[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.

[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

Valor clínico y pronóstico del ecocardiograma en pacientes hemodializados crónicos / Clinical and prognostic value of echocardiogram in hemodialysis chronic patients

Con el fin de determinar la incidencia, gravedad y evolución de las alteraciones cardíacas en la insuficiencia renal terminal se realizaron ecocardiogramas modo M y 2-D previos a una hemodiálisis en 20 pacientes. En sólo 1 de ellos el estudio resultó normal. Se dividieron a los pacientes en 2 grupos según que cumplieran (grupo A, 9 pacientes) o no (grupo B, 11 pacientes) con 2 de los siguientes ítems: a) espesor septal en diástole > = 1,4cm; b) velocidad de acortamiento circunferencial < = 1,1, y c) masa ventricular > = 350g. El grupo A mostró mayor diámetro diastólico ventricular izquierdo, mayor espesor septal, menor velocidad de acortamiento circunferencial, mayor masa ventricular, mayor incidencia de edemas, de disnea y de insuficiencia cardíaca, y mayor edad. Se realizaron ecocardiogramas periódicos durante un promedio de 18 meses. Al finalizar el estudio 6 de los 9 pacientes del grupo A habían fallecido súbitamente o por edema agudo de pulmón. De los 11 pacientes del grupo B fallecieron 2 por causas extracardíacas. Estos resultados sugieren que mediante el ecocardiograma es posible separar 2 subgrupos de pacientes con diferencias significativas en cuanto a la gravedad de los trastornos cardíacos y a la sobrevida (AU)

Valor clínico y pronóstico del ecocardiograma en pacientes hemodializados crónicos / Clinical and prognostic value of echocardiogram in hemodialysis chronic patients

Con el fin de determinar la incidencia, gravedad y evolución de las alteraciones cardíacas en la insuficiencia renal terminal se realizaron ecocardiogramas modo M y 2-D previos a una hemodiálisis en 20 pacientes. En sólo 1 de ellos el estudio resultó normal. Se dividieron a los pacientes en 2 grupos según que cumplieran (grupo A, 9 pacientes) o no (grupo B, 11 pacientes) con 2 de los siguientes ítems: a) espesor septal en diástole > = 1,4cm; b) velocidad de acortamiento circunferencial < = 1,1, y c) masa ventricular > = 350g. El grupo A mostró mayor diámetro diastólico ventricular izquierdo, mayor espesor septal, menor velocidad de acortamiento circunferencial, mayor masa ventricular, mayor incidencia de edemas, de disnea y de insuficiencia cardíaca, y mayor edad. Se realizaron ecocardiogramas periódicos durante un promedio de 18 meses. Al finalizar el estudio 6 de los 9 pacientes del grupo A habían fallecido súbitamente o por edema agudo de pulmón. De los 11 pacientes del grupo B fallecieron 2 por causas extracardíacas. Estos resultados sugieren que mediante el ecocardiograma es posible separar 2 subgrupos de pacientes con diferencias significativas en cuanto a la gravedad de los trastornos cardíacos y a la sobrevida