Benjamín Romero-Navarro

Hospital Infantil de México Federico Gómez, Ciudad de México, The Federal District, Mexico

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Publications (15)11.59 Total impact

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    ABSTRACT: The aim of the study was to evaluate whether or not serum levels of soluble interleukin 2 receptor (sIL-2R) predict acute rejection in pediatric recipients. We studied 51 pediatric renal transplant recipients divided into three groups: Group 1) Biopsy-proven cellular acute rejection (n = 19), Group 2) Graft dysfunction with histological diagnosis other than acute rejection (n = 8) and Group 3) Patients with stable graft function, no biopsy (n = 24). Serum samples for sIL-2R measurement by sandwich ELISA were obtained at the time of renal transplant and at the time of renal biopsy due to graft dysfunction (Groups 1 and 2) or at six months post-transplant in the case of Group 3. The mean ± s.e. serum values of sIL-2R were higher in patients during acute rejection (6539 ± 1802 pg/mL) compared to patients with other causes of graft dysfunction (2217 ± 256 pg/mL) or stable graft function at six months (2183 ± 283 pg/mL) (Kruskal-Wallis p = 0.004). When the sIL2-R levels at the time of transplant were compared to those at the time of biopsy (Groups 1 and 2) or at six months post-transplant in Group 3, there was no significant difference between baseline and biopsy in the acute rejection group (paired t-test = 0.07), whereas there was a significant reduction in Groups 2 and 3.
    Pediatric Transplantation 02/2012; 16(3):274-9. · 1.50 Impact Factor
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    ABSTRACT: Background. Although new immunosuppressive therapies have signifcantly improved the clinical progression of kidney transplants, acute and chronic rejection continue to limit long-term graft survival. Despite this, the aim of the study was to determine the presence of human leukocyte antigen (HLA) antibodies class I and class II in children with acute renal graft rejection.
    Boletín médico del Hospital Infantil de México. 12/2010; 67(6):492-502.
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    ABSTRACT: The conditions under which the allocation of deceased donor organs takes place are cause for controversy. Objective. To identify the criteria for allocating deceased donor kidneys in pediatric care services in twelve countries in Latin America and the Caribbean. Results. In ten surveyed countries, the waiting lists for kidney transplants in pediatrics are regional, generally for administrative reasons more than to reduce cold ischemia times. HLA matching is done and a point-score system is taken into account when selecting the ultimate recipient. In some countries, young donor (<30 years) kidneys are not always for pediatric recipients. Conclusion. There are point-score systems for allocating deceased donor organs in most Latin American and Caribbean countries, and children have priority. Guatemala and Nicaragua do not have a deceased donor program. In the case of Mexico, although there is a growing transplant structure, there is no point-score system and only some transplant groups, through their own initiative, afford priority to children. A consensus on this issue within in the Latin American transplant community is needed to provide for less subjective and fairer deceased donor kidney allocation.
    Persona y Bioética. 12/2010; 14(2):151-162.
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    ABSTRACT: The Mexican Health Law stipulated that the criteria to be taken into account for deceased donor kidney allocation should include the following: "seriousness of recipient's condition, opportunity of transplant, expected benefits, compatibility with recipient, and all other accepted medical criteria." The practical application of these criteria has been perceived by several members of transplantation committees as allowing inequity in kidney allocation. The aims of this study were to learn the opinions of transplantation committees regarding current national allocation policies, and to obtain their opinions about the advantages of a point-score system. A prepared questionnaire was validated with the collaboration of a team of transplantation physicians from the Mexican Society of Transplantation (MST). Ninety members of the Society, who represent transplantation groups were invited by mail to participate in the survey. We received 70 answered questionnaires, including 54 that represented the views of their respective internal transplantation committees. In agreement with the legislation and allocation policies currently in force were 50% of responders; however, 60% believed that a point-score system for organ allocation should be mandatory and 75% believed that only patients without a possible live donor should be included on the waiting list to compete for a deceased donor kidney. Also, 84% believed that only patients with a complete pre-transplant protocol, including recent viral serology, as well as clinically relevant pre-transplant evaluations by other specialists such as cardiology, psychiatry/psychology and urology should qualify for allocation of deceased donor organs; 76% believed that patients who compete for a deceased donor organ must have permanent support for immunosuppressive drugs as well as for short-term and long-term medical care. The answers gathered through this survey pointed out the necessity for continuous coordinated work between healthcare authorities and members of the MST to achieve the best guidelines for allocation of deceased donor kidneys including a point-score system.
