Letter to the Editor
Development of deep vein thrombosis during treatment with plasmapheresis
Desarrollo de trombosis coincidiendo con la realización de plasmaféresis
Maria Teresa Jaldo Rodríguez, Francisco J. Borrego Utiel
, Josefa Borrego Hinojosa, Maria Pilar Pérez del Barrio
Corresponding author
Servicio de Nefrología, Complejo Hospitalario de Jaén, Jaén, Spain
Read
9881
Timeswas read the article
2485
Total PDF
7396
Total HTML
Share statistics
array:25 [ "pii" => "S2013251417300792" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.04.007" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "269" "copyright" => "Sociedad Española de Nefrología" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2017;37:219-20" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3866 "formatos" => array:3 [ "EPUB" => 348 "HTML" => 2838 "PDF" => 680 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0211699516301497" "issn" => "02116995" "doi" => "10.1016/j.nefro.2016.09.014" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "269" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia. 2017;37:219-20" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4739 "formatos" => array:3 [ "EPUB" => 382 "HTML" => 3733 "PDF" => 624 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Desarrollo de trombosis coincidiendo con la realización de plasmaféresis" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "219" "paginaFinal" => "220" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Development of deep vein thrombosis during treatment with plasmapheresis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Maria Teresa Jaldo Rodríguez, Francisco J. Borrego Utiel, Josefa Borrego Hinojosa, Maria Pilar Pérez del Barrio" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Maria Teresa" "apellidos" => "Jaldo Rodríguez" ] 1 => array:2 [ "nombre" => "Francisco J." "apellidos" => "Borrego Utiel" ] 2 => array:2 [ "nombre" => "Josefa" "apellidos" => "Borrego Hinojosa" ] 3 => array:2 [ "nombre" => "Maria Pilar" "apellidos" => "Pérez del Barrio" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2013251417300792" "doi" => "10.1016/j.nefroe.2017.04.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417300792?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699516301497?idApp=UINPBA000064" "url" => "/02116995/0000003700000002/v1_201704211146/S0211699516301497/v1_201704211146/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2013251417300779" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.04.005" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "266" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2017;37:221-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5077 "formatos" => array:3 [ "EPUB" => 338 "HTML" => 4054 "PDF" => 685 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "The star fruit as a cause of acute kidney injury" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "221" "paginaFinal" => "222" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La fruta estrella causa fracaso renal agudo" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 480 "Ancho" => 991 "Tamanyo" => 64032 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image of <span class="elsevierStyleItalic">Averrhoa carambola</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Molina, Enrique Morales, Beatriz Navarro, Candela Moliz, Manuel Praga" "autores" => array:5 [ 0 => array:2 [ "nombre" => "María" "apellidos" => "Molina" ] 1 => array:2 [ "nombre" => "Enrique" "apellidos" => "Morales" ] 2 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Navarro" ] 3 => array:2 [ "nombre" => "Candela" "apellidos" => "Moliz" ] 4 => array:2 [ "nombre" => "Manuel" "apellidos" => "Praga" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699516301461" "doi" => "10.1016/j.nefro.2016.09.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699516301461?