34 results on '"Correa-Rotter, Ricardo"'
Search Results
2. 38 - Diálisis peritoneal en situaciones especiales
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Palma, Harold Ismael Ayala, Santana, Sergio Saúl Irízar, and Correa-Rotter, Ricardo
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- 2021
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3. 21 - Defensas peritoneales
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López, Edgar Dehesa and Correa-Rotter, Ricardo
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- 2021
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4. 17 - Evaluación de la dosis adecuada de diálisis
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Correa-Rotter, Ricardo and López, Edgar Dehesa
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- 2021
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5. Desarrollo de una herramienta de tamizaje para consumo elevado de sodio en una población adulta mexicana
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Miranda-Alatriste, Paola Vanessa, Colín Ramírez, Eloísa, Guillén Hernández, Marymar, Rivera Mancía, Susana, Cartas Rosado, Raúl, Espinosa-Cuevas, Ángeles, Correa-Rotter, Ricardo, and Vallejo, Maite
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Sal ,Validación ,Cuestionario de frecuencia de alimentos ,Food frequency questionnaire ,Salt ,Validation ,Dieta ,Diet - Abstract
Resumen Introducción: la excreción de sodio en orina de 24 horas es el método de referencia para evaluar la ingesta de sodio; sin embargo, se requieren herramientas que puedan aplicarse de manera más práctica tanto en el ámbito clínico como en el poblacional. Objetivos: desarrollar y evaluar un cuestionario autoadministrable de frecuencia de consumo de alimentos ricos en sodio (CFCA-S) como herramienta de tamizaje para consumo elevado de sodio en una población adulta de la Ciudad de México. Métodos: se desarrolló un CFCA-S con 28 categorías de alimentos ricos en sodio y su sistema de puntuación respectivo. El percentil 75 del puntaje total del CFCA-S se probó como punto de corte para clasificar a las personas con alto consumo de sodio a dos niveles (≥ 2.000 y ≥ 3.000 mg/día), considerando la excreción urinaria de sodio en 24 horas como método de referencia. Resultados: se incluyeron 95 participantes (mediana de edad: 39 [percentiles 25-75: 26-46] años; hombres: 39 [41,1%]). Un puntaje total de 51,2 en el CFCA-S mostró una sensibilidad del 31,6% (intervalo de confianza [IC] 95%: 19,1-47,5), una especificidad del 78,9% (IC 95%: 66,7-87,5), valor predictivo positivo del 50% (IC 95%: 31,4-68,6) y valor predictivo negativo del 63,4% (IC 95%: 51,8-73,6), para clasificar a las personas con consumo de sodio ≥ 3.000 mg/día. Un puntaje ≥ 51,2 se asoció significativamente con una ingesta de sodio ≥ 3.000 mg/día, resultando en una razón de momios de 3,12 (IC 95%: 1,03-9,44, p = 0,04), después de ajustar por sexo, edad e índice de masa corporal (IMC). Conclusiones: el CFCA-S es una herramienta práctica, factible de aplicarse y útil para identificar a personas en riesgo de tener un consumo elevado de sodio. Abstract Background: twenty-four-hour urinary sodium excretion is the reference method to assess sodium intake; however, tools that can be more easily applied in the clinical and population setting are needed. Objectives: to develop and evaluate a self-administered high-sodium food frequency questionnaire (abbreviated to CFCA-S in Spanish) as a screening tool for high sodium intake in an adult Mexico City population. Methods: a CFCA-S including 28 sodium-rich food categories and a scoring system were developed. The 75 percentile for the total score was tested as cut-off point to classify high sodium consumers at two different levels (≥ 2,000 and ≥ 3,000 mg/day) against 24-h urinary sodium excretion as reference method. Results: ninety-five participants were included (median age: 39 [25th-75th percentiles: 26-46] years; men: 39 [41.1%]). A total score of 51.2 in the CFCA-S showed a sensitivity of 31.6% (95% confidence interval [CI]: 19.1-47.5), specificity of 78.9 (95% CI: 66.7-87.5), positive predictive value of 50% (95% CI: 31.4-68.6) and negative predictive value of 63.4% (95% CI: 51.8-73.6) to classify high-sodium consumers at a level of intake ≥ 3,000 mg/day. A total score ≥ 51.2 was significantly associated with a sodium intake ≥ 3,000 mg/day, observing an odds ratio of 3.12 (CI 95%: 1.03-9.44, p = 0.04), after adjusting by sex, age, and body mass index. Conclusions: the sodium CFCA-S developed in this study is a practical, feasible and useful tool to identify individuals at greater risk of having a high sodium intake.
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- 2020
6. Colaboradores
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Melgar, Ángel Alonso, Miani, Pablo Amair, Iraola, Gema Ariceta, Rodulfo, J. Ildefonzo Arocha, Lezama, Javier Arrieta, Palma, Harold Ismael Ayala, Rubio, María Auxiliadora Bajo, Balbi, André Luis, Castellanos, Loreley Ana Betancourt, Ortega, Saioa Bilbao, Cabañas, Concepción Blasco, Sans, Mercè Borràs, Brandão, Fausto S., Fuster, Juan Manuel Buades, Cannata-Andía, Jorge B., Martínez, Araceli Caro, Carrero, Juan Jesús, Carrillo-López, Natalia, García, Diego Casas, Delgado, José Ignacio Cornago, Díaz, Francisco Coronel, Correa-Rotter, Ricardo, Sanabria, Laura Cortés, Hospital, Lourdes Craver, Manzano, Alfonso M. Cueto, Fernandes, Natália Maria da Silva, González, Mª Ángeles Daza, López, Edgar Dehesa, Gilsanz, Gloria del Peso, Espinosa-Cuevas, María de los Ángeles, Prado, Encarnación Fernández, Fonseca-Correa, Jorge I., Arnold, Cristina Fragío, Ríos, Francisco Javier Gainza de los, Múgica, María Galán, Massignan, Bianca Garcez, Erauzkin, Gorka García, Ledesma, Paula García, García-Llana, Helena, Martínez, Júlia Garro, Cunquero, José Manuel Gil, Casanova, Beatriz Gil-Casares, Bedat, María Carlota González, Cabrera, Fayna González, Peña, Olga González, Rico, Miguel González, Ríos, Carmen María González, Teruel, José Luis Górriz, Martínez, Eduardo Gutiérrez, García, Esther Hernández, Santana, Sergio