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1.
Bol. micol. (Valparaiso En linea) ; 36(1): 39-46, jun. 2021. tab
Article in Portuguese | LILACS | ID: biblio-1381275

ABSTRACT

O transplante renal é uma alternativa eficaz como tratamento da Doença Renal Crônica, dado seu custo efetividade e o aumento na sobrevida dos pacientes. Os imunossupressores também garantem maior sobrevida do enxerto, porém tornam o receptor susceptível a infecções, como as fúngicas. O objetivo do estudo foi conhecer as infecções fúngicas de pacientes da enfermaria de transplante renal do Hospital de Referência do Maranhão, através de pesquisa dos prontuários destes com diagnóstico de micose entre 2014 a 2018. Foram encontrados 9 casos, 5 de criptococose, 2 de aspergilose e 2 de candidíase, sendo 6 pacientes homems e 3 mulheres; 5 receptores de doadores vivos e 4, doadores falecidos. Em 7 casos, a terapia de imunossupressão prescrita foi metilprednisolona e basiliximab, e em 2 casos, timoglobulina. O exame diagnóstico foi o micológico direto em 6 casos e endoscopia digestiva alta, biópsia de pele e exame clínico em 1 caso cada. As espécies isoladas foram Cryptococcus sp. (3), C. neoformans (2), Aspergillus sp. (2), Candida tropicalis, C. krusei (1) e C. albicans (1). Excetuando-se um caso de candidíase tratado com fluconazol e um caso com a forma desoxicolato, todos os outros foram tratados com anfotericina B lipídica e fluconazol como manutenção. Sete casos tiveram a cura como desfecho, e 2 o óbito. Percebe-se a importância do estudo dessas infecções, o olhar cuidadoso em relação as mesmas e a atuação do farmacêutico para monitorização da farmacoterapia, para maior segurança do paciente. (AU)


Renal transplantation has been an effective alternative as the treatment of Chronic Renal Disease, due to its cost effectiveness and the increase of the patients' survival. Immunosuppressants also ensure the longer survival of the graft, but make the recipient susceptible to infections, such as fungi. The objective of the study was to know as the main fungal infections of patients with transplant renal disease at the Reference Hospital of Maranhão, through the study of the medical records of patients diagnosed with fungal infection in the period from 2014 to 2018. There were 9 cases, cryptococcosis, 2 aspergillosis and 2 per candidiasis, 6 male and 3 female patients, 5 live donor recipients and 4 deceased donors. In 7 cases, a prescribed immunosuppressive therapy was methylprednisolone and basiliximab, and in 2 cases thymoglobulin. The clinical examination was done in 6 cases and upper digestive endoscopy, skin biopsy and clinical examination in 1 case each. The species were Cryptococcus sp. (3), C. neoformans (2), Aspergillus sp. (2), Candida tropicalis, C. krusei (1) and C. albicans (1). Except for one case of candidacy treated with fluconazole and one case with a deoxycholate form, all others were treated with amphotericin B lipid complex and fluconazole as maintenance. Seven cases had a cure as an outcome, and 2 a death. It was noticed the importance of the study of these infections, the careful look at them and the pharmacist's performance to monitor pharmacotherapy, for greater patient safety. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Kidney Transplantation , Renal Insufficiency, Chronic/surgery , Mycoses/drug therapy , Aspergillosis , Candidiasis , Epidemiology, Descriptive , Cross-Sectional Studies/instrumentation , Prospective Studies , Retrospective Studies , Cryptococcosis , Fungi/pathogenicity , Immunosuppressive Agents/therapeutic use
2.
Rev. enferm. Cent.-Oeste Min ; 11: 4276, 20210000.
Article in Portuguese | LILACS, BDENF | ID: biblio-1357884

ABSTRACT

Objetivo: Descrever as perspectivas de receptores de transplante renal, profissionais da saúde e gestores sobre a rede de apoio social. Método: Estudo qualitativo realizado com transplantados renais, profissionais e gestores. Os dados coletados foram entrevistas individuais gravadas em áudio a partir de dois instrumentos que compuseram perguntas por meio das escalas Assessment for Chronic Illness Care (ACIC) e Patient Assessment of Chronic Illness Care (PACIC), adaptadas para a cultura brasileira. Resultados: Os dados revelaram a participação das entidades não-governamentais e dos profissionais de saúde e o vínculo que estabelecem com os receptores de transplante renal, sobretudo, com o profissional médico, com a enfermagem, além de outras categoriais profissionais. Também, outros dados trazidos foi o parecer dos profissionais de saúde sobre o vínculo que estabelecem com a família da pessoa. Conclusão: O vínculo estabelecido continua forte mesmo após o transplante renal, o que demonstra o sucesso no estabelecimento de vínculos emocionais pela equipe multiprofissional, incluindo a enfermagem.(AU)


Objective: To describe the perspectives of kidney transplant recipients, health professionals and managers on the social support network. Method: A qualitative study conducted with kidney transplant recipients, professionals and managers. The data collected was audiorecorded individual interviews from two instruments that composed questions using the Assessment for Chronic Illness Care (ACIC) and Patient Assessment of Chronic Illness Care (PACIC) scales, adapted for the Brazilian culture. Results: The data revealed the participation of non-governmental entities and health professionals and the link that they establish with kidney transplant recipients, especially with the medical and nursing professionals, in addition to other professional categories. Also, other data brought up was the opinion of health professionals about the bond that they establish with the family of the person. Conclusion: The established bond remains strong even after kidney transplantation, which demonstrates the success in establishing emotional bonds by the multi-professional team, including nursing(AU)


Objetivo: Describir las perspectivas de los receptores de trasplantes de riñón, profesionales sanitarios y gestores acerca de la red de apoyo social. Método: Estudio cualitativo realizado con trasplantados renales, profesionales y gestores. Los datos recolectados fueron entrevistas individuales grabadas en audio a partir de dos instrumentos que componían preguntas adaptadas a través de escalas Assessment for Chronic Illness Care (ACIC) y Patient Assessment of Chronic Illness Care (PACIC), adaptadas a la cultura brasileña. Resultados: Los datos revelaron la participación de entidades no gubernamentales y profesionales de salud y el vínculo que establecen con el receptores de trasplante de riñón, especialmente con el profesional médico, con la enfermería, además de otras categorías profesionales. Asimismo, otro dato aportado fue la opinión de profesionales de salud sobre el vínculo que establecen con la familia de la persona. Conclusión: El vínculo establecido mantiene fuerte incluso después del trasplante renal, lo que demuestra el éxito en el establecimiento de vínculos emocionales por parte del equipo multiprofesional, incluida la enfermería.(AU)


