RESUMO
Case report of a 18-year-old patient with long lasting hypertension, who developed acute renal failure, in course of an antihypertensive therapy modification, backgrounded by undiagnosed aneurysm of the solitary kidney renal artery. The acute renal function decrease was caused by single dose of ACE inhibitor causing an equivalent drop in serum ACE activity. Aneurysm excision followed by implantation of a venous bypass normalized restored renal function and blood pressure for over 24 months of observation.
Assuntos
Aneurisma/cirurgia , Hipertensão Renal/cirurgia , Rim/anormalidades , Obstrução da Artéria Renal/cirurgia , Trombose/cirurgia , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/cirurgia , Adolescente , Aneurisma/diagnóstico , Angiografia , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Aorta Torácica/cirurgia , Quimioterapia Combinada , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Hipertensão Renal/diagnóstico , Hipertensão Renal/tratamento farmacológico , Masculino , Perindopril/administração & dosagem , Perindopril/efeitos adversos , Artéria Renal/cirurgia , Obstrução da Artéria Renal/diagnóstico , Veia Safena/transplante , Trombose/diagnósticoRESUMO
We report the case of a 61-year-old man with nephrotic syndrome due to glomerulonephritis and chronic brucellosis complicated by dissecting aortic aneurysm. The patient worked as a veterinarian and was diagnosed for chronic but non-active brucellosis with positive serum test for Brucella melitensis in the past. Administration of cyclosporine in combination with low dose prednisone resulted at least in proteinuria reduction and partial remission for 3 years. Dissecting aortic aneurysm was treated by insertion of a stent-graft, that resulted in canalization of blood flow and retraction of aneurysm wall later in the course in our patient.
Assuntos
Aneurisma da Aorta Torácica/etiologia , Dissecção Aórtica/etiologia , Brucelose/complicações , Síndrome Nefrótica/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Arteriovenous fistula (AVF) creation for hemodialysis (HD) could predispose to local arterial insufficiency of the hand (steal syndrome). Patients with diabetes mellitus, peripheral arterial disease and elderly patients tend to have a higher risk of hand ischemia. PURPOSE AND METHODS: To estimate the influence of AVF on the blood supply to the hands in the elderly population and to identify steal syndrome cases by non-invasive diagnostics (finger photoplethysmography (PPG), pulse volume recording (PVR), Doppler analysis and pulseoxymetry). The evaluation was carried out in 25 random patients (10 females, 15 males) >75 yrs of age (79.6 +/- 3.87 yrs), whose functioning autologous AVFs had been placed at least 1 month previously. RESULTS: Mean PPG and PVR amplitudes did not differ in statistical analysis (p > 0.05) between hands with and without an AVF. One patient (4%) with end-to-side anastomosis was diagnosed with steal syndrome (typical manifestation confirmed in PPG, Doppler and pulseoxymetry). Two other patients with high brachio-cephalic anastomosis presented subclinical steal syndrome (only low PPG and PVR). CONCLUSIONS: Even in the very elderly, AVF creation should be considered due to a lesser influence on the blood supply to the hands. Non-invasive diagnostics used by us seemed to be useful in identifying steal syndrome after AVF creation.
