The Occurrence or Fibrillary Glomerulonephritis in Patients with Diabetes Mellitus May Not Be Coincidental: A Report of Four Cases

Although clinical presentation of fibrillary glomerulonephritis is similar to most forms of glomerulonephritis, it is usually difficult to make the diagnosis. Clinical manifestations include proteinuria, microscopic haematuria, nephrotic syndrome, and impairment of renal function. A diagnosis of fibrillary glomerulonephritis is only confirmed by renal biopsy and it must comprise electronmicroscopy-verified ultrastructural findings. We report four cases between 45–50 years old with documented type 2 diabetes mellitus (T2DM) and arterial hypertension. All patients were found to have fibrils on kidney biopsy. The differential diagnosis of fibrils in the setting of diabetes mellitus is also discussed

Estudio ERCA. Características basales, evaluación de la aplicación de la información estructurada para la elección de tratamiento renal sustitutivo y evolución a un año de los pacientes incidentes en la consulta ERCA

[ES] Antecedentes y objetivos: Conocer evolución de pacientes ERC estadios 4 y 5 (ERCA) e influencia de la información (proceso educativo [PE]) que reciben para elección de la modalidad de tratamiento renal sustitutivo (TRS) o tratamiento conservador (TC) en consulta multidisciplinar de ERCA. Material y métodos: Estudio prospectivo, multicéntrico (3 centros españoles). Pacientes incidentes: consulta ERCA desde el 1 de junio del 2014 al 1 de octubre del 015; observación: 12 meses o inicio del TRS o fallecimiento si antes de los 12 meses; finaliza el 1 de octubre del 2016. Resultados: Trescientos treinta y tres pacientes (60% varones), mediana y rango intercuartil: edad 71,5 (17) años (55% ≥ 70 años), FGe CKD-EPI inicio 21 (9) ml/min/1,73 m2, índice de Charlson (ICh) con/sin edad 8 (3)/4 (2). Pacientes diabéticos: 52,4%. Recibieron PE 168 pacientes, FGe al inicio 15 (10) ml/min/1,73m2. Tratamiento inicial elegido: 26% diálisis peritoneal (DP), 45% hemodiálisis (HD), 26% TC, trasplante renal 3%; 60 pacientes iniciaron TRS: 3,3% trasplante renal, 30% DP, 66% HD. Ingresos: 104 en 73 pacientes, la causa más frecuente fue por enfermedad cardiovascular (42%). Fallecimiento: 23 pacientes (6,8%), de mayor edad (78,4 [6] vs. 67,8 [13,4], p < 0,001), ICh más elevado 9,8 [2,1] vs. 7,4 [2,5], p < 0,001). Todos los fallecidos con PE habían decidido TC; el 61% de los fallecidos tenían al menos un ingreso hospitalario vs. 39%vivos (p < 0,001). Regresión Cox: variables predictivas mortalidad: edad e ICh. Conclusiones: La población de ERCA es añosa, comórbida y con elevado índice de ingresos hospitalarios. La incidencia de DP es mayor a la habitual. El PE ha sido una herramienta de gran utilidad y favorece la elección de DP.[EN] Background and objectives: To analyze evolution Renal Chronic Failure stage 4-5 (ACRF) patients and influence information they receive (educational process, EP) in modality Renal Replacement Therapy (RRT) or conservative treatment (CT) in multidisciplinar ACRF Office. Material and methods: Prospective, multicenter study (3 centers). Inclusion: from June-01-2014 to October-01-2015; observation: 12 months or until start RRT or death if they occur before 12 months; ends October-01-2016. Results: 336 patients were included (60% males), median and intercuartile rank 71.5 (17), 55% ≥ 70 years; Follow up initiation eGFR CKD-EPI: 21 (9) ml / min / 1.73m2; Charlson Index (ChI) with / without age 8 (3) / 4 (2); Diabetic patients: 52,4%. The EP was carried out in 168, eGFR 15 (10) ml / min / 1.73m2. The initial treatment election: 26% peritoneal dialysis (PD), 45% hemodyalisis (HD), 26% CT, kidney trasplant 3%; 60 patients started RRT: 3.3% kidney traspant; 30% PD, 66% HD; 104 admissions in 73 patients, the most frequent cause: cardiovascular disease (42%). Deceased: 23 patients (6.8%). Age was higher (78.4 (6) vs. 67.8 (13.4), P<.001), higher ChI 9.8 (2.1) vs. 7.4 (2.5), P<.001). All deceased who received EP had chosen CT; 61% of deceased had at least one hospital admission vs. 39% alive (P<0.001). Cox regression: age and Charlson index were the predictive mortality variables. Conclusions: The population of ACRF patients is elder, comorbid, with high hospitalizations rate. The PD election is higher than usual. The EP has been very useful tool and has favored the PD choice.El estudio ha sido promovido y financiado por la empresa Baxter SL

Anaemia and fever in kidney transplant. The role of human parvovirus B19

Infections remain an issue of particular relevance in renal transplant patients, particularly viral infections. Human parvovirus B19 infection causes severe refractory anaemia, pancytopenia and thrombotic microangiopathy. Its presence is recognised by analysing blood polymerase chain reaction (PCR) and by the discovery of typical giant proerythroblasts in the bone marrow. We report the case of a 65 year-old man with a history of deceased donor renal transplant in September 2014. At 38 days after the transplant, the patient presented progressive anaemia that was resistant to erythropoiesis-stimulating agents. At 64 days after transplant, hyperthermia occurred with progressive deterioration of the patient's general condition. The viral serology and the first blood PCR for human parvovirus B19 were both negative. At 4 months and 19 days after, a bone marrow biopsy was conducted, showing giant erythroblasts with nuclear viral inclusions that were compatible with parvovirus; a PCR in the tissue confirmed the diagnosis. A second blood PCR was positive for parvovirus. After treatment with intravenous immunoglobulin and the temporary discontinuation of mycophenolate mofetil, a complete remission of the disease occurred, although the blood PCR for parvovirus B19 remained positive, so monitoring is necessary for future likely recurrence

User-centred design for developing e-Health system for renal patients at home (AppNephro)

Background Despite the promising benefits of the e-Health approaches (including provide technology-based healthcare services to anyone, anytime, and anywhere), few solutions are adopted in daily practice. User acceptance is one of the major obstacles that hinder the success of technology approaches. End-users often stress misalignments among their problems and the solutions that technology systems aim to solve. In other cases, systems developed are unfriendly or unadjusted to the daily practice of clinicians or patient’s life. To maximize user acceptance, the relevance of adopting user-centred design and development techniques is well-known. However, users are often assumed to be a homogeneous group with the same set of requirements, what leads to an ineffective identification and addressment of user requirements. Furthermore, usability and accessibility issues must be carefully addressed to guarantee also the right alignment of solutions with user needs. Objective to develop an e-Health system for renal patients at home by adopting user-centred design practices, usability and accessibility standards. Material and methods users were categorized in four different groups (i.e., digital patients/caregivers, non-digital patients/caregivers, clinicians and nurses) and a sample was included in the design and development team. Questionnaires and interviews were used to identify user requirements and assess prototypes. Results Requirements were considered for every kind of user, what resulted on a multi-faceted e-Health system implying different technologies and functionalities regarding to each target user. Conclusion Identification and continuous involvement of all kind of users allow their needs to be properly understood and addressed by technology, raising user acceptance of the final product