Browsing by Author "Vega, Jorge"

Now showing 1 - 17 of 17
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    Antineutrophil cytoplasmic antibody (ANCA) associated renal vasculitis and pregnancy. Report of one case
    (SOC MEDICA SANTIAGO, 2016) Vega, Jorge; Mendez, Gonzalo P.
    ANCA mediated vasculitis mainly occur between the fourth and fifth decade of life; therefore, it is very uncommon to see pregnant patients with the disease. Vasculitis may affect significantly the course of pregnancy; in turn pregnancy can change the course of vasculitis. We report a 20 years old woman with AN-CA-mediated renal vasculitis lasting 10 years who consulted with a pregnancy of 15 weeks. She was in remission and had amenorrhea attributed to ovarian toxicity due to cyclophosphamide. Pregnancy had an uneventful course with spontaneous delivery at the 37th week, giving birth to a healthy newborn. Proteinuria increased during the course of pregnancy with a mild deterioration of kidney function. During the year after delivery, she had nephrotic proteinuria and a worsening of renal function.
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    Antología: un siglo de dramaturgia chilena: tomo III período 1973-1990
    (Publicaciones Comisión Bicentenario Chile 2010, 2010) De la Parra, Guillermo; Prado, Jorge; Vega, Jorge; Meza, Gustavo; De la Parra, Marco Antonio; Vadell, Jaime; Salcedo, José Manuel; Rivano, Luis; Benavente, David; Radrigán, Juan; Griffero, Ramón; Cerda, Carlos; Hurtado, María de la Luz; Barría, Mauricio
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    Causes of death with a functioning graft among kidney allograft recipients
    (SOC MEDICA SANTIAGO, 2012) Vega, Jorge; Videla, Christian; Borja, Hernan; Goecke, Helmuth; Martinez, Felipe; Betancour, Pablo
    Background: Death with a functioning graft (DWGF) is now one of the main causes of renal transplant (RTx) loss. Aim: To determine whether the causes of DWGF, characteristics of donors and recipients and complications of RTx have changed in the last two decades. Subjects and Methods: Cooperative study of a cohort of 418 kidney grafts performed between 1968 and 2010. Patients were divided into two groups according to whether their kidney transplants were performed between 1968 and 1992 (Group 1) or 1993 and 2010 (Group 2). Results: Sixty eight patients experienced DWGF. Infections were the leading cause of DWGF in both groups (38 and 41%, respectively), followed by cardiovascular diseases (24 and 23% respectively), gastrointestinal disorders (21 and 26% respectively) and cancer (17 and 10% respectively). There were no significant differences in causes of death between the two groups according to the time elapsed since the renal transplantation. In patients in Group 1, the interval between diagnosis of renal failure and dialysis (HD) and the interval between the start of HD and kidney transplantation were significantly lower than in Group 2. The former had also an increased number of acute rejections in the first five years of kidney transplantation (p < 0.001). In Group 2, patients more often received their kidneys from deceased donors, had previous kidney transplantation, higher rate of antibodies to a panel of lymphocytes and an increased incidence of cardiovascular disorders after five years of RTx. Conclusions: The proportion of graft loss due to DWGF has increased over the last 2 decades, but its causes have not changed significantly. Infections are the most common causes of DWGF followed by cardiovascular and digestive diseases. (Rev Med Chile 2012; 140: 295-304).
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    Complete remission of nephrotic syndrome associated with carcinoma of the cervix after treatment of the tumor. Report of two cases
    (SOC MEDICA SANTIAGO, 2012) Vega, Jorge; Santamarina, Mario; Mendez, Gonzalo P.
    Nephrotic syndrome secondary to paraneoplastic glomerulopathies is exceptional. We are aware of only three cases reported of cervical carcinomas associated with nephrotic syndrome. Two women, aged 40 and 79 years, presented with nephrotic syndrome. The first had a membranous nephropathy and the second was not biopsied. The first women had a metrorrhagia after 8 months of unsuccessful therapy with corticosteroids and immunosuppressive drugs. An advanced cervical carcinoma with lymph node metastases was found. In the second patient, a cervical carcinoma and hematometra was discovered two months after diagnosis of a nephrotic syndrome. The syndrome subsided completely, nine months after radiotherapy and chemotherapy in the first patient and 10 months after hysterectomy in the second patient. (Rev Med Chile 2012; 140: 1580-1584).
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    Complete remission of non-HIV collapsing glomerulopathy with deflazacort and lisinopril in an adult patient
    (2010) Vega, Jorge; Javier Guarda, Francisco; Goecke, Helmuth; Mendez, Gonzalo P.
