J Ortuño

Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain

Are you J Ortuño?

Claim your profile

Publications (384)1889.21 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Pauci-immune vasculitis is a heterogeneous disorder with an unfavourable prognosis. Renal involvement is frequently observed in antineutrophil cytoplasm autoantibody (ANCA)-associated small-vessel vasculitis and is an important cause of end-stage renal disease (ESRD). Renal replacement therapy (RRT) is frequently required. Although better prognosis under dialysis is well known, the long-term follow-up of pauci-immune renal vasculitis with RRT is rarely reported. We described 24 patients with pauci-immune vasculitis and requirement of dialysis who were admitted in our institutions from January 1989 to December 2008. Mean age was 65 ± 12 years at the beginning of dialysis. There were 12 males and 12 females. Patients with Wegener's granulomatosis, Churg-Strauss syndrome or evidence of anti-glomerular basement membrane were excluded. The study group was formed by patients with a diagnosis of necrotizing extracapillary glomerulonephritis and microscopic polyangiitis. The distribution according to ANCAs was 14 p-ANCA (58%), 5 c-ANCA (21%) and 5 ANCA-negative (21%) pauci-immune renal vasculitis. Pulmonary renal syndrome (PRS) was observed in 10 patients at the onset of vasculitis. Corticosteroids and daily cyclophosphamide were administered to 18 patients, and one patient had intravenous cyclophosphamide. Five patients received isolated corticosteroid therapy. Early reduction in cyclophosphamide dosage was required in five patients due to leucopaenia. Mean follow-up after first dialysis was 89 ± 66 months (range 2-208). Twenty patients were included in haemodialysis (HD), and four patients were included in peritoneal dialysis (PD). At the end of the study, nine patients had received a cadaveric kidney transplant (KT). Relapses rate after the onset of dialysis was 0.03 episode/patient/year. PRS-associated relapses after beginning dialysis were observed in four patients. Main therapy in relapses was also corticosteroids and cyclophosphamide. Survival rates for year 1, 2 and 5 was 91%, 91% and 85%, respectively. Overall mortality at the end of the study was 31.8%. Five patients died in the PRS group, but only one death was associated with progressive pulmonary fibrosis. Higher mortality was observed in PRS vasculitis present at the onset of RRT (50% vs 16.7%, P = NS). Better outcome in patients who received a renal transplantation was observed (88.8% vs 53.8%, P = NS). Conclusions. Despite a low number of patients in this series, pauci-immune vasculitis prognosis under dialysis seems equal to other causes of chronic kidney disease. This study observed a low rate of relapses after beginning dialysis. Poor prognosis is related to severe complications at the beginning of RRT. Today, kidney transplantation is an important therapeutic option for these patients.
    Nephrology Dialysis Transplantation 04/2011; 26(4):1360-6. · 3.37 Impact Factor
  • Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis. 01/2010; 30(3):374-8.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Peritoneal dialysis (PD) accounts for 6% of patients on maintenance dialysis. There are several factors responsible for this low prevalence. Transfer of patients to hemodialysis when any problem in the technique is present is probably one of the most frequent reasons. Thus, when a problem in the PD catheter appears they are routinely removed instead of subjecting to salvage procedures. We report three cases of accidental cutting of the peritoneal catheter and present the steps taken to salvage the catheter without discontinuing the technique and avoiding withdrawal of the catheter.
    Seminars in Dialysis 10/2009; 22(6):677-8. · 2.25 Impact Factor
  • Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 05/2009; 29(2):175-6. · 1.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Kidney transplant recipients are considered to have chronic kidney disease (CKD) irrespective of glomerular filtration rate (GFR) or presence or absence of markers of kidney damage. The aim of this work was to investigate the prevalence of CKD-stages and whether the guidelines for general population (Kidney Disease Outcomes Quality Initiative) are routinely followed in kidney transplant in Spain. Two thousand one hundred sixty renal transplant recipients followed up at the outpatient clinics in 4 University Hospitals were included. The estimated GFR (eGFR) was calculated according to the abbreviated modification of diet in renal disease equation, and the patients were classified following the Kidney Disease Outcomes Quality Initiative stages. Chronic kidney failure (eGFR <60 mL/min/1.73 m) was present in 1505 patients (69.7%), 54.4% were 3T-stage (eGFR 30-59); 13.0% were 4T-stage (eGFR 15-30), and 2.3% were 5T-stage. The prevalence of severe anemia increased from 4.1% in 1T-stage to 44% in 5T-stage (P=0.000) as did the percentage of patients on erythropoiesis-stimulating agents from 1.3% to 68% (P=0.000). The intact parathyroid hormone levels increased as graft function declined and 45% of 5T-stage patients had intact parathyroid hormone levels more than 300. Calcium and vitamin D supplements were administered to 50% and 40% of patients, respectively. Hypertension was quite common and increased with the progression of CKD. The mean total cholesterol was 192+/-39 mg/dL, and the levels did not increase with the decline in graft function. Approximately 60% had suboptimal cholesterol despite 50% being on statins treatment. CKD and their complications were prevalent in renal transplant recipients. The control of some of these complications is far below targets established for nontransplant CKD patients despite a progressive intensification of therapy as graft function declines.