Raúl Irízar, Heffernan, José A. Jiménez, García, Isabel Juan, Luengo, Manuel Lanuza, Santos, Juan Pablo Leiva, Lobbedez, Thierry, Cabrera, Manuel López, López-Gómez, Juan M., Canals, Francisco Maduell, Robayna, Silvia Marrero, Martin-Cleary, Catalina, Castelao, Alberto Martínez, Losa, Adoración Martínez, Calonge, Victorio Menoyo, Pesquera, José Ignacio Minguela, Martínez, Isabel Montenegro, Martínez, Jesús Montenegro, Ruiz, Enrique Morales, Silva, Jesús Eduardo Muñoz, Musso, Carlos Guido, Seijas, José Andrés Octavio, Arduan, Alberto Ortiz, González, Marta Ossorio, Gómez, Victoria Oviedo, Acero, Jesús Ángel Padierna, Panizo-García, Sara, Filho, Roberto Pecoits, Díaz, Vicente Pérez, Fontán, Miguel Pérez, García, Rafael Pérez, Petraglia, Lucas, Gabriel, Daniela Ponce, Clemente, Esther Ponz, Pérez, José M. Portolés, Velasco, Mario Alfredo Prieto, Moraes, Thyago Proença de, Montesa, María Jesús Puchades, Ganga, Pedro Luis Quirós, Rodríguez, César Remón, Riella, Miguel Carlos, Gorrín, Maite Rivera, Benítez, María Patrocinio Rodríguez, Suárez, Carmen Rodríguez, Rodríguez-Carmona de la Torre, Ana, Campos, Enrique Rojas, Díez, Guillermo Rosa, Álvarez, José Emilio Sánchez, García, Luisa Sánchez, González, Carmen Sánchez, Hernández, Rosa Sánchez, Moreno, Ana Sánchez, Rotaeche, Ramón Saracho, Morena, Julián Segura de la, Gutiérrez, Rafael Selgas, Solís Salguero, Miguel Ángel, Marenco, Mercedes Tejuca, Molina, Fernando Tornero, Romero, Fernando Tornero, Maicas, Isidro Torregrosa, Torres, Pablo Ureña, Díaz, Nicanor Jesús Vega, and Rivera, Manel Vera
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- 2021
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7. Caracterización de los programas de especialización en nefrología de América Latina
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Bernardo, Juan José Di, González-Martínez, Francisco, Rienzo, Paula Di, Cortés-Sanabria, Laura, Cerdas-Calderón, Manuel, García-García, Guillermo, Correa-Rotter, Ricardo, and Fernández-Cean, Juan
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Medical education ,Educación médica ,Residents training ,Posgrado ,Postgraduate training ,Competencias ,Currículo ,Curriculum ,Competences ,Residencia - Abstract
Objetivo. Caracterizar los componentes curriculares aplicados para la formación de médicos nefrólogos en Latinoamérica. Sujetos y métodos. Estudio descriptivo que incluye nueve países latinoamericanos. Se solicitó a cada uno los programas vigentes de especialización en nefrología. Se analizaron diferentes variables curriculares y se adoptó, como marco epistemológico, el modelo de educación médica basada en competencias, y como referencia, las dimensiones del Accreditation Council for Graduate Medical Education (ACGME) de Estados Unidos. Resultados. Los programas de los nueve países (Argentina, Bolivia, Chile, Costa Rica, Ecuador, Guatemala, México, Perú y Uruguay) buscan mejorar el perfil del especialista y cubrir demandas sanitarias. Las plazas se adecuan a la capacidad de los centros y los aspirantes se seleccionan por concursos abiertos. Todos contemplan formación de internista como condición de ingreso o dentro del programa, que causa disparidad en cargas horarias. Algunos no explicitan perfil del graduado. El modelo dominante es 'posgrado con residencia', con estructuras y organización heterogéneas. Los contenidos son pertinentes y existe equivalencia en las competencias que se deben desarrollar, que mayoritariamente coinciden con las del ACGME, salvo 'habilidades interpersonales y comunicación' y 'práctica basada en sistemas de salud', que tienen menor peso. Todos destinan el 75% de la carga horaria para tareas de 'formación en servicio con responsabilidades crecientes bajo supervisión' e incluyen actividades académicas. Las evaluaciones están integradas en el programa con herramientas adecuadas para evaluar competencias. Conclusiones. Se debería unificar el nivel de posgrado y duración, definir claramente las competencias del 'producto que se va a formar', incluir más 'habilidades interpersonales' y 'práctica en sistemas de salud', y establecer actividades de atención primaria de la salud. Aim. To characterized curricular components apply for nephrology medical training in Latin-America. Subjects and methods. Descriptive study including nine countries. It was request to current Nephrology Training Programs. We analized different curricular variables, taking as epistemological hallmark the competence-based medical education and dimensions from Accreditation Council for Graduate Medical Education (ACGME) from USA as reference. Results. Programs from nine countries (Argentina, Bolivia, Costa Rica, Chile, Ecuador, Guatemala, Mexico, Peru and Uruguay) look to improve the specialist profile and cover sanitary demands. The positions suit the centers capacity and applicants are selected in open competition. The programs include internal medicine training causing disparity in duty hours. Some of them don't explicit graduate profile. The predominant model is 'postgraduate course with residency' with heterogeneous structures and organization. Contents are pertinent and there is equivalence within competences to develop that generally match with ACGME except for 'interpersonal and communication skills' and 'system-based practice' with less impact. All programs destiny 75% of duty hours for clinical practice-based learning with progressive responsibilities under guidance and supervision including academic activities. Evaluations are integrated to the program with adequate tools for competence assessment. Conclusions. Postgraduate level and duration should be unified, defining clearly competences of program's graduate and establishing primary health care activities into the curriculum.
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- 2016
8. Funcionamiento de las fórmulas MDRD-IDMS y CKD-EPI, en individuos mexicanos con función renal normal
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Arreola-Guerra, José M., Rincón-Pedrero, Rodolfo, Cruz-Rivera, Cristino, Belmont-Pérez, Teresa, Correa-Rotter, Ricardo, and Niño-Cruz, José A.
