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1.
Buenos Aires; Médica Panamericana; 2019. 184 p. tab, ilus.
Monografia em Espanhol | LILACS | ID: biblio-1006088

RESUMO

Las consultas pediátricas por enfermedad renal o de las vías urinarias son frecuentes e incluyen una amplia variedad diagnóstica que desafía al pediatra en su abordaje, la detección de riesgos en el corto y largo plazo, la derivación oportuna al especialista y el seguimiento de las condiciones que generaron cronicidad. En este nuevo volumen de las Series de Pediatría Garrahan se han reunido prestigiosos pediatras y nefrólogos infantiles para actualizar y trasnmitir el manejo integral de algunas de las patologías de mayor prevalencia e impacto, muchas de las cuales causan morbilidad alejada y requieren equipos multidisciplinarios que aseguren una transición en el cuidado del niño, el adolescente y el adulto. Entre sus caracterísitcas se destacan: El estudio detallado de patologías clínicas como las infecciones urinarias, la lesión renal aguda, el síndrome nefrótico, la enfermedad renal progresiva, las terapias de reemplazo renal y la hypertensión arterial. El desarrollo de casos clínicos con las secuencias habituales en el transcurso habitual de las enfermedades que permite destacar las presentaciones clínicas, las alternativas diagnósticas y terapéuticas, así como las posibilidades evolutivas. El cierre de cada capítulo con un recordatorio de puntos clave y lecturas recomendadas y, además, el material complementario disponible en el sitio web. El objetivo es compartir la modalidad de trabajo del hospital, con base en el rol central del pediatra como coordinador de la atención interdisciplinaria en cada una de sus etapas. Una obra actualizada y práctica que aporta información científica y experiencia de los profesionales de una institución de prestigio, de granutilidad para todos aquellos miembros del equipo de salud que atienden y cuidan niños, dondequiera que trabajen al servivio de la salud infantil.


Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Infecções Urinárias , Diálise Renal , Diálise Peritoneal , Insuficiência Renal Crônica , Lesão Renal Aguda , Síndrome Nefrótica
2.
Pediatr Nephrol ; 33(10): 1791-1798, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29961127

RESUMO

OBJECTIVES: (1) Evaluate mortality rate in patients with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome, (2) determine the leading causes of death, and (3) identify predictors of mortality at hospital admission. METHODS: We conducted a multicentric, observational, retrospective, cross-sectional study. It included patients under 18 years old with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome hospitalized between January 2005 and June 2016. Clinical and laboratory data were obtained from the Argentine National Epidemiological Surveillance System of Hemolytic Uremic Syndrome. Clinical and laboratory variables were compared between deceased and non-deceased patients. Univariate and multivariate analyses were performed. ROC curves and area under the curve were obtained. RESULTS: Seventeen (3.65%) out of the 466 patients died, being central nervous system involvement the main cause of death. Predictors of death were central nervous system involvement, the number of days since the beginning of diarrhea to hospitalization, hyponatremia, high hemoglobin, high leukocyte counts, and low bicarbonate concentration on admission. In the multivariate analysis, central nervous system involvement, sodium concentration, and hemoglobin were independent predictors. The best cut off for sodium was ≤ 128 meq/l and for hemoglobin ≥ 10.8 g/dl. CONCLUSIONS: Mortality was low in children with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome, being central nervous system involvement the main cause of death. The best mortality predictors found were central nervous system involvement, hemoglobin, and sodium concentration. Hyponatremia may be a new Shiga toxin-producing Escherichia coli hemolytic uremic syndrome mortality predictor.


Assuntos
Infecções por Escherichia coli/mortalidade , Síndrome Hemolítico-Urêmica/mortalidade , Hiponatremia/mortalidade , Doenças do Sistema Nervoso/mortalidade , Escherichia coli Shiga Toxigênica/isolamento & purificação , Pré-Escolar , Estudos Transversais , Infecções por Escherichia coli/sangue , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/microbiologia , Feminino , Hemoglobinas/análise , Síndrome Hemolítico-Urêmica/sangue , Síndrome Hemolítico-Urêmica/complicações , Síndrome Hemolítico-Urêmica/microbiologia , Humanos , Hiponatremia/sangue , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Lactente , Masculino , Doenças do Sistema Nervoso/sangue , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/etiologia , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Sódio/sangue
3.
Pediatr Nephrol ; 33(1): 175-180, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28821968

