Revista de nefrología y terapéutica

Cardiovascular mortality is the leading cause of death in patients with chronic kidney disease and is markedly higher than in the general population when stratified by age, race, and gender. However, a portion of cardiovascular disease (CVD) in the ESRD population cannot be explained by these and other traditional risk factors alone. Defects in mineral metabolism, particularly hyperphosphatemia and secondary hyperparathyroidism, increase the risk of CVD in patients on dialysis. The burden of vascular calcification in the dialysis population is reflected by the higher prevalence and severity of coronary artery calcification when compared to age-matched healthy controls. In addition to abnormalities in serum calcium and phosphorus, risk factors for the development for vascular calcifications also include increased age, longer duration of dialysis, inflammation, hypertension, dyslipidemia, and calcium-based phosphate binders. The process of vascular calcification is a complex process, and attributing the pathogenesis to the precipitation of calcium and phosphate in the walls of arteries oversimplifies the problem. Inflammation, uremia, hyperphosphatemia, hypertension, hyperlipidemia, and hypercalcemia, all could be expected to play a role in this process. Interestingly, some dialysis patients, despite the uremic environment and hyperphosphatemia, do not develop vascular calcifications. Reducing the risk of vascular calcifications has been aimed at controlling serum phosphorus, calcium, and PTH. As with calciphylaxis, in severe cases of coronary and peripheral vascular disease, parathyroidectomy may be indicated and can lower the rate of long-term mortality associated with secondary hyperparathyroidism. Before that, traditional control of serum phosphorus, however, may have the biggest impact in reducing the risk of progression of extraosseous calcification. Use of calcium-based phosphate binders and the nonabsorbable polimer sevelamer both have roles in controlling serum phosphorus; however, the calcium load imposed by high doses of calcium salts may increase the risk of vascular calcification.

Background: Renal Failure, even at an early stage, increases the risk of developing and exacerbating cardiovascular (CV) disease. The corollary of that observation should be that CV disease would not only increase the risk of renal function deterioration, but also cause renal damage, a concept not previously proposed. Aim: Evaluate renal function after follow-up in different levels of hemodynamic response to exercise stress test, as an index of CV function. Method: The hemodynamic response to a graded exercise stress test was measured in 70 candidates to evaluate the association of heart rate and blood pressure change (â??HR and â?? SBP), heart rate reserve (HRR), chronotropic incompetence (% in achievement of maximal predicted heart rate-%MPHR), and circulatory power (CirP) with the development of severe renal failure (eGFR<30) during a 123 (33-179) month follow-up period. Results: Survival analysis methods demonstrated that the probability of severe renal failure development was greater in subjects with lower levels of â??HR, HRR, %MPHR and CirP (Log-rank test, P=0.002, 0.01, 0.02, 0.008 respectively). These effects remained significant after multivariate adjustment for age, resting pulse pressure (rPP), hypertension, diabetes and exercise test result using a cox-proportional hazard analysis (Hazard Ratio= 5.9, 2.9, 3.3, 2.9, respectively; all P<0.05). Having an rPP ≥60 was accompanied by 7.4 (95% CI: 1.8-30.9) times greater risk of developing severe renal failure, independent of age and resting SBP (P=0.006). However the data did not show a significant association between â?? SBP and development of severe renal failure. Conclusion: The hemodynamic responses to a standard graded exercise stress test independently predicted the development of severe renal failure. While rPP, an indirect measure of arterial compliance, was a strong predictor for developing severe renal impairment, arterial stiffness may also be a factor linking ventricular and kidney function. The results also suggest that the early diagnosis of kidney disease should include a CV assessment and vice versa

