Acute renal failure (ARF) is a clinic syndrome characterized by decline in renal function occurring over a short time period. Is a relatively common complication in hospitalized critically ill patients and is associated with high morbidity and mortality. ARF has often a multi-factorial etiology syndrome usually approached diagnostically as pre-renal, post-renal, or intrinsic ARF. Most intrinsic ARF is caused by ischemia or nephrotoxins and is classically associated with acute tubular necrosis (ATN). High mortality is associated with severity of ARF, age more than 60 years old and presence of pulmonar and cardiovascular complications. Most patients who survive an episode of ARF recover sufficient renal function; however, 50% have subclinical functional defects in renal function or scarring on renal biopsy. ARF is irreversible in approximately 5% of patients, usually as a consequence of complete cortical necrosis.

Experimental studies in animals demonstrate the ability of the bone marrow stem cells to differentiate in cardiomyocytes, vascular endothelium cells and smooth muscle cells. There is evidence that these cells can regenerate infarcted myocardium and induce myogenesis and angiogenesis. Clinical studies in humans suggest the feasibility and safety of the utilization of the stem cells to recovery the ventricular function in patients with acute myocardial infarction. We report the first experience in Colombia using autologous bone marrow cells for cardiomyoplasty in isquemic heart disease. This report shows the two months follow-up of four patients, three with acute myocardial infarction of the anterior myocardial wall and one patient with severe chronic isquemic heart disease. Extensive myocardial damage demonstrated by absence of viability in scintigraphic images and ejection fraction less than 40%. The patients received an optimum postinfarction medical treatment, successful coronary percutaneous intervention (three patients) or direct intramyocardial injection (one patient) to transfer of autologous bone marrow cells mobilised with granulocyte-colony stimulating factor during five days. Demographics and results The exercise capacity improve importantly, evidenced by increase in contractility, the six minutes test, the treadmill exercise time and the functional capacity in METS. There were not changes in the myocardial perfusion at two months follow-up, there were not complications related to the cellular transplant or the utilization of the granulocyte-colony stimulating factor. This is the first experience in Colombia with the bone marrow cells and selective intracoronary transplantation for myocardial regeneration and angiogenesis. We observed functional recovery of the left ventricle, improvement in the exercise capacity without adverse effects or complications related to the therapy. Patient # 1 2 3 4 MI= myocardial infarction, IHD= isquemic heart disease, B/A= before/after 2 months, EF= eyection fraction, ESV=end systolic volume Age/sex 51/M 23/M 59/M 53/M Diagnosis acute MI acute MI acute MI chronic IHD Diagnosis to transplant 3 weeks 2 weeks 4 weeks > 1 year CD34 dose 19.7x10(6) 16.8x10(6) 19.5x10(6) 21.7x10(6) EF% B/A 36/43 26/40 40/41 45/55 ESV (cc) B/A 80/60 116/103 65/70 101/84 METS B/A 4/14 4/17 5/12 5/14 6-min test (mts) B/A 420/540 216/462 260/450 414/727

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