Subject(s)
Humans , Male , Female , Professional-Patient Relations , Social Support , Kidney Transplantation , Health Personnel , Health Manager , Transplant Recipients/psychology , Interviews as Topic , Qualitative Research , Renal Insufficiency, Chronic/surgery
4.
Prensa méd. argent ; 106(6): 366-370, 20200000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1367080

ABSTRACT

Introducción: El síndrome de Sagliker es una enfermedad rara que requiere manejo de la vía aérea por personal experimentado, fue descrito en 2004 por Sagliker. Presentación del caso: Mujer de 30 años de edad, hipertensa con enfermedad renal crónica de 10 años de evolución, trasplante renal derecho con rechazo al año y manejada con hemodiálisis. Se le realizó paratiroidectomía bilateral, el manejo de la vía aérea fue con la paciente despierta y uso de fibroscopio. La evolución transoperatoria fue buena, se extubó sin incidentes y después de 3 días fue egresada a su domicilio. Conclusiones: El manejo de la vía aérea en pacientes con Síndrome de Sagliker requiere de experiencia ya que un manejo inadecuado compromete la vida de los pacientes.


Sagliker syndrome is a rare disease that requires airway management by experienced personnel, it was described in 2004 by Sagliker. Case presentation: 30-year-old woman, hypertensive with chronic kidney disease of 10 years of evolution, right kidney transplant with one-year rejection and managed with hemodialysis. A bilateral parotidectomy was performed, the airway was managed with the patient awake and using a fibroscope. The intraoperative evolution was good, she was extubated without incident and after 3 days she was discharged to her home. Conclusions: The management of the airway in patients with Sagliker Syndrome requires experience, since inadequate management compromises the lives of patients.


Subject(s)
Humans , Female , Adult , Parathyroidectomy , Renal Insufficiency, Chronic/surgery , Renal Insufficiency, Chronic/therapy , Airway Management/methods , Hyperparathyroidism, Secondary/complications
5.
Arq. gastroenterol ; 57(1): 45-49, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1098060

ABSTRACT

ABSTRACT BACKGROUND: Direct-acting antivirals have revolutionized hepatitis C treatment, also for patients with chronic kidney disease (CKD), but some controversy exists regarding the use of sofosbuvir (SOF) in patients with glomerular filtration rate (GFR) <30 mL/min. OBJECTIVE: To evaluate the efficacy and safety of these regimens for hepatitis C treatment of patients with CKD and after renal transplantation, as well as the impact of SOF on renal function in non-dialysis patients. METHODS: All patients with hepatitis C and CKD or renal transplant treated with direct-acting antivirals at a referral center in Brazil between January 2016 and August 2017 were included. Efficacy was evaluated based on viral load (HCV RNA) and a sustained virological response (SVR) consisting of undetectable RNA 12 and/or 24 weeks after the end of treatment (SVR12 and SVR24) was defined as cure. Safety was determined by adverse events and ribavirin, when combined, was administered in escalating doses to all patients with GFR <60 mL/min. The impact of SOF on renal function was determined by the measurement of baseline creatinine during and after the end of treatment and its increase was evaluated using the Acute Kidney Injury Network (AKIN) classification. RESULTS: A total of 241 patients (52.7% females) with a mean age of 60.72±10.47 years were included. The combination of SOF+daclatasvir was the predominant regimen in 75.6% of cases and anemia was present in 28% of patients who used ribavirin (P=0.04). The SVR12 and SVR24 rates were 99.3% and 97.1%, respectively. The treatment was well tolerated and there were no major clinically relevant adverse events, with the most prevalent being asthenia (57.7%), itching (41.1%), headache (40.7%), and irritability (40.2%). Among conservatively treated and renal transplant patients, oscillations of creatinine levels (AKIN I) were observed in 12.5% of cases during treatment and persisted in only 8.5% after the end of treatment. Of these, 2.0% had an initial GFR <30 mL/min and this percentage decreased to 1.1% after SOF use. Only 0.5% and 1.6% of the patients progressed to AKIN II and AKIN III elevation, respectively. CONCLUSION: The direct-acting antivirals were safe and efficacious in CKD patients treated with SOF-containing regimens, with the observation of high SVR rates, good tolerability and few severe adverse events. The combination with ribavirin increased the risk of anemia and the administration of escalating doses seems to be useful in patients with GFR <60 mL/min. In patients with GFR <30 mL/min, SOF had no significant renal impact, with serum creatinine returning to levels close to baseline after treatment.


RESUMO CONTEXTO: Os antivirais de ação direta revolucionaram o tratamento da hepatite C, inclusive para os pacientes com doença renal crônica (DRC), porém ainda há divergências no emprego do sofosbuvir (SOF) quando taxa de filtração glomerular (TFG) <30 mL/min. OBJETIVO: Avaliar a eficácia e segurança desses esquemas no tratamento da hepatite C em pacientes com DRC e pós-transplante renal, além de avaliar o impacto do SOF sobre a função renal dos não-dialíticos. MÉTODOS: Todos os pacientes com hepatite C e DRC ou transplante renal que realizaram tratamento com antivirais de ação direta em centro referenciado do Brasil no período de janeiro/2016 a agosto/2017 foram incluídos. A eficácia foi avaliada por meio da carga viral (HCV-RNA), considerando-se cura uma resposta virológica sustentada (RVS) com resultado indetectável após 12 e/ou 24 semanas do término do tratamento (RVS12 e RVS24). A segurança foi determinada pelos eventos adversos e a ribavirina, quando associada, foi introduzida de forma escalonada em todos os pacientes com TFG <60 mL/min. Para determinação do impacto do SOF sobre a função renal, foram observadas as dosagens de creatinina basal, durante e após término do tratamento com seu incremento avaliado por meio da classificação de AKIN (acute kidney injury network). RESULTADOS: Foram incluídos 241 pacientes, sendo 52,7% do sexo feminino, com média de idade de 60,72±10,47 anos. A associação de SOF+daclatasvir predominou em 75,6% dos casos e anemia esteve presente em 28% dos pacientes que utilizaram ribavirina (P=0,040). As taxas de RVS12 e RVS24 foram de 99,3% e 97,1%. O tratamento foi bem tolerado, com eventos adversos pouco relevantes, sendo os mais prevalentes: astenia (57,7%), prurido (41,1%), cefaleia (40,7%) e irritabilidade (40,2%). Entre os pacientes em tratamento conservador e transplantados renais, os valores de creatinina sofreram oscilações AKIN I em 12,5% dos casos, durante o tratamento, persistindo em apenas 8,5% da amostra após o término, dos quais 2,0% apresentavam TFG <30 mL/min inicialmente, com queda para 1,1% após uso do SOF. Apenas 0,5% e 1,6% evoluíram com elevação AKIN II e AKIN III. CONCLUSÃO: Os antivirais de ação direta foram seguros e eficazes em pacientes com DRC tratados com esquemas contendo SOF, apresentando altas taxas de RVS, boa tolerabilidade e poucos eventos adversos graves. A associação com ribavirina aumentou o risco de anemia, portanto sua introdução de forma escalonada parece ser útil nos pacientes com TFG <60 mL/min. Em pacientes com TFG <30 mL/min o SOF não apresentou impacto renal significativo, com creatinina sérica retornando a valores próximos ao basal após o tratamento.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Antiviral Agents/administration & dosage , Kidney Transplantation/adverse effects , Hepacivirus/genetics , Hepatitis C, Chronic/drug therapy , Ribavirin/administration & dosage , Treatment Outcome , Viral Load , Drug Therapy, Combination , Renal Insufficiency, Chronic/surgery , Simeprevir/administration & dosage , Sofosbuvir/administration & dosage , Sustained Virologic Response , Genotype , Glomerular Filtration Rate/genetics , Imidazoles/administration & dosage , Middle Aged
7.
J. bras. nefrol ; 41(4): 570-574, Out.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1056613

