RESUMEN
BACKGROUND: Over-hydration (OH) and malnutrition are prevalent among patients on dialysis therapy. The prevalence of OH and malnutrition as well as the risk factors associated with OH and malnutrition in our patients on home peritoneal dialysis (PD) and home haemodialysis (HD) are examined. DESIGN AND METHODS: This was a cross-sectional study. The hydration and nutritional status of the study groups were assessed by a Body Composition Monitor. Patients who were stable on home dialysis therapy for over one year were invited to participate. Univariate and multivariate analyses were performed to identify associated factors and determine the predictors of OH and malnutrition, respectively. RESULTS: Eighty-eight patients (41 PD and 47 home HD) were recruited. A 32.95% of our patients on home dialysis therapy were in OH status. There was a significance difference in the prevalence of hydration status between patients on PD and home HD (p = 0.014), as overhydration was more common in patients on PD than home HD (46.34 vs. 21.28%). Dehydration was more common in patients on home HD than PD (29.79 vs. 9.76%). Male gender, decreasing haemoglobin level and presence of diabetes mellitus (DM) were risk factors of OH on multivariable analysis. There was no significance difference in the prevalence of malnutrition between patients on PD and home HD (p = 0.27). Increasing Fat Tissue Index (FTI), height and patients on PD therapy were at higher risk of malnutrition. CONCLUSION: OH and malnutrition were prevalent patients on home dialysis therapy.
Asunto(s)
Anticuerpos Anticitoplasma de Neutrófilos/inmunología , Glomerulonefritis/patología , Leucemia Linfocítica Crónica de Células B/patología , Anciano , Linfocitos B/inmunología , Femenino , Glomerulonefritis/complicaciones , Glomerulonefritis/inmunología , Humanos , Leucemia Linfocítica Crónica de Células B/complicacionesRESUMEN
Emergence of multidrug-resistant bacteria is important in solid organ transplant recipients, because it can jeopardize patient and graft survival. Methicillin-resistant Staphylococcus aureus (MRSA) infections are not rare in kidney transplant recipients. On the other hand, infections related to community-associated MRSA (CA-MRSA) strains are seldom reported in the literature. Herein, we report the first patient, to our knowledge, with CA-MRSA renal graft abscess who was successfully treated with drainage and parenteral antibiotics.
Asunto(s)
Absceso/microbiología , Infecciones Comunitarias Adquiridas/microbiología , Trasplante de Riñón/efectos adversos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/microbiología , Antibacterianos/uso terapéutico , Femenino , Humanos , Huésped Inmunocomprometido , Resistencia a la Meticilina , Persona de Mediana EdadRESUMEN
OBJECTIVE: To investigate the prevalence of metabolic syndrome in Chinese renal transplant recipients, using two different sets of diagnostic criteria. DESIGN: Cross-sectional study. SETTING: Regional hospital, Hong Kong. PATIENTS: All Chinese patients who received solitary living-related or cadaveric kidney transplantation from 1 July 1997 to 31 December 2005 in our hospital with follow-up of more than 6 months were recruited. The diagnosis of metabolic syndrome was made according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) criteria and the International Diabetes Federation criteria. RESULTS: Using the modified (Asian) NCEP-ATPIII criteria, a total of 39 (32%) of 121 patients had metabolic syndrome, which included 20/69 (29%) of the males and 19/52 (37%) of the females. Using the International Diabetes Federation criteria, metabolic syndrome was diagnosed in 26% of the patients, 22% in males and 31% in females. In our patients, the most common component of metabolic syndrome was hypertension and the least common was low high-density-lipoprotein-cholesterol level. Low high-density-lipoprotein-cholesterol levels were significantly more common in female patients. CONCLUSION: This study shows that there is a high prevalence of metabolic syndrome in our Chinese renal transplant recipients.
