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Biomedical subjects

L Orofino

Publications and source records attributed to L Orofino.

At least 19 recordsLinked to original sources
PubMed1999

Treatment of secondary hyperparathyroidism in hemodialyzed patients with high-dose calcium carbonate without vitamin D3 supplements.

BACKGROUND: Vitamin D compounds are usually indicated for the treatment of secondary hyperparathyroidism in dialysis patients. The possibility to induce a reversal of hyperparathyroidism with calcium supplementation alone is controversial. The present study was conducted to assess if oral calcium carbonate may constitute a therapeutic option for the control of hyperparathyroidism in patients with high PTH concentrations at the beginning of the treatment with chronic hemodialysis. METHODS: Thirty-one patients with end-stage renal failure with an intact PTH concentration above 250 pg/ml at the beginning of chronic hemodialysis therapy were treated with high doses of calcium carbonate; no patient received either aluminium-containing binders or vitamin D compounds. To minimize hypercalcemia, a calcium dialysate concentration of 2.5 mEq/l was used in all patients. The goal of the study was to reduce the intact PTH concentration to 250 pg/ml with oral calcium carbonate supplements alone. RESULTS: Throughout the first year on hemodialysis treatment, the intact PTH concentration decreased from 538 +/- 256 to 251 +/- 218 pg/ml (p < 0.001). By the end of the study, the therapeutic objective was achieved in 22 patients (71%) ('responder' group). The remaining 9 patients were classified as the 'treatment failure' group. The basal intact PTH concentration was not different between both groups (508 +/- 235 vs. 612 +/- 303 pg/ml, respectively, p = n.s.), but 5 'treatment failure' patients admitted to take a dose of calcium carbonate lower than that prescribed. There were 40 episodes of hyperphosphatemia (11% of all measurements) in 7 of 31 patients, 5 of them belonged to the noncompliance 'treatment failure' patients. Only 15 episodes (4% of all measurements) of transient hypercalcemia (range 11.1 - 11.9 mg/dl) were detected in 8 patients. CONCLUSIONS: Secondary hyperparathyroidism in hemodialysis patients can often be reverted by oral calcium carbonate alone. But a good adherence to treatment is absolutely necessary.

Administration, Oral↗
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↗
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↗
PubMed1996

Acute cardiovascular effects of intravenous cyclosporine.

The acute effects of intravenous (i.v.) cyclosporine A (CsA) on blood pressure and other haemodynamic parameters were examined in 8 patients with end-stage renal disease on haemodialysis (HD). The study was performed after the mid-week haemodialysis session, when the patients were on their dry body weight. Each patient received an i.v. infusion of 5 mg/kg of CsA in 120 ml of 5% dextrose in water during 2 hours. Heart rate, systolic and diastolic blood pressure (SBP, DBP) were monitored by the Holter system. An echocardiogram (M-mode 2-dimensional and Doppler sonography) was performed using an automatic device (Ultramark 6) before CsA administration, at 30, 60 and 120 minutes during CsA infusion, and at 30 minutes thereafter. SBP, DBP and calculated peripheral vascular resistance (CPVR) increased significantly in respect to basal values at 120 and 150 minutes (SBP: basal 130 +/- 21, 120 min: 136 +/- 20, 150 min: 140 +/- 18, p < 0.05 and p < 0.01, respectively. DBP: basal 80 +/- 9, 120 min: 86 +/- 13, 150 min: 88 +/- 13, p < 0.05 and p < 0.01, respectively. CPVR: basal 1000 +/- 228, 120 min: 1178 +/- 305, 150 min: 1236 +/- 270 dyne/s/cm5, p < 0.01). However, systolic volume (SV) and cardiac output (CO) showed significant decreases from the basal values (SV: basal 103 +/- 29, 120 min: 85 +/- 22, 150 min: 85 +/- 17, p < 0.05. CO: basal 8.2 +/- 2, 120 min: 7.3 +/- 1.1, 150 min: 7 +/- 1.2 l/min, p < 0.05). In conclusion, CsA infusion produces a significant elevation of blood pressure, which seems to be mediated by a direct action on peripheral vascular resistance.

