... JL Teruel, J. Martins, JL Merino, M. Fernández Lucas, M. Rivera, R. Marcén C. Quereda y J. Or... more ... JL Teruel, J. Martins, JL Merino, M. Fernández Lucas, M. Rivera, R. Marcén C. Quereda y J. Ortuño Servicio de Nefrología. ... Tres enfermos fue-ron excluidos de entrada: dos por sufrir un proceso intercurrente (infección de catéter intravenoso y cua-dro isquémico cerebral) y el ...
To appraise the prognosis of adult polycystic kidney disease (APKD), 107 patients (58 male and 49... more To appraise the prognosis of adult polycystic kidney disease (APKD), 107 patients (58 male and 49 female) were studied retrospectively. The mean age at the time of diagnosis was 45.9 years (ages ranging from 18 to 83 years). Ninety-eight patients had symptomatic APKD. At diagnosis, 30 of these patients had normal renal function, and 68 presented with chronic renal failure (serum creatinine higher than 1.5 mg/dl). Nine of the 107 patients were asymptomatic. Hypertension was the most common feature in symptomatic APKD, present in 51% of these patients as initial manifestation, and was observed in 46% of the patients with normal renal function. Forty of the 107 patients (37%) went into end-stage renal disease (ESRD) at a mean age of 52.7 years. The probability of being alive and not having ESRD, estimated using a time-to-event analysis, was 74% by the age of 50, 51% by the age of 58 and 37% by the age of 70 years. Thus, the prognosis for patients with APKD is better than some reports suggested some years ago.
The influence of body iron stores on the concentration of serum erythropoietin was studied in 48 ... more 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.
BACKGROUND AND AIMS The safety of non-selective -blockers (NSBB) has been questioned in refractor... more BACKGROUND AND AIMS The safety of non-selective -blockers (NSBB) has been questioned in refractory ascites (RA). We studied the effects of NSBB on cardiac systolic function, systemic hemodynamics, and renal perfusion pressure (RPP) and function in patients with diuretic-responsive (DRA) and RA. METHODS Prospective pre-post repeated-measures study in cirrhotic patients, 18 with DRA and 20 with RA on NSBB for variceal bleeding prophylaxis. The following were measured at baseline and 4-weeks after propranolol: systolic function by the ejection intraventricular pressure difference (EIVPD), hepatic venous pressure gradient (HVPG), cardiopulmonary pressures, RPP, and sympathetic activation. RESULTS EIVPD was elevated at baseline (RA: 4.5 [2.8-5.7] and DRA: 4.2 [3.1-5.7] mmHg; normal: 2.4-3.6 mmHg) and directly related to the severity of vasodilation and sympathetic activation. NSBB led to similar reductions in heart rate and HVPG in both groups. NSBB reduced EIPVD in RA but not in DRA (-20% vs. -2%, p<0.01). In RA, the reduction in EIPVD by NSBB correlated with the severity of vasodilation and with higher plasma nitric oxide, norepinephrine and IL-6 (r>0.40, all p<0.05). NSBB reduced RPP in both groups, but impaired renal function only in RA. Reduction in EIPVD by NSBB correlated with decreases in RPP and eGFR (r>0.40, all p<0.01). After NSBB, RPP dropped below the threshold of renal flow autoregulation in 11 of the 20 (55%) RA patients, including the 4 fulfilling HRS-AKI criteria. CONCLUSION Renal perfusion and function depend critically of systolic function and sympathetic hyperactivation in RA. NSBB blunt the sympathetic overdrive on cardiac function, hamper cardiac output, lower RPP below the critical threshold and impair renal function.-blockade should be cautious or even avoided in RA.
Objectives: The present study was conducted to determine the prevalence of renal artery stenosis ... more Objectives: The present study was conducted to determine the prevalence of renal artery stenosis (RAS) after kidney transplantation (KT) in hypertensive patients, the efficacy of transluminal angioplasty in the treatment of hypertension secondary to RAS and the morbidity and mortality of angioplasty. Methods: RAS was suspected in patients with hypertension refractory to medical treatment, with or without functional deterioration or murmur over the graft. Hypertension control, renal function and requirement of drugs were evaluated in 578 transplants performed from 1979 to 1994. Results: The prevalence of hypertension post-transplantation was 43.8% (253/578): 14.2% (42/253) had arteriographically demonstrated RAS, accounting for 7.2% (42/578) of the series. Of these 42 patients, 23 (57%) received antihypertensive drugs: 13 (31%) were treated by angioplasty and 6 (12%) underwent surgical revascularization as the first approach. In the patients submitted to transluminal angioplasty, the stenosis was postanastomotic in 7 and anastomotic in 5: one patient was lost to follow-up. Angioplasty was successful in 8 patients and failed in 4. A graft was lost due to artery thrombosis. Complications were observed in 8 patients. There were no deaths and the incidence of RAS recurrence postangioplasty was 33% (4/12). Conclusions: RAS is a potentially reversible cause of hypertension post-transplantation. Transluminal angioplasty is the first approach in RAS when medical treatment has failed. The success rate of angioplasty was 66% and the incidence of RAS recurrence was 33%.