Asunto(s)
Trasplante de Riñón , Síndrome Metabólico/epidemiología , Adulto , Índice de Masa Corporal , Estudios Transversales , Femenino , Hong Kong/epidemiología , Humanos , Lipoproteínas HDL/sangre , Masculino , Síndrome Metabólico/diagnóstico , Prevalencia , Factores Sexuales , Triglicéridos/sangre , Circunferencia de la CinturaRESUMEN
A38-year-old cadaveric kidney transplant recipient presented with fever, pneumonia, and mesenteric lymphadenopathy 9 months after transplant. Blood culture, bone marrow culture, and fine-needle aspiration cytology of mesenteric lymph nodes confirmed the diagnosis of disseminated Penicillium marneffei infection. He recovered after receiving parenteral amphotericin B followed by oral itraconazole therapy. P. marneffei infection is a dimorphic fungal opportunistic infection endemic in Southeast Asia, southern China, Taiwan, and Hong Kong. It has been well reported in human immunodeficiency virus (HIV)-positive patients in the endemic areas, and also in other immunocompromised patients. This diagnosis must be considered for all febrile transplant recipients who have the relevant clinical features and travel history to Southeast Asia. Prompt treatment with anti-fungal therapy improves the survival and outcome of these patients.
Asunto(s)
Trasplante de Riñón/efectos adversos , Linfadenitis Mesentérica/microbiología , Penicillium/aislamiento & purificación , Neumonía/microbiología , Adulto , Cadáver , Humanos , Enfermedades Pulmonares Fúngicas/microbiología , Masculino , Micosis/microbiologíaAsunto(s)
Infecciones por Citomegalovirus/prevención & control , Ganciclovir/economía , Ganciclovir/uso terapéutico , Trasplante de Riñón/fisiología , Adulto , Antivirales/administración & dosificación , Antivirales/economía , Antivirales/uso terapéutico , China , Costos y Análisis de Costo , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/epidemiología , Femenino , Ganciclovir/administración & dosificación , Humanos , Infusiones Intravenosas , Masculino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/virología , Recurrencia , Estudios Retrospectivos , Factores de TiempoRESUMEN
This report describes a patient with mixed normal anion gap hyperchloremic metabolic and respiratory acidosis associated with hypokalemia attributed to cough mixture abuse. Metabolic acidosis was likely related to an overdose of ammonium chloride, whereas respiratory acidosis was probably related to the effect of hypokalemia on respiratory muscles, causing hypoventilation. Hypokalemia was caused by a transcellular shift of potassium induced by ephedrine and pseudoephedrine. Both ammonium chloride and ephedrine were probably present in the cough mixture obtained by our patient as an over-the-counter medication. Physicians should be aware of the potential for cough mixture abuse to cause major electrolyte disturbances that may carry the risk for major cardiac arrhythmias, particularly in youth.
Asunto(s)
Acidosis/inducido químicamente , Cloruro de Amonio/envenenamiento , Antitusígenos/envenenamiento , Hipopotasemia/inducido químicamente , Medicamentos sin Prescripción/envenenamiento , Trastornos Relacionados con Sustancias/complicaciones , Acidosis Respiratoria/inducido químicamente , Adulto , Sobredosis de Droga , Humanos , Masculino , Debilidad Muscular/inducido químicamente , Músculos Respiratorios/efectos de los fármacosRESUMEN
Cefepime is a cephalosporin with a broad spectrum of activity against most gram-positive and gram-negative pathogens. In this study, we attempted to compare the safety and efficacy of cefepime monotherapy against the potentially more toxic combination of vancomycin and netilmicin in the treatment of continuous ambulatory peritoneal dialysis (CAPD)-associated bacterial peritonitis. Eighty-one consecutive CAPD patients who presented with peritonitis from January 1, 1998, to June 30, 2000, were recruited for study. Patients were randomized to be administered either intraperitoneal (IP) cefepime, 1 g once daily (group A), or intravenous vancomycin and netilmicin at conventional doses (group B) for 10 days. Bacterial growth was