Adolescent↗
PubMed1996

Membranous nephropathy: recurrence after kidney transplantation.

BACKGROUND: It is supposed that about 5% of dialysis patients had membranous nephropathy as a cause for their renal failure. Despite of this prevalence, only 33 cases of recurrent membranous nephropathy after kidney transplantation have been reported in the English literature. METHODS: Among 509 recipients of renal allografts, membranous glomerulonephritis was the cause of renal failure in five patients, who received six transplants. RESULTS: Recurrence of the disease was observed in three allografts (50%) in three patients, all of them were on treatment with cyclosporin and low-dose prednisone. Proteinuria appeared at 2, 5 and 19 months after grafting. One patient experienced a spontaneous remission after 12 months and he is free from proteinuria and with good renal function after 5 years. The remaining two patients presented progressive renal function deterioration and returned to haemodialysis 24 and 17 months after th appearance of proteinuria. In these patients increasing the immunosuppression did not produce any beneficial effect. One of those patients underwent a second transplant; recurrence of the membranous nephropathy has not been observed after 3 years of follow-up. CONCLUSIONS: In this study three new cases of recurrence of membranous nephropathy are reported. One patient experienced a spontaneous remission of proteinuria. Recurrence of membranous nephropathy in renal allograft was very high in our series. Its appearance was associated with poor prognosis of the graft in most patients, although spontaneous remission of proteinuria is possible.

Adult↗
PubMed1995

Impairment of tubular secretion of urate in renal transplant patients on cyclosporine.

The prevalence of hyperuricemia was investigated in 214 kidney allograft recipients, 81 were on azathioprine and steroids and 133 on cyclosprine (CyA) and low-dose steroids or on triple therapy. All had stable renal function, serum creatinine < 2.5 mg/dl, and a follow-up between 12 and 120 months. At the time of the study, blood and urine samples were obtained to perform tests of renal function. The renal handling of urate was evaluated by a combined pyrazinamide and probenecid test in 35 selected patients (12 normouricemic on azathioprine, 9 normouricemic on CyA and 14 hyperuricemic on CyA). The prevalence of hyperuricemia was higher in the group of patients on CyA (19.7 vs. 66.9%, p < 0.001), as well as the concentration of serum urate (6.1 +/- 1.9 vs. 7.6 +/- 1.7, p < 0.001), and serum creatinine (1.2 +/- 0.3 vs. 1.4 +/- 0.4, p < 0.001). In patients on CyA, multivariate analysis showed that the most important predictive variables of hyperuricemia were: serum creatinine, FEurate, diuretic use and CyA blood levels (r = 0.73, p < 0.0001). Thirteen patients on CyA (9.9%) had at least one episode of gouty arthritis. Those patients were older than the hyperuricemic patients without gout (45.7 +/- 6.7 vs. 37.1 +/- 13.5 years, p < 0.01), had worse renal function (serum creatinine 1.9 +/- 0.4 vs. 1.5 +/- 0.4 mg/dl, p < 0.01), and higher prevalence of hypertension (100 vs. 63.1%, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Vascular complications in renal transplantation].

Between the years 1979 and 1992 we a total of 479 renal transplants (RT) were performed. In 62 patients (12.9%) there were some clinically significant vascular complications. These have consisted of: 10 cases of arterial thrombosis (2%); 10 cases of venous thrombosis (2%); 5 cases of arterial and venous thrombosis (1%); 31 cases of arterial stenosis (6.5%); and 6 cases of acute haemorrhage originated at the vascular anastomosis level (1.2%). In all those cases with arterial or venous thrombosis, or both, it was necessary to perform transplantation. The arterial stenosis cases were treated with antihypertensive agents in 13 patients; with endoluminal percutaneous angioplasty (EPA) in other 13 patients and with surgery in 5. Both arterial stenosis and complications from their treatment resulted in 5 transplantations. In all cases with early post-surgical haemorrhage originated at the vascular anastomosis level, a surgical review and suture of bleeding site was performed. A total of 31 grafts (6.5%) were lost as a result of vascular complications.

