Revista Colombiana de Nefrología最新文献

{"title":"COVID-19 in kidney transplant recipients: A experience in Colombia","authors":"C. Duran, Mayra Estacio, L. Mesa, J. Schweinberg, J. G. Posada, D. Espinosa, E. Manzi, Fredy Lozano, A. Castro","doi":"10.22265/acnef.9.3.610","DOIUrl":"https://doi.org/10.22265/acnef.9.3.610","url":null,"abstract":"Background: Patients with kidney transplants seem to be at particularly high risk for severe COVID19 disease due to their impaired immune responses and comorbidities.\u0000Purpose: This study aims to describe kidney transplant patients’ clinical characteristics and outcomes with SARSCOV-2 infection in a fourth-level hospital in Cali, Colombia.\u0000Methodology: We performed an observational study of kidney transplant recipients with SARS-CoV2 infection admitted at Fundación Valle del Lili from June to December 2020. To be eligible for this study, patients have symptoms compatible, a positive RT-PCR and inpatient management. Asymptomatic patients were excluded.\u0000Results: We enrolled a total of 50 patients. 64% were male, and the median age was 53.5 years (range 46-60). The comorbidities were 36 (70%) hypertension, 16 (32%) diabetes mellitus, 5 (10%) obesity. The most common immunosuppressive regimen was tacrolimus, mycophenolate and prednisone. The median time from symptoms onset to the positive RT-PCR was 7 days. The most common initial symptom was fever (64%), and fatigue (58%), cough (44%) and dyspnea (36%). Baseline levels of CRP was 6.43 mg/dL (3.25-11.22). The median lymphocyte count was 785 mm3/uL (550-1230). Baseline D-Dimer was 0.767 ug/ml (0.484-1153.5), ferritin median level was 1011ng/ml (670-2145). Six of the patients died (12%), 4/6 were by sepsis-related multi-organ failure and 2/6 were by ARDS.\u0000Conclusions: Major complications such as acute kidney injury, acute respiratory distress syndrome and mortality related to COVID-19 infection observed in our study are lower than those reported in other countries.","PeriodicalId":121036,"journal":{"name":"Revista Colombiana de Nefrología","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124995679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcoma de Kaposi en orofaringe en paciente postrasplante renal y manejo con inhibidor de señal de coestimulación e inhibidor de mTOR","authors":"Rodolfo Eduardo Torres-Serrano, Jairo Camilo Montero Cetina, Edwar Ferney Ortiz-Henao, Gloria Constanza Pastrana-Mejía, Larry Salamanca-Rodríguez","doi":"10.22265/acnef.9.3.560","DOIUrl":"https://doi.org/10.22265/acnef.9.3.560","url":null,"abstract":"Introducción: el sarcoma de Kaposi en pacientes de postrasplante renal es poco frecuente y está asociado usualmente a infección por herpes 8 y a dosis altas de inmunosupresión.\u0000Objetivo: descripción reporte de caso de Sarcoma de Kaposi en orofaringe en paciente postrasplante renal manejo con inhibidor de señal de coestimulación e inhibidor mTOR.\u0000Presentación del caso: en este artículo se describe el caso de una paciente, con antecedente de trasplante renal, con diagnóstico de sarcoma de Kaposi en una localización muy poco frecuente: a nivel orofaríngeo. Se realiza una revisión de los factores de riesgo, patogenia y un acercamiento en el manejo. De igual manera, se realiza un seguimiento y manejo con inhibidor de señal de coestimulación (belatacept) e inhibidor de mTOR.\u0000Discusión y conclusión: el sarcoma de Kaposi es una de las neoplasias postrasplante con mayor incidencia comparativamente con la población no trasplantada, donde el papel de la reactivación de la infección viral, más el papel de la inmunosupresión, son puntos fundamentales en la génesis de la neoplasia. La determinación del estatus serológico IgG para HHV8 podría ser una estrategia de determinación del riesgo en el pretrasplante.","PeriodicalId":121036,"journal":{"name":"Revista Colombiana de Nefrología","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126997511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Myeloid Leukemia in a Geriatric Patient with a History of Minimal Change Disease","authors":"A. Alp, Gokhan Pektas, İ. M. Çi̇ri̇ş","doi":"10.22265/acnef.9.3.590","DOIUrl":"https://doi.org/10.22265/acnef.9.3.590","url":null,"abstract":"Background: The increase in the incidence of malignancies globally, and the increase in the usage frequency and types of new anti-cancer drugs, have made onconephrology more important in our clinical practice. Paraneoplastic glomerulonephritis constitutes an important part of this approach as well.\u0000Purpose: The association of AML-nephrotic syndrome is relatively less defined in the literature compared to other hematological malignancies.\u0000Case presentation: In this article, we present a case of acute myelocytic leukemia in a patient who was diagnosed with minimal change disease many years ago.