Infarto renal agudo: complicación de displasia fibromuscular / Acute renal infarction: complication of fibromuscular dysplasia

La hipertensión renovascular (HTRV) es una de las formas identificables de hipertensión arterial (HTA). A pesar de que la mayoría de las lesiones renovasculares corresponden a aterosclerosis, la displasia fibromuscular (DFM) es la principal causa en el resto de los casos. La fibrodisplasia de la capa media suele ser la lesión más común y presenta un curso menos progresivo. La afectación intimal y periarterial es menos frecuente pero presenta una evolución más rápida hacia la oclusión arterial, pudiendo ocasionar infarto en diferentes localizaciones. Presentamos el caso de una mujer diagnosticada de HTRV en relación con DFM complicada con infarto renal derecho por oclusión de arteria renal

Renovascular hypertension (RVHT) is one of the forms of identifiable hypertension. Whereas most renovascular lesions are caused by atherosclerosis, in the remaining cases fibromuscular dysplasia is the causative factor. Fibrous dysplasia of the tunica media is generally the most common lesion and a progressive course may be less frequently seen. Intimal and periarterial lesions are less common but usually show rapid progression to arterial occlusion, and can cause infarction of several systems. We report the case of a woman with RVHT secondary to fibromuscular dysplasia complicated with renal infarction

Peritoneal dialysis is not a risk factor for primary vascular graft thrombosis after renal transplantation.

OBJECTIVE: To find out if patients undergoing peritoneal dialysis (PD) have an increased risk of primary vascular thrombosis of the renal allograft, compared with patients on hemodialysis (HD). DESIGN: Observational, retrospective cohort study. SETTING: Tertiary care hospital, covering an approximate population of 2,000,000. Extensive use of suboptimal donors for renal transplantation. PATIENTS AND METHODS: The study included 827 patients receiving a cadaveric renal transplantation (RTx) in our center between 1988 and 1997 (700 on HD and 127 on PD). We searched for a potential difference in the incidence of graft thrombosis, according to the pretransplant dialysis modality and taking into consideration the main reported risk factors for this complication of RTx. RESULTS: The accumulated incidence of primary graft thrombosis was 4.7% in PD patients, and 6.1% in HD patients (NS). Arterial and venous thrombosis were also similar in both groups. Logistic regression analysis demonstrated that extremes of age of the donor, use of the right kidney, protracted cold ischemia, delayed graft function, and transplantation to a hypersensitized recipient independently predicted graft thrombosis. Peritoneal dialysis was not independently associated with the complication under study (adjusted odds ratio HD/PD = 2.5, 95% CI = 0.8-7.7). CONCLUSIONS: Peritoneal dialysis is not associated with an increased risk of primary vascular thrombosis of the renal allograft.

Treatment of CAPD-related peritonitis with ciprofloxacin: results after seven years.

We present the results of a protocol of empiric monotherapy of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis with ciprofloxacin (CPX), with a special emphasis on the evolution of our results after seven years of continued use of this drug. One hundred and fifteen episodes of bacterial peritonitis were treated with CPX between 1988 and 1992 (group A), and 115 episodes were treated between 1993 and 1995 (group B). The etiologic spectrum of peritonitis was similar in both groups, except for a higher incidence of polymicrobial infections in group B. The clinical success rate decreased from 86.5% in group A to 75% in group B (p < 0.05). This was partly due to the high failure rate of CPX against polymicrobial peritonitis, but the success rate also tended to decrease for gram-positive and, especially, gram-negative bacteria. However, in vitro sensitivity to CPX decreased only for coagulase-negative staphylococci, remaining stable for Staphylococcus aureus and gram-negative bacteria. CPX is still a valid alternative for the treatment of CAPD-related peritonitis in our unit. However, bacterial sensitivity must be closely monitored, especially in the case of coagulase-negative staphylococci. A different therapeutic approach may be indicated if polymicrobial peritonitis is suspected.