Impact of pregnancy on the function of transplanted kidneys.

INTRODUCTION: This study reviewed the course of pregnancies in terms of impact on renal function and delivery-related data among women who received kidney transplants in our unit. METHODS: We reviewed the medical records of women transplanted between 1982 and 2002 who became pregnant. We recorded the data of medical, obstetrical, and transplant-related complications, plasma creatinine levels, and blood pressures at baseline, delivery, and 12 months after delivery. RESULTS: Thirty women had 37 pregnancies. Immunosuppressive protocols included cyclosporine, ketoconazole, azathioprine, and prednisone in 22 patients or azathioprine and prednisone in 15. Renal function decreased significantly: mean creatinine levels at baseline, delivery, and after 1 year were: 1.19 +/- 0.38 mg/dL; 1.44 +/- 0.70 mg/dL; and 1.38 +/- 0.53 mg/dL, respectively (P = .023 and P = .004 vs baseline respectively). Systolic and diastolic blood pressures at delivery were higher than at baseline (134 +/- 19 and 86 +/- 14 mm Hg vs 126 +/- 21 and 79 +/- 13 mm Hg (P = .029 and P = .053, respectively). These values normalized 1 year later (128 +/- 21 and 80 +/- 16). Decreased use of antihypertensive drugs were the cause of poor blood pressure control (1.8 +/- 1.3 vs 0.9 +/- 0.7, P < .01). Blood pressure control improved following delivery. The most frequent complications were preeclampsia (18.9%), intrahepatic cholestasis (13.5%), and urinary tract infections (13.5%). There were five rejection episodes. Seven miscarriages took place and one mole. Eleven pregnancies were uncomplicated. CONCLUSION: Renal transplantation is the best treatment for fertile women with end-stage renal disease who want to become pregnant. However, pregnancy is risky for the mother, fetus, newborn, and allograft.

[Usefulness of thoracic radiography after insertion of transitory catheters for hemodialysis]. / Utilidad de la radiografía de tórax posterior a la instalación de catéteres transitorios para hemodiálisis.

A chest X-ray has been routinely used to evaluate possible complications of a catheter installed for hemodialysis. The objective of the present study was to evaluate the utility of routine chest X-ray to detect complications derived from the installation of temporary catheters through a jugular vein access. We studied prospectively 95 successive jugular catheters for hemodialysis. After installation the operator answered a questionnaire that asked for details of the procedure and his opinion of the utility of a chest X-ray to detect a complication in each particular case. A chest X-ray was done in every patient and analyzed blindly. There were 17 minor complications: 7 arterial punctures, 5 neck hamatomas and 5 malpositions of catheters. No major complications were found. Sixty per cent of the catheters that required three or more punctures had a complication vs only 10% of the ones that required two or less puncture (p < 0.05). In five occasions the catheters were malpositioned, in four of these cases a complication was suspected. The wire guide was twisted in all of these cases. The procedure was considered of medium or high difficulty in four of the five malpositioned catheters, in contrast a medium or highly difficult case was considered only in 13 of the 90 well positioned catheters (p < 0.05). The time employed for the catheters installation was significantly higher for the malpositioned catheters. In 29.5% of the cases the operator considered a chest X-ray necessary, 2/3 of the cases did not have a well founded clinical suspicion of complication. We conclude that routine chest X-ray after installation of a jugular catheter for hemodialysis has a low diagnostic value for the detection of complications derived from the procedure and should be ordered only when clinical features suggest a complication.

Utilidad de la radiografía de tórax posterior a la instalación de catéteres transitorios para hemodiálisis / Value of the chest radiograph after the insertion of temporary dialysis catheters

Para evaluar el valor de la radiografía de tórax de rutina posterior a la instalación de catéteres transitorios para hemodiálisis estudiamos prospectivamente 95 catéteres sucesivos. Una vez instalado cada catéter el operador contestó una encuesta sobre los detalles del procedimiento y manifestó su opinión sobre la utilidad de la radiografía para descartar alguna complicación en el caso en particular. En 95 catéteres hubo 17 complicaciones: 7 punciones arteriales, 5 hematomas y 5 malposiciones del catéter. No hubo hamotórax ni neumotórax. Presentaron alguna complicación el 60 % de los catéteres que requirieron 3 o más intentos antes de canular la vena y el 10% de los que requirieron menos intentos p < 0,05. En el 29,5% de los catéteres el operador consideró necesario realizar la radiografía de tórax, en el 65,4% de ellas sin una sospecha clínicamente fundada de complicación. En 5 ocasiones el catéter quedó mal posicionado, en 4 de estas se sospechó alguna complicación pero solo en 2 oportunidades se sospecho la mal posición, en las 5 oportunidades la guía de alambre salío acodada. En el 4 de 5 oportunidades en que el catéter quedó en mala posición y en 13 de las 90 en que el catéter quedó en buena posición el procedimiento fue considerado como alta o mediana dificultad por el operador p < 0,05. El tiempo necesario para la instalación fue mayor en los catéteres que quedaron en mala posición. En conclusión: La radiografía de tórax de rutina posterior a la instalación de catéteres para Hemodiálisis tiene poco rendimiento en el diagnóstico de complicaciones derivadas del procedimiento y debería ser practicada solo en presencia de hechos clínicos que sugieran una complicación

A chest X-ray has been routinely used to evaluate possible complications of a catheter installed for hemodialysis. The objetive of the present study was to evaluate the utility of routine chest X-ray to detect complications derived from the installation of temporary catheters through a jugular vein access. We studied prospectively 95 successive jugular catheters for hemodialysis. After installation the operator answered a questionnaire that asked for details of the procedure and his opinion of the utility of a chest X-ray to detect a complication in each particular case. A chest X-ray was done in every patient and analyzed blindly. There were 17 minor complications: 7 arterial punctures, 5 neck hamatomas and 5 malpositions of catheters. No major complications were found. Sixty per cent of the catheters that required three or more punctures had a complication vs only 10% of the ones that required two or less puncture (p < 0.05). In five occasions the catheters were malpositioned, in four of these cases a complication was suspected. The wire guide was twisted in all of these cases. The procedure was considered of medium or high difficulty in four of the five malpositioned catheters, in contrast a medium or highly difficult case was considered only in 13 of the 90 well positioned catheters (p < 0.05). The time employed for the catheters installation was significanthy higher for the malpositioned catheters. In 29.5% of the cases the operator considered a chest X-ray neccesary, 2/3 of the cases did not have a well founded clinical suspicion of complication. We conclude that routine chest X-ray after installation of a jugular catheter for hemodialysis has a low diagnostic value for the detection of complications derived from the procedure and should be ordered only when clinical features suggest a complication