Epidemiology of urinary infections in renal transplant recipients.

Urinary tract infection (UTI) remains a significant cause of infectious complications in renal transplant recipients. We evaluated prospectively all the UTIs in 161 kidney recipients transplanted between July 2003 and July 2005. All patients received prophylaxis with sulfadoxine-pyrimethamine. We excluded asymptomatic bacteriuria. Forty-one patients (25%) suffered at least one UTI episode. Ninety-two episodes of infection were confirmed with an incidence rate of 97 UTI episodes per 100 patient-years. The most common clinical features were uncomplicated acute bacterial cystitis, 71 episodes (77%), and acute pyelonephritis, 21 episodes (23%). Microbiological isolation was confirmed in 58 episodes (63%). Bacterial infections were the most frequent etiologies: gram-negative bacilli in 52 (90%), gram-positive cocci in 4 (7%), fungal in 2 (3%), and one viral BK virus (2%) infection. The causative microorganisms were E. coli as the principal isolated agent in 41 cases (71%), including 10 (24%) that were extended-spectrum betalactamases (ESBLEC). All episodes showed a favorable course. The survival rate of the graft at the end of the study period was 90.7%, and the survival rate of the transplant recipients was 97.5%. The incidence of UTI in transplant patients who received antibiotic prophylaxis was high. E. coli (ESBLEC) was the main agent isolated. Uncomplicated UTI, the most frequent post transplantation infection, showed a good prognosis.

[Renal failure as a factor leading to epileptic seizures]. / Insuficiencia renal como factor desencadenante de crisis epilépticas.

OBJECTIVE: To analyze the incidence of convulsive seizures in renal failure by studying the semiological characteristics of the convulsive episodes, their subsequent evolution and the presence of possible sequelae. The relationship between the different potential causes of the seizures and their evolution and treatment was also analyzed. MATERIAL AND METHODS: We retrospectively reviewed the clinical histories of 108 patients admitted to the hospital over a 20-year period with a diagnosis of renal failure: 55 were undergoing predialysis, 42 renal transplantation, 7 peritoneal dialysis and 3 hemodialysis. One patient was excluded for not fulfilling the selection criteria. Computer study of the 18 quantitative and qualitative variables was carried out with the SPSS 9.0.1 program. RESULTS: Of the 107 patients, 16 (14.95 %) had suffered some type of convulsive seizure. None was in the predialysis group. As triggering factors, hydroelectrolyte imbalance was found in eight patients and hypertension was found in four. In the remaining patients the causes were not well-defined. Only three patients with epilepsy prior to renal failure presented sequelae. CONCLUSIONS: Epileptic seizures in renal failure in childhood can be considered as occasional seizures that do not usually become chronic or produce sequelae. Information on the management of seizures in renal failure should be disseminated among professionals treating systemic diseases.

Insuficiencia renal como factor desencadenante de crisis epilépticas / Renal failure as a factor leading to epileptic seizures

Objetivo: Se pretende analizar la incidencia de las crisis convulsivas en la insuficiencia renal, estudiando las características semiológicas de los episodios convulsivos, su posterior evolución y la presencia de posibles secuelas. Se han relacionado los distintos factores desencadenantes de las crisis, con su evolución y con su tratamiento. Material y métodos: Estudio retrospectivo por revisión de historias clínicas. Durante un período de 20 años se revisan de forma retrospectiva 108 pacientes ingresados en el hospital con el diagnóstico de insuficiencia renal: 55 con prediálisis, 42 con trasplante renal, 7 con diálisis peritoneal, y 3, hemodiálisis. Un caso se desechó por no cumplir los criterios de selección. Se analizaron 18 variables cuantitativas y cualitativas, utilizando las medidas de tendencia central o de localización en las variables cuantitativas, y los porcentajes en las cualitativas. El test de chi cuadrado ( 2) se usó al comparar dos proporciones. Resultados: Del total de enfermos, 16 habían sufrido algún tipo de crisis convulsiva (14,95%), y de ellos ninguno se encontraba en el grupo de prediálisis. Como factor desencadenante, hubo un desequilibrio hidroelectrolítico en 8 casos, hipertensión en cuatro, y otras causas no bien determinadas en los restantes. Sólo en 3 casos que correspondían a epilepsias previas a la insuficiencia renal, se mantenían las manifestaciones críticas. Conclusiones: Las crisis epilépticas de la insuficiencia renal en la infancia pueden considerarse crisis ocasionales, que no suelen cronificarse ni dejar secuelas deficitarias. El tratamiento de las crisis en la insuficiencia renal debe ser divulgado entre los profesionales que atienden enfermedades sistémicas (AU)