RESUMO

BACKGROUND: Growth retardation and its impact on adult height is considered to be one of the most common complications in patients with chronic kidney disease (CKD). Treatment with recombinant human growth hormone (rhGH) has been effective in improving growth in kidney transplantation (KTx) patients, but little data are available on adult height in patients who began rhGh treatment in late puberty. METHODS: Near-adult height was evaluated in 13 KTx patients treated with rhGH [growth hormone group (GHGr); dose 9.33 mg/m2 per week] for a period of at least 18 months. At initiation of rhGH treatment, testicular volume was >8 ml and serum testosterone was >1 ng/ml compared with the control group (CGr) of ten KTx patients who did not receive rHGH. All subjects were of similar chronological age and bone age and had similar creatinine clearance (CrCl) levels, cumulative corticoid dose, height standard deviation score (SDS), target height SDS, and target height:initial height at the beginning of the study. RESULTS: Near-adult height was significantly greater in the GHGr than in the CGr (-1.8 ± 0.8 vs. -2.9 ± 1.1; p = 0.018). The difference between initial height and near-adult height in the GHGr revealed a significant height gain (initial height -3.1 ± 1.1; near-adult height -1.8 ± 0.8 SDS, respectively; delta 1.2 ± 0.3; p = 0.021). The CrCl level was not significantly different between the GHGr and CGr at either at study initiation or when attaining near-adult height (p = 0.74 and p = 0.23, respectively). CONCLUSIONS: Treatment with rhGH was effective in improving adult height in KTx patients who began treatment in late puberty, without any effect on renal function.


Assuntos
Estatura/efeitos dos fármacos , Transtornos do Crescimento/tratamento farmacológico , Hormônio do Crescimento Humano/uso terapêutico , Transplante de Rim/efeitos adversos , Insuficiência Renal Crônica/complicações , Adolescente , Adulto , Taxa de Filtração Glomerular , Gráficos de Crescimento , Transtornos do Crescimento/etiologia , Humanos , Transplante de Rim/métodos , Masculino , Puberdade , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Transplantados , Resultado do Tratamento
4.
Farm. hosp ; 41(2): 150-168, mar.-abr. 2017. tab, graf
Artigo em Inglês | IBECS | ID: ibc-160947

RESUMO

Objective: Therapeutic monitoring during interchange of tacrolimus commercial formulations is essential to ensure similar exposure in transplant patients. However, there are limited data in the pediatric transplant population. This study aims to evaluate exposure, safety and efficacy in maintenance pediatric transplant patients under generic tacrolimus substitution. Method: Pediatric patients who underwent interchange of tacrolimus formulations were detected by the Service of Pharmacy and included in this study. Tacrolimus trough levels (C0), laboratory parameters and clinical characteristics were recorded before and after the switch. Statistical analysis was performed using Wilcoxon matched pair t-test. Results: In total, 10 patients with kidney, liver, heart and hematopoietic stem cell transplantation received the innovator and switched to the generic product. The median (range) of the C0 normalized by the dose before and after switch was 74.8 [(ng/ml)/(mg/kg)] (13.8-518.4) and 65.1 [(ng/ml)/(mg/ kg)] (13.5-723.5), respectively (p>0.05). Tacrolimus dose was 0.070(mg/kg) (0.024-0.461) and 0.069(mg/kg) (0.017-0.571) for the innovator and generic formulation, respectively, with no difference when comparing both values (p>0.05). Laboratory parameters did not change after conversion (p>0.05). Adverse events, acute rejection, death and graft loss were not observed. Conclusion: In our study population, no significant differences in terms of laboratory parameters, drug exposure and dose were observed. We emphasize the need of close monitoring to ensure a safe interchange, especially in vulnerable populations such as the pediatric (AU)


