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R Maiorca

Publications and source records attributed to R Maiorca.

At least 55 records · Page 3Linked to original sources
PubMed1996

Cholesterol atheromatous embolism: an increasingly recognized cause of acute renal failure.

BACKGROUND: Cholesterol atheromatous embolism is a systemic disease resulting from cholesterol crystal embolization to many organs, including the kidney. Vascular surgery, vascular radiology investigations and anticoagulation have been identified as inciting factors. METHODS: Fifteen patients with extensive atherosclerosis, presenting with simultaneous occurrence of acute renal failure and peripheral ischaemic changes were diagnosed as having acute renal failure due to cholesterol atheromatous embolism. RESULTS: The patients, 12 men and three women, had an average age of 65 years. In one patient, spontaneous occurrence of the disease was observed. An inciting factor was identified in 14 patients: aortography in 10, aortic surgery in two, and thrombolysis in two. Clinical course of acute renal failure was quite variable. Four patients required dialysis; 11 were conservatively managed. All patients had concomitant skin lesions, including digital mottling, cyanosis and gangrene of the toes, and livedo reticularis of the lower limb and abdomen. Eosinophilia was the most common laboratory abnormality. The diagnosis of cholesterol atheromatous embolism was confirmed by tissue examination in eight; in three it was based on the finding of retinal cholesterol emboli; in four patients it was made on clinical grounds. Seven patients died within 36 months. Death was most commonly from cardiac causes. CONCLUSIONS: Since the population at risk for cholesterol embolism is growing and the disease is iatrogenic in origin, we should expect to detect cholesterol embolism with greater frequency as cause of acute renal failure in the future.

Acute Kidney Injury↗
PubMed1996

Comparison of long-term survival between hemodialysis and peritoneal dialysis.

We have reviewed the literature and our own center's results for patients on long-term continuous ambulatory peritoneal dialysis (CAPD) in comparison to results for patients on hemodialysis (HD). Contrary to recent American data showing one-year survivals to be worse on CAPD, the Canadian Registry and other studies show no significant difference in survivals on the two methods. Results are also conflicting for diabetics. Insufficient adjustments for age and case-mix variations are probably the most important causes for differences. For the general population, personal Cox-adjusted data show no difference between CAPD and HD up to ten-year follow-up, with very close curves for the adults and non-significant differences for the elderly. Old elderly (> 75 years) have better survival on CAPD in the first years of treatment. Dropout, which is higher on CAPD, decreases with age, and the patient retention on CAPD is worse than on HD for all patients, except the old elderly, for whom it is similar. These data were obtained in patients receiving a standard treatment, modified in order to give a more adequate dialysis dose only in recent years. The results of a prospective three-year study on the effect of nutritional [serum albumin and transferrin, normalized protein catabolic rate (PCRN), and subjective global assessment of malnutrition] and adequacy indices [Kt/V, creatinine clearance (Ccr), residual renal function] on patient survival on CAPD and HD are reported. Survival was not different for the two methods. Using the Cox analysis, nutritional indices did not affect survival whereas adequacy indices did. The effect of low serum albumin on survival was referable to the predialysis nutritional state. The similar survivals obtained on CAPD and HD, with Kt/V more or less than 1.0/treatment for HD and 1.7/week for CAPD, support the "peak concentration hypothesis" of Keshaviah et al. Survival in different groups of patients with different Kt/V and Ccr shows that the adequate dose on CAPD is Kt/V between 1.96 and 2.03 and Ccr > or = 70 L/week. A group of 26 patients who remained on CAPD treatment for more than eight years was also studied. Patient age and predialysis comorbidity were the most important factors affecting survival. Patients surviving longest had > 3 g/dL of serum albumin, > 0.8 g/kg/day of PCRN, a Kt/V > 1.6, and a weekly Ccr > 54L/week.

Adolescent↗
PubMed1995

Predictive value of dialysis adequacy and nutritional indices for mortality and morbidity in CAPD and HD patients. A longitudinal study.