\u0000Discussion and Conclusion: Hematological malignancies-MCD association, is one of the best described examples of paraneoplastic glomerulonephritis. We know that cancer can be clinically diagnosed years after the detection of renal disease in paraneoplastic glomerulonephritis. In this case; rationality of follow-up, not only during the diagnosis of glomerulonephritis but also periodically in the long term, especially in clinical situations such as MCD that occur in geriatric patients, should be discussed.","PeriodicalId":121036,"journal":{"name":"Revista Colombiana de Nefrología","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132333268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the Impact of Fatigue on the Degree of Dependance in Hemodialysis Patients","authors":"A. Figueiredo, Julia Domingues de Figueiredo, Isadora Santos Bueno","doi":"10.22265/acnef.9.3.627","DOIUrl":"https://doi.org/10.22265/acnef.9.3.627","url":null,"abstract":"Background: Patients undergoing hemodialysis (HD) go through a number of physical and emotional symptoms that can interfere with their comfort and quality of life, a common symptom is tiredness, a condition which is conventionally called post dialysis fatigue (PDF). Therefore, the objective is to evaluate the relationship between fatigue and the degree of dependence in performing basic and instrumental activities of daily living on patients undergoing hemodialysis.\u0000Method: Cross-sectional study, carried out at the hemodialysis unit of Hospital São Lucas da Pontificia Universidad Católica do Rio Grande do Sul.. The study reporting adheres to the STROBE checklist.\u0000Results: From the 101 patients interviewed, 63 (62.4%) had post dialysis fatigue, with a mean age of 59±7 years, where the majority were men with 66.3% (n=67).  The presence of PDF was related to vintage on HD (p<0,041), session recovery time (p<0,000) and shift of the session (p<0.001). There was no association of PDF with the degree of dependence on basic and instrumental activities of daily living.\u0000Conclusion: More than half of the patients on HD experience PDF, it is less frequent in patients dialyzing in the night shift and it is associated with dialysis vintage and with greater recovery time.","PeriodicalId":121036,"journal":{"name":"Revista Colombiana de Nefrología","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123001683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Actualización en lesión renal aguda inducida por contraste en pediatría","authors":"Andrés David Aranzazu Ceballos, Valentina Herrera Mejía, Juan José Vanegas, Catalina Velez Echeverri, C. Ochoa","doi":"10.22265/acnef.9.3.584","DOIUrl":"https://doi.org/10.22265/acnef.9.3.584","url":null,"abstract":"Contexto: la lesión renal aguda inducida por contraste se ha convertido en un tema de gran interés en la comunidad médica a nivel mundial, siendo la tercera causa de lesión renal aguda adquirida en el hospital.\u0000Objetivo: el presente artículo presenta una revisión de la literatura con el fin de actualizar los conceptos de esta patología en el personal de la salud que está en contacto con la población pediátrica y que es sometida a procedimientos con medios de contraste.\u0000Metodología: en esta revisión narrativa de la literatura, presentamos la definición, los factores de riesgo, el enfoque clínico y las medidas preventivas de la nefropatía inducida por contraste en pediatría.\u0000Resultados: se define que hay un deterioro en la función renal aguda después de la administración del medio de contraste en donde se excluyen otras posibles etiologías y se establece una verdadera relación causal con la sustancia. Los factores de riesgo son múltiples, sin embargo, factores estrictamente relacionados en los niños no han sido establecidos en su totalidad. El abordaje de los pacientes que van a ser sometidos a estudios con medios de contraste inicia desde una historia clínica, un examen físico y unas medidas de laboratorio que permiten evaluar el estado basal de cada paciente para instaurar medidas preventivas. Por su parte, las estrategias de prevención de esta condición son múltiples, sin embargo, no existen guías basadas en la evidencia acerca de esta condición en el paciente pediátrico.\u0000Conclusiones: el artículo presenta una revisión de la literatura sobre lesión renal aguda para actualizar los conceptos de esta patología en el personal de la salud que está en contacto con la población pediátrica que se somete a procedimientos con medios de contraste.","PeriodicalId":121036,"journal":{"name":"Revista Colombiana de Nefrología","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126068121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Additional Considerations in the Treatment of Diabetic Nephropathy Based on the KDOQI Clinical Practice Guideline","authors":"Jorge Rico Fontalvo, Juan David Montejo Hernández, Rodrigo Daza Arnedo, José Cabrales","doi":"10.22265/acnef.9.3.602","DOIUrl":"https://doi.org/10.22265/acnef.9.3.602","url":null,"abstract":"Obesity is a risk factor for the development and progression of CKD, which has been shown in numerous studies. The mechanism of how this occurs is not completely understood, but several putative mechanisms proposed via adiposity, include low adiponectin high leptin and resistin, causing inflammation, insulin resistance, RAAS activation and oxidative stress, leading to CKD; in addition, it also causes diabetes mellitus, hypertension, and cardiovascular disease. Obesity is a persistent inflammatory state, and inflammation has been shown to play an important role in the development and progression of diabetic kidney disease, hence controlling obesity has become a key component as a preventative strategy in the development of kidney disease.