[Acquired renal cystic disease. Polysyndromatic entity as cause of non-immunological progression of renal failure]. / Enfermedad renal quística adquirida. Entidad polisindromática causa de progresión no inmunológica de insuficiencia renal.

We present a patient with rapidly progressive glomerulonephritis who after immunosuppression and hemodialysis treatment showed an improvement in his condition. Eight years later a computed tomography discovered an acquired renal cystic disease (ARCD) characterized by the development of 3 or more cysts in both kidneys of patients with chronic renal disorders and no history of hereditary cystic disease. ARCD may be asymptomatic or as it occurred in this patient, associated with several complications related to renal cysts such as polyuria-polydipsia syndrome, renal hemorrhagic cyst, perinephric hemorrhage and renal cell carcinoma. Along 12 years of follow-up the renal function showed a very slow declination which could be attributed to ARCD. It is suggested that ARCD can be considered as a non-immunological factor of renal progression when it develops in patients with mild chronic renal failure.

Enfermedad renal quística adquirida. Entidad polisindromática causa de progresión no inmunológica de insuficiencia renal. / [Acquired renal cystic disease. Polysyndromatic entity as cause of non-immunological progression of renal failure]

We present a patient with rapidly progressive glomerulonephritis who after immunosuppression and hemodialysis treatment showed an improvement in his condition. Eight years later a computed tomography discovered an acquired renal cystic disease (ARCD) characterized by the development of 3 or more cysts in both kidneys of patients with chronic renal disorders and no history of hereditary cystic disease. ARCD may be asymptomatic or as it occurred in this patient, associated with several complications related to renal cysts such as polyuria-polydipsia syndrome, renal hemorrhagic cyst, perinephric hemorrhage and renal cell carcinoma. Along 12 years of follow-up the renal function showed a very slow declination which could be attributed to ARCD. It is suggested that ARCD can be considered as a non-immunological factor of renal progression when it develops in patients with mild chronic renal failure.

Relationship between routine hematological parameters, serum IL-3, IL-6 and erythropoietin and mild anemia and degree of function in the elderly.

To investigate the influence of functioning on unexplained senile anemia, we measured commonly used hematological parameters (serum iron, transferrin, iron saturation and ferritin) in addition to specific erythropoietic factors, such as interleukin-3 (IL-3), interleukin-6 (IL-6), and erythropoietin (EPO) in 48 elderly subjects aged 65-90 years. The subjects were divided into 3 groups: 1) 17 patients with unexplained mild anemia; 2) 17 non-anemic patients with newly acquired stroke and who previously were functionally active; 3) 14 functionally active patients with no major disease who served as controls. Anemia was defined as hemoglobin (Hb) values under 12.0 g/dL. The degree of functional ability was defined and scored by the "functional independence measure" (FIM) test. Data are presented as mean values +/- SD. The results revealed a correlation between the functional state and levels of Hb, iron and transferrin with unchanged iron saturation. Patients in the mild anemia group were found to be functionally declined (FIM = 57 +/- 19.4) with the relatively lowest mean iron (75.1 +/- 17 micrograms/dL) and transferrin levels (243 +/- 42.6 micrograms/dL). The stroke group (FIM = 62 +/- 17.7) had intermediate levels of iron (85.4 +/- 20.3 micrograms/dL) and transferrin (245 +/- 45.2), and with the continuation of the declined functional state the Hb level decreased significantly (13.7 +/- 0.9 to 12.0 +/- 1.0 g/dL, p < 0.001). The highest mean values of iron (102 +/- 27.9 micrograms/dL) and transferrin (322 +/- 42.7 micrograms/dL) were found in the control group (FIM = 122.7 +/- 5.8). The ferritin levels showed an opposite trend. IL-3 values were undetectable in the anemic and control groups, and were elevated in some patients in the stroke group. The lowest IL-6 level was observed in the anemic group, and the highest in the control group. Serial IL-6 assays in the stroke group showed an upward trend. Erythropoietin levels in all groups showed no difference.

