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1.
BMC Nephrol ; 21(1): 419, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004002

RESUMO

BACKGROUND: Infection with the severe acute respiratory coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic with coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2, overwhelming healthcare systems globally. Preliminary reports suggest a high incidence of infection and mortality with SARS-CoV-2 in patients receiving kidney replacement therapy (KRT). The aims of this study are to report characteristics, rates and outcomes of all patients affected by infection with SARS-CoV-2 undergoing KRT in Scotland. METHODS: Study design was an observational cohort study. Data were linked between the Scottish Renal Registry, Health Protection Scotland and the Scottish Intensive Care Society Audit Group national data sets using a unique patient identifier (Community Health Index (CHI)) for each individual by the Public Health and Intelligence unit of Public Health, Scotland. Descriptive statistics and survival analyses were performed. RESULTS: During the period 1st March 2020 to 31st May 2020, 110 patients receiving KRT tested positive for SARS-CoV-2 amounting to 2% of the prevalent KRT population. Of those affected, 86 were receiving haemodialysis or peritoneal dialysis and 24 had a renal transplant. Patients who tested positive were older and more likely to reside in more deprived postcodes. Mortality was high at 26.7% in the dialysis patients and 29.2% in the transplant patients. CONCLUSION: The rate of detected SARS-CoV-2 in people receiving KRT in Scotland was relatively low but with a high mortality for those demonstrating infection. Although impossible to confirm, it appears that the measures taken within dialysis units coupled with the national shielding policy, have been effective in protecting this population from infection.


Assuntos
Betacoronavirus/isolamento & purificação , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus , Falência Renal Crônica , Transplante de Rim/estatística & dados numéricos , Pandemias , Pneumonia Viral , Terapia de Substituição Renal , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/cirurgia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Mortalidade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Saúde Pública/métodos , Sistema de Registros/estatística & dados numéricos , Terapia de Substituição Renal/métodos , Terapia de Substituição Renal/estatística & dados numéricos , Escócia/epidemiologia
2.
Rev Assoc Med Bras (1992) ; 66(9): 1229-1234, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33027450

RESUMO

OBJECTIVE: To evaluate the effects of hemodialysis, peritoneal dialysis, and renal transplantation on the quality of life of patients with end-stage renal disease (ESRD) and analyze the influencing factors. METHODS: A total of 162 ESRD patients who received maintenance hemodialysis, continuous ambulatory peritoneal dialysis, and renal transplantation from February 2017 to March 2018 in our hospital were divided into a hemodialysis group, a peritoneal dialysis group, and a renal transplantation group. The baseline clinical data, serum indices, as well as environmental factors such as education level, marital status, work, residential pattern, household income, and expenditure were recorded. The quality of life was assessed using the short-form 36-item (SF-36) scale reflecting the Physical Component Summary (PCS) and the Mental Component Summary (MCS). One-way analysis of variance and logistic stepwise multiple regression analysis were performed to analyze the factors influencing the quality of life. RESULTS: The renal transplantation group had the highest average scores for all dimensions of the SF-36 scale. The PCS and MCS scores of this group were higher than those of the hemodialysis and peritoneal dialysis groups. The peritoneal dialysis group had higher scores for physical functioning, physical role, bodily pain, general health, mental health, PCS, and MCS than those of the hemodialysis group. Age, HGB, GLU, and ALP were the main factors influencing PCS. Age, education level, residential pattern, medication expenditure, and monthly per capita income mainly affected MCS. CONCLUSION: In terms of quality of life, renal transplantation is superior to peritoneal dialysis and hemodialysis.


Assuntos
Falência Renal Crônica , Transplante de Rim , Diálise Peritoneal , Humanos , Falência Renal Crônica/terapia , Qualidade de Vida , Diálise Renal
3.
Rev Assoc Med Bras (1992) ; 66(9): 1235-1240, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33027451