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Glomerular filtration rate equations ,MDRD ,CKD-EPI ,Fórmulas de cálculo de la función renal ,Función renal normal ,CKD-EPI equation ,Normal renal function ,Índice de masa corporal ,Body mass index - Abstract
Antecedentes: El funcionamiento de las fórmulas para la estimación de tasa de filtrado glomerular (TFG) CKD-EPI y MDRD en pacientes de origen hispano con función renal normal tiene pocos antecedentes y en México requiere validación. Material y métodos: Se incluyeron individuos mexicanos, adultos y previamente sanos. Se recabaron variables clínicas y se determinó el nivel de creatinina sérica para calcular las fórmulas CKD-EPI y MDRD-IDMS. Este resultado fue comparado con el estándar de referencia (TFG medida con Tc99DTPA). Se evaluaron otras variables clínicas que afectaran el funcionamiento de la fórmula CKD-EPI. Resultados: Se incluyeron 97 individuos voluntarios sanos, 55 varones y 42 mujeres; edad promedio 35 años (18 a 73). La creatinina media fue de 0,76 mg/dl (± 0,18). El funcionamiento de CKD-EPI fue significativamente mejor que el de MDRD-IDMS en todas las comparaciones (sesgo, correlación y exactitud). La diferencia entre los sesgos de las fórmulas fue 6,08 ml/min/1,73 m² (IC 95 % 2,58 a 9,58) (p < 0,001). Las personas con índice de masa corporal (IMC) mayor de 25 kg/m² presentaron un mejor funcionamiento que el grupo con menor IMC (diferencia de medias 7,39 ml/min/1,73 m²; IC 95 % 1,17 a 13,6; p < 0,02). Ambas fórmulas sobrestimaron la TFG. El IMC se asoció significativamente con el funcionamiento de la fórmula CKD-EPI (β 0,82; IC 95 % 0,085 a 1,56; p = 0,029). Conclusiones: En individuos adultos mexicanos sanos la fórmula CKD-EPI predice mejor la TFGm que la fórmula MDRD-IDMS. El IMC se asocia de manera significativa al funcionamiento de la fórmula CKD-EPI, siendo mejor en aquellos con IMC superior a 25 kg/m². Ambas fórmulas sobrestiman la TFGm. Background: The performance of the CKD-EPI and MDRD formulae for estimating glomerular filtration rate (GFR) in patients of Hispanic origin with normal renal function has been poorly explored and requires validation in Mexico. Material and method: We included previously healthy Mexican adults. We obtained clinical variables and determined serum creatinine to calculate the CKD-EPI and MDRD-IDMS formulae. These results were compared with the gold standard (GFR measured by Tc99DTPA). We evaluated other clinical variables that could affect the performance of the CKD-EPI formula. Results: A total of 97 healthy volunteers were included, 55 males and 42 females; the mean age was 35.8 years old (18 to 73). Mean creatinine was 0.76mg/dl (±0.18). CKD-EPI performance was significantly better than MDRD-IDMS in all comparisons (bias, correlation and accuracy). The bias difference between the formulae was 6.08ml/min/1.73m² (95% CI 2.58 to 9.58) (p
- Published
- 2014
9. Guías de práctica clínica para la prevención, diagnóstico, evaluación y tratamiento de los trastornos minerales y óseos en la enfermedad renal crónica (TMO-ERC) en adultos
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Bellorin-Font, Ezequiel, Ambrosoni, Pablo, Carlini, Raúl G., Carvalho, Aluizio B., Correa-Rotter, Ricardo, Cueto-Manzano, Alfonso, Jara, Aquiles, Jorgetti, Vanda, Negri, Armando, Olaizola, Inés, Salusky, Isidro, Slatopolsky, Eduardo, and Weisinger, José R.
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Ostodistrofia renal ,Hiperparatiroidismo secundario ,Trastornos del metabolismo ,Vitamina D ,Metabolismo mineral y óseo ,Enfermedad renal crónica ,PTH - Abstract
Las guías de práctica clínica para la prevención, diagnóstico, evaluación y tratamiento de los trastornos minerales y óseos en la enfermedad renal crónica (TMO-ERC) en adultos, de la Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH), comprenden un conjunto de recomendaciones elaboradas para dar apoyo al médico en el manejo de estas anormalidades en pacientes adultos con enfermedad renal estadios 3 a 5. No se incluyen las alteraciones asociadas al trasplante renal. Los temas abordados en las guías están distribuidos en cuatro capítulos: 1) Evaluación de las alteraciones bioquímicas; 2) Evaluación de las alteraciones óseas; 3) Evaluación de las calcificaciones vasculares, y 4) Tratamiento de los TMO-ERC. Las guías tienen como base las recomendaciones propuestas y publicadas por la Kidney Disease: Improving Global Outcomes (KDIGO) para la prevención, diagnóstico, evaluación y tratamiento de los TMO-ERC (KDIGO Clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder [CKD-MBD]), adaptadas a las condiciones de pacientes, instituciones y recursos disponibles en Latinoamérica, con el aval de KDIGO. En algunos casos, las guías corresponden a recomendaciones de manejo definidas directamente por el grupo de trabajo para su aplicación en nuestra región, basadas en la evidencia disponible en la literatura. Cada capítulo contiene las guías propiamente dichas y su fundamentación con base en numerosas referencias bibliográficas actualizadas. Desafortunadamente, existen pocos estudios controlados y con un poder estadístico suficiente en Latinoamérica para dar soporte a recomendaciones específicas para la región, por lo que la gran mayoría de las referencias utilizadas corresponden a estudios realizados en otras regiones. Esto pone en evidencia la necesidad de planificar estudios de investigación dirigidos a establecer la situación actual de los trastornos del metabolismo mineral y óseo en Latinoamérica, así como definir las mejores opciones terapéuticas para nuestra población.
- Published
- 2013
10. Guías prácticas esenciales en diálisis y trasplante
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Ocharan-Corcuera, Julen, Foraster, Andreu, and Correa-Rotter, Ricardo
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- 2011
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11. Eficacia de la complementación oral durante la sesión de hemodiálisis versus la complementación oral domiciliaria sobre el estado de nutrición, composición corporal y calidad de sueño en pacientes adultos con enfermedad renal crónica en hemodiálisis
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González Ortiz, Ailema Janeth, Espinosa Cuevas, Angeles, Valencia Flores, Matilde, Correa Rotter, Ricardo, and Carrero Roig, Juan Jesús
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Ciencias Biológicas, Químicas y de la Salud ,Nutrición ,Ciencias de la vida ,Ciencias médicas - Published
- 2020
12. Adaptación transcultural y validación de la versión mexicana del Kidney disease questionnaire KDQOL SF36 version 1.3
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Dehesa López, Edgar and Correa Rotter, Ricardo
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Ciencias Biológicas, Químicas y de la Salud ,Medicina ,Patología ,Enfermedades - Published
- 2016
13. Evaluación del efecto de la globulina policlonal anti-timocito en la proliferacion homesotática del linfocito t y en la prevención del rechazo celular agudo del injerto renal
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Valdez Ortiz, Rafael, Grinyó Boira, Josep María, and Correa Rotter, Ricardo
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Ciencias Biológicas, Químicas y de la Salud ,Medicina ,Patología ,Enfermedades - Published
- 2015
14. Efecto de la aplicación de vacunas sobre el desarrollo de anticuerpos anti-HLA de Novo
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Morales Buenrostro, Luis Eduardo, Correa Rotter, Ricardo, Gamba Ayala, Gerardo, and Granados Arriola, Julio
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Ciencias Biológicas, Químicas y de la Salud ,Medicina ,Patología ,Biología humana ,Ciencias de la vida ,Inmunoglobulinas ,Ciencias médicas ,Enfermedades - Abstract
tesis que para obtener el grado de Doctor en Ciencias Médicas Odontológicas y de la Salud, presenta Luis Eduardo Morales Buenrostro ; asesor Ricardo Correa Rotter, Gerardo Gamba Ayala, Julio Granados Arriola. 71 páginas : ilustraciones. Doctorado en Ciencias Médicas Odontológicas y de la Salud UNAM, Facultad de Medicina, 2011
- Published
- 2011
15. Impacto de la corrección de la sobrecarga hídrica en los marcadores inflamatorios PCR, IL-6 y TNF [alfa] en pacientes en diálisis peritoneal
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Dehesa López, Edgar, Correa Rotter, Ricardo, and Morales Buenrostro, Luis Eduardo
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Citocinas IL-6 ,Medicina ,Citocinas ,Patología ,Pacientes en diálisis peritonial ,Síndrome desnutrición inflamación ,Enfermedades ,Ciencias Biológicas, Químicas y de la Salud ,Reacción en cadena de la polimerasa ,Factor de necrosis tumoral alpha ,Proteína C reactiva ,Biología humana ,Ciencias de la vida ,Ciencias médicas - Published
- 2009
16. Comment on "Clinical practice guidelines for the treatment of systemic lupus erythematosus by the Mexican College of Rheumatology".
