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Quereda C, Orofino L, Marcen R, Sabater J, Matesanz R, Ortuño J. Influence of Dialysate and Membrane Biocompatibility on Hemodynamic Stability in Hemodialysis. Int J Artif Organs 2018. [DOI: 10.1177/039139888801100409] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The contributions of membrane biocompatibility, dialysate temperature and sodium concentration to hemodynamic stability during hemodialysis were studied in 8 patients with a high incidence of hemodialysis-induced symptomatic hypotension. Patients were treated during 8 different periods, randomly ordered in each case, resulting from the combination of the following: the membrane, either Cuprophan or Polyacrylonitrile; the dialysate temperature, 37 or 35°C, and the sodium concentration, 133 or 139 mmol/l. The incidence of symptomatic hypotension was lower at 35°C in the entire study with either membrane and either sodium concentration. It was also lower with a sodium concentration of 139 mmol/l with either temperature and either membrane. There was a lower incidence of symptomatic hypotension when using Polyacrylonitrile, but this difference was not significant. We conclude that changes in physicochemical parameters of dialysate lead to worth-while improvement of symptomatic hypotension in hemodialysis patients, but membrane biocompatibility seems to play a minor role.
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Affiliation(s)
- C. Quereda
- Servicio de Nefrologia Hospital Ramon y Cajal Madrid - Spain
| | - L. Orofino
- Servicio de Nefrologia Hospital Ramon y Cajal Madrid - Spain
| | - R. Marcen
- Servicio de Nefrologia Hospital Ramon y Cajal Madrid - Spain
| | - J. Sabater
- Servicio de Nefrologia Hospital Ramon y Cajal Madrid - Spain
| | - R. Matesanz
- Servicio de Nefrologia Hospital Ramon y Cajal Madrid - Spain
| | - J. Ortuño
- Servicio de Nefrologia Hospital Ramon y Cajal Madrid - Spain
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Marcen R, Lamas S, Orofino L, Quereda C, Barcia F, Castro J, De Caso PA, Ortuño J. Dipyridamole Thallium-201 Perfusion Imaging for the Study of Ischemic Heart Disease in Hemodialysis Patients. Int J Artif Organs 2018. [DOI: 10.1177/039139888901201207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To assess the usefulness of dipyridamole thallium perfusion imaging in the evaluation of myocardial perfusion in hemodialysis (HD), we studied 29 HD patients divided into three groups: A) 13 patients with clinical angina, B) 8 patients without angina but similar in age, sex, time on HD and hematocrit and C) 8 young asymptomatic patients (mean age 33 ± 9.7 years). Dipyridamole thallium-201 (TI-201) perfusion imaging revealed myocardial perfusion defects in 8 patients (61%) from group A, 4 (50%) from group B and 1 (12.5%) from group C. These defects were localized in the inferior, posterior and septal segments of the left ventricle. Abnormal myocardial perfusion was associated with age over 50 years and aortic calcifications (p < 0.05). Eight patients died within the following four years. All had aortic calcifications (p < 0.001). Our results show that myocardial perfusion defects are frequent even in non-symptomatic HD patients. This suggests that ischemic heart disease could be more frequent than estimated by clinical symptoms alone. TI-201 scintigraphy may be a useful non-invasive procedure in cardiological evaluation of HD patients
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Affiliation(s)
- R. Marcen
- Departments of Nephrology, Hospital Ramon Y Cajal, Madrid - Spain
| | - S. Lamas
- Departments of Nephrology, Hospital Ramon Y Cajal, Madrid - Spain
| | - L. Orofino
- Departments of Nephrology, Hospital Ramon Y Cajal, Madrid - Spain
| | - C. Quereda
- Departments of Nephrology, Hospital Ramon Y Cajal, Madrid - Spain
| | - F. Barcia
- Cardiology, Hospital Ramon Y Cajal, Madrid - Spain
| | - J.M. Castro
- Nuclear Medicine, Hospital Ramon Y Cajal, Madrid - Spain
| | | | - J. Ortuño
- Departments of Nephrology, Hospital Ramon Y Cajal, Madrid - Spain
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Morales JM, Serrano M, Martinez-Flores JA, Gainza FJ, Marcen R, Arias M, Escuin F, Pérez D, Andres A, Martínez MA, Maruri N, Alvarez E, Castañer JL, López-Hoyos M, Serrano A. Pretransplant IgA-Anti-Beta 2 Glycoprotein I Antibodies As a Predictor of Early Graft Thrombosis after Renal Transplantation in the Clinical Practice: A Multicenter and Prospective Study. Front Immunol 2018; 9:468. [PMID: 29593726 PMCID: PMC5857545 DOI: 10.3389/fimmu.2018.00468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/21/2018] [Indexed: 11/26/2022] Open
Abstract
Background Graft thrombosis is a devastating complication after renal transplantation. We recently described the association of anti-beta-2-glycoprotein-I (IgA-ab2GP1) antibodies with early graft loss mainly caused by thrombosis in a monocenter study. Methods Multicenter prospective observational cohort study. Setting and participants Seven hundred forty patients from five hospitals of the Spanish Forum Renal Group transplanted from 2000 to 2002 were prospectively followed-up for 10 years. Outcomes Early graft loss and graft loss by thrombosis. Measurements The presence of IgA anti-B2GP1 antibodies in pretransplant serum was examined using the same methodology in all the patients. Results At transplantation, 288 patients were positive for IgA-B2GP1 (39%, Group-1) and the remaining were negative (Group-2). Graft loss at 6 months was higher in Group-1 (12.5 vs. 4.2% p < 0.001), vessel thrombosis being the most frequent cause of early graft loss, especially in Group-1 (6.9 vs. 0.4% p < 0.001). IgA-aB2GP1 was the most important independent risk factor for graft thrombosis (hazard ratio: 13.83; 95% CI: 3.17-60.27, p < 0.001). Furthermore, the, presence of IgA-aB2GP1 was associated with early graft loss and delayed graft function. At 10 years, survival figures were also lower in Group-1: graft survival was lower compared with Group-2 (60.4 vs. 76.8%, p < 0.001). Mortality was significantly higher in Group-1 (19.8 vs. 12.2%, p = 0.005). Limitations Patients were obtained during a 3-year period (1 January 2000-31 December 2002) and kidneys were only transplanted from brain-dead donors. Nowadays, the patients are older and the percentage of sensitized and retransplants is high. Conclusion In a prospective observational multicenter study, we were able to corroborate that pretransplant presence of IgA-aB2GP1 was the main risk factor for graft thrombosis and early graft loss. Therefore, a prospective study is needed to evaluate the efficacy and safety of prophylactic anticoagulation to avoid this severe complication.