    Transplantation Proceedings 12/2010; 42(10):3924-6. · 0.95 Impact Factor
  • Transplantation 01/2010; 90. · 3.78 Impact Factor
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    ABSTRACT: focal segmental glomerulosclerosis (FSGS) is observed in about 10 % of children with idiopathic nephrotic syndrome; this disorder is usually resistant to corticoid therapy. In the last few years, five histological types of FSGS have been recognized; the collapsing nephropathy type is characterized by a rapid evolution to chronic renal failure. a four-year-old boy presented with an irrelevant past history; eight months before admission he developed idiopathic nephrotic syndrome. He was treated with steroids without improvement, and a renal biopsy was performed in which minimal glomerular changes were found. Despite combined immunosuppressive treatment, he developed renal failure, septic shock and death. Collapsing nephropathy was demonstrated by immunohistochemistry, light and electron microscopy; renal new human papovirus (BK) infection was also found in the postmortem study. collapsing nephropathy is an aggressive disorder resistant to immunosuppressive treatment, as occurred in our patient. Although some viral diseases have been associated with collapsing nephropathy, to our knowledge, BK infection has not been previously described in those patients.
    Revista medica del Instituto Mexicano del Seguro Social 01/2009; 47(1):95-100.
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    ABSTRACT: Introduction. Henoch–Schönlein purpura (HSP) is the most frequent vasculitis in children. Objective: To describe the clinical presentation and clinical outcome in children with HSP treated in our hospital in the last 5 years.
    Boletín médico del Hospital Infantil de México. 10/2006; 63(5):314-321.
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    ABSTRACT: Introduction. Parvovirus B19 can present in children as erythema infectious rash, aplastic anemia in patients with hemolytic diseases and pure red cell aplasia in immunocompromised patients, such as in bone marrow and solid organ transplant recipients.
    Boletín médico del Hospital Infantil de México. 08/2006; 63(4):255-263.
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    ABSTRACT: Despite being considered a high risk procedure, renal transplantation has been recognized for more than 20 years as the best therapeutic option for children with end–stage renal disease since it is superior than any available dialytic procedure in improving the neuropsychological development and the quality of life. Today pediatric patients have similar graft survival than adults, and 10 year–old children or less have better outcome than any other age group. These remarking results are due to the development of specialized pediatric transplant centers and research programs, improvement in the selection and preparation of donors and recipients, refinement of the surgical technique and the use of new immunossupressive drugs.
    Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion 04/2005; 57(2):230-236. · 0.31 Impact Factor
  • Transplantation 01/2004; 78. · 3.78 Impact Factor
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    ABSTRACT: IgA nephropathy, also called Berger's disease, is characterized by recurrent gross hematuria or persistent microscopic hematuria, together with mesangial glomerular deposits of IgA found in the renal biopsy. Seven children with IgA nephropathy were studied. Most of them presented initially with recurrent macroscopic hematuria and low or moderate-grade proteinuria, without hypertension or renal function impairment. Only one patient presented with a rapidly progressive glomerulonephritis. Four patients did not receive any treatment; one of them is in remission, one has improved and two remain with moderate proteinuria and hematuria. One patient with significant proteinuria improved after prednisone and azathioprine treatment. The patient with rapidly progressive glomerulonephritis improved his renal function after oral prednisone and intravenous boluses of methylprednisolone and cyclophosphamide.
    Boletín médico del Hospital Infantil de México 01/1993; 49(12):832-8.