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Mejia-Vilet JM, Tejeda-Maldonado J, and Correa-Rotter R
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- Humans, Mexico, Societies, Medical standards, Lupus Erythematosus, Systemic diagnosis, Lupus Erythematosus, Systemic drug therapy, Rheumatology standards
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- 2020
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17. [Prevention and control of SARS-CoV-2 (Covid-19) coronavirus infection in hemodialysis units.]
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Vega-Vega O, Arvizu-Hernández M, Domínguez-Cherit JG, Sierra-Madero J, and Correa-Rotter R
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- Algorithms, COVID-19, Disinfection, Early Diagnosis, Humans, Patient Education as Topic, Personal Protective Equipment, Primary Prevention, SARS-CoV-2, Betacoronavirus, Coronavirus Infections epidemiology, Coronavirus Infections prevention & control, Pandemics prevention & control, Pneumonia, Viral epidemiology, Pneumonia, Viral prevention & control, Renal Dialysis, Renal Insufficiency, Chronic therapy
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The SARS-CoV-2 pandemic is of hich risk for patients on chronic hemodialysis due to their immunosuppressed state, advanced age, and the coexistence of significant comorbidities, in particular cardiovascular disease, diabetes mellitus, and others. Additionally, they constitute a closed conglomerate since they come to treatment regularly, spending hours in the treatment places, exposed to a possible acquisition of the infection. Finally, going to their treatment regularly prevents them from remaining in home isolation and with potential exposure. These recommendations summarize the interventions proposed by three international organizations and add some suggested by national experts, with the aim to early identify the patients and health personnel at risk and reducing the risk of infection., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.
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- 2020
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18. [Development of a screening tool for a high sodium intake in an adult Mexican population].
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Miranda Alatriste PV, Ramírez EC, Guillén Hernández M, Rivera Mancía S, Cartas Rosado R, Espinosa-Cuevas Á, Correa-Rotter R, and Vallejo M
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- Adult, Aged, Feeding Behavior, Female, Humans, Male, Mexico, Middle Aged, Nutrition Assessment, Surveys and Questionnaires, Young Adult, Mass Screening instrumentation, Sodium, Dietary
- Abstract
Background: twenty-four-hour urinary sodium excretion is the reference method to assess sodium intake; however, tools that can be more easily applied in the clinical and population setting are needed., Objectives: to develop and evaluate a self-administered high-sodium food frequency questionnaire (abbreviated to CFCA-S in Spanish) as a screening tool for high sodium intake in an adult Mexico City population., Methods: a CFCA-S including 28 sodium-rich food categories and a scoring system were developed. The 75 percentile for the total score was tested as cut-off point to classify high sodium consumers at two different levels (≥ 2,000 and ≥ 3,000 mg/day) against 24-h urinary sodium excretion as reference method., Results: ninety-five participants were included (median age: 39 [25th-75th percentiles: 26-46] years; men: 39 [41.1%]). A total score of 51.2 in the CFCA-S showed a sensitivity of 31.6% (95% confidence interval [CI]: 19.1-47.5), specificity of 78.9 (95% CI: 66.7-87.5), positive predictive value of 50% (95% CI: 31.4-68.6) and negative predictive value of 63.4% (95% CI: 51.8-73.6) to classify high-sodium consumers at a level of intake ≥ 3,000 mg/day. A total score ≥ 51.2 was significantly associated with a sodium intake ≥ 3,000 mg/day, observing an odds ratio of 3.12 (CI 95%: 1.03-9.44, p = 0.04), after adjusting by sex, age, and body mass index., Conclusions: the sodium CFCA-S developed in this study is a practical, feasible and useful tool to identify individuals at greater risk of having a high sodium intake.
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- 2018
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19. Performance of MDRD-IDMS and CKD-EPI equations in Mexican individuals with normal renal function.
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Arreola-Guerra JM, Rincón-Pedrero R, Cruz-Rivera C, Belmont-Pérez T, Correa-Rotter R, and Niño-Cruz JA
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- Adolescent, Adult, Aged, Body Mass Index, Cross-Sectional Studies, Female, Humans, Male, Mathematical Concepts, Mexico, Middle Aged, Reference Values, Renal Insufficiency, Chronic diagnosis, Young Adult, Glomerular Filtration Rate, Kidney physiology
- Abstract
Background: The performance of the CKD-EPI and MDRD formulae for estimating glomerular filtration rate (GFR) in patients of Hispanic origin with normal renal function has been poorly explored and requires validation in Mexico. , Material and Method: We included previously healthy Mexican adults. We obtained clinical variables and determined serum creatinine to calculate the CKD-EPI and MDRD-IDMS formulae. These results were compared with the gold standard (GFR measured by Tc99DTPA). We evaluated other clinical variables that could affect the performance of the CKD-EPI formula. , Results: A total of 97 healthy volunteers were included, 55 males and 42 females; the mean age was 35.8 years old (18 to 73). Mean creatinine was 0.76mg/dl (±0.18). CKD-EPI performance was significantly better than MDRD-IDMS in all comparisons (bias, correlation and accuracy). The bias difference between the formulae was 6.08ml/min/1.73m2 (95% CI 2.58 to 9.58) (p<.001). Individuals with a body mass index (BMI) above 25kg/m2 displayed a better performance than the group with a lower BMI (difference of means 7.39ml/min/1.73m2; 95% CI 1.17 to 13.6 p<.02). Both formulae overestimated the GFR. BMI was significantly associated with the performance of the CKD-EPI formula (β 0.82; 95% CI 0.085 to 1.56 p=.029). , Conclusions: In healthy Mexican adults, the CKD-EPI formula is a better predictor of the mGFR than the MDRD-IDMS formula. BMI is significantly associated with the performance of the CKD-EPI formula and is better in those with a BMI greater than 25kg/m2. Both formulae overestimate mGFR.
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- 2014
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20. [Risk factors for the development of thrombotic complication in patients with lupus erythematosus and lupus nephropatic].
