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J J Villafruela

Publications and source records attributed to J J Villafruela.

17 recordsLinked to original sources
PubMed1998

Delayed graft function does not reduce the survival of renal transplant allografts.

BACKGROUND: The aim of the present study was to investigate the effect of delayed graft function (DGF) in graft outcome when adjusted by the presence of acute rejection in the first month after transplantation. METHODS: A total of 437 cadaveric renal transplant patients on cyclosporine and steroids were included in the study. Variables related to donor, recipient, and graft were prospectively collected. RESULTS: The incidence of DGF was 44.4%. When patients dying with a functioning graft were censored, graft survival rates at 1 and 6 years were similar in patients with immediate function to those with DGF, when rejection was not present (96% and 81% vs. 95% and 83%, respectively). Rejection negatively influenced graft survival rates at 1 and 6 years, both in patients with immediate graft function (80% and 73%, P<0.05 vs. no DGF/no rejection) and more deeply in those with associated DGF (77% and 62%, P<0.001 vs. no DGF/no rejection). Rejection was more frequently diagnosed in patients with DGF than in those with immediate graft function (50% vs. 39.9%, P<0.05). Length of hospitalization was longer and the number of needle core biopsies was higher in patients with DGF or rejection. The presence of both complications had an additive effect. CONCLUSIONS: This study showed that DGF did not adversely affect kidney graft survival in patients without rejection. However, it increased the length of hospitalization and the number of graft biopsies, thus increasing the cost of transplantation. Moreover, rejection was more frequent in patients with DGF, and it had a negative impact on graft outcome. Because the association of DGF and rejection gave the poorest outcome, an effort should be made to prevent both complications.

Adolescent↗
PubMed1996

Urinary calcium excretion in treated and untreated essential hypertension.

A high prevalence of hypercalciuria has been reported in patients with essential hypertension. Nevertheless, the clinical and therapeutic implications of this finding have scarcely been studied. This study was designed to determine the prevalence of hypercalciuria in an unselected population with essential hypertension and to analyze the relationship between the urinary calcium and the clinical and therapeutic status of these patients. This article presents a prospective study of 112 patients with essential hypertension and 49 healthy normotensive control subjects. Urinary excretion rates of calcium, sodium, chloride, potassium, urinary calcium/creatinine index, the fractional excretion of sodium, potassium and uric acid, the creatinine clearance and serum values of creatinine, urea, uric acid, electrolytes, total proteins, parathormone (intact molecule), plasma renin activity, aldosterone, glucose, and insulin (fasting and after an oral glucose load) were performed in every patient and control subject. Untreated hypertensive patients had a higher prevalence of hypercalciuria (35% had a urinary calcium/creatinine ratio > 0.20 versus 20% of treated hypertensives and 2% of control subjects; P < 0.001). Patients on thiazide or beta-blocker monotherapy had lower urinary excretion rates of calcium and urate than patients on calcium-antagonist monotherapy or untreated patients. Urinary calcium, sodium, and urate correlated positively both in treated and untreated essential hypertension patients. Patients with the higher urinary calcium levels also had higher excretion rates of sodium and urate, higher creatinine clearance rates, and lower serum creatinine and serum uric acid levels. It was concluded that hypercalciuria is a frequent finding of untreated essential hypertension. The association of high urinary calcium levels with high urinary urate excretion rates in the same patient may predispose to development of lithiasis in patients with essential hypertension. Antihypertensive drugs have a variable effect on calciuria-uricosuria, which may constitute an additional criterion in the selection and individualization of therapy. Thiazides and beta-blockers can decrease calciuria and uricosuria and, therefore, the lithogenic risk in these patients.

Adrenergic beta-Antagonists↗
PubMed1995

Evolution of serum erythropoietin after androgen administration to hemodialysis patients: a prospective study.

