Renal vascular disease in the elderly.

The aging of Western societies is causing a progressive increase in the number of patients over 65 starting dialysis. The EDTA Registry shows that in 1995 this section of the population represented nearly 45% of patients under dialysis, and the percentage is even higher in the USRDS at 48%, 20% of whom are over 75. These changes have not only been quantitative, but have also modified the causes of end-stage renal disease (ESRD). Diabetic nephropathy (DN) and renal vascular disease (RVD) account for more than 50% of all these causes, reaching 66% according to the latest USRDS calculations. According to these numbers, RVD represents 29% of all causes, the incidence varying with the age group, and has become the main cause of ESRD in the elderly (38% of all cases). Until a few years ago, RVD was synonymous with hypertension, but as the population ages, the range of diseases in this group is increasing. The main RVDs that cause ESRD in the elderly are: hypertensive RVD (nephrosclerosis), atheromatous RVD (either as ischemic atherosclerotic nephropathy or as atheroembolism), and acute occlusion of renal arteries (either bilateral or unilateral in single-kidney patients). The diagnosis of nephrosclerosis in the absence of histological confirmation is a presumed clinical diagnosis, made in most cases by exclusion, and is therefore clearly overestimated. On the other hand, atheromatous RVD is an underdiagnosed disease that is often overlooked. The prevalence, natural history, diagnosis and prognosis are discussed in this report.

[Lupus nephropathy in childhood and familial lupus. Genetic study of a family]. / Nefropatía lúpica en la infancia y lupus familiar. Estudio genético de una familia.

We report a case of a 14 1/2-year-old boy who was diagnosed of systemic lupus erythematosus in the background of an acute nephritic syndrome, 3 1/2 years after being diagnosed of idiopathic thrombocytopenic purpura. The familial history suggested the presence of other cases of SLE, which were proven with relevant clinical and laboratory studies. A genetic study for disease markers was carried out and a correlation was found with haplotypes HLA A25, B18, BW6, DRX, and DQW; C2 deficiency was ruled out. We conclude that it is of paramount importance to rule out the existence of familial SLE in front of infantile SLE, particularly in boys, and we emphasize the necessity of keeping on further searching for genetic markers of the disease.

[Renovascular hypertension: results of surgical treatment with a three-year follow-up (author's transl)]. / Hipertensión arterial vasculorrenal: resultados del tratamiento quirúrgico con un seguimiento medio de tres años.

Between 1966 and December 1979, 58 patients with renovascular hypertension were surgically treated at our center. Follow-up was a minimum of one year in all patients and in all cases permeability of revascularization was assessed through angiography from one to six months after surgery. The mean follow-up was 39 months. Thirty-eight (65.5%) were male and 20 (34.6%) female. Age of onset was between 3 and 53 years (mean 36.3 years). Etiology was arteriosclerotic in 27 cases and fibrous dysplasia in all its manifestations in another 27, in 2 cases vascular compression due to retroperitoneal fibrosis and renal hypoplasia in the remaining two. In 4 cases lesions were bilateral. The cure rate was 37 patients (63.8%), Improvement in 16 (27.6%), while there was no improvement in 5 (8.6%). Surgical mortality rate was nil. The different techniques used, indications, long and short term complications and different results according to etiology are discussed.

[Nephronophthisis: study of 10 cases. Incidence, natural history and associated pathology (author's transl)]. / Nefronoptisis: análisis de 10 casos. Incidencia, historia natural y patología asociada.

Nephronophthisis is a chronic interstitial nephropathy which in childhood may lead to terminal renal failure. Between January 1975 and July 1980, 41 children with terminal renal failure were seen in our service, of which 10 (21.9%) presented with nephronophthisis. Age of the patients ranged from 3.5-18 years, boys were in the majority (8/2). Three cases were isolated and 7 were familial (3 families). Onset was during the first year of life in 8 patients, and polydipsia-polyuria were the first symptoms. Retarded growth and anemia proportionate to the degree of renal failure were present in all patients. When diagnosed, 5 patients (50%) presented terminal renal failure, and the other 5 had renal failure of different degrees. Moderate proteinuria was found in 4 patients, without changes in urine sediment. Sodium depletion in urine was high in 5 cases and maximal urine osmolarity was less than 500 muOsm/l after hydropenia in all cases. Four had associated mental deficiency with cerebellar ataxia associated in two and congenital hepatic fibrosis (confirmed histologically) in one. The diagnosis was confirmed by biopsy in 8 and in two of these on frozen section during nephrectomy prior to kidney transplantation. At present, five of the patients are in maintenance hemodialysis, two died at home due to cardiovascular complications in terminal renal insufficiency and the remaining ones presented different degrees of renal insufficiency. Time elapsed between onset of the symptoms and inclusion in hemodialysis or death ranges form 6 months to 13 years (mean 6.7 years).

[Kidneys from donors less than 5 years of age for transplantation: how to use them?]. / Riñones de donante menor de cinco años para trasplante: cómo utilizarlos?

We evaluated the results of 27 renal transplants (RT) from donors less than 5 years of age (mean 2.1 +/- 1.1 years). Seven were transplanted en bloc and the rest separately. Fourteen recipients were children and 13 were adults. The overall graft survival at one year was 51%. Kidneys from donors less than 2 years of age that had not been transplanted en bloc had a survival rate of 21%. There was a marked improvement in the one-year graft survival (71%) for kidneys from donors under 2 years of age that had been transplanted en bloc, and a slight improvement (53%) for those from donors over 2 years of age. No urological complications were observed. Five RT were lost due to vascular complications. Good renal graft function was observed in both children (mean plasma creatinine 1.65 mg/dl.) and adults (mean plasma creatinine 1.90 mg/dl.). The one-year graft survival rate was 59% for the adult recipients and 42% for the children. We can conclude from these findings that kidneys from pediatric donors can be transplanted to children as well as adults and should probably be performed en bloc when the donor is less than 2 years of age.

Cisplatin nephrotoxicity: symptomatic hypomagnesemia and renal failure.

Cisplatin is an inorganic platinum compound used in the treatment of solid tumors. Clinical trials have proved its efficacy whilst recognising the nephrotoxicity of the drug. We report the case of a 14 1/2 year old female with an epidermoid carcinoma of the lung, who developed acute renal failure following two courses of Cisplatin. The predominant features were symptomatic hypomagnesaemia, hypocalcaemia and hypokalaemia which were corrected following the administration of intravenous magnesium. Renal failure persisted for several months and the patient died due to her primary disease. Electrolyte disturbances should be anticipated when high dose Cisplatin is used.