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Biomedical subjects

R Marcén

Publications and source records attributed to R Marcén.

At least 91 records · Page 5Linked to original sources
PubMed1989

Easy and early prognosis in acute tubular necrosis: a forward analysis of 228 cases.

Multiple factors still influence the high rate of mortality in acute tubular necrosis. Trying to analyze the influence of each risk factor present in an individual patient and the possible interdependence between these factors, as well as to obtain an early prognosis, we have applied a forward analysis to demographic data, acute renal failure origin, need of dialysis, diuresis and clinical conditions in 228 patients, using a multiple linear regression model contained in a computer package. Based on this approach we have found that three variables: deep neurological coma, persistent blood hypotension and assisted respiration have significant influence on mortality. Also, a regression equation was obtained which could be applied as a discriminant score to patient prognosis. This score, calculated with the three aforementioned variables and oliguria when the nephrologist sees the patient for the first time, allows an easy and early prognosis in each patient with acute tubular necrosis.

Acute Kidney Injury↗
PubMed1988

Hemodialysis with low-temperature dialysate: a long-term experience.

The effect of cool dialysate in hemodialysis (HD)-induced symptoms was studied in a group of 8 patients, neither diabetic nor anephric, with a high incidence of HD-induced hypotension (20-90%). Patients were studied during two consecutive periods of 6 months, the first one with dialysate at 37 degrees C (598 sessions) and the second one at 35 degrees C (599 sessions). Dialysis at low temperature was associated with a decrease in symptomatic hypotension (SH) (47.4 vs. 33.9%, p less than 0.001), a greater loss of weight during HD (1.52 +/- 0.03 vs. 1.71 +/- 0.03 kg, p less than 0.001) and stabilization of predialysis systolic blood pressure (SBP) at a lower level (144 +/- 0.69 vs. 139 +/- 0.98 mm Hg, p less than 0.001). At 37 degrees C, SH was associated with a higher ultrafiltration (1.71 +/- 0.05 vs. 1.32 +/- 0.05 kg, p less than 0.001). There was an improvement of symptoms both taken as a whole (55.6 vs. 45.8%, p less than 0.01) or one by one, cramps were the only exception as they increased at 35 degrees C (2.7 vs. 10.9%, p less than 0.001) being related with a greater weight loss at both temperatures (1.47 +/- 0.04 vs. 2.04 +/- 0.25 kg at 37 degrees C, p less than 0.001; 1.76 +/- 0.03 kg vs. 2.23 = 0.10 kg at 35 degrees C, p less than 0.001). In spite of the increase in the frequency of cramps, 7 out of 8 patients experienced some amelioration of dialysis symptoms (range between 7 and 21.4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Lupus-like in vitro anticoagulant activity in end-stage renal disease.

Lupus-like anticoagulant is diagnosed by a prolonged activated plasma thromboplastin time not corrected after incubation with normal plasma, prolongation of diluted tissue thromboplastin time and of diluted Russel's viper venom time, excluding factor deficiencies or specific coagulation inhibitors. We studied the presence of this 'lupus-like anticoagulant' in 100 patients with end-stage renal disease, 56 on hemodialysis and 44 on conservative treatment. 'Lupus-like anticoagulant' activity was found in vitro in the blood of 22 patients (22%) being a significantly higher prevalence than that found in 125 patients with systemic lupus erythematosus (15%) and in 50 healthy controls (0%). Hemodialysis patients showed 'lupus-like anticoagulant' activity in 30% cases, compared to 11% patients on conservative treatment. The presence of 'lupus-like anticoagulant' was unrelated with primary disease or medication received. The incidence of thrombosis in patients with this in vitro anticoagulant was higher than in patients without it (23 vs. 13%), although this difference is not significant. We conclude that prevalence of 'lupus-like anticoagulant' is high in patients with end-stage renal disease, a previously unreported observation. Its clinical and pathogenetic significance should be studied further.

Adolescent↗
PubMed1988

Immunoglobulin class and specificity of lymphocytotoxic antibodies after kidney transplantation.

The immunoglobulin class and specificity of the cytotoxic antibodies were investigated in sera collected during the first weeks following transplantation from 35 patients with functioning and 20 patients with failed grafts. No patient had had cytotoxic antibodies before the transplant, but 71.5% (25 of 35) of patients with functioning and 75% (15 of 20) of patients with failed graft subsequently developed them. The addition of dithiothreitol, which digests IgM antibodies, resulted in the disappearance of cytotoxicity in all positive sera from patients with a functioning graft. However, in the patients with failed grafts, the immunoglobulin class of the antibody varied; seven patients had only IgM antibodies, and seven had both IgM and IgG. After graft nephrectomy, IgG antibodies appeared in another six patients. In five of six patients with functioning grafts, mouse monoclonal antibodies blocked the cytotoxic activity; four with HLA-DQ monoclonal antibodies (Leu 10), one with HLA Class I (GD5). In the patients with failed grafts, blocking was seen in all nine patients studied; eight by GD5, six by Leu 10, and two by a monoclonal antibody to a monomorphic determinant of HLA-DR (100/77). Although the frequency of antibody-positive patients was similar in the successful and failed groups, the immunoglobulin class of the antibodies developed was IgM in the former group, whereas in the latter group some were IgM and others were IgG. Characterisation of the antibodies could be useful in the interpretation of a positive cross-match, since IgG antibodies are damaging to the graft whereas IgM antibodies are not.

Adult↗
PubMed1987

HLA antigens and serum ferritin in hemodialysis patients.

The evolution of serum ferritin levels in 111 chronic-hemodialysis patients is prospectively studied. Patients were classified in two groups according to the presence or absence of 'hemochromatosis antigens' (HLA A3, B7 or B14) in their HLA typing. Levels of serum ferritin were similar in both groups before they started dialysis and during the first year. On the contrary, in the second and third hemodialysis years serum ferritin was higher in the group carrying 'hemochromatosis antigens'. These differences were observed in patients treated with parenteral iron either in the form of transfusions or as intravenous dextran-iron but not in patients receiving oral iron. We conclude that the risk of developing iron overload is greater in hemodialysis patients with HLA A3, B7 or B14. Nevertheless, this potential risk can be minimized with a restrictive policy on the use of parenteral iron (transfusions, intravenous dextran-iron).

Anemia, Hypochromic↗
PubMed1987

Os penis in a hemodialysis patient.

A case of os penis in a patient on chronic hemodialysis is described for the first time. Bilateral involvement of the corpora cavernosa was present, covered by an ossification plate.

Calcinosis↗