Anticuerpos contra virus de hepatitis C en pacientes hemodializados / Antibodies against hepatitis C virus in patients hemodialyzated

Con el fin de determinar la prevalencia de anticuerpos antivirus C (anti-HCV) en pacientes hemodializados (PH) se estudiaron por el método de ELISA, 149 pacientes de dos centros urbanos de diálisis. Se encontró anti-HCV en 58 de ellos (38,9%). La edad y la distribución por sexos era similar en ambos grupos. El tiempo de permanencia en diálisis era mayor para los PH con anti-HVC positivo (50,51 ñ 44,5 vs 37,3 ñ 38,6) pero la diferencia era no significativa. Sin embargo 49/91 pacientes negativos habia recibido hemodiálisis por menos de 24 meses vs. 12/58 del grupo positivo (p <.001). 23/91 anti-HCV negativo no habían recibido ninguna transfusión comparado con 5/53 del grulo anti-HCV positivo (p=.02). La transaminasas se encontraron elevadas en 36/91 PH en el grupo anti-HCV negativo y en 22/58 de los anti-HCV positivo (p = NS). Se encontraron 16/149 portadores de HBsAg (10,7%). Sólo dos de ellos eran anti-HCV positivos. 28 pacientes (19,5%) presentaron elevación de transaminasa con marcadores para hepatitis negativos. Concluimos que 1) La prevalencia de anti-HCV en PH en estas unidades es similar a la reportada por autores españoles y mayor que la referida por otros autores 2) Las transfusiones parecen ser el principal factor de riesgo asociado, 3)La prevalencia de anti-HCV en pacientes no tranfundidos plantea la posibilidad de su contagio intradiálisis o en la comunidad

Anticuerpos contra virus de hepatitis C en pacientes hemodializados / Antibodies against hepatitis C virus in patients hemodialyzated

Con el fin de determinar la prevalencia de anticuerpos antivirus C (anti-HCV) en pacientes hemodializados (PH) se estudiaron por el método de ELISA, 149 pacientes de dos centros urbanos de diálisis. Se encontró anti-HCV en 58 de ellos (38,9%). La edad y la distribución por sexos era similar en ambos grupos. El tiempo de permanencia en diálisis era mayor para los PH con anti-HVC positivo (50,51 ñ 44,5 vs 37,3 ñ 38,6) pero la diferencia era no significativa. Sin embargo 49/91 pacientes negativos habia recibido hemodiálisis por menos de 24 meses vs. 12/58 del grupo positivo (p <.001). 23/91 anti-HCV negativo no habían recibido ninguna transfusión comparado con 5/53 del grulo anti-HCV positivo (p=.02). La transaminasas se encontraron elevadas en 36/91 PH en el grupo anti-HCV negativo y en 22/58 de los anti-HCV positivo (p = NS). Se encontraron 16/149 portadores de HBsAg (10,7%). Sólo dos de ellos eran anti-HCV positivos. 28 pacientes (19,5%) presentaron elevación de transaminasa con marcadores para hepatitis negativos. Concluimos que 1) La prevalencia de anti-HCV en PH en estas unidades es similar a la reportada por autores españoles y mayor que la referida por otros autores 2) Las transfusiones parecen ser el principal factor de riesgo asociado, 3)La prevalencia de anti-HCV en pacientes no tranfundidos plantea la posibilidad de su contagio intradiálisis o en la comunidad

Anticuerpos contra virus de hepatitis C en pacientes hemodializados / Antibodies against hepatitis C virus in patients hemodialyzated

Con el fin de determinar la prevalencia de anticuerpos antivirus C (anti-HCV) en pacientes hemodializados (PH) se estudiaron por el método de ELISA, 149 pacientes de dos centros urbanos de diálisis. Se encontró anti-HCV en 58 de ellos (38,9%). La edad y la distribución por sexos era similar en ambos grupos. El tiempo de permanencia en diálisis era mayor para los PH con anti-HVC positivo (50,51 ñ 44,5 vs 37,3 ñ 38,6) pero la diferencia era no significativa. Sin embargo 49/91 pacientes negativos habia recibido hemodiálisis por menos de 24 meses vs. 12/58 del grupo positivo (p <.001). 23/91 anti-HCV negativo no habían recibido ninguna transfusión comparado con 5/53 del grulo anti-HCV positivo (p=.02). La transaminasas se encontraron elevadas en 36/91 PH en el grupo anti-HCV negativo y en 22/58 de los anti-HCV positivo (p = NS). Se encontraron 16/149 portadores de HBsAg (10,7%). Sólo dos de ellos eran anti-HCV positivos. 28 pacientes (19,5%) presentaron elevación de transaminasa con marcadores para hepatitis negativos. Concluimos que 1) La prevalencia de anti-HCV en PH en estas unidades es similar a la reportada por autores españoles y mayor que la referida por otros autores 2) Las transfusiones parecen ser el principal factor de riesgo asociado, 3)La prevalencia de anti-HCV en pacientes no tranfundidos plantea la posibilidad de su contagio intradiálisis o en la comunidad

[The correction of anemia with a high requirement for transfusion in patients on maintenance hemodialysis by conventional and reduced doses of recombinant human erythropoietin]. / Corrección de la anemia con alto requerimiento transfusional de pacientes en hemodiálisis de mantenimiento mediante dosis convencionales y reducidas de eritropoyetina recombinante humana.

