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    "textoCompleto" => "To the editor&#58; Cardiovascular disease is the most common cause of mortality in long-term transplant recipients&#59; it is <br></br>therefore important to address associated risk factors such as hyperlipidemia&#46; The etiology of hypertriglyceridemia is influenced by obesity&#44; diabetes mellitus&#44; drugs &#40;tacrolimus&#44; &#946;-blockers&#44; corticosteroids&#44; etc&#46;&#44; alcohol consumption&#44; <br></br>hypothyroidism&#44; renal failure&#44; nephrotic syndrome and HIV infection&#46;1 Hypertriglyceridemia in the order of 2000 <br></br>mg&#47;dl is almost always of a secondary or familial origin&#46; <br></br><br></br>Heparin is widely used as effective prophylaxis and treatment in patients with thrombosis&#46; Independently of its <br></br>anticoagulant action&#44; the administration of heparin gives rise to two opposite phenomena regarding the effect of the <br></br>drug on the patient lipid profile&#44; derived from its action upon lipoprotein lipase&#58; in the first hour&#44; heparin stimulates the enzyme2 and reduces the triglyceride levels&#44; while posteriorly the enzyme is inhibited and the triglyceride levels consequently increase&#46;3 Although controversial&#44; a number of studies have reported the favorable effects of low molecular weight heparins &#40;LMWHs&#41; upon lipid profile&#46;4&#44;5 <br></br><br></br>We report the case of a 37-year-old male with a history of arterial hypertension&#44; hypercholesterolemia&#44; terminal <br></br>chronic renal failure secondary to reflow nephropathy and a first kidney transplant in 1984&#44; with a return to hemodialysis in 2002 because of chronic graft nephropathy&#46; In 2005&#44; a second dead donor kidney was grafted&#44; with <br></br>the introduction of quadruple immunosuppression in the form of basiliximab&#44; corticosteroids&#44; mycophenolate mofetil <br></br>and tacrolimus&#46; The subsequent course proved favorable&#44; with creatinine clearance 75 ml&#47;min &#40;Cockroft-Gault&#41;&#46; Four months after transplantation&#44; the patient developed bilateral deep venous thrombosis and pulmonary thromboembolism&#46; At that time kidney function remained stable&#44; with normal lipid metabolism &#40;cholesterol 213 mg&#47;dl&#44; triglycerides 163 mg&#47;dl&#41; and thyroid hormones&#44; and normal thrombophilia findings&#46; Treatment was provided in the form of tacrolimus&#44; mycophenolate mofetil&#44; prednisone&#44; bisoprolol&#44; furosemide and omeprazole&#46;&#160; Anticoagulation was started with dalteparin 18&#44;000 U&#47;24 hours&#46; The posterior controls showed a gradual increase in triglyceride levels &#40;fig&#46; 1&#41;&#59; gemfibrozil was therefore started at increasing doses&#44; associated to atorvastatin &#191; though with scant response&#46; Due to the suspicion of hypertriglyceridemia secondary to dalteparin treatment&#44; the latter was replaced with acenocoumarol&#46; This was followed by a decrease in triglyceride levels&#44; as a result of which the lipidlowering medication was gradually withdrawn &#40;fig&#46; 1&#41;&#46; <br></br><br></br>Hypertriglyceridemia is a side effect of heparin administration&#46; Our patient was obese&#44; with grade II renal failure&#44; <br></br>and was subjected to antihypertensive treatment &#40;bisoprolol&#41; and immunosuppression &#40;corticosteroids and tacrolimus&#41;&#46; All these hypertriglyceridemiacontributing factors were present before the start of treatment with dalteparin&#46; From introduction of the latter drug&#44; the triglyceride levels were found to be uncontrollable despite intensive medical care&#46; Only dalteparin withdrawal proved effective&#46; <br></br><br></br>We therefore conclude that dalteparin&#44; one of the LMWHs with the most beneficial effects upon patient lipid profile&#44;6 was the cause of severe hypertriglyceridemia in our case&#46; This is an unusual side effect of LMWHs that nevertheless <br></br>must be taken into consideration by physicians&#44; in view of the widespread use of both LMWHs and unfractionated <br></br>heparins&#46; In addition&#44; their use in patients at high cardiovascular risk must be carefully evaluated&#46; <br></br>"
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        "resumen" => "Sr Director&#58; La enfermedad cardiovascular es la causa m&#225;s frecuente de muerte en enfermos trasplantados a largo plazo&#44; por lo que es importante incidir en factores de riesgo como la hiperlipemia&#46; En la etiolog&#237;a de la hipertrigliceridemia influyen la obesidad&#44; diabetes mellitus&#44; medicamentos &#40;tacrolimus&#44; &#946;-bloqueantes&#44; corticoesteroides&#44;&#46;&#46;&#46;&#41;&#44; consumo de alcohol&#44; hipotiroidismo&#44; insuficiencia renal&#44; s&#237;ndrome nefr&#243;tico e infecci&#243;n por VIH1&#46; Hipertrigliceridemias entorno a 2000 mg&#47;dL casi siempre son secundarias o de origen familiar&#46; "
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An infrequent cause of hypertriglyceridemia in kidney transplantation
Causa poco frecuente de hipertrigliceridemia en el trasplante renal
P.. Frailea, P.. García-Cosmesa, T.. Garcíaa, J.M.. Taberneroa
a Servicio de Nefrología, Hospital Universitario de Salamanca Salamanca Salamanca España,
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ISSN: 20132514
Original language: English
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