Trabajos de Grado

|

Alteraciones tromboelastográficas en pacientes con urgencia dialítica

Torres Serrano, Rodolfo | 2016-01-15

Background: Renal insufficiency triggers alterations in blood homeostasis, increasing the risk of thrombotic events or bleeding. Objective: To determine coagulation abnormalities in patients with renal insufficiency and dialytic urgency based on thromboelastography and conventional tests. Patients and methods: A series of 32 adult patients hospitalized by the Nephrology Department with dialytic urgency who did not receive renal replacement therapy and who required catheter placement prior to dialysis. Blood samples were taken at admission, and a study of the thromboelastography and conventional tests (bleeding time, hemogram, platelet count, and coagulation times) was performed to evaluate homeostatic abnormalities. Results: Using thromboelastography, 59.4% of the patients were identified as being in a hypercoagulable state, followed by hyperfibrinogenemia in 53.1% and platelet hyperaggregability in 34.4% of the patients, while the partial thromboplastin and bleeding times were cataloged as hypercoagulable in 6.4% and 3.6% of the patients, respectively. The prothrombin time was not altered in the study. The changes in the platelet count were very minor and not clinically significant. Conclusions: The most frequent coagulation disorder identified by thromboelastography in patients with dialytic urgency was the hypercoagulable state, which was not observed with other conventional tests and was explained by the overall assessment of the cellular and enzymatic functions of coagulation, which other studies failed to evaluate.

Comportamiento del perfil mineral óseo en diálisis peritoneal ambulatoria continua vs diálisis peritoneal automatizada

Olivares Algarín, Orlando | 2016-06-01

Introducción: En países como Estados Unidos, la mayoría de pacientes con insuficiencia renal crónica que inician diálisis peritoneal lo hacen en la modalidad de diálisis peritoneal automatizada; estudios que valoran los resultados comparando con diálisis peritoneal continua ambulatoria concluyen que no hay diferencias significativas en variables como mantenimiento de la función renal residual, calidad de vida, incidencia de peritonitis y manejo de hipervolemia. Objetivo: El objetivo del presente estudio es comparar los resultados del comportamiento del perfil mineral óseo (inicial y a los 9 meses) en pacientes adultos en dos modalidades de diálisis (diálisis peritoneal automatizada vs diálisis peritoneal continua ambulatoria). Métodos: Se condujo un estudio de cohorte retrospectivo en 2 unidades renales de Fresenius Medical Care en Bogotá – Colombia. Se tomaron datos a los 9 meses desde el ingreso del paciente. La normalidad de las variables se evaluó mediante la prueba de Shapiro Wilk; para las comparaciones según la modalidad de diálisis peritoneal se empleó la prueba U de Mann-Whitney. Resultados: El estudio incluyó 98 pacientes en diálisis peritoneal (51 en diálisis peritoneal automatizada y 47 en diálisis peritoneal continua ambulatoria). El 43,9% de los pacientes es de sexo masculino; la mediana de edad fue de 53,5 años (RIC: 19-65). Aunque no se han encontrado diferencias estadísticamente significativas, es importante tener en cuenta las tendencias evidenciadas en este corto tiempo, especialmente en aquellos pacientes que aún conservan su función renal residual, así como el comportamiento de este ion en los diferentes tipos de transportador. Conclusiones: A la luz del presente estudio no es posible hacer recomendaciones para la elección de una modalidad específica de DP basado solo en el comportamiento del PMO. Se recomienda el seguimiento de la cohorte con reporte de resultados a 3 y 5 años para establecer con mayor fiabilidad la existencia o no de resultados diferenciales.

Hallazgos histológicos en biopsia por protocolo asociados con reducción en función renal 12 meses post trasplante en receptores de trasplante renal con bajo riesgo inmunológico recibiendo inducción con Basiliximab

Montero, Camilo | 2016-06-29

Introduction: Identifying factors that are associated of allograft function loss might be an important step toward prolonging kidney allograft survival. Purpose: In this study we found to determine the association between histologic changes on 1-year surveillance biopsies and changes in graft function. Methods: Recipients of kidneys from deceased donors or living donors trasplanted between 2007 and 2012. The primary end point was reduction in calculated glomerular filtration rate (Cockroft anf Gault) higher 5ml/min 12 months post transplant vs calculated glomerular filtration rate previous surveillance biopsie. Results: This analysis included 114 adults, recipients of kidneys with low immunological risk receiving basiliximab induction from deceased donors (95%) or living donors (5%), transplanted between august 2007 and july 2012. The primary end point was reduction in calculated glomerular filtration rate (Cockroft & Gault) higher 5ml/min 12 months post trasplant . 25 of 114 patientes showing reduction; The histologic changes associated with renal function reduction were glomerulitis (p=0,024), interstitial inflamation (p=0,001), tubulitis (p=0,001), capilaritis (p=0,001), glomerulitis + capilaritis (p=0,001), polyoma virus nephropathy (p=0,04) and subclinical rejection (p=0,015). By regression analyses, interstitial inflamation (OR = 2,11; IC 95%: 1,13-3,95) and capilaritis (0R=7,12; IC 95%:1,57-32,27) were associated with renal function redcution 12 month post-transplant. Conclusion: inflammation and capilaritis in protocol biopsies in first year post-transplant predict loss of graft function and independently of other variables.