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Affiliation(s)
- Jose M. Morales
- Hospital 12 de Octubre, Nephrology Department, Healthcare Research Institute (Imas12), Madrid, Spain
- Hospital 12 de Octubre, Immunology Department, Healthcare Research Institute (Imas12), Madrid, Spain
| | - Manuel Serrano
- Hospital 12 de Octubre, Nephrology Department, Healthcare Research Institute (Imas12), Madrid, Spain
- Hospital 12 de Octubre, Immunology Department, Healthcare Research Institute (Imas12), Madrid, Spain
| | - Jose Angel Martinez-Flores
- Hospital 12 de Octubre, Nephrology Department, Healthcare Research Institute (Imas12), Madrid, Spain
- Hospital 12 de Octubre, Immunology Department, Healthcare Research Institute (Imas12), Madrid, Spain
| | - Fracisco Javier Gainza
- Nephrology Department, Hospital Universitario de Cruces, Biocruces Health Research Institute, Baracaldo, Spain
| | - Roberto Marcen
- Hospital Ramon y Cajal, Nephrology Department, Madrid, Spain
- Hospital Ramon y Cajal, Immunology Department, Madrid, Spain
| | - Manuel Arias
- Hospital Marques de Valdecilla, Nephrology Department, Santander, Spain
- Hospital Marques de Valdecilla, Immunology Department, Santander, Spain
| | | | - Dolores Pérez
- Hospital 12 de Octubre, Nephrology Department, Healthcare Research Institute (Imas12), Madrid, Spain
- Hospital 12 de Octubre, Immunology Department, Healthcare Research Institute (Imas12), Madrid, Spain
| | - Amado Andres
- Hospital 12 de Octubre, Nephrology Department, Healthcare Research Institute (Imas12), Madrid, Spain
- Hospital 12 de Octubre, Immunology Department, Healthcare Research Institute (Imas12), Madrid, Spain
| | - Miguel Angel Martínez
- Hospital 12 de Octubre, Nephrology Department, Healthcare Research Institute (Imas12), Madrid, Spain
- Hospital 12 de Octubre, Immunology Department, Healthcare Research Institute (Imas12), Madrid, Spain
| | - Naroa Maruri
- Nephrology Department, Hospital Universitario de Cruces, Biocruces Health Research Institute, Baracaldo, Spain
| | - Eva Alvarez
- Nephrology Department, Hospital Universitario de Cruces, Biocruces Health Research Institute, Baracaldo, Spain
| | - José Luis Castañer
- Hospital Ramon y Cajal, Nephrology Department, Madrid, Spain
- Hospital Ramon y Cajal, Immunology Department, Madrid, Spain
| | - Marcos López-Hoyos
- Hospital Marques de Valdecilla, Nephrology Department, Santander, Spain
- Hospital Marques de Valdecilla, Immunology Department, Santander, Spain
| | - Antonio Serrano
- Hospital 12 de Octubre, Nephrology Department, Healthcare Research Institute (Imas12), Madrid, Spain
- Hospital 12 de Octubre, Immunology Department, Healthcare Research Institute (Imas12), Madrid, Spain
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Cruzado JM, Lauzurica R, Pascual J, Marcen R, Moreso F, Gutierrez-Dalmau A, Andrés A, Hernández D, Torres A, Beneyto MI, Melilli E, Manonelles A, Arias M, Praga M. Paricalcitol Versus Calcifediol for Treating Hyperparathyroidism in Kidney Transplant Recipients. Kidney Int Rep 2017; 3:122-132. [PMID: 29340322 PMCID: PMC5762965 DOI: 10.1016/j.ekir.2017.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 02/06/2023] Open
Abstract
Introduction Secondary hyperparathyroidism (SHPT) and vitamin D deficiency are common at kidney transplantation and are associated with some early and late complications. This study was designed to evaluate whether paricalcitol was more effective than nutritional vitamin D for controlling SHPT in de novo kidney allograft recipients. Methods This was a 6-month, investigator-initiated, multicenter, open-label, randomized clinical trial. Patients with pretransplantation iPTH between 250 and 600 pg/ml and calcium <10 mg/dl were randomized to paricalcitol (PAR) or calcifediol (CAL). The intention-to-treat population (PAR: n = 46; CAL: n = 47) was used for the analysis. The primary endpoint was the percentage of patients with serum iPTH >110 pg/ml at 6 months. Secondary endpoints were bone mineral metabolism, renal function, and allograft protocol biopsies. Results The primary outcome occurred in 19.6% of patients in the PAR group and 36.2% of patients in the CAL group (P = 0.07). However, there was a higher percentage of patients with iPTH <70 pg/ml in the PAR group than in the CAL group (63.4% vs. 37.2%; P = 0.03). No differences were observed in bone turnover biomarkers and bone mineral density. The estimated glomerular filtration rate was significantly higher in the CAL group than in the PAR group without differences in albuminuria. In protocol biopsies, interstitial fibrosis and tubular atrophy tended to be higher in the PAR group than in the CAL group (48% vs. 23.8%; P = 0.09). Both medications were well tolerated. Conclusion Both PAR and CAL reduced iPTH, but PAR was associated with a higher proportion of patients with iPTH <70 pg/ml. These results do not support the use of PAR to treat posttransplantation hyperparathyroidism.
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Affiliation(s)
- Josep M Cruzado
- Nephrology Department, Hospital Universitari de Bellvitge, University of Barcelona, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ricardo Lauzurica
- Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Roberto Marcen
- Department of Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Francesc Moreso
- Hospital Universitari Vall d'Hebron, Nephrology, Barcelona, Spain
| | | | - Amado Andrés
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | | | - Armando Torres
- Department of Nephrology, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Edoardo Melilli
- Nephrology Department, Hospital Universitari de Bellvitge, University of Barcelona, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Manonelles
- Nephrology Department, Hospital Universitari de Bellvitge, University of Barcelona, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Arias
- Nephrology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Manuel Praga
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
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Cruzado J, Lauzurica R, Pascual J, Marcen R, Moreso F, Gutierrez A, Andrés A, Hernández D, Torres A, Beneyto MI, Melilli E, Arias M, Praga M. TO019CONTROLLED RANDOMIZED STUDY COMPARING PARICALCITOL WITH CALCIFEDIOL FOR TREATING HYPERPARATHYROIDISM IN KIDNEY ALLOGRAFT RECIPIENTS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx130.to019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Morales J, Serrano M, Martinez-Flores J, Gainza J, Marcen R, Arias M, Escuin F, Andres A, Martinez MA, Maruri N, Alvarez E, Castañer J, Castañer J, Lopez Hoyos M, Serrano A. SO026PRE-TRANSPLANT ANTIBODIES IGA-ANTI-BETA 2 GLICOPROTEIN I: A NEW PREDICTOR OF GRAFT THROMBOSIS AFTER RENAL TRANSPLANTATION. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx104.so026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Torres A, Torregrosa V, Marcen R, Campistol JM, Arias M, Hernández D, Fernández C, Esforzado N, Paschoalin R, Pérez N, García AI, Del Amo M, Pomés J, González Rinne A, Marrero D, Pérez E, Henríquez F, Díaz JM, Silva I, López V, Perello M, Ramos D, Beneyto I, Cruzado JM, Martínez Castelao A, Bravo J, Rodríguez M, Díaz C, Crespo J, Anaya F, Rodríguez ML, Cubero JJ, Pascual P, Romero R, Andrés Belmonte A, Checa MD, Jiménez C, Escuin F, Crespo M, Mir M, Gómez G, Bayes B, González MJ, Gutiérrez A, Cuberes M, Rodríguez Benoit A, García T, Llamas F, Ortega A, Conde JL, Gómez Alamillo C. Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study). Nefrologia 2016; 36:255-67. [PMID: 27133898 DOI: 10.1016/j.nefro.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 03/06/2016] [Accepted: 03/11/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. METHOD We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. RESULTS Vitamin D deficiency (25OHD3<15ng/ml) was more common in female recipients at CKD-T stages I-III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. CONCLUSIONS Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients.
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Affiliation(s)
- Armando Torres
- Servicio de Nefrología, HospitalUniversitario de Canarias, CIBICAN, Universidad de La Laguna, RedInRen RD12/0021/0008-Instituto de Salud Carlos III, Tenerife, Spain.
| | - Vicens Torregrosa
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Roberto Marcen
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal (RedInRen, RD12/0021/0020-Instituto de Salud Carlos III), Madrid, Spain
| | - Josep María Campistol
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Manuel Arias
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, RedInRen RD12/0021/0007-Instituto de Salud Carlos III, Santander, Spain
| | - Domingo Hernández
- Servicio de Nefrología, Hospital Regional Carlos Haya, Universidad de Málaga (IBIMA), RedInRen RD12/0021/0015-Instituto de Salud Carlos III, Málaga, Spain
| | - Constantino Fernández
- Servicio de Nefrología, Complexo Hospitalario Universitario Juan Canalejo, A Coruña , Spain
| | - Nuria Esforzado
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Raphael Paschoalin
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Nuria Pérez
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Ana Isabel García
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Montserrat Del Amo
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Jaume Pomés
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Ana González Rinne
- Servicio de Nefrología, HospitalUniversitario de Canarias, CIBICAN, Universidad de La Laguna, RedInRen RD12/0021/0008-Instituto de Salud Carlos III, Tenerife, Spain
| | - Domingo Marrero
- Servicio de Nefrología, HospitalUniversitario de Canarias, CIBICAN, Universidad de La Laguna, RedInRen RD12/0021/0008-Instituto de Salud Carlos III, Tenerife, Spain
| | - Estefanía Pérez
- Servicio de Nefrología, HospitalUniversitario de Canarias, CIBICAN, Universidad de La Laguna, RedInRen RD12/0021/0008-Instituto de Salud Carlos III, Tenerife, Spain
| | - Fernando Henríquez
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Juan Manuel Díaz
- Servicio de Nefrología, Fundació Puigvert I.U.N.A, Barcelona, Spain
| | - Irene Silva
- Servicio de Nefrología, Fundació Puigvert I.U.N.A, Barcelona, Spain
| | - Verónica López
