Causas de muerte en pacientes con un injerto renal funcionante: ¿Han ocurrido cambios en las últimas décadas? / Causes of death with a functioning graft among kidney allograft recipients

Background: Death with a functioning graft (DWGF) is now one of the main causes of renal transplant (RTx) loss. Aim: To determine whether the causes of DWGF, characteristics of donors and recipients and complications of RTx have changed in the last two decades. Subjects and Methods: Cooperative study of a cohort of 418 kidney grafts performed between 1968 and 2010. Patients were divided into two groups according to whether their kidney transplants were performed between 1968 and 1992 (Group 1) or 1993 and 2010 (Group 2). Results: Sixty eight patients experienced DWGF. Infections were the leading cause of DWGF in both groups (38 and 41%, respectively), followed by cardiovascular diseases (24 and 23% respectively), gastrointestinal disorders (21 and 26% respectively) and cancer (17 and 10% respectively). There were no significant differences in causes of death between the two groups according to the time elapsed since the renal transplantation. In patients in Group 1, the interval between diagnosis of renal failure and dialysis (HD) and the interval between the start of HD and kidney transplantation were significantly lower than in Group 2. The former had also an increased number of acute rejections in the first five years of kidney transplantation (p < 0.001). In Group 2, patients more often received their kidneys from deceased donors, had previous kidney transplantation, higher rate of antibodies to a panel of lymphocytes and an increased incidence of cardiovascular disorders after five years of RTx. Conclusions: The proportion of graft loss due to DWGF has increased over the last 2 decades, but its causes have not changed significantly. Infections are the most common causes of DWGF followed by cardiovascular and digestive diseases.

La hiponatremia al momento de ingreso como factor de riesgo de mortalidad hospitalaria / Hyponatremia on admission to the emergency room as a risk factor for hospital mortality

Background: Patients who develop hyponatremia during their hospitalization have higher hospital mortality. Aim: To determine if the presence of hyponatremia on admission to the emergency room is a risk factor for hospital mortality. Patients and Methods: Two hundred forty five patients consecutively admitted to the emergency room and then transferred to the Medicine Department, where they finally died, were matched for age and gender with 245 control subjects admitted to the emergency room and hospitalized in the Medicine Department at the same time, but survived. The dependent variable was death, and the exposure variable was hyponatremia. Admission diagnosis and Charlson comorbidity index was considered as confounding variables. Results: Hyponatremia at admission occurred in 30 and 17 percent of patients who died and survived, respectively, rendering an adjusted odds ratio for death of 2.13 (95 percent confidence intervals = 1.27-3.57). Charlson Comorbidity Index according to age score was higher in subjects with hyponatremia compared to those without hyponatremia (8.1 ± 3.1 and 7.2 ± 2.8; p = 0.01). Multivariate analysis showed that age, gender, length of stay, cause of hospitalization and chronic diseases did not significantly modify the effect of hyponatremia on hospital mortality. Conclusions: Hyponatremia on admission at emergency room had a significant association with hospital mortality. Subjects with hyponatremia had a higher Charlson Comorbidity Index score.

Enfermedad renal crónica: Clasificación, identificación, manejo y complicaciones / Clinical guidelines on identitication, management and complications of chronic kidney disease

The key messages of these guidel ines on chronic kidney disease are: • Chronic kidney disease (CKD) is a public health problem due to its wide distribution, high rate of complications and cost. • CKD is a common condition, its prevalence being about 10 percent, and is treatable if it is detected on time. • A patient with CKD has a higher risk of cardiovascular mortality than of progression of its underlying renal disease. • A new definition of CKD, based on estimated Glomerular Filtration Rate (eGFR) and kidney damage, facilitates its detection and management. • CKD is detected with three simple tests: 1) Blood pressure measurement, 2) Detection of proteinuria or albuminuria in an isolated urine sample, and 3) Estimation of renal function (eGFR), based on serum creatinine, age, gender and race. • The CKD risk groups are individuáis with diabetes, hypertension and a family history of renal disease. • The most cost-effective measures are to detect and treat diabetic and hypertensive patients in the community. • Therapy must emphasize the maximal reduction of cardiovascular risk. • The complications of CKD such as anemia and renal osteodystrophy can be identified and treated on time. • Most patients with chronic kidney disease are detected in the community, therefore their initial care must be organized at the level of primary care, along with programs for hypertension and diabetes.

Recurrencia de crisis febriles en una población chilena / Febrile seizures recurrence in Chilean children

Objective: Evaluate the clinical presentation and risk factors for recurrence of first febrile seizure (FS) in patients at Pediatric Emergency Department or Neurology Units at Clinical Hospital Universidad Catolica (UC) and Hospital Herminda Martin from Chillan (HM). Method: Descriptive-observational study of children with age average of 2.9 years-old, with first febrile seizure between January 1, 2003 and December 31, 2005. Results: Total 158 patients; 76 percent presented a simple FS and 24 percent a complex FS as first episode, only 1 case with febrile epileptic status. In 22 percent and 18 percent respectively, there was a FS history and epilepsy in first degree relatives. 34 percent of patients presented a second episode; 36 percent of these cases present a third FS and 9 percent more than 3 episodes. The average time of recurrence was 6.9 months. The most important risk factors for recurrence were: epilepsy history in first degree relatives and type of febrile seizure, with hazard ratio of 2.5 (p = 0.001) and 1,8 (p = 0.03) respectively. When fitting both variables, only family history of epilepsy was significant. Conclusions: Most of FS episodes are simple and 34 percent present recurrence. Family history of epilepsy and type of febrile seizure are associated recurrence risk factors. The follow-up of these patients does not predict their future risk of epilepsy.

Objetivo: Evaluar la presentación clínica, recurrencia y factores de riesgo de recurrencia en un grupo de pacientes con primoconvulsión febril que consultaron en Urgencia pediátrica y/o consulta neurológica en los hospitales Clínico Universidad Católica (UC) y Herminda Martín de Chillan (HM). Método: Estudio observacional descriptivo de niños con primoconvulsión febril entre el Iº de Enero del 2003 y el 31° de Diciembre 2005 con seguimiento promedio de 2,92 años. Resultados: De 158 pacientes, el 76 por ciento debutó con una CF simple y el 24 por ciento con una CF compleja (1 status febril). En el 22 y 18 por ciento había antecedentes de CF y epilepsia en familiares de primer grado respectivamente. Recurrieron 34 por ciento de los pacientes y de ellos el 36 por ciento presento una tercera CF y el 9 por ciento más de tres episodios. El promedio de tiempo de recurrencia fue 6,9 meses. Los factores de riesgo más importantes de recurrencia fueron el antecedente de epilepsia en familiares de primer grado y tipo de crisis con un hazard ratio de 2,5 (p = 0,001) y 1,8 (p = 0,03) respectivamente. Al ajustar ambas variables sólo antecedentes familiares de epilepsia fue significativa. Conclusiones: La mayoría de las CF es simple y recurre un 34 por ciento. Los antecedentes familiares de epilepsia y tipo de crisis son factores de riesgo asociados a recurrencia). El seguimiento no permite evaluar el riesgo de epilepsia a futuro en estos pacientes.