espanolIntroduccion y objetivos: La anticoagulacion sistemica se utiliza de forma habitual en la hemodialisis, pero puede estar contraindicada o ser aconsejable no utilizarla en algunos casos. Pretendemos analizar mediante este estudio observacional que con el dializador de triacetato de celulosa Solacea 21 H pueden realizarse sesiones de hemodialisis sin heparina. Material y metodos: Estudio prospectivo observacional, pacientes en Hemodialisis en el HCU Lozano Blesa de Zaragoza. Criterios de inclusion: Realizacion de dialisis sin heparina con dializador de Triacetato de Celulosa (Solacea). En todas las sesiones realizadas se evalua la coagulacion del circuito sanguineo: Nivel 0.- No hay coagulacion evidente de capilares. Nivel 1.-0 a 25% capilares coagulados. Nivel 2.- 25 a 50% capilares coagulados. Nivel 3.- de 50 a 75% de capilares coagulados. Nivel 4.- 75 a 100% capilares coagulados, suspension anticipada de la sesion de HD. Resultados: Un total de 33 pacientes han sido dializados con HD sin heparina con el dializador Solacea 2,1 H. De ellos, 7 fueron descartados por no disponer de todos los datos. Edad media 68 ± 13,2, varones 20 casos por solo 6 mujeres. Numero de sesiones realizadas con dializador Solacea y dialisis sin heparina 96 ± 6,8 sesiones (rango entre 1 y 39 sesiones). Valoracion del nivel de coagulacion: Nivel 0, 79 sesiones (82,4%); nivel 1, 13 (13,5%); nivel 2, 2 (2,1%); nivel 3, 0 y nivel 4, 1 sesion (1%). Conclusiones: El dializador de Triacetato de Celulosa Solacea es una opcion util a valorar en dialisis sin heparina. EnglishIntroduction: Systemic anticoagulation is used routinely in hemodialysis, but it may be contraindicated in some cases. We analyze through this observational study whether hemodialysis sessions without heparin can be performed with the Solacea 21 H cellulose triacetate dialyser. Material and methods: Prospective observational study, patients on hemodialysis at the HCU Lozano Blesa de Zaragoza. Inclusion criteria: Carrying out dialysis without heparin with a Cellulose Triacetate dialyzer (Solacea). In all the sessions, the coagulation of the blood circuit is evaluated: Level 0.- There is no evident coagulation of capillaries. Level 1.- 0 to 25% coagulated capillaries. Level 2.- 25 to 50% coagulated capillaries. Level 3.- 50 to 75% of coagulated capillaries. Level 4.- 75 to 100% clotted capillaries, early suspension of the HD session. Results: A total of 33 patients have been dialysed with HD without heparin with the Solacea 2.1 H dialyzer. Of these, 7 were discarded due to not having all the data. Mean age 68 ± 13.2, males 20 cases for only 6 females. Number of sessions performed with Solacea dialyzer and dialysis without heparin 96 ± 6.8 sessions (range between 1 and 39 sessions). Coagulation level assessment: Level 0, 79 sessions (82.4%); level 1, 13 (13.5%); level 2, 2 (2.1%); level 3, 0 and level 4, 1 session (1%). Conclusions: The Solacea Cellulose Triacetate dialyzer is a useful option to evaluate in dialysis without heparin
espanolLa hipertension arterial y la fragilidad son patologias comunes asociadas al envejecimiento. Su enfoque al considerar el tratamiento antihipertensivo podra tener implicaciones en el pronostico vital del paciente. El grado de control de presion arterial a alcanzar en el anciano fragil deberia individualizarse, para lo cual se hace necesario implementar una correcta evaluacion de fragilidad y de la situacion clinica en los protocolos y guias de hipertension arterial. EnglishHypertension and frailty are common pathologies associated with aging. Your approach in considering antihypertensive treatment may have prognostic implications patient´s. The degree of blood pressure to be achieved in the frail elderly should be individualized, for which it is necessary to implement a correct assessment of frailty and of the clinical situation in the protocols and guidelines for hypertension.
