Monday, February 23, 2015

I'm sharing "A randomized trial of icatibant in ACE-inhibitor-induced angioedema."


New England Journal of Medicine 2015 Jan 29; 372 (5) : 418-25.

A randomized trial of icatibant in ACE-inhibitor-induced angioedema.
Murat Baş, Jens Greve, Klaus Stelter, Miriam Havel, Ulrich Strassen, Nicole Rotter, Johannes Veit, Beate Schossow, Alexander Hapfelmeier, Victoria Kehl, Georg Kojda, Thomas K Hoffmann

PMID: 25629740



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Alberto Reino Buelvas

Saturday, February 21, 2015

The Bionic Pancreas: Novel Perspectives on Insulin Replacement Therapies



Alberto Reino Buelvas 
Médico Internista Nefrólogo


Dramatic Improvement of Severe Cryptococcosis-Induced Immune Reconstitution Syndrome With Adalimumab in a Renal Transplant Recipient.

AJT Dramatic Improvement of Severe Cryptococcosis-Induced Immune Reconstitution Syndrome With Adalimumab in a Renal Transplant Recipient.

In solid organ transplant recipients, immune reconstitution inflammatory syndrome (IRIS) is a rare complication of cryptococcosis, which may require steroids in its most severe forms. Here, we report the case of a renal transplant recipient who developed severe cryptococcal meningitis-associated IRIS 1 week after immunosuppression reduction. High-dose steroids failed to improve the disease. Finally, a recombinant human monoclonal tumor necrosis factor-α (TNF-α) antagonist, adalimumab, was prescribed, and the patient rapidly experienced dramatic neurological improvement. No IRIS relapse occurred within 14 months following adalimumab discontinuation.



http://www.unboundmedicine.com/medline/citation/25611999/Dramatic_Improvement_of_Severe_Cryptococcosis_Induced_Immune_Reconstitution_Syndrome_With_Adalimumab_in_a_Renal_Transplant_Recipient_

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Alberto Reino Buelvas 
Médico Internista Nefrólogo


Tuesday, February 17, 2015

Consensus Conference on Best Practices in Live Kidney Donation: Recommendations to Optimize Education, Access, and Care.

KIDNEY TRANSPLANTATION NEWS Consensus Conference on Best Practices in Live Kidney Donation: Recommendations to Optimize Education, Access, and Care.

AJT Consensus Conference on Best Practices in Live Kidney Donation: Recommendations to Optimize Education, Access, and Care.

Live donor kidney transplantation is the best treatment option for most patients with late-stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. A consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the living donor evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation.



http://www.unboundmedicine.com/medline/citation/25648884/Consensus_Conference_on_Best_Practices_in_Live_Kidney_Donation:_Recommendations_to_Optimize_Education_Access_and_Care_

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Alberto Reino Buelvas 
Médico Internista Nefrólogo





http://feedproxy.google.com/~r/KidneyTransplantationNews/~3/-IFJf-uutHs/consensus-conference-on-best-practices.html

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Alberto Reino Buelvas

OPTN/SRTR 2013 Annual Data Report: Kidney.

KIDNEY TRANSPLANTATION NEWS OPTN/SRTR 2013 Annual Data Report: Kidney.

AJT OPTN/SRTR 2013 Annual Data Report: Kidney.

A new kidney allocation system, expected to be implemented in late 2014, will characterize donors on a percent scale (0%-100%) using the kidney donor profile index (KDPI). The 20% of deceased donor kidneys with the greatest expected posttransplant longevity will be allocated first to the 20% of candidates with the best expected posttransplant survival; kidneys that are not accepted will then be offered to remaining 80% of candidates. Waiting time will start at the time of maintenance dialysis initiation (even if before listing) or at the time of listing with an estimated glomerular filtration rate of 20 mL/min/1.73 m(2) or less. Under the current system, the number of candidates on the waiting list continues to increase, as each year more candidates are added than are removed. Median waiting times for adults increased from 3 years in 2003 to more than 4.5 years in 2009. Donation rates have not increased. Short-term outcomes continue to improve; death-censored graft survival at 90 days posttransplant was 97% or higher for deceased donor transplants and over 99% for living donor transplants. In 2013, 883 pediatric candidates were added to the waiting list; 65.8% of pediatric candidates on the list in 2013 underwent deceased donor transplant. Five-year graft survival was highest for living donor recipients aged younger than 11 years (89%) and lowest for deceased donor recipients aged 11 to 17 years (68%).