    Transplantation 05/2009; 87(9):1340-6. · 3.78 Impact Factor
  • Transplantation 02/2009; 87(2):303-4. · 3.78 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The use of M-tor inhibitors plus withdrawal of anticalcineurins after 3 months of posttransplantation is usually linked to improvements in renal function. The long-term effects of substitution of anticalcineurinis by everolimus remain unknown. The aim in this study was to evaluate the evolution of renal function and the proteinuria after a complete switch of long-term functioning allograft patients to everolimus. We treated 30 renal transplanted patients with everolimus, at a mean time posttransplantation of 123.8 +/- 74.2 months. The 27 patients, including 17 treated with tacrolimus and 10 with cyclosporine, who were controlled for at least 6 months were included in this study. Seventeen of them were diagnosed to display chronic allograft nephropathy (CAN). The patients with CAN showed a basal creatinine of 1.81 +/- 0.4; with after a year, 1.61 +/- 0.38; and after 2 years, 1.56 +/- 0.49 mg/dL (P < .05). No significant changes were observed among patients without CAN: 1.1 +/- 0.32, 0.97 +/- 0.15, and 0.97 +/- 0.15 mg/dL, respectively. In CAN patients, the protein/creatinine quotient was: basal = 0.30 +/- 0.13, one year = 0.63 +/- 0.68, and 2 years = 0.48 +/- 0.34. In the other patients the values were 0.2 +/- 0.07, 0.73 +/- 0.7, and 0.32 +/- 0.17, respectively, after a late switch to everolimus. The improved renal function occurred mainly in patients with CAN. Patients who did not suffer from it showed a greater rise in proteinuria. Nevertheless, both groups experienced decreased proteinuria after 2 years.
    Transplantation Proceedings 01/2009; 41(6):2345-7. · 0.95 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Kidney Disease Outcome Quality Initiative (K/DOQI) clinical practice guidelines in chronic kidney disease (CKD) give some recommendations about diagnosis and treatment of vitamin D deficiency. These guidelines may also be applied to renal transplant recipients. The aim of the present study was to assess the vitamin D status and the effects of vitamin D3 supplements among a cohort of kidney graft recipients. Five hundred nine renal transplant recipients with a follow-up of more than 12 months were included in this retrospective cross-sectional study. A total of 189 patients were treated with vitamin D3 supplements, 171 with calcitriol (0.25 or 0.5 microg x 3 weekly) and 18 with cholecalciferol (400 IU/d). 25OHD deficiency was present in 38.3% of patients, insufficiency in 46.9%, and normal levels in 14.7%. There were no differences in the prevalence of deficiency or insufficiency between patients who were not treated or those who were treated with vitamin D3 supplements. Upon multivariate analysis, 25OHD concentrations correlated with gender, length of follow-up, season of 25OHD determination, iPTH and 1.25OHD concentrations, and treatment with ACEI/ARB (R(2) = 0.17; P = .000). 25OHD deficiency or insufficiency is frequent after renal transplantation even in sunny regions. The clinical significance of such a high prevalence of apparent 25OHD deficiency/insufficiency is unclear and requires further study.