ABSTRACT

Abstract The occurrence of ascites after Renal Transplant (RT) is infrequent, and may be a consequence of surgical or medical complications. Case report: 61 year-old, male, history of arterial hypertension, tongue carcinoma and alcoholic habits 12-20g/day. He had chronic kidney disease secondary to autosomal dominant polycystic kidney disease, without hepatic polycystic disease. He underwent cadaver donor RT in September 2017. He had delayed graft function by surgically corrected renal artery stenosis. He was admitted in January 2018 for ascites de novo, with no response to diuretics. HE had visible abdominal collateral circulation. Graft dysfunction, adequate tacrolinemia, Innocent urinary sediment, mild anemia, without thrombocytopenia. Serum albumin 4.0g / dL. Normal hepatic biochemistry. Peritoneal fluid with transudate characteristics and serum albumin gradient > 1.1. Ultrasound showed hepatomegaly, permeable vascular axes, without splenomegaly. Mycophenolate mofetil was suspended, with reduced remaining immunosuppression. He maintained refractory ascites: excluded infectious, metabolic, autoimmune and neoplastic etiologies. No nephrotic proteinuria and no heart failure. MRI: micronodules compatible with bile cysts. Upper Digestive Tract Endoscopy did not show gastroesophageal varicose veins. Normal abdominal lymphoscintigraphy. He underwent exploratory laparoscopy with liver biopsy: incomplete septal cirrhosis of probable vascular etiology some dilated bile ducts. He maintained progressive RT dysfunction and restarted hemodialysis. The proposed direct measurement of portal pressure was delayed by ascites resolution. There was further recovery of the graft function. Discussion: Incomplete septal cirrhosis is an uncommon cause of non-cirrhotic portal hypertension. Its definition is not well known, morphological and pathophysiological. We have not found published cases of post-RT ascites secondary to this pathology, described as possibly associated with drugs, immune alterations, infections, hypercoagulability and genetic predisposition.


Resumo A ocorrência de ascite no pós-Transplante Renal (TR) é infrequente, podendo ser consequência de complicações cirúrgicas ou médicas. Caso clínico: 61 anos, masculino, antecedentes de hipertensão arterial, carcinoma da língua e hábitos alcoólicos 12-20g/dia. Doença renal crônica secundária à doença renal poliquística autossômica dominante, sem poliquistose hepática. Submetido a TR de doador cadáver em setembro de 2017. Atraso na função de enxerto por estenose da artéria renal, corrigida cirurgicamente. Internado em janeiro de 2018 por ascite de novo, sem resposta a diuréticos. Circulação colateral abdominal visível. Disfunção do enxerto, tacrolinemia adequada. Sedimento urinário inocente. Anemia ligeira, sem trombocitopenia. Albumina sérica 4,0g/dL. Bioquímica hepática normal. Líquido peritoneal com características de transudado e gradiente sero-ascítico de albumina > 1,1. Ecografia com hepatomegalia, eixos vasculares permeáveis, sem esplenomegalia. Suspendeu micofenolato mofetil, reduziu restante imunossupressão. Manteve ascite refratária: excluídas etiologias infecciosas, metabólicas, autoimunes e neoplásicas. Sem proteinúria nefrótica e sem insuficiência cardíaca. RM: micronódulos compatíveis com quistos biliares. EDA sem varizes gastroesofágicas. Linfocintigrafia abdominal normal. Submetido a laparoscopia exploradora com biópsia hepática: cirrose septal incompleta de provável etiologia vascular, alguns ductos biliares dilatados. Manteve disfunção progressiva do TR, reiniciou hemodiálise. Proposta medição direta da pressão portal, protelada por resolução da ascite. Recuperação posterior da função de enxerto. Discussão: A cirrose septal incompleta é uma causa incomum de hipertensão portal não cirrótica. A sua definição é morfológica e a fisiopatologia, pouco conhecida. Não encontramos publicados casos de ascite pós-TR secundária a esta patologia, descrita como possivelmente associada a fármacos, alterações imunitárias, infecções, hipercoagulabilidade e predisposição genética.


Subject(s)
Humans , Male , Middle Aged , Ascites/etiology , Kidney Transplantation/adverse effects , Renal Insufficiency, Chronic/surgery , Liver Cirrhosis/pathology , Ascites/diagnosis , Renal Dialysis/standards , Polycystic Kidney, Autosomal Dominant/complications , Delayed Graft Function/complications , Hypertension, Portal/etiology , Liver Cirrhosis/complications
9.
Int. braz. j. urol ; 45(4): 765-774, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019890

