ABSTRACT
PURPOSE: To study the efficacy of tacrolimus in immune posterior uveitis. METHODS: Twenty-one eyes of 11 patients with immune posterior uveitis under tacrolimus treatment were prospectively followed for 1 to 5 years. Tacrolimus dosage was adjusted to maintain blood levels in the range of 7 to 10 ng/mL. Systemic and ophthalmic evaluations were performed at baseline and during follow-up. RESULTS: After a mean follow-up of 45 months, no treatment other than tacrolimus was necessary to control the inflammation in 6 cases (54.5%). The number of annual recurrences decreased from 3.2 to 1.29 during tacrolimus treatment (p=0.021). In four patients, tacrolimus was suspended after a treatment period of 27+/-3.5 months and a follow-up period of 12 months free of uveitis relapses. All four were free from relapses following tacrolimus withdrawal. Visual acuity remained unchanged in 16/21 (76%) eyes, deteriorated in 4/21 (19%), and improved in 1/21 (5%). Renal function transiently deteriorated in four patients from basal serum creatinine levels of 0.84, 1.1, 0.88, and 0.78 mg/dL to maximum levels of 1.33, 2.48, 1.38, and 1.39 mg/dL, respectively. This deterioration was directly related with elevated tacrolimus serum levels, returning to normal when doses were reduced. During the overall controlled evolution period, a slight increase of serum creatinine from a basal value of 0.89+/-0.2 mg/dL to a final of 1+/-0.19 mg/dL was detected, which was not statistically significant. All secondary effects were mild, transient, and did not require interruption of long-term treatment to be controlled. CONCLUSIONS: Tacrolimus was well tolerated and useful in controlling posterior immune uveitis. Tacrolimus could be considered a real alternative to cyclosporine, and not only in cases of cyclosporine resistance or toxicity.
Subject(s)
Immunosuppressive Agents/therapeutic use , Tacrolimus/therapeutic use , Uveitis, Posterior/drug therapy , Adult , Biological Availability , Creatinine/blood , Female , Follow-Up Studies , Humans , Immunosuppressive Agents/pharmacokinetics , Male , Middle Aged , Prospective Studies , Recurrence , Tacrolimus/pharmacokinetics , Treatment Outcome , Uveitis, Posterior/immunology , Uveitis, Posterior/metabolism , Visual AcuitySubject(s)
Algorithms , Glomerular Filtration Rate , Kidney Diseases/diagnosis , Adult , Aged , Creatinine/blood , Early Diagnosis , Evidence-Based Medicine , Forecasting , Humans , Kidney Diseases/blood , Kidney Diseases/therapy , Kidney Function Tests/standards , Metabolic Clearance Rate , Middle AgedSubject(s)
Kidney Failure, Chronic/epidemiology , Renal Dialysis , Adult , Aged , Comorbidity , Cross-Sectional Studies , Diabetic Nephropathies/complications , Diabetic Nephropathies/epidemiology , Disease Management , Female , Health Resources/statistics & numerical data , Humans , Hypertension/epidemiology , Kidney Diseases/blood , Kidney Diseases/complications , Kidney Diseases/economics , Kidney Diseases/epidemiology , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/economics , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/therapy , Male , Middle Aged , Nephrology , Prospective Studies , Referral and Consultation/statistics & numerical data , Renal Dialysis/economics , Renal Dialysis/statistics & numerical data , Retrospective Studies , Spain/epidemiologySubject(s)
Kidney Failure, Chronic/psychology , Nephrology , Quality of Life , Referral and Consultation , Renal Dialysis , Severity of Illness Index , Adult , Aged , Aged, 80 and over , Emotions , Female , Humans , Interpersonal Relations , Kidney Failure, Chronic/therapy , Male , Mental Health , Middle Aged , Pain , Physical Examination , Renal Dialysis/psychology , Surveys and Questionnaires , Time FactorsSubject(s)
Nephrology , Outpatient Clinics, Hospital , Ambulatory Care/methods , Ambulatory Care/statistics & numerical data , Forecasting , Goals , Hospitals, Urban/organization & administration , Humans , Interdisciplinary Communication , Kidney Diseases/epidemiology , Kidney Diseases/therapy , Outpatient Clinics, Hospital/organization & administration , Outpatient Clinics, Hospital/statistics & numerical data , Primary Health Care , SpainSubject(s)
