Subject(s)
Goiter, Nodular/complications , Hypothyroidism/physiopathology , Kidney Diseases/etiology , Kidney/pathology , Thyroiditis, Autoimmune/complications , Aged, 80 and over , Anemia/etiology , Atrophy , Cardiovascular Diseases/complications , Comorbidity , Female , Glomerular Filtration Rate , Humans , Hypothyroidism/drug therapy , Hypothyroidism/etiology , Ischemia/etiology , Kidney/blood supply , Kidney Diseases/physiopathology , Recovery of Function , Thyroxine/therapeutic use , VasoconstrictionABSTRACT
A retrospective study was performed in patients >60 years of age who had initiated hemodialysis (HD) at our hospital between 2000 and 2005 (n = 211). Of these, 47 were placed on the kidney transplantation waiting list and 164 were excluded and continued on HD. Cadaveric transplantation was performed in 31 patients using an expanded criteria donor organ (TR), while 16 remained on the waiting list (WL). We compared the 12-month survivals of patients in the 3 groups (TR/WL/HD), namely, 97%/78%/75% (P < .045). Survival at 24, 36, 48, and 60 months for TR/HD were 89%/57%; 86%/43%; 79%/32%; and 70%/16% (P < .001). HD patients showed greater comorbidity than TR patients: Charlson index >8 was 67.9% vs 19.4%. A total of 23.7% of patients were excluded solely due to advanced age. We compared survivals among the TR patients vs those excluded only because of age using paired comorbidity (Charlson index <8): 97%/95%, 89%/58%, and 86%/44% at 12, 24, and 36 months (P < .023). We concluded that kidney transplantation with an expanded criteria donor organ in elderly patients was a procedure that provided greater survival than HD for patients excluded from transplantation, for patients on the WL who did not receive a transplant, and for patients excluded solely due to advanced age who showed comorbidity comparable to the transplant recipients. According to our data, elderly patients with low comorbidity should be considered for inclusion on the WL for transplantation.
Subject(s)
Graft Survival/physiology , Kidney Failure, Chronic/surgery , Kidney Failure, Chronic/therapy , Kidney Transplantation/physiology , Patient Selection , Renal Dialysis , Actuarial Analysis , Aged , Cadaver , Comorbidity , Female , Humans , Kidney Failure, Chronic/mortality , Kidney Transplantation/mortality , Male , Middle Aged , Retrospective Studies , Spain , Survival Rate , Tissue Donors , Waiting ListsABSTRACT
We report the clinical case of a 55 year-old male patient, with a previous history of nephrectomy by hypernephroma sixteen years ago, first presenting hypercalcemia and rising of intact parathyroid hormone (iPTH) levels. A localization study revealed an intrathyroid nodule with cystic appearance. After undergoing a hemi-thyroidectomy, the patient is diagnosed with parathyroid carcinoma. This article analyzes previously published cases presenting parathyroidal pathologies associated with hypernephroma. A broader differential diagnosis--including the screening of parathyroidal pathologies should be considered in patients with hypercalcemia and hypernephroma.
Subject(s)
Carcinoma, Renal Cell/surgery , Carcinoma/diagnosis , Kidney Neoplasms/surgery , Neoplasms, Second Primary/diagnosis , Parathyroid Neoplasms/diagnosis , Aged , Humans , MaleABSTRACT
Presentamos el caso de un varón de 55 años con antecedentes de nefrectomía por hipernefroma dieciseis años antes que debuta con hipercalcemia y aumento de parathormona intacta (PTHi 1-84). En el estudio de localización se identifica un nódulo intratiroideo de apariencia quística. Tras hemitiroidectomía, se llega al diagnóstico anatomopatológico de carcinoma paratiroideo. En este artículo se analizan los casos publicados con anterioridad con asociación entre patología paratiroidea e hipernefroma. En pacientes con hipercalcemia e hipernefroma debe considerarse la realización de un diagnóstico diferencial más amplio que incluya el despistaje de patología paratiroidea
We report the clinical case of a 55 year-old male patient, with a previous history of nephrectomy by hypernephroma sixteen years ago, first presenting hypercalcemia and rising of intact parathyroid hormone (iPTH) levels. A localization study revealed an intrathyroid nodule with cystic appearance. After undergoing a hemi-thyroidectomy, the patient is diagnosed with parathyroid carcinoma.This article analyzes previously published cases presenting parathyroidal pathologies associated with hypernephroma. A broader differential diagnosis- including the screening of parathyroidal pathologies- should be considered in patients with hypercalcemia and hypernephroma
Subject(s)
Male , Middle Aged , Humans , Carcinoma, Renal Cell/complications , Parathyroid Neoplasms/complications , Parathyroid Hormone , Nephrectomy , Hypercalcemia/diagnosis , Diagnosis, Differential , Kidney Neoplasms/pathologyABSTRACT
En la literatura se encuentra ampliamente descrita la relación entre el desarrollo de una hiponatremia y el tratamiento con diuréticos tiazídicos y en asociación. Aportamos un caso llamativo por la intensidad de la hiponatremia (Na+p: 104 mEq/L), que respondió bien al tratamiento con suero salino hipertónico y cuyo diagnóstico de certeza se llevó a cabo mediante el estudio del aclaramiento de agua libre, aclaración de agua libre de electrolitos y del gradiente trastubular de potasio. Proponemos el abordaje diagnóstico de esta entidad mediante el uso de éstos conceptos y el control riguroso de factores de riesgo en pacientes susceptibles de desarrollar esta complicacion
