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Biomedical subjects

F Liaño

Publications and source records attributed to F Liaño.

At least 19 recordsLinked to original sources
PubMed2003

A low incidence of new-onset insulin-dependent diabetes mellitus using tacrolimus in kidney recipients in Europe.

Employing tacrolimus (Tac) for routine immunosuppression in renal transplantation (RT), produced an incidence of new-onset, insulin-treated, diabetes mellitus (newDM) as high as 20%. More recently, several large multicenter kidney studies using Tac as the primary immunosuppressant have been reported in Europe. Between 1997 and 2001, we performed 155 RTs using Tac (0.2 mg/k/per day, targeting whole blood trough levels <15 ng/mL) with a rapid steroid taper. The acute rejection rate was 13%, and 89% of grafts are still functioning. Only 5 Tac-treated patients not previously requiring insulin needed insulin therapy for > or =30 days (3.2%). Eight separate studies employing Tac in at least one arm (N=2728) have been reported between 1997 and 2002. Tac was combined with azathioprine or MMF, and/or steroids. The incidence of new DM at study end ranged from 2.3% to 8.3%. The only trial with >6% incidence was the first one, using an initial dose of 0.3 mg/kg per day. The most recent studies utilized an initial dose of 0.2 mg/kg per day, targeting whole blood trough levels of <15 ng/mL and a steroid taper, with newDM at <6%. On the basis of these data, we confirm in that the use of Tac as a first-line immunosuppressant in renal transplant patients affords protection against acute rejection with a low level of newDM. The tendency to employ lower oral doses of Tac, lower blood target levels, and a reduced steroid dose appear to minimize glucose disturbances in RT.

Diabetes Mellitus, Type 1↗
PubMed2003

Cytomegalovirus infection after renal transplantation: selective prophylaxis and treatment.

We have reviewed our experience in selective cytomegalovirus (CMV) infection prophylaxis and treatment in our renal transplant population. Between 1996 and 2001, 263 cadaveric renal transplant recipients had at least 6 months follow up. Immunosuppression was based on cyclosporine Neoral (n=108) or tacrolimus (n=155). CMV infection prophylaxis (oral acyclovir or gancyclovir at half usual doses) was only prescribed in recipients receiving a CMV positive ve kidney and in recipients treated with OKT3. CMV infection was diagnosed by a positive pp65 antigenemia upon appearance of CMV-related symptoms, leading to specific treatment (IV ganciclovir) only if symptoms were intense or there was visceral involvement. Thus, no preemptive treatment or programmed or periodic antigenemia was performed in any case. Nineteen episodes of symptomatic CMV infection were diagnosed (prevalence 7.2%). The frequency was similar for all immunosuppressive regimens. Only 9 of 19 (47%) of patients were given IV ganciclovir; the others were not treated. All patients survived without apparent complications, relapses, or recurrences. No oral gancyclovir was delivered after IV treatment. Our CMV prophylaxis protocol was limited to high-risk patients, using lower gancyclovir dosages than those usually advocated. It does not include programmed or scheduled search for CMV antigenemia in asymptomatic renal transplant patients. Despite these factors, our CMV infection rate and severity were similar to those reported with more aggressive protocols, with extended prophylaxis, preemptive therapy, or intense surveillance.

Acyclovir↗
PubMed2001

Prognosis of patients with acute renal failure without cardiopathy.

BACKGROUND: The outcome for children with acute renal failure (ARF) may be poor. However, relatively few published studies have considered prognosis of these patients. METHODS: We prospectively studied, from 1978 to 1998, 92 such children without heart disease to try to identify risk factors for mortality. RESULTS: Forty five per cent of children with tumours, shock, and other causes died compared with none of those with a primary urinary tract related problem. ARF did not seem to be the cause of death in any case. Univariate analysis showed that in the non-primary urinary problem group (55 cases), patients with hypotension, high values of BUN or creatinine, or who needed mechanical ventilation or dialysis, had a poor outcome. Multivariate analysis showed that probability of death can be estimated using the following score: -0.02 + 0.28 (hypotension) + 0.19 (ventilation) + 0.27 (dialysis) + 0.01 (BUN). CONCLUSIONS: Mortality of patients with ARF was related to aetiology, the need for dialysis and/or ventilator use, hypotension, and BUN values.