The hematologic findings of chronic renal failure are consistent with hypoproliferative anemia; the pathogenesis of the anemia is primarily due to decreased erythropoietin production by the diseased kidneys. There are aggravating factors (AF) contributing to this primordial cause: inhibitors to erythroid marrow function, shortened red cell survival, nonevident chronic blood loss (owing to uremic platelet dysfunction), iron and/or folate deficiency, aluminium toxicity, hemolysis (acute or chronic), etc. Ten patients with end stage renal disease, treated with maintenance hemodialysis and high transfusional requirement (more than 300 ml/month) are presented; in five the AF were discarded by a previously presented protocol (Table 1) and they were treated with human recombinant erythropoietin (r-HuEPO) intravenously, in conventional schemes (three times a week) and doses (195 +/- 41 Units/Kg)-Group A-. The AF were not studied in the other five and the r-HuEPO treatment employed different doses (125 +/- 70 U/K/W) and protocols (1.7 +/- 0.5 times a week)-Group B-(Table 2). The transfusional requirement disappeared and the hematocrit and the hemoglobin rose significantly in both groups (more in group A) (Table 3). The significant drop in ferritin levels (147 +/- 30 ng/ml vs 27.5 +/- 11 ng/ml at the 12th week) and the stabilization in reticulocyte count (1.4% at start vs 2% at 12th week) indicate iron consumption; in the meantime, the persistent increment in reticulocyte production index (1 at start vs 3 at 12th week) revealed a continuous stimulation of the erythropoiesis (Fig. 1). No clinical and/or vascular complications were observed; arterial pressure and serum potassium levels did not rise significantly so that r-HuEPO treatment was not canceled in any case.(ABSTRACT TRUNCATED AT 250 WORDS)

Corrección de la anemia con alto requerimiento transfusional de pacientes en hemodiálisis de mantenimiento mediante dosis convencionales y reducidas de eritropoyetina recombinante humana. / [The correction of anemia with a high requirement for transfusion in patients on maintenance hemodialysis by conventional and reduced doses of recombinant human erythropoietin]

The hematologic findings of chronic renal failure are consistent with hypoproliferative anemia; the pathogenesis of the anemia is primarily due to decreased erythropoietin production by the diseased kidneys. There are aggravating factors (AF) contributing to this primordial cause: inhibitors to erythroid marrow function, shortened red cell survival, nonevident chronic blood loss (owing to uremic platelet dysfunction), iron and/or folate deficiency, aluminium toxicity, hemolysis (acute or chronic), etc. Ten patients with end stage renal disease, treated with maintenance hemodialysis and high transfusional requirement (more than 300 ml/month) are presented; in five the AF were discarded by a previously presented protocol (Table 1) and they were treated with human recombinant erythropoietin (r-HuEPO) intravenously, in conventional schemes (three times a week) and doses (195 +/- 41 Units/Kg)-Group A-. The AF were not studied in the other five and the r-HuEPO treatment employed different doses (125 +/- 70 U/K/W) and protocols (1.7 +/- 0.5 times a week)-Group B-(Table 2). The transfusional requirement disappeared and the hematocrit and the hemoglobin rose significantly in both groups (more in group A) (Table 3). The significant drop in ferritin levels (147 +/- 30 ng/ml vs 27.5 +/- 11 ng/ml at the 12th week) and the stabilization in reticulocyte count (1.4

at start vs 2

at 12th week) indicate iron consumption; in the meantime, the persistent increment in reticulocyte production index (1 at start vs 3 at 12th week) revealed a continuous stimulation of the erythropoiesis (Fig. 1). No clinical and/or vascular complications were observed; arterial pressure and serum potassium levels did not rise significantly so that r-HuEPO treatment was not canceled in any case.(ABSTRACT TRUNCATED AT 250 WORDS)