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Zaldívar-Alcántara H, Herrera-Jiménez LE, Dehesa-López E, and Correa-Rotter R
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- Adult, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Antiphospholipid Syndrome epidemiology, Comorbidity, Diabetes Mellitus, Type 2 epidemiology, Female, Humans, Hypertension epidemiology, Immunosuppressive Agents therapeutic use, Incidence, Kidney Function Tests, Lupus Erythematosus, Systemic drug therapy, Lupus Nephritis complications, Lupus Nephritis drug therapy, Male, Recurrence, Retrospective Studies, Risk Factors, Serositis epidemiology, Thrombosis etiology, Venous Thrombosis epidemiology, Venous Thrombosis etiology, Young Adult, Lupus Erythematosus, Systemic complications, Thrombophilia etiology, Thrombosis epidemiology
- Abstract
Introduction: Thrombotic events constitute a frequent complication in patients with systemic lupus erythematosus (SLE) and are associated with increased morbidity and mortality of these patients., Objective: To identify clinical and laboratorial factors associated with the development of arterial or venous thrombosis in patients with SLE and lupus nephritis (LN)., Material and Methods: We reviewed 200 files of patients with SLE and LN to determine if any patients had presented a symptomatic episode of thrombosis confirmed by an image study. We collected demographic, clinical and laboratory data. Logistic regression was used to determine clinical and laboratorial factors associated with thrombotic complications., Results: There were 25 thrombotic events in 23 patients, of which 68% (n = 17) occurred in the venous bed. The overall incidence rate of thrombotic events was 29.1 per 1,000 patient-years. The class IV was the most frequent class of LN with 40.8% of cases. There were no differences in the distribution of the different classes of NL, eGFR, magnitude of proteinuria and markers of lupus activity among patients with and without thrombotic complications. In multivariate analysis, previous diagnosis of antiphospholipid-antibody syndrome (APS) (OR = 126; IC95% 11.3-1419; p < 0.001), serositis (OR = 5; IC95% 0.95-26.9; p = 0.05) and history of arterial thrombosis (OR = 24; IC95% 1.8-314; p = 0.01) were associated with thrombotic complications and the use of ACE inhibitors showed a protective effect (RM = 0.19; IC95% 0.03-0, 98; p = 0.04)., Conclusions: Thrombotic complications were frequent in our population. Risk factors related with thrombotic complications were a personal history of arterial thrombosis, serositis and previous diagnosis of APS. Interestingly, the use of ACE inhibitors was associated with reduced risk. We found no greater or lesser risk of thrombosis with renal factors such as proteinuria, histological type of LN and eGFR.
- Published
- 2013
21. Clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of mineral and bone disorders in chronic kidney disease (CKD-MBD) in adults.
- Author
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Bellorin-Font E, Ambrosoni P, Carlini RG, Carvalho AB, Correa-Rotter R, Cueto-Manzano A, Jara A, Jorgetti V, Negri AL, Olaizola I, Salusky I, Slatopolsky E, and Weisinger JR
- Subjects
- Bone Diseases, Metabolic etiology, Bone Diseases, Metabolic prevention & control, Chronic Kidney Disease-Mineral and Bone Disorder diagnosis, Chronic Kidney Disease-Mineral and Bone Disorder etiology, Chronic Kidney Disease-Mineral and Bone Disorder therapy, Humans, Metabolic Diseases etiology, Metabolic Diseases prevention & control, Vascular Calcification diagnosis, Vascular Calcification etiology, Vascular Calcification therapy, Bone Diseases, Metabolic diagnosis, Bone Diseases, Metabolic therapy, Metabolic Diseases diagnosis, Metabolic Diseases therapy, Minerals metabolism, Renal Insufficiency, Chronic complications
- Abstract
The clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of chronic kidney disease mineral and bone disorders (CKD-BMD) in adults, of the Latin American Society of Nephrology and Hypertension (SLANH) comprise a set of recommendations developed to support the doctor in the management of these abnormalities in adult patients with stages 3-5 kidney disease. This excludes changes associated with renal transplantation. The topics covered in the guidelines are divided into four chapters: 1) Evaluation of biochemical changes, 2) Evaluation of bone changes, 3) Evaluation of vascular calcifications, and 4) Treatment of CKD-MBD. The guidelines are based on the recommendations proposed and published by the Kidney Disease: Improving Global Outcomes (KDIGO) for the prevention, diagnosis, evaluation and treatment of CKD-MBD (KDIGO Clinical practice guidelines for the diagnosis, evaluation, prevention and treatment of Chronic Kidney Disease Mineral and Bone Disorder [CKD-MBD]), adapted to the conditions of patients, institutions and resources available in Latin America, with the support of KDIGO. In some cases, the guidelines correspond to management recommendations directly defined by the working group for their implementation in our region, based on the evidence available in the literature. Each chapter contains guidelines and their rationale, supported by numerous updated references. Unfortunately, there are few controlled studies with statistically sufficient weight in Latin America to support specific recommendations for the region, and as such, most of the references used correspond to studies carried out in other regions. This highlights the need to plan research studies designed to establish the current status of mineral and bone metabolism disorders in Latin America as well as defining the best treatment options for our population.
- Published
- 2013
- Full Text
- View/download PDF
22. Efforts to reduce dietary salt in the Americas.
- Author
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Campbell NR, Correa-Rotter R, Legowski B, and Legetic B
- Subjects
- Americas, Humans, Health Promotion, Sodium Chloride, Dietary administration & dosage
- Published
- 2012
- Full Text
- View/download PDF
23. [Fabry-Anderson disease: current state of knowledge].
- Author
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Vega-Vega O, Pérez-Gutiérrez A, and Correa-Rotter R
- Subjects
- Chromosomes, Human, X genetics, Cohort Studies, Endothelium, Vascular enzymology, Enzyme Replacement Therapy, Humans, Kidney enzymology, Lysosomes enzymology, Male, Myocardium enzymology, Organ Specificity, Phenotype, Randomized Controlled Trials as Topic, alpha-Galactosidase analysis, alpha-Galactosidase biosynthesis, alpha-Galactosidase genetics, alpha-Galactosidase therapeutic use, alpha-N-Acetylgalactosaminidase therapeutic use, Fabry Disease diagnosis, Fabry Disease drug therapy, Fabry Disease enzymology, Fabry Disease epidemiology, Fabry Disease genetics
- Abstract
Fabry-Anderson disease is a lysosomal storage disease caused by deficiency of the enzyme alpha-galactosidase. This enzymatic defect results in the accumulation of glycosphingolipid into different lines cells. Usually the deficiency is complete, resulting in a multisystem disorder, with injury in different organs, predominantly heart, kidney and nervous system. However, in some patients the enzymatic deficit is partial and causes diverse clinical variants of the disease (renal or cardiac variety), this cause a difficult diagnostic and the absence of real epidemiology data. This review is about the epidemiology, the metabolic defect of this disease, it's molecular and genetics bases, the different forms of clinical presentation and the enzyme replacement therapy.
- Published
- 2011
24. [Is a calcineurin inhibitor required as part of the immunosuppression scheme in kidney transplant recipients that share 2-haplotypes with their donors?].
