RESUMO
The economic environment has pushed our political leaders to severely limit the health care spending. Belgian nephrologists have signed an agreement to attain more than 40 % of " alternative " dialysis techniques such as peritoneal dialysis (PD) and home hemodialysis (HHD). They will become unavoidable and major future therapy modalities. This article summarizes PD and HDD techniques in order to help health professionals and to inform them about innovative research in home dialysis techniques. It is a non exhaustive list of the many advantages, if not superiority, of the treatment of end stage renal disease (ESRD) at home instead of in-center HD. These therapies, which can be used before kidney transplantation, complete the panel of possible treatments of ESRD for health care providers.
La conjoncture économique pousse nos instances dirigeantes à réaliser des coupes sombres dans le budget des soins de santé. Les néphrologues belges, par convention, se sont engagés à réaliser plus de 40 % de modalités d'épuration extra-rénales dites " alternatives " à l'hémodialyse en centre hospitalier. Techniques phares de la dialyse à domicile, la dialyse péritonéale (DP) d'une part et l'hémodialyse à domicile (HDD) d'autre part, deviennent donc incontournables et connaîtront un essor sans précédent. Cet article aborde de manière générale la DP et l'HDD afin d'informer les acteurs de terrain. Il est aussi l'occasion de faire le point sur les diverses nouveautés et avancées en la matière. Ceci constitue une revue non exhaustive des nombreux avantages, si pas de la supériorité d'un traitement de l'insuffisance rénale terminale (IRT) à la maison par rapport à l'hémodialyse en centre hospitalier. Ces thérapies, en préambule à une éventuelle transplantation rénale, complètent l'arsenal mis à la disposition du soignant.
RESUMO
The secretion of large volumes of fluid into cysts and changes in the structure and mobility of the cilia of the renal tubular epithelium can lead to nephromegaly. This in turn often causes a deterioration of kidney function and arterial hypertension. In recent clinical studies, somatostatin analogues have demonstrated efficacy in isolated polycystic liver disease and, to a lesser extent, in polycystic kidney disease. Since the publication of these clinical studies, several patients have been referred to us for somatostatin analogue treatment. Here, we report our experience with 6 patients who were treated with lanreotide autogel 120 mg every 4 weeks over 6, 12 or 18 months and were longitudinally followed using CT scans without contrast agents, to evaluate the total bilateral kidney volume. We observed a mean decrease in volume of 4%, with mild to moderate side effects.
RESUMO
Two different dialysis techniques have been developed and have considerably evolved in parallel to center hemodialysis (HD). These techniques, peritoneal dialysis (PD) and home hemodialysis (Home HD) show many advantages and present different indications to be distinguished from HD. This article summarizes PD and Home HD to help health professionals and to provide them emulation for giving the best choice to their patients. This bright choice gives the patient the access to an adapted home therapy. It's a non exhaustive list of the many advantages, if not superiority, of the treatment of end stage renal disease (ESRD) at home instead of center HD. These therapies, eventually before kidney transplantation, do complete the panel of treatments of ESRD for health providers.
Assuntos
Diálise Peritoneal Ambulatorial Contínua , Diálise Peritoneal , Contraindicações , Humanos , Falência Renal Crônica/terapiaAssuntos
Antibacterianos/efeitos adversos , Ciclosporina/efeitos adversos , Imunossupressores/efeitos adversos , Transplante de Rim/fisiologia , Miocamicina/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Adulto , Interações Medicamentosas , Feminino , Humanos , Transplante de Rim/imunologia , Faringite/tratamento farmacológico , Rinite/tratamento farmacológicoRESUMO
Recently, evidence has been presented for a possible association between hepatitis C virus (HCV) infection and essential mixed cryoglobulinemia (EMC). Eleven consecutive patients with EMC and two with cryoglobulinemia type I were examined for the presence of markers of HCV infection. Eleven of 13 patients (10 with EMC and 1 with type I cryoglobulinemia) had anti-HCV antibodies (as determined by a second generation anti-HCV assay) and HCV-RNA in plasma or serum. HCV-RNA was also detected in liver biopsies of five patients. Genotyping showed that HCV genotype 1 was found in 10 of 11 patients with HCV-RNA (9 genotype 1b and 1 genotype 1a) and only one patient had HCV genotype 2. However, a similar high prevalence of genotype 1b (100%) was found in a group of 14 consecutive patients with chronic hepatitis C, who had no clinical evidence of cryoglobulinemia. Concomitant infection was present in three patients with genotypes 2, 3 and 4, respectively. These findings stress the high prevalence of HCV infection in patients with EMC and further study shows that a difference in genotype prevalence was not found between HCV-related EMC and chronic hepatitis C without clinical manifestations of EMC.