RESUMO

INTRODUCTION: Sarcopenia is characterized by the involuntary loss of lean body mass associated with a progressive reduction of muscle strength. OBJECTIVE: To determine the prevalence of sarcopenia in kidney transplant recipients and its association with the determining factors that control muscle homeostasis. METHODS: We evaluated renal transplant recipients undergoing follow-up at the University Hospital of the Federal University of Maranhão from June 2017 to July 2018 and who met the inclusion criteria. Sarcopenia was defined according to the European criteria. The skeletal muscle mass index was measured by dual-energy radiological absorptiometry; the values <7,26 kg/m2 for men and <5,5 kg/m2 for women were adopted for muscle depletion. For handgrip strength, values of <30 kg for men and <20 kg for women were considered as reduced muscle strength. In both sexes, the cutoff point for walking speed was <0,8 m/s. RESULTS: We evaluated 83 renal transplant recipients with a mean age of 48.8 ± 12,1 years and predominantly males (57,8%). The prevalence of sarcopenia was 19,3%. Among individuals without sarcopenia, 17,9% had a decrease in handgrip strength and 40,3% has altered gait speed. DISCUSSION: Individuals submitted to renal transplant may develop sarcopenia while still young and already present altered muscle function and strength even before the depletion of lean body mass. CONCLUSION: Early diagnosis may allow the prevention of sarcopenia and provide a better quality of life for patients.


Assuntos
Transplante de Rim , Sarcopenia , Adulto , Feminino , Força da Mão , Homeostase , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida
4.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(5): 495-500, 2020 May 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879096

RESUMO

OBJECTIVES: To summarize the emergency management of the kidney transplantation for a large tertiary first-class hospital in response to the epidemic of coronavirus disease 2019 (COVID-19). METHODS: The clinical data of inpatients in the Department of Kidney Transplantation from January 24, 2020 to February 29, 2020 were retrospectively analyzed. Since the outbreak of COVID-19, we conducted telephone, Wechat follow-up, and online education for kidney transplant recipients and patients on waiting-list for kidney transplantation one by one. We also strictly screened for COVID-19 in outpatients. To guarantee the security of medical staff and recipients and to reduce the transmission risk of COVID-19, we have made detailed approaches to prevent COVID-19, which mainly included 6 aspects of preventive approaches, such as kidney transplant clinic, kidney transplant ward, patients on waiting-list for kidney transplantation, kidney transplant operation, medical staff self-protection, and postoperative follow-up of kidney transplant recipients. RESULTS: There were altogether 47 inpatients which included 20 recipients who had just received kidney transplantation in the meantime, 2 577 kidney transplant recipients, 1 689 patients on waiting-list for kidney transplantation, and 794 outpatients in our hospital. No case of COVID-19 occurred in this period. CONCLUSIONS: Through strictly implementing proactive and preventive approaches, we avoid the occurrence of COVID-19 in carrying out kidney transplantation in the epidemic period.


Assuntos
Infecções por Coronavirus/epidemiologia , Transplante de Rim , Pneumonia Viral/epidemiologia , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Estudos Retrospectivos , Centros de Atenção Terciária , Transplantados , Listas de Espera
5.
J Med Vasc ; 45(5): 294-297, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862988

RESUMO

The transplant renal artery stenosis occurred up to 23% after kidney transplantation. Endovascular treatment has become the treatment of choice of this complication, but could be challenging in immediate postoperative anastomotic narrowing. We report the case of a adolescent with early renal graft artery stenosis located in the anastomosis and diagnosed 3 days after renal transplantation, with necessity of haemodialysis. This complication was treated by angioplasty on the 25th day, using a polymer free drug eluting stent with a good result. We discussed the precautions and technical features of this procedure.


Assuntos
Angioplastia/instrumentação , Stents Farmacológicos , Transplante de Rim/efeitos adversos , Obstrução da Artéria Renal/terapia , Adolescente , Humanos , Masculino , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular
6.
J Bras Nefrol ; 42(2 suppl 1): 32-35, 2020 Aug 26.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32877496

