RESUMO
Emergence of multidrug-resistant bacteria is important in solid organ transplant recipients, because it can jeopardize patient and graft survival. Methicillin-resistant Staphylococcus aureus (MRSA) infections are not rare in kidney transplant recipients. On the other hand, infections related to community-associated MRSA (CA-MRSA) strains are seldom reported in the literature. Herein, we report the first patient, to our knowledge, with CA-MRSA renal graft abscess who was successfully treated with drainage and parenteral antibiotics.
Assuntos
Abscesso/microbiologia , Infecções Comunitárias Adquiridas/microbiologia , Transplante de Rim/efeitos adversos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/microbiologia , Antibacterianos/uso terapêutico , Feminino , Humanos , Hospedeiro Imunocomprometido , Resistência a Meticilina , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: The number of actual donors per million population is the most commonly used metric to measure organ donation rates worldwide. It is deemed inadequate, however, because it does not take into account the potential donor pool. The aim of this study was to determine the true potential for solid organ donation from deceased brain-dead donors and the reasons for non-donation from potential donors in the Chinese community. METHODS: Medical records of all hospital deaths between 1 January and 31 December 2014 at a large regional hospital in Hong Kong were reviewed. Those who were on mechanical ventilation with documented brain injury and aged ≤75 years were classified as possible organ donors. The reasons why some potential organ donors did not become utilised organ donors were recorded and evaluated. RESULTS: Among 3659 patient deaths, 121 were classified as possible organ donors. The mean age of the possible organ donors was 59.4 years and 72.7% of them were male. The majority (88%) were from non-intensive care units. Of the 121 possible organ donors, 108 were classified as potential organ donors after excluding 13 unlikely to fulfil brain death criteria. Finally 11 patients became actual organ donors with an overall conversion rate of 10%. Reasons for non-donation included medical contra-indication (46%), failure to identify and inform organ donation coordinators (14%), failure of donor maintenance (11%), brain death diagnosis not established (18%), and refusal by relatives (11%). CONCLUSIONS: It is possible to increase the organ donation rate considerably by action at different stages of the donation process. Ongoing accurate audit of current practice is necessary.
Assuntos
Família , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Morte Encefálica/diagnóstico , Criança , Pré-Escolar , Feminino , Hong Kong , Humanos , Masculino , Auditoria Médica , Prontuários Médicos , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto JovemRESUMO
Acute interstitial nephritis is a common cause of acute kidney injury. Acute interstitial nephritis is most commonly induced by drug although the cause may also be infective, autoimmune, or idiopathic. Although eosinophilia and eosinophiluria may help identify this disease entity, the gold standard for diagnosis remains renal biopsy. Prompt diagnosis is important because discontinuation of the culprit drugs can reduce further kidney injury. We present a patient with an underlying psychiatric disorder who was subsequently diagnosed with clozapine-induced acute interstitial nephritis. Monitoring of renal function during clozapine therapy is recommended for early recognition of this rare side-effect.
Assuntos
Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Nefrite Intersticial/induzido quimicamente , Adulto , Transtorno Bipolar/tratamento farmacológico , Feminino , Humanos , Rim/efeitos dos fármacos , Esquizofrenia Paranoide/tratamento farmacológicoRESUMO
Vascular calcification in children with long-standing dialysis is a unique phenomenon. Hyperphosphataemia and hyperparathyroidism are the major pathogenic risk factors. We describe a young patient with end-stage renal disease diagnosed since childhood and underwent prolonged dialysis therapy. He was admitted for recurrent episodes of acute joint pain. Investigations confirmed diffuse periarticular, vascular, and intracardiac calcifications which were rarely seen in the young population. He underwent parathyroidectomy and incidentally found to have a co-existing papillary carcinoma of thyroid. After parathyroidectomy, serial X-rays showed resorption of these calcifications.