    Collapsing glomerulopathy is a form of focal segmental glomerulosclerosis that is usually associated with HIV-1 infection, and is characterized by its poor prognosis and almost inevitable progression to end-stage renal disease. Its pathological features include collapsed glomeruli, podocyte hypertrophy and hyperplasia, and pseudocrescents. This case report shows the evolution of a 58-year-old patient with non-HIV idiopathic collapsing glomerulopathy who presented with severe nephrotic syndrome and renal insufficiency and was treated with lisinopril and deflazacort, a synthetic corticosteroid that has shown fewer cosmetic effects and glucose and bone metabolism complications than prednisone. The patient responded with full recovery of renal function and normal range of protein excreted in urine after less than two years of treatment. The patient has not suffered a recurrence of his nephrotic syndrome after three years of steroid withdrawal. There is no proven therapy for collapsing glomerulopathy, and this case highlights an alternative for treating this disease with few secondary effects.
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    Efectos en la función renal de la suplementación de creatina con fines deportivos
    (2019) Vega, Jorge; Huidobro Espinosa, Juan Pablo
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    Erdheim-Chester disease. Report of one case
    (SOC MEDICA SANTIAGO, 2011) Vega, Jorge; Cisternas, Marcela; Bergoeing, Michel; Espinosa, Roberto; Zapico, Alvaro; Chadid, Pedro; Santamarina, Mario
    We report a 76-year-old male who was admitted due to progressive congestive heart failure lasting several months. An echocardiogram showed a large pericardial effusion with early signs of pericardial tamponade and an irregular surface suggestive of cancer infiltration. The patient was operated, creating a pericardial window and draining 1,200 ml of a brownish yellow fluid with abundant cellularity. Pericardial biopsy showed infiltration by CD68 (+), CD1a (-) and S100 (-) cells. Twenty-eight months earlier, due to fatigue, dyspnea, and a non-specific inflammatory process, an enhanced-contrast-scan showed that aorta was coated with a hypodense tissue that began near the aortic valve and extended until the inferior mesenteric artery, with stenosis of the left subclavian, celiac axis, renal and upper mesenteric arteries. An angioplasty and stent placing was carried out in the last two arteries. Both kidneys had the appearance of "hairy kidneys". A bone scan showed increased uptake in femurs and tibiae and X-ray examination showed osteosclerosis in metaphysis and diaphysis. The diagnosis of Erdheim-Chester disease (non-Langerhans-cell histiocytosis) was made and the patient was treated with steroids and methotrexate. (Rev Med Chile 2011; 139: 1054-1059).
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    Fibrosis retroperitoneal asociada a uso crónico de ergotamina. Tratamiento con colchicina y esteroides. Caso clínico
    (SOC MEDICA SANTIAGO, 2011) Vega, Jorge; Goecke, Helmuth; Santamarina, Mario
    Retroperitoneal fibrosis (RPF) associated with chronic use of ergotamine is a very rare disorder. We report a 45-year-old woman who presented with a RPF after using, almost daily for 23 years, ergotamine tartrate for migraine relief FRP presented as a chronic inflammatory state, anemia, abdominal and lumbosacral pain and a hypogastric mass. A CT-Scan showed a periaortic mass and left hydronephrosis. A percutaneous biopsy was obtained and the patient was subjected to a surgical ureterolysis and tissue resection. The biopsy confirmed the presence of RPF. Due to persistent symptoms and increase in the volume of periaortic tissue, treatment with colchicine 1 mg/day and deflazacort 30 mg/day was started, resulting in a rapid disappearance of symptoms, disappearance of inflammation and a significant reduction in the volume of the periaortic tissue. The patient remains in complete remission after 29 months of follow-up. (Rev Med Chile 2011; 139: 489-494).
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    Hyperbaric oxygen therapy in a patient with autosomal dominant polycystic kidney disease with a perinephritic abscess
    (2011) Vega, Jorge; Goecke, Helmuth; Manriquez, Francisco; Escobar, Carlos; Escobar, Max; Videla, Christian; Santamarina, Mario; Echeverria, Carlos; Javier Guarda, Francisco
    A 68-year-old female in hemodialysis due to autosomal dominant polycystic kidney disease underwent resection of cysts in her right kidney via a laparoscopic approach due to abdominal pain. Three weeks after surgery, she was admitted with sepsis. A CT scan showed a large abscess around the right kidney. Percutaneous drainage of abscess was performed. The pus smear showed Gram-positive cocci and the culture contained methicillin-resistant Staphylococcus aureus. Ciprofloxacin, clindamycin and vancomycin were given. In the 3 weeks following admission, she remained febrile and septic and showed a progressive deterioration in her general condition, along with malnutrition and persistent drainage of purulent material from her right flank. The antibiotic therapy was changed to vancomycin, metronidazole and meropenem, but no improvement was observed. Because of the high risk associated with carrying out an open nephrectomy, we decided to use hyperbaric oxygen therapy (HBOT) as a potentially useful measure to control her infection. The patient underwent 26 daily sessions of 100% hyperbaric oxygen (2.5 atm). The use of HBOT induced a notable break in the clinical course of this patient's retroperitoneal infection. She was discharged after day 58 without any signs of inflammatory activity, and she has not presented reactivation of infection since then. We think that this case suggests that this therapy could be a new therapeutic tool in the management of patients with similar clinical features when all other therapeutic measures have failed. We did not find any other reports of the use of HBOT in infections of renal cysts.