RESUMO

INTRODUCTION: The impact of the new coronavirus (SARS-COV-2) and its worldwide clinical manifestations (COVID-19) imposed specific regional recommendations for populations in need of specialized care, such as children and adolescents with kidney diseases, particularly in renal replacement therapies (RRT). We present the recommendations of the Brazilian Society of Nephrology regarding the treatment of pediatric patients with kidney diseases during the COVID-19 pandemic. METHODS: Articles and documents from medical societies and government agencies on specific recommendations for children on RRT in relation to COVID-19 as well as those focused on epidemiological aspects of this condition in Brazil Were evaluated and analyzed. RESULTS: We present recommendations on outpatient care, transportation to dialysis centers, peritoneal dialysis, hemodialysis, and kidney transplantation in children and adolescents during the COVID-19 pandemic in Brazil. DISCUSSION: Despite initial observations of higher mortality rates in specific age groups (the elderly) and with comorbidities (obese, diabetics, and those with cardiovascular diseases), patients with chronic kidney disease (CKD) on RRT are particularly prone to develop COVID-19. Specific measures must be taken to reduce the risk of contracting SARS-CoV-2 and developing COVID-19, especially during transport to dialysis facilities, as well as on arrival and in contact with other patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Nefropatias/terapia , Pneumonia Viral/epidemiologia , Terapia de Substituição Renal/normas , Adolescente , Assistência Ambulatorial , Brasil/epidemiologia , Criança , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Higiene/normas , Transplante de Rim , Máscaras , Nefrologia/normas , Doenças Profissionais/prevenção & controle , Pandemias/prevenção & controle , Isolamento de Pacientes , Pediatria , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Terapia de Substituição Renal/métodos , Sociedades Médicas , Avaliação de Sintomas , Transporte de Pacientes
7.
Urologiia ; (4): 73-78, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-32897018

RESUMO

BACKGROUND: The concept of the formation of immunological tolerance is a promising direction for correcting the renal transplant rejection. One of these methods is extracorporeal photochemotherapy (ECP), however, according to the literature, there is no single concept of its mechanisms of action in the formation of immunological tolerance in transplantology. AIM: To assess the effect of the preventive use of extracorporeal photochemotherapy on the factors of cellular immunity that contribute to the development of long-term tolerance in patients after kidney transplantation. MATERIALS AND METHODS: A total of 24 patients after a cadaveric kidney transplantation with group matching were included in the study. During the first six months after transplantation, 15 patients of the main group (MG) underwent 10 sessions of ECP in combination with the standard immunosuppression protocol, and 9 patients of the control group (CG) received only standard immunosuppressive therapy. Immunological studies were carried out by the 3rd year after transplantation. The number of cells expressing the antigens CD3, CD4, CD8, CD19, CD16 and CD56, the expression of co-stimulating molecules CD25, CD28 on T-lymphocytes, the number of T-regulatory cells with the CD3+ CD4+ CD25+ (hi) CD127- phenotype was evaluated. RESULTS: Compared with early post-transplant period, the number of naive CD3+CD4+CD45RO-CD28+ T-cells and CD28+ antigen expression was not different between two groups by 3 years after transplantation and with a group of otherwise healthy individuals (p=0.47 and p=0.26, respectively). Three years after transplantation, the T-helper lymphocyte count (CD3+CD4+) in MG were significantly higher than in CG (48.5+/-7.3% vs. 