Systemic Lupus Erythematosus (SLE) is an autoimmune chronic disease that causes potentially systemic injury or/and inflammation. We report a case of a 18 year old Mexican man; presenting with serum creatinine elevation in a routine laboratories without any symptoms. We only found C3 alterations at the initial study. We provide a review of the literature describing Systemic lupus erythematosus characteristics.
Acute kidney injury (AKI) is a common complication in hospitalized patients, and is an independent predictor of mortality. Approximately 4-5% of patients in ICU will need renal replacement therapy (RRT), and more than two-thirds of these patients will develop AKI, with a mortality of 50 to 60%. Although continuous renal replacement therapy (CRRT) is the preferred treatment in patients with AKI in ICU, especially if there is hemodynamic instability, no differences in survival compared to intermittent hemodialysis (IHD) or hybrid therapies, such as prolonged intermittent renal replacement therapies (PIRRT), have been demonstrated.
To describe our experience with different renal replacement therapies and the survival of our patients.
There is no difference in short-term survival between patients with AKI or acute chronic disease who required RRT, such as CRRT or hybrid therapy, than those who were treated using intermittent hemodialysis (IHD).
A retrospective study was conducted from March 2009 to June 2012 on all patients who were treated with RRT in ICU, with survival being assessed after 28 days follow-up.
The study included a total of 33 patients, of whom 20 were male and 13 females. They were divided into therapy groups, with 21 for CRRT, 6 for hybrid therapies, and 6 de IHD. The percentage survival was 28.6% for CRRT, 16.7% for hybrid, and 33.3% for IHD.
It could not be demonstrated that there was a greater survival in any of the therapies in this study.
To estimate the diagnostic validity of the resistance index (RI) in renal transplant patients with graft dysfunction, using the histopathological findings as gold standard.
A retrospective review was performed on the biopsies of 85 patients with renal graft dysfunction. Patients were grouped according to the histological findings: normal findings, acute rejection, chronic rejection, and other findings. The RI was assessed by Doppler ultrasound, considering values of < .55 and > .75 as pathological, and were analyzed along with the findings in the biopsy. Sensitivity, specificity, positive predictive value and negative predictive value of RI were assessed. The mean RI was compared between patients with normal and abnormal pathological findings.
The RI was normal in 59 patients, and pathological in 26. The RI showed a specificity of 72.73% and a high positive predictive value of 88.46% in patients with graft dysfunction. There was no statistically significant difference (P = .196) in the RI between patients with normal and pathological histopathology in the biopsy.
Despite its low sensitivity, the RI is reliable in detecting an abnormal parameter when its value is outside the reference range. However the performing a biopsy is still required to determine the cause of the kidney disease.
The case is presented of a pregnant patient at 20 weeks gestation with chronic renal disease in advanced stage and in poor general condition, which required initiation of renal replacement therapy due to uremia and fluid retention. Although her referral was delayed, it was possible to improve her general condition in all aspects, allowing her to have an electively scheduled abdominal birth at 38 weeks, with favorable results for the newborn that exceeded the statistics described in these patients. This case is presented along with a review of the literature and a critical analysis of the management of these patients.
Renal function reserve (RFR) represents the capacity of the kidney to increase glomerular filtration rate (GFR) in response to certain physiological or pathological stimuli or conditions.
Baseline GFR displays variable values according to the diet or other factors, and may be normal even when there is an important lowering of nephron number. Once baseline GFR is determined, RFR can be assessed clinically by oral protein load or intravenous aminoacid infusion.
RFR is the difference between peak (stress-induced) GFR and basal GFR. In clinical scenarios where hyper-filtration is present (high baseline GFR due to pregnancy, hypertensive or diabetic nephropathy, solitary kidney or kidney donors) RFR may be fully or partially used to achieve normal or supra-normal renal function.
RFR test may represent a sensitive and early way to asses kidney functional decline and recovery. In cases of healing with a defect and fibrosis, clinical assessment may suggest a complete recovery, but a reduced RFR may be a sign of a maladaptive repair or sub-clinical loss of renal mass. Therefore, a reduction of RFR may represent the equivalent of renal frailty or susceptibility to insults. The main aim of this article is to review the concept of RFR, its utility in different clinical scenarios and future perspective for its use.
Sleep disorders are one of the most common comorbidities among patients on hemodialysis. The aims of this study were to determine the prevalence of poor sleep quality as well as to establish potential factors associated with poor sleep quality.
A cross-sectional study was performed enrolling patients with chronic kidney disease on hemodialysis. The outcome was sleep quality evaluated using the Pittsburgh Scale, whereas the exposure variables were time on hemodialysis, history of type-2 diabetes and hypertension, depressive symptoms, anemia, and uremia. We used Poisson regression model to determine the association of interest, reporting prevalence ratios (PR) and 95% confidence intervals (95%CI).
A total of 450 patients were enrolled, 259 (57.5%) were male, aged from 18 to 97 years. The prevalence of poor sleep quality was 79.3% (95%CI: 75.6%–83.1%). Poor sleep quality was associated with depressive symptoms (PR = 1.28; 95%CI: 1.17-1.39), anemia (PR = 1.18; 95%CI: 1.04-1.34) and uremia (PR = 1.26; 95%CI: 1.17-1.36) after controlling for potential confounders.
The presence of depressive symptoms, anemia and uremia were positively associated with poor sleep quality among patients with chronic kidney disease on hemodialysis. A great proportion of this population had poor sleep quality. Strategies are needed to improve sleep quality in these patients.
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