La enfermedad renal crónica (ERC) es una enfermedad multifactorial de carácter progresivo e irreversible. En esta enfermedad la función renal se encuentra deteriorada; en estadios avanzados requiere, por lo general, terapias de reemplazo renal (TRR). El elevado costo del tratamiento sustitutivo de la ERC representará un importante reto para los sistemas de salud. En nuestro país, históricamente ha predominado el uso de diálisis peritoneal, aunque recientemente se ha dado impulso a la hemodiálisis. Por un lado, en México, la hemodiálisis sigue siendo poco accesible para la mayoría de los pacientes. Por otro lado, el trasplante renal (TR) es la única modalidad de TRR que realmente previene el desarrollo ABSTRACT Introduction: Chronic Kidney Disease (CKD) is a multifactorial disease of a progressive and irreversible nature, in which renal function is impaired that in end stages requires renal replacement therapies (RRT). The high cost of CKD replacement therapy will represent a major challenge for health systems. Mexico is a country in which the use of peritoneal dialysis has historically predominated, although hemodialysis has recently been encouraged. On the other hand, in Mexico, hemodialysis remains poorly accessible for most patients. Kidney transplantation (KT) is the only modality of RRT that really prevents the development of uremia, but, unfortunately, not all patients with CKD are candidates for KT. For this

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Immunosuppression therapy during pregnancy of KT women did not affect global intellectual performance of their offspring, except maybe for visuospatial working memory in preschool children.

Introduction: Hepatic rupture in HELLP syndrome is a deadly complication for the mother-child binomial. Multiple therapeutic options have been described, such as hepatic packing, segmental resections, and even liver transplantation for severe cases. Clinical case: In a 32-year-old female with HELLP syndrome, a cesarean section was performed, hepatic subcapsular hematoma was found in the left lobe, initially liver packing and ligation of the common hepatic artery was done, and left hepatectomy was performed as a defi nitive management, with adequate evolution. Discussion and conclusions: The reported case was successfully treated by various surgical methods. The early recognition of this complication, aggressive surgical management and multidisciplinary support are bases to reduce morbidity and mortality.

Conclusiones: Los factores de riesgo para los desenlaces fueron trasplante de donante fallecido, receptor mayor de 50 años y uso de agentes policlonales. Las infecciones y la edad están relacionadas con la muerte del paciente.