    Transplantation Proceedings 01/2009; 41(6):2388-90. · 0.95 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Use of mycophenolate mofetil (MMF) in kidney transplantation has led to significant improvements in the acute rejection index and graft survival. Posttransplant MMF levels are known to be of value for discriminating patients at risk of acute rejection. Trough MMF levels were measured in 153 patients who had undergone kidney transplantation more than 1 year before and showed stable graft function. MMF dosage was adjusted based on hematologic or gastrointestinal toxicity. The quotient between the weight-adjusted dose and through MMF levels was calculated in order to establish absorption type. We analyzed the diagnostic value of this quotient in relation to creatinine proteinuria, hematologic and gastrointestinal toxicity based upon percentiles of 10, 25, 50, 75, and 90, which were used as cutoff points. Mean MMF levels were 3.79 +/- 3.3 mg/L. Mean quotient value was 6.55 +/- 9.2. A significant correlation was found between MMF dosage and MMF trough levels (r = .34, P < .01). However, no correlation was seen between MMF dosage and the quotient. There were no significant differences in the analyzed parameters and the percentiles established as cutoff points. However, patients with gastrointestinal toxicity had a larger quotient (9.07 +/- 7.45.3 vs 5.28 +/- 4.9). The relationship between MMF dose and levels does not establish differences in kidney function and proteinuria among stable transplant patients; patients with diarrhea may show decreased absorption.
    Transplantation Proceedings 01/2009; 41(6):2317-9. · 0.95 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: New immunosuppressive regimens have dramatically reduced rejection rates but this positive effect has not been followed by an improvement in long-term graft outcomes. The aim of the present work was to investigate the incidence of graft rejection and graft outcomes with various immunosuppressive protocols. Included in our study were 1029 first renal transplantations performed at our unit between November 1979 and December 2007. Basal immunosuppression included azathioprine (AZA) in 198 recipients, cyclosporine (CsA) in 524 recipients, and tacrolimus (TAC) in 307 recipients. Recipient and donor ages increased progressively from the AZA to the TAC era. Delayed graft function was less frequent among AZA than CsA and TAC recipients (29.8 vs 39.3% vs 42.0%; P = .014). The incidence of acute rejection episodes was 68.7% on AZA, 38.2% on CsA, and 11.4% on TAC (P = .000). Graft survival rates at 1, 5, and 10 years were 69%, 56%, and 46% on AZA, 82%, 69%, and 54% on CsA, and 88%, 77%, and 60% on TAC, respectively (P = .001). However, the differences disappeared when only grafts surviving >12 months were analyzed. On multivariate analysis, the variables associated with worse graft outcomes after 12 months were older recipient age, male gender, longer time on dialysis, lower body weight, and higher serum creatinine level at 6 months. New immunosuppressants have decreased the incidence of acute rejection. But this was not followed by a significant improvement in graft outcomes after 12 months. The beneficial effects on rejection are possibly affected by the older age of donor and recipient and the worse early graft function.
    Transplantation Proceedings 01/2009; 41(6):2357-9. · 0.95 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of the present study was to investigate the prevalence of hyperparathyroidism among a population of kidney graft recipients. We investigated biochemical bone parameters of 509 renal transplant recipients with a mean follow-up of 113 +/- 76 months. Among these patients, 257 patients were treated with either vitamin D or calcium supplements or both. The mean estimated glomerular filtration rate (eGFR) was 47.2 +/- 18.4 mL/min/1.73 m(2) and the mean intact parathyroid hormone (iPTH) level was 144 +/- 149 pg/mL. A total of 70 patients (13.7%) had hypercalcemia defined by a corrected serum calcium >10.2 mg/dL. When the patients were classified according to iPTH concentrations following the Kidney Disease Outcome Quality Initiative (K/DOQI) clinical practice guidelines: 22.4% had iPTH <70 pg/mL; 30.8% between 70 and 110 pg/mL; 16.5% between 110 and 150 pg/mL; 24.3% between 150 and 300 pg/mL; and 6.9% >300 pg/mL. There were no differences in biochemical bone parameters between those that were or were not on calcium and vitamin D supplements, but there was a higher percentage of patients with normal iPTH among the treated group (28.0% vs 16.7%; P = 0.003). In patients not receiving calcium and/or vitamin D supplements, multiple linear regression demonstrated that only time on dialysis, eGFR, and serum 25-hydroxyvitamin D (25OHD) levels were significantly predictive of iPTH concentrations (R(2) = 0.21; P = .000). About 80% of patients displayed high iPTH concentrations. The persistence of hyperparathyroidism was associated with graft dysfunction, longer time on dialysis, and low concentrations of 25OHD. Treatment with vitamin D produced a slight improvement in the prevalence of hyperparathyroidism.
