Sobrevida del injerto en los primeros 100 trasplantes renales del Hospital Carlos Van Buren / Survival of grafts in the first 100 renal transplants at the Carlos Van Buren hospital in Chile

Background: Renal transplant is the best therapeutic alternative for chronic renal failure, although it is not exempt of risks. Aim: To report the survival of renal transplant recipients and grafts and the main complications at a public hospital in Chile. Patients and methods: This is a non experimental, open historical cohort study, with reposition of the first 100 transplants in 94 patients, performed at the Carlos van Buren Hospital between 1984 and 1998. Seventy grafts came from cadaveric donors and 30 from live donors. As immunosuppressive therapy, prednisone + azathioprine was used in 48 transplants and the same regimen plus cyclosporine in 52. Results: Mean age of recipients was 36 ñ 23 years old. Ten years actuarial survival of patients was 80.5 percent in transplants from cadaveric donors and 86 percent in transplants from live donors. Ten years graft survival was 57.5 percent in transplants from cadaveric donors and 42 percent in transplants from live donors. The period in which the transplant was performed (first or second half of the observation period), type of donor, HLA B-DR compatibility and sensitization ( percent PRA) had no effect on survival. Twenty five subjects lost their graft, 12 due to acute steroid resistant rejection, 10 due to chronic graft nephropathy and three due to renal artery thrombosis. Fifteen subjects died with a functioning graft, 10 due to infections, two due to an acute myocardial infarction, two due to an acute pancreatitis and one due to a brain tumor. Conclusions: Survival of grafts and renal transplant recipients was not influenced by the type of donor, period of transplantation and immune variables. Main causes of recipient death were infections and the main cause of graft failure was acute rejection

Encefalopatía de Wernicke y diálisis: dos casos clínicos / Wernicke's encephalopathy and dialysis: 2 clinical cases

Wernicke encephalopathy is considered a complication of dialytic therapy, but there are few reports of this complication. We report a 57 years old man a 45 years old woman, with grade IV renal failure, who after acute peritoneodialysis and chronic hemodialysis respectively, had a confusional syndrome that responded to the administration of thiamine. CT scans in both patients discarded abnormal blood collections or new cerebrovascular episodes. The man had two previous cerebrovascular episodes, a severe anemia that was corrected, angina and an episode of arrhythmia during the dialytic procedure previous to the confusional episode. The woman had an acute uremic syndrome and a concomitant urinary tract infection during the confusional episode. Wernicke encephalopathy must be suspected in patients in dialysis with confusional episodes

Nocardiosis en un paciente con trasplante renal / Nocardiosis in a renal transplanted patient

We report a unilateral pulmonary nocardiosis in a 51 years old male that received a renal allograft. The clinical picture appeared 68 days after transplantation and the culture of a bronchoalveolar lavage showed the presence of Nocardia ateroides. Cyclosporine and azathioprine were discontinued and trimethoprim-sulphamethoxazole was started with a good clinical response. Afterwards, azathioprine was restarted and the patient is asymptomatic at the present moment

Síndrome nefrótico en artritis reumatoidea tratada con penicilamina / Penicillamine- induced nephrotic syndrome

Presentamos un caso de Artritis Reumatoídea seronegativa, tratada con Penicilamina durante 11 meses desarrollando un Síndrome Nefrótico a lesiones mínimas, que remite espontáneamente a los dos meses de suspendida la droga