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    Improving Simulated Annealing Performance by means of Automatic Parameter Tuning
    (2015) Cabrera-Guerrero, Pablo; Guerrero, Guillermo; Vega, Jorge; Johnson, Franklin
    A common problem when using (meta)-heuristic techniques to solve complex combinatorial optimization problems is related to parameters tuning. Finding "the right" parameter values can lead to significant improvements in terms of best solution objective value found by the heuristic, heuristic reliability and heuristic convergence, among others. Unfortunately, this is usually a tedious and complicated task if done manually. In this paper, we propose a framework that is based on Genetic Programming to fine-tune a key parameter of the well-known Simulated Annealing (SA) algorithm. Experiments on a set of small instances of the Facility Location Problem with capacity constraints are performed. Results show that automatically adjusting a key parameter in SA by means of Genetic Programming leads to an average value of the obtained solution that is closer to the optimal solution than the average value obtained by the simple SA algorithm with a priori selected values. More important, standard deviation of the algorithm is greatly improved by our approach which makes it much more reliable if time limitations are imposed.
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    La indexación a la superficie corporal disminuye la estimación de la velocidad de filtración glomerular y aumenta la severidad en la clasificación de la enfermedad renal crónica en la población con sobrepeso y obesidad
    (2024) Vega, Jorge; Huidobro, E. Juan Pablo; Sepulveda Palamara, Rodrigo Andrés
    Glomerular filtration rate estimates are usually indexed to a standard body surface area (BSA) of 1.73 m2. This allows comparing values of individuals of different sizes but has the potential of affecting individuals with extremes BSA. Aim: evaluating the differences in GFR estimates with or without indexing for BSA in a large cohort of ambulatory pa-tients grouped by different body mass index (BMI) and how indexing affects CKD classification. Methods: demographic and anthropometric data of 390 patients evaluated with ambulatory 24-hour creatinine clearance were registered in an anonymous database. Patients were divided in 3 groups according to BMI (18-24.9; 25-29.9; >30 kg/m2). GFR was estimated using creatinine clearance (CrCl), CKD-EPI 2009 and 2021 equations, both indexed to a standardized BSA of 1.73 m2and using the actual BSA of the patients. CKD classification was per-formed with and without indexing. Results: 224 of 390 patients were men (57.4%). 103 (26.4%) had normal BMI (group 1), 193 (49.5%) BMI of 25-29.9 (group 2) and 94 (24.1%) had BMI of 30 or more kg/m2 (group 3). Mean CrCl was 67.9 +/- 32.7 ml/min. Indexed to a BSA of 1.73 m2 CrCl was 64.8 +/- 30.5 ml/min (difference of -3.1 ml/min) (p< 0.001). The difference between real and indexed CrCl was +2.2 ml/min, -2.9 ml/min y -9.3 ml/min in groups 1, 2 and 3, respectively. Real CrCl was significantly higher in group 3 compared to group 1. Indexed ClCr was similar between the 3 groups. GFR estimation using equations was over 2 mL/min higher when removing indexation for standard BSA. Group 1 had higher indexed GFR estimates than groups 2 and 3. However, when removing indexing the 3 groups had similar GFR estimates. Classification of CKD was significantly affected by removing indexing, with almost 20% of the patients changing CKD stage. Diagnosis of GFR <60 mL/min was less frequent when removing indexing. Conclusion: Indexing to standard BSA lowers GFR estimation in overweight and obese patients, leading to a higher prevalence of GFR < 60 mL/min and CKD diagnosis
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    Nephrotic Syndrome and Acute Tubular Necrosis Due to Meloxicam Use
    (TAYLOR & FRANCIS LTD, 2012) Vega, Jorge; Goecke, Helmuth; Mendez, Gonzalo P.; Guarda, Francisco J.
    Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used by patients all over the world. Five to eighteen percent of the patients who receive NSAIDs can suffer from kidney-related side effects. Among them, the most relevant are sodium and water retention, hyponatremia, worsening of hypertension or preexisting cardiac failure, hyperkalemia, acute kidney injury, chronic kidney disease, papillary necrosis, nephrotic syndrome (NS), and acute interstitial nephritis. We report the case of a 65-year-old woman who developed acute tubular necrosis and NS a few days after receiving 15 mg of meloxicam (MLX) for 3 days for tendinitis. Steroid therapy was begun with normalization of kidney function after 7 weeks of treatment. NS (minimal change disease) was characterized by frequent remissions and relapses as prednisone was lowered under 30 mg/day. Azathioprine (100 mg/day) was added on the fifth month of diagnosis and a complete remission was finally obtained 4 years after hospital admittance. In her last medical checkup, 8 years after her debut and receiving azathioprine (50 mg) and prednisone (5 mg/day), renal function was normal (creatinine 1.0 mg/dL and creatinine clearance 80 mL/min/1.73 m(2)), proteinuria was 150 mg/day and there was no hematuria or hypertension.
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    Outcome of renal transplantation in patients with autosomal dominant polycystic kidney disease
    (SOC MEDICA SANTIAGO, 2012) Vega, Jorge; Lira, Daniel; Medel, Simon; Betancour, Pablo; Goecke, Helmuth; Carrasco, Alejandra
    Background: Patients with autosomal dominant polycystic kidney disease (ADPKD) have a better survival in chronic dialysis than patients with other etiologies of renal failure. It has been suggested that extra-renal manifestations of ADPKD may increase the odds of complications and mortality, if these patients are transplanted. Aim: To determine whether survival and complications in transplanted patients with ADPKD are different from kidney graft recipients with other etiologies of renal failure. Subjects and Methods: Four hundred six patients with kidney transplantation were followed in three hospitals between 1976 and 2011 and 19 were carriers of ADPKD. The latter were matched by type of donor, gender, age and date of kidney transplant, with 38 graft recipients with other etiologies of renal failure. Results: Graft and patient 1, 5, 10 and 15 years survival were similar in both groups. Hospitalizations due to viral infections and sepsis were more common in patients with ADPKD. There were no differences in the rate of acute rejection, delayed graft function, cancer, gastrointestinal disorders and hospitalizations due to cardiovascular diseases. The frequency of graft loss due to death with a functioning kidney was similar between both groups. Conclusions: Patient and graft survival in transplanted patients with ADPKD were similar to patients with other etiologies of renal failure. The rate and type of complications were similar between groups with the exception of hospitalizations due to sepsis and viral infections, which were more common in ADPKD patients. (Rev Med Chile 2012; 140: 990-998).
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    Rituximab in the treatment of acute cellular rejection of renal allograft with CD20-positive clusters in the infiltrate
    (2011) Vega, Jorge; Goecke, Helmuth; Carrasco, Alejandra; Escobar, Carlos; Escobar, Max; Espinosa, Roberto; Mendez, Gonzalo; de los Angeles Rodriguez, Maria
    A 31-year-old woman with nephronophthisis received a cadaveric kidney transplant, and was immunosuppressed with cyclosporine, azathioprine and steroids. Twelve days after transplant a biopsy showed acute rejection with vascular damage. She was treated with 3 pulses of methylprednisolone and change of immunosuppression to mycophenolate mofetil and tacrolimus, without improving graft function. At day 21, a second biopsy showed accentuation of interstitial and vascular rejection. Antibody-mediated rejection was suspected and plasmapheresis and rituximab were prescribed. Graft function improved rapidly. Staining for C4d was negative and there were no circulating antibodies against the donor. In the interstitial infiltrate there were clusters of B lymphocytes that accounted for 40% of cells, which was thought to be an ominous sign, as it has been associated with poor graft outcome. Acute T-cell-mediated rejection grade III (Banff 07) was diagnosed. Thirty-nine months after transplant her kidney function is stable with no other complication. This clinical case generates the hypothesis that rituximab may have a beneficial role in the therapy of acute cellular rejection when there are clusters of B lymphocytes in the infiltrate and a good response has not been obtained to conventional anti-rejection therapy.
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    Síndrome nefrótico e injuria renal aguda con microangiopatía trombótica en mujer con enfermedad celíaca. Caso clínico
    (2013) Vega, Jorge; Díaz, Rienzi; Méndez Olivieri, Gonzalo Patricio; Goecke, Helmuth
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    Vasculitis de grandes vasos en paciente con vasculitis ANCA (+). Caso clínico
    (2015) Vega, Jorge; Guarda Vega, Francisco