Síndrome de nefritis tubulointersticial y uveítis / Interstitial Tubule Nephritis Syndrome and Uveitis

El síndrome de nefritis tubulointersticial y uveítis es una causa infrecuente de disfunción renal aguda en los adultos. El diagnóstico puede hacerse difícil, pues con frecuencia no coinciden temporalmente los síntomas oculares y renales. Se presentaron dos casos de síndrome de nefritis tubulointersticial y uveítis en adultos, con evolución favorable con tratamiento esteroideo sistémico(AU)

Tubulointerstitial nephritis syndrome and uveitis is an uncommon cause of acute renal dysfunction in adults. The diagnosis can be difficult, as ocular and renal symptoms often do not coincide temporarily. Two cases of tubulointerstitial nephritis syndrome and uveitis in adults, with favorable evolution with systemic steroid treatment are presented in this paper(AU)

Síndrome de nefritis tubulointersticial y uveítis / Interstitial Tubule Nephritis Syndrome and Uveitis

El síndrome de nefritis tubulointersticial y uveítis es una causa infrecuente de disfunción renal aguda en los adultos. El diagnóstico puede hacerse difícil, pues con frecuencia no coinciden temporalmente los síntomas oculares y renales. Se presentaron dos casos de síndrome de nefritis tubulointersticial y uveítis en adultos, con evolución favorable con tratamiento esteroideo sistémico(AU)

Tubulointerstitial nephritis syndrome and uveitis is an uncommon cause of acute renal dysfunction in adults. The diagnosis can be difficult, as ocular and renal symptoms often do not coincide temporarily. Two cases of tubulointerstitial nephritis syndrome and uveitis in adults, with favorable evolution with systemic steroid treatment are presented in this paper(AU)

Acute kidney injury: Renal disease in the ICU.

Acute kidney injury (AKI) in the ICU frequently requires costly supportive therapies, has high morbidity, and its long-term prognosis is not as good as it has been presumed so far. Consequently, AKI generates a significant burden for the healthcare system. The problem is that AKI lacks an effective treatment and the best approach relies on early secondary prevention. Therefore, to facilitate early diagnosis, a broader definition of AKI should be established, and a marker with more sensitivity and early-detection capacity than serum creatinine - the most common marker of AKI - should be identified. Fortunately, new classification systems (RIFLE, AKIN or KDIGO) have been developed to solve these problems, and the discovery of new biomarkers for kidney injury will hopefully change the way we approach renal patients. As a first step, the concept of renal failure has changed from being a "static" disease to being a "dynamic process" that requires continuous evaluation of kidney function adapted to the reality of the ICU patient.

[Renal replacement therapy in Intensive Care Units in Catalonia (Spain)]. / Utilización de las terapias de depuración extracorpórea en los Servicios de Medicina Intensiva de Cataluña (España).

OBJECTIVE: To assess the indications, settings and techniques used in renal replacement therapy (RRT) in Intensive Care Units (ICUs). STUDY DESIGN: A prospective, multicenter observational study was carried out. SETTING: Intensive Care Units. PATIENTS: All patients admitted to ICUs during the two-month study period in 2011 who required RRT. INTERVENTIONS: None. VARIABLES OF INTEREST: Patient demographic characteristics, baseline clinical data, RRT technique and materials used. RESULTS: Thirty-three patients were analyzed. RRT was started within the first 24hours after ICU admission in 17 of the 33 patients (52%). At the start of RRT, 18% of the patients (n=6) presented grade R on the RIFLE acute kidney injury (AKI) scale. The most common disorder associated with AKI was multiple organ dysfunction syndrome (64%; n=21). At the start of RRT, most patients (76%; n=25) presented hemodynamic instability, while the remaining 24% (n=8) were considered hemodynamically stable. The most common RRT technique in hemodynamically stable patients was continuous renal replacement therapy (CRRT) (63%; n=5). CRRT was the technique of choice in all 25 of the hemodynamically unstable patients (100%). Anticoagulation was used in 55% (n=18) of the patients. In most cases (61%, n=20), RRT was administered through the right femoral vein. In 84% (n=28) of the patients, the ultrafiltration effluent flow rate was ≤ 35ml/kg/h. CONCLUSIONS: The ICU physicians in this study followed current RRT guidelines. CRRT was preferred over intermittent renal replacement therapy, regardless of patient hemodynamic status.

Disfunción Renal Aguda: comportamiento en la Unidad de Cuidados Intensivos. Hospital Universitario “General Calixto García”. 2009-2010 / Acute kidney dysfunction; comportment in the Intensive Care Unit. General Calixto García University Hospital. 2009-2010

La Disfunción Renal Aguda se define por el deterioro de la función renal cuya expresión común es un aumento de la concentración de los productos nitrogenados en sangre con reducción o no del volumen urinario. Se realizó un estudio descriptivo, longitudinal y prospectivo sobre el comportamiento de la Disfunción Renal Aguda, en la Unidad de Cuidados Intensivos del Hospital Universitario “Gral. Calixto García” de Ciudad de la Habana, en el período comprendido de agosto del 2009 a julio del 2010. La Disfunción Renal Aguda fue más frecuente en el grupo de edad de 70 a 79 años, el 46,6 por ciento de los pacientes no presentó factores de riesgo previo, fue más frecuente en los casos quirúrgicos, y en aquellos con un APACHE II al ingreso > 24 puntos, los factores precipitantes más incidentes fueron la ventilación mecánica, la hipotensión/shock y la sepsis. Según la clasificación RIFLE predominó el estadio de injuria. La hemodiálisis fue el método de terapia de restitución renal utilizado. Al aplicar el Índice de Severidad Individual el mayor porcentaje tuvo más de 0.5 puntos y fue el grupo de mayor mortalidad(AU)

Acute renal dysfunction defined by the deterioration of the renal function which is common expression increased nitrogen concentration in blood products with reduced urinary volume or not. We performed a descriptive, longitudinal and prospective performance of acute renal failure in the intensive care unit of the University Hospital “General Calixto Garcia “in Havana, in the period August 2009 to July 2010. Acute renal dysfunction was more frequent in the age group 70 to 79 years, 46.6 percent of patients had no previous risk factors, was more frequent in surgical cases, and in those with an APACHE II at admission > 24 points, more incidents precipitating factors were mechanical ventilation, hypotension / shock and sepsis. According to the RIFLE classification stadium injury predominated. Haemodialysis was the method used renal replacement therapy. Applying Individual Severity Index had the highest percentage over 0.5 points and was the group with the highest mortality(AU)