Diálisis y Trasplante最新文献

It is not an uncommon event that patients with stabilized kidney failure or healthy individuals develop a sudden deterioration in their kidney function requiring dialysis, while lacking an adequate vascular access. In these situations, the implant of a double-lumen tunneled catheter within the internal jugular vein should be considered the best option to start hemodialysis.

The vascular approach must be practiced preferentially on the right side, under ultrasound control and fluoroscopy guidance to verify the correct location of the tip of the catheter in the right atrium. Catheters with outer caliber between 13.5 and 15.5 Fr can provide adequate blood flow for hemodialysis.

As the use of different types of anticoagulants and antiplatelet drugs is so widely extended, it is necessary, before implanting the catheter, to check the coagulation parameters and platelet count; and, when required, the establishment of specific corrective actions to prevent hemorrhagic complications during the implant of the catheter should be undertaken.

Gaining vascular access may involve complications. Infection or sepsis is not a rarity, and its prevention requires carrying out the procedure with strict adherence to the rules for an aseptic insertion of the implant, and performing an adequate care and cleaning after every use of the catheter. Anti-microbial solutions for sealing the lumen are also effective in this context, but if an infection develops, the catheter must be removed and an appropriate antibiotic regimen must be established. Other situations that may involve removal of the catheter are: malfunction, breaking, venous thrombosis and central venous stenosis or occlusion. However, there are cases of venous thrombosis in which, before removing the catheter, direct fibrinolysis may be tried. Similarly, in selected cases of central venous stenosis or occlusion, pneumatic dilatation with balloon catheter (angioplasty, APT) may be tried (once or more) to restore the venous caliber. Finally, in very infrequent situations in which APT fails, it is possible to implant a stent to resolve the stenosis; however, as it is frequently not effective in the medium term, it should only be considered as a last resort.

In conclusion, jugular access for dialysis in patients without a competent internal arterio-venous fistula is an optimum choice. Although it presents a wide range of complications, if being expected, an effective and appropriate treatment may be safely established. As complications involving complex instrumentation, such as APT or stenting, show a low frequency (below 3%), jugular access can be considered a safe, comfortable and effective access for dialysis procedures.

Introduction

The largest population group of 65, usually more susceptible to emotional and nutritional effects arising from chronic kidney disease. Currently, there are no studies that establish an association between emotional states, cognitive impairment, with the nutritional status of elderly patients on hemodialysis.

Objective

To determine the correlation of cognitive, functional and emotional state to nutritional status in a population of 64 years on hemodialysis.

Materials and methodmethods

An observational, cross-sectional study; 107 adult patients were analyzed, with chronic kidney disease stage 5 on hemodialysis. We evaluated it been cognitive per test mini-mental state examination (MMSE), emotional state as HADS scale and short -12 Form (SF-12), quality of life by Karnofsky scale and SF-12, assessment of nutritional status by subjective global assessment (VGS), body mass index (BMI) and biochemical parameters.

Results

The mean age was 70.6 ± 5.2 years, with a state of mild malnutrition 29.9%, 65.4% moderately malnourished and 4.7% severely malnourished; an average MMSE score of 20.6 ± 5.2, as mild cognitive impairment, Karnofsky score of 71.4 ± 10.9 representing a slight functional deficit, 29.9% to 18.7% with depression and anxiety; an association between nutritional status and cognitive impairment (r −0401, P<.01), nutritional status and functional status (r −0361, P<.01) was found.

Conclusion

Based on our data it is possible to establish an association of cognitive and functional status with the degree of malnutrition in the elderly population, these constitute an important determinant of nutritional deficit.

Primary hyperaldosteronism is a result of excessive aldosterone secretion due to overactivity of the adrenal cortex, usually due to a solitary adenoma. A clinical case is presented of a patient with Conn syndrome who had persistent very high blood pressure levels despite surgical and intensive pharmacologic treatment. There are several clinical features that can be used as predictors of the response to the surgical and medical treatment.

Introduction and objectives

Tuberculosis is an infectious disease that can compromise the success of kidney transplantation. The objective of the present study was to identify and assess the clinical and epidemiological differences of kidney transplantation subjects according to tuberculosis status in a Brazilian state.

Methods

The records of 843 subjects were analyzed retrospectively in a case–control protocol. We performed crude and adjusted analyses according to tuberculosis diagnosis after kidney transplantation.

Results

The average age among subjects who underwent kidney transplantation were 40 ± 14 years. Approximately 60% of the patients were males, and 57% were non-Caucasian. Tuberculosis was diagnosed in 13 kidney transplantation recipients (1.54%; 95% CI: 0.71–2.38%). The adjusted analysis revealed that patients with a history of tuberculosis were 41 times more likely to develop tuberculosis after kidney transplantation than were other patients (OR = 40.71; 95% CI: 2.54–651.84). The number of infectious episodes (OR = 1.35; 95% CI: 1.10–1.67) and the use of sirolimus during initial immunosuppression also increased this risk (OR = 41.40; 95% CI: 2.59–660.31).