Objetivo: La monitorización terapéutica durante el intercambio de marcas comerciales de inmunosupresores es esencial para mantener una similar exposición al fármaco en pacientes trasplantados. Sin embargo, la información disponible en trasplante pediátrico es limitada. El objetivo del trabajo fue evaluar la exposición, seguridad y eficacia en pacientes pediátricos trasplantados en etapa de mantenimiento, sujetos a intercambio entre el producto innovador y el genérico de tacrolimus. Método: El Área de Farmacia del hospital detectó aquellos pacientes sujetos a intercambio de formulaciones según la disponibilidad de medicamentos. Se obtuvieron las concentraciones de tacrolimus en el valle (C0), parámetros de laboratorio y características clínicas antes y después del intercambio. El análisis estadístico se realizó mediante el test de muestras pareadas de Wilcoxon. Resultados: Se incluyeron 10 pacientes con trasplante renal, hepático, cardíaco y de células hematopoyéticas. La mediana (rango) del C0 normalizado por la dosis pre y post intercambio fue 74,8[(ng/ml)/(mg/kg)](13,8-518,4) y 65,1[(ng/ml)/(mg/kg)] (13,5-723,5), respectivamente (p>0,05). La dosis de tacrolimus fue 0,070(mg/kg) (0,024-0,461) y 0,069(mg/kg) (0,017-0,571) para el innovador y el genérico, respectivamente (p>0,05). Los parámetros de laboratorio de funcionalidad renal y hepática no cambiaron con la conversión de marcas (p>0,05). No se observaron eventos adversos, rechazo agudo, muerte o pérdida del injerto durante el periodo analizado. Conclusiones: En la población estudiada, no se observaron diferencias significativas en los parámetros de laboratorio, exposición al tacrolimus o dosis en el intercambio de marcas comerciales. Destacamos el rol de la monitorización terapéutica a la hora de garantizar una sustitución segura, especialmente en poblaciones vulnerables (AU)


Assuntos
Humanos , Criança , Monitoramento de Medicamentos/métodos , Tacrolimo/administração & dosagem , Transplante de Órgãos , Imunologia de Transplantes , Medicamentos Genéricos/uso terapêutico , Substituição de Medicamentos , Imunossupressores/administração & dosagem
5.
Farm Hosp ; 41(2): 150-168, 2017 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-28236795

RESUMO

OBJECTIVE: Therapeutic monitoring during interchange of tacrolimus commercial formulations is essential to ensure similar exposure in transplant patients. However, there are limited data in the pediatric transplant population. This study aims to evaluate exposure, safety and efficacy in maintenance pediatric transplant patients under generic tacrolimus substitution. METHOD: Pediatric patients who underwent interchange of tacrolimus formulations were detected by the Service of Pharmacy and included in this study. Tacrolimus trough levels (C0), laboratory parameters and clinical characteristics were recorded before and after the switch. Statistical analysis was performed using Wilcoxon matched pair t-test. RESULTS: In total, 10 patients with kidney, liver, heart and hematopoietic stem cell transplantation received the innovator and switched to the generic product. The median (range) of the C0 normalized by the dose before and after switch was 74.8 [(ng/ml)/(mg/kg)] (13.8-518.4) and 65.1 [(ng/ml)/(mg/kg)] (13.5-723.5), respectively (p>0.05). Tacrolimus dose was 0.070(mg/kg) (0.024-0.461) and 0.069(mg/kg) (0.017- 0.571) for the innovator and generic formulation, respectively, with no difference when comparing both values (p>0.05). Laboratory parameters did not change after conversion (p>0.05). Adverse events, acute rejection, death and graft loss were not observed. CONCLUSION: In our study population, no significant differences in terms of laboratory parameters, drug exposure and dose were observed. We emphasize the need of close monitoring to ensure a safe interchange, especially in vulnerable populations such as the pediatric.


Assuntos
Imunossupressores/uso terapêutico , Monitorização Fisiológica/métodos , Transplante de Órgãos/métodos , Tacrolimo/uso terapêutico , Adolescente , Criança , Pré-Escolar , Medicamentos Genéricos , Feminino , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Lactente , Masculino , Estudos Retrospectivos , Tacrolimo/administração & dosagem , Tacrolimo/efeitos adversos , Resultado do Tratamento
7.
Pediatr Transplant ; 19(7): 684-90, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26212912

RESUMO

Donor-specific anti-HLA antibodies (DSA) causing CAMR are responsible for a high proportion of long-term graft failures after RTX. We studied the prevalence of DSA in RTX children biopsied for creeping Cr, its relationship with NA, and patient and graft survival according to histopathology. Between 2008 and 2013, 92 children were biopsied at a median of 38 months post-RTX. At biopsy, the prevalence of DSA was 49% and C4d 70%. NA rate was 45%, higher in adolescents (60%). Most frequent diagnoses were CAMR (72%) and interstitial fibrosis with tubular atrophy (IFTA) (28%). Forty-five of 66 patients with CAMR (68%) had detectable DSA. Twenty-one DSA-negative patients with CAMR had histological damage (IFTA + C4d positivity). C4d was detected in 64 of 66 biopsies with CAMR. Recipients with IFTA alone had neither C4d, nor detectable DSA, and were adherent. Graft survival at five yr was 89% in patients with CAMR, 79% in those with CAMR + TCMR Banff I, 33% in those with CAMR + TCMR Banff II, and 96% in those with IFTA. ABMR and complement activation were frequent in children biopsied for creeping Cr. Recipients with DSA were more likely to be non-adherent and have CAMR or CAMR + TCMR and worse graft survival.