- Servicio de Nefrología, Hospital Regional Carlos Haya, Universidad de Málaga (IBIMA), RedInRen RD12/0021/0015-Instituto de Salud Carlos III, Málaga, Spain
| | - Manuel Perello
- Servicio de Nefrología, Hospital Vall D́Hebrón, Barcelona, Spain
| | - David Ramos
- Servicio de Nefrología, Hospital Universitario La Fe, Valencia, Spain
| | - Isabel Beneyto
- Servicio de Nefrología, Hospital Universitario La Fe, Valencia, Spain
| | - José María Cruzado
- Servicio de Nefrología, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Juan Bravo
- Servicio de Nefrología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Minerva Rodríguez
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carmen Díaz
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Josep Crespo
- Servicio de Nefrología, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Fernando Anaya
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Rodríguez
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan José Cubero
- Servicio de Nefrología, Hospital Regional Universitario Infanta Cristina, Badajoz, Spain
| | - Pilar Pascual
- Servicio de Nefrología, Hospital Clínico Universitario de Valladolid, Spain
| | - Rafael Romero
- Servicio de Nefrología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - María Dolores Checa
- Servicio de Nefrología, Centro Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Carlos Jiménez
- Servicio de Nefrología, Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Escuin
- Servicio de Nefrología, Hospital Universitario La Paz, Madrid, Spain
| | - Marta Crespo
- Servicio de Nefrología, Hospital del Mar, Barcelona, Spain
| | - Marisa Mir
- Servicio de Nefrología, Hospital del Mar, Barcelona, Spain
| | - Gonzalo Gómez
- Servicio de Nefrología, Hospital Universitario Son Dureta, Palma de Mallorca, Spain
| | - Beatriz Bayes
- Servicio de Nefrología, Hospital Universitario Germans Trias I Pujol, Barcelona, Spain
| | - María José González
- Servicio de Nefrología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Alex Gutiérrez
- Servicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Marta Cuberes
- Servicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Teresa García
- Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Francisco Llamas
- Servicio de Nefrología, Complejo Hospitalario y Universitario de Albacete, Spain
| | - Agustín Ortega
- Servicio de Nefrología, Complejo Hospitalario y Universitario de Albacete, Spain
| | - José Luis Conde
- Servicio de Nefrología, Hospital Complejo Hospitario de Toledo, Spain
| | - Carlos Gómez Alamillo
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, RedInRen RD12/0021/0007-Instituto de Salud Carlos III, Santander, Spain
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Krämer BK, Montagnino G, Krüger B, Margreiter R, Olbricht CJ, Marcen R, Sester U, Kunzendorf U, Dietl KH, Rigotti P, Ronco C, Hörsch S, Banas B, Mühlbacher F, Arias M. Efficacy and safety of tacrolimus compared with ciclosporin-A in renal transplantation: 7-year observational results. Transpl Int 2015; 29:307-14. [PMID: 26565071 DOI: 10.1111/tri.12716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 05/27/2015] [Accepted: 10/30/2015] [Indexed: 12/28/2022]
Abstract
The European Tacrolimus versus Ciclosporin-A Microemulsion (CsA-ME) Renal Transplantation Study demonstrated that tacrolimus decreased acute rejection rates at 6 months. Primary endpoints of this investigator-initiated, observational 7-year follow-up study were acute rejection rates, patient and graft survival rates, and a composite endpoint (BPAR, graft loss, and patient death). We analyzed data from the original intent-to-treat population (n = 557; 286 tacrolimus, 271 CsA-ME). A total of 237 tacrolimus and 208 CsA-ME patients provided data. At 7 years, Kaplan-Meier estimated rates of patients free from BPAR were 77.1% in the tacrolimus arm and 59.9% in the CsA-ME arm, graft survival rates amounted to 82.6% and 80.6%, and patient survival rates to 89.9% and 88.1%. Estimated combined endpoint-free survival rates were 60.2% in the tacrolimus arm and 47.0% in the CsA-ME arm (P = <0.0001). A higher number of patients from the CsA-ME arm crossed over to tacrolimus during 7 year follow-up: 19.7% vs. 7.9% (P = <0.002). More patients in the tacrolimus group stopped steroids and received immunosuppressive monotherapy. Significantly, more CsA-ME patients received lipid-lowering medication and experienced cosmetic and cardiovascular adverse events. Tacrolimus-treated renal transplant recipients had significantly higher combined endpoint-free survival rates mainly driven by lower acute rejection rates despite less immunosuppressive medication at 7 years.
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Affiliation(s)
- Bernhard K Krämer
- Universitätsmedizin Mannheim, Vth Department of Medicine, Medical Faculty of the University of Heidelberg, Mannheim, Germany
| | - Giuseppe Montagnino
- Division of Nephrology and Dialysis, Ospedale Maggiore di Milano IRCCS, Milano, Italy
| | - Bernd Krüger
- Universitätsmedizin Mannheim, Vth Department of Medicine, Medical Faculty of the University of Heidelberg, Mannheim, Germany
| | | | | | | | - Urban Sester
- Universitätsklinik des Saarlandes, Homburg, Germany
| | | | | | | | | | | | - Bernhard Banas
- Abteilung für Nephrologie, University of Regensburg, Regensburg, Germany
| | | | - Manuel Arias
- Hospital Marqués de Valdecilla, Santander, Spain
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Elias S, Marcen R, Jimenez S, Fernandez A, Galeano C, Quereda C. Expanded Criteria Donors Allow Successful Expansion On the Donor and Recipient Pools. A Single Centre Experience. Transplantation 2014. [DOI: 10.1097/00007890-201407151-02012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Burgos FJ, Bueno G, Gonzalez R, Vazquez JJ, Diez-Nicolás V, Marcen R, Fernández A, Pascual J. Endourologic implants to treat complex ureteral stenosis after kidney transplantation. Transplant Proc 2010; 41:2427-9. [PMID: 19715941 DOI: 10.1016/j.transproceed.2009.06.068] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of nitinol stents and the Detour extra-anatomical ureteral bypass graft in treatment of ureteral stenosis after kidney transplantation. PATIENTS AND METHODS Eighteen kidney transplant recipients with complex stenosis caused by failure of primary treatment or with high surgical risk or a poorly functioning graft (serum creatinine concentration >2.5 mg/dL) were treated using antegrade percutaneous implantation of nitinol stents (n = 16) or extra-anatomical ureteral bypass grafts (n = 3); 1 patient was treated with both techniques. RESULTS Mean (range) follow-up of ureteral stents was 51.2 (3-118) months. Patency rate at last follow-up, resumption of dialysis therapy, or death was 75% (12 of 16 patients). In 4 patients (25%), stent occlusion developed, which was treated using a double-J catheter in 2 patients, stent removal and pyeloureterostomy using the native ureter in 1 patient, and implantation of an extra-anatomical bypass graft in 1 patient. Mean follow-up in patients with extra-anatomical ureteral bypass grafts was 32 (8-64) months. One patient developed a urinary tract infection, and another had encrustation with obstruction. CONCLUSIONS Use of nitinol ureteral stents and extra-anatomical ureteral bypass grafts is a safe and effective alternative to surgery for treatment of post-kidney transplantation ureteral stenosis in patients with chronic graft dysfunction, those at high surgical risk, and those in whom previous surgical treatment has failed.
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Affiliation(s)
- F J Burgos
- Department of Urology, Hospital Ramon y Cajal, Universidad de Alcalá, Madrid, Spain.
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11
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Fernández A, Villafruela J, Amezquita Y, Caldés S, Marcen R, Galeano C, Pascual J, Rodriguez-Mendiola N, Ortuño J. Mycophenolate Mofetil Absorption Quotient: Interest to Clinical Practice. Transplant Proc 2009; 41:2317-9. [DOI: 10.1016/j.transproceed.2009.06.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gonzalez Molina M, Morales JM, Marcen R, Campistol JM, Oppenheimer F, Serón D, Gil-Vernet S, Capdevila L, Andrés A, Lampreave I, Del Castillo D, Cabello M, Burgos D, Valdés F, Anaya F, Escuín F, Arias M, Pallardó L, Bustamante J. Renal function in patients with cadaveric kidney transplants treated with tacrolimus or cyclosporine. Transplant Proc 2007; 39:2167-9. [PMID: 17889126 DOI: 10.1016/j.transproceed.2007.07.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Renal function predicts graft survival in kidney transplant patients. This study compared the 2-year evolution of renal function in patients treated with cyclosporine or tacrolimus in combination with mycophenolate mofetil (MMF) and prednisone. METHODS We studied 1558 cadaveric renal transplant recipients from 14 Spanish hospitals between January 2000 and December 2002. Of these, 1168 were treated with tacrolimus and 390 with cyclosporine. The primary efficacy endpoint was long-term renal function. Renal function was measured by serum creatinine and glomerular filtration rate (GFR) by creatinine clearance calculated from the Cockcroft-Gault formula. This report summarizes the 2-year results. RESULTS At 24 months the tacrolimus group showed significantly better serum creatinine (1.5 +/- 0.7 vs 1.8 +/- 0.8 mg/dL, P < .001) and GFR (60.5 +/- 20.9 mL/min vs 47.9 +/- 10.0, P < .001) than the cyclosporine group. Additionally, recipients with ideal graft donors (23.5 +/- 2.8 vs 24.0 +/- 2.9 years) had a better serum creatinine at 2 years (1.23 +/- 0.2 vs 1.5 +/- 0.4 mg/dL, P < .05). Multivariate analysis showed that tacrolimus was an independent factor associated with better renal function: odds ratio 1.6, 95% confidence interval (1.2 to 2.2), P < .001. CONCLUSIONS Patients with a renal transplant treated with tacrolimus in combination with MMF and prednisone displayed better renal function at 2 years than those who received cyclosporine.
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Affiliation(s)
- M Gonzalez Molina
- Department of Nephrology and the Kidney Transplantation Unit, Carlos Haya, Malaga, Spain.