Diabetic nephropathy (DN) develops in patients with diabetes mellitus (DM) and has become the leading cause of end- stage renal disease. Early identification and subsequent renoprotective treatment are of utmost importance. Renin- angiotensin-aldosterone system (RAAS) has a key role in the pathogenesis of DN. The aim of this study is to compare the efficacy of the anti-angiotensinic drugs; ramipril and irbesartan on the vascular protection of kidneys of Streptozotocin (STZ)- induced diabetic rats (DR). 110 male albino rats were divided into 7 main groups. Group 1 (10 untreated rats) was used as a control. Group 2 (10 rats) was injected intra-peritoneally (i.p) with STZ to induce DM. Group 3 (10 rats) was controlled by insulin after induction of DM with STZ. Groups 4 to 7 consisted of 20 rats, each of which was injected i.p. with STZ and further subdivided into 2 subgroups that received either low or high dose of ramipril or irbesartan with or without insulin. Two months post treatment, rat tail blood samples were collected to measure: fasting blood sugar, HbA1c, Total and free serum proteins (Albumin and Globulin) and lipid profiles. Urine samples were collected to measure Albuminuria. Kidneys were isolated for histopathological study to confirm any biochemical findings. Biochemically, both ramipril and irbesartan lowered albumin concentration in urine samples of DR especially in high doses. However, histopathological examination of the kidneys failed to demonstrate beneficial response of low and high doses of both drugs. Only lowering of blood glucose by insulin together with either drug in DR has beneficial effects biochemically and histopathologically, especially in high doses. Low and high dose irbesartan seems to be more renoprotective as compared to ramipril. The other biochemical parameters showed negligible response to both drugs. In conclusion, low dose irbesartan and high doses of both drugs have renoprotective effect in DR treated with insulin

India lags behind in the world average rate of the deceased donor per million. India with a population of 1.2 billion has a renal transplantation rate of 3.25 per million population, which is very low when compared to countries such as Spain, United states of America, Portugal and Thailand. There is a huge burden of morbid disease like diabetes and hypertension in India. The crude and age adjusted incidence rates of end stage renal diseases are estimated to be 151 and 232 per million populations in India. In case of ESRD the only hope for the patient is organ transplantation. This is because the survival rate of the patients after reaching ESRD beyond 3 months is <10%. This signifies how important organ transplantation is in today?s scenario in India. Number of deceased donor per million populations per year for USA, UK, Thialand and India are 21, 15, 1, and 0.12 respectively. Why there was a need for a model for transplantation because due to imbalance between supply and demand, commercialization of the organs increased in various parts of India. This has led to formation of a model for deceased donor transplantation by Tamil Nadu government in clamping down the commercialization of live organ transplantation and promotion of the deceased donor transplantation. The government of India promulgated the transplantation of Human organ Act in 1994 after which deceased donor transplantation initiated. In 2007, Tamil Nadu government decided to make policies and new frameworks to form a model. Deceased donor transplantation is well suited to the main source for organ transplantation requirements. It can save lives and eliminate commercialization, without any moral compulsion on near relative to donate organ and would benefit rich and poor. The structure of this model is comprised of anchor, called the convenor. The convenors role is to maintain a list of recipients awaiting transplantation and allocate organs, call meetings of the advisory committee, collect data on transplantation and take up generation awareness programme. To maintain the transparency of the programme, all the allocation and prioritization of the organs is done under the norms of government orders given by the ministry of family and welfare. Tamil Nadu Cadaver transplant programme facilitated the retrieval of 2460 organ and tissues from 445 donors from October 2008 to 31 January 2014. Out of total organs 814 kidneys were retrieved from 445 donors. It is ten times as compared to the rate of whole country. The deceased donor transplantation programme is successful in Tamil Nadu because this programme is the outcome of a collaborative effort between state government, private sectors and NGOS, the Tamil Nadu model can be a good example for spreading awareness of organ donation in other states of India and other developing countries that can follow this model to eliminate commercialization