In the literatura it is found widely described, the relationship between development o fan hyponatremia and the prescription of thiazidic and mixed diuretic. We contribute with a notorius case, by the intensity of the hyponatremia, that responded well to treatment with hypertonic saline serum and whose certainly diagnosis was carried out by the study of the free water clearance, free water electrolytes clearance and transtubular potassium gradient. We propose the diagnostic approach of this entity by the use of these concepts with the accuracy control of risk factors in susceptible patients to develop such complication
Subject(s)
Female , Aged , Humans , Hyponatremia/chemically induced , Amiloride/adverse effects , Hydrochlorothiazide/adverse effects , Risk Factors , Osmolar Concentration , Diagnosis, DifferentialSubject(s)
Colonic Pseudo-Obstruction/etiology , Deamino Arginine Vasopressin/adverse effects , Hyponatremia/chemically induced , Accidents , Aged , Chronic Disease , Consciousness Disorders/complications , Constipation/complications , Deamino Arginine Vasopressin/administration & dosage , Deamino Arginine Vasopressin/pharmacokinetics , Deamino Arginine Vasopressin/therapeutic use , Drinking , Drug Overdose , Enuresis/drug therapy , Humans , Hyponatremia/complications , MaleABSTRACT
La principal causa de hiperparatiroidismo (HPT) secundario es la insuficiencia renal terminal, que frecuentemente precisa de cirugía para suc orrección. Tras esta cirugía aparece el síndrome de hueso hambriento, por el que aumentan las necesidades de calcio (Ca) y fósforo (P) en el organismo. Estas necesidades pueden preverse según los niveles de fosfatasa alcalina (FA) previos a la cirugía. En determinadas circunstancias, las necesidades reales exceden a las teóricas. Planteamos considerar como una de las posibles causas de esta mayor necesidad la existencia de tumores pardos. Aportamos dos casos que justifican esta pretensión
The main cause of secondary hyperparathyriodismis end-stage renal disease, that requires surgical correction in many cases. Hungry Bone Syndrome following parathyroidectomy can be recognized by hypocalcemia, that requires (extra) calcium and phosphorus administration. Serum alkaline phosphatase level before surgery is a good predictor of right quantity of calcium and phosphorus nedeed. However, real needs somethimes exceed theoretical ones. We consider brown tumor as one of fue possible reasons for this gap. We report cases which support it
Subject(s)
Male , Adult , Aged , Humans , Parathyroidectomy , Hyperparathyroidism, Secondary/complications , Neoplasms, Adipose Tissue/pathology , Renal Insufficiency, Chronic/complications , Alkaline Phosphatase/analysis , Calcium/administration & dosage , Phosphorus/administration & dosage , Osteitis Fibrosa Cystica/drug therapy , Osteitis Fibrosa Cystica/diagnosis , Adipose Tissue, Brown/pathologyABSTRACT
No disponible
Subject(s)
Male , Aged , Humans , Colonic Pseudo-Obstruction/etiology , Hyponatremia/chemically induced , Deamino Arginine Vasopressin/adverse effects , Accidents , Chronic Disease , Consciousness Disorders/complications , Constipation/complications , Drinking , Enuresis/drug therapy , Hyponatremia/complications , Drug Overdose , Deamino Arginine Vasopressin/administration & dosage , Deamino Arginine Vasopressin/pharmacology , Deamino Arginine Vasopressin/therapeutic useABSTRACT
No disponible
Subject(s)
Male , Aged , Humans , Hypertension, Renovascular/complications , Kidney Tubules, Proximal , Nephrotic Syndrome/complications , Kidney Diseases/complicationsABSTRACT
El embolismo de colesterol es una entidad infradiagnosticada que cursa con Insuficiencia renal subaguda y eosinofilia. Su pronóstico vital y renal es malo a corto plazo. Históricamente no ha tenido un tratamiento específico. Últimamente, se incide en la necesidad de tratarlo de forma más agresiva para mejorar su pronóstico. Entre otras agentes se preconiza el uso de estatinas con este fin. Presentamos el caso de un varón de 79 años con embolismo de colesterol que mejoró su función renal con el uso de estatinas (AU)
Cholesterol embolism is a disease underdiagnosed that can be recognised by subacute renal insufficiency and eosinophilia. Its vital and renal prognosis is bad in a short-term. It has not had a specific treatment along the years. Nowadays, there is a tendency that insists on the need to treat this more aggressively in order to improve the prognosis. Among other agents, the use of statins is recommended. We present now the case of a 79-year-old man with cholesterol embolism and whose renal function improved after the use of statins (AU)
Subject(s)
Humans , Male , Aged , Embolism, Fat/complications , Renal Insufficiency/etiology , Eosinophilia/complications , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Anticholesteremic Agents/therapeutic use , Risk FactorsSubject(s)
Catheters, Indwelling/microbiology , Cross Infection/drug therapy , Drug Resistance, Multiple, Bacterial/drug effects , Granulocyte Colony-Stimulating Factor/therapeutic use , Renal Dialysis/adverse effects , Aged , Cross Infection/etiology , Female , Filgrastim , Humans , Male , Middle Aged , Recombinant Proteins , Treatment OutcomeABSTRACT
No disponible