Assuntos
Creatinina/sangue , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/imunologia , Antígenos HLA/imunologia , Isoanticorpos/sangue , Transplante de Rim , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Seguimentos , Rejeição de Enxerto/sangue , Rejeição de Enxerto/diagnóstico , Histocompatibilidade , Humanos , Isoanticorpos/imunologia , Estimativa de Kaplan-Meier , Masculino , Modelos de Riscos Proporcionais
8.
Int J Clin Pharm ; 36(4): 779-86, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24861769

RESUMO

BACKGROUND: Cyclosporin is a calcineurin inhibitor widely used in renal transplant patients to prevent organ rejection. Several position papers have been published but no reports on the practical experience in pediatric patients undergoing conversion between cyclosporin innovator and generic products are available. OBJECTIVE: To evaluate the pharmacokinetics and safety as part of therapeutic monitoring of cyclosporin in renal transplant pediatric patients who switch from the innovator to the generic formulation in Argentina. SETTING: Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina. METHODS: Stable pediatric renal transplant patients (6 months post-transplant) switched from the innovator to the generic formulation of cyclosporin microemulsion capsule. Cyclosporin pharmacokinetic parameters were obtained while taking the innovator and after starting with the generic formulation. Blood samples were drawn before and 1, 2, and 3 h after drug administration and subsequently quantified. Pharmacokinetic parameters were obtained by means of a Bayesian approach. MAIN OUTCOMES MEASURE: Cyclosporin pharmacokinetic parameters (area under the curve, AUC; Blood concentration after 2 h, C2), adverse events and graft rejection. RESULTS: A total of 12 patients were included. Median (range) age and time post-transplant were 10.7 years (6.5-17.7) and 8.3 years (3.4-14.0), respectively. Two patients or their parents did not consent to the switch. Median (range) dose normalized cyclosporin AUC and C2 were 1.15 (mg*h/L)/mg/kg (0.72-3.0) and 265.5 (ng/ml)/mg/kg (120.8-725.7), respectively, on the innovator therapy and 1.05 (mg*h/L)/mg/kg (0.54-2.22) and 317.1 (ng/ml)/mg/kg (116.7-564.7) for the generic drug after the switch. The median (range) percentage of change in the AUC and C2 when switching between formulations were 16.7 % (0.7-56.7) and 13.1 % (3.7-68.6), respectively. No significant changes in serum creatinine levels were registered when comparing before and after substitution of products. Adverse events (number of events) recorded 5 months before and after the switch included hirsutism (2), hypertension (2), and gingival hyperplasia (1). CONCLUSION: Conversion of cyclosporin from innovator brand to generic in pediatric renal transplant patients needs to be closely monitored.


Assuntos
Inibidores de Calcineurina/uso terapêutico , Ciclosporina/uso terapêutico , Monitoramento de Medicamentos , Medicamentos Genéricos/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Adolescente , Argentina , Teorema de Bayes , Biomarcadores/sangue , Inibidores de Calcineurina/administração & dosagem , Inibidores de Calcineurina/efeitos adversos , Inibidores de Calcineurina/farmacocinética , Cápsulas , Criança , Pré-Escolar , Ciclosporina/administração & dosagem , Ciclosporina/efeitos adversos , Ciclosporina/farmacocinética , Composição de Medicamentos , Medicamentos Genéricos/administração & dosagem , Medicamentos Genéricos/efeitos adversos , Medicamentos Genéricos/farmacocinética , Emulsões , Estudos de Viabilidade , Feminino , Seguimentos , Hospitais Pediátricos , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Imunossupressores/farmacocinética , Masculino
10.
Pediatr Transplant ; 16(6): 582-8, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22533794

