ABSTRACT
Atypical uremic haemolytic syndrome is a variant of thrombotic micro-andiopathy characterized by non-autoimmune hemolytic anemia, thrombocytopenia and acute renal failure as a result of excessive activation of the complement. Up to 60% of patients have mutations in the genes that encode the complement system. A disensing factor is required for its manifestation, including gestation. It is an entity with a high morbidity, which can decrease drastically if an early diagnosis is made and appropriate treatment is initiated. Administration of ecuilizumab has demonstrated rapid process disruption, reducing the need for extrarenal purification therapies and improving renal function and patient prognosis.
Subject(s)
Acute Kidney Injury , Anemia, Hemolytic , Atypical Hemolytic Uremic Syndrome , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Atypical Hemolytic Uremic Syndrome/diagnosis , Atypical Hemolytic Uremic Syndrome/therapy , Female , Humans , Pregnancy , PrognosisABSTRACT
Atypical uremic haemolytic syndrome is a variant of thrombotic micro-andiopathy characterized by non-autoimmune hemolytic anemia, thrombocytopenia and acute renal failure as a result of excessive activation of the complement. Up to 60% of patients have mutations in the genes that encode the complement system. A disensing factor is required for its manifestation, including gestation. It is an entity with a high morbidity, which can decrease drastically if an early diagnosis is made and appropriate treatment is initiated. Administration of ecuilizumab has demonstrated rapid process disruption, reducing the need for extrarenal purification therapies and improving renal function and patient prognosis.
ABSTRACT
Introducción: El fracaso renal agudo (FRA) tras la cirugía cardiaca es un factor de riesgo asociado a mortalidad y consumo de recursos. Algunos estudios encuentran efectos beneficiosos del flujo pulsátil en la circulación extracorpórea (CEC) sobre la función renal. El objetivo de este estudio es describir la morfología ecográfica de la onda arterial renal modificando los parámetros de la CEC pulsátil. Material y método: Estudio descriptivo de 10 pacientes intervenidos mediante cirugía cardiaca con CEC sin FRA previo. Se realizó ecografía renal pre-, intra- y poscirugía. Durante la CEC pulsátil se modificaron la amplitud y el flujo base. Se obtuvieron registros de Doppler pulsado en arterias intrarrenales, se midió la velocidad máxima sistólica y la velocidad mínima diastólica, el índice de resistencia (IR) y el tiempo de aceleración (TAcel). Resultados: La ecografía previa a la CEC (pre-CEC) muestra que hay diferencias significativas cuando se compara con los valores obtenidos en la modalidad A50F50 (p = 0,013), A50F30 (p = 0,013) y A60F50 (p = 0,003). No las hay para la modalidad A30F30 (p = 0,125). Conclusiones: La disminución de la amplitud y del flujo base de la pulsatilidad durante la CEC permite obtener una morfología ecográfica renal más parecida a la fisiológica. Estudios posteriores utilizando estas características durante la CEC pulsátil podrían mostrar la repercusión de este modo de perfusión sobre el FRA que se produce tras la cirugía cardiaca
Introduction: Acute renal failure (ARF) after cardiac surgery is a risk factor associated with mortality and use of resources. Some studies have reported beneficial effects of pulsatile flow on cardiopulmonary bypass (CPB) on renal function. The aim of this study is to describe the echographic morphology of the renal arterial wave modifying the parameters of pulsatile CPB. Material and method: Descriptive study was performed on 10 patients without previous AFR and undergoing cardiac surgery with CPB. Pre-, intra- and post-surgery renal ultrasound was performed. During pulsatile CPB, the amplitude and the baseline flow were modified. Recordings of pulsed Doppler in intrarenal arteries were obtained by measuring maximum systolic velocity, minimum diastolic velocity, resistance index (RI) and acceleration time (AT). Results: Statistical differences were found in ultrasounds pre-CPB between A50F50 modality (P=.013), A50F30 (P=.013) and A60F50 (P=.003). No statistically significance was found with A30F30 modality (P=.125). Conclusions: The decrease in the amplitude and the baseline flow of pulsatility during CPB shows a renal ultrasound morphology that is more similar to the physiological one. Subsequent studies using these characteristics during pulsatile CPB could thus show perfusion over the ARF that occurs after cardiac surgery
Subject(s)
Humans , Echocardiography, Doppler, Pulsed/methods , Kidney/blood supply , Extracorporeal Circulation/methods , Acute Kidney Injury/diagnostic imaging , Renal Artery/diagnostic imaging , Epidemiology, Descriptive , Diuretics/therapeutic use , Diabetes Mellitus, Type 2/epidemiologyABSTRACT
INTRODUCTION: Acute renal failure (ARF) after cardiac surgery is a risk factor associated with mortality and use of resources. Some studies have reported beneficial effects of pulsatile flow on cardiopulmonary bypass (CPB) on renal function. The aim of this study is to describe the echographic morphology of the renal arterial wave modifying the parameters of pulsatile CPB. MATERIAL AND METHOD: Descriptive study was performed on 10 patients without previous AFR and undergoing cardiac surgery with CPB. Pre-, intra- and post-surgery renal ultrasound was performed. During pulsatile CPB, the amplitude and the baseline flow were modified. Recordings of pulsed Doppler in intrarenal arteries were obtained by measuring maximum systolic velocity, minimum diastolic velocity, resistance index (RI) and acceleration time (AT). RESULTS: Statistical differences were found in ultrasounds pre-CPB between A50F50 modality (P=.013), A50F30 (P=.013) and A60F50 (P=.003). No statistically significance was found with A30F30 modality (P=.125). CONCLUSIONS: The decrease in the amplitude and the baseline flow of pulsatility during CPB shows a renal ultrasound morphology that is more similar to the physiological one. Subsequent studies using these characteristics during pulsatile CPB could thus show perfusion over the ARF that occurs after cardiac surgery.