Acute Kidney Injury↗
PubMed2000

Differences between blood flow as indicated by the hemodialysis blood roller pump and blood flow measured by an ultrasonic sensor.

BACKGROUND/AIM: The ultrasonic transit time is currently the best method for measuring the blood flow rate in the extracorporeal hemodialysis circuit. The purpose of this study was to analyze the differences between blood flow as indicated by the hemodialysis blood roller pump (prescribed blood flow) and by an ultrasonic flowmeter (delivered blood flow). METHODS: The ultrasonic blood flow was measured in 20 patients on chronic hemodialysis who were dialyzed through an arteriovenous fistula. During each dialysis session the ultrasonic blood flow was measured at three different blood roller pump flow rates (300, 350, and 400 ml/min). In order to analyze the influence of inflow and outflow pressures on blood flow, this study was conducted during nine consecutive dialysis sessions during which needles of different sizes were used. RESULTS: The ultrasonic flow was always lower than indicated by the blood roller pump: 265+/-12, 304+/-15, and 341+/- 19 ml/min for blood roller pump flow rates of 300, 350, and 400 ml/min, respectively (variability: -11.6, -13.1, and -14.8%, respectively). An univariate regression analysis showed that the reduction in flow recorded ultrasonically correlated with both venous blood line pressure (r = -0.2679, p<0.001) and negative arterial blood line pressure (r = 0. 6773, p<0.001). By multivariate analysis, only the arterial blood line pressure has a predictive value. When all measurements were grouped by arterial blood line pressure ranges, the variability between ultrasonic blood flow and blood roller pump flow was found to be similar in those groups with the same arterial blood line pressure, regardless of the blood roller pump flow rate. CONCLUSIONS: The blood flow indicated by the dialysis blood roller pump is always greater than the delivered blood flow, and this difference is in turn conditioned by the negative pressure induced by the blood roller pump in the arterial blood line.

Blood Flow Velocity↗
PubMed2000

[Nanobacteria. An experimental neo-lithogenesis model].

OBJECTIVE: To study the phenomenon of biomineralization in an experimental model of lithogenesis by percutaneous renal punction without laparotomy and no antibiotics. METHODS/RESULTS: The study comprised 4 Brown-Norway rats. Nanobacteria inoculum (X, 2X and 4X) was administered to three rats and the remaining one was used as control. The analytical and radiological findings showing the development of obstructive pyelocaliceal lithiasis in the kidneys of rats no. 2 and 3 are presented. CONCLUSIONS: Translumbar percutaneous renal puncture has permitted performing laparotoy without antibiotic coverage, which was the main difficulty of the experimental model of lithogenesis. Nanobacteria were cultured successfully, but not without difficulty, and formation of calculi in the rat pyelocaliceal system was achieved. This experimental model will provide further insight into lithogenesis and will allow us to find the answers to some of the many questions concerning this condition that remain.

Animals↗
PubMed1998

Laryngeal tuberculosis in renal allograft patients.

Laryngeal tuberculosis, although the most common granulomatous disease of the larynx, is a rare form of extrapulmonary tuberculosis, never reported in immunosuppressed allograft recipients. We present two cases of laryngeal tuberculosis in renal transplant patients and a review of the literature. Two women, a 29-year-old and a 60-year-old, each more than 9 years after their cadaveric renal allograft, presented with a 2-week febrile illness with hoarseness and dysphagia, and both were found to have laryngeal tuberculosis by direct laryngoscopy. Although both radiographs were unremarkable, both patients had sputum positive for acid-fast bacilli that subsequently grew Mycobacterium tuberculosis. Clinical response promptly followed institution of isoniazid, rifampicin, and pyrazinamide in each case, although both required threefold increases in daily cyclosporin A dosage to maintain therapeutic levels.

Adult↗
PubMed1998

Causes and prognosis of acute renal failure in the very old. Madrid Acute Renal Failure Study Group.