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    ABSTRACT: Several renal and renal-related disturbances have been described in patients with AIDS (acquired immune deficiency syndrome), in adults and children as well. These are mainly electrolyte and acid-base imbalance, acute renal failure and nephrotic syndrome. The latter is usually steroid non-responder. The renal histopathological lesions described more commonly are minimal change, mesangial hyperplasia and focal segmental glomerulosclerosis. Herein, we describe a 5 year-old with AIDS, that developed nephrotic syndrome, characterized by edema, ascites, hypoalbuminemia and massive proteinuria. A percutaneous renal biopsy showed mesangial proliferation. She did not respond to a 6 week treatment with prednisone. She died with sepsis after several viral and bacterial infections.
    Boletín médico del Hospital Infantil de México 10/1992; 49(9):600-4.
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    ABSTRACT: Africanized bees are unique in their aggressive behavior, characterized by massive attacks during which the victims are injected an important amount of venom. For this reason, Africanized bees are extremely dangerous. Their venom contains biological toxic substances, mainly mellitin, phospholipases, histamine, hyaluronidase and apamin. Non-sensitized persons that survive a massive attack may develop acute renal failure, as a consequence of the severe hemolysis, rhabdomyolysis and shock. These complications may lead to acute renal tubular necrosis. Also, the clinical pattern and treatment of the acute renal failure secondary to bee stings are discussed.
    Boletín médico del Hospital Infantil de México 07/1992; 49(6):388-90.
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    ABSTRACT: Despite being considered a high risk procedure, renal transplantation has been recognized for more than 20 years as the best therapeutic option for children with end-stage renal disease since it is superior than any available dialytic procedure in improving the neuropsychological development and the quality of life. Today pediatric patients have similar graft survival than adults, and 10 year-old children or less have better outcome than any other age group. These remarking results are due to the development of specialized pediatric transplant centers and research programs, improvement in the selection and preparation of donors and recipients, refinement of the surgical technique and the use of new immunossupressive drugs.
    Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion 57(2):230-6. · 0.31 Impact Factor
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    ABSTRACT: Anatomic and functional disorders of the lower urinary tract represent up to 40% of the causes of renal failure in children. Several centers avoid renal transplantation in these patients because of the high risk of complications and lower graft survival. The aim of this work was to determine the frequency of urinary tract abnormalities (UTAs) among our pediatric series, and to compare the frequency of complications, function, and long-term graft survival among patients without versus with UTA. This single-center, retrospective study compared outcomes between pediatric recipients with versus without UTA. We analyzed demographic features, etiology, pretransplant protocol, urinary tract rehabilitation, incidence of complications, rejection events, as well as graft function and survival. Among 328 pediatric cases performed between 1998 and 2008, we excluded nine patients due to incomplete medical records, analyzing 319 procedures in 312 patients. Sixty-seven patients (21%) had UTA. The average age, weight, and height at the time of grafting were significantly lower in the urologic group: 11.1 versus 12.6 years, 28.8 versus 34.4 kg; 125.4 versus 138.4 cm, respectively. There were significantly higher frequencies of a transperitoneal approach and vena cavae and aortic anastomoses among patients with UTA (P < .001), posing a greater technical challenge in this population. No differences in creatinine levels were observed at 0.5, 1, 2, 5, and 10 years: 1.3 versus 1.6 at 5 years, and 1.4 versus 1.5 at 8 years. Urologic complications, including urinary tract infections (UTIs), occurred among 80.6% of patients with UTA versus 42.1% in the non-UTA group (P < .001). UTIs appeared predominantly in patients with UTA (62.7% vs 35.3%, P < .001), representing a 2.7-fold risk compared with those children transplanted for other reasons. Rejection incidence was similar in both groups (49.8%). There was no significant difference in 5-y (89.8% vs 85%) or 10-year (83% vs 67%) graft survivals between the groups (P = .162). Our results demonstrated that with proper interdisciplinary care, graft and patient survivals of pediatric recipients with UTAs were not affected; therefore, these patients should not be rejected for transplantation.
    Transplantation Proceedings 42(6):2365-8. · 0.95 Impact Factor