Epidemiología de la patología tumoral en el trasplante renal / Epidemiology of tumoral pathology in renal transplantation

Introducción: La patología tumoral (PT) implica una morbimortalidad no despreciable después del trasplante renal, siendo la inmunosupresión un factor de riesgo potencialmente responsable de su desarrollo. El objetivo de nuestro estudio es determinar la prevalencia de malignidad durante el trasplante y estudiar su posible asociación con el uso de anticuerpos antilinfocitarios, infección por citomegalovirus y el antecedente de rechazo agudo. Métodos: Se trata de un estudio de cohorte, retrospectivo, en 1034 receptores de trasplante renal en el que se revisaron los eventos tumorales acontecidos entre abril de 1981 y marzo de 2010. Se consignaron el uso de anticuerpos antilinfocitarios (AAL), infección por CMV y episodios de rechazo agudo (RA), relacionando estas variables con el desarrollo posterior de patología tumoral. Resultados: NO se detectó mayor frecuencia de PT maligna en aquellos que recibieron AAL (13,8% vs. 17,6%, p=0,094) p=0,094). No hubo mayor frecuencia de PT en pacientes con infección por CMV (16,3% vs. 15,2%, p=0,69). Por último, hubo mayor frecuencia de PT en aquellos con antecedentes de RA, si bien con significación limítrofe (19,5% vs. 14,3%, p=0,05). Conclusiones: La patología tumoral maligna se ve potencialmente favorecida por la inmunosupresión cada vez más potente y duradera. No hemos encontrado asociación entre la administración de AAL, infección y / o enfermedad por CMV; si bien esta se ve ligeramente incrementada en aquellos pacientes con el antecedente de RA.

Introduction: Tumoral pathology (TP) implies morbidity which is significant after the renal transplantation; Immunosuppression is a risk factor which is potentially responsible for tumoral development. The aim of our study is to determine the prevalence of malignancy during transplantation and to study its possible relation with the usage of antillymphocvte antibodies, cytomegalovirus infection and the history of acute rejection. Methods: It is a cohort study, retrospective, in 1014 receptors of Kidney transplantation in which tumoral events were revised between April 1981 and March 2010. The development of tumoral pathology in recipients was related with the usage of AAL, CMV infection and AR episodes. Results: a greater frequency of malign TP was no recorded in those who received AAL (13.8% vs. 17.6%, p=0.094). There was not greater frequency of TP in patients with infection due to CMV (16,3% vs, 15.2%, p=0.69). Finally, there was greater frequency of TP in those with antecedent of AR, though with bordering significance (19.5%, vs. 14.3% p=0.05). Conclusions: Malign tumoral pathology is potentially favored by immunosuppression increasingly powerful lasting. We have not found any relationship between AAL use, infection and/ or disease due to CMV, although this is slightly increased in those patients with AR history.

Comportamiento de la diabetes mellitus postrasplante en el Instituto de Nefrología Dr. Abelardo Buch López / Behavior of the post-transplantation diabetes mellitus in the Dr. Abelardo Buch López Institute of Nephrology

Se realizó un estudio observacional descriptivo de casos y controles que incluyó todos los pacientes que recibieron trasplantes renales en el Instituto de Nefrología entre 1970 y 2008 para conocer las características de los que desarrollaron diabetes mellitus postrasplante, los factores de riesgo para esta entidad y determinar la efectividad del tratamiento hipoglucemiante usado. Fueron revisadas todas las pancartas e historias clínicas de los casos y de 99 pacientes con DMPT, la mayoría tenía entre 40 y 59 años de edad y este factor de riesgo se asoció de forma significativa con la diabetes, 66 eran del sexo masculino, el mayor número de casos era de la raza blanca, estos factores no tuvieron significación estadística. Los antígenos HLA que se encontraron con más frecuencia fueron el A2, B35, B7 y el A3. El mayor número de casos debutó antes de 18 meses postrasplante, no eran obesos aunque, al comparar con el grupo control, este factor de riesgo sí tuvo significación estadística, el tratamiento con ciclosporina como inmunosupresor y los antecedentes familiares de diabetes también fueron factores de riesgo asociados con significación estadística al comienzo de la DMPT, no así el tratamiento con pulsos de metilprednisolona como terapia antirrechazo. El mejor control de la glucemia se logró con la dieta solamente, le siguió con el uso de glibenclamida como hipoglucemiante oral y, por último, los pacientes que eran tratados con insulina fueron los que peor control metabólico tuvieron