Assuntos
Hiperparatireoidismo Secundário/etiologia , Achados Incidentais , Falência Renal Crônica/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Calcificação Vascular/etiologia , Análise Química do Sangue , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/terapia , Pré-Escolar , Ecocardiografia Doppler/métodos , Seguimentos , Humanos , Hiperparatireoidismo Secundário/fisiopatologia , Hiperparatireoidismo Secundário/cirurgia , Hiperfosfatemia/etiologia , Hiperfosfatemia/fisiopatologia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Paratireoidectomia/métodos , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/métodos , Medição de Risco , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/métodos , Tomografia Computadorizada por Raios X/métodos , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/terapia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologiaRESUMO
Manystudies have shown that kidney transplant recipients have a higher incidence of cancers when compared with general population. However, most data on the posttransplant malignancies (PTM) are derived from Western literature and large population-based studies are rare. There is also lack of information about the posttransplant cancer-specific mortality rate. We conducted a population-based study of 4895 kidney transplants between 1972 and 2011, with data from the Hong Kong Renal Registry. Patterns of cancer incidence and mortality in our kidney transplant recipients were compared with those of the general population using standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) respectively. With 40 246 person-years of follow-up, 299 PTM was diagnosed. The SIR of all cancers was 2.94 (female 3.58 and male 2.58). Non-Hodgkin lymphoma (NHL), kidney, and bladder cancers had the highest SIRs. The overall SMR was 2.3 (female 3.4 and male 1.7) and the highest SMR was NHL. The patterns of PTM differ among countries. Increases in cancer incidence can now translate into similar increases in cancer mortality. NHL is important in our kidney transplant recipients. Strategies in cancer screening in selected patient groups are needed to improve transplant outcomes.
Assuntos
Transplante de Rim/efeitos adversos , Neoplasias/epidemiologia , Neoplasias/etiologia , Sistema de Registros , Adulto , Distribuição por Idade , Idoso , Estudos de Coortes , Intervalos de Confiança , Feminino , Hong Kong/epidemiologia , Humanos , Incidência , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Análise de SobrevidaAssuntos
Anticorpos Anticitoplasma de Neutrófilos/imunologia , Glomerulonefrite/patologia , Leucemia Linfocítica Crônica de Células B/patologia , Idoso , Linfócitos B/imunologia , Feminino , Glomerulonefrite/complicações , Glomerulonefrite/imunologia , Humanos , Leucemia Linfocítica Crônica de Células B/complicaçõesRESUMO
OBJECTIVES: To define the risk factors for delayed graft function and study the impact of such delays on renal function and long-term allograft survival in renal transplant recipients. DESIGN: Single-centre retrospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: Records of 118 Chinese renal transplant recipients from 1 July 1997 to 31 July 2005 were reviewed, and categorised into delayed and immediate graft function groups. RESULTS: Delayed graft function was observed in about 19% of patients, for which cold ischaemic time was an important independent predictor. For each additional hour of cold ischaemic time, the odds ratio increased for delayed function by 0.002 (95% confidence interval, 0.001-0.003; P=0.03). Multivariate analysis revealed that neither cold ischaemic time nor delayed graft function was associated with acute rejection. On the other hand, at 1 year both delayed graft function (odds ratio=18.5; 95% confidence interval, 2.6-130.5; P=0.003) and donor age (1.2; 1.1-1.3; P=0.003) were related to a glomerular filtration rate of less than 30 mL/min. When renal function between patients with and without delayed graft function during the first 3 years was compared, it was significantly better in those without delayed graft function. However, there was no significant difference in death-censored graft survival between delayed graft function and immediate graft function groups. CONCLUSIONS: Delayed graft function has a significant adverse effect on graft function at 1 year. Limiting cold ischaemic time is important as it is an independent predictor of delayed graft function.
