Hemolysis in Hemodialysis, Secondary to Severe Vena Cava Stenosis.

Complications in hemodialysis patients are increasingly rare thanks to advances in technology, including more compatible membranes, more flexible lines, safety in water treatments, alarms in the circuit, and standardization in dialysate fluids plus exhaustive chemical and microbiological tests. In addition, it is highly unusual having hemolysis on hemodialysis; however, it is a life-threatening complication, so the cause must be identified and early managed. The etiology can be chemical or mechanical; however, so far, there are no reports in the literature of an association with severe stenosis of the vena cava, as it is described in the case reported here, where a patient presented hemolysis in two hemodialysis sessions, without initially being possible to find the cause; the only identifiable factor was that he had a dysfunctional tunneled jugular catheter, with a history of difficult vascular access.

Brain abscess caused by Cladophialophora bantiana after renal allograft loss: A case report.

Cerebral feohifomycosis are severe infections caused by dematiaceous fungi. Cladophialophora bantiana is one of the most commonly isolated species; it has central nervous system tropism and it often manifests as a brain abscess in immunocompetent patients. In immunocompromised patients, it can lead to brain abscesses and disseminated infections.

Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review.

Methotrexate is an effective medication to control several diseases; however, it can be very toxic, being myelosuppression one of its main adverse effects, which increases in severity and frequency in patients with renal failure. We present the case of a 68-year-old man with chronic, end-stage renal disease associated with ANCA vasculitis, under treatment with peritoneal dialysis, who received the medication at a low dose, indicated by disease activity, which presented as a complication with severe pancytopenia with mucositis that improved with support measures and multiple-exchange peritoneal dialysis. We reviewed 20 cases published to date of pancytopenia associated with methotrexate in patients on dialysis and found high morbidity and mortality, which is why its use in this type of patient is not recommended.

Lipocalina asociada con gelatinasa del neutrófilo como predictor de disfunción del injerto a un año del trasplante renal.

IntroducciÓn: Estudios recientes sugieren que la lipocalina asociada con la gelatinasa del neutrófilo urinaria (NGALu) es superior a la creatinina para la detección temprana de la disfunción del injerto renal, pero son pocos los estudios que evalúan su utilidad como predictor a largo plazo de dicha función.

Objetivo: Explorar si los valores de NGALu en las primeras 48 horas después del trasplante renal predicen la función del injerto a largo plazo.

MÉtodo: Cohorte prospectiva en la que se evaluaron los valores de NGALu a las 2, 12, 24 y 48 horas postrasplante renal.

Successful kidney transplant with eculizumab, thymoglobulin and belatacept therapy in a highly-sensitised patient with atypical haemolytic uraemic syndrome due to factor H mutation.

Atypical haemolytic uremic syndrome is a disease caused by complement regulation abnormalities that generally progresses to chronic end-stage renal disease with a high rate of recurrence in kidney transplantation and a high risk of graft loss. Anti-complement therapy has improved the prognosis of these patients, achieving disease remission in most cases, increasing the likelihood of a successful kidney transplant and increasing patient and graft survival. Drugs with low risk of induction of thrombotic microangiopathies such as belatacept and mycophenolate have also been used with satisfactory results.

[Severe hypoxemic respiratory failure caused by Pneumocystis jirovecii in a late kidney transplant recipient].

Pneumonia caused by Pneumocystis jirovecii is an uncommon infection in kidney transplant patients that can have an acute and rapid progression to respiratory failure and death. The period of greatest risk occurs in the first six months after the transplant, and it relates to the high doses of immunosuppression drugs required by patients. However, it may occur late, associated with the suspension of prophylaxis with trimethoprim-sulfamethoxazole.

Primary hiperoxaluria diagnosed after kidney transplantation: report of 2 cases and literature review.

Primary hyperoxaluria (PH) is a very rare genetic disorder; it is characterized by total or partial deficiency of the enzymes related to the metabolism of glyoxylate, with an overproduction of calcium oxalate that is deposited in different organs, mainly the kidney, leading to recurrent lithiasis, nephrocalcinosis and end stage renal disease (ESRD). In patients with ESRD that receive kidney transplantation alone, the disease has a relapse of 100%, with graft loss in a high percentage of patients in the first 5 years of transplantation. Three molecular disorders have been described in PH: mutation of the gene alanin glioxalate aminotransferase (AGXT); glyoxalate reductase/hydroxy pyruvate reductase (GRHPR) and 4-OH-2-oxoglutarate aldolase (HOGA1).

Treatment of post-transplantation lymphoproliferative disorders after kidney transplant with rituximab and conversion to m-TOR inhibitor.