espanolLas gammapatias monoclonales son un conjunto de enfermedades que sintetizan y segregan una inmunoglobulina monoclonal o uno de sus componentes (cadenas ligeras o pesadas). Dentro de esta patologia hay diferentes entidades entre las que se encuentran la gammapatia monoclonal de significado incierto, mieloma multiple, macroglobulinemia de Waldenstrom y otras enfermedades hematologicas de la serie blanca. Recientemente se ha definido la gammapatia monoclonal de significado renal como aquella cuya patologia se limita a nivel renal sin sintomatologia en otros organos. Menos conocida es la afectacion renal por gammapatias monoclonales diferentes al mieloma multiple. En general, el dano se produce por el acumulo de inmunoglobulinas y/o de sus partes (cadenas ligeras o pesadas) en los distintos compartimentos renales (glomerulo, tubulo, intersticio, vasos) formando o no depositos. Estos depositos pueden ser tanto organizados como no organizados. La enfermedad renal en la macroglobulinemia de Waldenstrom es infrecuente y, generalmente, se debe al acumulo de proteina amiloide, GMN crioglobulinemica, deposito de IgM o infiltracion directa de las celulas linfoplasmociticas al intersticio renal. A raiz de un caso clinico en el Hospital Universitario Miguel Servet, realizamos una revision donde se resumen las principales caracteristicas de las enfermedades renales de las gammapatia monoclonales. EnglishMonoclonal gammopathies are a group of diseases that synthesize and secrete a monoclonal immunoglobulin or one of its components (light or heavy chains). Within this pathology there are different entities like monoclonal gammopathy of uncertain significance, multiple myeloma, Waldenstrom macroglobulinemia and other hematological diseases of the white series. Monoclonal gammopathy of renal significance has recently been defined as one whose pathology is limited to the kidney without symptoms in other organs. Less well known is renal involvement by monoclonal gammopathies different than multiple myeloma. In general, the damage is produced by the accumulation of immunoglobulins and / or their parts (light or heavy chains) in the different renal compartments (glomerulus, tubule, interstitium, vessels), forming or not deposits. These can be both organized and unorganized. Kidney disease in Waldenstrom macroglobulinemia is rare and is generally due to accumulation of amyloid protein, cryoglobulinemic GMN, IgM deposition, or direct infiltration of lymphoplasmacytic cells into the renal interstitium. As a result of a clinical case at the Miguel Servet University Hospital, we carried out a review that summarizes the main characteristics of monoclonal gammopathy kidney diseases.
Since the last months of 2019, SARS-CoV-2 was identified as a highly contagious virus, March 11, 2020 WHO classified SARS-CoV-2 as a pandemic. Since April 21, 2020 Mexican Government declared Phase 3 of his Contingency plan to fight SARS-CoV-2 pandemic. SARS-CoV-2 is mainly a respiratory virus, but there are reports of involvement in organs distant from the lungs, including the kidneys. SARS-CoV-2 kidney involvement is sign of worse prognosis. Is important to know the characteristics of this injury, the way to diagnose it, its treatment and how to prevent it. Here we review some theories about kidney injury related to SARS-CoV-2 infection and its histopathological correlation. We also evaluate the relationship between SARS-CoV-2 and Angiotensin Converting Enzyme 2 receptors, the kidney injury related to the use of the novels therapies against SARS-CoV-2, renal replacement therapies prescription in SARS-CoV-2 y in kidney transplant patients. Since the lasts months SARS-CoV-2 has invaded and modified our knowledge and daily routine. Healthcare staff from the different specialties, including Nephrologist must keep in constant learning and training to fight against this pandemic with the better weapons.
espanolEl sindrome hemolitico uremico atipico (SHUa) es una enfermedad ultra-rara que se asocia a mal pronostico vital y fallo renal irreversible en un porcentaje elevado de casos. El tratamiento especifico con eculizumab, basado en la patogenia de la enfermedad, ha cambiado drasticamente el pronostico de estos pacientes, siendo aun limitada su experiencia a largo plazo. Presentamos un caso de SHUa en dialisis peritoneal con una recuperacion renal tardia tras recibir tratamiento con eculizumab. EnglishAtypical hemolytic uremic syndrome (aHUS) is an ultra-rare disease associated with a poor life prognosis and irreversible kidney failure in a high percentage of cases. Based on the pathogenesis of the disease, treatment with eculizumab, has drastically modified the prognosis of these patients, but long-term results are still limited. We report a case of aHUS on peritoneal dialysis with a late renal recovery after treatment with eculizumab.