- Author
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Vega O, Pérez-Gutiérrez A, Hernández-Ordóñez S, Correa-Rotter R, Alberú J, and Morales-Buenrostro LE
- Subjects
- Adult, Drug Therapy, Combination, Female, Haplotypes immunology, Humans, Male, Retrospective Studies, Tissue Donors, Calcineurin Inhibitors, Immunosuppression Therapy, Immunosuppressive Agents therapeutic use, Kidney Transplantation immunology
- Abstract
Introduction: The recipients of HLA-identical live-donors grafts (RKT 2HP) have a low immunologic risk, and it is common to use immunosuppressive regimen with two medicaments excluding the calcineurin inhibitor. This study compares the long term outcomes of the double immunosuppressive therapy versus the triple therapy in RKT 2HP., Materials and Methods: This study is a retrolective cohort. The patients were divided in two groups: (1) RKT 2HP who receive double immunosupresive therapy and (2) RKT 2HP with triple immunosupresive therapy. The outcomes evaluated were: renal function, acute rejection rate, lost of renal allograft, death rate, infections and hospitalization, change in the immunosupresive therapy and its causes., Results: We analyzed 85 kidney transplant recipients who share two haplotypes, 60 in the group 1 and 25 in the group 2. The median of time of follow-up in the group 1 was 138 months (min 23 and max 302) and 55 months (min 12 and max 106) in the group 2. There were four cellular acute rejection and nine allograft lost in patients of the group 1. There wasn't any significant difference between the allograft outcome and the renal function at 60 months of follow out between the groups. 23 patients had change in the immunosuppressive therapy, 12 (53%) in the group 1 and 11 (47%) in the group 2. The major cause of change of therapy in the group 1 was leucopenia by azatioprin (five patients); and in the group 2 was nephrotoxicity for calcineurin inhibitor (six patients)., Discussion: Despite the evident nephrotoxicity, the use of calcineurin inhibitor is useful even in patients with low immunologic risk. According to the time of follow-up between the groups, even when the allograft survival was superior in group 2, the difference wasn't significative, it might be because the lower number of patients in group 1.
- Published
- 2010
25. [Clinical and laboratorial predictors related to progression to chronic kidney disease in patients with autosomal dominant polycystic kidney disease].
- Author
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Dehesa-López E, Pérez-Gutiérrez RA, Valdez-Ortiz R, Morales-Buenrostro LE, and Correa-Rotter R
- Subjects
- Adult, Chronic Disease, Disease Progression, Female, Humans, Male, Predictive Value of Tests, Retrospective Studies, Risk Factors, Kidney Diseases etiology, Polycystic Kidney, Autosomal Dominant blood, Polycystic Kidney, Autosomal Dominant complications
- Abstract
Objective: To determine clinical and laboratorial factors related to progression to chronic kidney disease in patients with autosomal dominant polycystic kidney disease (ADPKD)., Material and Methods: Retrolective cohort. We reviewed the files of patients with diagnosis of ADPKD between 1980 and 2008. We collected demographic, clinical and laboratory data. The primary endpoint was the development of advanced kidney disease (GFR estimated < 15 mL/min with MDRD, renal replacement therapy or kidney transplantation). The Cox proportional hazards model was used to investigate the effect of clinical and laboratorial covariates on the progression to advanced kidney disease., Results: Advanced chronic kidney disease developed in 37.4% (n = 34) of the patients with median survival renal of 57 years (IC95% 50.3-63.8). Variables associated with progression to advanced chronic kidney disease in the multivariate analysis were the levels of serum creatinine (HR = 1.59 IC95% 0.99-2.55 p = 0.05) and dyslipidemia (HR = 3.40; IC95% 1.23-9.39; p = 0.01)., Conclusions: Progression to advanced chronic renal failure was common in our population and the predicting factors for progression were the levels of serum creatinine and dyslipidemia.
- Published
- 2009
26. [Bioimpedance vector analysis for body composition in Mexican population].
- Author
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Espinosa-Cuevas Mde L, Rivas-Rodríguez L, González-Medina EC, Atilano-Carsi X, Miranda-Alatriste P, and Correa-Rotter R
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Body Height, Body Water, Body Weight, Female, Humans, Male, Mexico, Middle Aged, Reference Values, Body Composition, Electric Impedance
- Abstract
Objective: To construct bivariate tolerance ellipses from impedance values normalized for height, which can be used in Mexican population for the assessment of body composition and compare them with others made in different populations., Methods: Body composition was assessed by bioelectrical impedance analysis (BIA) in 439 subjects (204 men and 235 women), 18 to 82 years old, with a BMI between 18-31, using an impedanciometer Quadscan 4000. Resistance, reactance and phase angle were used to calculate bioelectrical impedance vectors and construct bivariate tolerance ellipses., Results: Mean age in men was 47.1 +/- 16 years and 42.4 +/- 13 for women, mean weight (73.4 + 9 vs. 60.1 + 8 kg) and height (1.68 vs. 1.55 m) were significant greater in men than in women (p < 0.002). Women in comparison with men, had greater values of impedance (622.96 +/- 66.16 S2 vs. 523.59 +/- 56.56 D) and resistance (618.96 +/- 66.10 Q 61.97 vs. 521.73 +/- 61.97 2), as well as of resistance and reactance standardized by height (398.24 +/-46.30 S2/m vs. 308.66 +/- 38.44) (44.32 +/- 7.14 i/m vs. 39.75 +/-6.29) respectively, with a significant difference in all of them (p < 0.0001). Similarly, the reactance was greater in females, nevertheless this difference did not reach statistical significance (68.96 +/- 11.17 vs. 67.18 +/- 10.3; p = 0.0861). The phase angle was greater in men than in women, with a statistically significant difference (7.330 +/- 0.88 vs. 6.360 +/- 0.97; p < 0.0001). Bivariate tolerance ellipses (50%, 75% and 95%) derived from Mexican subjects showed a significant upward deviation (p < 0.05) from previously published references from Mexican American and Italian populations. New ellipses of tolerance were therefore constructed for the Mexican population., Conclusions: Bioimpedance vectors in Mexican subjects are significantly different from the existing ones, supporting the need of population specific bivariate tolerance ellipses for the evaluation of body composition.
- Published
- 2007
27. [Systemic hypertension after kidney transplantation: associated risk factors and influence on graft survival].
- Author
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Chew-Wong A, Alberú-Gómez J, Abasta-Jiménez M, Márquez-Díaz F, and Correa-Rotter R
- Subjects
- Adult, Female, Graft Survival, Humans, Male, Prevalence, Risk Factors, Hypertension epidemiology, Hypertension etiology, Kidney Transplantation adverse effects
- Abstract
Systemic hypertension after kidney transplant (HAPT) has been associated with a reduction in graft survival and increased morbidity and mortality of kidney transplant recipients. With the use of calcinuerin inhibitors, prevalence of HAPT has increased to 60-80%. The purpose of this study was to document the prevalence of HAPT in kidney transplant recipients attending the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" associated risk factors and the effect of hypertension in long term graft survival. We retrospectively reviewed the clinical charts of all the patients that underwent kidney transplant from 1984 to 1994. The following risk factors were studied: age, gender, cause of renal failure, presence of hypertension before kidney transplant, histocompatibility, acute rejection episodes, chronic rejection, serum creatinine values and use of cyclosporine. We divided subjects in two groups: normotensive (NT) and hypertensive (HT). HAPT included 3140/90 mmHg blood pressure level observed at least during two consecutive evaluations or the use of antihypertensive medication. We analyzed 215 grafts from 205 patients (10 patients had two kidney transplants); mean age at transplant of 30 +/- 9 years, 131 subjects were female and 84 male. One hundred and eighty eight patients (88%) displayed pretransplant hypertension. The mean follow up was 56+/-32 months. In the postransplant period 152 (71%) were HT and 63 (29%) NT. The HT group had significantly higher blood pressure and serum creatinine values than the NT group (P < 0.001), in spite of an adequate blood pressure control in 65% of the patients from the HT group. The NT group displayed a higher graft survival than the HT group; 60 +/- 30 months vs. 51 +/- 32 months respectively (p<0.01). Multivariate analysis did not show any risk factors independently associated with the development of HAPT. The prevalence of HAPT in our series is similar to the one reported in the literature. During the postransplant period there was a reduction of hypertensive patients (88% pretransplant vs. 71% postransplant). HAPT is a significant risk factor associated with long term survival of the graft.
