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Immune response to hepatitis B vaccine in a group of patients on hemodialysis
e70
Abstracts
Drug-related adverse events (DRAE) represent an important problem which have significant social, healthcare and economic consequences. DRAE is any damage in health caused by the therapeutic use of a drug. Age and number of drugs are directly associated with the appearance of DRAE, both being are the characteristics of patients hospitalized in internal medicine. Close monitoring of GFR in patients treated with loop diuretics, ARBs and ACE inhibitors may result in improved efficiency of ADR detection.
ID: 671 Immune response to hepatitis B vaccine in a group of patients on hemodialysis M.A. Estebana, A.M. Lazoa, M.I. Povedab, S. Domingoa, C. Maldonadoa, B. Hernándeza, A. Garcíaa, M.J. Martíneza, J. Romeroa, P. Hidalgoa a
Internal Medicine, Torrecardenas Hospital, Almeria, Spain Nephrology, Torrecardenas Hospital, Almeria, Spain
b
doi:10.1016/j.ejim.2013.08.169
Nephrology Department, General Hospital of Edessa, Edessa, Greece Department of Internal Medicine, General Hospital of Edessa, Edessa, Greece
UN
CO
RR
EC
TE
DP
Aims: Ischemic hepatitis is a rare entity characterized by elevated serum aminotransferase levels in the absence of other causes of liver failure. The aim of the present report is to describe for the first time a case of ischemic hepatitis after repeated periods of systemic hypotension during hemodialysis in a patient with end-stage renal disease. Case report: A 52-year old female patient, with a history of end-stage renal disease undergoing hemodialysis during the last month, was admitted to our department due to atypical abdominal pain, nausea, elevated serum aminotransferase levels (aspartic aminotransferase: 346 IU/L and alanine aminotransferase 450 IU/L with a normal range of 10–37 IU/L) and increased prothrombin time (30.2 s). During her last two hemodialysis sessions the patient had episodes of systemic hypotension presenting with no detectable blood pressure for approximately 15–20 min. The patient's history includes arterial hypertension, hypertensive renal disease and surgical closure of atrial communication in childhood. The rest routine laboratory findings (including bilirubin levels and hepatitis virus testing) revealed no other abnormalities. Abdominal CT scanning showed slight hepatomegaly, impaired hepatic perfusion and cardiomegaly. Cardiac echocardiography reported reduced left-ventricular ejection fraction (40%) with a hypokinetic interventricular septum, enlarged right heart chambers and mild mitral and moderate tricuspid regurgitation (MVR + 1 and TCVR + 2). The patient was treated symptomatically with inotropic support. During her hospitalization, blood pressure levels increased and no further hypotensive episodes were observed during hemodialysis. Serum aminotransferase levels were gradually reduced to normal levels. Discussion and conclusion: Ischemic hepatitis is a rare clinical syndrome whose exact features and pathophysiology remain to be clearly determined. It is mainly observed in patients with a history of heart failure (valvular abnormalities, ischemic heart disease or hypertension) after systemic hypotension. On the other hand, ischemic colitis is the most common gastrointestinal complication of hemodialysis as patients with end-stage renal disease suffer from vascular abnormalities and autonomic dysfunction leading to hypotensive episodes. Taking into consideration that heart failure due to valvular abnormalities and hypertension is also common in a hemodialysis patient, ischemic hepatitis should always be included in the differential diagnosis of elevated serum aminotransferase levels in these patients.