    Transplantation Proceedings 01/2009; 41(6):2391-3. · 0.95 Impact Factor
  • European Urology Supplements - EUR UROL SUPPL. 01/2009; 8(4):144-144.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Available studies of early serum creatinine (SCr) as a surrogate marker for long-term graft loss are multicenter, registry-based or limited to 5- to 7-year survival. This was a single-center observational retrospective study. SCr during the first year post-kidney transplant as an independent variable in determining long-term (>10-year) graft survival in 754 first cadaver kidney transplants was assessed with univariate and multivariate models. Kaplan-Meier survival estimates showed that recipient female sex, a transplant procedure performed after 1997, donor age under 55 years, immunosuppression including tacrolimus and/or mycophenolate mofetil and absence of acute rejection, were significantly related to better long-term graft survival. SCr at 1, 3, 6 and 12 months stratified into <or=1.5, 1.6-2 and >2 mg/dL groups was also strongly related to long-term graft survival. Multivariate Cox models showed that increased SCr at any point during the first year had a higher relative risk for ultimate graft loss. Early graft function is strongly correlated with long-term graft survival (>or=10 years). Mild differences in SCr (1.5 vs. 1.6-2 mg/dL) are associated with highly significant impact on long-term survival, longer than previously described. However, the "hard" predictive value of SCr as an isolated tool is not strong enough. Other early surrogate end points for graft loss are needed.
    Journal of nephrology 01/2009; 22(1):90-8. · 2.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Renal graft thrombosis is an important cause of early graft loss. In a case-controlled analysis including only thrombosed kidneys and their counterparts from the same donors, we found that the right kidney as opposed to the left kidney was the only risk factor for early graft vascular thrombosis. No other recipient, donor, or perioperative factor was significantly associated with the complication. Our findings suggested that implantation of a right kidney might be followed by prophylactic anticoagulant or antiaggregant therapy.
    Transplantation Proceedings 12/2008; 40(9):2891-3. · 0.95 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The European tacrolimus versus ciclosporin A microemulsion (CsA-ME) renal transplantation study showed that tacrolimus was significantly more effective in preventing acute rejection and had a superior cardiovascular risk profile at 6 months. The endpoints of this investigator-initiated, observational, 36-month follow-up were acute rejection incidence rates, rates of patient and graft survival and renal function. An additional analysis was performed using the combined endpoints BPAR, graft loss and patient death. Data available from the original ITT population (557 patients; 286 tacrolimus and 271 CsA-ME) were analysed. A total of 231 tacrolimus and 217 CsA-ME patients participated. At 36 months, Kaplan-Meier-estimated BPAR-free survival rates were 78.8% in the tacrolimus group and 60.6% in the CsA-ME group, graft survival rates were 88.0% and 86.9% and patient survival rates were 96.6% and 96.7%, respectively. The estimated combined endpoint-free survival rate was 71.4% with tacrolimus and 55.4% with CsA-ME (P <or= 0.001, chi-square test). Significantly more CsA-ME patients crossed over to tacrolimus during the 3-year follow-up: 21.2% versus 2.6%, P <or= 0.0001, chi-square test. Most patients in the tacrolimus arm discontinued steroids and received monotherapy and fewer tacrolimus patients remained on a triple regimen. Mean serum creatinine concentration was 145.4 +/- 90.9 micromol/L with tacrolimus and 149.0 +/- 92.1 micromol/L with CsA-ME. Significantly more CsA-ME patients had a classified cholesterol value >6 mmol/L (26.3% versus 12.6%, P <or= 0.0003, chi-square test). Patients treated with tacrolimus had significantly higher combined endpoint-free survival rates and lower acute rejection rates with less immunosuppressive medication at 36 months.
    Nephrology Dialysis Transplantation 07/2008; 23(7):2386-92. · 3.37 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Atherosclerotic cardiovascular disease is the most common cause of death among hemodialysis patients; it has been attributed to increased oxidative stress, dyslipidemia, malnutrition, and chronic inflammation. Activation of neutrophils is a well-recognized feature in dialysis patients, and superoxide-anion production by neutrophil NADPH oxidase may contribute significantly to oxidative stress. The aim of the study was to compare the effects of dietary supplementation with concentrated red grape juice (RGJ), a source of polyphenols, and vitamin E on neutrophil NADPH oxidase activity and other cardiovascular risk factors in hemodialysis patients. Thirty-two patients undergoing hemodialysis were recruited and randomly assigned to groups to receive dietary supplementation with RGJ, vitamin E, or both or a control condition without supplementation or placebo. Blood was obtained at baseline and on days 7 and 14 of treatment. RGJ consumption but not vitamin E consumption reduced plasma concentrations of total cholesterol and apolipoprotein B and increased those of HDL cholesterol. Both RGJ and vitamin E reduced plasma concentrations of oxidized LDL and ex vivo neutrophil NADPH oxidase activity. These effects were intensified when the supplements were used in combination; in that case, reductions in the inflammatory biomarkers intercellular adhesion molecule 1 and monocyte chemoattractant protein 1 also were observed. Regular ingestion of concentrated RGJ by hemodialysis patients reduces neutrophil NADPH-oxidase activity and plasma concentrations of oxidized LDL and inflammatory biomarkers to a greater extent than does that of vitamin E. This effect of RGJ consumption may favor a reduction in cardiovascular risk.