BACKGROUND: The effects of dialysis inadequacy on patient survival and nutritional status and that of malnutrition on survival have not been clearly assessed. Studies comparing dose/mortality and morbidity curves on continuous ambulatory peritoneal dialysis (CAPD) and on haemodialysis (HD) are also needed, to assess adequate treatment on CAPD. METHODS: We have evaluated the effects of age, 13 pretreatment risk factors, serum albumin, transferrin, normalized protein catabolic rate, Kt/V, normalized weekly creatinine clearance, residual renal function and subjective global assessment of nutritional status on survival and morbidity, in a 3-year prospective study of 68 CAPD and 34 HD patients. RESULTS: Survivals did not differ for CAPD and HD patients. In the Cox hazard regression model, age, peripheral vasculopathy, serum albumin < 3.5 g/dl and Kt/V < 1.0/treatment on HD and < 1.7/week on CAPD were independent factors negatively affecting survival. On the contrary, adjusted survivals were not affected by gender, modality, other comorbid factors, normalized protein catabolic rate, or subjective global assessment of nutritional status. Persistence of residual renal function significantly improved survival. Observed and adjusted survival did not significantly differ for CAPD and HD patients with either low (HD, < 1.0/treatment; CAPD, < 1.7/week) or high ( > or = 1.0 and > or = 1.7) Kt/V. On HD, adjusted survivals were similar for 1.0 < or = Kt/V < 1.2 or > or = 1.2. On CAPD, Kt/V > or = 1.96/week was associated with definitely better survival, with only one death/23 patients versus 19/45, with Kt/V < or = 1.96. Survival was not different for 1.96 < or = Kt/V < 2.03 and > or = 2.03. Normalized weekly creatinine clearance and wKt/V were positively related on CAPD (r 0.39, P < 0.01) and wKt/V = 1.96 corresponded to 58 litres of normalized weekly creatinine clearance. CONCLUSIONS: Indices of adequacy were predictors of mortality and morbidity, both on CAPD and HD, whereas normalized protein catabolic rate and subjective global assessment of nutritional status were not. Serum albumin did not decrease during dialysis; hence its predictive effect for survival is due to the predialysis condition and not to dialysis-induced malnutrition.

Adult↗
PubMed1995

Influence of protein catabolic rate on nutritional status, morbidity and mortality in elderly uraemic patients on chronic haemodialysis: a prospective 3-year follow-up study.

It has been recently reported that elderly chronic haemodialysis (CHD) patients have a reduced protein catabolic rate (PCRn) in spite of an adequate Kt/V. However until now the long-term consequences of this fact on the nutritional status, morbidity, and mortality were not known. This prospective study evaluates, over a period of 3 years, the effect of the reduced PCRn on some nutritional parameters, morbidity mortality in CHD patients older than 65 years with adequate and stable Kt/V. Over the period 1990-1993 we evaluated 42 CHD patients over 65 years (mean +/- SD 72 +/- 5 years). PCRn, total serum proteins, serum albumin concentration, body weight, body mass index (BMI) and serum transferrin were determined at the start of the study and followed yearly until the end of observation. The incidence of hospitalization/patient-year, the mortality rate and the causes of death were also recorded. All the patients were managed to maintain a Kt/V > 0.9 throughout the study. Twenty-two patients (Group A), mean age 70 +/- 4 years, completed the entire period of observation. Their Kt/V was 1.10 +/- 0.12, PCRn was 0.95 +/- 0.12 g/kg/day, and serum albumin concentration was 40.2 +/- 1.5 g/l, and these did not change significantly. The other parameters also remained stable over time. Twenty patients (Group B) died. Their mean age was 74 +/- 6 years. This group's Kt/V was 1.11 +/- 0.15, PCRn was 0.94 +/- 0.18 g/kg/day, and serum albumin concentration was 39 +/- 3.1 g/l, and there were no significant variations between the start and the end of observation for all the parameters studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Which treatment for which patient in the future? Possible modifications in CAPD.

On 578 unselected new patients followed from 1981 through 1993, 51% on CAPD and 49% on HD, long-term patient and method survivals, cause of death, and drop-out in the two methods were compared. Survival, adjusted for patient selection biases, was not different on CAPD and HD up to 10 years. 50% of the patients were still in their first treatment after 3.5 years on CAPD and after 7 years on HD, and 5 and 28% respectively, after 10 years. Patient survival on CAPD was not falsely improved by drop-outs. Drop-out is increasing for CAPD, mainly due to patient/partner burn-out, which should be relieved by a more liberal application of automated PD. Malnutrition is more frequent on CAPD than on HD but not for the elderly. In a 3 year prospective study on 60 CAPD and 34 HD patients serum albumin, nPCR and nutritional status, as assessed by SGA did not influence survival in each modality. Survival was similar with K(p,r)t/V > or = 1.7/week on CAPD and Kt/V > or = 1/treatment on HD, and worse below these values. On CAPD, a Kp,rt/V > or = 1.96 gave better survivals.

Humans↗
PubMed1994

Low incidence of peritonitis with the T-set.