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13
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Burgos FJ, Gómez V, Pascual J, Marcen R, Villafruela JJ, Correa C, Cuevas B, Mampaso F, García-Gonzalez R. Pancreas islet transplantation in the genitourinary tract associated with renal transplantation: an experimental study. Transplant Proc 2007; 38:2585-7. [PMID: 17098010 DOI: 10.1016/j.transproceed.2006.08.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Conceptually, pancreas islet transplantation (PIT) associated with renal transplantation (RT) should resolve not only chronic renal failure but also diabetes. Although the most frequently used site for PIT is the portal vein, genitourinary locations could be technically feasible during RT. Seventeen pigs (age 3 to 4 months; mean weight 34.5 kg) underwent the following experimental steps: On day 1 a left nephrectomy was performed and the kidney was perfused with cold Wisconsin solution. This was followed by a caudal pancreatectomy and islet isolation by means of digestion with intraductal collagenase. Islets were stained with Dithizone and cultured overnight al 37 degrees C and 5% CO(2). On day 2 a right nephrectomy and orthotopic RT of the preserved left kidney were performed. The islets were transplanted into four different sites: subcapsular in the kidney graft, in the bladder submucosa, in the testis by puncture, and in the testis by infusion through the vas deferens. On day 7 the animals were sacrificed. Islet viability was determined by histological examination with insulin immunostaining and determination of insulin in the blood of the veins draining the implantation sites. The mean weight of the pancreatic specimens was 27.8 g (13 to 46). The mean number of islets was 536,000 (16,600 to 1,5000,000). Islets were shown in the bladder submucosa and the testes after vas deferens infusion. The number of viable islets in the other implantation sites was very scarce. The insulin levels of the venous effluents were: 15.1 microU/mL for bladder submucosa, 10.2 microU/mL for intradeferential injection in the testis, 7.3 microU/mL for intratesticular injection by puncture, and 2.6 microU/mL for subcapsular implantation in the graft. In conclusion, the bladder submucosa and testis via the vas deferens might represent alternative sites for PIT. The latter route may benefit from the immunoprivileged and special trophic conditions of the testis. For the first time, the feasibility of the bladder submucosa as an implantation site for pancreas islets was demonstrated.
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Affiliation(s)
- F J Burgos
- Urology Department, Hospital Ramon y Cajal Madrid, Spain.
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Burgos FJ, Pascual J, Quicios C, Marcen R, Fernández A, López Fando L, Ortuño J. Post–Kidney Transplant Surgical Complications Under New Immunosuppressive Regimens. Transplant Proc 2006; 38:2445-7. [PMID: 17097962 DOI: 10.1016/j.transproceed.2006.08.192] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
New immunosuppressive regimens have decreased acute rejection rates after kidney transplant. However, the use of these new agents has modified the profile of surgical complications. We compared the incidence of surgical complications in relation with the use of three types of drugs: calcineurin inhibitors, antiproliferative agents, and mammalian target of rapamycin (mTOR) inhibitors. This retrospective study included 359 cadaveric recipients who received an allograft between 1997 and 2004. The mean age was 54 years. The prevalence of diabetes was 8.5% and that of obesity (body mass index > 30 kg/m(2)) was 15.4%. The mean follow-up time was 44 +/- 5.6 months. The regimen most frequently used was tacrolimus (TACRO), mycophenolate mofetil (MMF), and prednisone (PRED) (n = 172), followed by TACRO-PRED (n = 49), cyclosporine (CSA) and MMF and PRED (n = 41), and CSA-azathioprine (AZA) and PRED (n = 24). A surgical complication was considered to be any type of event during the first year, although minimal, directly related to surgery. The rate of surgical complications was 34.8% (122/350). Collections and bleeding were higher in CSA than in TACRO regimens, 12% versus 3.8% (P < .05) and 11.5% versus 3% (P = .002), respectively. The incidence of lymphoceles was higher in regimens with than without mTOR inhibitors: 16% versus 3.7% (P = .012). The incidence of surgical complications was not influenced by the use of MMF or diabetes. In conclusion, the use of mTOR inhibitor-based immunosuppressive regimens leads to a higher incidence of lymphoceles, while the use of MMF does not increase the incidence of surgical complications.
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Affiliation(s)
- F J Burgos
- Urology Department, Hospital Ramon y Cajal, Madrid, Spain.
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Martínez-Castelao A, Hernández MD, Pascual J, Morales JM, Marcen R, Errasti P, Romero R, Oliver J, Jimeno L, Garcia Martinez J, Mendiluce A, Garcia Cosme P, Mazuecos A, Danz-Guajardo D, Alarcon A, Marrero D. Detection and treatment of post kidney transplant hyperglycemia: a Spanish multicenter cross-sectional study. Transplant Proc 2006; 37:3813-6. [PMID: 16386547 DOI: 10.1016/j.transproceed.2005.10.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The prevalence of diabetes mellitus (DM) is greater among patients with solid organ transplants than in the general population, although the factors associated with posttransplant DM (PTDM) are unknown. OBJECTIVES The objective of this study was to estimate the prevalence of and assess the risk factors for PTDM. PATIENTS AND METHODS We included outpatients with functioning isolated solid organ allografts (kidney, liver, heart, and lung). We collected demographic and posttransplant clinical data that included DM diagnostic ADA criteria, DM treatment, DM family history, presence of hepatitis C virus (HCV), immunosuppression treatment, hypertension, and dyslipidemia. RESULTS A total of 2178 patients included, 1410 kidney recipients, 489 liver transplants, 207 heart transplants, and 72 lung recipients. Seventeen and four-tenths percent of the patients who did not have DM prior to transplantation, developed PTDM (median time: 79 days). A greater prevalence was observed among patients with a family history, HCV, and tacrolimus treatment (with or without steroids P < .05). By logistic regression analyses, OR for these factors were 1.51, 1.65, and 1.38, respectively. Of those patients who did not suffer PTDM, 55.2% showed basal blood glucose values under 100 mg/dL; only 68% presented with a hemoglobin Alc under 6. CONCLUSIONS The prevalence of PTDM among kidney recipients was higher than that in the general population. DM family history, HCV positive, and tacrolimus were risk factors associated with this entity.
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Burgos FJ, Pascual J, Marcen R, García-Navas R, García IG, Alarcón C, Gómez V, García-Ortells D, Tabernero G, Ortuño J. Self-Expanding Metallic Ureteral Stents for Treatment of Ureteral Stenosis After Kidney Transplantation. Transplant Proc 2005; 37:3828-9. [PMID: 16386553 DOI: 10.1016/j.transproceed.2005.09.198] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The incidence of post-renal transplantation ureteral stenosis ranges from 2%-12%. Because the role of self-expanding ureteral metallic stents for its treatment has been scarcely reported, the aim of this study was to evaluate the efficacy of Nitinol stents. Eleven ureteral stenoses in patients with chronic graft dysfunction (8 cases) or high surgical risk (3 cases) were treated by antegrade percutaneous implantation of Nitinol stents through a nephrostomy tract. The mean follow-up period was 48 +/- 7 months (range, 3-85 months). The patency rate at the moment of return to dialysis, death, or last check-up was 73% (8/11). Three patients (27%) developed stent occlusion. Two patients were treated using a trans-stent double-J catheter and 1 patient using stent removal and pyeloureterostomy using the native ureter. The mean percentage decrease in serum creatinine (Cr) level after stent implantation was 41% (range, 14%-63%). Nitinol ureteral stent implantation is an effective alternative for the treatment of ureteral stenosis in patients with chronic graft dysfunction or high surgical risk.
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Affiliation(s)
- F J Burgos
- Department of Urology, Hospital Ramon y Cajal, Universidad de Alcalá, Madrid, Spain.
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17
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Burgos FJ, Linares A, Pascual J, Marcen R, Villafruela J, Zamora J, Cuevas B, Correa C, Gómez V. Modifications of Renal Blood Flow and Serum Interleukin Levels Induced by Laparoscopic and Open Living Donor Nephrectomies For Kidney Transplant: An Experimental Study in Pigs. Transplant Proc 2005; 37:3676-8. [PMID: 16386502 DOI: 10.1016/j.transproceed.2005.10.083] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The increase of intraabdominal pressure (IAP) during laparoscopy modifies renal blood flow (RBF). However, laparoscopic techniques are less invasive than open procedures. The use of interleukins (IL) to evaluate operative trauma of different surgical techniques is controversial. The aim of the study was to analyze the, modifications induced by laparoscopic and open nephrectomies on RBF, renal function and IL levels. Thirty pigs underwent left nephrectomy, 15 by laparoscopy and 15 by an open approach in an experimental autotransplant model. A significant reduction in RBF was observed among the laparoscopic (80 +/- 27 mL/min) versus the open group (263 +/- 3 mL/min, P < .05). Laparoscopy reduced glomerular filtration (GF) (37.6 +/- 1.1%) to a greater extent than an open technique (80.5 +/- 0.4%; P < .05). Serum levels of IL-2, IL-6, IL-10, and tumor necrosis factor (TNF) were lower during laparoscopic than open nephrectomy: 6.8 +/- 0.6 versus 13 .9 +/- 1.1 pg/mL for IL-2, 46.2 +/- 2.3 versus 84.4 +/- 2.5 pg/mL for IL-6, 26.1 +/- 2.4 versus 92.8 +/- 12.6 pg/mL for IL-10, and 17.6 +/- 2.1 versus 38.5 +/- 4.8 pg/mL for TNF (P <.001). In conclusion, laparoscopic nephrectomy for living donor kidney transplant induced significant reductions in RBF and GF. However, there was less increase in IL levels during laparoscopic than the open approach. The influence of these circumstances on graft function after kidney transplantation is not clearly established.