ABSTRACT

ABSTRACT Objectives To primarily evaluate the functional outcomes of PCNL for bilateral renal calculi/calculi in solitary functioning kidney with Chronic Kidney Disease(CKD). To identify factors affecting the renal replacement therapy following PCNL. Materials and Methods Patients with bilateral renal calculi/calculi in solitary kidney and CKD (eGFR<60/s.creatinine>2) and Good Performance Status [Eastern Cooperative Oncology Group (ECOG): 0-2] were included in the study. Results A total of 60 patients with CKD who had bilateral renal calculi/calculi in solitary functioning kidney underwent PCNL. At 6 months, eGFR improved or stabilized in 45 (75%) patients, while in 15 (25%) patients eGFR deteriorated. A total of 5 (14.28%) and 2 (25%) patients of CKD stage 4 and 5 respectively had improvement in eGFR as well as CKD stage. Fourteen (82.35%), 21 (60%), 3 (37.5%) patients of CKD stage 3, 4, 5 had improvement in eGFR but not significant enough to cause stage migration. Again 3 (17.65%) , 9 ( 40%) and 3 (37.5%) patients of CKD stage 3, 4, 5 had reduction in eGFR but not significant enough to cause stage migration. None of the patients had worsening of CKD stage. Preoperative CKD stage and eGFR were compared with measurements made at the final follow up visit (6 months). Conclusion Our results indicate that most patients of renal calculi with CKD show improvement or stabilization of renal function with aggressive stone removal. Improvement is more in patients who have mild to moderate CKD. Aggressive management of comorbidities, peri-operative UTI and complications may delay or avoid progression of CKD status in such patients.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Aged , Young Adult , Kidney Calculi/surgery , Renal Insufficiency, Chronic/surgery , Nephrolithotomy, Percutaneous/methods , Postoperative Complications/etiology , Time Factors , Severity of Illness Index , Kidney Calculi/physiopathology , Feasibility Studies , Prospective Studies , Reproducibility of Results , Risk Factors , Follow-Up Studies , Urinalysis , Treatment Outcome , Creatinine/blood , Renal Insufficiency, Chronic/physiopathology , ErbB Receptors/blood , Nephrolithotomy, Percutaneous/adverse effects , Glomerular Filtration Rate , Middle Aged
10.
Rev. bras. cir. cardiovasc ; 34(3): 279-284, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013475

ABSTRACT

Abstract Objective: The purpose of this study was to compare the operative mortality rate and outcomes of endovascular aneurysm repair (EVAR) between young and geriatric people in a single center. Methods: Eighty-five patients with abdominal aortic aneurysms who underwent EVAR between January 2012 and September 2016 were included. Outcomes were compared between two groups: the young (aged < 65 years) and the geriatric (aged ≥ 65 years). The primary study outcome was technical success; the secondary endpoints were mortality and secondary interventions. The mean follow-up time was 36 months (3-60 months). Results: The study included 72 males and 13 females with a mean age of 71.08±8.6 years (range 49-85 years). Of the 85 patients analyzed, 18 (21.2%) were under 65 years old and 67 patients (78.8%) were over 65 years old. There was no statistically significant correlation between chronic disease and age. We found no statistically significant difference between aneurysm diameter, neck angle, neck length, or right and left iliac angles. The secondary intervention rate was 7% (six patients). The conversion to open surgery was necessary for only one patient and only three deaths were reported (3.5%). There was no statistically significant difference in the mortality and reintervention rates between the age groups. The three deaths occurred only in the geriatric group and two died secondary to rupture. Kidney failure was observed in three patients in the geriatric group (4.5%). Conclusion: Our single-center experience shows that EVAR can be used safely in both young and geriatric patients.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/mortality , Endovascular Procedures/methods , Endovascular Procedures/mortality , Reference Values , Coronary Artery Disease/surgery , Coronary Artery Disease/mortality , Retrospective Studies , Follow-Up Studies , Age Factors , Treatment Outcome , Sex Distribution , Age Distribution , Pulmonary Disease, Chronic Obstructive/surgery , Pulmonary Disease, Chronic Obstructive/mortality , Renal Insufficiency, Chronic/surgery , Renal Insufficiency, Chronic/mortality , Peripheral Arterial Disease/surgery , Peripheral Arterial Disease/mortality
11.
Gac. méd. Méx ; 155(3): 243-248, may.-jun. 2019. tab
Article in English, Spanish | LILACS | ID: biblio-1286499

ABSTRACT

Resumen Introducción: La enfermedad renal crónica representa parte del gasto en salud en general; una potencial etiología es la relacionada con variaciones, ausencia o presencia de algunos alelos del human leucocyte antigen (HLA). Método: Se realizó el análisis de 1965 reportes de HLA sin etiología determinada y de 1361 donadores renales. Se llevó a cabo tecnología Luminex con base en fluorimetría de flujo celular para los locus A, B, DRB1 y DQA. Se realizó análisis con tablas de contingencia para determinar razón de momios (RM) e intervalos de confianza (IC). Se efectuó análisis cuantitativo. Resultados: De 101 alelos encontrados, 13 presentaron asociación, siete con riesgo para enfermedad renal crónica, de los cuales el más significativo fue HLA-DR17, con RM = 3.91 (IC 95 % = 2.96-5.17), y el de mayor significación de protección fue HLA-DR9, con RM = 0.043 (IC 95 % = 0.005-0.3224). Conclusiones: Es necesario entender que las enfermedades renales pueden estar ligadas a procesos inmunológicos, en los que se tiene que conocer la asociación de la ausencia o presencia de algún alelo.


Abstract Introduction: Chronic kidney disease accounts for part of overall health expenditure; a potential etiology is related to variations, absence or presence of some human leukocyte antigen (HLA) alleles. Method: An analysis of HLA reports of 1965 kidney recipients with no determined etiology, and 1361 kidney donors was performed. It was carried out with Luminex based in cell flow fluorometry for the A, B, DRB1 and DQA loci. An analysis was performed with contingency tables in order to determine the odds ratio (OR) and confidence intervals (CI). Quantitative analysis was also carried out. Results: Of the 101 alleles found, 13 showed association, 7 with risk for chronic kidney disease, with the most significant being HLA-DR17 with an OR of 3.91 (95 % CI = 2.96-5.17) and the one with the highest significance for protection being HLA-DR9, with an OR of 0.043 (95 % CI = 0.005-0.3224). Conclusions: It is necessary to understand that kidney diseases can be associated with yet unknown immune processes, where the association of the absence or presence of any allele should be known.