43.0+/-4.6%, respectively; p=0,04), cytotoxic T-lymphocytes count (CD3+CD8+) was 29.5+/-8.9% in MG, compared to 36.1+/-8.6% in CG (p=0.09), the ratio of CD4+/CD8+ in MG was significantly higher (1.83+/-0.72) than in CG (1.29+/-0.49) (p=0.04). CD19+ lymphocytes count was significantly below normal values in both groups, but in the CG it was more pronounced than in the MG (5.06+/-2.1% and 7.73+/-3%, respectively, (p=0.02) In the long-term period, CD3+CD4+CD25+(hi)CD127- T-regulatory cells count in MG was significantly higher than in CG (20.6+/-10.76*106/L and 12.9+/-4.97*106/l, respectively) (p=0.04). CONCLUSION: ECP initiates immunological tolerance through the activation of a second co-activation pathway between B-7 and CTLA-4 molecules in the early period after kidney transplantation. As a result, a clone of tolerogenic CD3+CD4+ T-lymphocytes is formed, which differentiates into T-regulatory cells and maintains immunological tolerance in the long-term period. Using ECP as a part of combination therapy allows to normalize the indicators of cellular immunity in the long-term period. BACKGROUND: The concept of the formation of immunological tolerance is a promising direction for correcting the renal transplant rejection. One of these methods is extracorporeal photochemotherapy (ECP), however, according to the literature, there is no single concept of its mechanisms of action in the formation of immunological tolerance in transplantology. AIM: To assess the effect of the preventive use of extracorporeal photochemotherapy on the factors of cellular immunity that contribute to the development of long-term tolerance in patients after kidney transplantation. MATERIALS AND METHODS: A total of 24 patients after a cadaveric kidney transplantation with group matching were included in the study. During the first six months after transplantation, 15 patients of the main group (MG) underwent 10 sessions of ECP in combination with the standard immunosuppression protocol, and 9 patients of the control group (CG) received only standard immunosuppressive therapy. Immunological studies were carried out by the 3rd year after transplantation. The number of cells expressing the antigens CD3, CD4, CD8, CD19, CD16 and CD56, the expression of co-stimulating molecules CD25, CD28 on T-lymphocytes, the number of T-regulatory cells with the CD3+ CD4+ CD25+ (hi) CD127- phenotype was evaluated. RESULTS: Compared with early post-transplant period, the number of naive CD3+CD4+CD45RO-CD28+ T-cells and CD28+ antigen expression was not different between two groups by 3 years after transplantation and with a group of otherwise healthy individuals (p=0.47 and p=0.26, respectively). Three years after transplantation, the T-helper lymphocyte count (CD3+CD4+) in MG were significantly higher than in CG (48.5+/-7.3% vs. 43.0+/-4.6%, respectively; p=0,04), cytotoxic T-lymphocytes count (CD3+CD8+) was 29.5+/-8.9% in MG, compared to 36.1+/-8.6% in CG (p=0.09), the ratio of CD4+/CD8+ in MG was significantly higher (1.83+/-0.72) than in CG (1.29+/-0.49) (p=0.04). CD19+ lymphocytes count was significantly below normal values in both groups, but in the CG it was more pronounced than in the MG (5.06+/-2.1% and 7.73+/-3%, respectively, (p=0.02) In the long-term period, CD3+CD4+CD25+(hi)CD127- T-regulatory cells count in MG was significantly higher than in CG (20.6+/-10.76*106/L and 12.9+/-4.97*106/l, respectively) (p=0.04). CONCLUSION: ECP initiates immunological tolerance through the activation of a second co-activation pathway between B-7 and CTLA-4 molecules in the early period after kidney transplantation. As a result, a clone of tolerogenic CD3+CD4+ T-lymphocytes is formed, which differentiates into T-regulatory cells and maintains immunological tolerance in the long-term period. Using ECP as a part of combination therapy allows to normalize the indicators of cellular immunity in the long-term period.


