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1.
Int. j. morphol ; 38(3): 585-591, June 2020. graf
Article in English | LILACS (Americas) | ID: biblio-1098291

ABSTRACT

Acetaminophen (also called paracetamol, or APAP) induced nephrotoxicity is reported after accidental or intentional ingestion of an overdose of the drug. Renal tubular ultrastructural alterations induced by APAP overdose associated with the induction of biomarkers of kidney injury have not been investigated before. Also, we investigated whether the combined polyphenolic anti-inflammatory and antioxidants agents, resveratrol (RES) and quercetin (QUR) can protect against APAP-induced acute kidney injury. The model group of rats received a single dose of APAP (2 g/kg), whereas the protective group of rats was pre-treated for 7 days with combined doses of RES (30 mg/kg) and QUR (50 mg/kg) before being given a single dose of APAP. All rats were then sacrificed one day post APAP ingestion. Harvested kidney tissues were prepared for transmission electron microscopy (TEM) staining and blood samples were assayed for urea, creatinine, and biomarkers of inflammation and oxidative stress. TEM images and blood chemistry analysis showed that APAP overdose induced kidney damage as demonstrated by substantial alterations to the proximal convoluted tubule ultrastructure, and a significant (p<0.05) increase in urea, creatinine, tumor necrosis factor-alpha (TNF-a), and malondialdehyde (MDA) blood levels, which were protected by RES+QUR. These findings indicate that APAP induces alterations to the renal tubular ultrastructure, which is inhibited by resveratrol plus quercetin, which also decreases blood levels of kidney injury biomarkers.


El objetivo de este trabajo fue estudiar la nefrotoxicidad inducida por acetaminofeno (también llamado paracetamol o APAP) después de la ingestión accidental o intencional de una sobredosis de la droga. Las alteraciones ultraestructurales tubulares renales inducidas por sobredosis de APAP asociadas con la inducción de biomarcadores de daño renal no se han investigado. Además, estudiamos si los agentes combinados antiinflamatorios y antioxidantes polifenólicos, el resveratrol (RES) y la quercetina (QUR) pueden proteger contra la lesión renal aguda inducida por APAP. El grupo modelo de ratas recibió una dosis única de APAP (2 g / kg), mientras que el grupo protector de ratas se trató previamente durante 7 días con dosis combinadas de RES (30 mg / kg) y QUR (50 mg / kg) antes de recibir una dosis única de APAP. Todas las ratas se sacrificaron un día después de la ingestión de APAP. Los tejidos renales fueron preparados para el análisis a través de la microscopía electrónica de transmisión (MET). En las muestras de sangre se determinaron la urea, creatinina y los biomarcadores de inflamación y estrés oxidativo. Las imágenes MET y el análisis químico de la sangre mostraron que la sobredosis de APAP inducía daño renal, como lo demuestran las alteraciones sustanciales en la ultraestructura del túbulo contorneado proximal, y además, de un aumento significativo (p <0,05) de la urea, creatinina, factor de necrosis tumoral alfa y niveles sanguíneos de malondialdehído, protegidos por RES + QUR. Estos hallazgos indican que APAP induce alteraciones en la ultraestructura tubular renal, inhibida por el resveratrol más quercetina, que también disminuye los niveles sanguíneos de biomarcadores de daño renal.


Subject(s)
Animals , Rats , Quercetin/administration & dosage , Resveratrol/administration & dosage , Kidney Tubules/drug effects , Acetaminophen/toxicity , Quercetin/pharmacology , Urea/blood , Rats, Sprague-Dawley , Creatinine/blood , Microscopy, Electron, Transmission , Disease Models, Animal , Drug Overdose , Resveratrol/pharmacology , Kidney Tubules/pathology , Anti-Inflammatory Agents/administration & dosage , Antioxidants/administration & dosage
2.
J. bras. nefrol ; 41(4): 534-538, Out.-Dec. 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1056606

ABSTRACT

ABSTRACT Introduction: The number of incident and prevalent patients on dialysis has increased, as well as the number of candidates for renal transplantation in Brazil, without a proportional increase in the number of organ donors. The use of expanded kidneys, as to renal function, may be an alternative to increase the supply of organs. Objective: to discuss the feasibility of using expanded kidneys for renal function, which are in severe acute renal injury. Methods: All cases of renal transplantation of deceased donors performed at the Hospital das Clínicas de Botucatu of UNESP, from January 2010 to June 2018, totaling 732 cases were evaluated. Cases with final donor creatinine greater than 6 mg/dL were selected. Results: four patients were selected, of whom all donors were in severe acute kidney injury (AKI). These donors presented rhabdomyolysis as a probable cause of severe AKI, were young, with no comorbidities and had decreased urinary volume in the last 24 hours. The clinical evolution of all the recipients was satisfactory, with a glomerular filtration rate after transplantation ranging from 48 to 98 mL/min/1.73 m2. Conclusion: this series of cases shows the possibility of using renal donors in severe AKI, provided the following are respected: donor age, rhabdomyolysis as the cause of AKI, and implantation-favorable biopsy findings. Additional studies with better designs, larger numbers of patients and longer follow-up times are needed.


RESUMO Introdução: O número de pacientes incidentes e prevalentes em diálise tem aumentado, assim como o número de candidatos ao transplante renal no Brasil, sem um aumento proporcional do número de doadores de órgãos. O uso de rins expandidos, quanto à função renal, pode ser uma alternativa para aumentar a oferta de órgãos. Objetivo: discutir a viabilidade do uso de rins expandidos quanto à função renal, que estejam em lesão renal aguda severa. Métodos: foram avaliados todos os casos de transplante renal de doador falecido realizados no Hospital das Clínicas de Botucatu da UNESP, de janeiro de 2010 a junho de 2018, totalizando 732 casos. Selecionou-se os casos com creatinina final do doador maior do que 6 mg/dL. Resultados: quatro pacientes foram selecionados, dos quais todos os doadores estavam em lesão renal aguda (LRA) severa. Esses doadores apresentavam rabdomiólise como provável causa de LRA severa, eram jovens, sem comorbidades e apresentavam diminuição de volume urinário nas últimas 24 horas. A evolução clínica de todos os receptores foi satisfatória, com taxa de filtração glomerular após o transplante variando entre 48 a 98 mL/min/1,73m2. Conclusão: essa série de casos mostra a possibilidade de utilização de doadores renais em LRA severa, desde que respeitadas as condições seguintes: idade do doador, rabdomiólise como causa de LRA e achados de biópsia favoráveis à implantação. Estudos adicionais com melhores desenhos, maior número de pacientes e maiores tempos de seguimento são necessários.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Rhabdomyolysis/diagnosis , Tissue Donors/statistics & numerical data , Kidney Transplantation/methods , Delayed Graft Function/diagnosis , Acute Kidney Injury/surgery , Research Design , Brazil/epidemiology , Cadaver , Feasibility Studies , Retrospective Studies , Renal Dialysis/statistics & numerical data , Kidney Transplantation/statistics & numerical data , Outcome Assessment, Health Care , Creatinine/blood , Delayed Graft Function/etiology , Acute Kidney Injury/etiology , Glomerular Filtration Rate/physiology , Graft Survival/physiology , Kidney/physiopathology
3.
J. bras. nefrol ; 41(4): 509-517, Out.-Dec. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1056618