- Published
- 2005
28. [Evaluation of the renal transplant recipient].
- Author
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Cuéllar-González JV and Correa-Rotter R
- Subjects
- Aged, Aged, 80 and over, Cardiovascular Diseases diagnosis, Comorbidity, Contraindications, Diabetes Complications diagnosis, Diagnostic Techniques, Urological, Humans, Infections diagnosis, Interdisciplinary Communication, Kidney Diseases diagnosis, Lupus Erythematosus, Systemic diagnosis, Mental Disorders diagnosis, Obesity diagnosis, Preoperative Care, Recurrence, Kidney Transplantation, Patient Selection
- Published
- 2005
29. [Conn's syndrome: surgical experience].
- Author
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Echeverría-Valenzuela I, Us-De-Paz G, Fajardo-Cevallos R, Correa-Rotter R, Gómez-Pérez FJ, and Herrera MF
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Adrenalectomy, Hyperaldosteronism surgery
- Abstract
Background: Primary aldosteronism is a syndrome clinically characterized by systemic arterial hypertension and hypokalemia that occurs most frequently as a consequence of the excessive production of aldosterone by adrenal cortical hyperplasia or a functioning tumor. Surgical resection of the tumor leads to cure of the disease in most patients. The aim of this study was to analyze a series of patients with an adrenal aldosterone-producing tumor., Patients and Methods: Clinical records of 13 patients with Conn syndrome were reviewed analyzing the clinical presentation, diagnosis, localizing techniques, treatment and follow-up with emphasis in the postoperative outcome of hypertension and serum potassium., Results: From a total of 105 patients who underwent adrenalectomy in a 12-year period (August 1991-February 2003), 13 patients were operated on to remove an adrenal aldosterone-producing tumor. Mean age was of 43 +/- 11 years, 8 were women and 5 men. All presented with arterial hypertension and 11 also had hypokalemia. Diagnosis of Conn syndrome was established by laboratory tests and an adrenal tumor was found by image studies in all patients. Open adrenalectomy was performed in 2 patients and 11 underwent a laparoscopic procedure. There was neither surgical morbidity nor mortality. The histological analysis established the diagnosis of adenoma in 12 patients and carcinoma in 1. Mean postoperative hospital stay was 3.1 days. A total of 12 patients became normotensive after surgery and potassium levels returned to normal in all cases., Conclusions: Conn syndrome was present in 12% of patients undergoing adrenal surgery. Arterial hypertension, low plasma renin activity levels, and hypokalemia were present in all patients. Image studies were able to localize the tumor in all cases and surgical resection of the tumor lead to normal arterial blood pressure in 92% of the patients and eukalemia in 100%.
- Published
- 2003
30. [Early referral to the nephrologist: impact on initial hospitalization and the first 6 months of continuous ambulatory peritoneal dialysis].
- Author
-
Sabath E, Vega O, and Correa-Rotter R
- Subjects
- Adult, Humans, Longitudinal Studies, Middle Aged, Time Factors, Hospitalization, Kidney Failure, Chronic therapy, Nephrology, Peritoneal Dialysis, Continuous Ambulatory, Referral and Consultation
- Abstract
Background: The prognosis and outcome in patients with end stage renal disease is significantly related to the predialysis care and early or late nephrological referral. Late nephrological referral has been associated with more hospital admissions and mortality at six months after the dialysis was initiated. We lack information about the role of early nephrological referral and its impact in biochemical variables and first hospitalization in our country., Methods: The charts of all patients that were admitted to peritoneal dialysis in the period 01/1999-06/2001 were reviewed. We divided the population in group A with patients referred to nephrologist more than 3 months before the start of dialysis (early referral) and group B with those patients referred for a period shorter than three months or no referred before the start of dialysis (late referral or no referral). The patient's characteristics, laboratory values, characteristics of the first hospitalization and drugs were analyzed when dialysis was initiated and after six months of follow-up., Results: Patients in group A were older and the percentage of patients with diabetes and hypertension was higher. The patients with early referral started dialysis with higher levels of hemoglobin (9.2 vs. 8.3 g/dL, p = 0.01) and with lower serum levels of BUN (91 vs. 122.5 mg/dL, p = 0.0001), creatinine (8.4 vs. 12.8 mg/dL, p = 0.0002) and phosphorus (6.4 vs. 7.7 mg/dL, p = 0.01). The length of the first hospitalization was shorter in patients of Group A (5.7 vs. 10.5 days, p = 0.004) and the emergency department was less used to peritoneal catheter placement in this group (46.3 vs. 86.9%, p = 0.01). There were not differences in hospitalization between the two groups after six months., Conclusion: Patients with early referral to a nephrologist show better biochemical variables, shorter first hospitalization length and higher percentage of elective placement of catheter.
- Published
- 2003
31. [Renal artery stenosis after transplantation: treatment using percutaneous transluminal angioplasty and placement of an expandable metal luminal prosthesis].
- Author
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Guzmán-Rodríguez JH, Plata-Muñoz JJ, Mancilla E, Dorantes J, Narváez R, Martínez R, Tielve M, Bezaury P, Correa-Rotter R, and Alberú J
- Subjects
- Adolescent, Adult, Female, Humans, Male, Middle Aged, Renal Artery Obstruction etiology, Treatment Outcome, Angioplasty, Balloon, Kidney Transplantation, Postoperative Complications surgery, Renal Artery Obstruction surgery, Stents
- Abstract
Unlabelled: Transplant renal artery stenosis (TRAS) is a cause of severe post transplant hypertension with a widely variable reported incidence from 1 to 25%. We herein report 3 cases of endoluminal stent placement after percutaneous transluminal angioplasty for treatment of TRAS. Clinical and laboratory findings during their follow-up, suggestive of TRAS included: elevated mean blood pressure, bruit over the graft area(2/3), and increase in serum creatinine (2/3). Doppler sonography, radioisotope renography and arteriography were performed to confirm TRAS diagnosis. The series includes 2 female and 1 male patients; the time elapsed between transplantation and TRAS diagnosis was 25 d, 12 and 65 months, respectively. All grafts were from living related donors. Patients received at least 3 antihypertensive drugs without adequate blood pressure control. Vascular anastomosis was end to end from the renal to the hypogastric artery in two cases, and end to side to the external iliac artery in the other one. After the diagnosis of TRAS, percutaneous transluminal angioplasty with endoluminal metallic Palmaz stent placement was accomplished in the three cases. No complications occurred during or after the procedures. Beneficial clinical results were obtained in all cases documented by a decrease in both: serum creatinine, and mean blood pressure. Average follow-up after stent placement was 13, 19 and 36 months, respectively without evidence of stenosis recurrence, Conclusions: Percutaneous transluminal angioplasty with stent placement is a safe and effective treatment for TRAS associated hypertension and renal dysfunction. Extended follow-up is necessary to evaluate long-term efficacy and safety of this procedure.