Assuntos
Isquemia Fria/métodos , Função Retardada do Enxerto/complicações , Transplante de Rim/métodos , Adulto , Função Retardada do Enxerto/epidemiologia , Função Retardada do Enxerto/etiologia , Feminino , Taxa de Filtração Glomerular , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Hong Kong , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
Lipoprotein glomerulopathy is a rare kidney disease in which lipoprotein thrombi are seen in the glomerular capillaries. Most of these patients are found in Japan and East Asian countries. The presenting symptoms include proteinuria, an abnormal plasma lipoprotein profile that resembles type III hyperlipoproteinaemia, and a marked increase in serum apolipoprotein E concentration. Previous studies have suggested that lipoprotein glomerulopathy might be related to APOE gene mutation. No effective therapeutic regimen has been established for lipoprotein glomerulopathy. We report the first case of biopsy-proven lipoprotein glomerulopathy in Hong Kong in a patient who presented with nephrotic syndrome and dyslipidaemia. DNA analysis revealed apolipoprotein E Kyoto together with a novel apolipoprotein E mutation, apolipoprotein E (Asp230Tyr) Hong Kong. There was significant improvement in the clinical parameters and resolution of symptoms after the introduction of statins. Further studies will be needed to clarify the role of apolipoprotein E Hong Kong and its interaction with apolipoprotein E Kyoto in the pathogenesis of lipoprotein glomerulopathy.
Assuntos
Apolipoproteínas E/sangue , Apolipoproteínas E/genética , Nefrose Lipoide/diagnóstico , Nefrose Lipoide/genética , Adulto , Análise Mutacional de DNA , Glomerulonefrite/diagnóstico , Glomerulonefrite/tratamento farmacológico , Hong Kong , Humanos , Hipolipemiantes/administração & dosagem , Lipoproteínas/sangue , Masculino , Mutação , Nefrose Lipoide/tratamento farmacológico , Síndrome Nefrótica , Reação em Cadeia da Polimerase , Proteinúria , Sinvastatina/administração & dosagemRESUMO
OBJECTIVE: To investigate the prevalence of metabolic syndrome in Chinese renal transplant recipients, using two different sets of diagnostic criteria. DESIGN: Cross-sectional study. SETTING: Regional hospital, Hong Kong. PATIENTS: All Chinese patients who received solitary living-related or cadaveric kidney transplantation from 1 July 1997 to 31 December 2005 in our hospital with follow-up of more than 6 months were recruited. The diagnosis of metabolic syndrome was made according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) criteria and the International Diabetes Federation criteria. RESULTS: Using the modified (Asian) NCEP-ATPIII criteria, a total of 39 (32%) of 121 patients had metabolic syndrome, which included 20/69 (29%) of the males and 19/52 (37%) of the females. Using the International Diabetes Federation criteria, metabolic syndrome was diagnosed in 26% of the patients, 22% in males and 31% in females. In our patients, the most common component of metabolic syndrome was hypertension and the least common was low high-density-lipoprotein-cholesterol level. Low high-density-lipoprotein-cholesterol levels were significantly more common in female patients. CONCLUSION: This study shows that there is a high prevalence of metabolic syndrome in our Chinese renal transplant recipients.
Assuntos
Transplante de Rim , Síndrome Metabólica/epidemiologia , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Hong Kong/epidemiologia , Humanos , Lipoproteínas HDL/sangue , Masculino , Síndrome Metabólica/diagnóstico , Prevalência , Fatores Sexuais , Triglicerídeos/sangue , Circunferência da CinturaRESUMO
The area under the concentration time curve (AUC) for oral tacrolimus (FK) may provide a more precise model for FK monitoring after renal transplantation. The purpose of this study is to identify a simple, cost-effective method for predicting FK AUC. FK concentrations were measured at 0, 1, 2, 4, 6, 8, and 12 hours after the morning dose. The predicted AUCs (AUC(p)s) derived from regression equations were used to estimate the actual 12-hour AUCs (AUC(12)s). The relationship between AUC(p) and AUC(12) was validated by determining the coefficient of multiple determination (R(2)), percentage of prediction error (PE%), and percentage of absolute prediction error (APE%). Eighteen stable Oriental renal transplant recipients (9 men, 9 women) with a mean age of 42.6 +/- 6 years and mean body weight of 62.7 +/- 10 kg were recruited for the study. The FK AUC(12), trough, 2-hour, and 4-hour concentrations were 125 +/- 24 h. ng/mL (range, 87.7 to 181.9 h. ng/mL), 6 +/- 1.3 ng/mL, 18.1 +/- 4.7 ng/mL, and 11 +/- 2.4 ng/mL, respectively. Trough FK concentration did not have a significant correlation with AUC(12) (r = 0.34; P = 0.17). AUC(p) obtained by a two-time point regression equation using 2-hour (C2) and 4-hour (C4) FK concentrations: (AUC(P) = 16.2 + 2.4*C2 + 5.9*C4) obtained an R(2), PE%, and APE% of 0.93, -0.2% +/- 5.2% (range, -13% to 9.3%), and 3. 6% +/- 3.7% (range, 0.02% to 13%), respectively. We conclude that a two-point sampling method using C2 and C4 may be a more cost-effective FK monitoring strategy than morning FK trough levels in transplant recipients.