A descriptive and observational study was conducted in cases and controls including all patients underwent renal transplantation in the Institute of Nephrology between 1970 and 2008 to know the features of those patients developed post-transplantation diabetes mellitus, the risk factors for this entity and to determine the effectiveness of hypoglycemic treatment used. All placards and medical records of cases and from 99 patients with post-transplantation diabetes mellitus (PTDM) were reviewed, most aged 40 and 59 and this risk factor was associated in a significant way with diabetes, 66 were men and most of cases were of white race, these factors have not statistical significance. The more frequent HLA antigens were the A2, B35, B7 and A3. Most of cases debuted before the 18 months post-transplantation, non obese although compared with the control group, this risk factor had statistical significance, the treatment with cyclosporine as immunosuppressive agent and the family history of diabetes also were risk factors associated with the statistical significance at onset of PTDM, but not the treatment with impulse methylprednisolone like a anti-rejection therapy. The better control of the glycemia was achieved with the diet alone, followed by the use of glibenclamide as oral hypoglycemic agent and finally, the patients treated with insulin were those with the poorer metabolic control

Clinical and pathological correlations of C4d immunostaining and its infl uence on the outcome of kidney transplant recipients / Correlações clinico-patológicas da marcação de C4d e sua influência na evolução de receptores de transplante renal

INTRODUCTION: C4d is a marker of antibody-mediated rejection (ABMR) in kidney allografts, although cellular rejection also have C4d deposits. OBJECTIVE: To correlate C4d expression with clinico-pathological parameters and graft outcomes at three years. METHODS: One hundred forty six renal transplantation recipients with graft biopsies by indication were included. C4d staining was performed by paraffin-immunohistochemistry. Graft function and survival were measured, and predictive variables of the outcome were determined by multivariate Cox regression. RESULTS: C4d staining was detected in 48 (31 percent) biopsies, of which 23 (14.7 percent) had diffuse and 25 (16 percent) focal distribution. Pre-transplantation panel reactive antibodies ( percentPRA) class I and II were significantly higher in C4d positive patients as compared to those C4d negative. Both glomerulitis and pericapillaritis were associated to C4d (p = 0.002 and p < 0.001, respectively). The presence of C4d in biopsies diagnosed as no rejection (NR), acute cellular rejection (ACR) or interstitial fibrosis/ tubular atrophy (IF/TA) did not impact graft function or survival. Compared to NR, ACR and IF/TA C4d-, patients with ABMR C4d+ had the worst graft survival over 3 years (p = 0.034), but there was no difference between ABMR versus NR, ACR and IF/TA that were C4d positive (p = 0.10). In Cox regression, graft function at biopsy and high percentPRA levels were predictors of graft loss. CONCLUSIONS: This study confirmed that C4d staining in kidney graft biopsies is a clinically useful marker of ABMR, with well defined clinical and pathological correlations. The impact of C4d deposition in other histologic diagnoses deserves further investigation.