Purpose: Noncompliance (NC) is not always intentional. The medical team, in the absence of objective evidence, rarely takes into account the non-intentional NC linked to the difficulty of taking drugs regularly and feelings of the patient, unless objective evidence is present. Better understanding of the triggers and determinants of NC would allow elaboration of educational tools designed to help out chronic patients with their treatment. Methods: 340 hemodialysis patients in 9 centers in three areas in France were included on a voluntary basis in this descriptive study. Among them, 10 patients responded to a qualitative interview focused on individual beliefs, attitudes and motivations towards phosphate binders? therapy. 26% of patients attended an educational program. Statistical methods consist of frequencies analysis and Exploratory Factor Analysis to determine combination of factors which significantly influence the compliance to phosphate binders. The semi-structured interviews were analyzed according to qualitative content analysis. Results: 329 self-administered questionnaires (50 items) were analyzed, 297 were complete for analysis (mean age 61 years, 62% male, dialysis duration 4.5 years, number of medication 9 per day) . The majority of patients consider treatment as important (80%). However, they mostly relativize the treatment as vital (45%). Factor analysis helped to identify two kind of independent behaviors: those which indicate concerns for the treatment and those relative to the use of the treatment as a necessity. Age, level of education and gender influence these two factors. Older patients are more compliant. The higher the level of education the more frequently patients adapt the treatment. The swallowable tablets are preferred (75%). The shape and color has little influence on decision. 60% of the patients consider they received enough pre therapeutic information. The involvement into educational formation has a not high enough influence on adherence. Conclusion: In conclusion, this large study provides clues to better understanding of non-compliance to phosphate binder determinants. Based on these assumptions, educational program should be more efficient and fruitful to chronic dialyzed patients

Lymphoproliferative illnesses address one or the possibly deadly inconveniences or organ transplantation. framing a gathering or heterogeneous lymphoid multiplications by their clinical show and histological viewpoints, going from receptive plasma hyperplasia to the appearance or harmful lymphomas. The presence of these pathologies is around 1% in renal transfer patient. Lymphoproliferative sicknesses address one or the conceivably deadly inconveniences or organ transplantation. framing a gathering or heterogeneous lymphoid multiplications by their clinical show and histological angles, going from receptive plasma hyperplasia to the appearance or harmful lymphomas. The presence of these pathologies is around 1% in renal transfer patient. Materials and methods:We report 3 instances of kidney relocate patients, who introduced after renal transplantation lymphoproliferative sicknesses. The point of our work Is to Illustrate the clinical, para-clnical, restorative and developmental introductions. Results:This is around three renal transfer patients, one lady and two men, matured 49, 21 and 65, individually. The relocated kidney to the female patient came from a cerebrum demise contributor and in the other 2 patients from relative living givers. The conclusion of the lymphoproliferative infection in the female patient was analyzed after a hematological assault, spurring the acknowledgment of a myelogram that affirmed a light chains myeloma. For the 2 other male patients. they introduced a tumor condition, a biopsy acted in these 2 patients uncovered enormous cells of B lymphoma related with n positive EBV PCR. The normal time among transplantation and finding was between 1.5 years and 15 years. Determination: The event of a lymphoproliferative illnesses comprises a transformative defining moment which undermines the crucial anticipation or patients and the funct1ons or the unite. It Increases the death rates and the profits to dialysis. Patient endurance has been improved as of late through prophylactic measure and restorative ones (reduction of immunosuppresses).

Post-relocate lymphoproliferative problems (PTLD) is a genuine complexity identified with the force of post-relocate immunosuppression. The part of Epstein-Barr infection (EBV) in PTLD advancement is grounded; notwithstanding, improvement of PTLD in EBV negative patients isn't remarkable. The critical advance in the administration of PTLD is to diminish the immunosuppressive burden. Relocate clinicians ought to be careful to the chance of this inconvenience, especially in patients with previous history of openness to immunosuppression during treatment of the essential renal illness. High file of doubt is essential for opportune conclusion. Remedial alternatives incorporate rituximab, chemotherapy, antivirals, assenting treatment and medical procedure.  This is around three renal transfer patients, one lady and two men, matured 49, 21 and 65, separately. The relocated kidney to the female patient came from a mind demise contributor and in the other 2 patients from relative living givers.

The analysis of the lymphoproliferative illness in the female patient was analyzed after a hematological assault, persuading the acknowledgment of a myelogram that affirmed a light chains myeloma. For the 2 other male patients. they introduced a tumor disorder, a biopsy acted in these 2 patients uncovered enormous cells of B lymphoma related with n positive EBV PCR. The normal time among transplantation and conclusion was between 1.5 years and 15 years. For the female patient, she got a chemotherapy convention dependent on dexamethasone, cyclophosphamide and thalidomide. The development was set apart by the profit from hemodialysis and afterward the demise of the patient after Infectious entanglements. For the 21-Year-Old patient, he profited with the R·-CHOP chemotherapy convention with a clinico-radiological abatement, and an improvement in the renal capacity. For the 65-year-old patient, a rituximab based treatment was started with diminished immunosuppression. The development was set apart by the passing or the patient. The lymphoproliferative infections post renal transplantation contrast from those of the immunocompetent subject by their viro-actuated quality (EBV), their incessant extra ganglionic confinement, the chance of mind harm and their p expected l reaction to a diminishing in immunosuppressive treatment The event of a lymphoproliferative illnesses establishes a transformative defining moment which undermines the essential anticipation or patients and the funct1ons or the unite. It Increases the death rates and the profits to dialysis. Patient endurance has been improved as of late through prophylactic measures (stay away from EBV contamination for seronegative patients) and remedial ones (reduction of immunosuppresses).

