Anemia in kidney transplants without erythropoietic agents: levels of erythropoietin and iron parameters.

AIM: To study the association between hemoglobin, endogenous erythropoietin (EPO) levels and ferric parameters in kidney recipients not treated with EPO-stimulating agents. MATERIALS AND METHODS: Transverse study of 219 kidney transplant outpatients. The median time after transplantation was 54 months (P(25-75), 23-107). We assessed blood counts, ferric parameters, EPO levels, renal function (MDRD-4), and adjuvant treatment. We performed a linear regression analysis to predict hemoglobin. RESULTS: Median EPO values were 14.05 mUI/mL (P(25-75) = 10.2-19.7). Applying the formulas described by Beguin, kidney transplant recipients showed a low observed/expected ratio of erythropoietin and of transferrin. Considering anemia to be an hemoglobin of < 12 g/dL in women and < 13 g/dL in men, 24.2% of subjects were anemic (n = 53), including 2.3% with hemoglobin < 11 g/dL. Anemic patients displayed worse renal function (49.2 ± 18.5 versus 55.46 ± 16.58 mL/min/1.73 m(2) in nonanemic; P = .021). There were no differences in C-reactive protein. The patients receiving a combination of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) showed the highest prevalence of anemia compared with other groups (42.9%, P = .027). EPO levels were significantly lower among patients treated with these drugs (P = .041), without differences in transferrin and ferritin. The percentage of anemic patients treated with mammalian target of rapamycin inhibitors (mTORi) was 31% versus 22.2% among those not receiving these immunosuppressants (P = .23). Although there were no differences in hemoglobin levels, patients treated with mTORi, showed higher EPO levels (P = .005) and lower mean corpuscular volume (P < .001). Regarding the etiology of chronic kidney disease, less frequently anemic patients were those with polycystic kidney disease (8.6% versus 26.7% in the rest, P = .021). The formula obtained by multiple linear regression to calculate hemoglobin was: hemoglobin = 11829-0909 log (EPG level) - 0455 (if female) + 0.010 0.013 transferrin + 0.013 creatinine clearance (r = .424, P < .001). CONCLUSIONS: Treatment with ACEI and/or ARBs seemed to produce a defect in the synthesis of EPO, while those treated with mTORi, a hyporesponsive state.

Síndrome de secreción inadecuada de hormona antidiurética asociado con síndrome de Guillain-Barré / Syndrome of inappropriate antidiuretic hormone hypersecretion associated with Guillain-Barré syndrome

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Mieloma múltiple IgDlambda con fracaso renal agudo. A propósito de un caso / No disponible

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La importancia de un diagnóstico precoz en el pronóstico de la nefritis tubulointersticial inmunoalérgica / No disponible

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Cytomegalovirus infection in seronegative patients treated with prophylaxis: case-controlled study.

Primary cytomegalovirus (CMV) infection is common in infancy with approximately 90% to 95% of subjects developing antibodies against this virus. CMV seronegative renal allograft recipients generally receive this infection with a graft or with blood transfusions, showing a high morbidity and mortality. Prophylaxis in these patients has shown good results; however, the published studies have included a small number of patients. Our case-controlled study evaluated 163 kidney transplant recipients: 76 seronegatives for CMV and 87 seropositive for CMV as controls. The evaluated parameters were: CMV infection, CMV disease, renal function, and survival of the patient and graft. We studied our experience among CMV seronegative patients treated with various prophylaxis guidelines. Our conclusions were that CMV prophylaxis in seronegative patients was effective because it showed a risk of infection that was equal (or even less) than that in seropositive patients and revealed a delay in the onset of the disease. CMV seronegativity may be a positive prognostic factor for graft survival.

Hipertensión y plomo

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[Familial and hereditary mesangial glomerulonephritis with IgA deposits (author's transl)]. / Glomerulonefritis mesangial con depósitos de IgA, familiar y hereditaria.

Idiopathic mesangial glomerulonephritis with IgA deposits was observed in two relatives, father and son, in a family of 5 members. In the father the disease started at age 43 with relapsing macroscopic hematuria, proteinuria, renal failure and hypertension, with a progressive course in the ensuing four years. The affected son, the oldest of three brothers, developed relapsing macroscopic hematuria at age 16; two years later renal function was normal and there was no hypertension, but microhematuria persisted without proteinuria. The mother and the other two brothers had no clinical or biological signs of renal disease. Serum immunoglobulins (IgG, IgA, and IgM) and complement (C3, C4, C3 proactivator) were normal in the patients and their relatives. Histocompatibility typing demonstrated the presence of HLA-Bw35 in the father and the two unaffected sons, being negative in the mother and the affected son. The analysis of HLA-Bw35 in 23 patients with IgA mesangial glomerulonephritis gave positive results in 30% of them, while the control group had a positivity of 15% (p non significant with the X2 test). The present observations suggest that IgA mesangial glomerulonephritis is a potentially familial and hereditary renal disease. HLA-Bw35 antigen appears not to be a genetic marker of the disease in our geographical area.

[Diuretic evaluation of bumetanide (author's transl)]. / Evaluación diurética de la bumetanida.

The intravenous administration of 2 mg bumetanide produces a sudden rise in diuresis in a state of hydropenia as well as in a state of previous aqueous diuresis. This rise, which is not accompanied by changes in the glomerular filtrate and renal plasma flow, seems to be due to a decrease in the reabsorption of chloride and sodium in the Henle's loop and probably to a decrease in the absorption of fluid in the proximal tubule, as is apparently indicated by the fractional excretion of water and sodium and the clearance of phosphorus and uric acid.