RESUMO

We studied efficacy and safety of conversion from CNI- to SRL-based immunosuppression in 92 kidney TX recipients, mainly due to CAN (69%). Median time of conversion was 31 months (r: 0.3-165); median time of follow-up: 36 months (r: 2-102). In the whole group mean eGFR increased from 53 ± 22 to 67 ± 26mL/min/1.73 m(2) at three months (p = 0.02) and did not change subsequently. Patients with grade I CAN had higher eGFR than those with grade II CAN. Patient and graft survival was 96% and 70% 10 yr after conversion. Patients with grade I CAN had better graft survival than those with grade II CAN: 89% vs. 65% at six yr (p = 0.02) post conversion. There were two episodes of BPAR. Baseline proteinuria >20 mg/kg/day (HR: 10) and baseline eGFR <50 mL/min/1.73 m(2) (HR: 8) were independent predictors of graft loss. Sixty-seven of 92 subjects had ≥1 AEs: diarrhea (n = 52), urinary tract infections (n = 35), and lower respiratory tract infections (n = 12) were the most frequent. Patients with >2 AEs had SRL blood levels >9 ng/mL at month 3 (p = 0.01). In conclusion, patients converted from CNI to SRL had good graft survival and tolerable but frequent AEs. Independent predictors of graft loss were baseline proteinuria and eGFR.


Assuntos
Inibidores de Calcineurina , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Transplante de Rim/métodos , Sirolimo/uso terapêutico , Biópsia , Criança , Estudos de Coortes , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Rejeição de Enxerto , Sobrevivência de Enxerto , Hemoglobinas/metabolismo , Humanos , Lipídeos/sangue , Masculino , Pediatria/métodos , Proteinúria/diagnóstico , Resultado do Tratamento
11.
Perit Dial Int ; 24(2): 186-90, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15119641

RESUMO

OBJECTIVE: To assess if application of fibrin glue sealant to the peritoneal cuff suture is useful in the prevention of early dialysate leakage in children with end-stage renal disease on chronic peritoneal dialysis (CPD). DESIGN: Single-center, open-label, prospective randomized study. SETTING: University Pediatric Hospital. METHODS: 52 catheters were implanted in 45 children (mean age 6.2 +/- 4.5 years). Catheters were randomly assigned to either the control group or the sealant group. In the latter group, 1 mL of fibrin glue sealant was applied to the peritoneal cuff suture. 18 catheters were used for the first time within 5 days after implantation (early-used catheters). Leakage, exit-site or tunnel infection, peritonitis, and adverse secondary effects were evaluated during the initial 60 days after implantation. RESULTS: No adverse secondary effects were seen after the application of the fibrin glue sealant. The incidence of exit/tunnel infection and peritonitis was similar in the two groups. The incidence of leakage was significantly lower in the sealant group (p < 0.02). In the early-used catheters, leakage was detected in 9% of the catheters in the sealant group and in 57% of the control group (p < 0.05). CONCLUSIONS: The application of 1 mL of fibrin glue to the peritoneal cuff suture prevented early dialysate leakage without secondary adverse effects in children on CPD.


Assuntos
Cateterismo/métodos , Cateteres de Demora/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/prevenção & controle , Adesivo Tecidual de Fibrina/uso terapêutico , Diálise Peritoneal , Adesivos Teciduais/uso terapêutico , Criança , Pré-Escolar , Falha de Equipamento , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Humanos , Falência Renal Crônica/terapia , Estudos Prospectivos , Técnicas de Sutura
12.
Med. infant ; 9(1): 12-16, mar. 2002. tab, graf
Artigo em Espanhol | LILACS | ID: lil-518000

RESUMO

La evolución del trasplante renal en pacientes adultos con enfermedad renal secundaria a nefritis lúpica (NL) es similar a la de los pacientes con otras causas de insuficiencia renal crónica (IRC). La bibliografía en pediatría es escasa. El propósito de este estudio fue comprar la evolución del trasplante renal (tx R) en pacientes con NL con la de niños con otras causas de IRC que recibieron un injerto en el servicio de Nefrología del hospital Juan P. Garrahan. Se comparó la evolución de 9 tx R en pacientes con NL con 18 tx R pareados en tiempo entre el 1/12/1989 y el 30/06/1999. La edad media del receptor y del donante, tiempo de diálisis, el número de incompatibilidades HLA, tiempo de isquemia y terapia inmunosupresora fuerom similares en ambos grupos. Resultados: Ambos grupos no presentaron diferencias en el número de episodios de rechazos celulares agudos, de infecciones, en la dosis media de inmunosupresión y en la función renal durante su seguimiento. La sobrevida de los pacientes fueron comparable, 88 por ciento en el grupo LE y 95 por ciento en el grupo control a los 12,24 y 36 meses. No se observó recurrencia de la nefritis lúpica. Conclusión: la evolución del tx R en los pacientes pediátricos con lupus eritematoso es similar a la de los niños con otras enfermedades renales.


Assuntos
Criança , Evolução Clínica , Transplante de Rim , Nefrite Lúpica , Estudos Retrospectivos , Análise Estatística
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