INTRODUÇÃO: A fração do complemento C4d é um marcador de rejeição mediada por anticorpos (RMA) em aloenxertos renais, embora na rejeição celular também se observem depósitos de C4d. OBJETIVOS: Correlacionar a expressão de C4d com parâmetros clínicopatológicos e a evolução do enxerto renal em três anos. MÉTODOS: Foram incluídos 146 receptores de transplante renal com biópsias por indicação. A marcação de C4d foi feita por imuno-histoquímica em parafina. Foram medidas a função e a sobrevida do enxerto e determinadas as variáveis preditivas de sua evolução por meio de modelo de regressão de Cox. RESULTADOS: A marcação positiva para C4d foi detectada em 48 (31 por cento) biópsias, das quais 23 (14,7 por cento) tinham marcação difusa e 25 (16 por cento), focal. A reatividade contra painel ( por centoPRA) de classe I e II pré-transplante foi significativamente maior nos pacientes C4d+ quando comparada aos C4d-. Tanto glomerulite quanto pericapilarite foram associadas com C4d (p = 0,002 e p < 0,001, respectivamente). A presença de C4d em biópsias sem rejeição (SR), rejeição celular aguda (RCA) ou fibrose intersticial/atrofia tubular (FI/AT) não teve impacto na função ou na sobrevida do enxerto. Comparados a indivíduos com SR, RCA e FI/AT C4d-, pacientes com RMA C4d+ tiveram pior sobrevida do enxerto em 3 anos (p = 0,034), mas não houve diferença entre RMA versus SR, RCA e FI/AT C4d+ (p = 0,10). Na regressão de Cox, função do enxerto no momento da biópsia e por centoPRA alto foram preditores de perda do enxerto. CONCLUSÕES: A pesquisa de C4d em biópsias do enxerto renal é útil para identificar RMA, com correlações clínicopatológicas bem definidas. O impacto do C4d em outros diagnósticos histológicos necessita de investigação adicional.

Uso de riñones para trasplante renal provenientes de donantes de 55 o más años / Use of kidneys for renal transplant from donors aged 55 and over

Introducción: Uno de los principales obstáculos para el trasplante renal es la escasez de donantes ante el incremento del número receptores, por lo que se ha requerido la utilización de vísceras provenientes de donantes de edades avanzadas. Objetivos: Conocer cuál es la frecuencia de utilización de los donantes de 55 años o más en nuestro centro, los resultados logrados y las principales complicaciones que se pueden presentar. Métodos: Estudio descriptivo, retrospectivo y de tipo casos y controles, incluyendo todos los trasplantes realizados en el Hospital Hermanos Ameijeiras desde el año 1984 al 2008, la muestra se separó en 2 grupos según la edad del donante, 55 años o más y menores de 55. Resultados: La frecuencia de utilización del donantes de 55 años constituyó solo el 10,6 por ciento de la muestra, 2,8 por ciento para el dador vivo y 12,5 por ciento para el cadáver, el tiempo de isquemia fría y la edad de los receptores fue mayor en el grupo que utilizó los donantes de mayor edad, lo que justifica una más frecuente y duradera aparición de complicaciones como la necrosis tubular aguda, así como menor tasa de función al alta en este grupo. Las complicaciones vasculares y urológicas fueron más frecuentes e influyeron en la pérdida de los trasplantes al compararlas con el grupo control. Aunque la supervivencia del injerto fue menor en este estudio, en el grupo cuyos trasplantes provenían de donantes más añosos, no cabe duda que si se mejoran las condicionales que han envuelto esta práctica en nuestro centro, el empleo de donantes de edad avanzada es una opción válida

Introduction: One of the major obstacles for renal transplantation is the donor shortage versus the increasing number of recipients, being necessary the use of viscera from old age donors. Objectives: To know what the use frequency of donors aged 55 or more in our center, the results obtained and the potential main complications. Methods: A retrospective and descriptive and of cases-control study was conducted including all transplantations carried out in the Hermanos Ameijeiras Clinical Surgical Hospital from 1984 to 2008, sample was divided into two groups according to donor's age, 55 years or more and under 55. Results: Use frequency of donors aged 55 was only of the 10,6 percent of sample, 2,8 percent for live donor and 12,5 percent for cadaver, time of cold ischemia and the recipient's age was great in the group where were used old age donors, justifying a more frequent and lasting appearance of complications like the acute tubular necrosis, as well as a low rate of discharge function in this group. The urologic and vascular complications were more frequent and influenced on the lost of transplantations compared to control group. Although graft survival was less in present study, in group whose transplantations came from older donors there`s not doubt that if conditions involved in this practice in our institution are improved, the use of old age donors is a valid option

Patologia do transplante renal: achados morfológicos principais e como laudar as biópsias / Renal transplant pathology: main morphological findings and how to sign out biopsies

O transplante renal alcançou expressivos e crescentes índices de sucesso desde sua implantação, constituindo atualmente uma terapia substitutiva de larga escala. É cada vez mais freqüente o encontro de biópsias de enxerto renal na rotina dos laboratórios de patologia, cujos achados são os mais variados. Este artigo resulta da experiência dos membros do Clube do Rim (da Sociedade Brasileira de Patologia) e apresenta um panorama geral da patologia do transplante renal, enfatizando a atual classificação de Banff, com suas principais categorias e entidades de diagnóstico problemático.