OF
a
b
RO
ID: 593 Ischemic hepatitis during hemodialysis in a patient with end-stage renal disease Nikolaos Sampanisa, Eleni Gavriilakib, Eleni Paschoub, Georgios Kavlakoudisa, Aikaterini Lysitskaa, Christos Dontsosb, Asterios Kalaitzogloub, Christos Papadimosb, Sotirios Vasileioua
Objective: Immune response to hepatitis B vaccine in a group of patients on hemodialysis The hepatitis B virus is a DNA virus primarily transmitted parenterally. Has a low incidence of around 1%, due to the emergence of a vaccine in 1986, the reduction in transfusions for the use of erythropoietin and control thereof in blood banks. Vaccination is indicated in all patients on hemodialysis if HBs antibodies are negative, and will be applied at the time of 0, 1, and 6 months. Our objetive is to analyze the immune response to hepatitis B vaccine in a group of patients on hemodialysis vaccinated Hemodialysis Unit Hospital Torrecárdenas of Almeria. Methods: A retrospective observational study of 58 patients with chronic kidney disease stage 5D on hemodialysis program studied in the period between January 1, 2011 and 1st January 2012. We analyzed epidemiological and clinical variables (age, sex, duration of hemodialysis, and renal disease etiology) and the immune response to vacunción against hepatitis B. Results: We describe 58 cases, 57% male and 43% female, with mean age of 59.7 years. The average time on hemodialysis program was 47.3 months. The etiology of renal disease was unknown, 32.8%, 17.2% glomerulonephritis, diabetes 13.8%, 12%, nephrosclerosis, interstitial 13.8%, 5.2% vasculitis, vascular 3.4%, and 1, 7% neoplasia. Of the 58 patients 100% had HBsAg negative, mean titer of HBsAb medium was 193.64 mIU/ml Only 6.9% of patients had high titre of HBsAb (N100 mIU/ml) per year of vaccination. The 15.5% had a titer of HBsAg 10–100 mIU/ml booster dose specifying which 100% of patients were respondendores. The 50% of patients had a title HBsAg b10 mIU/ml so that required complete revaccination responding with a titre of N100 mIU/ml at 6 months by 29% of patients. 27.6% had natural immunity (HBsAg negative, anti-HBc positive and anti-HBs positive). Conclusions: From the results of this study show that despite adequate HBV vaccination a high percentage of patients requires booster dose or revaccination. Therefore conclude the importance of comprehensive control and monitoring of HBsAg titers and booster doses and booster if necessary.
doi:10.1016/j.ejim.2013.08.170
doi:10.1016/j.ejim.2013.08.171
ID: 679 Role of mass-spectrometry in diagnostics of chronic glomerulonephritis M. Gasanov, M. Batyushin, V. Terentyev, D. Pasetchnik, D. Tsvetkov, N. Sadovnichaya, A. Sokolova, E. Lapina Internal medicine #1, Rostov State Medical University, Rostov-on-Don, Russian Federation
Objective: Early diagnostics and prognosis of the risk of renal pathology allow modulating of approaches of prophylaxis and treatment that, in turn, affects both life expectancy and standards of living. The goal of this study was to reveal the markers of pathological process in patients with renal pathology using noninvasive techniques. Methods: The study involved 13 patients: 6 males and 7 females (average age 37 years) with different morphological variants of chronic glomerulonephritis. The remote molecular diagnostic pattern was
Abstracts
Drug-related adverse events (DRAE) represent an important problem which have significant social, healthcare and economic consequences. DRAE is any damage in health caused by the therapeutic use of a drug. Age and number of drugs are directly associated with the appearance of DRAE, both being are the characteristics of patients hospitalized in internal medicine. Close monitoring of GFR in patients treated with loop diuretics, ARBs and ACE inhibitors may result in improved efficiency of ADR detection.
ID: 671 Immune response to hepatitis B vaccine in a group of patients on hemodialysis M.A. Estebana, A.M. Lazoa, M.I. Povedab, S. Domingoa, C. Maldonadoa, B. Hernándeza, A. Garcíaa, M.J. Martíneza, J. Romeroa, P. Hidalgoa a
Internal Medicine, Torrecardenas Hospital, Almeria, Spain Nephrology, Torrecardenas Hospital, Almeria, Spain
b
doi:10.1016/j.ejim.2013.08.169
Nephrology Department, General Hospital of Edessa, Edessa, Greece Department of Internal Medicine, General Hospital of Edessa, Edessa, Greece
UN
CO
RR
EC
TE
DP
Aims: Ischemic hepatitis is a rare entity characterized by elevated serum aminotransferase levels in the absence of other causes of liver failure. The aim of the present report is to describe for the first time a case of ischemic hepatitis after repeated periods of systemic hypotension during hemodialysis in a patient with end-stage renal disease. Case report: A 52-year old female patient, with a history of end-stage renal disease undergoing hemodialysis during the last month, was admitted to our department due to atypical abdominal pain, nausea, elevated serum aminotransferase levels (aspartic aminotransferase: 346 IU/L and alanine aminotransferase 450 IU/L with a normal range of 10–37 IU/L) and increased prothrombin time (30.2 s). During her last two hemodialysis sessions the patient had episodes of systemic hypotension presenting with no detectable blood pressure for approximately 15–20 min. The patient's history includes arterial hypertension, hypertensive renal disease and surgical closure of atrial communication in childhood. The rest routine laboratory findings (including bilirubin levels and hepatitis virus testing) revealed no other abnormalities. Abdominal CT scanning showed slight hepatomegaly, impaired hepatic perfusion and cardiomegaly. Cardiac echocardiography reported reduced left-ventricular ejection fraction (40%) with a hypokinetic interventricular septum, enlarged right heart chambers and mild mitral and moderate tricuspid regurgitation (MVR + 1 and TCVR + 2). The patient was treated symptomatically with inotropic support. During her hospitalization, blood pressure levels increased and no further hypotensive episodes were observed during hemodialysis. Serum aminotransferase levels were gradually reduced to normal levels. Discussion and conclusion: Ischemic hepatitis is a rare clinical syndrome whose exact features and pathophysiology remain to be clearly determined. It is mainly observed in patients with a history of heart failure (valvular abnormalities, ischemic heart disease or hypertension) after systemic hypotension. On the other hand, ischemic colitis is the most common gastrointestinal complication of hemodialysis as patients with end-stage renal disease suffer from vascular abnormalities and autonomic dysfunction leading to hypotensive episodes. Taking into consideration that heart failure due to valvular abnormalities and hypertension is also common in a hemodialysis patient, ischemic hepatitis should always be included in the differential diagnosis of elevated serum aminotransferase levels in these patients.
