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F Maduell

Publications and source records attributed to F Maduell.

33 records · Page 2Linked to original sources
PubMed1993

Treatment of nephrotic syndrome associated with idiopathic rapidly progressive glomerulonephritis and cyclosporin A.

Recent reports suggest that cyclosporin A is beneficial in inducing remission of idiopathic nephrotic syndrome. Nephrotic syndrome is seen in 10-30% of patients with rapidly progressive glomerulonephritis. We report a case of a 69-year-old man with nephrotic syndrome, associated with idiopathic rapidly progressive glomerulonephritis, who was treated initially with corticosteroid and cyclophosphamide. Three months later he developed thrombophlebitis and leucopenia and cyclophosphamide was suspended. Relapse of nephrotic syndrome associated with rapidly progressive glomerulonephritis developed and therapy with cyclosporin A was used with a good response.

Administration, Oral↗
PubMed1992

Low molecular weight heparin (CY-216) versus unfractionated heparin in chronic hemodialysis.

In 14 patients undergoing chronic hemodialysis, we investigated the safety and efficacy of the low molecular fragment (CY-216) in comparison to unfractionated heparin (UFH) in the prevention of clotting in the extracorporeal circuit (ECC). In this study, 168 hemodialysis sessions were undertaken with UFH in 2 bolus doses (5,437 +/- 1,477 SD IU) and 231 with CY-216 in a single bolus dose [initial dose 150 anti-Xa U Institut Choay (IC)/kg]. There were no clots in the bubble trap in any UFH sessions, and 14.8% had coagulated fibers in the dialyzer. Clotting in the bubble trap was observed in 2 CY-216 sessions (0.8%) and coagulated fibers in 22.6% of the sessions. At the end of the study, the mean dose of CY-216 was 250 anti-Xa UIC/kg but a dose of 350 anti-Xa UIC/kg was needed in the 2 patients treated by recombinant human erythropoietin. Anti-Xa levels at the end of the runs were higher (0.47 +/- 0.1 U/ml) in the CY-216 group than in the UFH group (0.28 +/- 0.1 U/ml). There was a correlation between anti-Xa levels and efficacy in the CY-216 group. An anti-Xa activity above 0.4 U/ml was needed in order to minimize thrombus formation. Antithrombin III-protease complexes (ATM) and D dimer fibrin derivatives (D dimer) were used as thrombotic markers but they were of little value for the detection of fibrin formation in the ECC. Our findings suggest that CY-216 administered as a single bolus dose seems to be of similar effectiveness to UFH.

Aged↗
PubMed1990

Alterations of the Cl-/NaCO3- anion exchanger in erythrocytes of uraemic patients.

We have studied the transport activity of the erythrocyte anion exchanger by measuring the DIDS-sensitive Li+ influx in fresh red blood cells incubated in HCO3- medium. In addition, the amount of erythrocyte band 3 protein was determined by electrophoretic analysis. The study was performed in twenty uraemic patients on chronic haemodialysis (12 males and 8 females, mean age 47.9 years), and in 20 healthy controls (10 males and 10 females, mean age 44.7 years). Mean time on haemodialysis was 63.9 months (range 6-170 months). The DIDS-sensitive Li+ influx was decreased in erythrocytes from uraemic patients as compared to erythrocytes from controls (619.6 +/- 34.1 vs 761.2 +/- 36.6 mumol/l cell x h, P less than 0.01). The content of band 3 protein was decreased in erythrocytes from uraemic patients as compared to erythrocytes from controls (30.01 +/- 0.39 vs 32.12 +/- 0.48%, P less than 0.01). These results indicate that the Cl-/NaCO3- anion exchanger is altered in erythrocytes from uraemic patients in chronic haemodialysis, and suggest that the regulation of ion content may be compromised in the red blood cells of these patients.

4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid↗
PubMed1990

Loss of renal graft due to recurrent IgA nephropathy with rapidly progressive course: an unusual clinical evolution.

Recurrence of IgA nephropathy following renal transplantation has been described in 40-50% of patients, and it usually has a good outcome. We present the case of a 54-year-old man with IgA nephropathy who developed terminal renal failure in 1985, 3 years after the onset of the disease. In March 1986 he received a cadaveric renal allograft following treatment with ciclosporin and steroids. Eight months later he developed microhaematuria and proteinuria and 10 months later he developed acute nephritic syndrome and rapidly progressive renal failure. Renal biopsy disclosed an IgA nephropathy with epithelial crescents in 60% of glomeruli. Treatment with plasma exchange and cyclophosphamide was unsuccessful and the patient lost his graft and returned to regular haemodialysis 15 months after renal transplantation.

