Podocitopatía como inicio de un lupus eritematoso sistémico / Podocytopathy as debut of a systemic lupus erythematosus

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Importancia del seguimiento y tratamiento del fracaso de maduración en la fístula arteriovenosa radio-cefálica en prediálisis. Papel de la ecografía / Importance of monitoring and treatment of failed maturation in radiocephalic arteriovenous fistula in predialysis: Role of ultrasound

El objetivo del estudio fue analizar las FAV-RC en prediálisis en las que se hizo un seguimiento clínico y ecográfico de la maduración y cuyo fracaso se trató. Material y métodos: Estudiamos 127 FAV-RC en 117 pacientes prediálisis. Todos disponían de un mapa preoperatorio. La FAV-RC era madura si tenía un flujo en la arteria humeral mayor que o igual a 500ml/min y un diámetro en la vena cefálica mayor o igual a 4mm. Se trató el fracaso de maduración según el tipo de lesión. Un total de 58 pacientes iniciaron hemodiálisis durante el seguimiento. Resultados: En las 106 FAV-RC funcionantes, 72 (68%) fueron maduras y 34 (32%) inmaduras. El 97% de las inmaduras presentaron al menos una lesión y la localización más frecuente fue la vena postanastomótica. El 31% de las FAV-RC maduras tenían lesiones y en el 18% precisaron tratamiento. El tratamiento más frecuente del fracaso de maduración fue radiológico. A los 6 meses la permeabilidad primaria y secundaria fue del 59 y del 78%; a los 12 meses del 48 y del 77%, respectivamente. El 80% de los pacientes iniciaron hemodiálisis con una FAV distal (76% radio-cefálicas y 4% cubitobasílicas). Ningún paciente con una FAV-RC inmadura tratada lo hizo con CVC y un 78% lo hizo con dicha FAV. Conclusión: La ecografía en el seguimiento de la maduración aporta ventajas frente al seguimiento clínico. Con nuestro abordaje del AV en prediálisis conseguimos que el 80% de nuestros pacientes inicien hemodiálisis mediante una FAV distal (AU)

The aim of the study was to analyse outcomes of AVF-RC in predialysis stage in which a clinical and radiological follow up of its maturation had been done and primary failure had been treated. Material and methods: We studied 127 RC-AVF in 117 predialysis patients. All cases had a preoperative map. The RC-AVF was considered mature if it had a brachial artery flow greater than or equal to 500ml/min and a cephalic vein diameter of greater than or equal4mm. Primary failure was treated radiologically or surgically depending on the type of lesion. Fifty-eight patients started dialysis at the time of the study. Results: In 106 RC-AVF without thrombosis, 72 (68%) were mature and 34 (32%) were immature. A total of 97% of the immature had at least one lesion, and the most common site was the post-anastomotic vein. Lesions were found in 31% of mature RC-AVF, and 18% of patients required treatment. Radiological treatment was the most frequent for maturation failure. After 6 months, primary and secondary patency were 59% and 78%, while after 12 months they were 48% and 77%, respectively. The 80% of patients started dialysis with a distal AVF (76% RC-AVF and 4% ulnar basilic). None of the patients with treated immature RC-AVF started dialysis with CVC, while 78% of the patients started with said AVF. Conclusion: Ultrasonography for monitoring maturation provides advantages over clinical monitoring. With our management of RC-AVF in predialysis, 80% of patients start dialysis with an adequate distal AVF (AU)

Importance of monitoring and treatment of failed maturation in radiocephalic arteriovenous fistula in predialysis: Role of ultrasound. / Importancia del seguimiento y tratamiento del fracaso de maduración en la fístula arteriovenosa radio-cefálica en prediálisis. Papel de la ecografía.

UNLABELLED: The aim of the study was to analyse outcomes of AVF-RC in predialysis stage in which a clinical and radiological follow up of its maturation had been done and primary failure had been treated. MATERIAL AND METHODS: We studied 127 RC-AVF in 117 predialysis patients. All cases had a preoperative map. The RC-AVF was considered mature if it had a brachial artery flow ≥500ml/min and a cephalic vein diameter of ≥4mm. Primary failure was treated radiologically or surgically depending on the type of lesion. Fifty-eight patients started dialysis at the time of the study. RESULTS: In 106 RC-AVF without thrombosis, 72 (68%) were mature and 34 (32%) were immature. A total of 97% of the immature had at least one lesion, and the most common site was the post-anastomotic vein. Lesions were found in 31% of mature RC-AVF, and 18% of patients required treatment. Radiological treatment was the most frequent for maturation failure. After 6 months, primary and secondary patency were 59% and 78%, while after 12 months they were 48% and 77%, respectively. The 80% of patients started dialysis with a distal AVF (76% RC-AVF and 4% ulnar basilic). None of the patients with treated immature RC-AVF started dialysis with CVC, while 78% of the patients started with said AVF. CONCLUSION: Ultrasonography for monitoring maturation provides advantages over clinical monitoring. With our management of RC-AVF in predialysis, 80% of patients start dialysis with an adequate distal AVF.