Presentation: Tetanus is a serious contamination portrayed by the fit of skeletal muscles that frequently advances toward respiratory disappointment. Intense Renal disappointment (ARF) is a significant intricacy related Tetanus disease, happening in 15%-39% of cases. Show of cases: A past sound 14-year-old kid was conceded to Tetanus ward of a clinic in Kabul giving serious muscle fits. On day four of affirmation, he began having cola-shaded pee with diminished pee yield. Because of absence of peritoneal dialysis, he went under hemodialysis considering quickly bringing up in blood urea (from gauge 32 mg/dl to 150 mg/dl), and creatinine from (benchmark 0.9 mg/dl to 6.2g/dl). In spite of all endeavors, he had abrupt heart failure and spent away on day 6 of confirmation. Conversation: ARF is a complexity of lockjaw, answered to be gentle and non-oliguric. Proposed obsessive components incorporate, autonomic brokenness, and rhabdomyolysis, inferable from uncontrolled muscle fits. Autonomic brokenness, generally apparent in initial fourteen days of contamination. End: The commonness and mortality of lockjaw is high in Afghanistan. Doctors and pediatricians should know about this complexity of lockjaw, to take suitable preventive measures and to perceive and oversee it early.

Catchphrases: Afghanistan, Acute Renal Failure, ARF, Child, Mortality. Lockjaw is an extreme disease portrayed by the fit of skeletal muscles that frequently advances toward respiratory disappointment The causative microorganism, Clostridium tetani, is normally found in the climate and its spores may enter the body through cuts or scraped spots, including cut injury. The lockjaw bacillus creates tetanospasmin and tetanolysin, the previous poison causes nearby aggravation by following up on gangliosides inside neighborhood nerve terminals, bringing about the clinical disorder The fundamental trait of lockjaw is muscle fit; lockjaw influences 95.7% of contaminated patients, neck solidness 89.3%, body fit/firmness 73%, and dysphagia 38.9% Most of new instances of lockjaw presently happen in South Asia; albeit the rate pace of lockjaw in this district has fallen 14-overlap, from near a large portion of 1,000,000 cases in 1990 to 33,000 out of 2017 (Hannah Behrens 2019), the death rate is as yet half 70% in certain spaces.

Regardless of the accessibility of an exceptionally compelling and modest lockjaw immunization, this contamination actually stays a significant wellbeing concern and reason for death in incalculable individuals in low-and center pay Following quite a while of war, Afghanistan, as an agricultural nation, has a powerless general wellbeing framework with a lack of doctors and huge fragments of the populace that are not being deal with. Neediness is endemic similar to an absence of schooling. The Ministry of Public Health of Afghanistan (MoPH) has been intending to expand inoculation inclusion with 3 portions of Diphtheria-Pertussis-Tetanus (DPT) antibody to 90%, be that as it may, 40 out of 329 areas as of now report under half inclusion with DPT3 and 15%–25% of the populace have no admittance to vaccination through immunization. Continuous struggle in certain pieces of the nation has denied half of the number of inhabitants in admittance to inoculation inclusion Lockjaw is one of the significant reasons for maternal and neonatal mortality in Afghanistan; in light of the latest information accessible, the level of Afghan pregnant ladies getting lockjaw antibody during pregnancy in 2017, was just 36% and the extent of births ensured against neonatal lockjaw was 53% ((MoPH) 2018). As indicated by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), assessed first-portion DPT inoculation inclusion in Afghanistan in 2016 was 73%, 3% lower than 2005, while third-portion inclusion was just 65% (World Health Organization (WHO), 2018a, World Health Organization (WHO), 2018b).