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Teruel JL, Marcen R, Ocaña J, Fernández-Lucas M, Rivera M, Tabernero G, Ortuño J. Clinical significance of C-reactive protein in patients on hemodialysis: a longitudinal study. Nephron Clin Pract 2005; 100:c140-5. [PMID: 15855797 DOI: 10.1159/000085443] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2004] [Accepted: 02/07/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM The levels of C-reactive protein (CRP) have been related to hypoalbuminemia and the necessity of erythropoietin in patients on maintenance hemodialysis. However, in several studies, the patients' clinical situation is not taken into account. The aim of the present work was to analyze the relationship between CRP and serum albumin and hemoglobin and the erythropoietin resistance index (ERI) in a population of patients on chronic hemodialysis classified according to their clinical situation. METHODS In a cohort of 53 patients followed for 12 months, we analyzed the CRP level and its association with albumin and hemoglobin levels and the ERI (ratio of total weekly erythropoietin dose in units/weight to hemoglobin concentration in g/dl) at the start of the study and at 6 and 12 months thereafter. The patients were divided into three groups based on the presence of inflammatory/infectious disorders during the 4 weeks prior to CRP determination (group A) or the use of a jugular catheter (group B) or an arteriovenous fistula (group C) as vascular access for hemodialysis. RESULTS At baseline, the CRP levels (47.1 mg/l in group A, 30.7 mg/l in group B, and 9.4 mg/l in group C) and the ERI (23.9 in group A, 24.6 in group B, and 10.7 in group C) were higher in groups A and B than in group C (p < 0.001 for both parameters). Serum albumin (3.9 g/dl in group A, 4.1 g/dl in group B, and 4.4 g/dl in group C) and hemoglobin (10.4 g/dl in group A, 11.3 g/dl in group B, and 12 g/dl in group C) were lower in groups A and B than in group C (p < 0.05 for serum albumin and p < 0.01 for hemoglobin). In all patients, the baseline CRP level correlated with the albumin level (r = -0.3853, p < 0.01), with the hemoglobin level (r = -0.2950, p < 0.05), and with the ERI (r = 0.4378, p < 0.01). However, if we only considered the group C patients, there was no correlation between baseline CRP and albumin, hemoglobin, and ERI. Similar results were observed at 6 and 12 months. CONCLUSIONS The CRP, albumin, and hemoglobin levels and the ERI mostly depend on the existence of ongoing inflammatory/infectious disorders and the use of a catheter as vascular access. In the absence of these clinical conditions, we could not correlate the CRP level with the other parameters. The relationship between CRP, albumin, and anemia may be an epiphenomenon.
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Affiliation(s)
- José L Teruel
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain.
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Burgos FJ, Pascual J, Marcen R, García-Navas R, Gómez V, Ortuño J. The role of imaging techniques in renal transplantation. World J Urol 2004; 22:399-404. [PMID: 15517281 DOI: 10.1007/s00345-004-0412-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2004] [Accepted: 04/28/2004] [Indexed: 11/30/2022] Open
Abstract
Our aim is to review the utility of the different imaging techniques in the field of renal transplantation (RT). A total of 500 potential RT recipients have been evaluated and were included in the waiting list. From 1978 to 2003, a total of 900 RT recipients were clinically followed-up and different imaging techniques assessed. The main indications for the different techniques were: (1) MR angiography to establish the vascular anatomy of the living donor with 95% accuracy for the detection of multiple renal vessels. (2) Abdominal ultrasound of the donor in order to detect lithiasis, incidental renal tumors or anatomic anomalies. (3) Vascular evaluation of the recipients was essential considering the aging character of this population. X-ray film of the abdomen was a routine technique. Doppler ultrasound (DOP-US) of the iliac vessels and an angiographic study (DSA, CT, MR) of the iliac and splenic arteries were indicated only in selected cases. (4) DOP-US was useful in the diagnosis of graft dysfunction after RT. It allowed the exclusion of thrombosis and urinary obstruction, and was useful to distinguish between acute tubular necrosis, cyclosporine nephrotoxicity and acute rejection (AR). (5) Finally, ultrasound was used as a percutaneous approach to pyelocaliceal systems of grafts affected by ureteral stenosis or fistula and for draining fluid collections after RT (lymphocele, abscess, hematoma or urinoma).
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Affiliation(s)
- F Javier Burgos
- Department of Urology, Hospital Ramon y Cajal, Universidad de Alcalá, Madrid, Spain.
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Gómez García I, Burgos Revilla FJ, Sanz Mayayo E, Rodríguez Patrón R, Arias Fúnez F, Marcen R, Pascual J, Escudero Barrilero A. [Acute obstructive kidney failure after kidney transplantation caused by calculi transfer from donor]. ARCH ESP UROL 2003; 56:1047-50. [PMID: 14674293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVES To report one case of lithiasis transference from the donor associated with renal transplant. METHODS 53-year-old female with obstructive uropathy within the first post transplant month. RESULTS/CONCLUSIONS Lithiasis transference after transplant is a cause of early obstructive uropathy after kidney transplantation. The low the incidence of lithiasis transference does not justify the performance of x-ray and/or ultrasound of the donor organ in terms of cost effectiveness. Extracorporeal shockwave lithotripsy is a valid therapeutic option on transplanted kidneys.
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Burgos FJ, Pascual J, Briones G, Cuevas B, Villafruela J, Correa C, Marcen R, Gomez V. Influence of laparoscopic live donor nephrectomy in ischemia-reperfusion syndrome and renal function after kidney transplantation: an experimental study. Transplant Proc 2003; 35:1664-5. [PMID: 12962748 DOI: 10.1016/s0041-1345(03)00622-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The increase of intra-abdominal pressure during laparoscopic techniques provokes oliguria and reduction of the renal blood flow (RBF). The aim of this study is to evaluate this effect during living donor nephrectomy and its influence in the ischemia-reperfusion syndrome and renal function after kidney transplantation. Autotransplantation was performed using 22 pigs (15 after conventional open nephrectomy and 7 after laparoscopic nephrectomy). During donor nephrectomy a significant reduction in RBF was observed in the laparoscopic group (70 mL/min) vs the open group (260 mL/min) (P<.05). After a cold ischemia period of 24 hours an autotransplantation was performed. During the first hour after revascularization RBF was lower for the laparoscopic than for the open group: 60 vs 180 mL/s at 1 minute and 160 vs 400 mL/s at 60 minutes (P<.05). The decrease of creatinine was slower for the laparoscopic than for the open group during the first posttransplant week (2 vs 1.3 mg/dL on the first day and 1.4 vs 0.8 mg/dL on the seventh day posttransplant, respectively) (P<.05).
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Affiliation(s)
- F J Burgos
- Department of Urology, Hospital Ramon y Cajal, Universidad Alcala, Madrid, Spain
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Affiliation(s)
- F J Burgos
- Department of Urology, Hospital Ramon y Cajal, Universidad Alcala, Madrid, Spain
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Orofino L, Pascual J, Quereda C, Burgos J, Marcen R, Ortuño J. Influence of overweight on survival of kidney transplant. Nephrol Dial Transplant 1997; 12:855. [PMID: 9141040 DOI: 10.1093/ndt/12.4.855] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Teruel JL, Lasuncion MA, Rivera M, Aguilera A, Ortega H, Tato A, Marcen R, Ortuño J. Nandrolone decanoate reduces serum lipoprotein(a) concentrations in hemodialysis patients. Am J Kidney Dis 1997; 29:569-75. [PMID: 9100047 DOI: 10.1016/s0272-6386(97)90340-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We have studied the changes in the lipid profile of 14 chronic hemodialysis patients receiving a 6-month cycle of nandrolone decanoate as treatment for anemia. Nandrolone decanoate was administered in a weekly intramuscular dose of 200 mg and resulted in an increase in the hemoglobin concentration (baseline, 7.9 +/- 0.9 g/dL; month 6, 10.8 +/- 1.7 g/dL; P < 0.001, ANOVA) and also produced relevant modifications in the lipid concentrations. The most significant finding was a decrease in the concentration of lipoprotein(a) [Lp(a)]: baseline, 19.8 mg/dL (median), month 2, 10.6 mg/dL; month 4, 8.7 mg/dL; and month 6, 7.1 mg/dL (P < 0.001, Friedman). Other lipid changes induced by nandrolone decanoate were an increase in the concentrations of apolipoprotein B (P < 0.02, ANOVA) and triglyceride (P = NS, ANOVA) and a decrease of high-density lipoprotein (HDL) cholesterol (P < 0.001, ANOVA) and apolipoprotein A-I (P = NS, ANOVA). The decrease in HDL cholesterol was at the expense of the HDL2 cholesterol subfraction, whereas HDL3 remained unchanged. These lipid modifications were reversible; 4 months after nandrolone decanoate withdrawal, the lipid concentrations were similar to the basal values. The changes in Lp(a) levels did not correlate with those of hemoglobin or the other lipid parameters, suggesting that the underlying mechanisms are unrelated. Our findings could be clinically relevant if confirmed by further studies.
