Publications (5)2.7 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Patients with end stage renal disease in dialysis are a population susceptible to suffer various types of cancers, mainly in the kidney and urinary tract. These tissues suffer systemic carcinogenic effects, including all that result from chemical and immunological changes secondary to renal failure, from the treatment they receive and dialysis itself. In the present article we determine the clinical, epidemiological, and pathological characteristics of patients with chronic renal failure in dialysis who presented renal tumors during the evolution of their disease over the last ten years. We reviewed the medical charts of patients with chronic renal failure receiving dialysis in our institution who were diagnosed of renal tumors and received surgical treatment over the last 10 years. Patients with incomplete medical charts, HIV infection, and renal adult policystic disease were excluded from the study. 10 tumors were detected in a total of nine patients with a mean age of 45.22 years (range 41-65 years), six males and three females; regarding the mean time from the start of dialysis to de diagnosis of the tumor: 5 appeared the first year, 2 between 2 and 5 years, and 2 more than five years from the start of dialysis. The most frequent cause of chronic renal failure was high blood pressure, in 55.5% of the patients. 90% of the tumors were diagnosed incidentally during a control study, with ultrasound being the main diagnostic test (100%), a finding that was confirmed with MRI and CT scan in 60% and 30% of the patients respectively. The operative findings were: 8 solid masses, 1 mixed mass, and 1 cystic mass. Six patients underwent open surgery and 4 laparoscopic surgery. The most frequent pathologic diagnosis was clear cell carcinoma in 60% of the tumors. In our study population, we found that performance of periodic ultrasound controls enabled us to achieve early diagnosis and treatment of tumors of the kidney in patients in dialysis. Over the last years laparoscopy has become the treatment of choice for renal tumors, even in patients with chronic renal failure in dialysis.
- [Show abstract] [Hide abstract] ABSTRACT: Resumen.-OBJETIVO: Los pacientes con insuficiencia renal crónica terminal en diálisis, son una población susceptible a padecer diferentes tipos de cánceres, es-pecialmente del riñón y tracto urinario. Estos tejidos padecen los efectos carcinogénicos sistémicos, inclu-yendo todos los que resultan de los cambios químicos e inmunológicos propios de la insuficiencia renal, del tratamiento al que son sometidos y a la terapia dialítica per se. En el presente estudio se determinan las carac-terísticas clínicas y epidemiológicas y anatomopatoló-gicas de los pacientes con insuficiencia renal crónica en diálisis, que presentaron tumores renales durante la evolución de su enfermedad en los últimos 10 años. MÉTODOS: Se revisaron las historias clínicas de los pacientes con insuficiencia renal crónica que recibían tratamiento dialítico en nuestra institución en los últimos 10 años, que presentaron durante la evolución de su enfermedad tumores renales y fueron sometidos a tra-tamiento quirúrgico. Se excluyeron del estudio a los pacientes que tenían una historia clínica con datos in-completos, pacientes con HIV, pacientes con poliquisto-sis renal del adulto. RESULTADOS: Se detectaron10 tumores renales en un total de 9 pacientes con una edad media de 45.22 años (Rango de 41-65 años), 6 varones y 3 mujeres, en relación tiempo promedio de seguir en el programa de diálisis al detectarse el tumor, 5 en el primer año, 2 entre 2 a 5 años y 2 más de 5 años. La causa de insu-ficiencia renal crónica mas frecuente fue la hipertensión arterial en 55.5% de pacientes. El 90% de tumores fue-ron diagnosticados de manera casual durante un estu-dio de control, siendo la ecografía el principal método diagnostico (100%), hallazgo que fue confirmado por RMN y TC en un 60% y 30% respectivamente. Den-tro de los hallazgos radiológicos 8 fueron informados como masas sólidas, 1 como masa mixta y 1 como masa quística. Seis se operaron mediante cirugía abier-ta y 4 por cirugía laparoscópica. El resultado anatomo-patológico mas frecuente fue de tumor de células claras en el 60% de tumores.