Peritonitis is still one of the most important complications of peritoneal dialysis. Over the last few years, many efforts have been made in developing new device systems. A remarkable improvement has been obtained by modifying the original connection between the catheter and the bag, especially after the introduction of the Y-set. The aim of this study was to verify whether the use of a new device system, called the T-set, could reduce the incidence of peritonitis. This connector adds the advantages of the Y-set to those of the twin bag. In a group of 53 patients enrolled in a three-year period with a follow-up of 797 patient-months, we observed an incidence of peritonitis of one episode every 50 months. Furthermore, in the subgroup of 39 new patients, we observed an incidence of peritonitis of one episode every 89 patient-months. This new device can be a further step in the evolution of connectors that reduce the incidence of peritonitis.

Aged↗
PubMed1994

Simultaneous catheter replacement-removal during infectious complications in peritoneal dialysis.

The aim of this study was to verify whether the replacement of the peritoneal catheter in a single operation and during infectious complications of peritoneal dialysis is effective and safe. Sixty-eight infectious complications refractory to appropriate antibiotic therapy were treated by this technique: 26 tunnel infections, 22 peritonitis-complicating tunnel infections, 12 refractory peritonitis, and 8 recurrent peritonitis. Operations were successful in all cases of tunnel infection and recurring peritonitis, and in all cases but one of peritonitis-complicating tunnel infection. Ten failures occurred among the 12 catheters removed for refractory peritonitis. Microorganisms cultured in these 10 failures were: Fungi (3 cases), Mycobacterium (2 cases), Pseudomonas (2 cases), Acinetobacter (1 case), Acinetobacter+Pseudomonas (1 case), and Enterococcus (1 case). Complications were 3 one-way obstructions and 2 external dialysate leaks. This study supports the simultaneous catheter replacement-removal procedure during infectious complications of peritoneal dialysis (PD) with the exception of refractory peritonitis; this technique spares the patient the temporary vascular access, the shift to hemodialysis, and a second operation to insert a new catheter. There are few complications.

Catheters, Indwelling↗
PubMed1993

Association between silica exposure and necrotizing crescentic glomerulonephritis with p-ANCA and anti-MPO antibodies: a hospital-based case-control study.

A hospital-based case-control study was carried out to investigate the association between ANCA positive rapidly progressive glomerulonephritis (RPGN) and occupational exposure to silica dust. All ANCA positive male patients admitted to the Department of Nephrology of the University of Brescia between 1987 and 1992 were enrolled in the study as cases. The controls were pts of the same age, admitted at the Department immediately before or after the cases, affected by other renal diseases. Seven of the 16 cases and one of the 32 controls, had a positive history for jobs exposing to silica dust (relative risk 14; 95% C.I.: 1.7-113.8, p < 0.001). ANCA pattern was p-ANCA with anti-MPO antibodies in 6/7 of exposed pts. The review of renal histology showed a distinctive glomerular lesion consisting in peripheral nodular areas of glomerular sclerosis, in addition to the crescentic necrotizing glomerulonephritis, in 3/6 silica exposed pts, but in none of the unexposed pts.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1993

Clinical manifestations in patients on chronic dialysis with high titres of ANCA.

Eight untreated patients with an apparent renal-limited disease continued to maintain high titres of ANCA long after the onset of the disease and the start of dialysis. In spite of the high ANCA titres, three of them remained for a long time free of symptoms related to the disease. Three pts developed, at various times from the beginning of the disease, fatal pulmonary hemorrhages.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1993

Effect of age on protein catabolic rate, morbidity, and mortality in uraemic patients with adequate dialysis.

To test the validity of the assumption that the protein catabolic rate (PCRn g/kg/day) is dependent on the normalized dose of dialysis (Kt/V urea), and to try to define the characteristics of the patients in the undefined domain A of the mechanistic map of the National Cooperative Dialysis Study (NCDS), which should include patients with adequate amount of dialysis but inadequate PCRn, urea kinetic modelling was performed over 12 months on 85 patients undergoing haemodialysis. All the patients were managed to maintain a Kt/V urea > or = 0.9. During the entire period of study the total number of hospitalizations and the number of days of hospitalization were recorded. Total serum proteins and serum albumin concentrations were measured at the start and at the end of the study. The results of the study show that there was no correlation between Kt/V and PCRn nor between Kt/V and patient's age, but there was a strong inverse correlation between age and PCRn (r = 0.578; P < 0.0001). Further division of the patients into four groups according to age showed that the lowest values of PCRn were for the group of patients > or = 75 years old. Twelve patients with PCRn < or = 0.8 and Kt/V > or = 0.9 were included in domain A of the mechanistic map. Eleven (92%) of these 12 patients were > or = 65 years old. No correlations were found between the total number of hospitalizations, the total days of hospitalization, Kt/V, time on HD, body weight and PCRn by multiple regression analysis, while the inverse correlation between PCRn and age was confirmed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