Subject(s)
Humans , Tissue Donors , Renal Insufficiency, Chronic/genetics , Transplant Recipients , HLA Antigens/genetics , Retrospective Studies , Risk Factors , Cohort Studies , Kidney Transplantation/methods , Alleles , Renal Insufficiency, Chronic/surgery , Protective Factors , Fluorometry
12.
Gac. méd. Méx ; 155(3): 223-228, may.-jun. 2019. tab, graf
Article in English, Spanish | LILACS | ID: biblio-1286495

ABSTRACT

Abstract Introduction: The management of kidney transplant recipients requires glomerular filtration rate (GFR) monitoring, which is an indicator of graft primary function and patient survival. Objective: To evaluate the performance of different creatinine or cystatin-based formulas in the estimation of glomerular filtration rate in Mexican patients receiving kidney transplantation. Method: 30 transplant recipients were included, in whom the glomerular filtration rate was measured by means of iothalamate, and was also calculated using seven equations based on cystatin or creatinine. Results: The formula with the best performance was the one proposed by the chronic kidney disease epidemiology collaboration (CKD-EPI), with a bias of −2.4 mL/min/1.73 m2: and an accuracy of 9.6; 96.7 % of patients were within 30 % of the measured GFR. The second best formula was the modification of diet in renal disease (MDRD) equation. Cystatin-based equations showed a poor performance. Conclusions: Our study suggests that, in Mexican patients receiving kidney transplantations, the best equations to estimate GFR are the CKD-EPI and MDRD equations.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Kidney Transplantation/methods , Creatinine/analysis , Renal Insufficiency, Chronic/surgery , Cystatin C/analysis , Glomerular Filtration Rate/physiology , Reproducibility of Results , Kidney Function Tests , Mexico
13.
J. bras. nefrol ; 40(3): 266-272, July-Sept. 2018. tab
Article in English | LILACS | ID: biblio-975906

ABSTRACT

ABSTRACT Introduction: The incidence of gastrointestinal disorders among patients with chronic kidney disease (CKD) is high, despite the lack of a good correlation between endoscopic findings and symptoms. Many services thus perform upper gastrointestinal (UGI) endoscopy on kidney transplant candidates. Objectives: This study aims to describe the alterations seen on the upper endoscopies of 96 kidney-transplant candidates seen from 2014 to 2015. Methods: Ninety-six CKD patients underwent upper endoscopic examination as part of the preparation to receive kidney grafts. The data collected from the patients' medical records were charted on Microsoft Office Excel 2016 and presented descriptively. Mean values, medians, interquartile ranges and 95% confidence intervals of the clinic and epidemiological variables were calculated. Possible associations between endoscopic findings and infection by H. pylori were studied. Results: Males accounted for 54.17% of the 96 patients included in the study. Median age and time on dialysis were 50 years and 50 months, respectively. The most frequent upper endoscopy finding was enanthematous pangastritis (57.30%), followed by erosive esophagitis (30.20%). Gastric intestinal metaplasia and peptic ulcer were found in 8.33% and 7.30% of the patients, respectively. H. pylori tests were positive in 49 patients, and H. pylori infection was correlated only with non-erosive esophagitis (P = 0.046). Conclusion: Abnormal upper endoscopy findings were detected in all studied patients. This study suggested that upper endoscopy is a valid procedure for kidney transplant candidates. However, prospective studies are needed to shed more light on this matter.


RESUMO Introdução: A incidência de doenças gastrointestinais altas em pacientes com doença renal crônica é elevada, porém não há boa correlação entre achados endoscópicos e sintomas. Assim, muitos serviços preconizam a realização de Endoscopia Digestiva Alta (EDA) nos candidatos a transplante renal. Objetivos: Descrever alterações endoscópicas presentes em 96 candidatos a transplante renal no período de 2014 a 2015. Métodos: Noventa e seis pacientes renais crônicos submetidos à EDA como preparo para transplante renal. Prontuários médicos dos pacientes foram revisados, os dados tabulados no programa Microsoft Office Excel 2016 e apresentados de maneira descritiva. Calculou-se média, mediana, intervalo interquartílico e intervalo de confiança de 95% das variáveis utilizadas. Alterações endoscópicas foram apresentadas quanto ao número, intervalo de confiança e valor de P, e correlacionadas com a presença ou ausência de infecção por Helicobacter pylori. Resultados: Dos 96 pacientes, 54,17% eram homens e 45,83% mulheres. As medianas de idade e tempo em diálise foram 50 anos e 50 meses, respectivamente. O achado mais comum na EDA foi pangastrite enantematosa (57,30%), seguida de esofagite erosiva (30,20%). Metaplasia intestinal gástrica e úlcera péptica foram encontradas em 8,33% e 7,30% dos pacientes, respectivamente. Pesquisa para H. pylori foi positiva em 49 pacientes, e somente houve correlação entre infecção por H. pylori e esofagite não erosiva (P = 0,046). Conclusão: Afecções gastrointestinais foram detectadas em todos os pacientes estudados. Os achados deste estudo sugerem que a realização de EDA em candidatos a receber transplante renal é desejável. Entretanto, estudos prospectivos são necessários para responder a esta questão.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Stomach Diseases/etiology , Duodenal Diseases/etiology , Esophageal Diseases/etiology , Renal Insufficiency, Chronic/complications , Stomach Diseases/diagnosis , Cross-Sectional Studies , Endoscopy, Gastrointestinal , Kidney Transplantation , Duodenal Diseases/diagnosis , Esophageal Diseases/diagnosis , Renal Insufficiency, Chronic/surgery
14.
Rev. chil. radiol ; 24(1): 34-39, mar. 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-959571

ABSTRACT

El trasplante de páncreas es una alternativa terapéutica para pacientes diabéticos con complicaciones metabólicas severas y/o enfermedad renal crónica terminal. En el 80% de los casos, se realiza trasplante simultáneo de páncreas y riñón. El ultrasonido (US) es la técnica de elección para una primera evaluación del injerto, principalmente el modo Doppler espectral. Este último permite la evaluación de la vasculatura y perfusión de injerto. La tomografía computada (TC) y resonancia magnética (RM) se reservan para la evaluación de complicaciones (Tabla 1). Se realizó una revisión retrospectiva de una serie casos de trasplante páncreas-riñón realizada en nuestra institución entre los años 2014 y 2017, con un total de 12 casos.