ABSTRACT

Abstract Introduction: Although microalbuminuria remains the gold standard for early detection of diabetic nephropathy (DN), it is not a sufficiently accurate predictor of DN risk. Thus, new biomarkers that would help to predict DN risk earlier and possibly prevent the occurrence of end-stage kidney disease are being investigated. Objective: To investigate the role of zinc-alpha-2-glycoprotein (ZAG) as an early marker of DN in type 2 diabetic (T2DM) patients. Methods: 88 persons were included and classified into 4 groups: Control group (group I), composed of normal healthy volunteers, and three patient groups with type 2 diabetes mellitus divided into: normo-albuminuria group (group II), subdivided into normal eGFR subgroup and increased eGFR subgroup > 120 mL/min/1.73m2), microalbuminuria group (group III), and macroalbuminuria group (group IV). All subjects were submitted to urine analysis, blood glucose levels, HbA1c, liver function tests, serum creatinine, uric acid, lipid profile and calculation of eGFR, urinary albumin creatinine ratio (UACR), and measurement of urinary and serum ZAG. Results: The levels of serum and urine ZAG were higher in patients with T2DM compared to control subjects and a statistically significant difference among studied groups regarding serum and urinary ZAG was found. Urine ZAG levels were positively correlated with UACR. Both ZAG levels were negatively correlated with eGFR. Urine ZAG levels in the eGFR ˃ 120 mL/min/1.73m2 subgroup were higher than that in the normal eGFR subgroup. Conclusion: These findings suggest that urine and serum ZAG might be useful as early biomarkers for detection of DN in T2DM patients, detectable earlier than microalbuminuria.


Resumo Introdução: Embora a microalbuminúria continue sendo o padrão ouro para a detecção precoce da nefropatia diabética (ND), ela não é um preditor suficientemente preciso do risco de ND. Assim, novos biomarcadores para prever mais precocemente o risco de ND e possivelmente evitar a ocorrência de doença renal terminal estão sendo investigados. Objetivo: Investigar a zinco-alfa2-glicoproteína (ZAG) como marcador precoce de ND em pacientes com debates mellitus tipo 2 (DM2). Métodos: Os 88 indivíduos incluídos foram divididos em quatro grupos: grupo controle (Grupo I), composto por voluntários saudáveis normais; e três grupos de pacientes com DM2 assim divididos: grupo normoalbuminúria (Grupo II), subdivididos em TFG normal e TFG > 120 mL/min/1,73 m2), grupo microalbuminúria (Grupo III) e grupo macroalbuminúria (Grupo IV). Todos foram submetidos a urinálise e exames para determinar glicemia, HbA1c, função hepática, creatinina sérica, ácido úrico, perfil lipídico, cálculo da TFG, relação albumina/creatinina (RAC) e dosagem urinária e sérica de ZAG. Resultados: Os níveis séricos e urinários de ZAG foram mais elevados nos pacientes com DM2 em comparação aos controles. Foi identificada diferença estatisticamente significativa entre os grupos estudados em relação aos níveis séricos e urinários de ZAG. Os níveis urinários de ZAG foram positivamente correlacionados com a RAC. Ambos os níveis de ZAG foram negativamente correlacionados com TFG. Os níveis urinários de ZAG no subgrupo com TFG ˃ 120 mL/min/1,73m2 foram maiores do que no subgrupo com TFG normal. Conclusão: Constatamos que a ZAG sérica e urinária pode ser um útil biomarcador precoce para detecção de ND em pacientes com DM2, sendo detectável mais precocemente que microalbuminúria.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Biomarkers/analysis , Seminal Plasma Proteins/analysis , Diabetes Mellitus, Type 2/complications , Diabetic Nephropathies/physiopathology , Case-Control Studies , Predictive Value of Tests , Sensitivity and Specificity , Risk Assessment , Creatinine/blood , Early Diagnosis , Diabetes Mellitus, Type 2/urine , Diabetic Nephropathies/urine , Diabetic Nephropathies/blood , Albuminuria/urine , Glomerular Filtration Rate/physiology , Kidney Failure, Chronic/prevention & control
4.
J. bras. nefrol ; 41(3): 315-322, July-Sept. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1040245

ABSTRACT

Abstract Introduction: It is hypothesized that increased macrophage migration inhibitory factor (MIF) expression may contribute to diabetic nephropathy (DN) pathogenesis. The aim of the present study was to investigate the renal effects of MIF inhibition in a diabetic experimental model. Methods: Eighteen male Wistar rats (230 ± 20 g) were divided into three groups: 1) control, 2) diabetic (STZ, 50 mg/kg, dissolved in saline, ip), 3) diabetic + MIF antagonist (p425, 1 mg/kg per day, ip, on the 21th day, for 21 consecutive days). The treatment started since we founwd a significant increase in urine albumin excretion (UAE) rate in the diabetic rats in comparison with the control rats. The rats were kept individually in metabolic cages (8 AM-2 PM) and urine samples were collected in the 21 and 42th day. At the end, blood and tissue samples were collected for biochemical (BS, UPE, urine GAG, BUN, Cr, Na, and K) and histological analyses. Results: The results of this study showed that MIF antagonist (p425) significantly decreased urine protein and GAG excretion, urine protein/creatinine ratio, and serum BUN and Cr in the streptozotocin-induced DN in the rats. Pathological changes were significantly alleviated in the MIF antagonist (p425)-administered DN rats. Conclusion: Collectively, these data suggested that MIF antagonist (p425) was able to protect against functional and histopathological injury in the DN.