Assuntos
Transplante de Rim , Fotoferese , Rejeição de Enxerto , Humanos , Monitorização Imunológica , Linfócitos T Reguladores/imunologia
8.
Urologiia ; (4): 151-156, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-32897030

RESUMO

The results of the analysis of domestic and foreign literature on complications of various approaches for nephrectomy are presented in the review. Along with open nephrectomy, complications of various minimally-invasive approaches are described, including laparoscopic, retroperitoneoscopic and robot-assisted nephrectomy. Recently, a large number of publications have been dedicated to donor nephrectomy, which is associated with the growing trend for these procedures in many clinics throughout the world using different approaches. The most of studies show that complications are more common for open nephrectomy (up to 30.4%) compared to laparoscopic (5.0-25.8%), retroperitoneoscopic (up to 17.1%) and robot-assisted (0-15%) nephrectomy. Unlike open procedure, minimally-invasive approaches have specific complications; however, most of the complications are identical for various methods. Retroperitoneoscopic access is associated with a minimal risk of damage to the abdominal organs.


Assuntos
Nefropatias , Transplante de Rim , Laparoscopia , Humanos , Nefrectomia , Coleta de Tecidos e Órgãos
11.
S Afr Med J ; 110(7): 691-694, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32880349

RESUMO

BACKGROUND: The most common clinical indication for renal biopsy in the early post-transplant period is early graft dysfunction (EGD), which may present either as delayed graft function (DGF) or acute graft dysfunction. Even though it is a valuable diagnostic tool, renal allograft biopsy is not without risk of major complications. Recent studies have suggested that, with modern immunosuppressive induction regimens and more accurate ways to determine high immunological risk transplants, early acute rejection (AR) is uncommon and routine biopsy for EGD does not result in a change in management. OBJECTIVES: To describe the histological findings and complications of renal allograft biopsies for EGD in our setting, and to determine whether our current threshold for biopsy is appropriate. METHODS: This study was a retrospective audit that included all patients who underwent renal allograft biopsy within the first 30 days of transplantation at Groote Schuur Hospital, Cape Town, South Africa, from 1 June 2010 to 30 June 2018. The indication for biopsy was any patient who showed significant EGD, characterised by acute graft dysfunction or DGF with dialysis dependence. RESULTS: During the study period, 330 patients underwent renal transplantation, of whom 105 (32%) had an early biopsy and were included in the study. The median age of recipients was 39 (range 17 - 62) years, with 65% males and 35% females. The majority of donors were deceased donations after brain death (70%), with an overall median cold ischaemic time of 9 hours (interquartile range (IQR) 4 - 16). The average number of human leukocyte antigen mismatches was 5 (IQR 4 - 7). A donor-specific antibody was recorded for 18% of recipients and a panel-reactive antibody score of >30% was recorded for 21%. The median duration after transplant for biopsy was 8 (IQR 6 - 10) days. During the first month of EGD, AR was diagnosed in 42% of patients who underwent biopsies. In 21% of these patients, there was acute cellular rejection, in 16% antibody-mediated rejection, and in 5% both of these. Acute tubular necrosis was the primary finding in 32%, with acute interstitial nephritis in 8%, and acute calcineurin toxicity in 4% of cases. A significant biopsy-related complication was recorded in 3 patients: 1 small-bowel perforation repaired via laparotomy, and 2 vascular injuries successfully embolised by interventional radiology. CONCLUSIONS: Considering the relative safety and high rate of detection of AR, a liberal approach to renal biopsy for EGD remains justifiable in our setting.


Assuntos
Aloenxertos , Biópsia , Transplante de Rim , Rim/patologia , Adolescente , Adulto , Calcineurina/efeitos adversos , Auditoria Clínica , Feminino , Rejeição de Enxerto/diagnóstico , Humanos , Necrose Tubular Aguda/patologia , Masculino , Pessoa de Meia-Idade , Nefrite Intersticial/patologia , Disfunção Primária do Enxerto/diagnóstico , Estudos Retrospectivos , África do Sul , Adulto Jovem
12.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(4): 538-543, 2020 Apr 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895143

RESUMO

OBJECTIVE: To investigate the optimal dose range of immunosuppressants in patients with autosomal dominant polycystic kidney disease (ADPKD) after renal transplantation. METHODS: A cohort of 68 patients with ADPKD who received their first renal transplantation between March, 2000 and January, 2018 in our institute were retrospectively analyzed, with 68 non-ADPKD renal transplant recipients matched for gender, age and date of transplant as the control group. We analyzed the differences in patient and renal survival rates, postoperative complications and concentrations of immunosuppressive agents between the two groups at different time points within 1 year after kidney transplantation. The concentrations of the immunosuppressants were also compared between the ADPKD patients with urinary tract infections (UTI) and those without UTI after the transplantation. RESULTS: The recipients with ADPKD and the control recipients showed no significantly difference in the overall 1-, 5-, and 10- year patient survival rates (96.6% vs 96.0%, 94.1% vs 93.9%, and 90.6% vs 93.9%, respectively; P > 0.05), 1-, 5-, and 10-year graft survival rates (95.2% vs 96.0%, 90.8% vs 87.2%, and 79.0% vs 82.3%, respectively; P > 0.05), or the incidences of other post- transplant complications including acute rejection, gastrointestinal symptoms, cardiovascular events, pneumonia, and neoplasms (P > 0.05). The plasma concentrations of both tacrolimus and mycophenolate mofetil (MPA) in ADPKD group were significantly lower than those in the control group at 9 months after operation (P < 0.05). The incidence of UTI was significantly higher in ADPKD patients than in the control group (P < 0.05). In patients with ADPKD, those with UTI after transplantation had a significantly higher MPA plasma concentration (P < 0.05). CONCLUSIONS: In patients with ADPKD after renal transplant, a higher dose of MPA is associated with a increased risk of UTI, and their plasma concentrations of immunosuppressants for long-term maintenance of immunosuppression regimen can be lower than those in other kidney transplantation recipients.