obtained in 52 episodes (66%), and pathogens identified included gram-positive organisms (30 episodes; 38%), gram-negative organisms (14 episodes; 18%), mixed organisms (2 episodes; 2.5%), and fungus (6 episodes; 8%). Eight patients were excluded after randomization for various reasons (6 patients, fungal peritonitis; 2 patients, wrong diagnoses). Because of the relatively low peritonitis rate after the use of a disconnect system, the sample size of this study was relatively small, giving a power of 0.45. There were no significant differences in primary response rates and cure rates (no relapse >28 days after completion of antibiotic therapy) between both groups of patients (group A versus group B, 82% [32 of 39 patients] versus 85% [29 of 34 patients] and 72% [28 of 39 patients] versus 76% [26 of 34 patients], respectively; P = not significant). No significant side effect was encountered in either group. Total peritonitis-related hospitalizations were 84 patient-days (1, 7, 8, 11, 20, and 37 patient-days) and 115 patient-days (3, 6, 9, 14, 21, 21, and 41 patient-days), whereas total costs per patient cure were estimated to be US $1,039 and US $1,371 in groups A and B, respectively. We conclude that once-daily 1-g IP cefepime monotherapy is a simple, safe, and cost-effective alternative to vancomycin and netilmicin therapy in the treatment of CAPD-associated bacterial peritonitis.
Asunto(s)
Antibacterianos/uso terapéutico , Cefalosporinas/uso terapéutico , Netilmicina/uso terapéutico , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/tratamiento farmacológico , Vancomicina/uso terapéutico , Adulto , Anciano , Cefepima , Femenino , Gentamicinas/uso terapéutico , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Grampositivas/efectos de los fármacos , Bacterias Grampositivas/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Peritonitis/etiología , Peritonitis/microbiología , Estudios Prospectivos , Resultado del TratamientoAsunto(s)
Supervivencia de Injerto , Hepatitis B/mortalidad , Trasplante de Riñón/mortalidad , Causas de Muerte , Femenino , Estudios de Seguimiento , Supervivencia de Injerto/inmunología , Hepatitis B/epidemiología , Hepatitis B/etnología , Hong Kong/epidemiología , Humanos , Trasplante de Riñón/inmunología , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Distribución por Sexo , Sobrevivientes , Resultado del TratamientoAsunto(s)
Ciclosporina/uso terapéutico , Supervivencia de Injerto/fisiología , Inmunosupresores/uso terapéutico , Trasplante de Riñón/inmunología , Tacrolimus/uso terapéutico , Adulto , Azatioprina/uso terapéutico , Cadáver , Causas de Muerte , Ciclosporina/efectos adversos , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Rechazo de Injerto/epidemiología , Rechazo de Injerto/patología , Supervivencia de Injerto/efectos de los fármacos , Humanos , Inmunosupresores/efectos adversos , Trasplante de Riñón/mortalidad , Trasplante de Riñón/fisiología , Masculino , Prednisolona/uso terapéutico , Tasa de Supervivencia , Tacrolimus/efectos adversos , Factores de Tiempo , Donantes de TejidosRESUMEN
We report a renal transplant patient who suffered from disseminated nocardiosis after empirical tacrolimus rescue therapy for chronic allograft rejection. The nocardiosis presented initially as only mildly tender subcutaneous calf nodules without any other signs of inflammation nor constitutional upset, which later spread to the lung and brain causing bronchopneumonia and brain abscesses. The risk factors for nocardial infection in our patient include the use of potent immunosuppressive agents such as tacrolimus, poorly controlled diabetes mellitus and kidney dysfunction. She responded well to combination antibiotic therapy comprising parenteral meropenem, cefotaxime and oral minocycline. We conclude that in transplant recipients, especially those receiving newer and more potent immunosuppressive agents like tacrolimus, nocardial infection can present as apparently 'cold' subcutaneous nodules without any systemic upset. An associated brain lesion should be excluded even in patients without neurological symptoms.