... JL Teruel, J. Martins, JL Merino, M. Fernández Lucas, M. Rivera, R. Marcén C. Quereda y J. Or... more ... JL Teruel, J. Martins, JL Merino, M. Fernández Lucas, M. Rivera, R. Marcén C. Quereda y J. Ortuño Servicio de Nefrología. ... Tres enfermos fue-ron excluidos de entrada: dos por sufrir un proceso intercurrente (infección de catéter intravenoso y cua-dro isquémico cerebral) y el ...
To appraise the prognosis of adult polycystic kidney disease (APKD), 107 patients (58 male and 49... more To appraise the prognosis of adult polycystic kidney disease (APKD), 107 patients (58 male and 49 female) were studied retrospectively. The mean age at the time of diagnosis was 45.9 years (ages ranging from 18 to 83 years). Ninety-eight patients had symptomatic APKD. At diagnosis, 30 of these patients had normal renal function, and 68 presented with chronic renal failure (serum creatinine higher than 1.5 mg/dl). Nine of the 107 patients were asymptomatic. Hypertension was the most common feature in symptomatic APKD, present in 51% of these patients as initial manifestation, and was observed in 46% of the patients with normal renal function. Forty of the 107 patients (37%) went into end-stage renal disease (ESRD) at a mean age of 52.7 years. The probability of being alive and not having ESRD, estimated using a time-to-event analysis, was 74% by the age of 50, 51% by the age of 58 and 37% by the age of 70 years. Thus, the prognosis for patients with APKD is better than some reports suggested some years ago.
The influence of body iron stores on the concentration of serum erythropoietin was studied in 48 ... more 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 &amp;amp;lt; 0.01). Serum erythropoietin levels were higher in the 18 ferropenic patients (serum ferritin &amp;amp;lt; 50 ng/ml) than in the 30 patients with normal serum ferritin concentration (18 +/- 13.8 vs. 7.8 +/- 4.7 mIU/ml, p &amp;amp;lt; 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 &amp;amp;lt; 0.01). Our data would suggest that the concentration of erythropoietin in hemodialyzed patients is influenced by the serum ferritin level.
BACKGROUND AND AIMS The safety of non-selective -blockers (NSBB) has been questioned in refractor... more BACKGROUND AND AIMS The safety of non-selective -blockers (NSBB) has been questioned in refractory ascites (RA). We studied the effects of NSBB on cardiac systolic function, systemic hemodynamics, and renal perfusion pressure (RPP) and function in patients with diuretic-responsive (DRA) and RA. METHODS Prospective pre-post repeated-measures study in cirrhotic patients, 18 with DRA and 20 with RA on NSBB for variceal bleeding prophylaxis. The following were measured at baseline and 4-weeks after propranolol: systolic function by the ejection intraventricular pressure difference (EIVPD), hepatic venous pressure gradient (HVPG), cardiopulmonary pressures, RPP, and sympathetic activation. RESULTS EIVPD was elevated at baseline (RA: 4.5 [2.8-5.7] and DRA: 4.2 [3.1-5.7] mmHg; normal: 2.4-3.6 mmHg) and directly related to the severity of vasodilation and sympathetic activation. NSBB led to similar reductions in heart rate and HVPG in both groups. NSBB reduced EIPVD in RA but not in DRA (-20% vs. -2%, p<0.01). In RA, the reduction in EIPVD by NSBB correlated with the severity of vasodilation and with higher plasma nitric oxide, norepinephrine and IL-6 (r>0.40, all p<0.05). NSBB reduced RPP in both groups, but impaired renal function only in RA. Reduction in EIPVD by NSBB correlated with decreases in RPP and eGFR (r>0.40, all p<0.01). After NSBB, RPP dropped below the threshold of renal flow autoregulation in 11 of the 20 (55%) RA patients, including the 4 fulfilling HRS-AKI criteria. CONCLUSION Renal perfusion and function depend critically of systolic function and sympathetic hyperactivation in RA. NSBB blunt the sympathetic overdrive on cardiac function, hamper cardiac output, lower RPP below the critical threshold and impair renal function.-blockade should be cautious or even avoided in RA.
Objectives: The present study was conducted to determine the prevalence of renal artery stenosis ... more Objectives: The present study was conducted to determine the prevalence of renal artery stenosis (RAS) after kidney transplantation (KT) in hypertensive patients, the efficacy of transluminal angioplasty in the treatment of hypertension secondary to RAS and the morbidity and mortality of angioplasty. Methods: RAS was suspected in patients with hypertension refractory to medical treatment, with or without functional deterioration or murmur over the graft. Hypertension control, renal function and requirement of drugs were evaluated in 578 transplants performed from 1979 to 1994. Results: The prevalence of hypertension post-transplantation was 43.8% (253/578): 14.2% (42/253) had arteriographically demonstrated RAS, accounting for 7.2% (42/578) of the series. Of these 42 patients, 23 (57%) received antihypertensive drugs: 13 (31%) were treated by angioplasty and 6 (12%) underwent surgical revascularization as the first approach. In the patients submitted to transluminal angioplasty, the stenosis was postanastomotic in 7 and anastomotic in 5: one patient was lost to follow-up. Angioplasty was successful in 8 patients and failed in 4. A graft was lost due to artery thrombosis. Complications were observed in 8 patients. There were no deaths and the incidence of RAS recurrence postangioplasty was 33% (4/12). Conclusions: RAS is a potentially reversible cause of hypertension post-transplantation. Transluminal angioplasty is the first approach in RAS when medical treatment has failed. The success rate of angioplasty was 66% and the incidence of RAS recurrence was 33%.
Uploads