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417300779?idApp=UINPBA000064" "url" => "/20132514/0000003700000002/v1_201705250045/S2013251417300779/v1_201705250045/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2013251417300809" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.04.008" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "271" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2017;37:217-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6164 "formatos" => array:3 [ "EPUB" => 388 "HTML" => 5008 "PDF" => 768 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Libman-Sacks’ endocarditis: A frequently unnoticed complication" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "217" "paginaFinal" => "219" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Endocarditis de Libman-Sacks: una manifestación frecuentemente inadvertida" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1084 "Ancho" => 2399 "Tamanyo" => 141022 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cardiac MRI with contrast dye. (A) Fast imaging employing steady-state acquisition (FIESTA) sequence in left ventricular (LV) outflow tract, showing a vegetation on the aortic valve (arrow). (B) Short-axis delayed gadolinium-enhanced sequence of the LV, showing an image of subepicardial enhancement at the level of the inferolateral segment suggestive of a vasculitic process (arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nerea Gómez-Larrambe, Lourdes González-Tabarés, Beatriz Millán, Carmen Cobelo, Victor Armesto, Montserrat Pousa, Secundino Cigarrán, Jesus Calviño" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Nerea" "apellidos" => "Gómez-Larrambe" ] 1 => array:2 [ "nombre" => "Lourdes" "apellidos" => "González-Tabarés" ] 2 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Millán" ] 3 => array:2 [ "nombre" => "Carmen" "apellidos" => "Cobelo" ] 4 => array:2 [ "nombre" => "Victor" "apellidos" => "Armesto" ] 5 => array:2 [ "nombre" => "Montserrat" "apellidos" => "Pousa" ] 6 => array:2 [ "nombre" => "Secundino" "apellidos" => "Cigarrán" ] 7 => array:2 [ "nombre" => "Jesus" "apellidos" => "Calviño" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699516301515" "doi" => "10.1016/j.nefro.2016.09.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699516301515?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417300809?idApp=UINPBA000064" "url" => "/20132514/0000003700000002/v1_201705250045/S2013251417300809/v1_201705250045/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Development of deep vein thrombosis during treatment with plasmapheresis" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "219" "paginaFinal" => "220" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Maria Teresa Jaldo Rodríguez, Francisco J. Borrego Utiel, Josefa Borrego Hinojosa, Maria Pilar Pérez del Barrio" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Maria Teresa" "apellidos" => "Jaldo Rodríguez" ] 1 => array:4 [ "nombre" => "Francisco J." "apellidos" => "Borrego Utiel" "email" => array:1 [ 0 => "fborregou@senefro.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "Josefa" "apellidos" => "Borrego Hinojosa" ] 3 => array:2 [ "nombre" => "Maria Pilar" "apellidos" => "Pérez del Barrio" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Nefrología, Complejo Hospitalario de Jaén, Jaén, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Desarrollo de trombosis coincidiendo con la realización de plasmaféresis" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In primary focal segmental glomerulosclerosis (FSGS) the response to drug treatment is 30–70%, depending on factors such as histological type, degree of proteinuria, presence of kidney failure or degree of resistance to steroid treatment.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> Plasmapheresis is used as rescue therapy when there is no response to drugs, results are variable and there are, frequent relapses.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> Plasmapheresis, accompanied by immunoadsorption in post-transplant relapse of FSGS, achieves good results with minimal complications.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Here we report a case of venous thrombosis that occurred while performing plasmapheresis on a patient with FSGS. The patient is 26-year-old man with severe nephrotic syndrome (NS) due to FSGS, a cellular variant, diagnosed 10 months earlier. The patient received treatment with steroids, cyclophosphamide, cyclosporine and mycophenolate, with no response, maintaining a proteinuria of 15–33<span class="elsevierStyleHsp" style=""></span>g/day. He was admitted the Hospital on 3 occasions for extreme generalised oedema, with ascites, effusion in the testicular region, no pleural effusion, and during the last admission the patient required ultrafiltration for oedema and oligoanuria, with no response to an intravenous albumin infusion. Four months later, he was re-admitted due to a new episode of extreme generalised oedema, with Cr 2.3<span class="elsevierStyleHsp" style=""></span>mg/dl, proteinuria 49.2<span class="elsevierStyleHsp" style=""></span>g/day, serum albumin 