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Biomedical subjects

N R Robles

Publications and source records attributed to N R Robles.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Treatment with chlorambucil of renal amyloidosis secondary to rheumatoid arthritis. Study of 6 cases].

BACKGROUND: Amyloidosis is a common complication of rheumatoid arthritis. Renal disease is the main manifestation and its usual outcome is the lost of renal function. Some clinical evidences suggest that low-dose treatment with chlorambucil may be effective as therapy of this complication. PATIENTS AND METHODS: The effect of chlorambucil treatment in a group of six patients diagnosed by renal biopsy of renal amyloidosis secondary to rheumatoid arthritis was evaluated. Patients were treated with 0.1 mg/kg body weight/day for a time above a year until reduction of proteinuria. RESULTS: 3 out of 6 patients showed decrease of proteinuria below 500 mg/day, two patients have started renal replacement therapy and one died without response to treatment. It was detected non reversible azoospermia in one patient. Mean follow-up time has been sixty months. CONCLUSIONS: Chlorambucil may be effective in the treatment of renal amyloidosis secondary to rheumatoid arthritis when treatment starts before renal function is impaired. Long term remissions can be obtained even after suspending treatment.

Adult↗
PubMed1999

Sympathetic skin response in hemodialysis patients: correlation with nerve conduction studies and adequacy of dialysis.

A sympathetic skin response (SSR) test was performed in diabetic and nondiabetic patients undergoing regular hemodialysis and the results correlated with nerve conduction studies (NCS): sensory conduction velocity (SCV) and motor conduction velocity (MCV). Comparisons were made between diabetic and nondiabetic patients and between cuprophane and polyacrylonitrile membrane dialyzed patients. Six nondiabetic uremic patients (30%) and all diabetic patients had no SSR. Eight nondiabetic uremic patients (40%) had a mildly impaired response. Nondiabetic patients with a normal response were younger (31.1+/-16.4 years) than the patients with abnormal SSR, whether mildly impaired response (58.3+/-20.3 years; p<0.05, Anova) or absent response (65.3+/-13.8 years; p<0.01, Anova). SCV, MCV, and SSR values were reduced (p<0.01) in uremic patients with respect to normal subjects. Severity and frequencies of sensory NCS abnormalities in nondiabetic patients were: normal 20%, mildly impaired 75%, and severely impaired 5%. Severity and frequencies of motor conduction abnormalities were: normal 80%, mildly impaired 20%, severely impaired 0%. The SSR abnormality incidence in patients with a normal NCS was similar to that in patients with either mildly or severely impaired NCS (chi-square test). There was a positive linear correlation between the SSR amplitude and SCV (r = 0.52, p<0.01) and MCV (r = 0.49, p<0.01). The SSR latency was also significantly related to SCV (r = 0.66, p<0.01) and MCV (r = 0.61, p<0.01). A significant negative correlation was found between age and SSR parameters, amplitude (r = -0.56, p<0.01) and latency (r = -0.66, p<0.01). No correlation was found between duration of hemodialysis or Kt/V and SSR. No differences were found in SSR, NCS, or Kt/V values between cuprophane membrane and polyacrylonitrile membrane dialyzed patients (Student's t test). The relationship between NCS and SSR in uremic patients was confirmed. Old age and diabetes mellitus, but not the dialysis membrane used, were confirmed as synergistic factors of neuropathic impairment. It appeared that SSR is more sensitive than NCS in detecting polyneuropathy in uremic patients on hemodialysis.

Adult↗
PubMed1998

[Familial membranoproliferative glomerulonephritis].

Familial membranoproliferative glomerulonephritis is a rare disease of which eight cases has been reported. Two new patients are described now, two brothers, both of then males. Type I membrano-proliferative glomerulonephritis was the finding of biopsy. A third male brother died due to end stage renal failure, but biopsy was not performed in this patient. Previously reported cases of the disease are reviewed and it is concluded that all known cases belong to type I membranoproliferative glomerulonephritis and are males, suggesting a sex-linked recessive hereditary transmission. Hypocomplementemia seems to be less frequent than in the sporadic form. Major histocompatibility antigen system may have a role in the pathogenesis, specially, HLA A2 (and those with cross-reaction like A28) and DQ7.

Adolescent↗
PubMed1998

[Treatment with pravastatin of dyslipidemia associated with diabetic nephropathy].

OBJECTIVE: Patients with type II diabetes mellitus have an increased risk of coronary he disease. We investigated the efficacy and safety of pravastatin in the treatment of patients with diabetic nephropathy and hypercholesterolemia. METHOD: In this 6-months study, 12 patients (4 men, 8 women, mean age 60.5 +/- 10.8 years), with diabetic nephropathy and hypercholesterolemia (fasting plasma low-density lipoprotein cholesterol levels -LDL-C- > 130 mg/dl) received pravastatin 10 mg/day. The dose could be doubled after 4 weeks. Seven patients have chronic renal failure. RESULTS: Significant reductions in LDL-C (-19.1%, p < 0.05), total cholesterol (-16%, p < 0.01), very-low-density lipoprotein cholesterol (-29.2%, p < 0.05), apolipoprotein B (-21.5%, p < 0.05), and triglycerides (-26.0%, p < 0.01) were noted. No changes were found either in high-density-cholesterol or its fractions (HDL2 and HDL3) or in apolipoprotein A plasmatic levels. Pravastatin was well tolerated and no one side effect was detected. No clinically significant changes on the control of diabetes, renal function, as assessed by plasmatic creatinin and creatinin clearance, and proteinuria were seen during the follow-up time. CONCLUSIONS: The results of the study demonstrate that pravastatin is well tolerated and effective in lowering total cholesterol and LDL-C in patients with diabetic nephropathy and hypercholesterolemia.