\u0000 ","PeriodicalId":121036,"journal":{"name":"Revista Colombiana de Nefrología","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124498185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal change disease associated with Graves’ disease and methimazole use","authors":"Andrés Fernando Rodríguez-Gutiérrez, Sandra Liliana Cabezas","doi":"10.22265/acnef.9.3.599","DOIUrl":"https://doi.org/10.22265/acnef.9.3.599","url":null,"abstract":"Introduction. Graves' disease causes kidney injury through multiple mechanisms, including the treatment for this condition. Nephrotic syndrome due to minimal change disease (MCD) is an unusual form of such kidney injury; the association between methimazole use and MCD is also rare. \u0000Case presentation. 36-year-old woman with a history of Graves' disease in use of methimazole for several months, who presented with edematous syndrome due to nephrotic syndrome associated with a KDIGO stage 3 acute kidney injury. Thionamide-induced hypothyroidism and the need of thyroid hormone replacement therapy  was evidenced at the time of consultation. Based on a renal biopsy, the patient was diagnosed with MCD. Her condition worsened as she experienced oliguria and hypervolemia, and renal replacement therapy with hemodialysis was temporarily required. Methimazole administration was suspended, and treatment consisting of prednisolone administration and levothyroxine supplementation was started, achieving hemodialysis suspension, gradual improvement of proteinuria until remission and full and maintained recovery of renal clearance. Radioiodine therapy was implemented as definitive treatment for Graves' disease, obtaining a successful outcome. \u0000Conclusions. Graves' disease and methimazole use are possible causes of minimal change disease. Systemic corticosteroid therapy is a possible management. However, further basic, clinical and epidemiological research on this subject is required.","PeriodicalId":121036,"journal":{"name":"Revista Colombiana de Nefrología","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126691238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semaglutide in Overweight and Obese patients: Cardiovascular and/or Renal Metabolic Benefits","authors":"Jorge Rico-Fontalvo, Rodrigo Daza-Arnedo, Jose Rafael Cabrales Juan, J. Montejo-Hernández","doi":"10.22265/acnef.9.3.614","DOIUrl":"https://doi.org/10.22265/acnef.9.3.614","url":null,"abstract":"We have read the article published by Kadowaki, et al. 1 “Semaglutide once a week in adults with overweight or obesity, with or without type 2 diabetes mellitus in an East Asian population (STEP 6): A randomized, double blind, double dummy, placebo controlled, phase 3a trial”, where the authors conclude that semaglutide at a dose of 2.4 mg, in diabetic and non-diabetic patients, reduces obesity and overweight compared to placebo in East Asian patients. These interesting results, demonstrate once again its benefits regarding overweight and obesity1,2. We consider that there should be several relevant aspects to have in mind. The study shows, once again, that semaglutide might have dose dependent effects and some that aren’t dose dependent, with weight loss being a dose-dependent effect. Regarding renal benefits, we consider that including albuminuria as a variable is of importance, given that only eGFR by CKD-EPI was included in the study. The average eGFR of the patients was 97.2 cc/min, patients with an eGFR less than 30 were excluded (eGFR less than 60 in patients receiving SGLT-2 inhibitors). We mention this since it would’ve been interesting to evaluate albuminuric vs non-albuminuric patients, hence seeing if there are any renal benefits, especially in albuminuric patients that may be dose dependent. Recently, Shaman, et al. 3 reported that liraglutide and semaglutide had renal benefits in type 2 diabetes mellitus, but their effect in albuminuria was higher in patients with 1 mg of semaglutide weekly vs 0.5 mg weekly. The latter allows to hypothesize that this effect may be dose dependent. Given this, it would be of interest to assess if higher doses bring increased renal benefits, as seen in weight loss. In summary, having in mind the renal benefits seen by semaglutide in other studies4, it would be of great importance to verify the impact of albuminuria in patients with obesity.  