Resumo Introdução: Supõe-se que elevações da expressão do fator de inibição da migração de macrófagos (MIF) possam contribuir para a patogênese da nefropatia diabética (ND). O objetivo do presente estudo foi investigar os efeitos renais da inibição do MIF em um modelo experimental diabético. Métodos: Dezoito ratos Wistar machos (230 ± 20g) foram divididos em três grupos: 1) controle, 2) diabético (STZ 50 mg/kg dissolvida em soro fisiológico, IP), 3) diabético + antagonista do MIF (p425 1 mg/kg por dia IP no 21o dia por 21 dias consecutivos). O tratamento começou após a identificação de aumento significativo na albuminúria nos ratos diabéticos em relação aos controles. Os ratos foram mantidos individualmente em gaiolas metabólicas (8h-14h) e amostras de urina foram colhidas no 21o e no 42o dia. Ao final do estudo, amostras de sangue e tecido foram colhidas para análises bioquímicas (BS, excreção urinária de proteína, excreção urinária de GAGs, BUN, Cr, Na e K) e histológicas. Resultados: O presente estudo demonstrou que o antagonista do MIF (p425) diminuiu significativamente proteinúria, excreção urinária de GAGs , relação proteína/creatinina na urina, BUN e Cr no grupo com ND induzida por estreptozotocina. As alterações patológicas foram significativamente abrandadas nos ratos com ND que receberam antagonista do MIF (p425). Conclusão: Coletivamente, os dados sugerem que o antagonista do MIF (p425) teve efeito protetor contra lesões funcionais e histopatológicas da ND.


Subject(s)
Animals , Male , Rats , Macrophage Migration-Inhibitory Factors/antagonists & inhibitors , Intramolecular Oxidoreductases/antagonists & inhibitors , Protective Agents/therapeutic use , Protective Agents/pharmacology , Diabetes Mellitus, Experimental/pathology , Diabetic Nephropathies/therapy , Blood Glucose , Rats, Wistar , Streptozocin/pharmacology , Creatinine/urine , Creatinine/blood , Diabetes Mellitus, Experimental/chemically induced , Diabetes Mellitus, Experimental/urine , Diabetes Mellitus, Experimental/blood , Diabetic Nephropathies/urine , Diabetic Nephropathies/pathology , Diabetic Nephropathies/blood , Albuminuria/drug therapy , Disease Models, Animal , Glycosaminoglycans/urine , Kidney/pathology , Macrophage Activation
5.
J. bras. nefrol ; 41(3): 323-329, July-Sept. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1040257

ABSTRACT

Abstract Introduction: The occurrence of acute kidney injury (AKI) after ischemic stroke has been associated to a worse prognosis. There is a lack of Brazilian studies evaluating this issue. This study aimed to describe the impact of AKI after a first-ever ischemic stroke in relation to fatality rate in 30 days. Methods: This was a retrospective hospital-based cohort. We included patients who had their first ischemic stroke between January to December 2015. AKI was defined by an increase of serum creatinine in relation to baseline value at admission ≥ 0.3 mg/dL or a rise in serum creatinine level by 1.5 times the baseline value at any point in the first week after admission. We performed a univariate and multivariate analysis to evaluate the presence of AKI with fatality in 30 days. Results: The final study population (n=214) had mean age of 66.46 ± 13.73 years, 48.1% were men, the mean NIHSS was 6.33 ± 6.27 and 20 (9.3%) presented AKI. Patients with AKI were older, had a higher score on the NIHSS, and had higher creatinine values on hospital discharge. The 30-day mortality was higher in the AKI subgroup compared to non-AKI (35% vs. 6.2%, p < 0.001). AKI was an independent predictor of fatality after an ischemic stroke but limited by severity of stroke (NIHSS). Conclusion: The presence of AKI is an important complication after ischemic stroke. Despite its impact on 30-day fatality, the predictive strength of AKI was limited by the severity of stroke.


Resumo Introdução: A ocorrência de insuficiência renal aguda (IRA) após acidente vascular cerebral isquêmico (AVCI) está associada a pior prognóstico. Há uma deficiência de estudos brasileiros a respeito dessa questão. O presente estudo teve como objetivo descrever o impacto da IRA após o primeiro episódio de AVCI em relação à taxa de letalidade em 30 dias. Métodos: A presente coorte retrospectiva de base hospitalar incluiu pacientes que sofreram seu primeiro AVCI entre janeiro e dezembro de 2015. IRA foi definida por elevações da creatinina sérica em relação ao valor basal na internação ≥ 0.3 mg/dL ou aumento da creatinina sérica equivalente a 1,5 vez o valor basal em qualquer instante durante a primeira semana após a internação. Foi realizada análise univariada e multivariada para avaliar a presença de IRA com letalidade em 30 dias. Resultados: A população final do estudo (n = 214) apresentou média de idade de 66,46 ± 13,73 anos; 48,1% eram homens; a média de pontuação no NIHSS foi 6,33 ± 6,27; e 20 (9,3%) apresentaram IRA. Pacientes com IRA tinham idade mais avançada, pontuação maior na NIHSS e valores mais elevados de creatinina no momento da alta hospitalar. A mortalidade em 30 dias foi maior no subgrupo com IRA em comparação ao grupo sem IRA (35% vs. 6,2%, p < 0,001). IRA foi preditor independente de mortalidade após AVCI, porém limitado pela gravidade do acidente vascular cerebral (NIHSS). Conclusão: A presença de IRA é uma complicação importante após AVCI. Apesar de seu impacto na letalidade de 30 dias, a força preditiva da IRA foi limitada pela gravidade do AVC.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Brain Ischemia/complications , Brain Ischemia/mortality , Hospital Mortality , Stroke/complications , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Prognosis , Severity of Illness Index , Brazil/epidemiology , Prevalence , Retrospective Studies , Risk Factors , Creatinine/blood , Stroke/mortality , Kaplan-Meier Estimate , Hospitalization
6.
J. bras. nefrol ; 41(2): 200-207, Apr.-June 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1012544