- Published
- 2003
32. [The evolution of nephrology: from the theory of humors to gene therapy].
- Author
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Morales Buenrostro LE and Correa-Rotter R
- Subjects
- DNA chemistry, DNA genetics, Erythropoietin genetics, Erythropoietin therapeutic use, Fabry Disease enzymology, Fabry Disease genetics, Forecasting, Genetic Therapy, History, 16th Century, History, 19th Century, History, 20th Century, History, Ancient, Humans, Isoenzymes therapeutic use, Nephrology trends, Protein Engineering, Recombinant Proteins therapeutic use, alpha-Galactosidase genetics, alpha-Galactosidase therapeutic use, Kidney Diseases genetics, Nephrology history
- Published
- 2003
33. [Effectiveness of preemptive therapy with ganciclovir in recipients of renal transplants at high risk (R-/D+) for the development of cytomegalovirus disease].
- Author
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Aranda-Verástegui F, Alberú J, Soto-Ramírez LE, González-Aguirre H, Muñoz Trejo T, Mancilla E, Díliz H, Correa-Rotter R, and Sierra-Madero J
- Subjects
- Adult, Antibodies, Viral blood, Antiviral Agents administration & dosage, Cost-Benefit Analysis, Creatinine blood, Cytomegalovirus immunology, Cytomegalovirus isolation & purification, Cytomegalovirus Infections diagnosis, Cytomegalovirus Infections epidemiology, Cytomegalovirus Infections transmission, Drug Costs, Follow-Up Studies, Ganciclovir administration & dosage, Humans, Immunoglobulin M blood, Immunosuppressive Agents therapeutic use, Mexico epidemiology, Phosphoproteins blood, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Postoperative Complications virology, Risk, Tissue Donors, Transplants virology, Viral Matrix Proteins blood, Viremia diagnosis, Viremia epidemiology, Viremia prevention & control, Antiviral Agents therapeutic use, Cytomegalovirus Infections prevention & control, Ganciclovir therapeutic use, Kidney Transplantation, Postoperative Complications prevention & control, Premedication economics
- Abstract
Current management of renal transplant recipients who are CMV seronegative (R-) and receive an organ from a seropositive donor (D+) is controversial. These patients are at high risk for CMV disease and are usually treated with ganciclovir prophylaxis at variable dose and duration. An alternative to this approach is to administer ganciclovir only to those patients who are identified by virological markers to be at the highest risk to develop the disease (preemptive therapy). This prospective trial was conducted to asses the value of preemptive therapy to prevent CMV disease in R-/D+ kidney transplant recipients on triple drug immunosuppression without antilymphocyte induction. Sixteen adults receiving their first kidney transplant were enrolled and followed with pp65 antigenemia assay performed biweekly for the first 16 postransplant weeks, and then monthly to complete 12 months. Ganciclovir (5 mg/kg/day i.v., for 15 days) was administered as preemptive therapy upon detection of one or more antigen-positive cells per 150 x 10(3) peripheral blood leucocytes examined. For those receiving preemptive therapy, pp65 antigenemia was also repeated after completion of the regimen. CMV antigenemia was detected in 7/16 patients. At mean follow-up of 9 months (4-12 m) none of the 16 patients developed CMV disease. CMV serology (IgM) became positive in all patients after the first antigenemia result. The last follow-up mean serum creatinine (SCr) level was similar in both groups (1.35 mg/dL). In CMV R-/D+, the use of preemptive therapy guided by pp65 antigenemia is effective in preventing CMV disease. By using this strategy, 9 of 16 patients were spared ganciclovir prophylaxis with no effect on rejection or CMV disease. The clinical benefit and cost/effectiveness of this strategy should be evaluated against universal prophylaxis in these high-risk patients.
- Published
- 2002
34. [Renal graft survival in patients with systemic lupus erythematosus].
- Author
-
Chew-Wong A, Soltero L, Diná E, Alvarez-Sandoval E, Alberú J, Gamba G, and Correa-Rotter R
- Subjects
- Adult, Female, Humans, Kidney Failure, Chronic surgery, Male, Retrospective Studies, Risk Factors, Thrombosis etiology, Treatment Outcome, Graft Survival, Kidney Failure, Chronic etiology, Kidney Transplantation adverse effects, Lupus Erythematosus, Systemic complications
- Abstract
Background: End-stage renal disease is an important cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). In 1975, the US Renal Transplant Registry reported the first lupus patients, who received a renal transplant. This study reported 60% and 55% patient/graft survival respectively at a mean time of two years; these results were similar to those of non-lupus transplanted patients in this same post-transplant lapse time. Renal transplantation is a world wide accepted therapeutic option in the treatment of SLE patients., Patients and Methods: In order to identify the risk factors associated to renal graft loss in SLE patients and to compare graft survival between these patients and control transplant patients, matched by age, gender, haplotype match, and transplant date (+/- three years), we performed a retrospective analysis of all SLE patients that received a renal transplant in our Institute., Results: From 1967 to March 1997, 25 (5.5%) out of 452 renal transplants were performed in 22 SLE patients, mean age 29 +/- 10 years, 20 were female (90%). In 18 patients (85.7%) we obtained pre-transplant histological diagnosis: 13 (72%) type IV glomerulonephritis according to the OMS classification, three (17%) type VI, and two (11%) type III. Twelve patients (57%) were subjected to hemodialysis in the pre-transplant period and none (43%) to peritoneal dialysis. The time elapsed between the diagnosis of SLE and the start of dialysis was 50 +/- 70 months, the time on dialysis was 18 +/- 17 months, the post-transplant renal follow-up 46.9 +/- 41.5 months, and the graft source: 18 (78%) from living related (three sharing 0 haplotypes, 12 sharing 1 haplotype, and three sharing 2 haplotypes), and five (22%) from cadaver donors. Triple drug immunosuppresive therapy (cyclosporine, azathioprine, and prednisone) was employed in 17 patients and double drug therapy (azathioprine and prednisone) in the remaining six cases. We registered seven acute rejection episodes in five patients (30%), one of them lost the graft. Five patients presented a post-transplant thrombotic event, two of these were in the graft's artery. In two patients post-transplant SLE activity was documented, one case in with renal activity in the graft and the other with extrarenal activity. Risk factors analyzed for graft loss: number of pre-transplant thrombosis events, time elapsed between diagnosis of SLE at start of dialysis (< or = 6 months), time on dialysis (< or = 12 months), graft source, chronic rejection, and follow-up were not significant; in contrast, post-transplant thrombosis was the only identified risk factor for graft loss. Graft survival analysis at 50 months in SLE transplanted patients versus control non-SLE transplanted patients did not show significant differences (74% vs. 83%, log rank 0.11)., Conclusions: Post-transplant thrombosis was identified as a risk factor for graft loss. In concordance with recent studies, pre-transplant thrombosis, time elapsed between diagnosis of SLE at start of dialysis and time on dialysis were not risk factors for graft loss in this study. Graft survival in renal transplants recipients with SLE was not different from that of the general renal transplant population.
- Published
- 2002
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