    American Journal of Clinical Nutrition 05/2008; 87(4):1053-61. · 6.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: After a period of time using an arteriovenous (AV) fistula as vascular access for hemodialysis, kidney transplant recipients usually undertake surgical closure if the fistula is not spontaneously closed. In all prospective studies addressing this issue, absence of major adverse events and progressive decrease in left ventricular volume and mass is the rule. However, in these studies, patients with heart failure New York Heart Association (NYHA) III or IV were not included, and consequently, the effects of AV ligation in these high-risk patients are not well known. We present a heart failure NYHA IV renal transplant patient with fatal evolution after surgical closure of her high-flow AV fistula.
    Annals of Vascular Surgery 02/2008; 22(1):134-5. · 0.99 Impact Factor
  • Source
    Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2008; 28(2):222-3. · 1.27 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Relapses of p-ANCA vasculitis during chronic dialysis treatment are infrequent. We report a patient with a pulmonary-renal syndrome and p-ANCA vasculitis who relapsed one year after starting hemodialysis treatment. Treatment with steroids and cyclosphosphamide successfully controlled the relapse, though cyclophosphamide had to be discontinued because of leucopenia. Clinical features of renal vasculitis, relapse after dialysis, the usefulness of ANCA titles as possible predictors and therapeutic options are discussed.
    Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2008; 28(4):457-60. · 1.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Kidney Disease Quality Initiative (K/DOQI) of the National Kidney Foundation has published guidelines for the diagnosis and management of chronic kidney disease (CKD). Renal transplant recipients frequently have CKD and complications similar to native kidney disease patients. The purpose of the present study was to compare the management of CKD complications of transplant recipients and nontransplant patients. Eighty three renal transplant recipients with CKD stages 4T and 5T were compared with 83 nontransplant CKD patients matched by CKD stage. There were no differences between the groups in serum hemoglobin, prevalence of anemia, and percentage of patients treated with erythropoiesis-stimulating agents, but serum ferritin levels were higher among recipients (186.3 +/- 161.3 vs 119.1 +/- 113.4 ng/mL; P = .003). Mean blood pressure (BP) was similar in both groups but a systolic BP > 130 mm Hg was more frequent among recipients (83.3% vs 72.6%). More recipients were treated with either angiotensin-converting enzyme (ACE)-inhibitors or angiotensin receptor antagonist (43.3% vs 8.4%; P < .001). Low-density lipoprotein cholesterol was lower in recipients (108.9 +/- 30.3 vs 120.8 +/- 39.5 mg/dL; P = .033) and a higher percentage was on statin treatment (44.6% vs 28.9%; P = .053). Serum calcium was higher in transplant recipients (9.5 +/- 0.8 vs 8.9 +/- 0.7 mg/dL; P < .005) and phosphate was lower (3.9 +/- 0.9 vs 4.2 +/- 1.1; P = .043); there were no differences in intact parathyroid hormone blood levels. The management of renal transplant recipients is no worse than that of nontransplant patients. However, in both populations, some parameters are far from the target recommended by the guidelines.
    Transplantation Proceedings 01/2008; 41(6):2409-11. · 0.95 Impact Factor

Publication Stats

2k Citations
1,889.21 Total Impact Points

Institutions

  • 1985–2011
    • Hospital Universitario Ramón y Cajal
      • Departamento de Investigación
      Madrid, Madrid, Spain
  • 2007
    • Hospital Universitario Severo Ochoa
      Madrid, Madrid, Spain
  • 2005
    • Comunidad de Madrid
      Madrid, Madrid, Spain
    • Hospital Universitario Henares
      Madrid, Madrid, Spain
  • 1994–2005
    • University of Alcalá
      Cómpluto, Madrid, Spain
  • 2002
    • Hospital 12 de Octubre
      Madrid, Madrid, Spain
  • 1986
    • Centro Especial Ramón y Cajal
      Madrid, Madrid, Spain