RESUMO
Despite the fact that concentrations of mycophenolic acid (MPA) are not routinely measured, accumulating data suggest the usefulness of this monitoring to optimize therapy. The aim of this study was to assess the influence of CsA and tacrolimus on MPA pharmacokinetics. Concentrations of MPA were measured using HPLC. An assay was performed before dose (the C(0)), as well as at 40 minutes and 1, 2, 4, 6, 8, 10, 12 hours after administration of mycophenolate mofetil (MMF). MPA profiles were assessed in 51 patients receiving tacrolimus at a dose of 1.0 g/d and prednisone as well as in 97 patients receiving CsA (2.0 g/d) and prednisone. Significant correlations of MPA levels with serum albumin and GFR were observed in both groups. Women presented with higher levels of MPA than men. C(0) MPA level among the tacrolimus group were significantly higher than those in CsA group: 3.18 +/- 2.21 microg/mL versus 1.68 +/- 1.03 microg/mL (P =.001). The level of MPA AUC((0-12)) in the tacrolimus group was nonsignificantly higher than that in the CsA group. There was no second peak of MPA level in a group of patients receiving CsA. We developed a limited sampling strategy to estimate MPA AUC((0-12)) in both tacrolimus and CsA groups. We observed a correlation between C(0) MPA and C(0) CsA (r =.35; P =.001) as well as, between tacrolimus dose and MPA C(40) and MPA C(max) (r =.24; P =.05; r =.27; P = 0.05, respectively). No relationship between MPA pharmacokinetics and tacrolimus blood concentrations was noticed. Tacrolimus and CsA both affect the pharmacokinetics of MPA; high MPA concentrations in patients treated with tacrolimus justify MMF dose reduction in this group. Alterations of CsA concentrations must be used to guide MMF dose adjustments.
Assuntos
Inibidores de Calcineurina , Transplante de Rim/imunologia , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/farmacocinética , Adulto , Ciclosporina/uso terapêutico , Quimioterapia Combinada , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Imunossupressores/farmacocinética , Imunossupressores/uso terapêutico , Masculino , Taxa de Depuração Metabólica , Ácido Micofenólico/uso terapêutico , Prednisona/uso terapêutico , Estudos Retrospectivos , Albumina Sérica/metabolismo , Tacrolimo/uso terapêutico , Fatores de TempoAssuntos
Transplante de Rim/mortalidade , Doadores de Tecidos/estatística & dados numéricos , Doença Aguda , Cadáver , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Causas de Morte , Humanos , Infecções/epidemiologia , Infecções/mortalidade , Transplante de Rim/estatística & dados numéricos , Cirrose Hepática/epidemiologia , Cirrose Hepática/mortalidade , Neoplasias/epidemiologia , Neoplasias/mortalidade , Peritonite/epidemiologia , Peritonite/mortalidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Falha de TratamentoRESUMO
BACKGROUND: There are controversies regarding the feasibility of autogenous vascular access creation in elderly hemodialysis (HD) patients. The aim of this retrospective study was to evaluate the results of creating different types of autogenous arteriovenous fistulas (AVFs) in a consecutive series of HD patients over 75 years of age. METHODS: The analysis was performed in 131 patients (65 females, 66 males, average age 79.1 +/- 3.6 years) in whom the creation of an autogenous AVF was considered within a 6-year period (February 1998 to February 2004). Among them, 26.7%were diabetics, 66.3% had hypertension, 30.7% were smokers, and 35.6% were obese. Patient survival and primary and secondary AVF patency were assessed. RESULTS: The survival rates for patients were 94, 88, 66, and 45% at 6 months and at 1, 3, and 5 years, respectively. Successful autogenous AVF formation was finally achieved in 107 patients (81.6%): in 99 patients in the forearm and in 8in the upper arm. A Kaplan-Meier analysis showed primary AVF patency rates of: 74 +/- 4.3% (+/- SE) at 1 month; 70 +/- 4.7% at 6 months; 59 +/- 4.9% at 1 year; 59 +/- 4.9% at 2 years; 59+/- 4.9% at 3 years; 59 +/- 4.9% at 4 years, and 58 +/- 4.9% at 5 years. The secondary patency rates were: 95 +/- 2.0; 92 +/- 2.2; 84 +/- 3.3; 79 +/- 4.0; 72 +/- 4.3; 71 +/- 4.4, and 69 +/- 4.5% in the corresponding periods, respectively. All postoperative complications in 10 patients were treated surgically, if applicable, without endovascular techniques. CONCLUSIONS: By exploiting all suitable types of autogenous AVF it is possible to establish the best form of vascular access even in the majority of elderly patients.