As most of conveyances in Afghanistan occur outside of formal clinical consideration, neonatal lockjaw is the principle field of concern with regards to the socioeconomics of the illness. In any case, this ought not detract from the meaning of the sickness frequency in other age gatherings, the degree of which is regularly ignored. In the current examination, we reflectively audit a progression of 24 recently analyzed grown-up instances of lockjaw all through Afghanistan which outline the insufficiencies in standing up to this preventable sickness. The included cases give an example of non-neonatal instances of lockjaw that may reveal insight into more extensive patterns in the occurrence, side effects, and wellbeing results of lockjaw in Afghanistan. To depict the clinical highlights and results of a case arrangement of grown-up lockjaw and delineate deficiencies in standing up to this preventable disease. This concentrate reflectively assessed 24 generally serious, affirmed instances of lockjaw, analyzed between March 2017 and December 2018, in Kabul Antani Hospital, Afghanistan. Concerning wellspring of the disease: 18 patients (75%) had a past filled with wounds, 1 had a background marked by a canine chomp and 1 was an intravenous medication client; 4 patients had no outer wounds or wounds. Dysphagia was the fundamental clinical sign for which patients looked for clinical treatment of the 12 patients who passed on, 7 gave disarray and seizure, 1 with intense kidney injury, and 2 with pneumonia.

Introduction: Kidney transplantation from living giver or mind dead is the replacement technique for decision in end stage renal illness. It depends on the standards of liberality and fortitude cannot be accomplished without the donation.After huge improvement of family agree rate to organ gift lately because of expansion in social exercises and social mindfulness, the level has been reached.This examination was performed to identify capable reasons for this level and furthermore the connected variables.

Materials and techniques: This is a solitary place review elucidating study directed more than 10 years (2010-2019), assembling all records of all potential benefactors mind dead selected by testing coordination unit of organs and tissues. We checked on precise reasons for family refusal from July 2015 to December 2016. The master organizers answerable for taking care of the bombed cases picked the reason for refusal from the recently pre-arranged rundown which was reevaluated by reaching the non benefactor families by telephone. The outcomes were contrasted with those got from comparative gathering of families in 2009. roll old enough and number of relatives in assent rate were additionally assessed.

Results:134 patients with cerebrum demise were recognized, having a mean time of 28.3, with a scope of 2 years - 62 years dominatingly Men (74%), the reason for death was the overwhelming genuine head injury (60%), trailed by stroke hemorrhagic (23%), a normal creatinine 11.13 mg/l, 60% of patients were on noradrenaline. 80% of kidney tests were related the corneas, liver or heart. As to purposes behind non-assortment, these were principally because of the refusal of families (63%),

counting the dad, mother and mate, propelling reasons as regard for the respectability of the body, the subject of religion, the shortfall of assumed assent of the expired or doubt against the clinical body. Against clinical signs addressed 14%non-examining, with 57% of heart failure, two HIV cases, 2 instances of viral hepatitis B and 2 instances of dynamic contamination. Different causes have recognized 2 patients with no family and an instance of non-accessibility of the careful group.

In the year and a half, 353 potential cadaveric contributors alluded to our organ obtainment unit. Mean age was 42.6 and 62 % were male. Primary driver of cerebrum passing were cerebrovascular mishap and injury (41.2% and 32.6%). Family assent rate was 84.4 % and 55 families dismissed the solicitation for organ gift. Driving reason for family refusal was strict accepts which came from Islamic minorities families for the most part. (43.6%). "Mind demise refusal" diminished altogether from 44.4% in 2009 to 12.7% in 2015-2016. "Inverse benefactor wishes", "unsteady family mind-set", "conviction of body respectability" and "assumption for a marvel" were different causes which had no reportable change. Neither huge contrasts were noted for the normal age, nor for the sexual orientation. In assent and refusal bunches in the two periods. In any case, when separated into three age bunches, critical contrast was found in pace of refusal to gift among age groups. (P <0.001). Moderately aged potential benefactors were less inclined to be agreed by their families in contrast with the two edges of the age range. Other than generally speaking contrast of number of relatives in assent and refusal gatherings, it was higher in the moderately aged possible benefactors, utilizing Kruskal-Wallis test. (6.6 ± 2.7 versus 9.1 ± 3.1, P<0.001). Despite what is generally expected, family assent rate was lower in this gathering. Hence, Kendall's tau-b test showed negative connection between's the variable and family assent status. (p<0.05 and connection coefficient= −0.812)

Conversation: The normal age of our populace is more youthful saw in the writing, the reason for most passings are stroke, while in our setting overwhelmed by head wounds brought about by street mishaps public. The body trustworthiness is a reason for repetitive dismissal in different investigations.

