V rámci stárnutí dialyzované populace se zvyšuje podíl starších čekatelů na transplantaci ledviny. Při kratší předpokládané době dožití a častějším úmrtí s funkčním štěpem je často těžké rozhodnout, kdy ještě nemocného do čekací listiny zařadit a kdy už ne. Křehkost (frailty) a kognitivní funkce jsou výrazným rizikovým faktorem, infekce pak častou příčinou úmrtí. Ač jsou dlouhodobé výsledky v přežití pacientů po transplantaci superiorní oproti netransplantovaným, v časném pooperačním období je riziko úmrtí u příjemců ledvin vyšší. Text shrnuje zkušenosti transplantačních center s danou problematikou a z toho pramenící doporučení.
As the dialysis population ages the proportion of elderly candidates for kidney transplantation is increasing. With a shorter life expectancy and more frequent deaths with a functional graft, the boundary between when to include a patient and when not to is often blurred. Frailty and cognitive function are significant risk factors for transplantation. Infection is a common cause of death. Although long-term survival in transplant population is superior to not transplant, in the early postoperative period the mortality risk is higher in kidney recipients. The text summarizes the experience of transplant centers with the issue and the resulting recommendation.
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BACKGROUND/AIMS: Goodpasture syndrome (GS) is an autoimmune disease affecting mainly the kidneys and lungs. This review article focuses on GS occurring during pregnancy, which can seriously threaten the lives of both mother and fetus. We summarize the current clinical diagnosis and management of GS in pregnancy. METHODS: A profound literature search was carried out to review all published articles or case studies reporting on GS in pregnancy. We extracted the following data from each case: patient age, parity, gestational age, therapy of GS during pregnancy, pregnancy outcome, neonatal outcome, mode of delivery, and the patient's kidney status. We describe in detail how a recent case of GS diagnosed in pregnancy was successfully treated. RESULTS: A review of the available literature revealed 4 cases of GS in pregnancy. The average patient age was 29.3 ± 2.5 years, and most were primiparous, with an average parity of 1.3 ± 1.5. The average gestational age at the time of diagnosis was 12.5 ± 5.9 weeks. The therapies of GS during pregnancy were remarkably varied. Furthermore, the neonatal outcomes were also quite individual among the observed cases. CONCLUSION: The occurrence of GS during pregnancy is very rare. This unusual pregnancy complication is associated with significant maternal and fetal morbidity. The management of GS during pregnancy requires intensive care and multidisciplinary cooperation.
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