1.6<span class="elsevierStyleHsp" style=""></span>g/dl and total protein 3.7<span class="elsevierStyleHsp" style=""></span>g/dl. Plasmapheresis was performed through a right femoral transient venous catheter, performing 3 sessions, extracting 3300<span class="elsevierStyleHsp" style=""></span>ml of plasma and infusing 1800<span class="elsevierStyleHsp" style=""></span>ml of 5% albumin and 1500<span class="elsevierStyleHsp" style=""></span>ml of fresh frozen plasma (FFP) every other day. Anticoagulation was performed with 3500<span class="elsevierStyleHsp" style=""></span>IU of subcutaneous bemiparin every 24<span class="elsevierStyleHsp" style=""></span>h. The patient maintained diuresis and had no episodes of hypotension. On the third day, the patient noticed pain in the left thigh, together with an increase in its volume of the extremity; the Doppler ultrasound showed bilateral iliofemoral venous thrombosis. The coagulation study showed D-dimer 14,895<span class="elsevierStyleHsp" style=""></span>ng/ml, fibrinogen 8.9<span class="elsevierStyleHsp" style=""></span>mg/dl, prothrombin activity at 77%, antithrombin III at 49% and platelets 534,000/mm<span class="elsevierStyleSup">3</span>. Proteinuria rose to 71.3<span class="elsevierStyleHsp" style=""></span>g/day during admission, and serum albumin initially rose to 2.2<span class="elsevierStyleHsp" style=""></span>g/dl and then decreased rapidly and remained at 1–1.3<span class="elsevierStyleHsp" style=""></span>g/dl. Antithrombin III (1000<span class="elsevierStyleHsp" style=""></span>IU/day) was administered for 10 days, achieving serum antithrombin III levels around 70% by discharge. The venous catheter was removed after the third round of plasmapheresis; the patient was anticoagulated with 7500<span class="elsevierStyleHsp" style=""></span>IU of subcutaneous bemiparin/day and discharged on acenocoumarol. Creatinine stayed at 1.6<span class="elsevierStyleHsp" style=""></span>mg/dl. Nine months later, the Doppler ultrasound was repeated, showing the complete permeability of the iliac and femoral axis. Plasmapheresis did not affect the subsequent changes in proteinuria. Rituximab and tacrolimus were subsequently administered, but, 13 months later, the patient entered the haemodialysis programme due to severe kidney failure (Cr 12.2<span class="elsevierStyleHsp" style=""></span>mg/dl), with no changes in proteinuria (25<span class="elsevierStyleHsp" style=""></span>g/day).</p><p id="par0015" class="elsevierStylePara elsevierViewall">It has been postulated that the most important predictive factor for the development of thrombosis in NS is a degree of proteinuria<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> at which hepatic synthesis can no longer compensate; this entails an imbalance between coagulation-regulating proteins and fibrinolysis.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a> Plasmapheresis would theoretically allow restautration of the balance this imbalance, in addition to removing the postulated permeabilising agent that mediates the podocyte lesion in FSGS. The curious nature of our case lies in the fact that the thrombosis coincided with the performance of plasmapheresis, an observation that we have not found described in the literature.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Several factors may have facilitated the thrombosis. Ultrafiltration can cause haemoconcentration, which may have raised levels of procoagulant factors; this could have promoted the thrombosis by a similar mechanism as in children following dehydration.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Replacement of FFP with plasmapheresis provides all the coagulation factors, as well as antithrombotic factors (antithrombin III, proteins C and S), while with 5% albumin we could increase serum albumin levels slightly, and so the thrombotic risk should be reduced.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> However, we observed that the antithrombin III levels during thrombosis were low; it is therefore possible that plasma infusion in cases of severe NS does not completely restore the coagulation/fibrinolysis imbalance. There is nothing in the literature describing how coagulation factors change after plasma replacement.