ABSTRACT

ABSTRACT Introduction: The prevalence of chronic kidney disease (CKD) is increasing, with a potential impact in the risk of acceleration of dementia. The potential association between glomerular filtration rate (eGFR) and cognitive performance was scarcely studied. The aim of this study was to evaluate cognitive performance levels across different degrees of kidney function. Methods: We analyzed 240 outpatients in a nephrology service, classified according to eGFR: Advanced (≤ 30ml/min/1.73m2), Moderate (30,1ml/min/1.73m2 to ≤ 60ml/min/1.73m2), and Mild CKD (> 60ml/min/1.73m2). Word list memory, Semantic fluency, Mental State Mini Exam and Trail Making Test (TMT) were applied to evaluate cognitive performance. In the TMT, lower scores are associated with better cognition. In linear regression, cognitive function was considered as dependent variables while groups based on eGFR were considered explanatory variables. The group with eGFR > 60ml/min was the reference and models were adjusted for confounding factors. Results: In our population (n = 240) 64 patients (26.7%) were classified as having advanced, 98(40,8%) moderate, and 78(32,5%) mild. There was no statistical difference among them in MMSE or in the verbal fluency test. However, comparing to mild, patients with advanced CKD presented significantly worse cognitive performance measured by TMTA [50,8s ± 31.1s versus 66,6s ± 35,7s (p = 0.016)] and TMTB [92,7s ± 46,2s versus 162,4s ± 35,7s (p < 0.001)]. Significantly lower TMTB scores (CI95%) 33,0s (4,5-61,6s) were observed in patients with mild compared to advanced CKD in the multivariate analysis adjusting for age, education, sex, diabetes, and alcohol use. Conclusion: Advanced CKD is independently associated with poorer cognitive performance measured by an executive performance test compared to mild CKD.


RESUMO Introdução: A elevação da prevalência de doença renal crônica (DRC) traz consigo um impacto potencial sobre o risco de aceleração da demência. A possível associação entre taxa de filtração glomerular (TFGe) e desempenho cognitivo foi pouco estudada. O objetivo do presente estudo foi avaliar os níveis de desempenho cognitivo em indivíduos com diferentes graus de função renal. Métodos: Foram analisados 240 pacientes ambulatoriais atendidos em um serviço de nefrologia classificados segundo a TFGe em grupos com DRC avançada (≤ 30ml/min/1,73m2), moderada (30,1ml/min/1,73m2 a ≤ 60ml/min/1,73m2) ou leve (> 60ml/min/1,73m2). Testes de memória por listas de palavras, fluência semântica, o mini exame do estado mental e o teste das trilhas (TT) foram aplicados para avaliar o desempenho cognitivo. No TT, escores mais baixos representam melhor cognição. Na regressão linear, função cognitiva foi considerada como variável dependente, enquanto os grupos baseados na TFGe foram considerados como variáveis explicativas. O grupo com TFGe > 60ml/min foi utilizado como referência e os modelos foram ajustados para fatores de confusão. Resultados: Em nossa população (n = 240), 64 pacientes (26,7%) foram diagnosticados com DRC avançada, 98 (40,8%) com DRC moderada e 78 (32,5%) com DRC leve. Não houve diferença estatística entre eles no MEEM ou no teste de fluência verbal. Contudo, em relação aos indivíduos com DRC leve, os pacientes com DRC avançada apresentaram desempenho cognitivo significativamente pior medido pelo TT A [50,8s ± 31,1s x 66,6s ± 35,7s (p = 0,016)] e TT B [92,7s ± 46,2s x 162,4s ± 35,7s (p < 0,001)]. Escores significativamente mais baixos no TT B (IC95%) 33,0s (4,5-61,6s) foram observados nos pacientes com DRC leve em comparação com o grupo com DRC avançada na análise multivariada ajustada para idade, escolaridade, sexo, diabetes e uso de álcool. Conclusão: DRC avançada esteve independentemente associada a pior desempenho cognitivo medido por um teste de desempenho executivo em comparação à DRC leve.


Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/epidemiology , Cognitive Dysfunction/etiology , Severity of Illness Index , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Risk Factors , Creatinine/blood , Executive Function , Mental Status and Dementia Tests , Glomerular Filtration Rate
7.
J. bras. nefrol ; 41(2): 293-295, Apr.-June 2019. graf
Article in English | LILACS (Americas) | ID: biblio-1012528

ABSTRACT

ABSTRACT Pauci-immune glomerulonephritis (GN) is more common in elderly people compared to children and the etiology is not completely understood yet. Antineutrophil cytoplasmic antibody (ANCA) positivity occurs in 80% of the patients. We report a case of a 7-year-old girl who presented with malaise and mildly elevated creatinine diagnosed as ANCA-associated pauci-immune crescentic glomerulonephritis with crescents in 20 of 25 glomeruli (80%). Of these 20 crescents, 12 were cellular, 4 fibrocellular, and 4 globally sclerotic. She did not have purpura, arthritis, or systemic symptoms and she responded well to initial immunosuppressive treatment despite relatively severe histopathology. The patient was given three pulses of intravenous methylprednisolone (30 mg/kg on alternate days) initially and continued with cyclophosphamide (CYC; 2 mg/kg per day) orally for 3 months with prednisone (1 mg/kg per day). In one month, remission was achieved with normal serum creatinine and prednisone was gradually tapered. The case of this child with a relatively rare pediatric disease emphasizes the importance of early and aggressive immunosuppressive treatment in patients with renal-limited ANCA-associated pauci-immune crescentic GN even if with a mild clinical presentation. As in our patient, clinical and laboratory findings might not always exactly reflect the severity of renal histopathology and thus kidney biopsy is mandatory in such children to guide the clinical management and predict prognosis.