Assuntos
Área Sob a Curva , Imunossupressores/administração & dosagem , Imunossupressores/farmacocinética , Transplante de Rim , Monitorização Imunológica/métodos , Tacrolimo/administração & dosagem , Tacrolimo/farmacocinética , Administração Oral , Adulto , Análise Custo-Benefício , Feminino , Humanos , MasculinoRESUMO
We modified the urea reduction ratio (URR) equation to correct the effects of ultrafiltration and intradialytic urea generation on the delivered dose of hemodialysis: mURR = [1 - (R/1 + 2*UF/BW) + 0.01*t] x 100% where mURR is modified URR, R is postdialysis plasma urea nitrogen (PUN) to predialysis PUN ratio, UF is ultrafiltrate volume in liters, BW is postdialysis body weight in kilograms, and t is dialysis session length in hours. The equation was validated against 145 hemodialysis treatments on 33 stable maintenance dialysis patients. The mURR values obtained closely predicted single-pool Kt/V (spKt/V) values. In contrast to conventional URR, the range of spKt/V values at each mURR value is narrow over a wide range of UF, t, and R values. Based on the mURR equation, mURR values of 64%, 70%, and 76% are mathematically equivalent to spKt/V levels of 1.0, 1.2, and 1.4, respectively. This equation can be a useful bedside tool to quantify hemodialysis dose.
Assuntos
Hemofiltração , Diálise Renal , Ureia/metabolismo , Nitrogênio da Ureia Sanguínea , Humanos , MatemáticaRESUMO
In 22 hemodialysis patients, during a dialysis session, the solute removal index (SRI) for urea obtained from the use of a partial spent dialysate collection method was compared with that derived from the use of a total spent dialysate collection technique. The partial spent dialysate collection method was used to harvest a small representative sample of the total spent dialysate. The volumes of spent dialysate collected by the partial and the total spent dialysate collection methods were 1.7 +/- 0.4 L and 129.6 +/- 15.3 L, respectively. The total amount of urea nitrogen removed by dialysis as estimated by the partial spent dialysate collection method was similar to that determined by the total spent dialysate collection approach. As a result, the SRI value for urea obtained by the partial spent dialysate collection method (namely, 63% +/- 8%) correlated very well (r = 0.95, P < 0.001) with that derived by the total spent dialysate collection technique (namely, 62% +/- 8%). Our data suggest that it is feasible to use a simple partial spent dialysate collection method to obtain SRI results in patients treated with hemodialysis.
Assuntos
Soluções para Hemodiálise/química , Ureia/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise RenalRESUMO
This report describes a patient with mixed normal anion gap hyperchloremic metabolic and respiratory acidosis associated with hypokalemia attributed to cough mixture abuse. Metabolic acidosis was likely related to an overdose of ammonium chloride, whereas respiratory acidosis was probably related to the effect of hypokalemia on respiratory muscles, causing hypoventilation. Hypokalemia was caused by a transcellular shift of potassium induced by ephedrine and pseudoephedrine. Both ammonium chloride and ephedrine were probably present in the cough mixture obtained by our patient as an over-the-counter medication. Physicians should be aware of the potential for cough mixture abuse to cause major electrolyte disturbances that may carry the risk for major cardiac arrhythmias, particularly in youth.
