Victor Burguera

Ceftriaxone-Associated Gallbladder Pseudolithiasis in a PD Patient

products: biochemical mechanisms. J am Soc nephrol 2002; 13:2478–87. 8. Agarwal R, Campbell RC, Warnock DG. Oxidative stress in hypertension and chronic kidney disease: role of angiotensin II. Semin nephrol 2004; 24:101–14. 9. Onozato ML, Tojo A, Goto A, Fujita T, Wilcox CS. Oxidative stress and nitric oxide synthase in rat diabetic nephropathy: effects of ACEI and ARB. Kidney Int 2002; 61:186–94. 10. Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensin-converting enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. n Engl J Med 1993; 329:1456–62. 11. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia). Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. lancet 1997; 349(9069):1857–63. 12. Li PK, Chow KM, Wong TY, Leung CB, Szeto CC. Effects of an angiotensin-converting enzyme inhibitor on residual renal function in patients receiving peritoneal dialysis. A randomized, controlled study. ann Intern Med 2003; 139: 105–12. 13. Suzuki H, Kanno Y, Sugahara S, Okada H, Nakamoto H. Effects of an angiotensin II receptor blocker, valsartan, on residual renal function in patients on CAPD. am J Kidney Dis 2004; 43:1056–64. 14. Kolesnyk I, Noordzij M, Dekker FW, Boeschotten EW, Krediet RT. A positive effect of AII inhibitors on peritoneal membrane function in long-term PD patients. nephrol Dial Transplant 2009; 24:272–7. 15. Fang W, Oreopoulos DG, Bargman JM. Use of ACE inhibitors or angiotensin receptor blockers and survival in patients on peritoneal dialysis. nephrol Dial Transplant 2008; 23:3704–10. 16. Strutz F, Muller GA. Transdifferentiation comes of age. nephrol Dial Transplant 2000; 15:1729–31. 17. Miyata T, Ueda Y, Asahi, Izuhara Y, Inagi R, Saito A, et al. Mechanism of the inhibitory effect of OPB-9195 [(+/-)-2-isopropylidene hydrazono-4-oxo-thiazolidin-5ylacetanilide] on advanced glycation end product and advanced lipoxidation end product formation. J am Soc nephrol 2000; 11:1719–25. 18. Miyata T, Ueda Y, Yamada, Izuhara Y, Wada T, Jadoul M, et al. Accumulation of carbonyls accelerates the formation of pentosidine, an advanced glycation end product: carbonyl stress in uremia. J am Soc nephrol 1998; 9:2349–56. 19. Duman S, Günal AI, Sen S, Asci G, Ozkahya M, Terzioglu E, et al. Does enalapril prevent peritoneal fibrosis induced by hypertonic (3.86%) peritoneal dialysis solution? Perit Dial Int 2001; 21:219–24. 20. Duman S, Sen S, Duman C, Oreopoulos DG. Effect of valsartan versus lisinopril on peritoneal sclerosis in rats. Int J artif organs 2005; 28:156–63. 21. Nakao N, Yoshimura A, Morita H, Takada M, Kayano T, Ideura T. Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomised controlled trial. lancet 2003; 361:117–24. doi:10.3747/pdi.2010.00015

Innovando en la docencia de la biopsia renal ecodirigida

El aprendizaje de la Medicina se ha basado, hasta ahora, en el estudio y en la práctica clínica habitual. La preocupación por la mejora en la seguridad del paciente, por la reducción de las complicaciones en las técnicas invasivas y por la reducción del gasto sanitario ha conducido a la creación de simuladores y modelos experimentales para el desarrollo de habilidades médicas y quirúrgicas en el proceso de enseñanza-aprendizaje. El uso de simuladores en las especialidades quirúrgicas está ampliamente introducido. Sin embargo, en las especialidades médicas que realizan técnicas invasivas, su uso está poco extendido. Este es el caso de la biopsia renal (BR), nuestra técnica invasiva por excelencia, técnica que puede acarrear morbimortalidad para el paciente, y que se aprende, aunque monitorizada por facultativos con experiencia, sobre los propios pacientes1. Existen muy pocos trabajos en la literatura referidos estrictamente a la docencia de la BR2–5. Mrug et al.2 realizan la simulación de la BR con control ecográfico sobre un modelo ex vivo utilizando un riñón de cerdo o vaca introducido en un pavo2, con lo que se consiguen imágenes ecográficas parecidas a las obtenidas sobre el paciente real y las características de resistencia a la penetración de la aguja, tanto en el tejido muscular como en el renal, equiparables a un modelo real. También3 investigaron la utilidad sobre la mejora en la confianza de los residentes en la ejecución de la BR y sobre la tasa de complicaciones hemorrágicas posbiopsia en los 2 periodos (prey postimplantación del simulador). Encuentran una

