Correlación entre renograma estándar e histología para diagnóstico etiológico de disfunción del injerto en pacientes trasplantados renales en el Hospital San Vicente Fundación en Medellín, Colombia, periodo enero/2009-diciembre/2013: serie de casos

Objective: Find the correlation between renal biopsy and renogram for evaluation of complications of renal transplantation.Methods: Correlation study, descriptive and retrospective records of patients who attended the kidney transplant service at the University Hospital Foundation San Vicente diagnosed with graft dysfunction in the period between January 2009 and December 2013.Criteria were reviewed inclusion in the study: Renal biopsy and standard MAG3 or DTPA renogram also demographic variables.Results: 33 medical records, only 18 eligible patients with the inclusion criteria were reviewed. We documented rejection in 7 patients with renal biopsies and 3 scans. In 11 patients without rejection was found by biopsy, scintigraphy ruled it in 6 of them. This translates into 42 % sensitivity (CI 0-86) and 45 % specificity (20-88), with a PPV of 33 % (CI 0-77) and NPV of 44% (CI 24-95).Conclusion: Our results differ from previous studies because renogram performance in our sample was poor for both rejection to acute tubular necrosis. Several independent factors could be related to our results.Objetivo: Encontrar la correlación entre la biopsia renal y el renograma, para evaluación de complicaciones del trasplante renal.Métodos: Estudio de correlación, descriptivo y retrospectivo, se revisaron los registros de pacientes que asistieron al servicio de trasplante renal del Hospital Universitario de San Vicente Fundación con diagnóstico de disfunción del injerto en el periodo comprendido entre enero de 2009 y diciembre de 2013.Criterio de inclusión al estudio: La biopsia renal y renograma estándar con MAG3 o DTPA, además de variables demográficas.Resultados: Después de revisar 33 historias clínicas fueron elegibles solo 18 pacientes según criterios de inclusión, y se documentó rechazo en 7 pacientes por biopsia renal y 3 por gammagrafía. De 11 pacientes que no se presentaron rechazo por biopsia, en 6 de ellos la ocurrencia del evento fue descartada por la gammagrafía. Esto reveló 42 % de sensibilidad (IC 0-86) y 45 % de especificidad (20-88), con un VPP de 33 % (IC 0-77) y VPN de 44 % (IC 24-95).Conclusión: Los anteriores resultados discreparon de estudios previos, ya que el rendimiento del renograma en esta muestra fue pobre tanto para rechazo como para necrosis tubular aguda, situación que podría estar relacionada con diversos factores independientes de la misma investigación

Associated urological malformations and development of chronic kidney disease in pediatric patients with urinary tract infection at San Vicente de Paúl Hospital (Medellín, Colombia) between 1960 and 2010 = Malformaciones urológicas asociadas y desarrollo de enfermedad renal crónica en pacientes pediátricos con diagnóstico de infección urinaria que consultaron al Hospital Universitario San Vicente de Paúl (Medellín, Colombia) entre los años 1960-2010

Introduction: Urinary tract infection (UTI) is a major cause of bacterial disease in the pediatric population. Associated factors such as vesicoureteral reflux (VUR), posterior urethral valves, neurogenic bladder and other anatomical malformations increase the likelihood of developing renal scarring and dysplasia/hypoplasia, which at the same time increase in the long term the risk of hypertension (HT), proteinuria and chronic kidney disease (CKD). Objective: To describe the malformations associated with the frequency of UTI and development of CKD in pediatric patients who consulted San Vicente de Paúl Hospital, in Medellin, Colombia, between 1960 and 2010. Methods: A descriptive, retrospective study in which the clinical records of 4.476 patients with UTI were evaluated. Results: Patients with urinary tract anomalies corresponded to 78.3% of the total (predominance of women: 52.8%). Primary VUR was found in 29.9%; out of these, 5.1% progressed to CKD. Neurogenic bladder was diagnosed in 8.6%, of which 70.8% were secondary to myelomeningocele and 4.9% developed CKD. The posterior urethral valves were present in 3.5% of the total sample, of which 28.5% developed CKD. Conclusion: UTI in the pediatric population is a marker of urinary tract malformation and the prognosis is determined by the presence of VUR, obstructive anomalies and/or renal dysplasia favoring renal scarring, and increasing the risk of hypertension, proteinuria and CKD. An appropriate diagnostic approach would be the basis to implement management strategies to prevent deterioration of renal function