RESUMO
Kidney graft loss because arterial thrombosis is not common and is related to risk factors such as recurrent vascular hemodialysis access thrombosis, collagen-vascular disease, repeated miscarriage, diabetes mellitus and thrombophilia. Patients having this last disorder have an increased risk of repeated thrombosis in successive transplants unless they receive anticoagulation therapy. We report a 51 year-old diabetic woman who had a history of recurrent vascular hemodialysis access thrombosis (both native and prosthetic) while on dialysis and received a cadaveric donor kidney. One month after transplantation she had axillary vein thrombosis complicated with pulmonary embolism and received anticoagulants for six months. Just days after stopping the anticoagulation, she became suddenly anuric due to renal artery thrombosis and complete graft infarction. The coagulation study showed moderate hyperhomocysteinemia and a significant protein C deficiency (39 percent). Days after nephrectomy she suffered a femoral vein thrombosis and anticoagulation was prescribed for life.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Anticoagulantes/uso terapêutico , Rejeição de Enxerto/etiologia , Transplante de Rim , Obstrução da Artéria Renal/tratamento farmacológico , Trombofilia/complicações , Trombose/tratamento farmacológico , Insuficiência Renal , Anastomose Cirúrgica , Veia Axilar , Cateteres de Demora , Veia Femoral , Hiper-Homocisteinemia/complicações , Deficiência de Proteína C/complicações , Recidiva , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/cirurgia , Diálise Renal/efeitos adversos , Trombose/etiologia , Trombose/cirurgia , Trombose Venosa/etiologiaRESUMO
The aim of this work was to study the impact of hospital admission on functional status of elders. 86 patients (63 male) aged 73ñ4 years old admitted to the Internal Medicine Service of a public hospital were studied. Funstional status was measured on admission, discharge and 15 days after discharge using the Northwestern Functional Status Review Instrument. 15 patients died during hospital stay. Functional status improved in patients admitted with disordered consciousness, in those admitted due to neurologic dosirders, in those with less than 2 chronic diseases, in those whose disease cured during hospitalization and those that did not acquire new disease during admission. Prolonged hospitalizations of more than 13 days were associated with functional status worsening. It is concluded that functional status of elders does not always deteriorate during hospital admissions