Pancreas transplantation is a therapeutic alternative for diabetic patients with severe metabolic complications and/or terminal chronic kidney disease. In 80% of cases, a simultaneous transplant of pancreas and kidney is performed. Ultrasound (US) is the technique of choice for a first evaluation of the implant, mainly the spectral Doppler mode, which allows evaluation of the graft vasculature and perfusion. Computed tomography (CT) and magnetic resonance imaging (MRI) are reserved for the evaluation of complications (Table). A retrospective review of a series of cases of pancreas-kidney transplantation performed at our institution between 2014 and 2017 was carried out, with a total of 12 cases.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Postoperative Complications/diagnostic imaging , Kidney Transplantation/methods , Pancreas Transplantation/methods , Tomography, X-Ray Computed , Retrospective Studies , Kidney Transplantation/adverse effects , Pancreas Transplantation/adverse effects , Ultrasonography, Doppler , Diabetes Mellitus/surgery , Renal Insufficiency, Chronic/surgery
15.
Rev. latinoam. enferm. (Online) ; 26: e3028, 2018. graf
Article in English | LILACS, BDENF | ID: biblio-961202

ABSTRACT

ABSTRACT Objective: To understand the experience of people living with Chronic Kidney Disease who have been transplanted, from the meanings constructed based on the experienced phenomenon. Method: Hermeneutic-phenomenological study based on the five lifeworld existentials, according to Van Manen's theoretical framework. Eleven transplanted patients participated in the study and data collection was carried out through semi-structured interviews, after approval of the study by the Ethics Committee of the University of Antioquia. Results: The theme of Living with Chronic Kidney Disease emerged, and the subthemes were grouped as lifeworld existentials of Temporality: something unexpected, being present and not seeing it, being young and sick. Relationality: support, feeling stuck and Terminal Chronic Renal Failure. Spatiality: changes in life, sadness and depression. Corporeality: body deterioration and changes in sex life. Materiality: effects on the economic status. Conclusions: The care provided to people must be oriented in order to recognize their individualities, understanding what the illness means for the individual and his family, how they live with it and what the changes are, leading them to modify their lives and start a long process, such as living with a chronic disease.


RESUMO Objetivo: Compreender a experiência vivida por pessoas com Doença Renal Crônica que foram transplantadas, a partir dos significados construídos em relação ao fenômeno vivenciado. Método: Estudo hermenêutico-fenomenológico baseado nos cinco existenciais, de acordo com o referencial teórico de Van Manen. Onze pessoas transplantadas participaram do estudo, e os dados foram coletados por meio de entrevistas semiestruturadas, após a aprovação do estudo pelo comitê de ética da Universidade de Antioquia. Resultados: Surgiu o tema de Viver com Doença Renal Crônica, e os subtemas foram agrupados como existenciais de Temporalidade: algo inesperado, estar presente e não vê-la, ser jovem e estar doente. Relacionalidade: o apoio, se sentir atados e Doença Renal Crônica Terminal. Espacialidade: mudanças de vida, tristeza e depressão. Corporeidade: deterioração do corpo e alteração da vida sexual. Materialidade: impacto na situação econômica. Conclusões: O cuidado proporcionado às pessoas deve ser orientado para o reconhecimento de suas individualidades, entendendo o que a doença significa para o indivíduo e para a família, como eles vivem com ela e quais são as mudanças que enfrentam, levando-os a modificar sua vida e iniciar um processo de longa duração, como é o fato de viver com uma condição de natureza crônica.


RESUMEN Objetivo: Comprender la experiencia vivida por personas con Enfermedad Renal Crónica que han sido trasplantadas, desde los significados construidos con respecto al fenómeno experimentado. Método: Estudio fenomenológico-hermenéutico, fundamentado en los cinco existenciales, desde el referencial teórico de Van Manen; 11 personas trasplantadas participaron en el estudio, los datos recolectados a través de entrevistas semiestructuradas, previa aprobación del comité de ética de la Universidad de Antioquia. Resultados: Emerge el tema de Vivir con Enfermedad Renal Crónica, los subtemas agrupados en los existenciales de Temporalidad: algo inesperado, estar presente y no verla, ser joven y estar enfermo. Relacionalidad: el apoyo, sentirse atados y Enfermedad Renal Crónica Terminal. Espacialidad: la vida cambia, tristeza y depresión. Corporeidad: el cuerpo deteriorado y la alteración de la vida sexual. Materialidad: impacto en la situación económica. Conclusiones: El cuidado brindado a las personas, debe orientarse a reconocer sus individualidades comprendiendo lo que para el individuo y familia significa la enfermedad, como la vive y cuáles son los cambios a los que se enfrentan, llevándolos a modificar su vida e iniciar un proceso de larga duración, como es el hecho de vivir en cronicidad.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Kidney Transplantation/psychology , Renal Insufficiency, Chronic/surgery , Renal Insufficiency, Chronic/psychology , Social Behavior , Qualitative Research , Hermeneutics
16.
Cad. Saúde Pública (Online) ; 33(10): e00160416, oct. 2017. tab
Article in Spanish | LILACS | ID: biblio-952320

ABSTRACT

Resumen: Este trabajo examina la atención renal desde la perspectiva de quienes han sido trasplantados, padeciendo enfermedad renal crónica (ERC), así como la de sus familias. Se realizó un estudio cualitativo en tres ciudades de Uruguay. Utilizando un muestreo teórico, seleccionamos 25 personas con ERC que vivieran con trasplante renal, y cinco familiares. Se hicieron entrevistas semi-estructuradas para explorar las perspectivas de los participantes; así como análisis de contenido. Cuatro ejes temáticos fueron construidos a partir del discurso de los participantes: reconociendo los logros del sistema de atención, teniendo derecho a la salud, identificando problemas en la atención y formulando propuestas de acción. El sistema de atención es considerado adecuado, eficiente y de calidad por quienes viven con trasplante renal, son jóvenes, trabajadores, de Montevideo y están cubiertos por el sector sanitario privado. Lo contrario sucede con los jubilados o pensionistas, con multi-morbilidad, del interior del país, cubiertos por el sector público y viviendo en la pobreza. Los participantes también formulan propuestas para resolver los problemas identificados. Además de reconocer el acceso gratuito y universal a las terapias renales, a las cuales consideran tener derecho, concluimos que los individuos con trasplante de riñón valoran favorablemente la atención sanitaria y los organismos involucrados. Sin embargo, algunos enfrentan serios obstáculos para acceder a una atención gratuita, oportuna y de calidad. Recomendamos impulsar estrategias para incorporar propuestas de los individuos enfermos y sus familias, a fin de mejorar dicha atención y disminuir las desigualdades sociales.


Abstract: This study examines renal care from the perspective of kidney transplant patients with chronic kidney disease (CKD), as well as their families. A qualitative study was performed in three cities of Uruguay. Using theoretical sampling, we selected 25 persons with CKD that were living with kidney transplants, in addition to five family members. Semi-structured interviews were held to explore the participants' perspectives, as well as content analysis. Four thematic lines were constructed from the participants' discourse: recognizing the successes of the system of care, the right to health, identifying problems in care, and formulating proposals for action. The system of care is rated as adequate, efficient, and high-quality by individuals living with kidney transplants who are young, employed, residing in the national capital of Montevideo, and covered by the private health sector. The opposite is true for retirees and pensioners, those with multiple morbidities, from inland Uruguay, covered by the public sector, and living in poverty. The participants also formulated proposals to solve the problems that were identified. In addition to acknowledging free and universal access to renal therapies to which patients feel they have the right, we conclude that kidney transplant patients assess the healthcare favorably and the agencies involved. Nevertheless, there are serious obstacles to accessing free, timely, and high-quality care. We recommend promoting strategies to incorporate proposals by patients and their families in order to improve such care and decrease social inequalities.