Renal transplant has reached remarkable and growing rates of success since its introduction; nowadays it is a widely used replacement therapy. Renal allograft biopsies are increasingly more frequent in the routine of pathology laboratories, whose histological findings are varied. This paper results from the expertise of the members of the Kidney Club of Sociedade Brasileira de Patologia, and presents a general overview of renal allograft pathology, focusing on the current Banff classification, its main categories and cases of difficult diagnosis.

Bone mineral density in kidney transplant recipients and patients on hemodialysis. A comparison with healthy individuals

We measured bone mineral density [BMD] before and after transplantation to determine the frequency and severity of preoperative and postoperative osteoporosis and compare them with the BMD in healthy individuals. We determined the BMD at the lumbar spine and femoral levels in 22 men and 18 women who were on long-term dialysis in Yazd, Iran, and a group of kidney transplant recipients including 43 men and 18 women. They were compared with each other and healthy individuals studied in a recent study in Iran. Factors potentially associated with alterations of the BMD were studied in each group. The frequency of osteoporosis in the vertebrae and femoral neck was higher in the kidney transplant recipients than the healthy population [21.3% versus 4.9%; P = .001; odds ratio, 5 and 9.8% versus 2.4%; P = .02; odds ratio, 5.4, respectively] but not significantly different from those in the patients on dialysis [17.9% and 17.5%, respectively]. In transplantation group, multivariate analysis showed that there was a significant negative correlation between the lumbar BMD and the cumulative prednisolone dose [r = -0.36, P = .003]. No correlation was found between BMD of lumbar or femoral neck and the body mass index, age, and cumulative cyclosporine level. Osteoporosis is more frequent in patients on dialysis and kidney transplant recipient than in general population. However, there is no difference in osteoporosis frequency between transplanted patients and those on dialysis. In the lumbar spine, a higher cumulative prednisolone dose results in decreased BMD among kidney transplant recipients

Attenuation of ischemia-reperfusion injury by ascorbic acid in the canine renal transplantation

This study examined the effects of ascorbic acid on the attenuation of an ischemia-reperfusion (I/R) injury after a canine renal transplantation. Eight beagle dogs were subjected to a renal auto-transplantation followed by the administration of ascorbic acid (treatment group) and the same amount of vehicle (physiological saline, control group). Blood samples were collected from these dogs to perform the kidney function tests and the invasive blood pressure was measured in the renal artery at pre- and post-anastomosis. The antioxidant enzymes of level 72 h after the transplant were measured. The kidneys were taken for a histopathology evaluation at day 21. The kidney function tests showed a significant difference between the control and treatment group. The invasive blood pressure in the renal artery was similar in the groups. The activity of the antioxidant enzymes in the blood plasma was significant lower in the control group than in the treatment group. The histopathology findings revealed the treatment group to have less damage than the control group. The results of this study suggest that ascorbic acid alone might play a role in attenuating I/R injury and assist in the recovery of the renal function in a renal transplantation model.

Pathological spectrum of cytomegalovirus infection of renal allograft recipients-an autopsy study from north India.

This is a retrospective study of autopsy material to highlight the histo-morphological changes in cytomegalovirus (CMV) infection amongst renal allograft recipients. Nineteen out of 80 patients (23.75%) autopsied during a seventeen-year period (1985-2001) had CMV infection. Pulmonary infection was present in 14 out of 19 cases of which four had isolated lung involvement. Likewise, there were two cases each of isolated oesophageal and renal involvement; one case with isolated colonic involvement. The other 10 cases had multi-organ involvement and the organs involved were kidneys (4), esophagus (6), stomach (1), colon (5), adrenals (3), pancreas (3), liver (1) and spleen (1). Pulmonary infection with CMV was associated with acute pneumonitis in 3 cases and lymphocytic interstitial pneumonitis in 9 instances. Four out of 6 cases had acute tubulo-interstitial nephritis induced by CMV and only two cases had no significant inflammatory response. Glomerular involvement in the form of CMV inclusions in the glomeruli was present in only one case. Gastrointestinal CMV infection (15) presented as acute necrotizing ulceration because of predominant endothelial involvement. Post transplant survival period varied from one month to three years, with majority (14) of the patients having survived for less than one year.