A prospective study of the evolution of serum erythropoietin level after androgen therapy was carried out in a group of 25 male patients on chronic hemodialysis treatment with nonferropenic anemia (serum ferritin > 50 ng/ml). The androgen used was nandrolone decanoate (200 mg/week intramuscularly, for 6 months). There was an increase of serum erythropoietin, that reached statistical significance in the 2nd week of treatment (8.6 +/- 6.4 vs. 14.2 +/- 9.8 mIU/ml, p < 0.05), and a stabilization after 1 month (1 month: 17.8 +/- 11.2 mIU/ml, 6 months: 19.6 +/- 14.9 mIU/ml). The hemoglobin also experienced a parallel increase to that observed in serum erythropoietin (basal value: 8 +/- 0.9 g/dl; at 1 month postandrogen: 9.2 +/- 1.3 g/dl, p < 0.001; at 6 months: 10.7 +/- 1.8 g/dl, p < 0.001). According to their response of serum erythropoietin the patients were divided into responders (15 patients) and nonresponders (10 patients). There were no differences between them concerning age, basal levels of serum erythropoietin and hemoglobin, and dose of nandrolone decanoate in relation to body weight. The evolution of hemoglobin was similar in both groups, and a correlation between serum erythropoietin and hemoglobin was not observed in the responder group. Fourteen patients were studied after androgen was discontinued. The serum erythropoietin returned to basal levels 6 weeks after the last dose of nandrolone decanoate (7.7 +/- 5.4 mIU/ml). However, hemoglobin was above the basal levels 16 weeks after discontinuing androgen (9.5 +/- 1.1 g/dl, p < 0.05), with no differences between the responder and nonresponder group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Influence of body iron stores on the serum erythropoietin concentration in hemodialyzed patients.

The influence of body iron stores on the concentration of serum erythropoietin was studied in 48 hemodialyzed patients not receiving human recombinant erythropoietin, androgens or iron supplements. The serum erythropoietin concentration was 11.6 +/- 10.4 mIU/ml. There was no correlation between the serum erythropoietin and the hematocrit or hemoglobin concentration; however, there was a correlation between the serum erythropoietin and the log of serum ferritin (r = -0.5699, p < 0.01). Serum erythropoietin levels were higher in the 18 ferropenic patients (serum ferritin < 50 ng/ml) than in the 30 patients with normal serum ferritin concentration (18 +/- 13.8 vs. 7.8 +/- 4.7 mIU/ml, p < 0.01). The administration of intravenous iron to the ferropenic patients resulted in a reduction in serum erythropoietin independent of the response of the anemia (18 +/- 13.8 basal and 7.9 +/- 6.5 mIU/ml at 4 weeks, p < 0.01). Our data would suggest that the concentration of erythropoietin in hemodialyzed patients is influenced by the serum ferritin level.

Adult↗
PubMed1994

Use of urinary parameters in the diagnosis of total acute renal artery occlusion.

Limited attention has been paid to the composition of the small amounts of urine that are frequently produced by patients with acute renal failure (ARF) of vascular origin. We have investigated the value of basic urinary parameters in the early diagnosis of total or partial acute renal artery occlusion (ARAO). We have reviewed the records of 30 patients with ARF: group 1 (n = 10) had total ARAO; group 2 (n = 10) had unilateral ARAO with a contralateral functioning kidney, and group 3 (n = 10) had hemodynamically mediated ARF subsequent to a major vascular abdominal surgical procedure, without arterial thrombosis. Serum sodium, potassium, urea, creatinine and osmolality, as well as urinary sodium, potassium, urea, creatinine and osmolality, were determined by standard techniques, and the fractional excretion of sodium (FENa) was calculated. Serum parameters were similar in all groups. Urinary sodium and FENa were higher in group 1 than in the other groups (p < 0.01), while urinary potassium was lower (p < 0.05). Urinary urea (p < 0.01) and osmolality (p < 0.05) were higher in group 2 than in the other groups, revealing a prerenal pattern in some cases. Serum and urinary concentrations of sodium, urea and creatinine and osmolality were similar in group 1, while respective serum and urinary concentrations and osmolality were different from each other in the other groups. Analysis of urine provides a useful diagnostic tool in ARF of vascular origin. When urinary concentrations of sodium, urea and creatinine are similar to those in serum and FENa approaches 100%, the strong likelihood of total ARAO should be acknowledged, and renal arteriography is mandatory.