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our case provides several interesting and practical reflections. First, should specific preventive anticoagulation be used when plasmapheresis is to be performed in a case of nephrotic syndrome? The dose of LMWH may need to be higher than that normally used if there is no nephrotic syndrome, given the low levels of antithrombin III, coupled with elevated procoagulant factors, plus the loss of LMWH via the kidneys compared with heparin sodium. Antithrombin III levels should be monitored before starting plasmapheresis and after each session, since it may not normalise, despite plasma infusion, as happened in our case. We do not know whether a LMWH with a higher molecular weight or with a longer half-life would be more effective or suitable for preventing venous thrombosis in cases with severe NS.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jaldo Rodríguez MT, Borrego Utiel FJ, Borrego Hinojosa J, Pérez del Barrio MP. Desarrollo de trombosis coincidiendo con la realización de plasmaféresis. Nefrologia. 2017;37:219–220.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focal segmental glomerulosclerosis in nephrotic adults: presentation, prognosis, and response to therapy of the histologic variants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.J. Chun" 1 => "S.M. Korbet" 2 => "M.M. Schwartz" 3 => "E.J. Lewis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.ASN.0000135051.62500.97" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Nephrol" "fecha" => "2004" "volumen" => "15" "paginaInicial" => "2169" "paginaFinal" => "2177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15284302" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and pathologic characteristics of focal segmental glomerulosclerosis pathologic variants" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.B. Thomas" 1 => "N. Franceschini" 2 => "S.L. Hogan" 3 => "S. Ten Holder" 4 => "C.E. Jennette" 5 => "R.J. Falk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.ki.5000160" "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "2006" "volumen" => "69" "paginaInicial" => "920" "paginaFinal" => "926" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16518352" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adding plasmapheresis to corticosteroids and alkylating agents: does it benefit patients with focal segmental glomerulosclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.H. Mitwalli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nephrol Dial Transplant" "fecha" => "1998" "volumen" => "13" "paginaInicial" => "1524" "paginaFinal" => "1528" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9641186" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plasma immunadsorption treatment in patients with primary focal and segmental glomerulosclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Haas" 1 => "Y. Godfrin" 2 => "R. Oberauer" 3 => "N. Yilmaz" 4 => "K. Borchhardt" 5 => "H. Regele" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nephrol Dial Transplant" "fecha" => "1998" "volumen" => "13" "paginaInicial" => "2013" "paginaFinal" => "2016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9719156" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plasmapheresis and immunoadsorption for treatment and prophylaxis of recurrent focal segmental glomerulosclerosis in adult recipients of deceased donor renal grafts" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Kandus" 1 => "R. Ponikvar" 2 => "J. Buturović-Ponikvar" 3 => "A.F. Bren" 4 => "M. Oblak" 5 => "G. Mlinšek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1744-9987.12093" "Revista" => array:6 [ "tituloSerie" => "Ther Apher Dial" "fecha" => "2013" "volumen" => "17" "paginaInicial" => "438" "paginaFinal" => "443" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23931886" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology and risk factors for thromboembolic complications of childhood nephrotic syndrome: a Midwest Pediatric Nephrology Consortium (MWPNC) study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.A. Kerlin" 1 => "N.B. Blatt" 2 => "B. Fuh" 3 => "S. Zhao" 4 => "A. Lehman" 5 => "C. Blanchong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpeds.2009.01.070" "Revista" => array:6 [ "tituloSerie" => "J Pediatr" "fecha" => "2009" "volumen" => "155" "paginaInicial" => "105" "paginaFinal" => "110" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19394032" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical correlation between hypercoagulability and thrombo-embolic phenomena" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Robert" 1 => "M. Olmer" 2 => "J. Sampol" 3 => "J.E. Gugliotta" 4 => "P. Casanova" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "1987" "volumen" => "31" "paginaInicial" => "830" "paginaFinal" => "835" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2437353" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coagulation factors in nephrotic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Kanfer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Nephrol" "fecha" => "1990" "volumen" => "10" "numero" => "Suppl 1" "paginaInicial" => "S63" "paginaFinal" => "S68" "itemHostRev" => array:3 [ "pii" => "S0091674914007283" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thrombosis and hemostasis in renal disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.J. Rabelink" 1 => "J.J. Zwaginga" 2 => "H.A. Koomans" 3 => "J.J. Sixma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "1994" "volumen" => "46" "paginaInicial" => "287" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7967339" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Red blood cell aggregation in nephrotic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Ozanne" 1 => "R.B. Francis" 2 => "H.J. Meiselman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "1983" "volumen" => "23" "paginaInicial" => "519" "paginaFinal" => "525" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6842967" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003700000002/v1_201705250045/S2013251417300792/v1_201705250045/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003700000002/v1_201705250045/S2013251417300792/v1_201705250045/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417300792?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 12 | 23 |
| 2024 October | 98 | 32 | 130 |
| 2024 September | 93 | 27 | 120 |
| 2024 August | 112 | 67 | 179 |
| 2024 July | 99 | 27 | 126 |
| 2024 June | 86 | 44 | 130 |
| 2024 May | 96 | 30 | 126 |
| 2024 April | 89 | 33 | 122 |
| 2024 March | 71 | 22 | 93 |
| 2024 February | 61 | 32 | 93 |
| 2024 January | 74 | 29 | 103 |
| 2023 December | 49 | 20 | 69 |
| 2023 November | 66 | 32 | 98 |
| 2023 October | 77 | 24 | 101 |
| 2023 September | 58 | 26 | 84 |
| 2023 August | 63 | 26 | 89 |
| 2023 July | 89 | 24 | 113 |
| 2023 June | 71 | 18 | 89 |
| 2023 May | 97 | 36 | 133 |
| 2023 April | 59 | 15 | 74 |
| 2023 March | 94 | 25 | 119 |
| 2023 February | 74 | 24 | 98 |
| 2023 January | 68 | 21 | 89 |
| 2022 December | 92 | 27 | 119 |
| 2022 November | 82 | 32 | 114 |
| 2022 October | 79 | 31 | 110 |
| 2022 September | 69 | 37 | 106 |
| 2022 August | 89 | 48 | 137 |
| 2022 July | 72 | 55 | 127 |
| 2022 June | 74 | 35 | 109 |
| 2022 May | 68 | 25 | 93 |
| 2022 April | 82 | 57 | 139 |
| 2022 March | 101 | 51 | 152 |
| 2022 February | 110 | 44 | 154 |
| 2022 January | 79 | 47 | 126 |
| 2021 December | 83 | 37 | 120 |
| 2021 November | 54 | 32 | 86 |
| 2021 October | 69 | 29 | 98 |
| 2021 September | 98 | 35 | 133 |
| 2021 August | 81 | 43 | 124 |
| 2021 July | 112 | 42 | 154 |
| 2021 June | 47 | 21 | 68 |
| 2021 May | 92 | 55 | 147 |
| 2021 April | 214 | 59 | 273 |
| 2021 March | 117 | 52 | 169 |
| 2021 February | 95 | 31 | 126 |
| 2021 January | 78 | 20 | 98 |
| 2020 December | 53 | 20 | 73 |
| 2020 November | 69 | 21 | 90 |
| 2020 October | 55 | 21 | 76 |
| 2020 September | 62 | 17 | 79 |
| 2020 August | 62 | 18 | 80 |
| 2020 July | 60 | 22 | 82 |
| 2020 June | 57 | 23 | 80 |
| 2020 May | 74 | 27 | 101 |
| 2020 April | 65 | 16 | 81 |
| 2020 March | 72 | 24 | 96 |
| 2020 February | 78 | 18 | 96 |
| 2020 January | 84 | 24 | 108 |
| 2019 December | 61 | 26 | 87 |
| 2019 November | 72 | 15 | 87 |
| 2019 October | 40 | 21 | 61 |
| 2019 September | 41 | 15 | 56 |
| 2019 August | 45 | 20 | 65 |
| 2019 July | 45 | 22 | 67 |
| 2019 June | 50 | 31 | 81 |
| 2019 May | 37 | 32 | 69 |
| 2019 April | 78 | 53 | 131 |
| 2019 March | 53 | 25 | 78 |
| 2019 February | 36 | 22 | 58 |
| 2019 January | 48 | 27 | 75 |
| 2018 December | 136 | 53 | 189 |
| 2018 November | 259 | 31 | 290 |
| 2018 October | 244 | 29 | 273 |
| 2018 September | 139 | 35 | 174 |
| 2018 August | 92 | 14 | 106 |
| 2018 July | 78 | 13 | 91 |
| 2018 June | 82 | 18 | 100 |
| 2018 May | 72 | 16 | 88 |
| 2018 April | 124 | 7 | 131 |
| 2018 March | 123 | 11 | 134 |
| 2018 February | 121 | 4 | 125 |
| 2018 January | 89 | 9 | 98 |
| 2017 December | 118 | 4 | 122 |
| 2017 November | 60 | 18 | 78 |
| 2017 October | 52 | 16 | 68 |
| 2017 September | 59 | 15 | 74 |
| 2017 August | 90 | 7 | 97 |
| 2017 July | 57 | 9 | 66 |
| 2017 June | 42 | 12 | 54 |
| 2017 May | 61 | 12 | 73 |
| 2017 April | 9 | 1 | 10 |
Show all
