes, 4 hombres y 13 mujeres con una edad media de 71,3 (11,3) años. El protocolo consistía en la utilización de un campo los más aséptico posible, el uso de guantes cada vez que se manipulara el catéter, uso de mascarillas tanto por el manipulador como por el paciente y la desinfección del orificio de salida del túnel con clorhexidina, así como de ambas conexiones del catéter al comenzar y al finalizar la sesión. A fecha 31 de diciembre la prevalencia de pacientes con catéter tunelizado era del 38,5%. Durante el periodo de estudio se produjeron un total de 8 bacteriemiasen un total de 4462 días de seguimiento(tasa de incidencia de 1,8 bacteriemias/1000 catéter-día). Cuatro hemocultivos fueron positivo aStaphylococcus epidermidis, 1 a Corynebacterium,1 a Staphylococcus auricularis y 2 fueron negativos. No se produjo ninguna bacteriemia por Staphylococcus aureus ni tampoco algún signo de infección del orificio de salida (AU)

Catheter-r elated bacteriaemia is one of the main complications increasing the risk of loss of the catheter or even death of the patient. The use of sealing of the catheter lumen with antibiotics or the use of topical mupirocin on the exit orifice of the catheter have been proven to reduce the incident of bacteriaemia; however, the most aseptic possible handling of the catheter is the main tool for reducing this incidence. Goal: to assess the rate of incident of bacteriaeima in patients with permanent tunnelled haemodialysis catheters without the use of sealing with antibiotics or the use of mupirocin, and placing particular emphasison asepsis during handling. All patients with tunnelled catheters between 1st January and31st December 2007 were included. In total there were 17 patients, 4 men and 13 women with an average age of 71.3 (11.3) years. The protocol consisted of using as aseptic a field as possible, the use of gloves each time the catheter was handled, use of masks both by the handler and the patient and the disinfection of the tunnel exit orifice with chlorhexidine, and of both catheter connections at the start and finish of the session. At 31st December the prevalence of patientswith tunnelled catheters was 38.5%. During the period studied, a total of 8 bacteriaemias occurred in a total of 4462 days of monitoring (incidence rate of 1.8 bacteriaemias/1000catheter-days). Four blood cultures were positive for Staphylococcus epidermidis, 1 for Corynebacterium,1 for Staphylococcus auricularis and 2were negative. No other Staphylococcus aureusbacteriaemia occurred, nor any other sign of infection of the exit orifice. Conclusion: an a septicas possible handling of the catheter reduces the risk of bacteriaemia related to the catheter without the need to use sealing with antibiotics ortopical mupirocin (AU)