Assuntos
Acidose/induzido quimicamente , Cloreto de Amônio/intoxicação , Antitussígenos/intoxicação , Hipopotassemia/induzido quimicamente , Medicamentos sem Prescrição/intoxicação , Transtornos Relacionados ao Uso de Substâncias/complicações , Acidose Respiratória/induzido quimicamente , Adulto , Overdose de Drogas , Humanos , Masculino , Debilidade Muscular/induzido quimicamente , Músculos Respiratórios/efeitos dos fármacosRESUMO
Cefepime is a cephalosporin with a broad spectrum of activity against most gram-positive and gram-negative pathogens. In this study, we attempted to compare the safety and efficacy of cefepime monotherapy against the potentially more toxic combination of vancomycin and netilmicin in the treatment of continuous ambulatory peritoneal dialysis (CAPD)-associated bacterial peritonitis. Eighty-one consecutive CAPD patients who presented with peritonitis from January 1, 1998, to June 30, 2000, were recruited for study. Patients were randomized to be administered either intraperitoneal (IP) cefepime, 1 g once daily (group A), or intravenous vancomycin and netilmicin at conventional doses (group B) for 10 days. Bacterial growth was obtained in 52 episodes (66%), and pathogens identified included gram-positive organisms (30 episodes; 38%), gram-negative organisms (14 episodes; 18%), mixed organisms (2 episodes; 2.5%), and fungus (6 episodes; 8%). Eight patients were excluded after randomization for various reasons (6 patients, fungal peritonitis; 2 patients, wrong diagnoses). Because of the relatively low peritonitis rate after the use of a disconnect system, the sample size of this study was relatively small, giving a power of 0.45. There were no significant differences in primary response rates and cure rates (no relapse >28 days after completion of antibiotic therapy) between both groups of patients (group A versus group B, 82% [32 of 39 patients] versus 85% [29 of 34 patients] and 72% [28 of 39 patients] versus 76% [26 of 34 patients], respectively; P = not significant). No significant side effect was encountered in either group. Total peritonitis-related hospitalizations were 84 patient-days (1, 7, 8, 11, 20, and 37 patient-days) and 115 patient-days (3, 6, 9, 14, 21, 21, and 41 patient-days), whereas total costs per patient cure were estimated to be US $1,039 and US $1,371 in groups A and B, respectively. We conclude that once-daily 1-g IP cefepime monotherapy is a simple, safe, and cost-effective alternative to vancomycin and netilmicin therapy in the treatment of CAPD-associated bacterial peritonitis.
Assuntos
Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Netilmicina/uso terapêutico , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/tratamento farmacológico , Vancomicina/uso terapêutico , Adulto , Idoso , Cefepima , Feminino , Gentamicinas/uso terapêutico , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/etiologia , Peritonite/microbiologia , Estudos Prospectivos , Resultado do TratamentoRESUMO
Systemic disorders, often immune in nature, can sometimes be associated with the presence of thymic pathology. Thymic enlargement due to lymphoid hyperplasia or thymoma is a common occurrence in patients with myasthenia gravis. In patients with pure red cell aplasia, at least 10% to 15% of patients are found to have thymoma, usually of spindle cell or medullary type. Pure red cell aplasia with demonstrable thymic enlargement due to lymphoid follicular hyperplasia is distinctly unusual, and has not been previously reported. The authors report such a case developing in a patient with end-stage renal failure maintained on hemodialysis and erythropoietin therapy. Because the red cell aplasia resolved after thymectomy, the disease process was considered etiologically related to the reactive lymphoid hyperplasia.
Assuntos
Eritropoetina/farmacologia , Aplasia Pura de Série Vermelha/etiologia , Timoma/complicações , Adulto , Resistência a Medicamentos , Feminino , Humanos , Hiperplasia , Falência Renal Crônica/complicações , Falência Renal Crônica/tratamento farmacológico , Aplasia Pura de Série Vermelha/fisiopatologia , Timoma/patologia , Timoma/fisiopatologia , Timo/patologiaRESUMO
This study validates Ing's partial dialysate collection method, which employs proportionate collection using a side tube capped with a small-gauge plastic needle. The urea nitrogen and creatinine levels of the small representative fraction of spent dialysate collected in the above fashion are undistinguishable from those obtained from the total spent dialysate. The estimated urea nitrogen removed during hemodialysis using this approach is similar to that using the total dialysate collection method; Ing's method is simple and useful in quantifying the dialysis dosage and in its assessment of the nutritional status of patients on hemodialysis.