OBJECTIVES: There is a tendency to treat older people with Acute Renal Failure (ARF) less aggressively because of the presumed less acceptable end results. This has not been proved, and their prognosis may be similar to that found in the younger population. There are no studies on the incidence, causes, and evolution of ARF in patients 80 years of age and older. DESIGN: A multicenter, prospective, longitudinal study. SETTING: The 13 hospitals with nephrology units that serve the 4.2 million people in Madrid, Spain. MEASUREMENTS: A number of demographic, clinical, and therapeutic variables were studied in each case. RESULTS: One hundred three episodes of ARF occurred in patients 80 years of age and older (Group 1), 256 in patients aged 65 to 79 years (Group 2), and 389 in people younger than age 65 (Group 3). Acute tubular necrosis was diagnosed in 39% of cases in Group 1, in 48% in Group 2, and in 55% in Group 3 (P = .004, 1 vs 3); prerenal ARF was diagnosed in 30%, 28%, and 21% (P = .054, 1 vs 3) and obstructive ARF in 20%, 11%, and 7% (P < .001, 1 vs 3) of cases, respectively. Serum creatinine at admission, peak values, values at discharge or death, duration of both admission and ARF episode, and mortality were similar in all groups. In stratified analysis, relative risk for mortality in patients aged more than 80 years was 1.09 [95%CI 0.86,1.36 (P = .562)], and in those aged 65 to 79 it was 0.99 [95%CI 0.83,1.18 (P = .954)] compared with patients aged less than 65 years. Risk of death was also similar when only acute tubular necrosis cases were considered. Sustained hypotension was associated with higher mortality (44% of nonsurviving older persons vs 9% of survivors, P < .001). CONCLUSION: Age is not a particularly poor prognostic sign, and outcome seems to be within acceptable limits for very old patients with ARF. Acute dialysis should not be withheld from patients solely because they are more than 80 years of age.

Acute Kidney Injury↗
PubMed1998

The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group.

Acute renal failure (ARF) is at a crossroads between nephrology and intensive care medicine. However, there seems to be wide differences between the ARF observed in the intensive care unit (ICU) compared to that observed in other areas of the hospital, particularly when examining the mortality rate. Among the ICU patients the 70% mortality rate is higher to the 50% found in an overall series of studies. Recently, Druml proposed that there is a changing trend in the clinical spectrum of ARF as a convincing reason to justify these differences. According to him, we are moving from an ARF seen as a mono-organ failure to another one observed in a multiorgan dysfunction syndrome (MODS) context. Although extremely coherent, this hypothesis has not been fully confirmed in a prospective study. In fact, most authors seem to look at the problem from opposite sides of the river, either from the critical medicine or the nephrological bank. To the best of our knowledge, only one retrospective study has dealt with this topic by comparing outcome of ARF in ICU and non-ICU patients. In this article we aim to overcome this problem by reviewing the data of the prospective epidemiological ARF study carried out in Madrid using two different approaches: (1) comparing the ARF cases observed in the ICU setting with those ARF studied outside the ICU, and (2) comparing the outcome of isolated ARF with the outcome of ARF as part of a MODS in patients treated in both settings.

Acute Kidney Injury↗
PubMed1998

Outcomes in acute renal failure.

Although patients with acute renal failure (ARF) are now older and sicker than in the past, mortality remains constant or even slightly lower, which suggests a better management of the syndrome. Several clinical conditions, mainly assisted respiration, hypotension, oliguria, coma and jaundice, have a detrimental effect on outcome. Previous health status, original disease, a hospital and/or ICU start of the ARF, and age of the patient also seem to affect outcome of these patients. ARF observed in the ICU setting has a poorer prognosis than the ARF treated in other hospital areas. This is because of the higher number of associated organ failures observed in the ICU. Estimation of outcome could be done either using specific ARF or general ICU score systems. They allow risk stratification of the patients, and some of them give an individual prognosis that at present should not be used for a withdrawal decision. Functional outcome of ARF is usually good, although some patients need to be maintained on chronic dialysis.

Acute Kidney Injury↗