Hence, we hope that in the upcoming trials, albuminuria is taken into consideration, so that we can highlight not only the cardio-metabolic benefits, but renal benefits in diabetic and non-diabetic patients that are obese or overweight, and to assess if there is a dose-dependent response.","PeriodicalId":121036,"journal":{"name":"Revista Colombiana de Nefrología","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123846004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manifestaciones hepatopancreáticas en síndrome hemolítico urémico atípico","authors":"Diana Vargas, Mariangel Castillo Arteaga, Maria Margarita Sánchez Tordecilla","doi":"10.22265/acnef.9.3.595","DOIUrl":"https://doi.org/10.22265/acnef.9.3.595","url":null,"abstract":"Introducción: el síndrome hemolítico urémico atípico es una enfermedad severa y huérfana, la cual en su variedad atípica se presenta con manifestaciones clínicas extrarrenales y sistémicas. La presencia de afectación gastrointestinal es infrecuente, pero en los pacientes en los que se manifiesta el pronóstico desfavorable, dado que estos cursan con más recaídas y mayor mortalidad, por lo cual se hace indispensable que el personal de salud esté entrenado en detectar y reconocer las manifestaciones menos frecuentes de esta patología, para así impactar positivamente en el desenlace de estos pacientes.\u0000Objetivo: se busca ilustrar un caso singular en cuanto a la sintomatología presentada infrecuente por el paciente y sobre una etiología no descrita previamente en la literatura.\u0000Presentación del caso: se reporta el caso de un escolar masculino de 8 años que presentó fiebre, ictericia, dolor abdominal y lumbar, diarrea, hematemesis y hematuria, al cual se le diagnosticó síndrome hemolítico urémico atípico. El paciente presentó un rápido deterioro clínico con compromiso multiorgánico, documentándose hipertensión arterial y lesión renal aguda, que recibió manejo con cristaloides y diurético de asa sin mejoría, por lo que requirió inicio de terapia de reemplazo renal e incluso múltiple soporte transfusional; sin embargo, continuó sin mejoría clínica, por lo que se indicó inicio de anticuerpo monoclonal IgG humanizado recombinante con buenos resultados.\u0000Discusión y conclusión: este caso es un claro ejemplo de que la afectación extrarrenal y multiorgánica puede ser la manifestación principal de esta enfermedad, por lo que es importante que el clínico se encuentre sensibilizado y conozca los signos y los síntomas de la presentación atípica de esta patología, con el fin de evitar retrasos diagnósticos y terapéuticos. Asimismo, el abordaje etiológico es de suma importancia para brindar un pronóstico más preciso al paciente y su familia.","PeriodicalId":121036,"journal":{"name":"Revista Colombiana de Nefrología","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130543830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cistitis hemorrágica por adenovirus en trasplante renal: revisión epidemiológica y resultados clínicos","authors":"Carlos Fernando Acuña, L. Valderrama, A. Mejía, Antonio Paredes-Fernández, Margarita Ramírez","doi":"10.22265/acnef.9.2.579","DOIUrl":"https://doi.org/10.22265/acnef.9.2.579","url":null,"abstract":"Contexto: la infección de vías urinarias (IVU), causada por adenovirus (ADV) posterior al trasplante renal, tiene el potencial de causar disfunción o pérdida del injerto. La presentación clínica es variable y el tratamiento difiere según la disponibilidad de medicamentos en el medio y la experiencia clínica.\u0000Objetivo: el estudio describe las características clínicas, de laboratorio y la respuesta al tratamiento de una serie de casos de pacientes trasplantados renales con IVU por ADV en un hospital de Cali, Colombia.\u0000Metodología: estudio retrospectivo que incluye a todos los pacientes adultos trasplantados con diagnóstico de IVU por ADV entre enero del 2015 hasta enero del 2021. El diagnóstico se realizó basado en la clínica, el resultado positivo de la prueba de reacción de cadena de polimerasa (PCR) y la carga viral del ADV.\u0000Resultados: de 256 pacientes trasplantados, ocho presentaron diagnóstico de cistitis hemorrágica o nefritis intersticial secundaria a infección por ADV. Se presentó de forma temprana (? 3 meses) en el 62?% de los casos, quienes debutaron con macrohematuria asociada a piuria estéril y linfopenia. Por otra parte, se presentó alteración en la función renal en el 87,5?% de los casos y la reducción de la inmunosupresión fue el pilar fundamental en el manejo clínico.\u0000Conclusiones: el reconocimiento de la infección por ADV en pacientes trasplantados renales ha ido en aumento. La sospecha clínica es clave para el diagnóstico (macrohematuria, síntomas urinarios irritativos y falla renal) y la reducción de la dosis de inmunosupresión para restaurar la función inmune puede ser suficiente en la resolución de la infección y la reversión de la disfunción renal.","PeriodicalId":121036,"journal":{"name":"Revista Colombiana de Nefrología","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114070705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}