http://www.unboundmedicine.com/medline/citation/25626344/OPTN/SRTR_2013_Annual_Data_Report:_Kidney_

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Alberto Reino Buelvas 
Médico Internista Nefrólogo





http://feedproxy.google.com/~r/KidneyTransplantationNews/~3/BTd571GAyZU/optnsrtr-2013-annual-data-report-kidney.html

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Alberto Reino Buelvas

OPTN/SRTR 2013 Annual Data Report: Kidney.

AJT OPTN/SRTR 2013 Annual Data Report: Kidney.

A new kidney allocation system, expected to be implemented in late 2014, will characterize donors on a percent scale (0%-100%) using the kidney donor profile index (KDPI). The 20% of deceased donor kidneys with the greatest expected posttransplant longevity will be allocated first to the 20% of candidates with the best expected posttransplant survival; kidneys that are not accepted will then be offered to remaining 80% of candidates. Waiting time will start at the time of maintenance dialysis initiation (even if before listing) or at the time of listing with an estimated glomerular filtration rate of 20 mL/min/1.73 m(2) or less. Under the current system, the number of candidates on the waiting list continues to increase, as each year more candidates are added than are removed. Median waiting times for adults increased from 3 years in 2003 to more than 4.5 years in 2009. Donation rates have not increased. Short-term outcomes continue to improve; death-censored graft survival at 90 days posttransplant was 97% or higher for deceased donor transplants and over 99% for living donor transplants. In 2013, 883 pediatric candidates were added to the waiting list; 65.8% of pediatric candidates on the list in 2013 underwent deceased donor transplant. Five-year graft survival was highest for living donor recipients aged younger than 11 years (89%) and lowest for deceased donor recipients aged 11 to 17 years (68%).



http://www.unboundmedicine.com/medline/citation/25626344/OPTN/SRTR_2013_Annual_Data_Report:_Kidney_

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Alberto Reino Buelvas 
Médico Internista Nefrólogo


Consensus Conference on Best Practices in Live Kidney Donation: Recommendations to Optimize Education, Access, and Care.

AJT Consensus Conference on Best Practices in Live Kidney Donation: Recommendations to Optimize Education, Access, and Care.

Live donor kidney transplantation is the best treatment option for most patients with late-stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. A consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the living donor evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation.



http://www.unboundmedicine.com/medline/citation/25648884/Consensus_Conference_on_Best_Practices_in_Live_Kidney_Donation:_Recommendations_to_Optimize_Education_Access_and_Care_

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Alberto Reino Buelvas 
Médico Internista Nefrólogo


Monday, February 16, 2015

Impact of Antibiotic Resistance on the Development of Recurrent and Relapsing Symptomatic Urinary Tract Infection in Kidney Recipients.

AJT Impact of Antibiotic Resistance on the Development of Recurrent and Relapsing Symptomatic Urinary Tract Infection in Kidney Recipients.

