Biomedical subjects
R Matesanz
Publications and source records attributed to R Matesanz.
European urgent liver graft scheme: a prospective study.
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Epidemiology of symptomatic hypotension in hemodialysis: is cool dialysate beneficial for all patients?
A prospective study on hypotension in hemodialysis was performed in 60 nondiabetic patients at two different dialysate temperatures during 12 months. A 37 degrees C bath (3,723 sessions) was used and after the first 6 months the temperature was changed to 35 degrees C (4,019 sessions). The prevalence of symptomatic hypotension was 15.3% and it was closely correlated with the presence of other symptoms. The most affected populations were women, patients over 55 years of age, patients with low body surface area and patients with a cardiovascular disease. A slight but significant decrease of symptomatic hypotension was seen by using a 35 degrees C dialysate (16.4 vs. 14.3%, p less than 0.01). In patients with frequent hypotension (in up to 30% of sessions), cool dialysate significantly reduced the incidence of the symptom (44.2 vs. 34.1%, p less than 0.001). These results were obtained in spite of a greater interdialysis weight gain at low temperature (2 +/- 0.6 vs. 1.9 +/- 0.7 kg, p less than 0.001). We consider that low-temperature dialysis is a simple, useful and economic procedure, especially for highly symptomatic patients. The association of cooling dialysate with higher sodium concentration, bicarbonate and special membranes could reduce dialysis symptoms dramatically.
[Metastatic calcification simulating a sacral tumor in a patient on periodic dialysis].
Renal osteodystrophy is usually a prominent feature in patients undergoing chronic hemodialysis. Metastatic calcifications are a frequent finding when secondary hyperparathyroidism is associated. We present a patient with a sacral soft tissue calcification resembling a malignant tumour.
Recombinant human erythropoietin treatment in patients on maintenance home haemodialysis.
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[Recent trends in the financial support of medical articles].
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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.
Serum ferritin levels after renal transplantation: a prospective study.
A prospective study was made of the evolution of serum ferritin levels in 112 renal transplant recipients with good graft function. The rise in hemoglobin value is accompanied by a decrease in basal serum ferritin levels which are lowest at the sixth month: 54.9 (2-1,516) vs. 109.6 (21-4,420) micrograms/l, p less than 0.001 (Xg and range). After this time, ferritin values increase, although they do not reach basal levels. Evolution after transplantation is mainly determined by the previous state of iron stores at the time of transplantation. While in the patients with high basal serum ferritin values these gradually decreased during the follow-up period, patients with low basal serum ferritin levels tend to replenish their iron stores after renal transplantation. These differences disappear at the third year when serum ferritin values are similar in all groups. An association between persistence of posttransplant anemia and low serum ferritin levels is observed. This event is not clinically relevant as anemia disappears in almost all cases and dietary iron is enough to normalize serum ferritin levels.
Veno-occlusive hepatic disease of the liver in renal transplantation: is azathioprine the cause?
Five male patients with veno-occlusive disease of the liver (VOD) were observed in 200 consecutive renal transplants (RT) treated with azathioprine and prednisone. Mild liver enzymatic increases not justified by other reasons were detected between 2 and 9 months after RT. All 5 patients developed portal hypertension and died between 18 and 79 months following RT. Diagnosis of VOD was histological; in 3 cases diagnosis was made while the patients were still alive. In our patients, 9 previous viral hepatotropic infections (5 during hemodialysis and 4 after TR) were demonstrated. Due to the reported low incidence of VOD in RT patients, when many of them have been treated with azathioprine, the etiological role of this drug must be questioned. However, the possible association of a previous hepatotropic viral infection and the use of an immunosuppressive agent should be considered as a probable cause of VOD in kidney grafts.
[Decrease of membranoproliferative glomerulonephritis in the Spanish population].
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[Prevention of iodinated contrast media nephrotoxicity in patients with renal insufficiency].
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[Home hemodialysis: the course in 100 patients treated at home].
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Lymphorrhea as postoperative complication of living donor nephrectomy: a case report.
We report a case of lymphorrhea after living donor nephrectomy. Clinically the donor presented with an increased flow of a liquid characteristic of lymph, which was treated successfully with iodinated povidone. The possible pathogenic mechanisms implicated in the development of lymphocele following renal transplantation are discussed.
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)
Urographic visualization of the native kidneys following renal transplantation: a demonstration of the intact nephron hypothesis.
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Pre-transplant transfusions in renal recipients treated with cyclosporine: a subject of controversy.
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Effect of desferrioxamine on anaemia of haemodialysis patients.
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The importance of urinary thromboxane B2 excretion in the diagnosis of acute renal rejection.
To establish whether or not urinary excretion TxB2 is a useful parameter in the diagnosis of acute renal rejection, 45 renal transplant patients were studied and classified in four groups: Group A. Ten observations of satisfactory clinical outcome (without either acute rejection or tubular necrosis). Urinary TxB2 was initially increased but had settled to normal by the 3rd postoperative day. Two patients had subsequent increases. Group B. Twenty-five episodes of acute rejection on a previously satisfactorily functioning graft. Nineteen had increases in TxB2 values before serum creatinine increased. Group C. Five episodes of tubular necrosis without acute rejection. The evolution was similar to Group A. Group D. Nine acute episodes of rejection on kidneys with tubular necrosis. The urinary output of TxB2 was increased from the beginning. This increase was maintained until the rejection was treated. This group had the highest values of urine TxB2. The principal significance of this parameter lies in its precocity and in its utility for diagnosis of acute rejection in the graft with tubular necrosis, as the persistence of raised values of TxB2 in the urine beyond the 3rd postoperative day is highly suggestive of an acute rejection.