RESUMO A glomerulonefrite (GN) pauci-imune é mais comum em idosos em comparação com crianças, e a etiologia ainda não é completamente compreendida. A positividade do anticorpo citoplasmático antineutrófilo (ANCA) ocorre em 80% dos pacientes. Relatamos o caso de uma menina de 7 anos de idade que apresentou mal-estar e creatinina discretamente elevada, diagnosticada como glomerulonefrite rapidamente progressiva pauci-imune associada a ANCA com crescentes em 20 dos 25 glomérulos (80%). Destes 20 crescentes, 12 eram celulares, 4 fibrocelulares e 4 globalmente escleróticos. Ela não apresentava púrpura, artrite ou sintomas sistêmicos e respondeu bem ao tratamento imunossupressor inicial, apesar da histopatologia relativamente grave. A paciente recebeu três pulsos de metilprednisolona intravenosa (30 mg/kg em dias alternados) inicialmente e continuou com ciclofosfamida (2 mg/kg por dia) por via oral durante 3 meses com prednisona (1 mg/kg por dia). Em um mês, a remissão foi alcançada com creatinina sérica normal e a prednisona foi gradualmente reduzida. O caso desta criança com uma doença pediátrica relativamente rara enfatiza a importância do tratamento imunossupressor precoce e agressivo em pacientes com GN rapidamente progressiva renal associada à ANCA, mesmo com uma apresentação clínica leve. Como em nossa paciente, os achados clínicos e laboratoriais podem nem sempre refletir exatamente a gravidade da histopatologia renal e, assim, a biópsia renal é obrigatória nessas crianças para orientar a conduta clínica e auxiliar no prognóstico.


Subject(s)
Humans , Child , Antibodies, Antineutrophil Cytoplasmic/blood , Glomerulonephritis/diagnosis , Glomerulonephritis/blood , Kidney/pathology , Biopsy , Methylprednisolone/administration & dosage , Methylprednisolone/therapeutic use , Prednisone/administration & dosage , Prednisone/therapeutic use , Follow-Up Studies , Treatment Outcome , Creatinine/blood , Cyclophosphamide/administration & dosage , Cyclophosphamide/therapeutic use , Glomerulonephritis/drug therapy , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/therapeutic use , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use
8.
J. bras. nefrol ; 41(2): 231-241, Apr.-June 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1012530

ABSTRACT

Abstract Introduction: Delayed graft function (DGF) is a frequent complication after deceased donor kidney transplantation with an impact on the prognosis of the transplant. Despite this, long-term impact of DGF on graft function after deceased donor kidney transplantation has not been properly evaluated. Objective: The main objective of this study was to evaluate risk factors for DGF and the impact of its occurrence and length on graft survival and function. Methods: A retrospective cohort study was performed in 517 kidney transplant recipients who received a deceased donor organ between January 2008 and December 2013. Results: The incidence of DGF was 69.3% and it was independently associated with donor's final serum creatinine and age, cold ischemia time, use of antibody induction therapy and recipient's diabetes mellitus. The occurrence of DGF was also associated with a higher incidence of Banff ≥ 1A grade acute rejection (P = 0.017), lower graft function up to six years after transplantation and lower death-censored graft survival at 1 and 5 years (P < 0.05). DGF period longer than 14 days was associated with higher incidence of death-censored graft loss (P = 0.038) and poorer graft function (P < 0.001). No differences were found in patient survival. Conclusions: The occurrence of DGF has a long-lasting detrimental impact on graft function and survival and this impact is even more pronounced when DGF lasts longer than two weeks.


Resumo Introdução: A função tardia do enxerto (FTE) é uma complicação frequente após transplantes renais com doadores falecidos com repercussões sobre o prognóstico do transplante. Contudo, o impacto a longo prazo da FTE sobre a função do enxerto após transplante renal com doador falecido não foi avaliado adequadamente. Objetivo: O principal objetivo do presente estudo foi avaliar os fatores de risco para FTE e o impacto de sua ocorrência e duração na sobrevida e função do enxerto. Métodos: O presente estudo observacional retrospectivo incluiu 517 receptores de transplante renal que receberam órgãos de doadores falecidos entre janeiro de 2008 e dezembro de 2013. Resultados: A incidência de FTE foi de 69,3%. Foi identificada associação independente entre FTE e creatinina sérica final e idade do doador, tempo de isquemia fria, uso de terapia de indução com anticorpos e diabetes mellitus do receptor. A ocorrência de FTE também foi associada a incidência mais elevada de rejeição aguda com classificação de Banff ≥ 1 A (P = 0,017), função reduzida do enxerto até seis anos após o transplante e menor sobrevida do enxerto censurada para óbito em 1 e 5 anos (P <0,05). Períodos de FTE superiores a 14 dias foram associados a maior incidência de perda do enxerto censurada para óbito (P = 0,038) e pior função do enxerto (P <0,001). Não foram identificadas diferenças de sobrevida nos pacientes. Conclusões: A ocorrência de FTE traz prejuízos de longa duração à função e sobrevida do enxerto. Tal impacto é ainda mais pronunciado quando a FTE persiste por mais de duas semanas.


Subject(s)
Humans , Male , Female , Middle Aged , Tissue Donors , Cadaver , Kidney Transplantation/adverse effects , Delayed Graft Function/epidemiology , Graft Survival , Incidence , Retrospective Studies , Risk Factors , Age Factors , Creatinine/blood , Delayed Graft Function/economics , Cold Ischemia/adverse effects , Glomerular Filtration Rate , Graft Rejection/epidemiology , Hypertension/complications
9.
J. bras. nefrol ; 41(2): 176-184, Apr.-June 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1012539

ABSTRACT

Abstract Introduction: The aim of the study was to report the implementation of a functional network for the early diagnosis of chronic kidney disease (CKD) in patients with risk factors and the coordinated work between primary and specialized care in social security in Perú. Material and methods: A cross-sectional analysis of the data of patients evaluated in a health network in the city of Lima (2013 to 2016), older than 18 years, with risk factors for CKD, evaluated with serum creatinine and creatine albumin ratio in random urine (ACR). A multivariate logistic regression analysis was performed to evaluate the factors associated with the finding of CKD. Results: The implementation included training in renal health, installation of a digital database, organization of laboratories, and empowerment of primary care. We evaluated 42,746 patients of which 41.8% were men, with median age 69.2 years. The most frequent cause of detection was hypertension (HBP): 23,921 (55.9%). The prevalence of CKD was 12,132 (28.4%), the most frequent stage of CKD was 3a: 4735 (39.0%). Of the total, 6214 (14.5%) patients had microalbuminuria and 1335 (3.1%), macroalbuminuria. The risk of CKD increased 2.5 times (95% CI: 2.3-2.7) in patients with diabetes (DM) and HBP, in men (OR 1.2, 95% CI: 1.2-1.3) and as age increased (> 77 years: OR 2.7, 95% CI: 2.5-2.8). The identification of the disease in the primary care setting is 60% less likely than in specialized care. Conclusions: One of every four patients are diagnosed with CKD, and the simultaneous diagnosis of DM and HBP and old age are the most important factors.