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Affiliation(s)
- J L Teruel
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain
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Teruel JL, Marcen R, Villafruela JJ, Navarro-Antolin J, Ortuño J. Quantitative assessment of erythropoiesis after subtotal parathyroidectomy. Nephrol Dial Transplant 1997; 12:367-8. [PMID: 9132671 DOI: 10.1093/ndt/12.2.367b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Teruel JL, Nitvarro JF, Marcen R, Aguilera A, Tato A, Ottuño J. Satisfactory control of secondary hyperparathyroidism with low-calcium dialysate in patients not receiving vitamin D. Miner Electrolyte Metab 1997; 23:19-24. [PMID: 9058365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The use of a dialysate calcium concentration of 2.5 mEq/1 for patients not receiving vitamin D is controversial. Therefore, it has been suggested that oral calcium supplements might be sufficient to avoid a negative calcium balance which could result in a worsening of secondary hyperparathyroidism. In order to clarify these aspects, we reduced the dialysis fluid calcium level in 26 patients on chronic hemodialysis with a dialysate calcium concentration of 3.25 mEq/l, all of them receiving low doses of calcium carbonate and aluminum hydroxide. No patient received supplements with vitamin D during the previous 2 years. These patients have been dialyzed using a dialysate calcium concentration of 2.5 mEq/l for 1 year. Gradually we increased the dose of calcium carbonate and decreased the dose of aluminum hydroxide to maintain the predialysis serum calcium and phosphate concentrations between 8-10 and 4-6 mg/dl, respectively. After 1 year of hemodialysis with a low-calcium dialysate (2.5 mEq/l), the oral dose of calcium carbonate was increased from 3.5 +/- 2.6 to 9.2 +/- 5.6 g/day (p < 0.001). In 22 patients (85%) the aluminum hydroxide was stopped, and in the remaining 4 cases the dose was lowered. The reduction in the dialysate calcium concentration did not increase the incidence of hypercalcemia or hyperphosphatemia. In the whole group, we did not observe a significant variation in the levels of intact parathyroid hormone (iPTH; 324 +/- 123 vs. 311 +/- 256 pg/ ml) or alkaline phosphatase (230 +/- 115 vs. 224 +/- 127 U/l), although there was a reduction in the serum aluminum concentration (33 +/- 31 vs. 21.8 +/- 20.2 micrograms/l; p < 0.001). We analyzed the evolution of iPTH in each case. In 15 patients (58%) the iPTH concentration decreased, in 6 cases (23%) it remained stable, and in only 5 subjects (19%) there was an increase (2 of them did not take the oral calcium dosage recommended). In conclusion, a low dialysate calcium concentration (2.5 mEq/l) is safe for most patients not receiving vitamin D. But adherence of patients to high doses of oral calcium supplements is absolutely necessary.
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Affiliation(s)
- J L Teruel
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain
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27
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Teruel JL, Aguilera A, Marcen R, Navarro Antolin J, Garcia Otero G, Ortuño J. Androgen therapy for anaemia of chronic renal failure. Indications in the erythropoietin era. Scand J Urol Nephrol 1996; 30:403-8. [PMID: 8936631 DOI: 10.3109/00365599609181318] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The high cost of recombinant human erythropoietin has led us to consider the existing indications for androgen treatment of anaemia in patients with chronic renal failure. In the present work, we have tried to identify those patients on haemodialysis for whom androgens could constitute a therapeutic alternative. The evolution of haemoglobin concentration was analysed in 84 patients (67 males and 17 females) treated with a cycle of nandrolone decanoate (200 mg per week given intramuscularly, for six months). In the total group of patients, haemoglobin rose from 69 g/L to 87 g/L (p < 0.01). The increment in haemoglobin was not related to sex, basal haemoglobin, primary renal disease, or dose of nandrolone decanoate corrected by body weight. However, we observed a relationship between this increment in haemoglobin and patient age. Haemoglobin increased by 8 g/L in patients younger than 46 years (n = 29), by 18 g/L in patients aged between 46 and 55 years (n = 28), and by 27 g/L in patients older than 55 years (n = 27) (p < 0.01 between groups). In the last group, haemoglobin concentration at the end of androgen treatment was 101 +/- 16 g/L. The haemoglobin level reached during androgen treatment was maintained for over a year after androgen withdrawal in 55% of the responder patients. A reversible rise in the serum concentration of triglycerides was the main side-effect observed. Nandrolone decanoate therapy was not associated with hepatotoxicity or an increase in blood pressure. Voice change and mild hirsutism were observed in most of the women receiving nandrolone decanoate, and these secondary effects constitute a real disadvantage to its use in females. In conclusion, our results showed that androgens are a useful alternative in the treatment of anaemia in male haemodialysis patients older than 55 years. Furthermore, the response obtained was similar to that observed with erythropoietin, but at a lower cost.
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Affiliation(s)
- J L Teruel
- Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain
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Marcen R, Mampaso F, Teruel JL, Rivera ME, Orofino L, Navarro-Antolin J, Ortuno J. Membranous nephropathy: recurrence after kidney transplantation. Nephrol Dial Transplant 1996. [DOI: 10.1093/oxfordjournals.ndt.a027468] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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Marcen R, Mampaso F, Teruel JL, Rivera ME, Orofino L, Navarro-Antolin J, Ortuño J. Membranous nephropathy: recurrence after kidney transplantation. Nephrol Dial Transplant 1996; 11:1129-33. [PMID: 8671981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND It is supposed that about 5% of dialysis patients had membranous nephropathy as a cause for their renal failure. Despite of this prevalence, only 33 cases of recurrent membranous nephropathy after kidney transplantation have been reported in the English literature. METHODS Among 509 recipients of renal allografts, membranous glomerulonephritis was the cause of renal failure in five patients, who received six transplants. RESULTS Recurrence of the disease was observed in three allografts (50%) in three patients, all of them were on treatment with cyclosporin and low-dose prednisone. Proteinuria appeared at 2, 5 and 19 months after grafting. One patient experienced a spontaneous remission after 12 months and he is free from proteinuria and with good renal function after 5 years. The remaining two patients presented progressive renal function deterioration and returned to haemodialysis 24 and 17 months after th appearance of proteinuria. In these patients increasing the immunosuppression did not produce any beneficial effect. One of those patients underwent a second transplant; recurrence of the membranous nephropathy has not been observed after 3 years of follow-up. CONCLUSIONS In this study three new cases of recurrence of membranous nephropathy are reported. One patient experienced a spontaneous remission of proteinuria. Recurrence of membranous nephropathy in renal allograft was very high in our series. Its appearance was associated with poor prognosis of the graft in most patients, although spontaneous remission of proteinuria is possible.
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Affiliation(s)
- R Marcen
- Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain
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30
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Teruel JL, Marcen R, Navarro-Antolin J, Aguilera A, Fernandez-Juarez G, Ortuño J. Androgen versus erythropoietin for the treatment of anemia in hemodialyzed patients: a prospective study. J Am Soc Nephrol 1996; 7:140-4. [PMID: 8808121 DOI: 10.1681/asn.v71140] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
According to this facility's protocol for the treatment of anemia in hemodialyzed patients, androgens were administered to male patients aged over 50 yr and recombinant human erythropoietin was administered to male patients below 50 yr of age and to female patients. In the study presented here, both therapeutic approaches have been prospectively analyzed. Patients were divided into two groups. Group A was composed of 18 patients, aged 62 +/- 12 yr, treated with nandrolone decanoate (200 mg/wk im) for 6 months; Group B was composed of 22 patients (6 men, 16 women) aged 47 +/- 15 yr, treated with subcutaneous recombinant human erythropoietin (initial dose, 6000 IU/wk) for 6 months. The increases of hemoglobin were similar in both groups; Group A, from 7.3 +/- 0.8 to 10.8 +/- 1.7 g/dL (P < 0.001), and Group B, from 7 +/- 0.6 to 10.4 +/- 1 g/dL (P < 0.001). In Group A, increases of triglycerides (159 +/- 71 versus 267 +/- 153 mg/dL, P < 0.001), serum albumin (3.9 +/- 0.3 versus 4.2 +/- 0.3 g/dL, P < 0.05), and dry weight (62.1 +/- 9.8 versus 64.9 +/- 10.1 kg, P < 0.001) were observed, which remained unmodified in Group B. Blood pressure control worsened in one patient (6%) from Group A, and in ten patients (45%) from Group B (P < 0.05). In conclusion, androgens produced an improvement in anemia in selected patients, similar to that achieved by use of recombinant human erythropoietin but at a lower cost. Androgens also have an appreciable anabolic effect and did not increase the blood pressure.
