[Embolization of non-functioning renal allograft: efficacy and control of systemic inflammation]. / Embolización del injerto renal no funcionante: eficacia y control del estado inflamatorio crónico.

BACKGROUND: The graft intolerance syndrome (fever, pain, haematuria) may lead to a chronic inflammatory disease, with cardiovascular repercussion. Nephrectomy is considered the classical treatment of these cases but nowadays renal vascular embolization has been suggested as a possible alternative treatment. The present study concerns seven cases trated with renal vascular embolization in our hospital summarizing data of graft intolerance syndrome and the chronic inflammatory disease. MATERIAL AND METHODS: Between january 2000 and december 2003 seven renal vascular embolization were performed in nonfunctioning renal allograft. The procedure was made with calibrated particles of 300-500micron. Data about complications related to the technique the same as analitic inflammatory parameters before and after treatment (CRP, ferritin, serum albumin, hemoglobin, erythropoietin) were registered. RESULTS: The patients were two men and five women, with median age of 39,7 +/- 8,8 years. The period beween the dialysis and the embolization was of 10,0 +/-8,2 months. Comparing the perion of admission in the hospital due to nephrectomy which was of 17,86+/-4,41 days, the period because of embolization was shorter, being 8,14 +/- 4,53 days. All analitic parameters studied, clearly improved after embolization with decrease of ferritin and CRP, increase of albumin and better hemoglobin level with lower erythropoietin dose. In five of the seven patients there was no renal captation with CT or gammagraphy. Four patients presented a postembolization syndrome, but no other important complication was registered. Neither reembolization nor renal nephrectomy was neccesary in any of the seven cases. CONCLUSION: Percutaneous renal embolization is a simple, easy, safety and effective technique that must be considered as an alternative treatment to nephrectomy, resolving the chronic inflammatory disease secondary to the graft intolerance syndrome.

[Familial periodic ataxia with myokymia sensitive to acetazolamide: a family case]. / Ataxia periódica familiar con mioquimia sensible a acetazolamida: presentación de una familia.

INTRODUCTION: Acetazolamide responsive hereditary paroxysmal cerebellar ataxia with myokymia is a type of autosomal dominant cerebellar ataxia which locus was found to be linked to the short arm of chromosome 12 and the etiology is unknown. CLINICAL CASE: A 12 years-old man who suffered from childhood daily episodes of sudden attacks sport induced with giddiness, ataxia and dysarthria for minutes. The familial history shows the same clinical findings in three generations. Intercritical general neurologic evaluation is otherwise normal. The following tests were performed with normal results: Biochemistry, electroencephalogram, cerebral magnetic resonance imaging. The electromyography showed myokymic discharges. The patient's symptoms improve on treatment with acetazolamide immediately. CONCLUSIONS: Acetazolamide responsive hereditary paroxysmal cerebellar ataxia with myokymia needs to think on it to be diagnosed. No typical complementary test (electromyography exception) induces to base diagnosis in the clinical findings, the familial history and the fast clinical improvement after starting treatment with acetazolamide.

Embolización del injerto renal no funcionante: eficacia y control del estado inflamatorio crónico / Embolization of non-functioning renal allograft: efficacy and control of systemic inflammation

Introducción: El síndrome de intolerancia al injerto (fiebre, dolor, hematuria), conlleva el desarrollo de un estado inflamatorio crónico, con consecuencias a nivel cardiovascular. La embolización percutánea del injerto renal no funcionante ha sido descrita como alternativa a la nefrectomía. Presentamos los resultados de la embolización de injertos renales no funcionantes en nuestro centro, respecto al síndrome de intolerancia al injerto y al estado inflamatorio. Material y métodos: Desde el 1-1-2000 hasta el 31-12-2003 hemos realizado siete embolizaciones de injertos renales no funcionantes. El procedimiento se realizó con partículas calibradas (embosferas) de 300-500 µ. Se analizaron datos referentes a las complicaciones de la técnica y los parámetros analíticos relacionados con el estado inflamatorio: PCR, ferritina, albúmina, hemoglobina, y dosis de eritropoyetina, antes y después de la embolización. Resultados: Los pacientes, dos varones y cinco mujeres, tenían una edad media de 39,7 ± 8,8 años. Desde el reinicio de la diálisis hasta la embolización transcurrieron 10,0 ± 8,2 meses. La duración del ingreso por embolización fue de 8,14 ± 4,53 días y por nefrectomía de 17,86 ± 4,41 días. No hubo complicaciones importantes, pero cuatro pacientes presentaron un síndrome postembolización. En cinco pacientes se confirmó la ausencia de captación renal por TC o gammagrafía. No ha sido necesaria la reembolización ni la trasplantectomía hasta el momento. Hemos observado una mejoría en todos los parámetros analíticos después de la embolización, con disminución de la PCR y de la ferritina, aumento de la albúmina, y clara mejoría de las cifras de hemoglobina para dosis de eritropoyetina inferiores. Conclusión: La embolización renal percutánea constituye una técnica sencilla, segura y efectiva, que puede indicarse como alternativa a la nefrectomía quirúrgica, y que resuelve el estado inflamatorio crónico secundario a intolerancia al injerto renal no funcionante

Background: The graft intolerance syndrome (fever, pain, haematuria) may lead to a chronic inflammatory disease, with cardiovascular repercussion. Nephrectomy is considered the classical treatment of these cases but nowadays renal vascular embolization has been suggested as a possible alternative treatment. The present study concerns seven cases trated with renal vascular embolization in our hospital summarizing data of graft intolerance syndrome and the chronic inflammatory disease. Material and methods: Between january 2000 and december 2003 seven renal vascular embolization were performed in nonfunctioning renal allograft. The procedure was made with calibrated particles of 300-500µ. Data about complications related to the technique the same as analitic inflammatory parameters before and after treatment (CRP, ferritin, serum albumin, hemoglobin, erythropoietin) were registered. Results: The patients were two men and five women, with median age of 39,7 ± 8,8 years. The period beween the dialysis and the embolization was of 10,0 ± 8,2 months. Comparing the perion of admission in the hospital due to nephrectomy which was of 17,86 ± 4,41 days, the period because of embolization was shorter, being 8,14 ± 4,53 days. All analitic parameters studied, clearly improved after embolization with decrease of ferritin and CRP, increase of albumin and better hemoglobin level with lower erythropoietin dose. In five of the seven patients there was no renal captation with CT or gammagraphy. Four patients presented a postembolization syndrome, but no other important complication was registered. Neither reembolization nor renal nephrectomy was neccesary in any of the seven cases. Conclusion: Percutaneous renal embolization is a simple, easy, safety and effective technique that must be considered as an alternative treatment to nephrectomy, resolving the chronic inflammatory disease secondary to the graft intolerance syndrome