Adolescent↗
PubMed1994

Recurrence of focal-segmental glomerulosclerosis in kidney transplant patients on ciclosporin.

Two patients on maintenance hemodialysis after terminal renal failure due to nephrotic syndrome and biopsy-proven focal-segmental glomerulosclerosis received three cadaver renal allografts. Immediate recurrence of nephrotic syndrome was observed. In two transplants immunosuppression consisted of ciclosporin A and low-dose steroids. One patient was unsuccessfully treated with immunoadsorption after the second transplant. All grafts were lost because of uncontrolled nephrotic syndrome. Renal allograft biopsy specimens showed findings indicating recurrence of the original disease.

Adolescent↗
PubMed1994

[Diagnostic yield of Echo-Doppler in dysfunction of the grafted kidney].

The study's goal is to analyze the usefulness of Eco-Doppler in the knowledge of renal graft hemodynamics and the description of its dysfunction. 234 examinations were performed in 110 patients. Acceleration, mean rate (MR), maximum systolic rate (MXSR) and minimal diastolic rate (MNDR), as well as resistance index (RI) and pulsatility index (PI) were determined in the external iliac, renal, segmentary, interlobular and arcuate arteries. RI and PI, as well as MXSR and the acceleration are higher in the extra-parenchymatous versus the intra-parenchymatous beds. Peak MR and MNDR values are reached in the renal artery. Termino-lateral to external iliac arterial anastomosis conditions higher MXSRs in the renal artery as opposed to termino-terminal to hypogastric artery (p < 0.05). In the arcuate artery, RI > 0.8 is reached in 51.6% of acute tubular necrosis (ATN), 46.9% of acute rejections (CR), 46.3% of chronic rejection (AR), 21% of grafts with cyclosporin-induced nephrotoxicity (NFX) and 12.5% of normal functioning kidneys isolated chance analysis with Eco-Doppler does not distinguish between AR and ATN. A dysfunctional graft with an RR in the arcuate artery of nearly 9.7 suggests NFX, but AR with interstitial predominance cannot be ruled out.

Acute Disease↗
PubMed1994

[Surgical complications in 479 renal transplantations].

Exposition of results obtained from the review of the surgical complications found in a series of 479 renal transplantations performed between 1978 and 1992 in our centre, although some of them lack clinical relevance. There was fluid accumulation in 69 patients, distributed between 31 perirenal haematoma. 17 lymphocele, 13 urinoma, 5 perirenal abscesses and 3 mixed. 27.7% required no action. Frequency of renal rupture was 18 cases, 9 due to acute rejection and 9 to vascular thrombosis. Incidence of urinary obstruction was 4.8% with 5.8% of urinary fistula. With regard to the surgical wound, 9 infections, 7 haematomas, 1 eventration and 1 necrotizing fasciitis were observed. Vascular complications consisted in 10 arterial thrombosis, 10 venous thrombosis, 5 mixed thrombosis and 31 arterial stenosis. Treatment instituted for the various cases, its evolution, and an statistical study of risk factors are illustrated.

Adolescent↗
PubMed1994

[Gastrointestinal complications in renal transplantation].

Seventy-nine gastrointestinal complications in 480 recipients of a renal transplant (RT) (16%) are described. The most frequent complication was high digestive haemorrhage (HDH) (19/480) (2.9%); other complications were: esophagitis, gastroenteritis, diverticulitis, cholecystitis, intestinal tuberculosis, rectal ulcer and colonic polyps. Mortality secondary to gastrointestinal complications was 1.1%. Sixty-seven percent of cases with peptic ulcer developed HDH, an incidence higher than that observed in the general population (20%). Twenty-one percent of transplanted patients with DH had ulcer background. Cholecystitis and diverticulitis were complications with a low incidence (0.2% and 0.6%, respectively) which do not seem to justify aggressive diagnostic and therapeutic manoeuvres prior to the transplant. Prevalence of intestinal tuberculosis in this series (0.4%) was higher to that described in the literature.

Adolescent↗