Background: Post-transplantation lymphoproliferative disorders are serious complications of organ transplantation which treatment is not yet standardized.

Objective: To describe the clinical response, overall and graft survival of patients in our center with this complication after kidney transplantation, which received rituximab as part of their treatment as well as conversion to m-TOR.

Methods: Retrospective study, which included patients, diagnosed with post-transplant lymphoproliferative disorders after kidney transplantation from January 2011 to July 2014.

[Three cases of de novo multiple myeloma after kidney transplantation].

Light chain-associated kidney compromise is frequent in patients with monoclonal gammopathies; it affects the glomeruli or the tubules, and its most common cause is multiple myeloma. It may develop after a kidney transplant due to recurrence of a preexisting multiple myeloma or it can be a de novo disease manifesting as graft dysfunction and proteinuria. A kidney biopsy is always necessary to confirm the diagnosis.

Neutrophil gelatinase-associated lipocalin as an early predictor of delayed graft function.

Introduction: Delayed graft function occurs in about 20 to 50 percent of kidney transplants. 

Objective: To describe the behavior of urinary neutrophil gelatinase-associated lipocalin (NGALu) in deceased-donor renal transplant recipients and to compare this indicator with the percentage of creatinine decrease (PdC) for the early detection of delayed graft function. 

Materials And Methods: NGALu levels were evaluated in a prospective cohort in the first, 12th, 24th and 48th hours after kidney transplant, and compared with the daily PdC until day 5.

Hemolytic uremic syndrome due to gemcitabine in a young woman with cholangiocarcinoma.

Gemcitabine is a medication used to treat various types of malignant neoplasms. Its association with hemolytic uremic syndrome (HUS) has been described in few cases, although these cases have resulted in mortality rates of at least 50%. We report on the case of a 25-year-old patient with cholangiocarcinoma in remission who developed microangiopathic hemolytic anemia with acute anuric renal failure after receiving 5 cycles of gemcitabine chemotherapy; this condition was consistent with HUS caused by the side effects of this drug.

Clinical outcomes of kidney transplants on patients with end-stage renal disease secondary to lupus nephritis, polycystic kidney disease and diabetic nephropathy.

Background: Patients with lupus nephritis could progress to end-stage renal disease (10-22%); hence, kidney transplants should be considered as the treatment of choice for these patients.

Objective: To evaluate the clinical outcomes after kidney transplants in patients with chronic kidney diseases secondary to lupus nephritis, polycystic kidney disease and diabetes nephropathy at Pablo Tobon Uribe Hospital.

Methods: A descriptive and retrospective study performed at one kidney transplant center between 2005 and 2013.

Tuberculosis in renal transplant patients: the experience of a single center in Medellín-Colombia, 2005-2013.

Introduction: Tuberculosis is a common opportunistic infection in renal transplant patients.

Objective: To obtain a clinical and laboratory description of transplant patients diagnosed with tuberculosis and their response to treatment during a period ranging from 2005 to 2013 at the Pablo Tobón Uribe Hospital.

Methods: Retrospective and descriptive study.

[Successful treatment of rhino-orbital-cerebral mucormycosis in a kidney transplant patient].

Rhino-orbital-cerebral mucormycosis is a potentially fatal mycotic infection in immunosuppressed patients. The main risk factors for acquiring this infection are poorly controlled diabetes mellitus, iron overload, potent immunosuppression and chronic steroid use. In this review, we present the case of a kidney transplant patient who, after treatment of an acute rejection episode with high doses of steroids and potent immunosuppression with tacrolimus and mycophenolate, presented with rapidly progressing rhino-orbital-cerebral mucormycosis that required aggressive surgical treatment, immunosuppression discontinuation and potent antifungal treatment.

Advances in the technology of automated, tidal, and continuous flow peritoneal dialysis.

Automated peritoneal dialysis (APD) has undergone substantial growth in recent years because of an increased demand for higher doses of peritoneal dialysis (PD) treatment and a need to improve quality of life for patients. The evolution of this treatment is closely linked with the development of new automatic machines and with recent advances in prescription and monitoring of PD treatment. In the present article, we describe the characteristics of the new generation of APD cyclers with particular regard to adequacy targets and safety.

Rational choice of peritoneal dialysis catheter.

The peritoneal catheter should be a permanent and safe access to the peritoneal cavity. Catheter-related problems are often the cause of permanent transfer to hemodialysis (HD) in up to 20% of peritoneal dialysis (PD) patients; in some cases, these problems require a temporary period on HD. Advances in connectology have reduced the incidence of peritonitis, and so catheter-related complications during PD have become a major concern.