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Calciphylaxis in Patients with Chronic Kidney Disease Case Presentation and Review

Open Journal of Nephrology 2021年第3期11卷 335-347页

作者： José Lucas Daza María Camila Correcha Ferro Andrés David Cárdenas Luis Daza Ivan Ortega Jonathan de Jong john galindo Gerardo Gutiérrez Luis Puello Yaroslad de la Cruz Nephrology Unit Hospital De Clinicas Buenos Aires Argentina Departmentof Medicine Manizales University Manizales Colombia Departmentof Medicine Cooperativa University Ibague Colombia Hematology Unit Fluminense University Rio de Janeiro Brazil Nephrology Unit Fresenius Medical Care Ibague Colombia

Calciphylaxis is a serious disorder that presents itself as ischemia and ne-crosis of the skin which occurs more frequently in patients with an end-stage chronic kidney disease, but not exclusively. The pathogenesis is a result of the reduction of arteriolar blood flow, caused by calcification, fibrosis, and thrombus formation that primarily involve the arterioles of the dermis and hypodermis, with a poor prognosis. Case presentation: A 44-year-old patient with a previous diagnosis of chronic kidney disease receiving hemodialysis secondary to polycystic kidney disease, with a history of parathyroidectomy due to primary hyperparathyroidism in 2011. In 2014 the patient presented skin lesions, for which a diagnostic biopsy of calciphylaxis was performed and began treatment with sodium thiosulfate with a poor progression and evolution. New histology compatible with the diagnosis of pyoderma gangrenosum and findings of calciphylaxis were performed. The patient begins treatment with corticosteroids and cyclosporine, with poor clinical evolution and the patient eventually passes away. The objective of this manuscript is to understand this pathology better, which is infrequent but with a high rate of morbidity and mortality.

关键词： Calciphylaxis Vascular Calcification Syndrome Calcific Uremic Arteriolopathy

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Multiple-Organ Extracorporeal Support Therapies in Critically Ill Patients

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Open Journal of Nephrology 2021年第2期11卷 281-293页

作者： José Lucas Daza María C. Correcha Ferro Andrés David Cardenas Luis Daza Emilio Rey Jonathan de Jong john galindo Gerardo Gutiérrez Luis Puello Yaroslad de la Cruz Nephrology Unit Hospital De Clinicas Buenos Aires Argentina Department of Medicine Manizales University Manizales Colombia Department of Medicine Cooperativa University Ibague Colombia Hematolology Unit Fluminense University Rio de Janeiro Brasil Nephrology Unit Fresenius Medical Care Ibague Colombia

The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, large surgeries, traumatic injuries, burn patients and brain injuries), this syndrome is characterized by global hemodynamic and organ perfusion alterations accompanied by an uncontrolled and marked inflammatory response unresponsive to pharmacological treatment due to which extracorporeal organ support can be a viable option. Acute renal lesion can occur in up to 60% of patients receiving intensive care, and close to 10% - 20% require renal replacement therapy (RRT) globally this can be provided as peritoneal dialysis (PD) or intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), hybrid therapies known as sustained slow efficiency dialysis (SLED), which combines the benefits IHD and CRRT, slow continuous ultrafiltration (SCUF). Extracorporeal membrane oxygenation (ECMO) and extracorporeal elimination of CO2, have been used more frequently lately, these are temporal artificial support used for respiratory and/or cardiac insufficiency that is refractory to conventional treatment. Acute liver failure in adults has a mortality rate close to 50% furthermore one-third of patients hospitalized for cirrhosis are likely to progress to acute liver failure which will drastically increase its mortality. Based on concepts of albumin dialysis, one of its most known is the following: Molecular Adsorbent Recirculating System (MARS), Fractionated Plasma Separation and Absorption—FPSA (Prometheus®) and also, hemoperfusion with different cartridges used in different extracorporeal therapies, used in liver failure, rhabdomyolysis, cytokine release syndrome and more in the context of the pandemic covid19. The objective of this review is to know the different extracorporeal therapies and the therapeutic utility in critical patients

关键词： MODS (Multiple Organ Dysfunction Syndrome) RRT (Renal Replacement Therapy CRRT (Continuous Renal Replacement Therapy) SLED (Slow Efficiency Dialysis ECMO (Extracorporeal Membrane Oxygenation) ECCO2 (Extracorporeal Elimination of Carbon Dioxide) ARDS (Acute Respiratory Distress Syndrome) AKI (Acute Kidney Injury)

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Hemodialysis in Pregnant with Systemic Lupus Erythematosus: Case Report and Review

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Open Journal of Nephrology 2022年第1期12卷 48-59页

作者： José Lucas Daza Yaroslad de la Cruz john Fredy galindo Luis Puello Gerardo Gutiérrez María Camila Correcha Carlos Alban Daniel Soto Andrés Cárdenas Luis José Daza Néstor Guarnizo Abel Caraballo Internist-Nephrologist Ibague Colombia Internist-Nephrologist Cali Colombia General Physician Ibague Colombia Internist-Nephrologist Cartagena Colombia Internist-Nephrologist Villavicencio Colombia Medical Student Santa Marta Colombia Internist-Hematologist Cartagena Colombia General Physician University of Tolima Ibague Intensivist Phsysician Barranquilla Colombia

Systemic lupus erythematosus is an autoimmune disease with an etiopathogenesis that is still unclear. With a higher incidence in women of childbearing age. Pregnancy in patients suffering from this pathology is a constant challenge for multidisciplinary teams. The changes of pregnancy, especially to the immune system and the kidney, have repercussions on the renal compromise secondary to lupus. Lupus nephropathy is more active during pregnancy and leads to adverse outcomes for the mother-fetus binomial. The early identification of pregnant women with a higher risk of complications, access to health resources and the participation of a multidisciplinary team is the strategy that increases maternal-fetal survival. A report case of a 25-year-old black female with SLE and a 10-week pregnancy who was admitted to the emergency department with criteria for dialysis. The literature focused on lupus nephritis and dialysis in pregnancy was reviewed. Articles were reviewed in databases such as PubMed, Cochrane, among others, focused on the topic of pregnancy with SLE and pregnancy with dialysis. A total of 15 review articles, 2 meta-analyses, 3 observational studies and 6 cohort studies (3 prospective and 3 retrospective) were filtered.

关键词： Dialysis Lupus Nephritis Pregnancy Renal Disease and Systemic Lupus Erythematous

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