Conclusion: Kidney gift in mind dead patients is the fundamental assurance of admittance to kidney transplantation for dialysis without possible living contributor. It is along these lines important to streamline withdrawals by growing the models of the contributor heart to be halted or more all to broadcast the presence of organ gift and its significance to society

Introduction: End stage renal disease is a major public health problem in Morocco. It results from a regular growth of its incidence and its prevalence. It has a heavy economic impact and a significant influence on the quality of life of patients.

The objective of this study was to describe the demographic, clinical, biological, therapeutic, and evolutionary aspects of patients with end stage renal disease hemodialysed in the resuscitation unit of the nephrology department at Ibn rochd university hospital center.

Patients and Methods: Retrospective analysis of records of 1061 patients with end stage renal disease hemodialysed in the resuscitation unit of the nephrology department at university hospital center Ibn rochd, during a period of 8 years, spanning from January 1st, 2008 to December, 31 th, 2015.

Results: The annual incidence was 132 cases /year with a mean age of 49.8 years, and a slight male predominance with a sex ratio of 1.11. the medical antecedents have been dominated by diabetes (33.18%), and high blood pressure (32.28%). The most common primary reasons for admission were the acute oedema of the lung (14.5%), followed by consciousness disorder (11.78%), then hyperkalemia (6.31%). The hyperkalemia has been noted at 38.56% of cases, and the anemia at 59.5% of cases. the mortality rate was high by about 18%.

Discussion: At the end of this work, we hope to reduce this high morbidity and mortality; for this, we suggest:

• Better access to care through better medical coverage
• Respect of the referential in terms of indications, surveillance modalities, management, and correction of dialysis complications,
• Appropriate care at the hemodialysis centers as well as the establishment of a guard system for hemodialysis in emergency,
• Improve the public-private partnership framework by increasing the number of dialysis sessions to 3 sessions per week instead of 2, hence the recommended 12 hours per week.

This guideline is written primarily for doctors and nurses working in dialysis units and related areas of medicine in the UK, and is an update of a previous version written in 2009. It aims to provide guidance on how to look after patients and how to run dialysis units, and provides standards which units should in general aim to achieve. We would not advise patients to interpret the guideline as a rulebook, but perhaps to answer the question: “what does good quality haemodialysis look like?”

      The guideline is split into sections: each begins with a few statements which are graded by strength (1 is a firm recommendation, 2 is more like a sensible suggestion), and the type of research available to back up the statement, ranging from A (good quality trials so we are pretty sure this is right) to D (more like the opinion of experts than known for sure). After the statements there is a short summary explaining why we think this, often including a discussion of some of the most helpful research. There is then a list of the most important medical articles so that you can read further if you want to – most of this is freely available online, at least in summary form.

       Haemodialysis continues to expand in the UK with over 25 000 patients now being treated, representing a 10% increase since publication of the previous Renal Association guideline for haemodialysis. In addition the patient group continues to develop: the typical patient is now 67 years old with a median history of 3.2 years on renal replacement therapy. The authors of this guideline aimed principally to update the previous guideline according to the latest research and experience, but also to expand the scope into areas not previously covered but relevant to haemodialysis practice.

     The guideline was written collaboratively: lead and co-authors for each section conducted literature reviews and wrote first drafts of the statements and rationale. Feedback and discussion were provided by all authors via email exchanges and meetings, revised versions were produced with editorial input from the chair, and these were subsequently agreed by all authors. Two current haemodialysis patients gave advice on tone and readability.

Conclusion: It’s a Chronic progressive disease, long silent, which requires a heavy treatment with a huge economic impact