ABSTRACT
BACKGROUND: Therapeutic Plasma Exchange (TPE) is a procedure in which plasma and harmful macromolecules are separated from the rest of the blood components by centrifugation or filtration through membranes and are replaced with solutions with albumin and/or plasma. AIM: To communicate our experience using TPE by filtration. MATERIAL AND METHODS: Review of records of 655 TPE sessions performed in 102 patients aged 50 ± 18 years (64% women). The requirement of renal replacement therapy (RRT) and seven days and one year mortality were recorded. RESULTS: Forty five percent of patients had hypertension or diabetes. The main indications for TPE were pulmonary-renal syndrome (PRS) (62%) and antibody mediated graft rejection (29%), followed by neurological diseases (36%). Fifteen percent of patients required RRT for one year. Mortality at seven days and one year was 20 and 30%, respectively. Out of the total of deaths associated with kidney diseases, 88% corresponded to PRS and ANCA vasculitis. The main complications were thrombocytopenia in 41%, hypocalcemia in 18%, and hypotension in 16%. CONCLUSIONS: In our experience, TPE by filtration is a safe technique, with mild and preventable complications. Despite this, the reported mortality is high, which reflects the severity of the diseases that motivated the indication for TPE.
Subject(s)
Humans , Male , Female , Plasma Exchange/adverse effects , Plasma Exchange/methods , Antibodies, Antineutrophil Cytoplasmic , Retrospective Studies , Albumins , Glomerulonephritis , Hemorrhage , Lung DiseasesABSTRACT
Sepsis is one of the leading causes of death in critically ill patients with COVID-19 and blood purification therapies have a role to immunomodulate the excessive inflammatory response and improve clinical results. One of the devices designed for these therapies is the oXiris® filter, allowing to perform renal replacement therapy combined with selective adsorption of endotoxins and cytokines. We report a 55-year-old male with COVID who developed a septic shock secondary to a sepsis caused by Pseudomona aeruginosa, refractory to the usual management. A veno-venous continuous hemofiltration was started using the oXiris® filter for 48 hours. Subsequently, there was an improvement in clinical perfusion parameters and a reduction in inflammatory markers. The patient was discharged from the intensive care one month later.
Subject(s)
Humans , Male , Middle Aged , Shock, Septic/complications , Shock, Septic/therapy , Sepsis/complications , COVID-19/complications , Cytokines , EndotoxinsABSTRACT
El síndrome hemolítico urémico se caracteriza por la presencia de anemia hemolítica microangiopática, trombocitopenia e injuria renal aguda. Es una de las causas más frecuentes de falla renal aguda en pacientes pediátricos. Objetivo: Conocer las características clínicas y la evolución de los pacientes con SHU hospitalizados en nuestro hospital. Material y Método: Se revisaron 55 historias clínicas de los pacientes egresados con el diagnostico de SHU en el Hospital Dr. Gustavo Fricke entre el año 2001 y 2011 y se extrajo la información más relevante sobre la presentación clínica y la evolución de esta enfermedad durante la hospitalización. Resultados: 4 pacientes fallecieron (5,7 por ciento). Un 62 por ciento presentó una diarrea aguda disentérica; 30,9 por ciento hipertensión arterial y 11 por ciento convulsiones. Un 84 por ciento fue transfundido con glóbulos rojos, 45 por ciento requirió terapia de sustitución renal. La duración de la hospitalización fue de 14 días en promedio. Al año solo un 66 por ciento permanecían en control médico. Conclusiones: El SHU continúa siendo una de las causas más frecuentes de injuria renal aguda con requerimiento de diálisis en nuestro hospital. La mayoría de los pacientes sufre anemias severas con necesidad de trasfusión de glóbulos rojos. La mortalidad es similar a la reportada en otros centros...
Hemolytic Uremic Syndrome (HUS) is characterized by the presence of hemolytic microangiopathic anemia, thrombocytopenia and acute renal failure. Is one of the most frequent causes of acute renal failure in pediatric patients. Objective: Know clinical characteristics and evolution of patients with HUS hospitalized at Hospital Dr. Gustavo Fricke. Material and Methods: 55 medical records of discharged patients with the diagnosis of HUS in Dr. Gustavo Fricke Hospital between 2001 and 2011 were reviewed. We extracted the most relevant information on clinical presentation and evolution of this disease during hospitalization. Results: 4 patients died (5.7 percent). 62 percent presented an acute dysenteric diarrhea; 30.9 percent evolved with hypertension and 11 percent presented seizures. 84 percent were transfused with red blood cells, 45 percent required renal replacement therapy. The hospital stay was 14 days on average. After one year, only 66 percent remained in medical control. Conclusions: HUS remains one of the most frequent causes of acute kidney injury who required dialysis at our hospital. Most patients have severe anemia requiring transfusion of RBCs. Mortality is similar to that reported in other centers...