Anticholesteremic Agents↗
PubMed1996

[Use of averaged concentration of urea and whole body urea clearance in prescribing the length of a dialysis session].

Urea kinetic-modelling was performed on 109 patients undergoing hemodialysis (518 urea kinetic studies). Then, the theoretic times for a target TAC = 50 mg/dl (TTAC) and a Kt/V = 1 (TKTV) were estimated. The differences and correlations of both times were calculated. Also the correlation of PCR and Kt/V was analyzed in relation to the range of Kt/V. For all cases no differences were found in dialysis session length (TTAC 221.4 +/- 42.6 min.; TKTV 222.9 +/- 48.9 min.). Mean Kt/V was 1.00 +/- 0.15 and mean TAC was 55.2 +/- 13.2. 313 studies (60.4%) have a TAC > 50 mg/dl. For Kt/V < 0.80, 15.6% have a TAC < 50 mg/dl, when Kt/V > 0.80 41.2% of cases have a TAC < 50 mg/dl (p < 0.01). A linear correlation of Kt/V and PCR was found (r = 0.36, p < 0.01). This correlation was stronger for Kt/V < 0.8 (r = 0.54, p < 0.01, n = 47). When TTAC was compared to TKTV a great variability was found: 20.1% have differences lesser than 15 minutes; and this difference was more than 30 minutes in 58.5%. In 107 cases (20.7%) the TTAC produced a Kt/V < 0.8. In all cases a significant (p < 0.01) linear correlation between TKTV and TTAC was found (r = 0.46). TKTV was greater than TTAC for real Kt/V < 1, and lesser than TTAC cuando the effective Kt/V was > 1. It is concluded that in patients treated by dialysis prescription of dialysis session length by TAC or by Kt/V produce rather different times for an unique patient. These differences are related to the PCR, which have a significant correlation with Kt/V. TAC tends toward under value dialysis session length in patients with inadequate dialysis.

Data Interpretation, Statistical↗
PubMed1996

[Incidence of diabetic nephropathy in the province of Badajoz along the period from 1990 to 1994].

Current registries provide information only on the number of diabetic patients with end-stage renal failure, more detailed information on the incidence of diabetic nephropathy with incipient renal failure is currently not available. The Nephrology Service of Hospital Infanta Cristina in Badajoz serves a population of approximately 650,000. In the time span between 1.1.90 and 31.12.94 the outpatient clinic and the renal ward had 1,717 admissions for evaluation of renal illness, 166 due to diabetic nephropathy (9.7% of total. Twelve (7.2%) were type I diabetics (mean age, 29.9 +/- 6.2 years), and 154 were type II diabetics (mean age 63.4 +/- 9.8 years). The annual incidence increased from 41.5/mio in 1990 to 61.5/mio in 1994. In parallel, 286 patients were admitted for renal replacement therapy, i.e. 88/mio/year. Of this group 60 patients had diabetes: type I, 8 patients (13.3%, mean age 3.7 +/- 6.4); type II, 52 patients (86.7%, mean age 66.0 +/- 6.6 years). This corresponds to an admission rate for dialysis of 18.5/mio/year (19.6% of all patients), with a increasing incidence rate from 13.8/mio in 1990 to 23.1/mio in 1994. This incidence of diabetic nephropathy is more than two-fold greater than the previously reported incidence by the EDTA registry for Spain, it is six-fold greater that the figure recorded for our region. Although the rates of incidence and prevalence of renal failure due to diabetic nephropathy founded in this study seems still to be lower than those of other developed european countries, it is detected a trend toward an increase of these figures in the latter years.

Diabetic Nephropathies↗
PubMed1995

[Clinical nephrological care not associated with substitutive treatment: the current situation and future needs for outpatient nephrology consultations].

The activity of an out-patient nephrology service during a period lasting from January 1991 to December 1993 (both inclusive) was studied. During this period, an average of 531 patients per million population and year were looked after, with a prevalence of 1,949 p.m.p. of chronic patients. Eleven point six per cent of the patients were discharged and 2.6% initiated treatment with hemodialysis, deducting nonappearances after examination, 66.9% of the patients were referred to permanent follow-up. Sixty seven point five per cent of the patients were older than 40 years and 31.2%, older than 60. The most frequent causes of consultation were AHT (17.4%), nephroangiosclerosis (5.7%), renal lithiasis (16.8%), idiopathic glomerulonephritis (10.9%) and diabetic nephropathy (8.2%). Fifty eight point five per cent of the patients were susceptible of out-patient care, especially those seen due to hypertension and lithiasis. We conclude that a significant increase in the needs of specialized care may be forecasted for the next years, mainly for arterial hypertension. Most of these needs could be covered through out-patient nephrology services.

Adolescent↗