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Affiliation(s)
- J L Teruel
- Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain
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31
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Teruel JL, Fernandez Juarez G, Marcen R, Nogueira J, Ortuño J. Effect of angiotensin-converting enzyme inhibitors on anemia in hemodialyzed patients. Nephron Clin Pract 1996; 73:113. [PMID: 8742977 DOI: 10.1159/000189020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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32
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Navarro JF, Teruel JL, Mateos ML, Marcen R, Ortuno J. Antibody level after hepatitis B vaccination in hemodialysis patients: influence of hepatitis C virus infection. Am J Nephrol 1996; 16:95-7. [PMID: 8919223 DOI: 10.1159/000168977] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Seroconversion after hepatitis B vaccine has been estimated to occur when the level of anti-HBs is higher than 10 IU/1, but recently is has been considered that an antibody titer above 100 IU/1 is necessary to guarantee an efficacious protection. We prospectively studied the evolution of anti-HBs after primary vaccination (3 doses; Engerix B, 40 mu g each) in 56 seronegative and not previously vaccinated hemodialysis patients. Three months after vaccine administration, seroconversion (anti-HBs > 10 IU/1) was found in 43 patients (76.7%), but an adequate response (titer > 100 IU/1) was observed only in 30 (53.5%). At 1 year after vaccination only 1 (3.3%) of the 30 cases with an effective response had lost his anti-HBs, while 12 of the 13 patients (92.3%) with an inadequate response (anti-HBs between 10 and 100 IU/1) had no detectable antibodies (p < 0.01, chi2). Considering that an antibody titer above 100 IU/1 following vaccination is necessary in order to maintain that level of antibody 1 year later, we analyzed the factors which influenced obtaining this level of antibody. Age, time on hemodialysis, serum albumin, Kt/V and protein catabolic rate did not affect the response to the vaccine. Females had a better response than males, and interestingly we found that hepatitis C virus (HCV) infection influenced the level of immunity. 27 out of the 43 HCV-negative cases (62.7%) obtained anti-HBs levels greater than 100 IU/1, but only 3 out of the 13 HCV-infected patients (23%) had an anti-HBs above 100 IU/1 (p < 0.01, chi2). Our results suggest that after hepatitis B vaccine, an antibody titer higher than 100 IU/1 is necessary to maintain the antibody level 1 year later, and that HCV infection may reduce the effectiveness of hepatitis B vaccine in hemodialysis patients.
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Affiliation(s)
- J F Navarro
- Department of Nephrology, Hospital Ramon y Cajal, Madrid, Spain
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33
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Quereda C, Sabater J, Villafruela J, Revalderia JG, Marcen R, Ortuño J. Urinary thromboxane B2 and cyclic AMP in cyclosporine-A-treated kidney transplantation. Transplant Proc 1994; 26:2604-5. [PMID: 7940810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- C Quereda
- Nephrology Dept., Ramon y Cajal Hospital, Alcala de Henares University, Madrid, Spain
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34
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Marcen R, Serrano P, Teruel JL, Rivera ME, Mitjavila M, Navarro J, Orofino L, Sabater J, Ortuño J. Oral cimetidine improves the accuracy of creatinine clearance in transplant patients on cyclosporine. Transplant Proc 1994; 26:2624-5. [PMID: 7940817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- R Marcen
- Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain
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35
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Mampaso F, Marcen R, Molina A, Pascual J, Martin A, Bricio T. Expression of adhesion molecules in allograft renal dysfunction: a distinct diagnostic pattern in rejection and cyclosporine nephrotoxicity. Transplant Proc 1994; 26:2859-60. [PMID: 7524222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- F Mampaso
- Department of Pathology, Hospital Ramon y Cajal, Madrid, Spain
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36
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Borrego J, Burgos FJ, Galmes I, Orofino L, Rodríguez Luna JM, Marcen R, Fernández E, Escudero A, Ortuño J. [Surgical complications in 479 renal transplantations]. Actas Urol Esp 1994; 18:253-7. [PMID: 7976709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Exposition of results obtained from the review of the surgical complications found in a series of 479 renal transplantations performed between 1978 and 1992 in our centre, although some of them lack clinical relevance. There was fluid accumulation in 69 patients, distributed between 31 perirenal haematoma. 17 lymphocele, 13 urinoma, 5 perirenal abscesses and 3 mixed. 27.7% required no action. Frequency of renal rupture was 18 cases, 9 due to acute rejection and 9 to vascular thrombosis. Incidence of urinary obstruction was 4.8% with 5.8% of urinary fistula. With regard to the surgical wound, 9 infections, 7 haematomas, 1 eventration and 1 necrotizing fasciitis were observed. Vascular complications consisted in 10 arterial thrombosis, 10 venous thrombosis, 5 mixed thrombosis and 31 arterial stenosis. Treatment instituted for the various cases, its evolution, and an statistical study of risk factors are illustrated.
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Affiliation(s)
- J Borrego
- Servicio de Urología, Hospital Ramón y Cajal, Madrid
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37
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Gómez V, Burgos J, Rivera M, Fernández M, Marcen R, Orofino L, del Hoyo JF, Ortuño J, Escudero A. [Gastrointestinal complications in renal transplantation]. Actas Urol Esp 1994; 18:277-80. [PMID: 7976713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Seventy-nine gastrointestinal complications in 480 recipients of a renal transplant (RT) (16%) are described. The most frequent complication was high digestive haemorrhage (HDH) (19/480) (2.9%); other complications were: esophagitis, gastroenteritis, diverticulitis, cholecystitis, intestinal tuberculosis, rectal ulcer and colonic polyps. Mortality secondary to gastrointestinal complications was 1.1%. Sixty-seven percent of cases with peptic ulcer developed HDH, an incidence higher than that observed in the general population (20%). Twenty-one percent of transplanted patients with DH had ulcer background. Cholecystitis and diverticulitis were complications with a low incidence (0.2% and 0.6%, respectively) which do not seem to justify aggressive diagnostic and therapeutic manoeuvres prior to the transplant. Prevalence of intestinal tuberculosis in this series (0.4%) was higher to that described in the literature.
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Affiliation(s)
- V Gómez
- Servicio de Urología, Hospital Ramón y Cajal, Madrid
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38
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Marcen R, Navarro JF, Mampaso F, Orofino L, Gonzalo A, Teruel JL, Ortuño J. Recurrence of focal-segmental glomerulosclerosis in kidney transplant patients on ciclosporin. Nephron Clin Pract 1994; 68:497-9. [PMID: 7870235 DOI: 10.1159/000188313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Two patients on maintenance hemodialysis after terminal renal failure due to nephrotic syndrome and biopsy-proven focal-segmental glomerulosclerosis received three cadaver renal allografts. Immediate recurrence of nephrotic syndrome was observed. In two transplants immunosuppression consisted of ciclosporin A and low-dose steroids. One patient was unsuccessfully treated with immunoadsorption after the second transplant. All grafts were lost because of uncontrolled nephrotic syndrome. Renal allograft biopsy specimens showed findings indicating recurrence of the original disease.
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Affiliation(s)
- R Marcen
- Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain
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39
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Teruel JL, Marcen R, Navarro JF, Villafruela JJ, Fernandez Lucas M, Rivera M, Ortuño J. Influence of body iron stores on the serum erythropoietin concentration in hemodialyzed patients. Am J Nephrol 1994; 14:95-8. [PMID: 8080013 DOI: 10.1159/000168696] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The influence of body iron stores on the concentration of serum erythropoietin was studied in 48 hemodialyzed patients not receiving human recombinant erythropoietin, androgens or iron supplements. The serum erythropoietin concentration was 11.6 +/- 10.4 mIU/ml. There was no correlation between the serum erythropoietin and the hematocrit or hemoglobin concentration; however, there was a correlation between the serum erythropoietin and the log of serum ferritin (r = -0.5699, p < 0.01). Serum erythropoietin levels were higher in the 18 ferropenic patients (serum ferritin < 50 ng/ml) than in the 30 patients with normal serum ferritin concentration (18 +/- 13.8 vs. 7.8 +/- 4.7 mIU/ml, p < 0.01). The administration of intravenous iron to the ferropenic patients resulted in a reduction in serum erythropoietin independent of the response of the anemia (18 +/- 13.8 basal and 7.9 +/- 6.5 mIU/ml at 4 weeks, p < 0.01). Our data would suggest that the concentration of erythropoietin in hemodialyzed patients is influenced by the serum ferritin level.