Assuntos
Transplante de Rim , Rim Policístico Autossômico Dominante , Sobrevivência de Enxerto , Humanos , Imunossupressores , Estudos Retrospectivos
13.
J Med Internet Res ; 22(10): e22068, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-32946412

RESUMO

BACKGROUND: The COVID-19 pandemic has markedly affected renal transplant care. During this time of social distancing, limited in-person visits, and uncertainty, patients and donors are relying more than ever on telemedicine and web-based information. Several factors can influence patients' understanding of web-based information, such as delivery modes (instruction, interaction, and assessment) and social-epistemological dimensions (choices in interactive knowledge building). OBJECTIVE: The aim of this study was to systemically evaluate the content, delivery modes, and social-epistemological dimensions of web-based information on COVID-19 and renal transplantation at time of the pandemic. METHODS: Multiple keyword combinations were used to retrieve websites on COVID-19 and renal transplantation using the search engines Google.com and Google.nl. From 14 different websites, 30 webpages were examined to determine their organizational sources, topics, delivery modes, and social-epistemological dimensions. RESULTS: The variety of topics and delivery modes was limited. A total of 13 different delivery modes were encountered, of which 8 (62%) were instructional and 5 (38%) were interactional; no assessment delivery modes were observed. No website offered all available delivery modes. The majority of delivery modes (8/13, 62%) focused on individual and passive learning, whereas group learning and active construction of knowledge were rarely encountered. CONCLUSIONS: By taking interactive knowledge transfer into account, the educational quality of eHealth for transplant care could increase, especially in times of crisis when rapid knowledge transfer is needed.


Assuntos
Infecções por Coronavirus/epidemiologia , Internet , Transplante de Rim , Conhecimento , Doadores Vivos/educação , Educação de Pacientes como Assunto , Pneumonia Viral/epidemiologia , Telemedicina , Betacoronavirus , Humanos , Pandemias , Educação de Pacientes como Assunto/normas , Educação de Pacientes como Assunto/estatística & dados numéricos , Ferramenta de Busca , Incerteza
14.
Medicine (Baltimore) ; 99(38): e22300, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957390

RESUMO

INTRODUCTION: Bardet-Biedl syndrome, which compromises airway management and the cardiovascular and renal systems, is a rare ciliopathic syndrome characterized by multisystem involvement and varying genetic etiologies and clinical manifestations. PATIENT CONCERNS: A 13-year-old female patient had a history of chronic renal failure, hypothyroidism, mental retardation, hypogonadotropic hypogonadism, obesity, and retinitis pigmentosa and was undergoing 4-hour hemodialysis 3 days a week. DIAGNOSIS: We diagnosed Bardet-Biedl syndrome based on the results of genetic tests. INTERVENTIONS: We performed renal transplantation under general anesthesia while considering the perioperative risks of airway obstruction and hypothermia. OUTCOMES: Multidisciplinary preoperative evaluation is crucial to avoid perioperative complications. The risk of an obstructed airway should be considered. Hypothyroidism is a rare consequence of Bardet-Biedl syndrome. Rocuronium and sugammadex are safe for anesthetic management during renal transplantation to address Bardet-Biedl syndrome. CONCLUSION: Safe anesthetic management can be achieved with the rigorous preoperative assessment of perioperative complications.


Assuntos
Anestesia Geral/métodos , Síndrome de Bardet-Biedl/complicações , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Anormalidades Múltiplas/etiologia , Adolescente , Feminino , Humanos , Falência Renal Crônica/diagnóstico por imagem , Falência Renal Crônica/etiologia , Cuidados Pré-Operatórios
15.
BMC Infect Dis ; 20(1): 707, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32977764

RESUMO

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome Coronavirus-2 has spread rapidly worldwide and disease spread is currently increasing. Data on the clinical picture of transplant recipients and management of the anti-rejection immunosuppressive therapy on COVID-19 infection are lacking. CASE PRESENTATION: We report two cases of COVID-19 infection in renal transplant recipients with variable clinical presentations. The first patient presented with mild respiratory symptoms and a stable clinical course. The second patient had more severe clinical characteristics and presented with severe pneumonia and multi-organ failure. Both patients received a combination therapy including antiviral treatment and reduced immunosuppression therapy and finally recovered. CONCLUSIONS: We report COVID-19 infection in two renal transplant recipients with a favorable outcome but different clinical courses, which may provide a reference value for treating such patients.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Transplante de Rim , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Antivirais/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/tratamento farmacológico , Transplantados , Resultado do Tratamento
17.
Pediatrics ; 146(Suppl 1): S48-S53, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737232

RESUMO

In this article, I review the ethical issues that arise in the allocation of deceased-donor organs to children and young adults. By analyzing the public media cases of Sarah Murnaghan, Amelia Rivera, and Riley Hancey, I assess whether public appeals to challenge inclusion and exclusion criteria for organ transplantation are ethical and under which circumstances. The issues of pediatric allocation with limited evidence and candidacy affected by factors such as intellectual disability and marijuana use are specifically discussed. Finally, I suggest that ethical public advocacy can coexist with well-evidenced transplant allocation if and when certain conditions (morally defensible criteria, expert evidence, nonprioritization of the poster child, and greater advocacy for organ transplantation in general) are met.