Kidney Failure, Chronic/therapy , Nephrology , Referral and Consultation/statistics & numerical data , Renal Dialysis , Adult , Aged , Aged, 80 and over , Anemia/economics , Anemia/etiology , Anemia/prevention & control , Anemia/therapy , Cost-Benefit Analysis , Cross-Sectional Studies , Drug Costs/statistics & numerical data , Female , Follow-Up Studies , Health Care Costs/statistics & numerical data , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/economics , Male , Middle Aged , Program Evaluation , Referral and Consultation/economics , Renal Dialysis/economics , Sampling Studies , Spain , Surveys and Questionnaires , Terminal Care/economics , Time FactorsABSTRACT
No disponible
Subject(s)
Humans , Nephrology/trends , Evidence-Based Medicine/trends , Biomedical Research/trends , Biomedical Research/methods , Diffusion of Innovation , Publication Bias/trends , Publications/trends , Education, Medical, Continuing/trends , Information DisseminationABSTRACT
No disponible
No disponible
Subject(s)
Humans , Renal Insufficiency, Chronic/therapy , Hemodialysis, Home/methods , Renal Insufficiency, Chronic/diagnosis , Quality of Health Care , Renal Dialysis/trends , Catheters, IndwellingABSTRACT
No disponible
No disponible
Subject(s)
Male , Female , Adult , Middle Aged , Aged , Humans , Renal Dialysis/methods , Renal Insufficiency, Chronic/therapy , Hemodialysis Units, Hospital , Renal Insufficiency, Chronic/etiology , Multicenter Studies as Topic , Cross-Sectional Studies , Retrospective Studies , Clinical Evolution , Quality of Life , Diabetic Nephropathies/complications , Vascular Diseases/complications , Glomerulonephritis/complicationsABSTRACT
No disponible
No disponible
Subject(s)
Male , Female , Adult , Middle Aged , Aged , Humans , Quality of Life , Renal Insufficiency, Chronic/epidemiology , Referral and Consultation/statistics & numerical data , Renal Insufficiency, Chronic/physiopathology , Mental Health/statistics & numerical data , Psychomotor Performance , Sex Distribution , PainABSTRACT
No disponible
No disponible
Subject(s)
Humans , Hemodialysis, Home/statistics & numerical data , Renal Insufficiency, Chronic/epidemiology , Physician's Role , Hemodialysis, Home/methods , Spain/epidemiology , Hemodialysis, Home/trends , Nephrology/trends , Renal Insufficiency, Chronic/therapyABSTRACT
No disponible
No disponible
Subject(s)
Humans , Referral and Consultation/statistics & numerical data , Renal Insufficiency, Chronic/epidemiology , Primary Health Care/statistics & numerical data , Referral and Consultation/trends , Treatment Outcome , Renal Insufficiency, Chronic/therapy , Health Care Costs/statistics & numerical data , Spain/epidemiologyABSTRACT
The Spanish nephrology is one of the medical specialties that have experienced a greater development in the last years. Defined initially as an activity in the hospital and consolidated in this sense, at the present time the "Libro Blanco of the Spanish Nephrology" makes a call of attention on the necessity of a change of welfare direction. The attention was called on the little development of the prevention activities and the delay in the arrival of the patient to the Service of Nephrology, which causes a worsening of his pathology. In order to approach us this reality it is necessary to give priority to the attendance of the patient out of the hospital and to guarantee a logical continuity between welfare levels. The welfare initiatives that have been carried out in the Spanish territory are scarce and still insufficient. The progressive increase in the incidence and prevalence of the ERD associated with a bad evolution and elevated costs is converting ERD in an important problem of public health, that requires specific plans of detection and prevention. The improvement of the coordination between general practioners and nephrologists is necessary. Multiple papers show a delayed reference of the patients with renal disease to the nephrologists. The initiatives of coordination between both levels should be centered in studies epidemiologists that clarify the real meaning of the renal pathology and in educating the GP on the early reference to the nephrologist of the patients with renal failure.
