Renal function recovery on hemodialysis
Recuperación de función renal en hemodiálsis
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aggressive treatment may be able to improve prognosis of conditions such as autoimmune, 2-4 tumoral,5,6 and even cardiovascular diseases.7,8 Some of these conditions were doubtfully amenable to renal replacement therapy until recently. In this group of new diseases admitted for hemodialysis, relative recovery of renal function may be seen without this involving discontinuation of such treatment in all cases. Our experience is briefly summarized below. <br></br><br></br>The first case reported is a 56-year-old male recently diagnosed of IgA multiple myeloma with plasma cell infiltration of 27%. He was referred to us with laboratory data suggesting advanced renal insufficiency (ClCr 7 mL/min, Cr 8.3 mg/mL) and no apparent signs of hemodynamic decompensation, hypercalcemia, or nephrotoxics. `Dialysis and simultaneous specific treatment for his underlying disease were immediately started. Three months after the first dialysis session, the patient has serum Cr levels of 2.36 mg/dL. <br></br><br></br>The second case was a 16-year-old female who attended the emergency room for a general syndrome of fatigue and anorexia, and reported a pharyngeal process in the previous days. Serum Cr levels were 10 mg/dL, and dialysis was therefore started. Laboratory tests suggested glomerulonephitis, and renal biopsy confirmed the presence of endocapillary and extracapillary proliferation with 50% of cell crescents. Corticosteroid and cyclophosphamide were administered as a bolus. Serum Cr levels of 1.4 mg/dL were found at 15 days. <br></br><br></br>The third case was an 83-year-old male patient admitted for fatigue who was found advanced uremia (Cr 5.8mg/dL) and clinical and biological evidence of rapidly progressive glomerulonephritis. No renal biopsy was performed because of the patient age and poor cooperation. He was treated with corticosteroid and  cyclophosphamide boluses. After 6 months on hemodialysis, serum creatinine value was 3.5 <br></br><br></br>mg/dL, and session time was shortened. A fourth, more complex case was that of a 64-year-old male patient with a history of alcohol-induced cirrhosis and moderate renal insufficiency who was admitted in a state of overshoot uremia. He underwent regular hemodialysis and recovered a certain renal function, but total withdrawal from replacement therapy was not considered appropriate because of his initial severe status and the great improvement in his quality of life. <br></br><br></br>Finally, regular hemodialysis for refractory heart failure was started in a 67-year-old male patient with Cr levels of 6 mg/dL. He had been diagnosed dilated cardiomyopathy based on echocardiographic data. Since hemodialysis was started 16 months ago, the patient has not required any hospital admission, performs a normal physical activity, <br></br>and has substantially recovered renal function. Hemodialysis discontinuation is not considered appropriate. <br></br><br></br>While it is true that our patients could be considered in some case potentially recoverable, considering the severity of the baseline condition and/or underlying disease, no statement could be made a priori. Special mention should be made of the improved quality of life and absence of hospital admissions once replacement therapy was started. The indication for monitoring of residual function is emphasized.9,10 <br></br>" "pdfFichero" => "P-E-S-A367-EN.pdf" "tienePdf" => true "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "La insuficiencia renal avanzada subsidiaria de hemodiálisis, distinta a la necrosis tubular aguda, puede ser recuperable total o parcialmente en ciertas patologías1. El tratamiento más eficaz y agresivo de las mismas, puede lograr mejorar su pronóstico, como en procesos de naturaleza autoinmune 2-4, tumorales 5,6, e incluso cardiovasculares (7,8). Algunas de estas entidades, dudosamente eran subsidiarias de tratamiento renal sustitutivo hasta fechas recientes. En relación con este abanico de nuevas patologías admitidas en hemodiálisis y sus nuevas propuestas terapéuticas, es posible asistir a recuperaciones relativas de funcionalismo renal sin que ello implique la suspensión de este tratamiento en todos los casos. Resumimos brevemente nuestra experiencia. " ] "en" => array:1 [ "resumen" => "To the editor: Advanced renal insufficiency requiring hemodialysis other than acute tubular necrosis may be totally or partially reversed in certain diseases. 1 More effective and aggressive treatment may be able to improve prognosis of conditions such as autoimmune, 2-4 tumoral,5,6 and even cardiovascular diseases.7,8 Some of these conditions were doubtfully amenable to renal replacement therapy until recently. In this group of new diseases admitted for hemodialysis, relative recovery of renal function may be seen without this involving discontinuation of such treatment in all cases. Our experience is briefly summarized below." ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Sekkarie MA, Port FK, Wolfe RA, Guire K y cols.: Recovery from end-stage renal disease. Am J Kidney Dis 15: 61-5, 1990. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2294734" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Levy JB, Hammad T, Coulthart A, Dougan T, Pusey CD: Clinical features and outcome of patients with both ANCA and anti-GBM antibodies. Kidney Int 66 (4): 1535-40, 2004. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15458448" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0735109708002635" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Jenette JC: Rapidly progressive crescentic glomerulonephritis. Kidney Int 63 (3): 1164-77, 2003. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12631105" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Serra A, Romero R: Fracaso renal agudo en las vasculitis sistémicas asociadas a anticuerpos anticitoplasma de los neutrófilos (ANCA) en pacientes de edad avanzada. Nefrología 21: 1-8, 2001" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Renal failure in multiple myeloma: reversibility and impact on the prognosis. Nordic Myeloma Study Group. Knudsen LM, Hjoth M, Hippe E. Eur J Haematol 65 (3): 175-81, 2000" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Renal failure in multiple myeloma: presenting features and predictors of outcome in 94 patients froma a single institution. Bladé J, Fernández-Llama P, Bosch F, Montolíu j, y cols. Arch Intern Med 28; 158 (17): 1889-93, 1998" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Circulatory respons to fluid overloada renoval by extracorporeal ultrafiltration in refractory congestive Herat failure. Marenzi G, Grazi M, Assanelli, Campodonico J y cols. J Am Coll Cardiol 38(4): 963-8, 2001" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Intermittent outpatient ultrafiltration for the treatment of sever refractory congestive heart failure. Sheppard R, Panyon K, Pohwani AL, Kapoor A, y cols. J Card Fail 10 (5): 380-3, 2004" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Evolución de la función renal residual en enfermos tratados con hemodiálisis. Gámez C, Teruel JL, Ortuño J. Nefrología 12: 125-9, 1992" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Recuperación de la función renal en apcientes en programa de diálisis. P. Rodríguez Benítez, Gómez Campderá, FJ, Rengel, M, Anaya F. Nefrología 22 (1), 92-3, 2002" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000002800000005/v0_201502091635/X2013251408004147/v0_201502091635/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/20132514/0000002800000005/v0_201502091635/X2013251408004147/v0_201502091635/en/P-E-S-A367-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251408004147?idApp=UINPBA000064" ]
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