Corrección de la anemia con alto requerimiento transfusional de pacientes en hemodiálisis de mantenimiento mediante dosis convencionales y reducidas de eritropoyetina recombinante humana. / [The correction of anemia with a high requirement for transfusion in patients on maintenance hemodialysis by conventional and reduced doses of recombinant human erythropoietin]

The hematologic findings of chronic renal failure are consistent with hypoproliferative anemia; the pathogenesis of the anemia is primarily due to decreased erythropoietin production by the diseased kidneys. There are aggravating factors (AF) contributing to this primordial cause: inhibitors to erythroid marrow function, shortened red cell survival, nonevident chronic blood loss (owing to uremic platelet dysfunction), iron and/or folate deficiency, aluminium toxicity, hemolysis (acute or chronic), etc. Ten patients with end stage renal disease, treated with maintenance hemodialysis and high transfusional requirement (more than 300 ml/month) are presented; in five the AF were discarded by a previously presented protocol (Table 1) and they were treated with human recombinant erythropoietin (r-HuEPO) intravenously, in conventional schemes (three times a week) and doses (195 +/- 41 Units/Kg)-Group A-. The AF were not studied in the other five and the r-HuEPO treatment employed different doses (125 +/- 70 U/K/W) and protocols (1.7 +/- 0.5 times a week)-Group B-(Table 2). The transfusional requirement disappeared and the hematocrit and the hemoglobin rose significantly in both groups (more in group A) (Table 3). The significant drop in ferritin levels (147 +/- 30 ng/ml vs 27.5 +/- 11 ng/ml at the 12th week) and the stabilization in reticulocyte count (1.4

at start vs 2

at 12th week) indicate iron consumption; in the meantime, the persistent increment in reticulocyte production index (1 at start vs 3 at 12th week) revealed a continuous stimulation of the erythropoiesis (Fig. 1). No clinical and/or vascular complications were observed; arterial pressure and serum potassium levels did not rise significantly so that r-HuEPO treatment was not canceled in any case.(ABSTRACT TRUNCATED AT 250 WORDS)

Potenciales evocados somatosensitivos corticales y espinales de los nervios tibial y mediano en pacientes con insuficiencia renal cronica y transplante renal / Cortical and spinal somatosensory potentials of tibial and median nerves in patients with chronic renal insufficiency and renal transplantations

Se realizaron potenciales evocados somatosensitivos corticales y espinogramas de los nervios tibial y mediano en 14 pacientes con enfermedad renal: 3 en tratamiento médico, 9 en hemodiálisis y 2 con trasplante renal. La conducción nerviosa central (CC) del nervio mediano (N20-N14) no demostró alteraciones significativas. La CC del tibial (O-N22) estuvo prolongada en 8 casos, 7 en hemodiálisis y uno en tratamiento médico. Las CCs de los pacientes con trasplante renal fueron normales. La conmbinación CC mediano normal y CC tibial aumentada sugiere alteración de laq conducción medular. Postulamos que el mismo factor metabólico que produce la disminución de la conducción periférica por una alteración metabólica no-estructural rápidamente reversible tras el trasplante renal podría atravesar la barrera hematoencefálica y producir el mismo efecto a nivel medular (AU)

Potenciales evocados somatosensitivos corticales y espinales de los nervios tibial y mediano en pacientes con insuficiencia renal cronica y transplante renal / Cortical and spinal somatosensory potentials of tibial and median nerves in patients with chronic renal insufficiency and renal transplantations

Se realizaron potenciales evocados somatosensitivos corticales y espinogramas de los nervios tibial y mediano en 14 pacientes con enfermedad renal: 3 en tratamiento médico, 9 en hemodiálisis y 2 con trasplante renal. La conducción nerviosa central (CC) del nervio mediano (N20-N14) no demostró alteraciones significativas. La CC del tibial (O-N22) estuvo prolongada en 8 casos, 7 en hemodiálisis y uno en tratamiento médico. Las CCs de los pacientes con trasplante renal fueron normales. La conmbinación CC mediano normal y CC tibial aumentada sugiere alteración de laq conducción medular. Postulamos que el mismo factor metabólico que produce la disminución de la conducción periférica por una alteración metabólica no-estructural rápidamente reversible tras el trasplante renal podría atravesar la barrera hematoencefálica y producir el mismo efecto a nivel medular