Assuntos
Doação Dirigida de Tecido/ética , Alocação de Recursos para a Atenção à Saúde/ética , Defesa do Paciente/ética , Alocação de Recursos/ética , Fatores Etários , Criança , Pré-Escolar , Fibrose Cística/cirurgia , Doação Dirigida de Tecido/legislação & jurisprudência , Feminino , Alocação de Recursos para a Atenção à Saúde/legislação & jurisprudência , Alocação de Recursos para a Atenção à Saúde/organização & administração , História do Século XXI , Humanos , Deficiência Intelectual , Transplante de Rim , Transplante de Pulmão/ética , Transplante de Pulmão/legislação & jurisprudência , Masculino , Redes Sociais Online , Pais , Defesa do Paciente/legislação & jurisprudência , Pneumonia/cirurgia , Preconceito , Opinião Pública , Alocação de Recursos/legislação & jurisprudência , Alocação de Recursos/organização & administração , Transtornos Relacionados ao Uso de Substâncias , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/organização & administração , Listas de Espera , Síndrome de Wolf-Hirschhorn/cirurgia , Adulto Jovem
19.
Artigo em Alemão | MEDLINE | ID: mdl-32736383
20.
Zhonghua Yi Xue Za Zhi ; 100(30): 2378-2382, 2020 Aug 11.
Artigo em Chinês | MEDLINE | ID: mdl-32791815

RESUMO

Objective: To observe the clinical effect of tonsillectomy on IgA nephropathy (IgAN) after renal transplantation. Methods: From March 2011 to July 2018, 201 kidney transplantation recipients who were diagnosed of IgAN by transplant renal biopsy in the Department of Organ Transplantation of the First Affiliated Hospital of Sun Yat-sen University were retrospectively reviewed, of which 18 patients underwent tonsillectomy after renal biopsy. The clinical data of the 18 patients were collected, patient and kidney survival time and function of the transplanted kidney were analyzed. Results: Of the 18 recipients, 13 were male and 5 were female, with an average age of (36.0±10.9) years. All 18 patients survived during follow-up. Two patients returned to dialysis treatment 10 months and 14 months after tonsillectomy, respectively. The creatinine was 94 (78, 133) µmol/L, 95 (74, 139) µmol/L, 106 (87, 158) µmol/L and 95(81, 147) µmol/L before tonsillectomy, 3 months, 1 year and 2 years after tonsillectomy, respectively (P=0.206). Urinary protein quantification was 0.31 (0.16, 1.38) g/24 h, 0.34 (0.10, 1.42) g/24 h, 0.33 (0.11, 0.56) g/24 h and 0.25 (0.10, 0.50) g/24 h at the same time points, respectively (P=0.104). The two patients who returned to dialysis were diagnosed of IgAN by transplant renal biopsy because of elevated creatinine, proteinuria and hematuria, 9 years and 4 years after kidney transplant respectively. Renal biopsy suggested that glomerular and segmental sclerosis were 7/24, 5/24 and 1/6, 2/6, respectively. Additionally, interstitial fibrosis and tubular atrophy (IF/TA) were both occupied 30% in the biopsies, and tonsillectomy was performed 461 days and 1 077 days after diagnosis of IgAN, respectively. Conclusions: Tonsillectomy can maintain the stability of renal function and prevent the aggravation of proteinuria in IgAN patients after renal transplantation. However, if pathology suggests obvious glomerulosclerosis or IF/TA, tonsillectomy may not be effective.


Assuntos
Glomerulonefrite por IGA , Transplante de Rim , Tonsilectomia , Adulto , Feminino , Humanos , Rim , Masculino , Pessoa de Meia-Idade , Proteinúria , Estudos Retrospectivos
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