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artículo
Publicado 2020
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La microangiopatía trombótica (MAT) es una complicación poco frecuente asociada al uso de tacrolimus en el trasplante renal. Puede estar relacionado a infecciones, rechazo mediado por anticuerpos (RMA), recurrencia de enfermedad o MAT de novo y a toxicidad por inhibidores de la calcineurina. Por lo general, se presenta como formas incompletas, lo que hace difícil su diagnóstico, por lo que puede provocar lesiones irreversibles. El caso presentado comparte la presencia de infección viral, datos sugerentes de rechazo concomitantemente con el uso de tacrolimus. El tratamiento incluye plasmaferesis y anticuerpos monoclonales como eculizumab. Sin embargo, en el caso presentado la suspensión o cambio del tacrolimus fue una medida más costo-efectiva
2
artículo
Publicado 2020
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Thrombotic microangiopathy (TMA) is an unusual complication associated to the use of tacrolimus in renal transplantation. This condition may be related to infections, antibody-mediated rejection (AMR), disease recurrence or de novo TMA, and toxicity of calcineurin inhibitors. Generally, this condition presents in non-complete forms, which makes diagnosis difficult, and irreversible lesions may supervene. This case features the presence of a viral infection, and data suggesting rejection with the concomitant tacrolimus use. Therapy includes plasmapheresis and the use of monoclonal antibodies such as eculizumab. Nonetheless, in this particular case suspending therapy or switching from tacrolimus to another agent were good cost-effective measures.
3
artículo
Publicado 2020
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Thrombotic microangiopathy (TMA) is an unusual complication associated to the use of tacrolimus in renal transplantation. This condition may be related to infections, antibody-mediated rejection (AMR), disease recurrence or de novo TMA, and toxicity of calcineurin inhibitors. Generally, this condition presents in non-complete forms, which makes diagnosis difficult, and irreversible lesions may supervene. This case features the presence of a viral infection, and data suggesting rejection with the concomitant tacrolimus use. Therapy includes plasmapheresis and the use of monoclonal antibodies such as eculizumab. Nonetheless, in this particular case suspending therapy or switching from tacrolimus to another agent were good cost-effective measures.
4
artículo
Publicado 2025
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Introduction: The COVID-19 pandemic resulted in high global mortality rates, particularly among patients with comorbidities such as Chronic Kidney Disease (CKD) undergoing dialysis. Material and methods: This study included data from 310 CKD patients on dialysis in a Peruvian hospital during the first and second waves of the pandemic. It assessed in-hospital mortality and its associated factors, and evaluated the effectiveness of the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC4C) score as a predictive indicator of patient deterioration. Additionally, one-year post-discharge mortality and the main causes of death were analyzed. Results: In-hospital mortality among dialysis patients with COVID-19 was 48.71%. Admission to the ICU and male sex were associated with an increased risk of death. The ISARIC4C score appeared to be a valid predictor of clinical...
5
artículo
The gap between supply and demand of organs available for transplant is increasing worldwide. Over the years, alternatives have been proposed, such as including donors who have died from fatal methanol poisoning. However, this idea still generates controversy and doubts due to the possibility of transmitting the methanol to the recipient or transplanting a damaged organ. Faced with the increase of methanol intoxication events in Peru and the absence of reports in our country, we present a case of a donor who died because of methanol, with a favorable evolution of the recipient, as well as the function of the kidney graft, thus corroborating the safety of transplantation in this type of donor.
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7
artículo
Publicado 2020
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Carta al editor que considera importante reconocer que las modificaciones de recomendaciones médicas en el contexto de una pandemia de tan rápido curso como la actual son perfectamente aceptables y no deben tener una connotación negativa, ya sea política o médica. Finalmente, creemos que el Perú se encuentra, por la capacidad de coordinación de políticas para el tratamiento de la COVID-19 en sus redes hospitalarias, en posición de ejecutar, de manera rápida, ensayos clínicos de alta calidad y gran escala para evaluar nuevas potenciales terapias para la COVID-19 de modo que se pueda contribuir al avance del conocimiento en la lucha mundial contra esta pandemia
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9
artículo
Publicado 2021
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Introducción: El presente artículo resume la guía de práctica clínica (GPC) para el tratamiento farmacológico inicial nefritis lúpica en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para tratamiento farmacológico inicial de adultos con nefritis lúpica clase I a V no refractarios en EsSalud. Material y Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos, el cual formuló preguntas clínicas. Se realizaron búsquedas sistemáticas de revisiones sistemáticas y –cuando fue considerado pertinente– estudios primarios en PubMed durante el 2021. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. Se evaluó la certeza de evidencia usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE)....
10
artículo
Publicado 2021
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Background: This article summarizes the clinical practice guideline (CPG) for the initial pharmacological treatment of lupus nephritis in the Social Security of Peru (EsSalud). Objective: To provide evidence-based clinical recommendations for initial pharmacological treatment of non-refractory adults with class I to V lupus nephritis in EsSalud. Material and Methods: A guideline development group (GDG) was formed, which included specialist physicians and methodologists, who formulated clinical questions. Systematic searches were conducted for systematic reviews and - when deemed relevant - primary studies in PubMed during 2021. Evidence was selected to answer each of the clinical questions posed. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic working meetings, the GEG used the GRADE meth...