- [Show abstract] [Hide abstract] ABSTRACT: Genetic polymorphisms of the renin-angiotensin system (RAS) have been implicated in the pathogenesis of nephropathy and end-stage renal disease (ESRD). The association between angiotensin-converting enzyme (ACE) gene polymorphism and nephropathy evolution was studied. A random sample of 161 subjects from the Nephrology Department (of Hospital de Sant Pau) were divided into two groups: (i) 117 with end-stage renal disease; (ii) 44 with established nephropathy; and (iii) control groups of 129 subjects. The ACE gene polymorphism was performed by using polymerase chain reaction. High DD genotype presentation was observed in the two groups of subjects with nephropathy (46.12 and 61.37%, respectively vs 35.66% in controls; P < 0.0482), and also, a decrease was observed in the II genotype (6.4 and 4.54%, respectively vs 13.17% in controls, P < 0.0404). Glomerular filtration rate (GFR) was evaluated after 44 months of follow up. An important decrease of GFR was observed in patients with DD polymorphism versus other genotypes (initial, 32.3 +/- 7.9 and at 44 months, 18.35 +/- 3.3 mL/min vs 31.4 +/- 11.9 and 11.7 +/- 3.2 mL/min; P < 0.039). In a non-longitudinal study of patients in ESRD, patients with an ACE-DD genotype had a lower period of time between diagnosis of nephropathy and ESRD than patients with other genotypes (10.45 +/- 9.32 vs 19.5 +/- 8.4 years; P < 0.034). In conclusion, the ACE gene that controls RAS response may influence the development and progression of nephropathy to ESRD. Patients who develop several types of nephropathy have a higher risk of severe evolution if they have a profile of ACE-DD genotype.
- [Show abstract] [Hide abstract] ABSTRACT: Inflammatory status is observed in patients with chronic renal failure (CRF). The relationship between oxygen free radical production and dialysis could play an important role in protein oxidation. Carbonyl protein plasma level is an important tool in the study of protein stress, and it is related to the arterial intima thickness in the atherosclerosis process. We studied protein oxidative stress in 21 peritoneal dialysis (PD) patients and 42 hemodialysis (HD) patients as compared with 32 undialyzed patients with CRF. Carbonyl protein plasma levels were measured in nanomoles per milligram protein by the ELISA method (Winterbourn et al). Dialysis patients had a higher protein carbonyl content than did CRF patients (0.1265 +/- 0.04 nmol/mg vs. 0.1594 +/- 0.03 nmol/mg, p < 0.0002). Patients on PD had a lower level than patients on HD (0.1452 +/- 0.03 nmol/mg vs. 0.1665 +/- 0.04, p < 0.004). Glucose administration in PD is known to be able to increase glucose degradation products (GDPs) and advanced glycosylation end-products (AGEs) with high carboxylic and oxidative stress. In our study, the carbonyl protein level was higher in HD patients than in PD patients, perhaps because more protein oxidative stress is associated with hemodialysis technique or because the PD patients had greater residual renal function.
- [Show abstract] [Hide abstract] ABSTRACT: PURPOSE/AIM -To review the clinical indications for the use of central venous catheters. -To define the utility of MDCT in the evaluation of the venous system in candidates for use of venous catheters and related complications. -To show MDCT angiographic technique to perform a proper venous system evaluation and the utility of 3D post processing techniques CONTENT ORGANIZATION - Types of vascular access for haemodialysis are reviewed with special focus on central venous catheters. - Indications for venous evaluation with MDCT are discussed. - MDCT venous angiography protocol and algorithm of 3D reconstructions are given to properly evaluate the cervicothoracic venous system in patients with central venous catheters for dialysis. - A sample of studies from our database is used to show radiological features emphasizing on normal findings and complications. SUMMARY Central venous catheters as vascular access for haemodialysis are increasing in use. In haemodialysis patients the use of iodinated intravenous contrast is not a problem and MDCT venous angiography may be performed. It is a useful tool to study cervicothoracic venous system permeability and anatomy prior central venous catheters implantation, and to evaluate complications related to them.