We sought to determine the frequency, risk factors, and clinical impact of recurrent urinary tract infections (UTI) in kidney transplant recipients. Of 867 patients who received a kidney transplant between 2003 and 2010, 174 (20%) presented at least one episode of UTI. Fifty-five patients presented a recurrent UTI (32%) and 78% of them could be also considered relapsing episodes. Recurrent UTI was caused by extended-spectrum betalactamase (ESBL)-producing Klebsiella pneumoniae (31%), followed by non-ESBL producing Escherichia coli (15%), multidrug-resistant (MDR) Pseudomonas aeruginosa (14%), and ESBL-producing E. coli (13%). The variables associated with a higher risk of recurrent UTI were a first or second episode of infection by MDR bacteria (OR 12; 95%CI 528), age >60 years (OR 2.2; 95%CI 1.15.1), and reoperation (OR 3; 95%CI 1.37.1). In addition, more relapses were recorded in patients with UTI caused by MDR organisms than in those with susceptible microorganisms. There were no differences in acute rejection, graft function, graft loss or 1 year mortality between groups. In conclusion, recurrent UTI is frequent among kidney recipients and associated with MDR organism. Classic risk factors for UTI (female gender and diabetes) are absent in kidney recipients, thus highlighting the relevance of uropathogens in this population.



http://www.unboundmedicine.com/medline/citation/25676738/Impact_of_Antibiotic_Resistance_on_the_Development_of_Recurrent_and_Relapsing_Symptomatic_Urinary_Tract_Infection_in_Kidney_Recipients_

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Alberto Reino Buelvas 
Médico Internista Nefrólogo


Sunday, February 15, 2015

Rituximab as Induction Therapy After Renal Transplantation: A Randomized, Double-Blind, Placebo-Controlled Study of Efficacy and Safety

AJT - Early Rituximab as Induction Therapy After Renal Transplantation: A Randomized, Double-Blind, Placebo-Controlled Study of Efficacy and Safety

We evaluated the efficacy and safety of rituximab as induction therapy in renal transplant patients. In a double-blind, placebo-controlled study, 280 adult renal transplant patients were randomized between a single dose of rituximab (375 mg/m2) or placebo during transplant surgery. Patients were stratified according to panel-reactive antibody (PRA) value and rank number of transplantation. Maintenance immunosuppression consisted of tacrolimus, mycophenolate mofetil and steroids. The primary endpoint was the incidence of biopsy proven acute rejection (BPAR) within 6 months after transplantation. The incidence of BPAR was comparable between rituximab-treated (23/138, 16.7%) and placebo-treated patients (30/142, 21.2%, p = 0.25). Immunologically high-risk patients (PRA >6% or re-transplant) not receiving rituximab had a significantly higher incidence of rejection (13/34, 38.2%) compared to other treatment groups (rituximab-treated immunologically high-risk patients, and rituximab- or placebo-treated immunologically low-risk (PRA ≤ 6% or first transplant) patients (17.9%, 16.4% and 15.7%, p = 0.004). Neutropenia (<1.5 × 109/L) occurred more frequently in rituximab-treated patients (24.3% vs. 2.2%, p < 0.001). After 24 months, the cumulative incidence of infections and malignancies was comparable. A single dose of rituximab as induction therapy did not reduce the overall incidence of BPAR, but might be beneficial in immunologically high-risk patients. Treatment with rituximab was safe.




http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajt.13052

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Alberto Reino Buelvas 
Médico Internista Nefrólogo


Wednesday, February 4, 2015

Antidiabetic Therapy in Post Kidney Transplantation Diabetes Mellitus

Transplantation Reviews Antidiabetic Therapy in Post Kidney Transplantation Diabetes Mellitus

Post-transplantation diabetes mellitus (PTDM) is a common complication after kidney transplantation that affects up to 40 % of kidney transplant recipients. By pathogenesis, PTDM is a diabetes form of its own, and may be characterized by a sudden, drug-induced deficiency in insulin secretion rather than worsening of insulin resistance over time. In the context of deteriorating allograft function leading to a re-occurrence of chronic kidney disease after transplantation, pharmacological interventions in PTDM patients deserve special attention.


http://www.transplantationreviews.com/article/S0955-470X(15)00002-6/abstract?rss=yes

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Alberto Reino Buelvas 
Médico Internista Nefrólogo