Resumo Introdução: O objetivo do presente estudo foi descrever a implementação de uma rede funcional para o diagnóstico precoce de doença renal crônica (DRC) em pacientes com fatores de risco e o coordenar os trabalhos entre atenção primária e especializada no sistema de seguridade social peruano. Material e métodos: Análise transversal dos dados de pacientes maiores de 18 anos com fatores de risco para DRC avaliados em uma rede de saúde na cidade de Lima (2013 a 2016) por meio de creatinina sérica e relação albumina/creatinina (RAC) em amostra aleatória de urina. Análise de regressão logística multivariada foi executada para avaliar os fatores associados à presença de DRC. Resultados: A implementação incluiu treinamento em saúde renal, instalação de um banco de dados digital, organização de laboratórios e empoderamento da atenção primária. Foram avaliados 42.746 pacientes, dos quais 41,8% eram homens, com idade mediana de 69,2 anos. A causa mais comum de detecção foi hipertensão, observada em 23.921 indivíduos (55,9%). A prevalência de DRC foi de 12.132 (28,4%), com estágio 3A sendo o mais frequente com 4735 casos (39,0%). Do total, 6214 (14,5%) pacientes apresentavam microalbuminúria e 1335 (3,1%) macroalbuminúria. O risco de DRC foi 2,5 vezes maior (IC 95%: 2,3-2,7) nos pacientes com diabetes e hipertensão, em homens (OR 1,2, IC 95%: 1,2-1,3) e idosos (> 77 anos: OR 2,7, IC 95%: 2,5-2,8). A identificação da doença no cenário da atenção primária é 60% menos provável do que na atenção especializada. Conclusões: Um em cada quatro pacientes é diagnosticado com DRC. Idade avançada e diagnóstico simultâneo de DM e hipertensão são os fatores mais relevantes.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Primary Health Care , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/epidemiology , Ambulatory Care Facilities , Peru/epidemiology , Prevalence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Creatinine/blood , Early Diagnosis , Diabetes Complications , Albuminuria , Renal Insufficiency, Chronic/etiology , Hypertension/complications
10.
J. bras. nefrol ; 41(2): 193-199, Apr.-June 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1012542

ABSTRACT

Abstract Objective: To describe the frequency of albuminuria in overweight and obese children and adolescents and to relate it to the severity of obesity, pubertal staging, associated morbidities and the glomerular filtration rate. Method: Cross-sectional study including 64 overweight and obese children and adolescents between 5 and 19 years of age. Data collected: weight, height, waist circumference and systemic arterial pressure. Laboratory tests: lipid profile; glycemia and insulin, used to calculate the Homeostasis Model Assessment (HOMA-IR); C-reactive protein; glutamic-pyruvic transaminase and albuminuria in an isolated urine sample (cutoff <30 mg/g). Creatinine was used to calculate the estimated glomerular filtration rate (eGFR, mL/min/1.73 m2). Results: The mean age was 11.6 ± 3.4 years, 32 (50%) and 29 (45.3%) were male and prepubertal. Forty-six (71.9%) had severe obesity. The frequency and median (min/max) of the observed values for albuminuria (> 30 mg/g) were 14 (21.9%) and 9.4 mg/g (0.70, -300.7 mg/g). The mean eGFR was 122.9 ± 24.7 mL/min/1.73 m2. There was no significant correlation between body mass index, pubertal staging, insulin and HOMA-IR with albuminuria values and neither with eGFR. Children with albuminuria tended to have higher values of diastolic blood pressure (75.0 ± 12.2 vs. 68.1 ± 12.4, p = 0.071). Conclusion: Albuminuria, although frequent in children and adolescents with obesity, was not associated with other morbidities and the glomerular filtration rate in these patients.


Resumo Objetivo: Descrever a frequência de albuminúria em crianças e adolescentes com sobrepeso e obesidade e relacioná-la com a gravidade da obesidade, estadiamento puberal, morbidades associadas e com a taxa de filtração glomerular. Método: Estudo transversal incluindo 64 crianças e adolescentes com sobrepeso e obesidade entre 5 e 19 anos de idade. Dados coletados: peso, estatura, circunferência abdominal e pressão arterial sistêmica. Exames laboratoriais: perfil lipídico; glicemia e insulina, utilizados para cálculo do Homeostasis Model Assessment (HOMA-IR); proteína C reativa; transaminase glutâmico-pirúvica e albuminúria em amostra isolada de urina (ponto de corte < 30 mg/g). A creatinina foi utilizada para o cálculo da taxa de filtração glomerular estimada (eTFG, mL/min/1,73m2). Resultados: A média de idade foi 11,6±3,4 anos, 32 (50%) e 29 (45,3%) eram do gênero masculino e pré-púberes. Quarenta e seis (71,9%) apresentavam obesidade grave. A frequência e a mediana (min/max) dos valores observados para albuminúria (> 30 mg/g) foram 14 (21,9%) e 9,4 mg/g (0,70; -300,7 mg/g). A média da eTFG foi 122,9±24,7 mL/min/1,73 m2. Não houve correlação significante entre o índice de massa corporal, estadiamento puberal, insulina e HOMA-IR com os valores de albuminúria e nem com a eTFG. Crianças com albuminúria tiveram tendência a valores mais elevados de pressão arterial diastólica (75,0±12,2 vs 68,1±12,4, p = 0,071). Conclusão: A albuminúria, apesar de frequente em crianças e adolescentes com obesidade, não se associou com outras morbidades e nem com a taxa de filtração glomerular nesses pacientes.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Young Adult , Albuminuria/epidemiology , Pediatric Obesity/epidemiology , Glomerular Filtration Rate , Severity of Illness Index , Blood Pressure , Body Mass Index , Prevalence , Cross-Sectional Studies , Morbidity , Puberty , Creatinine/blood , Insulin/blood
11.
An. bras. dermatol ; 94(2): 164-171, Mar.-Apr. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1001151