Acute Kidney Injury↗
PubMed1992

Hemodynamic changes in the dog connected to a dialysis circuit: influence of the body temperature.

Eighteen sessions in 9 mongrel dogs were carried out to know the hemodynamic effects produced by body temperature variation, when blood passes through a dialysis circuit with a Cuprophan dialyzer, without dialysate contact. The decrease of 2 degrees C in body temperature caused a decrease in heart rate and cardiac index (-8.6 and -17.6%, respectively) without significant changes in blood pressure. The increase of 2 degrees C in body temperature increased the heart rate, the cardiac index and the first derivative of ventricular pressure (+14.8, +17.3 and +27.8%, respectively) with a decrease of 13.6% in the systemic vascular resistance. Blood pressure did not change significantly. We conclude that the dog maintains the hemodynamic stability by two different mechanisms: when body temperature rises, by increasing the cardiac index; when body temperature decreases, by increasing the systemic vascular resistance.

Animals↗
PubMed1991

Nonenzymatic glycosylation of hemoglobin and total plasmatic proteins in end-stage renal disease.

In order to ascertain whether there are abnormalities of nonenzymatic glycosylation in uremia, the levels of nonenzymatically glycosylated hemoglobin (GHb), and total plasmatic glycosylated proteins (PGP) were studied using the thiobarbituric acid (TBA) method, a procedure not interfered with by carbamylation. Total hemoglobin A1 (HbA1) and the A1c fraction were also determined by ion exchange chromatographic methods. Sixty-six end-stage renal disease patients (29 nondiabetic and 8 diabetic uremic patients on conservative treatment, 29 nondiabetic hemodialysis patients) and 56 controls (32 nonuremic diabetic patients and 24 healthy controls) were studied. High levels of GHb and total PGP were found in the nondiabetic uremic group on conservative treatment with all the methods used, but the persistence of high chromatographically determined HbA1 levels in hemodialysis patients contrasts with the results obtained with the other techniques, which showed lower values on hemodialysis. Nondiabetic uremic patients with abnormal oral glucose tolerance curves had significantly higher levels of TBA-determined GHb and PGP. Uremic diabetic patients had the highest glycosylation levels of all the studied groups. We conclude that there is an abnormal nonenzymatic glycosylation of proteins in uremia, independent of carbamylation reactions and partially corrected by hemodialysis.

Adult↗
PubMed1990

Epidemiology of symptomatic hypotension in hemodialysis: is cool dialysate beneficial for all patients?

A prospective study on hypotension in hemodialysis was performed in 60 nondiabetic patients at two different dialysate temperatures during 12 months. A 37 degrees C bath (3,723 sessions) was used and after the first 6 months the temperature was changed to 35 degrees C (4,019 sessions). The prevalence of symptomatic hypotension was 15.3% and it was closely correlated with the presence of other symptoms. The most affected populations were women, patients over 55 years of age, patients with low body surface area and patients with a cardiovascular disease. A slight but significant decrease of symptomatic hypotension was seen by using a 35 degrees C dialysate (16.4 vs. 14.3%, p less than 0.01). In patients with frequent hypotension (in up to 30% of sessions), cool dialysate significantly reduced the incidence of the symptom (44.2 vs. 34.1%, p less than 0.001). These results were obtained in spite of a greater interdialysis weight gain at low temperature (2 +/- 0.6 vs. 1.9 +/- 0.7 kg, p less than 0.001). We consider that low-temperature dialysis is a simple, useful and economic procedure, especially for highly symptomatic patients. The association of cooling dialysate with higher sodium concentration, bicarbonate and special membranes could reduce dialysis symptoms dramatically.

Cold Temperature↗
PubMed1986

Variance analysis by use of a low cost desk top calculator.

A simple program for an HP-97 desk top calculator, which can be adapted to an HP-67, is presented. This program detects the presence of an added component of variance in any series classified with a unique criterion. Each series can be formed by any number of data. The program supplies additional information about this component. A brief theoretical description and a practical example are also included.

Analysis of Variance↗