Acute Kidney Injury↗
PubMedDate not supplied

[Interaction of the mechanisms of beta 2-microglobulin convection, diffusion, and adsorption in line hemodiafiltration].

The in vivo contribution of diffusion, convection ad adsorption to beta 2-microglobulin (beta 2-m) elimination by hemodiafiltration (HDF) was investigated. 11 patients (8M/3W), with a mean age of 59 +/- 10 years and weighing 62.7 +/- 8.7 kg were studied. A 1.89 m2 polysulphone membrane was used in 180 min postdilution HDF. Samples at blood inlet (bi), blood autlet (bo), dialysate outlet (do) and ultrafiltrate (uf) were taken to determine beta 2-m concentrations at 30 and 150 min. Rates of flow (Q, ml(min) prescribed were: infusion, Qinf = 103.6 +/- 12.3, Quf = 14.6 +/- 4.0 y Qb = 465 +/- 5.0. Effective Qbi was automatically measured by the machine and Qdo = 800 + Quf. The removed beta 2-m mass (M, mg/min) was obtained by multiplying rates of flow (Q, L/min) by beta 2-m concentrations (mg/L) at each sampling point. From mass balance, we calculated the mass of beta 2-m removed (mg/min) by adsorption 0.23 +/- 0.2, by convection 0.7 +/- 0.3 and by diffusion 1.0 +/- 0.4, at 30 min. At 150 min, the beta 2-m mass removed was -0.06 +/- 0.1 by adsorption 0.4 +/- 0.1 by convection and 0.3 +/- 0.1 by diffusion. In HDF, these beta 2-m eliminating mechanisms play a variable role throughout the session. The more significant conclusion is that diffusion of beta 2-m with a synthetic "open" membrane is an important method of removing beta 2-m, comparable to convection over the whole procedure. That result explain the relative efficacy of beta 2-m clearance by HDF convection, and also explain why isolated diffusion is an efficient mechanism for beta 2-m removal by high-flux hemodialysis.

Female↗
PubMedDate not supplied

[Comparison of dialyzers in on-line hemodiafiltration].

UNLABELLED: At present we have a great variety of high-flux dialyzers whose characteristics in vitro seem similar. On-line HDF is a technique which combines diffusion with elevated convection and uses dialysate as replacement fluid. On-line HDF provides the highest clearances for small, medium-sized and large molecules and gives the best performance from the dialyzers. Conscious of this wide choice of dialyzers we evaluated the performance of different dialyzers in renowing small and medium-large molecules. Eleven patients were included in this study, 7 males and 4 females. Every patient received 11 on-line HDF sessions with Fresenius 4008B machine, Qi 100 ml/min or 6 L/h, QB 400 ml/min, QB 800 ml/min, UF 0.5 L/h and Td 60 min. Only the dialyzer was changed: 1.9 m2 cellulose triacetate (Tricea 190G), 2.1 m2 poly methyl methacrylate of PMMA (BK-2.1P), 1.8 m2 polyester-polymer Allol or PEPA (FLX-18GWS), 2.05 m2 acrylonitrile (Filtral 20), 2.1 m2 polyamide (Poliflux 2.1) and 1.8-2.4 m2 polysulfones (HF 80, BS-1.8S, APS-900, Arylane H9, Idemsa 2000, HdF 100). Arterial pressure, venous pressure and transmembrane pressure (TMP) were monitored. Plasma, urea, creatinine, phosphate, uric acid and beta 2m concentrations were measured at the beginning and at the end dialysis from arterial and venous blood lines, and arterial blood line with the slow flow method. Recirculation, dialyzer solutes clearance and solute reduction rates were calculated. No significant differences were found in arterial pressure, venous pressure and recirculation. Small molecule removal was similar except in BK-2.1P and HdF 100 dialyzers which were lower and higher respectively. There were differences in TMP and beta 2m removal among dialyzers employed. Mean TMP, beta 2m clearance and beta 2m reduction ratio were: Tricea 190G (TMP 336 mmHg, beta 2m K 79 ml/min and beta 2m reduction ratio 44.9%), BK-2.1P (TMP 485, beta 2m K 102 and beta 2mRR 48.3%), FLX-18 GWS (TMP 195, beta 2m K 140 and beta 2mRR 54.6%), Filtral 20 (TMP 245, beta 2m K 132 and beta 2mRR 54.1%), Poliflux 2.1 (TMP 209, beta 2m K 158 and beta 2mRR 56.0%), HF 80 (TMP 208, beta 2m K 160 and beta 2mRR 57.4%), BS-1.8S (TMP 186, beta 2m K 179 and beta 2mRR 59.6%), APS-900 (TMP 174, beta 2m K 176 and beta 2mRR 64.8%), Arylane H9 (TMP 206, beta 2m K 171 and beta 2mRR 59.9%), Idemsa 2000 (TMP 203, beta 2m K 169 and beta 2mRR 60.4%), HdF 100 (TMP 152, beta 2m K 186 and beta 2mRR 64.6%). CONCLUSIONS: Of the dialyzers evaluated in on-line HDF, cellulose triacetate and PMMA have a smaller beta 2m removal and their use is limited by an elevated TMP. The polysulfones provide greater beta 2m removal with lower TMP, particularly the APS-900 and HdF 100 dialyzers. The acrylonitrile, PEPA and polyamide are intermediate.