Assuntos
Creatinina/análise , Soluções para Diálise/análise , Diálise Renal , Ureia/análise , Bicarbonatos/metabolismo , Creatinina/metabolismo , Reutilização de Equipamento , Humanos , Cinética , Reprodutibilidade dos Testes , Ureia/metabolismoRESUMO
Since the introduction of the peritoneal equilibration test (PET) by Twardowski in 1987, it became a widely accepted test that provided useful prognostic information on continuous ambulatory peritoneal dialysis (CAPD). It had been shown to be a readily reproducible test if the standard procedure was followed. Although there was wide interpersonal difference in the test results, the mean and range (and standard deviation, SD) were remarkably similar as suggested by Davies et al. in 1993 (3). We had performed PET on our CAPD patients for a few years, and all along we used the reference range established by Twardowski to classify our patients into High, High average, Low average, and Low transporters because no reference range had ever been established in Chinese. The aim of this study was to define the normal mean and range of the PET results in Chinese CAPD patients. We analyzed 100 PET results from 100 Chinese CAPD patients. The mean +/- (SD) of the ratio of dialysate/plasma of creatinine and glucose at four-hour dwell times were 0.71 (0.15) and 0.37 (0.12), respectively. There was a significant difference in the dialysate/plasma ratio of creatinine (p < 0.01) while that of glucose was similar when compared with those found by Twardowski. There was no difference in the solute transfer in diabetic and nondiabetic patients. We concluded that the creatinine clearance of the peritoneal membrane in Chinese CAPD patients was higher than the previously reported result in North American patients.
Assuntos
Diálise Peritoneal Ambulatorial Contínua , Peritônio/metabolismo , Adulto , Idoso , Povo Asiático , Transporte Biológico , Creatinina/metabolismo , Feminino , Glucose/metabolismo , Humanos , Falência Renal Crônica/metabolismo , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , PermeabilidadeRESUMO
We prospectively monitored the clinical outcome of 89 curled, double-cuff peritoneal catheters (PC) implanted by surgeons over one year. Thirty-six cases (40%) were supported with hemodialysis (HD) (group A) and 53 cases (60%) were supported with weekly intermittent peritoneal dialysis (IPD) (small exchange volume with a cycler) (group B) for four weeks before commencing continuous ambulatory peritoneal dialysis (CAPD). PC-related complications between the two groups were compared. Ten cases failed to complete the six-month observation period (8 died, 1 received kidney transplant, and 1 defaulted follow-up),Total experience accumulated was 494 patient-months (195 patient-months in group A, 299 patient-months in group B). The incidence of pericatheter leakage (group A vs group B) was significantly higher in group B (0% vs 13%, p < 0.05). There were no significant differences in the incidence of other PC-related complications, removal of PC, and mortality rate in the two groups. The incidence of pericatheter leakage was significantly higher in diabetic patients (71% vs 22%, p < 0.05), and group B patients with leakage had a higher incidence of external cuff erosion 57% vs 7%, p < 0.005) and delay in CAPD training (71% vs 7%, p < 0.005). We conclude that both HD and IPD are equally safe renal replacement therapies in the break-in period, while patients supported with IPD had a higher incidence of pericatheter leakage, which was associated with other catheter-related morbidities including external cuff erosion and delay in CAPD training.
Assuntos
Cateteres de Demora , Falência Renal Crônica/terapia , Diálise Peritoneal/instrumentação , Diálise Renal/instrumentação , Adulto , Idoso , Nefropatias Diabéticas/terapia , Desenho de Equipamento , Segurança de Equipamentos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Falha de Prótese , Fatores de RiscoRESUMO
A 52-year-old man with 6 years' history of human immunodeficiency virus infection who was receiving highly active antiretroviral therapy presented with acute renal failure and nephrotic syndrome. Renal biopsy revealed features consistent with nephropathy associated with human immunodeficiency virus infection. Treatment consisted of intravenous methylprednisolone followed by oral prednisolone. The patient's renal function improved, although proteinuria persisted. Human immunodeficiency virus-associated nephropathy is very rare in Asian populations and is more common among blacks. To the best of our knowledge, this is the first documented case of nephropathy associated with human immunodeficiency virus infection occurring in Hong Kong.