Home Palliative Care for Patients with Advanced Chronic Kidney Disease: Preliminary Results

Healthcare for patients with advanced chronic kidney disease (ACKD) on conservative treatment very often poses healthcare problems that are difficult to solve. At the end of 2011, we began a program based on the care and monitoring of these patients by Primary Care Teams. ACKD patients who opted for conservative treatment were offered the chance to be cared for mainly at home by the Primary Care doctor and nurse, under the coordination of the Palliative Care Unit and the Nephrology Department. During 2012, 2013, and 2014, 76 patients received treatment in this program (mean age: 81 years; mean Charlson age-comorbidity index: 10, and mean glomerular filtration rate: 12.4 mL/min/1.73 m2). The median patient follow-up time (until death or until 31 December 2014) was 165 days. During this period, 51% of patients did not have to visit the hospital’s emergency department and 58% did not require hospitalization. Forty-eight of the 76 patients died after a median time of 135 days in the program; 24 (50%) died at home. Our experience indicates that with the support of the Palliative Care Unit and the Nephrology Department, ACKD patients who are not dialysis candidates may be monitored at home by Primary Care Teams.

Infected renal cyst presented with pleural effusion in a woman with autosomal dominant polycystic kidney disease

Abstract We present a 64-year-old woman with autosomal dominant polycystic kidney disease and hepatic cysts admitted to our hospital for high fever, intense coughing and right abdominal pain. The chest X-ray showed right pleural effusion suggestive of pneumonia. An abdominal ultrasound and computed tomography (CT) were done but did not show evidence of cyst infection or other abdominal complications. A gallium-67-citrate single-photon emission CT/CT, a relatively cheaper technique than positron emission tomography/CT was performed. This revealed an infected kidney cyst that was the cause of the right pleural effusion and fever.

Necrotizing crescentic glomerulonephritis in a patient with positive serologies for lupus and antineutrophil cytoplasmic antibodies.

Dear Editor, Patients with acute renal failure due to pauci-immune necrotizing and crescentic glomerulonephritis with antinuclear antibody (ANCA) seropositivity can present with positive lupus serologies. On the other hand, patients with lupus nephritis present with ANCA seroconversion in 20% of cases. The fact that systemic lupus erythematosus (SLE) and positive myeloperoxidase (MPO) ANCA titers with kidney involvement can present with scant subendothelial deposits in the kidney biopsy, may suggest a forme fruste of lupus nephritis or a concomitant renal vasculitis with neutrophil priming.

Subphrenic Abscess as a Complication of Hemodialysis Catheter-Related Infection

We describe an unusual case of subphrenic abscess complicating a central venous catheter infection caused by Pseudomonas aeruginosa in a 59-year-old woman undergoing hemodialysis. The diagnosis was made through computed tomography, and Pseudomonas aeruginosa was isolated from the purulent drainage of the subphrenic abscess, the catheter tip and exit site, and the blood culture samples. A transesophageal echocardiography showed a large tubular thrombus in superior vena cava, extending to the right atrium, but no evidence of endocarditis or other metastatic infectious foci. Catheter removal, percutaneous abscess drainage, anticoagulation, and antibiotics resulted in a favourable outcome.

Peritoneal dialysis (PD) is a successful treatment after complete haemodialysis (HD) blood access failure complicated with superior vena cava syndrome (SVCS)

Abstract SVCS constitutes a serious clinical problem and often represents a definitive loss of vascular access for haemodialysis (HD). The patients must suffer numerous interventions in order to obtain a permanent vascular access for HD. Treatment of SVCS requires endovascular intervention or complex surgical revascularization. We present three patients with SVCS associated with central indwelling catheters for HD who were switched to peritoneal dialysis (PD) due to complete HD blood access failure, and discuss the evolution on PD.