Subject(s)
Cytomegalovirus Infections/drug therapy , Cytomegalovirus Infections/etiology , Ganciclovir/therapeutic use , Glomerulonephritis/drug therapy , Glomerulonephritis/virology , Kidney Transplantation/adverse effects , Adult , Glomerulonephritis/etiology , Humans , Male , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Treatment OutcomeABSTRACT
Glucocorticoid (GC) resistance has been observed in chronic kidney disease (CKD) patients on dialysis. It can be evaluated by binding assays based on the dissociation constant (Kd), which is inversely proportional to ligand affinity. CKD patients with GC resistance had increased number of acute rejection episodes. We followed up 26 patients that underwent kidney transplantation to observe whether GC resistance could affect the response to acute rejection episode pulse therapy and the long-term allograft outcome. Using Kaplan-Meier survival curve, GC resistant patients showed lower acute rejection-free survival (p=0.03) and lower kidney allograft survival (p=0.008). No difference was found regarding number of deaths. Multivariate logistic regression showed that high Kd value was an independent predictor of lower kidney allograft survival (p=0.001). There was a negative Spearman correlation between Kd and kidney allograft survival (r=-0.88, p=0.03). In conclusion, our findings indicate the usefulness of binding assay performed previously to kidney transplantation to define GC resistance. In addition, the dissociation constant (Kd) is a reliable and independent predictive marker of higher frequency of acute rejection episodes, lower rejection-free graft survival, poor response of acute rejection episodes to methylprednisolone pulse therapy, and lower kidney allograft survival in a long-term follow-up.
Subject(s)
Graft Rejection , Graft Survival , Kidney Transplantation/adverse effects , Metabolism, Inborn Errors/pathology , Receptors, Glucocorticoid/deficiency , Renal Dialysis/adverse effects , Adolescent , Adult , Female , Humans , Male , Methylprednisolone/therapeutic use , Middle Aged , Renal Insufficiency, Chronic/therapy , Retrospective Studies , Transplantation, Homologous , Treatment Outcome , Young AdultABSTRACT
A Prescrição médica intra-hospitalar é uma etapa dentro de um complexo processo de fornecimento de medicamentos, sendo apontada como uma das principais fontes de erros inesperados na evolução do tratamento de pacientes internados. Esse artigo tem como objetivos caracterizar a Prescrição médica como uma etapa do processo de fornecimento de medicação intra-hospitalar, fornecer base conceitual sobre a natureza desse processo, de modo a auxiliar a detecção de erros potenciais, e prover uma estrutura básica sobre a Prescrição, tendo como público-alvo principal o estudante de medicina no ciclo do internato. Não obstante, esse artigo também pode ser interessante para médicos em outras etapas da carreira e para outros profissionais que estejam envolvidos no processo.
The in-hospital prescription is one step in a complex process of drug supply, being identified as a major source of unexpected errors in the evolution of in-patient treatment. This paper aims to characterize the prescription as a step in the process of providing in-hospital medication providing conceptual basis of the nature of this process in order to help detect potential errors and provide a basic structure on prescription as having public main target medical student in the boarding cycle. Nevertheless, this article may be of interest to physicians in other stages of career professionals and others who are involved in the process.