Resumo: Este trabalho examina a atenção renal desde a perspectiva daqueles que foram transplantados, sofrendo insuficiência renal crônica (IRC), assim como desde a das suas famílias. Foi realizado um estudo qualitativo em três cidades do Uruguai. Utilizando uma amostragem teórica, selecionamos 25 pessoas com IRC que viveram com transplante renal, e cinco familiares. Foram realizadas entrevistas semiestruturadas para explorar as perspectivas dos participantes; assim como a análise de conteúdo. Quatro eixos temáticos foram construídos a partir da intervenção dos participantes: reconhecendo os resultados alcançados com o sistema de atenção, tendo direito à saúde, identificando problemas na assistência e formulando propostas de ação. O sistema de assistência é considerado adequado, eficiente e de qualidade por quem vive com transplante renal, são jovens, trabalhadores, de Montevidéu e estão cobertos pelo seguro de saúde privado. O oposto acontece com os aposentados ou pensionários, com multi-morbilidade, no interior do país, cobertos pelo sistema público e vivendo na pobreza. Os participantes também apresentam propostas para resolver os problemas identificados. Além disso, se reconhece o acesso gratuito e universal às terapias renais, para as quais consideram ter direito, concluímos que os indivíduos com transplante de rins valorizam favoravelmente a atenção sanitária e as instituições envolvidas. Porém, alguns enfrentam sérios obstáculos para aceder a uma atenção gratuita, adequada e de qualidade. Recomendamos incentivar estratégias para incorporar propostas dos indivíduos doentes e suas famílias, ao fim de melhorar a referida atenção e reduzir as desigualdades sociais.


Subject(s)
Humans , Male , Female , Pregnancy , Adult , Aged , Kidney Transplantation , Renal Insufficiency, Chronic/surgery , Primary Health Care , Uruguay , Family Health , Interviews as Topic , Delivery of Health Care , Health Services Accessibility , Middle Aged
17.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 9(4): 1145-1153, out.-dez. 2017.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-908510

ABSTRACT

Objetivo: Analisar a utilização de imunossupressores pelas pessoas com transplante renal. Métodos: Utilizou-se abordagem qualitativa do tipo descritivo, realizada com 20 pessoas transplantadas renais, no período de maio a julho de 2013. A coleta de dados ocorreu por meio de entrevista semiestruturada e utilizou-se a análise temática. Resultados: Participaram dez homens e dez mulheres, com idade entre 30 e 66 anos, a maioria da raça branca, católica, casada, com Ensino Fundamental incompleto e aposentada. Foram identificadas três categorias: rotina do uso das medicações imunossupressoras; presença dos efeitos colaterais das medicações imunossupressoras; e dispensação das medicações imunossupressoras. Conclusão: O estudo apresenta singularidades da experiência de pessoas dependentes de um tratamento medicamentoso contínuo; portanto, fornece subsídios teóricos que poderão qualificar as práticas de atenção direcionadas a quem vivencia a dependência destes medicamentos.


Objective: To analyze the use of immunosuppressants for people with renal transplant. Methods: It was used qualitative approach descriptive, conducted with 20 people renal transplanted, in the period from May to July 2013. The data collection was through semi-structured interview and used the thematic analysis. Results: Participated ten men and ten women, aged between 30 and 66 years, mostly of the white race, Catholic, married, with incomplete primary education and retired. Three categories were identified: routine use of immunosuppressants; presence of side effects of immunosuppressants; and dispensing of immunosuppressants. Conclusion: The study presents singularities of dependents experience an ongoing drug treatment therefore provides theoretical subsidies that may qualify the care practices aimed at people living in the dependence of these drugs.


Objetivo: Analizar la utilización de inmunosupresores por las personas con trasplante renal. Métodos: Utilizó abordaje cualitativa del tipo descriptivo, realizado con 20 personas trasplantadas renales, en el período de mayo a julio de 2013. La recolección de datos ocurrió a través de entrevista semiestructurada y utilizó el análisis temático. Resultados: Participaron diez hombres y diez mujeres, con edades entre 30 y 66 años, la mayoría de la raza blanca, católica, casada, con educación fundamental incompleto y jubilada. Fueran identificadas tres categorías: rutina de lo uso de las medicaciones inmunosupresoras; presencia de los efectos secundarios de las medicaciones inmunosupresoras; y dispensación de las medicaciones inmunosupresoras. Conclusión: El estudio presenta singularidades de la experiencia de personas dependientes de un tratamiento medicamentoso continuado, por lo tanto, fornece subsidios teóricos que pueden calificar las prácticas de atención direccionadas a quien vivencia la dependencia de estos medicamentos.


Subject(s)
Male , Female , Humans , Adult , Middle Aged , Aged , Drug-Related Side Effects and Adverse Reactions , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Kidney Transplantation , Brazil , Renal Insufficiency, Chronic/surgery
18.
J. pediatr. (Rio J.) ; 92(3,supl.1): 57-63, tab
Article in English | LILACS | ID: lil-787514

ABSTRACT

Abstract Objective: The abnormalities of the genitourinary tract development are the leading cause of chronic kidney disease (CKD) in children. The diagnosis of this disease in Brazil is late and incomplete, which results in increased morbidity and mortality in this age group. Early diagnosis of this condition is the prerogative of generalist pediatricians, and the aim of this study was to review the clinical signs and symptoms associated with developmental abnormalities of the genitourinary tract. Data sources: Based on the description of a symbolic clinical case, the authors conducted a non-systematic review of medical literature. Data synthesis: The results suggest that the following data should be used as a warning for early diagnosis of affected children: (a) combined urinary tract abnormalities (chromosomal abnormalities; sequence of malformations [VACTERLand Prune-Belly]; and musculoskeletal, digestive tract, heart, and nervous system malformations); (b) previous history (congenital anomalies of the kidney and urinary tract [CAKUT] in the family, low birth weight, and oligoamnios); (c) clinical signs (polyuria/nocturia, urinary tract infection, systemic arterial hypertension, failure to thrive, weak urinary stream, difficulty to start urination, distended bladder, non-monosymptomatic enuresis, urinary/urge incontinence, and bowel and bladder dysfunction); and (d) pre- and postnatal ultrasonographic alterations (increased anteroposterior diameter of the renal pelvis, mainly in the third trimester of pregnancy; single kidney; hydronephrosis associated with other abnormalities; and hydronephrosis with parenchymal involvement in the post-neonatal assessment). Conclusion: The suggestions shown here can help the pediatrician to establish clinical hypotheses for the early diagnosis of developmental abnormalities of the genitourinary tract without resorting to expensive and invasive procedures.