Alteraciones urinarias menores como indicadores de afecciones en el injerto renal / Minor urinary disorders as indicators of affections in kidney graft

Se realizó un estudio prospectivo en trasplantes renales y se efectuó biopsia a enfermos con alteraciones urinarias menores, por lo menos durante 3 meses consecutivos, consistentes en microhematuria, proteinuria ligera (0,3- 0,7 mg/min) y microhematuria más proteinuria ligera, en ausencia de afecciones que las justificaran y de infección urinaria, ultrasonido de riñones propios, injerto de uréteres y vejiga, normal y función renal estable dada por creatinina < 200 µM/L y variaciones menores del 25 por ciento durante el tiempo de seguimiento. Se realizaron 18 biopsias, en 1 enfermo el resultado fue normal; 5 presentaron nefropatía crónica del injerto (27,3 por ciento); 4, nefropatía por IgA (22,5 por ciento); 1, nefropatía membranosa (5,5 por ciento) y 1, nefritis por púrpura de Schõnlein-Henoch (5,5 por ciento). Se comprobó que estas afecciones glomerulares eran recidivas de las enfermedades de base; en otro enfermo se detectó como glomerulonefritis de novo, la glomerulosclerosis segmentaria y focal. Se confirmó en 2 y 3 pacientes, respectivamente, el rechazo agudo I-A y la toxicidad por ciclosporina A. Se correlacionó además el estudio histológico con el tipo de manifestación urinaria.

Percutaneous renal graft biopsy: a clinical, laboratory and pathological analysis

Renal allograft biopsies have been used as a good method for monitoring the evolution of kidney transplants for at least 20 years. Histological analysis permits differential diagnosis of the causes of allograft dysfunction to be made. Objectives: To correlate the data of urinalysis and serum creatinine with histological diagnosis of renal graft in a group of renal transplant patients. Design: Accuracy study, retrospective analysis. Setting: A university terciary referral center. Sample: 339 percutaneous allograft biopsies obtained from 153 patients. Blood and urine samples were obtained before the graft biopsy. Main Measurements: Laboratory evolution and hystological analysis (light microscopy, imunofluorescent eletronic microscopy). Results: Most of the biopsies (58.9 per cent) were performed during the first month post-transplant. An increase in serum creatinine was associated with acute tubular and/or cortical necrosis. Proteinuria and normal serum creatinine were associated with glomerular lesions. Non-nephrotic range proteinuria and an increase in serum creatinine were associated with chronic rejection. Conclusion: Evaluation of serum creatinine and urinalysis can be useful in suggesting the histological graft diagnosis.

Patología de los transplantes renales, reproductibilidad de los criterios de Banff para diagnosticar rechazo y correlación anatomoclínica. Experiencia de 5 años en el Hospital Central Militar / Pathologic findings related to renal transplantation. Reproductibility of the Banff criteria for diagnosis of transplant rejection. An anatomo-clinical correlationship. Five-year experience in the Military Central Hospital

Además del rechazo, existen otras condiciones patológicas que pueden alterar la función de un riñón transplantado. Los métodos bioquímicos determinan la función renal, pero no la causa. De acuerdo con los criterios de Banff, estudiamos de manera retrospectiva las biopsias renales de pacientes operados de transplante renal en el Hospital Central Militar durante 5 años. Reclasificamos las biopsias de acuerdo con estos criterios y comparamos las variables con los datos clínicos. Estudiamos 72 biopsias renales de 65 pacientes transplantados. El promedio de edad al momento del transplante fue de 27 años (15 a 70); 33 del sexo masculino y 32 del femenino; 56 biopsias (78 por ciento) se realizaron por disfunción y 16 fueron de control. Durante ese periodo se realizaron 82 transplantes (77 renales y 5 pancreatorrenales); 58 de donador davérico y 24 donador vivo emparentado; 4 pacientes fallecieron (uno por tuberculosis y 3 por sepsis bacteriana). Encontramos diferencia significativa en el tiempo de evolución del transplante y los valores de creatinina, (p de 0.1008 y 0.0087 respectivamente). También fue significativa la comparación de los grados de rechazo crónico (p de 0.0046 y 0.0041 respectivamente para el tiempo de evolución y los valores séricos de creatinina). Es recomendable revisar en nuestro Hospital las biopsias de riñones transplantados de acuerdo con los criterios de Banff