Equipment Design↗
PubMedDate not supplied

[Assessment of salt intake in hemodialysis].

One of the main goals of dialysis is to reach a correct sodium balance. Dietary sodium restriction facilitates control of thirst, water overload, hypertension and cardiac failure. Nowadays, it is possible to estimate sodium mass transfer and known interdialytic salt intake, by means of non-invasive methods. The use of dialysate sodium profiles improves dialysis tolerance but it has been reported that interdialytic thirst may increase because of an inappropriate sodium balance. The aim of this study was to evaluate the usual salt intake in hemodialysis patients, the effects on interdialytic gain weight, arterial pressure, blood volume preservation and dialysis tolerance of two different profiles of dialysate sodium and an additional session with salt restriction. Seventeen dialysis patients, 12 male and 5 females, were studied. Each patient underwent seven hemodialysis treatments: three consecutives sessions (a week) with constant sodium and ultrafiltration hemodialysis; three consecutive sessions with exponential decrease of conductivity (Initial 15.5-16.0, mid-session 14.3 and at the end 13.9-14 mS/cm) and ultrafiltration (1.6 l/h initial and 0.1 at the end) profiled hemodialysis; and an additional session which had a special dietary salt restriction. Dialysis parameters and dry weight were kept constant. Integra monitor with Diascan and Hemoscan biosensors (Hospal) were used in all sessions. We measured pre- and postdialytic plasma conductivity, sodium mass transfer, interdialytic weight gain, mean arterial pressure (MAP), percent reductions of blood volume (%R-BV) and hypotensive episodes during dialysis. Mean sodium mass transfer was 1,144 +/- 356 mmol (no profile week) vs 1,242 +/- 349 mmol (week with profiles), NS. It was equivalent to a salt ingestion of 9.6 +/- 3 and 10.4 +/- 3 g/day respectively. End plasma conductivity was 14.04 +/- 0.14 (no profile) versus 14.21 +/- 0.08 mS/cm (profiled), p < 0.001. Interdialytic weight gain was 2.49 +/- 0.76 (no profile) vs 2.32 +/- 0.56 kg (profiled), NS. MAP was 101 +/- 11 (no profile) vs 99 +/- 10 mmHg (profiled), NS. The %R-BV was -7.73 +/- 3 (no profile) vs -6.46 +/- 3% (profiled), p < 0.01. Hypotensive episodes/session were 0.66 +/- 0.75 (no profiles) vs 0.41 +/- 0.57 (profiled), NS. Mean sodium mass transfer was 356 +/- 125 mmol with usual salt intake and 240 +/- 81 mmol with salt restriction, p < 0.001. It was equivalent to a salt ingestion of 10.47 +/- 3 versus 7.06 +/- 2 g per day respectively, p < 0.001. Initial plasma conductivity was 14.31 +/- 0.21 (usually sodium intake) versus 14.16 +/- 0.17 mS/cm (salt restriction), p < 0.01. Predialysis blood pressures were decreased with dietary salt restriction, MAP was 99.1 +/- 11 vs 94.4 +/- 12 mmHg (p < 0.01). Interdialytic weight gain decreased with salt restriction, 2.32 +/- 0.76 vs 1.78 +/- 0.49 kg (p < 0.001). The %R-BV was -7.25 +/- 2 (usual sodium intake) vs -5.91 +/- 2% (salt restriction), p < 0.01. Hypotensive episodes/session were 0.71 +/- 0.8 (usual sodium intake) vs 0.18 +/- 0.5 (salt restriction), p < 0.05. In conclusion, automatic measurement of sodium mass transfer is a practical tool to follow dietary salt ingestion in hemodialysis patients. It allows us accurate, individualised and continual dietary interventions. The use of exponential decrease sodium profiles improve dialysis tolerance without changes in sodium balance, interdialytic weight gain or arterial pressure. A reduction of three g in salt intake observed in this study was beneficial in interdialytic weight gain, dialysis tolerance and blood pressure control.

Female↗
PubMedDate not supplied

[Daily hemodialysis].

Explore the source record for details and available documents.