Conclusion

The implementation of follow-up screening and procedures is necessary to avoid compromising the effectiveness of kidney transplantation by developing diseases such as tuberculosis. Follow-ups are also important for the development of new technologies to improve the diagnosis and management of the disease in these patients.

Introduction

The depression is a subdiagnosed problem in patients in hemodialysis with renal chronic insufficiency, increasing the risk of mortality.

Objectives

To determine the prevalence, range of age and predominant sex of depression in patients of the program of hemodialysis inside 5 hospitals of medical attention in Monterrey's metropolitan area, located in the northwest of Mexico.

Material and methods

observational, transversely study. Selection criteria: patients in the program of hemodialysis, both sexes, major of 19 years, with informed assent, excluding patients with additional pathologies, less than one month in the program, previous diagnosis of depression, which were in protocol of transplant and which they refused to inform. There was applied the inventory of depression of Beck II to 225 patients.

Results

The global depression prevalence was 47.1% (106), of which, 43 (19.1%) had slight depression, 31 (13.8%) moderate depression and 32 (14.2%) severe depression. Being in use measures of frequency, X² of Pearson and estimation of risk, was statistical significance in relation to the night shift, feminine sex, time inside the program and number of meetings.

Conclusions

Depression global prevalence in the patients studied was high. A detection test of depression must be realized in each one of patients enrolled in the hemodialysis program; furthermore, a protocol of attention must be standardized in every hospital in order to improve the quality of attention.

Introduction and objectives

Lupus nephritis continues to be the most common cause of renal failure of autoimmune origin that requires dialysis in our region. There is limited information available on the role of serial biopsies in lupus nephritis. Our objective was to compare the renal function of patients with lupus nephritis with a repeated renal biopsy at one year, with patients without a repeated biopsy.

Methods

A longitudinal, retrospective, observational and comparative analysis study was conducted on patients with lupus nephritis with at least one renal biopsy between January 2004 and January 2012.

Results

Of the 100 patients included with lupus nephritis, 57 of them had a repeated biopsy, and 43 had no repeated biopsy. The group without a repeated biopsy had a higher percentage of patients with declining renal function (58.1% vs. 41.9%) and a higher percentage of patients on dialysis after a one year follow up, in comparison to the group with repeated biopsies (90% vs. 10%, P = .002). Eighty percent of the patients with a repeated biopsy had a modification in their immunosuppressive treatment as a result of the serial biopsy. In this group, 57.9% of the patients received a more aggressive immunosuppressive treatment or a new treatment strategy.

Conclusions

Repeated renal biopsies in lupus nephritis allow an early modification of the immunosuppressive strategy, prevent progressive decline in renal function, and limit the use of dialysis in this group of patients.

The case is presented of a 52 year-old male patient, who was referred to our center with nephrotic syndrome. He had a urine protein level of 5.2 g/g creatinine. An atypical anatomical outline of the kidney, with suspicion of fusion, was observed while performing the ultrasound scan. A computed tomography scan was requested, which showed a horseshoe kidney, suggestive of an underlying glomerular disease. Due to technical difficulties, a laparoscopic technique was used to perform the renal biopsy, with no complications for the patient. The histopathology reported membranous nephropathy. Treatment was started with prednisone at 1 mg/kg/d and mycophenolate mofetil, with remission of the nephrotic syndrome at 3 months follow-up.

Background

Microbial biofilms are mechanisms used by microorganisms that cause chronic infections in humans. In hemodialysis patients with catheter-related bacteremia, Staphylococcus aureus is an independent risk factor for both infectious complications and failure of bacteremia treatment. We analyzed the characteristics of biofilms formed by these Staphylococcus species on non-tunneled hemodialysis catheters.

Patients and methods

A total of 50 adult patients with end-stage renal disease receiving hemodialysis through non-tunneled catheters, whose catheters were removed for catheter-related bacteremia, were studied.

Results

Catheter cultures were positive in only 32 patients and staphylococcal biofilm was found in 25 patients. All biofilm producers were S. aureus. In tissue culture plate method, 2 were strong biofilm producers, 15 were moderate biofilm producers and 5 isolates were considered as weak biofilm producers. In tube method, there were no strong biofilm producers, 12 were moderate biofilm producers and 13 were weak biofilm producers. In Congo red agar method there were no strong biofilm producers, 10 were moderate biofilm producers and 15 isolates were weak biofilm producers.

Conclusion

Our study shows that S. aureus is the most common bacteria isolated from patients with catheter-related bacteremia. S. aureus is the predominant microorganism responsible for biofilm formation in the non-tunneled HD catheters. Tissue culture plate method is more sensitive to detect biofilm formation by S. aureus.