Monitorizaçäo seqüencial do transplante renal com citologia aspirativa / Sequential monitoring of renal transplant with aspiration cytology

Objetivo. Avaliar a utilidade da citologia aspirativa renal convencional na monitorizaçao seqüencial da rejeiçao aguda de transplantes renais. Material e Método. 376 punçoes aspirativas renais em 30 pacientes transplantados. Os diagnósticos das situaçoes clínicas em que as aspiraçoes foram feitas foram estabelecidos de maneira independente. Resultados. Na avaliaçao seqüencial "cega" obteve-se 82,7 por cento de representatividade das amostras. Encontraram-se aumentos significativos do incremento corrigido total (ICT) e dos números de células imunoativas por lâminas nos episódios de rejeiçao aguda quando comparados aos valores obtidos durante os períodos de funçao estável do enxerto, necrose tubular aguda e nefrotoxicidade por ciclosporina. Os parâmetros diagnósticos para rejeiçao aguda foram: sensibilidade: 71,8 por cento; especificidade: 87,3 por cento; valor preditivo positivo: 50,9 por cento; valor preditivo negativo: 94,4 por cento; e acurácia: 84,9 por cento. Os resultados falsos-positivos para rejeiçao foram devidos, principalmente, a infecçao citomegálica ou subseqüentes ao uso de OKT3 para tratamento de episódios de rejeiçao aguda celular. Em 10 dos 11 resultados falsos-negativos, encontrou-se o diagnóstico de imunoativaçao incipiente, que deve ser considerado como um alerta para a possibilidade de rejeiçao aguda. Conclusoes. A citologia aspirativa renal é um método útil na monitorizaçao seqüencial da rejeiçao aguda no paciente transplantado renal. Os melhores resultados sao obtidos quando os dados da citologia aspirativa sao interpretados juntamente com o quadro clínico.

Remoçäo percutânea de cálculo em ureter de rim transplantado em paciente grávida / Percutaneous removal of an ureteral calculous from a transplanted kidney in a pregnant patient

We report a case of nephro-ureteral lithiasis causing obstruction in a pregnant woman at 23 weeks of gestation, treated successfully by percutaneous surgery. The kidney was punctured and dilated to 18 Fr. The ureter was antegrade accessed with a rigid ureteroscope (11.5 Fr) and the calculous was fragmented and retrieved with stone forceps. A double-J cateter was left in place and a nephrostomy tube was placed. The patient did well and the pregnancy was uneventful until a health newborn at term

Estudio comparativo de los niveles séricos de B2 microglobulina entre pacientes hemodializados crónicos y transplantados renales asociados al tiempo de hemodiálisis y diuresis residual de pacientes de la unidad de Hemodiálisis del Hospital Nacional de Sur-IPSS, Arequipa 1995