ABSTRACT

Abstract BACKGROUND: Tacrolimus, for its activity on modulation of collagen production and fibroblast activity, may have a role in the prevention of hypertrophic scars. OBJECTIVES: Evaluate macroscopic, microscopic, metabolic, laboratory effects and side effects of the use of topical tacrolimus ointment, in different concentrations, in the prevention of hypertrophic scars. METHODS: Twenty-two rabbits were submitted to the excision of 2 fragments of 1 cm of each ear, 4 cm apart, down to cartilage. The left ear of the animals was standardized as control and Vaseline applied twice a day. The right ear received tacrolimus ointment, at concentrations of 0.1% on the upper wound and 0.03% on the lower wound, also applied twice a day. Macroscopic, microscopic, laboratory criteria and the animals' weight were evaluated after 30 days of the experiment. RESULTS: Wounds treated with tacrolimus, at concentrations of 0.1% and 0.03%, when compared to control, showed a lower average degree of thickening (p = 0.048 and p <0.001, respectively). The average of scar thickness and lymphocyte, neutrophil and eosinophil concentrations are lower in the treated wounds compared to the control (p <0.001, p=0.022, p=0.007, p=0.044, respectively). The mean concentration of lymphocytes is lower in wounds treated with a higher concentration of the drug (p=0.01). STUDY LIMITATIONS: experiment lasted only 30 days. CONCLUSIONS: Tacrolimus at the 2 concentrations evaluated reduced the severity of inflammatory changes and positively altered the macroscopic aspect of the scar in the short term. Its use was shown to be safe, with no evidence of systemic or local adverse effects.


Subject(s)
Animals , Male , Rabbits , Tacrolimus/therapeutic use , Calcineurin Inhibitors/therapeutic use , Ointments , Urea/blood , Serum Albumin/analysis , Serum Albumin/drug effects , Administration, Topical , Tacrolimus/administration & dosage , Tacrolimus/pharmacology , Cicatrix, Hypertrophic/pathology , Cicatrix, Hypertrophic/prevention & control , Lymphocyte Count , Creatinine/blood , Alanine Transaminase/drug effects , Alanine Transaminase/blood , Disease Models, Animal , Ear, External/pathology , Erythema/pathology , Calcineurin Inhibitors/administration & dosage , Calcineurin Inhibitors/pharmacology , Inflammation/pathology , Inflammation/prevention & control
12.
J. bras. nefrol ; 41(1): 142-144, Jan.-Mar. 2019. graf
Article in English | LILACS (Americas) | ID: biblio-1002417

ABSTRACT

ABSTRACT Atheroembolic renal disease (AERD) is a kidney manifestation of atherosclerosis as a systemic disease. AERD is defined as a renal impairment secondary to embolization of cholesterol crystals with consequent occlusion of renal vascularization. The current case report describes one patient with multiple risk factors but without any inciting event history who presents a very atypical clinical course of a severe and massive atheroembolic disease that developed spontaneously and silently.


RESUMO A doença renal ateroembólica (DRAE) é uma manifestação renal da aterosclerose enquanto patologia sistêmica. A DRAE é definida como uma disfunção renal secundária à embolização de cristais de colesterol seguida da oclusão da vascularização renal. O presente relato descreve o caso de um paciente com vários fatores de risco, porém sem um evento precipitante, que se apresentou com um curso clínico bastante atípico de doença ateroembólica grave de evolução espontânea e silenciosa.


Subject(s)
Humans , Male , Aged , Renal Insufficiency/diagnostic imaging , Atherosclerosis/complications , Dyslipidemias/complications , Hypertension/complications , Biopsy , Platelet Aggregation Inhibitors/therapeutic use , Hypertriglyceridemia , Aspirin/therapeutic use , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Creatinine/blood , Diabetes Mellitus, Type 2/complications , Diabetic Nephropathies/etiology , Renal Insufficiency/etiology , /therapeutic use , Hypercholesterolemia , Kidney/pathology , Microscopy , Anti-Inflammatory Agents/therapeutic use
13.
J. bras. nefrol ; 41(1): 55-64, Jan.-Mar. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1002418

ABSTRACT

ABSTRACT Background and objectives: Anti-neutrophil cytoplasmic autoantibodies (ANCA) associated vasculitis is a small vessel vasculitis with insufficient epidemiologic estimates in the United States. We aimed to determine demographic and clinical features of ANCA associated vasculitis patients presenting to a large tertiary care referral center in Upstate New York. Design, setting, participants, and measurements: A retrospective analysis of cases with pauci-immune GN on renal biopsy and clinical diagnosis of ANCA vasculitis presenting over 11 years was conducted. Outcomes of interest were: demographics, ANCA antibody positivity, patient and renal survival, and regional trends. Results: 986 biopsies were reviewed, 41 cases met the criteria for inclusion: 18 GPA, 19 MPA, and 4 double positive (anti-GBM disease plus ANCA vasculitis). Mean age at presentation was 52.4 years (SD 23.7), 23 (56%) were male and median creatinine was 2.6 mg/dL. The median patient follow up was 77 weeks (IQR 10 - 263 weeks), with a 3-month mortality rate of 5.7% and a 1-year estimated mortality rate of 12%. Thirteen patients required hemodialysis at the time of diagnosis; 7 patients came off dialysis, with median time to renal recovery of 4.86 weeks (IQR 1.57 - 23.85 weeks). C-ANCA positivity (p < 0.001) and C-ANCA plus PR3 antibody pairing (p = 0.005) was statistically significant in GPA versus MPA. P-ANCA positivity was observed in MPA versus GPA (p = 0.02) and double positive versus GPA (p = 0.002), with P-ANCA and MPO antibody pairing in MPA versus GPA (p = 0.044). Thirty-seven of the 41 cases were referred locally, 16 cases were from within a 15-mile radius of Albany, Schenectady, and Saratoga counties. Conclusions: ANCA vasculitis is associated with end stage renal disease and increased mortality. Our study suggests the possibility of higher regional incidence of pauci-immune GN in Upstate New York. Further studies should investigate the causes of clustering of cases to specific regions.