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Affiliation(s)
- J L Teruel
- Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain
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40
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Mampaso F, Sanchez-Madrid F, Marcen R, Molina A, Pascual J, Bricio T, Martin A, Alvarez V. Expression of adhesion molecules in allograft renal dysfunction. A distinct diagnostic pattern in rejection and cyclosporine nephrotoxicity. Transplantation 1993; 56:687-91. [PMID: 8212167 DOI: 10.1097/00007890-199309000-00035] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We have studied in thirty renal biopsies (from 30 cadaver allograft patients) the expression of both LFA-1 and VLA-4 leukocyte adhesion receptors and their respective ICAM-1 and VCAM-1 endothelial cell ligands, during early allograft dysfunction (24 +/- 5 days after transplantation), reversed either by antirejection therapy (n = 14) or by reduction in CsA dose (n = 16). We have found that the levels of expression of the integrin VLA-4 and the activation signal AIM/CD69 (activation inducer molecule) on interstitial cells were significantly (P < 0.001) higher in rejection than in nephrotoxicity. A main differential expression pattern was observed for VCAM-1, the endothelial cell ligand of VLA-4. Interestingly, a strong staining pattern of the renal vascular endothelium and 35% of tubular epithelium was obtained with anti-VCAM-1 antibody in rejection, as compared with a weak reactivity in endothelium and discrete staining pattern on tubules in nephrotoxicity. On the other hand, we found that the mean percentage of infiltrating cells bearing LFA-1 molecules and the intensity of ICAM-1 (a LFA-1 ligand) expression on endothelium were closely similar in both rejection and CsA nephrotoxicity. Nevertheless, a discrete significant (P < 0.05) "de novo" expression of ICAM-1 was present on tubular cells during rejection. Our results strongly suggest that in rejection the interstitial cell infiltrate seems to be facilitated by the contribution of both LFA-1/ICAM-1 and VLA-4/VCAM-1 cell adhesion mechanisms, and also that VLA-4/VCAM-1 leukocyte interaction does not play a role in cases with CsA nephrotoxicity. Furthermore, the differential expression patterns of VLA-4 and VCAM-1 molecules found between rejection and CsA nephrotoxicity could provide valuable immunohistochemical criteria in the diagnosis of allograft dysfunction.
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Affiliation(s)
- F Mampaso
- Department of Pathology, Hospital Ramon y Cajal, Madrid, Spain
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41
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Marcen R, Gamez C, Mateos ML, Orofino L, Teruel JL, Serrano P, Pascual J, Quereda C, Nash R, Ortuño J. Hepatitis C antibody after kidney transplantation: clinical significance. Am J Nephrol 1993; 13:184-9. [PMID: 7692726 DOI: 10.1159/000168615] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The prevalence of antibodies to hepatitis C virus (HCV) was investigated in 231 renal transplantation recipients, by a first- and second-generation EIA assay and a second-generation immunoblot assay (4-RIBA). Before transplantation, prevalence of anti-HCV was 22.6% and was related to the time on dialysis (p < 0.01), transfusions (p < 0.01) and previous history of chronic liver disease (p < 0.01. Following transplantation, 32 patients (13.9%) were anti-HCV positive by the first-generation enzyme immunoassay (EIA) and it increased to 57 patients (24.7%) when anti-HCV was measured by the second-generation EIA. The 4-RIBA assay confirmed the positivity in 46 patients (80.7%), 11 patients (19.3%) were indeterminate. Seroconversion after grafting was observed in 7 negative patients, and another 7 patients became negative after the procedure. The presence of anti-HCV antibody after transplantation was determined by the patient status on dialysis, 80% of them being positive before surgery. Twenty-one 4-RIBA-positive transplantation patients (45.7%) had persistently or intermittently abnormalities on liver function tests, suggesting chronic liver disease. A liver biopsy performed on 10 of these patients showed; chronic active hepatitis in 6, chronic persistent hepatitis in 2, and chronic lobular hepatitis in the other 2 patients. Another 23 4-RIBA-positive transplantation patients had normal alanine aminotransferase levels despite long follow-up (66.2 +/- 32.2 months). The prevalence of anti-HCV antibody can be underestimated if the antibody is measured by first-generation EIA alone. About 50% of patients with anti-HCV had chronic liver disease, and the histological findings suggested a possible evolution to cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Marcen
- Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain
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42
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43
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Marcen R, Pascual J, Orofino L, Fernandez Muñoz R, Teruel JL, Celma ML, Liaño F, Ortuño J. Hepatitis C virus infection in kidney transplant patients. Transplant Proc 1992; 24:87-8. [PMID: 1371628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- R Marcen
- Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain
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44
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Orofino L, Marcen R, Gamez C, Orte L, Lopez-Velez R, Quereda C, Ortuño J. Visceral leishmaniasis in renal transplant patients. Nephrol Dial Transplant 1992; 7:651. [PMID: 1323078 DOI: 10.1093/ndt/7.7.651] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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45
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Sabater J, Quereda C, Marcen R, Orofino L, Herrera I, Muñoz ML, Villafruela JJ, Ortuño J. Comparative study of different methods for measuring blood cyclosporine A levels in kidney transplantation. Transplant Proc 1990; 22:1720-2. [PMID: 2202129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- J Sabater
- Servicio de Nefrologia, Hospital Ramón y Cajal, Madrid, Spain
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46
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Rivera M, Felipe C, Orofino L, Matesanz R, Marcen R, Ortuño J. [Metastatic calcification simulating a sacral tumor in a patient on periodic dialysis]. Rev Clin Esp 1990; 186:171-2. [PMID: 2367719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Renal osteodystrophy is usually a prominent feature in patients undergoing chronic hemodialysis. Metastatic calcifications are a frequent finding when secondary hyperparathyroidism is associated. We present a patient with a sacral soft tissue calcification resembling a malignant tumour.
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Affiliation(s)
- M Rivera
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid
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47
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Rivera M, Marcen R, Pascual J, Naya MT, Orofino L, Ortuño J. Kidney transplantation in systemic lupus erythematosus nephritis: a one-center experience. Nephron Clin Pract 1990; 56:148-51. [PMID: 2243569 DOI: 10.1159/000186123] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Eight patients with end-stage renal disease secondary to systemic lupus erythematosus (SLE) received 8 cadaveric renal allograft. Patient and graft survival was 100 and 87%, respectively. None of them showed extrarenal manifestations of SLE or recurrence of lupus nephritis after grafting. One graft was lost because of chronic rejection. In another patient, an episode of graft function deterioration due to bad control of arterial hypertension was observed. Three patients were transplanted during their first year on hemodialysis. Two women became pregnant after successful kidney transplantation; one suffered a spontaneous abortion and the other had a successful delivery. In neither of them, was SLE observed during or after pregnancy. Morbidity was low in this series, and infections were the most frequent complication. In summary, our experience with renal transplantation in SLE patients compares, favorably with the general nodiabetic transplanted population.
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Affiliation(s)
- M Rivera
- Department of Nephrology, Hospital Ramon y Cajal, Madrid, Spain
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Marcen R, Lamas S, Orofino L, Quereda C, Barcia F, Castro JM, Alonso de Caso P, Ortuño J. Dipyridamole thallium-201 perfusion imaging for the study of ischemic heart disease in hemodialysis patients. Int J Artif Organs 1989; 12:773-7. [PMID: 2613358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To assess the usefulness of dipyridamole thallium perfusion imaging in the evaluation of myocardial perfusion in hemodialysis (HD), we studied 29 HD patients divided into three groups: A) 13 patients with clinical angina, B) 8 patients without angina but similar in age, sex, time on HD and hematocrit and C) 8 young asymptomatic patients (mean age 33 +/- 9.7 years). Dipyridamole thallium-201 (Tl-201) perfusion imaging revealed myocardial perfusion defects in 8 patients (61%) from group A, 4 (50%) from group B and 1 (12.5%) from group C. These defects were localized in the inferior, posterior and septal segments of the left ventricle. Abnormal myocardial perfusion was associated with age over 50 years and aortic calcifications (p less than 0.05). Eight patients died within the following four years. All had aortic calcifications (p less than 0.001). Our results show that myocardial perfusion defects are frequent even in non-symptomatic HD patients. This suggests that ischemic heart disease could be more frequent than estimated by clinical symptoms alone. Tl-201 scintigraphy may be a useful non-invasive procedure in cardiological evaluation of HD patients.
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Affiliation(s)
- R Marcen
- Department of Nephrology, Hospital Ramon Y Cajal, Madrid, Spain
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Burgos FJ, Teruel JL, Herrero JM, Jiménez M, Marcen R, Ortuño J, Llorente MT. [Study of renal function after the administration of a low-osmolarity iodized contrast medium. Prospective study]. Actas Urol Esp 1989; 13:94-5. [PMID: 2728949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
UNLABELLED We analysed the development of various kidney function parameters in 40 patients on whom an intravenous urography had been carried out with a non-ionic contrast medium of low osmolarity (iohexol). No patient displayed prior renal insufficiency (serum creatinine 0.4-2mg/dl). Twenty-four hours after injection of the iodized contrast no significant variations in urea blood concentrations, creatinine, sodium or uric acid appeared. As a result of the urography an increase in urine osmolarity and a decrease in fractional sodium excretion took place. IN CONCLUSION in patients without renal insufficiency intravenous urography with iohexol does not give rise to a significant alteration in the renal excretory function.
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