OF
a
b
RO
ID: 593 Ischemic hepatitis during hemodialysis in a patient with end-stage renal disease Nikolaos Sampanisa, Eleni Gavriilakib, Eleni Paschoub, Georgios Kavlakoudisa, Aikaterini Lysitskaa, Christos Dontsosb, Asterios Kalaitzogloub, Christos Papadimosb, Sotirios Vasileioua
Objective: Immune response to hepatitis B vaccine in a group of patients on hemodialysis The hepatitis B virus is a DNA virus primarily transmitted parenterally. Has a low incidence of around 1%, due to the emergence of a vaccine in 1986, the reduction in transfusions for the use of erythropoietin and control thereof in blood banks. Vaccination is indicated in all patients on hemodialysis if HBs antibodies are negative, and will be applied at the time of 0, 1, and 6 months. Our objetive is to analyze the immune response to hepatitis B vaccine in a group of patients on hemodialysis vaccinated Hemodialysis Unit Hospital Torrecárdenas of Almeria. Methods: A retrospective observational study of 58 patients with chronic kidney disease stage 5D on hemodialysis program studied in the period between January 1, 2011 and 1st January 2012. We analyzed epidemiological and clinical variables (age, sex, duration of hemodialysis, and renal disease etiology) and the immune response to vacunción against hepatitis B. Results: We describe 58 cases, 57% male and 43% female, with mean age of 59.7 years. The average time on hemodialysis program was 47.3 months. The etiology of renal disease was unknown, 32.8%, 17.2% glomerulonephritis, diabetes 13.8%, 12%, nephrosclerosis, interstitial 13.8%, 5.2% vasculitis, vascular 3.4%, and 1, 7% neoplasia. Of the 58 patients 100% had HBsAg negative, mean titer of HBsAb medium was 193.64 mIU/ml Only 6.9% of patients had high titre of HBsAb (N100 mIU/ml) per year of vaccination. The 15.5% had a titer of HBsAg 10–100 mIU/ml booster dose specifying which 100% of patients were respondendores. The 50% of patients had a title HBsAg b10 mIU/ml so that required complete revaccination responding with a titre of N100 mIU/ml at 6 months by 29% of patients. 27.6% had natural immunity (HBsAg negative, anti-HBc positive and anti-HBs positive). Conclusions: From the results of this study show that despite adequate HBV vaccination a high percentage of patients requires booster dose or revaccination. Therefore conclude the importance of comprehensive control and monitoring of HBsAg titers and booster doses and booster if necessary.
doi:10.1016/j.ejim.2013.08.170
doi:10.1016/j.ejim.2013.08.171
ID: 679 Role of mass-spectrometry in diagnostics of chronic glomerulonephritis M. Gasanov, M. Batyushin, V. Terentyev, D. Pasetchnik, D. Tsvetkov, N. Sadovnichaya, A. Sokolova, E. Lapina Internal medicine #1, Rostov State Medical University, Rostov-on-Don, Russian Federation
Objective: Early diagnostics and prognosis of the risk of renal pathology allow modulating of approaches of prophylaxis and treatment that, in turn, affects both life expectancy and standards of living. The goal of this study was to reveal the markers of pathological process in patients with renal pathology using noninvasive techniques. Methods: The study involved 13 patients: 6 males and 7 females (average age 37 years) with different morphological variants of chronic glomerulonephritis. The remote molecular diagnostic pattern was