Clinical Trials as Topic↗
PubMedDate not supplied

[Secondary amyloidosis (AA) and renal disease].

Amyloidosis is a disease resulting from extracellular deposition of fibrillar protein in various organs. AA amyloidosis may complicate chronic inflammatory diseases, chronic infections and another chronic diseases. We review 31 patients (13 males and 18 females) with biopsy proven renal or rectal AA amyloidosis, referred to out hospital between january 1999 and november 2002. Renal failure was defined as serum creatinine > or = 1.5 mg/dl. Mean age was 58.4 +/- 15.7 years. The causes of AA amyloidosis were an underlying chronic rheumatologic disease (51.6%), chronic infection (41.9%) and a chronic inflammatory intestinal disorder (6.5%). Renal failure (RF) was detected in 20 patients (61.2%) and proteinuria and hematuria were found in 90.3% and 45.5 respectively. Proteinuria at diagnosis was 5.2 +/- 3.9 g/24 h and mean serum creatinine 3.5 +/- 3.7 mg/dl. Survival of patients without dialysis was 66.8 (51.1% RF, 90.9% non-RF) and 53.4% (38.2 RF, 77.9% non-RF) at 12 and 24 months respectively (p = 0.017). End-stage renal disease developed in 13 patients (41.9%). Ten patients were maintained on hemodialysis and 3 on CAD. Survival in dialysis at 6 and 12 months was 68.3% and 42.7% respectively. Fifteen patients died and the main causes of death were: infections (46.6) haemorrhagic complications (33.3%), cardiovascular events (13.3%) and cachexia (6.6%).

Amyloidosis↗
PubMedDate not supplied

[Evaluation of methods to calculate dialysis dose in daily hemodialysis].

UNLABELLED: Daily dialysis has shown excellent clinical results because a higher frequency of dialysis is more physiological. Different methods have been described to calculate dialysis dose which take into consideration change in frequency. The aim of this study was to calculate all dialysis dose possibilities and evaluate the better and practical options. Eight patients, 6 males and 2 females, on standard 4 to 5 hours thrice weekly on-line hemodiafiltration (S-OL-HDF) were switched to daily on-line hemodiafiltration (D-OL-HDF) 2 to 2.5 hours six times per week. Dialysis parameters were identical during both periods and only frequency and dialysis time of each session were changed. Time average concentration (TAC), time average deviation (TAD), normalized protein catabolic rate (nPCR), Kt/V, equilibrated Kt/V (eKt/V), equivalent renal urea clearance (EKR), standard Kt/V (stdKt/V), urea reduction ratio (URR), hemodialysis product and time off dialysis were measured. Daily on-line hemodiafiltration was well accepted and tolerated. Patients maintained the same TAC although TAD decreased from 9.7 +/- 2 in baseline to a 6.2 +/- 2 mg/dl after six months, p < 0.01. No significant changes were observed in weekly Kt/V and eKt/V throughout the study. However EKR, stdKt/V and weekly URR were increased during D-OL-HDF in 24-34%, 46% and 50%, respectively. Hemodialysis product was raised in a 95% and time off dialysis was reduced to half. CONCLUSION: Dialysis frequency is an important urea kinetic parameter which there are to take in consideration. It's necessary to use EKR, stdKt/V or weekly URR to calculate dialysis dose for an adequate comparison between different frequency dialysis schedules.

Aged↗
PubMedDate not supplied

[Atheroembolic disease. Presentation of a case of multisystemic involvement and review of the literature].

The atheroembolic disease is an entity characterized by obstruction of multiple small arteries by cholesterol crystals. The incidence rises steeply with advancing age and following an invasive procedure involving arteries in patients with atherosclerosis. Actually it has a growing interest due to the increased frequency and to the lack of appropriate therapy. In this paper we report a clinical case of multiple system disease secondary to anticoagulant therapy in a 69 years old patient. We review the pathogenesis, clinical features, laboratory dates and pathology of the disease.

Aged↗
PubMedDate not supplied

[Nephrologic aspects of amyloidosis].

Amyloidosis is a syndrome characterized by intercellular deposition of a predominantly proteic substance in any organ and tissue. The kidney is one of the most affected organs and very important in as much as its involvements might produce the initial manifestations of the syndrome and could be the one responsible to establish the prognosis in many cases. In this paper, the most relevant features of the different types of renal amyloidosis (glomerular, vascular and tubulo-interstitial), and one special type of amyloidosis in patients on chronic hemodialysis and likewise other interesting aspects in the evolution of amyloidosis of kidney transplanted patients were reviewed. Emphasis was placed on renal vascular amyloidosis and on amyloidosis among patients on hemodialysis as these might deserve special clinical and etiopathogenic considerations according to our own experience.

Amyloidosis↗