Recientemente se ha identificado una nueva entidad patológica, la Amiloidosis relacionada a la hemodiálisis donde la B2m es la principal componente de la sustancia amiloidea. TIPO DE ESTUDIO: Analítico, prospectivo, transversal, aleatorio y controlado. METODO: Los pacientes hemodializados crónicos que se consideraron para el estudio fueron 50, seleccionados en forma aleatoria simple, los mismos que se dializan usando menbranas de Cuprophane. Los pacientes transplantados renales seleccionados fueron 15 sin problemas de rechazo agudo. Los controles fueron 15. A los que se les determinó los niveles séricos de B2m mediante radio-inmunoensayo, RIA-125I. A través de la aplicación del Kit: B2-microglobulina IRMA 125Ix100. "Diagnostic Products Corp" USA. Se determinó las características poblacionales y el tiempo de hemodiálisis mediante la revisión de la historia clínica y la aplicación de una ficha de datos. Finalmente se midió la diuresis residual mediante la recolección y cuantificación volumétrica de las orinas. RESULTADOS: Los niveles séricos promedio y desviación standar de B2m en 50 pacientes hemodializados crónicos fueron: 45.23 ñ 15.92 mg/L. El tiempo de hemodiálisis promedio y desviación standar en 50 pacientes hemodializados crónicos son: 40.76 ñ 36.21 meses. La diuresis residual promedio y desviación standar en 50 pacientes hemodializados crónicos son: 260.92 ñ 437.86 ml. El coeficiente de correlación de Pearson al asociar B2m y el tiempo de hemodiálisis es (r=0.343,p<0.05) hasta los 84 meses. La linea de regresión de: y=0.27x + 36.79. El coeficiente de correlación de Pearson al asociar B2m y la diuresis residual es (r=-0.293,p<0.05) hasta los 84 meses. La linea de regresión de: y=-0.0106x + 48.76. Posterior a los 84 meses, ambas correlaciones se pierden. Según el concepto de exposición acumulada de B2m el 42 por ciento de la población tiene niveles mayores a 1500. El promedio y desviación standar de los niveles séricos de B2m en los pacientes controles sanos, y transplantados renales fueron: 1.17 ñ 0.084 mg/L; 4.52 ñ 1.34 mg/L respectivamente. Al comparar los niveles séricos de B2m entre los grupos de estudio incluyendo el grupo de hemodializados crónicos, se halló una diferencia altamente significativa(p<0.001 t student). CONCLUSIONES: Se concluye que existe correlación positiva entre los niveles séricos de B2m y el tiempo de hemodiálisis hasta las 84 meses(7 años). Existe correlación inversa entre los niveles séricos de B2m y la diuresis residual hasta los 84 meses(7 años). Los niveles séricos de B2m entre los pacientes hemodializados crónicos, controles sanos y transplantados renales son diferentes

Percutaneous renal biopsy using Monopty needle.

Forty six percutaneous renal biopsies (thirty one native and fifteen transplant kidneys) were performed using the Monopty needle, compared with equal number of biopsies performed using the Travenol Tru-cut needle. The core length of samples obtained ranged from 3-16 mm using Monopty and 5-13 mm using Tru-cut. Adequate tissue was obtained in 65.5% and 80.4% of cases with the use of Monopty and Tru-cut respectively. Both the needles gave equal number of reuses. The use of Tru-cut needle was associated with serious complications like gross haematuria requiring blood transfusions and perinephric haematoma in ten cases whereas only two cases developed haematuria when the Monopty needle was used. In view of its greater safety we have switched over to using the Monopty needle for percutaneous renal bipsies.

Shigelosis en una paciente con transplante renal / Shigellosis in a patient with kidney transplantation

Se estudia el caso de una paciente de 18 años de edad, con transplante renal exitos realizado hace 14 meses que, al cabo de este tiempo ingresa al Instituto de Nefrología para chequeo, por presentar cifras altas de creatinina. Posteriormente presenta dolor torácico y lesiones en la piel de aspecto vesicular, que hicieron pensar en un cuadro de varicela; además vómitos y diarreas mucopiosanguinolentas, y fallece a los 7 días del ingreso con un cuadro de shock séptico. Se recibió en el laboratorio de Microbiología del IPK una muestra postmortem de contenido de colon, de la cual se aisló un acepa de Shigella sonnei fase I. Se hacen consideraciones clínicas, microbiológicas y anatomopatológicas

Monitorizaçäo do transplante renal: revisäo dos métodos de investigaçäo da disfunçäo do enxerto / Monitoring of renal transplant: review of methods used to investigate graft dysfunction

Os autores revisam o tema Monitorizaçao do Transplante Renal através de uma análise crítica de vários métodos laboratoriais de investigaçao da disfunçao do enxerto renal. Sao analisadas as vantagens e desvantagens, as indicaçoes e as limitaçoes do exame do sedimento urinário, o significado da eosinofilia, as dosagens plasmáticas e urinária da neopterina e da beta-2-microglobulina, o valor da pressao intra-renal, os métodos de diagnóstico por imagem, a biópsia renal convensional, a "minicore biopsy" e a punçao aspirativa por agulha fina.