Resumo Objetivo: As anormalidades do desenvolvimento do trato geniturinário são a principal causa de doença renal crônica (DRC) em crianças. O diagnóstico dessa doença no Brasil é formulado de maneira incompleta e tardia, o que resulta em aumento na morbimortalidade nessa faixa etária. O diagnóstico precoce dessa condição é prerrogativa dos pediatras generalistas e o objetivo deste trabalho foi revisar os sinais e sintomas clínicos associados às anormalidades do desenvolvimento do trato geniturinário. Fontes dos dados: A partir da descrição de um caso clínico simbólico, fizemos uma revisão não sistemática da literatura médica. Síntese dos dados: Os resultados sugerem que os seguintes dados devem ser usados como alerta para o diagnóstico precoce das crianças acometidas: a) anomalias do trato urinário compostas (anomalias cromossômicas, sequências de malformações – Vacterl e Prune-Belly, malformações musculoesqueléticas, do trato digestivo, cardíacas e do sistema nervoso); b) antecedentes (anomalias congênitas do rim e trato urinário (CAKUT) na família, baixo peso ao nascer e oligoâmnio); c) sinais clínicos (polaciúria/noctúria, infecção urinária, hipertensão arterial sistêmica, baixo ganho de peso, jato urinário fraco, dificuldade para iniciar a micção, bexigoma, enurese não monossintomática, urge/incontinência urinária, disfunção do intestino e da bexiga) e d) alterações ultrassonográficas ante e pós-natais (diâmetro anteroposterior da pélvis renal aumentado principalmente no terceiro trimestre da gestação, rim único, hidronefrose associada a outras anomalias e hidronefrose com comprometimento de parênquima na avaliação pós-neonatal). Conclusão: As sugestões apresentadas podem ajudar o pediatra a estabelecer hipóteses clínicas para o diagnóstico precoce das anormalidades do desenvolvimento do trato geniturinário sem metodologias caras e invasivas.


Subject(s)
Humans , Child , Urogenital Abnormalities/complications , Urogenital Abnormalities/pathology , Renal Insufficiency, Chronic/etiology , Renal Insufficiency, Chronic/pathology , Urogenital Abnormalities/surgery , Urogenital Abnormalities/diagnostic imaging , Brazil , Risk Factors , Ultrasonography , Early Diagnosis , Renal Insufficiency, Chronic/surgery , Renal Insufficiency, Chronic/diagnostic imaging , Hydronephrosis/complications , Kidney/abnormalities
19.
Int. braz. j. urol ; 40(6): 763-771, Nov-Dec/2014. tab, graf
Article in English | LILACS | ID: lil-735990

ABSTRACT

Purpose To investigate risk factors for urine leak in patients undergoing minimally invasive partial nephrectomy (MIPN) and to determine the role of intraoperative ureteral catheterization in preventing this postoperative complication. Materials and Methods MIPN procedures done from September 1999 to July 2012 at our Center were reviewed from our IRB-approved database. Patient and tumor characteristics, operative techniques and outcomes were analyzed. Patients with evidence of urine leak were identified. Outcomes were compared between patients with preoperative ureteral catheterization (C-group) and those without (NC-group). Univariable and multivariable analyses were performed to identify factors predicting postoperative urine leak. Results A total of 1,019 cases were included (452 robotic partial nephrectomy cases and 567 laparoscopic partial nephrectomy cases). Five hundred twenty eight patients (51.8%) were in the C-group, whereas 491 of them (48.2%) in the NC-group. Urine leak occurred in 31(3%) cases, 4.6% in the C-group and 1.4% in the NC-group (p<0.001). Tumors in NC-group had significantly higher RENAL score, shorter operative and warm ischemic times. On multivariable analysis, tumor proximity to collecting system (OR=9.2; p<0.01), surgeon’s early operative experience (OR=7.8; p<0.01) and preoperative moderate to severe CKD (OR=3.1; p<0.01) significantly increased the odds of the occurrence of a postoperative urine leak. Conclusion Clinically significant urine leak after MIPN in a high volume institution setting is uncommon. This event is more likely to occur in cases of renal masses that are close to the collecting system, in patients with preoperative CKD and when operating surgeon is still in the learning curve for the procedure. Our findings suggest that routine intraoperative ureteral catheterization during MIPN does not reduce the probability of postoperative urine leak. In addition, it adds to the overall ...


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Nephrectomy/adverse effects , Urinary Catheterization/methods , Urinary Incontinence/etiology , Urinary Incontinence/prevention & control , Glomerular Filtration Rate , Intraoperative Care , Multivariate Analysis , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/methods , Nephrectomy/methods , Operative Time , Reproducibility of Results , Risk Factors , Renal Insufficiency, Chronic/surgery , Severity of Illness Index , Statistics, Nonparametric , Time Factors , Treatment Outcome
20.
Rev. méd. Chile ; 141(12): 1584-1588, dic. 2013. ilus
Article in Spanish | LILACS | ID: lil-705580

ABSTRACT

In renal transplants patients, metastatic pulmonary calcifications have been reported occasionally when the grafts are dysfunctional and rarely when they are functioning normally. We report a male who received a renal allograft in 1994 at the age of 61 years. Nineteen years later a routine chest X ray showed diffuse infiltrates and a CT scan showed diffuse calcifications in both lungs. These were interpreted as metastatic pulmonary calcifications. The last available laboratory determinations were a serum creatinine of 1.4 mg/dl and urinary protein excretion of 255 mg/24 hours. No further studies were done since the patient experienced a sudden death due to an acute myocardial infarction.


Subject(s)
Aged, 80 and over , Humans , Male , Calcinosis/etiology , Kidney Transplantation/adverse effects , Lung Diseases/etiology , Calcinosis/diagnosis , Creatinine/blood , Fatal Outcome , Lung Diseases/diagnosis , Proteinuria/blood , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/surgery , Tomography, X-Ray Computed , Transplantation, Homologous/adverse effects
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