RESUMO Introdução e objetivos: A vasculite associada a anticorpos anticitoplasma de neutrófilo (ANCA) é uma vasculite de pequenos vasos com estimativas epidemiológicas insuficientes nos Estados Unidos. Nosso objetivo foi determinar características demográficas e clínicas de pacientes com vasculite associada à ANCA, apresentando-se a um grande centro de referência de atendimento terciário em Upstate New York. Formato, cenário, participantes e medidas: Foi realizada uma análise retrospectiva dos casos de GN pauci-imune em biópsias renais e diagnóstico clínico de vasculite ANCA por mais de 11 anos. Os resultados de interesse foram: dados demográficos, positividade de anticorpos ANCA, sobrevidas renal e de pacientes e tendências regionais. Resultados: 986 biópsias foram revisadas, 41 casos preencheram os critérios de inclusão: 18 GPA, 19 PAM, e 4 duplo-positivos (doença anti-MBG com vasculite ANCA). A média de idade na apresentação foi de 52,4 anos (DP 23,7), 23 (56%) eram do sexo masculino e mediana de creatinina de 2,6 mg/dL. O acompanhamento mediano dos pacientes foi de 77 semanas (IQR 10 - 263 semanas), com uma taxa de mortalidade de 3 meses de 5,7% e uma taxa de mortalidade estimada em 1 ano de 12%. Treze pacientes necessitaram de hemodiálise no momento do diagnóstico; 7 pacientes saíram da diálise, com tempo médio para recuperação renal de 4,86 semanas (IQR 1,57 - 23,85 semanas). A positividade para C-ANCA (p < 0,001) e o pareamento de anticorpos C-ANCA mais PR3 (p = 0,005) foram estatisticamente significantes em GPA versus PAM. A positividade de P-ANCA foi observada em PAM versus GPA (p = 0,02) e duplo positivo versus GPA (p = 0,002), com pareamento de anticorpos P-ANCA e MPO em PAM versus GPA (p = 0,044). Trinta e sete dos 41 casos foram encaminhados localmente, 16 casos foram de dentro de um raio de 15 milhas dos condados de Albany, Schenectady e Saratoga. Conclusões: A vasculite por ANCA está associada à doença renal terminal e aumento da mortalidade. Nosso estudo sugere a possibilidade de maior incidência regional de GN pauci-imune no norte do estado de Nova York. Novos estudos devem investigar as causas do acúmulo de casos em regiões específicas.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Tertiary Healthcare , Anti-Glomerular Basement Membrane Disease/epidemiology , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/mortality , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/epidemiology , Kidney Failure, Chronic/epidemiology , Biopsy , Comorbidity , New York/epidemiology , Incidence , Retrospective Studies , Follow-Up Studies , Mortality/trends , Renal Dialysis , Antibodies, Antineutrophil Cytoplasmic/blood , Anti-Glomerular Basement Membrane Disease/blood , Creatinine/blood , Kaplan-Meier Estimate , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/blood , Kidney/pathology , Kidney Failure, Chronic/blood
14.
J. bras. nefrol ; 41(1): 29-37, Jan.-Mar. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1002428

ABSTRACT

ABSTRACT Introduction: Chronic kidney disease (CKD) is an independent risk factor for several unfavorable outcomes including cardiovascular disease (CVD), particularly in the elderly, who represent the most rapidly growing segment of the end-stage kidney disease (ESKD) population. Portugal has the highest European unadjusted incidence and prevalence rates of ESKD. In 2012, we started to follow a cohort of elderly CKD patients, we describe their baseline characteristics, risk profile, and cardiovascular disease burden. Methods: All CKD patients aged 65 years and older referred to our department during 2012 were enrolled. Baseline data included: demographic, CKD stage, medication, comorbid conditions. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-EPI formula. Results: A total of 416 patients, 50% referred by primary care physicians, aged 77 ± 7 years, 52% male, with a median eGFR of 32 mL/min/1.73m2 participated in the study. Fifty percent had diabetes (DM), 85% dyslipidemia, 96% hypertension; 26% were current/former smokers, and 24% had a body mass index > 30 kg/m2. The prevalence of CVD was 62% and higher in stage 4-5 patients; in diabetics, it gradually increased with CKD progression (stage 3a < stage 3b < stage 4-5) (39, 58, 82%; p < 0.001). Conclusions: At baseline, our CKD elderly cohort had a higher burden of CVD. The prevalence of CVD was greater than in other European CKD cohorts. Lower level of eGFR was associated with a greater burden of CVD and was more pronounced in diabetics, highlighting the importance of strategically targeting cardiovascular risk reduction in these patients.


RESUMO Introdução: Doença renal crônica (DRC) é fator de risco independente para vários desfechos desfavoráveis, incluindo doença cardiovascular (DCV), particularmente em idosos, o segmento de crescimento mais rápido da população com doença renal terminal (DRT). Portugal tem a maior incidência europeia não-ajustada e a maior prevalência de DRT. Neste artigo caracterizamos uma coorte de idosos com DRC, referenciados para a nefrologia, com particular ênfase para o risco e carga de doença cardiovascular. Métodos: Foram incluídos todos os pacientes com DRC com 65 anos ou mais encaminhados ao nosso departamento em 2012. Os dados basais incluíram: demografia, estágio da DRC, medicação e comorbidades. A taxa de filtração glomerular (TFGe) foi calculada pela fórmula CKD-EPI. Resultados: Metade dos 416 pacientes incluídos foram encaminhados por médicos da atenção primária; sua idade era 77 ± 7 anos; 52% eram homens; a TFGe mediana era de 32 mL /min/1,73 m2. Metade tinha diabetes (DM), 85% dislipidemia, 96% hipertensão; 26% eram fumantes atuais/ antigos; 24% tinham índice de massa corporal > 30 kg/m2. A prevalência de DCV foi de 62%, sendo maior entre pacientes nos estágios 4-5; em diabéticos, aumentou gradualmente com a progressão da DRC (estágio 3a < estágio 3b < estágio 4-5) (39%, 58%, 82%; p < 0,001). Conclusões: A coorte de idosos com DRC apresentava inicialmente maior carga de DCV. A prevalência de DCV foi maior que em outras coortes europeias com DRC. Níveis menores de TFGe foram associados a carga maior de DCV e foram mais pronunciados entre diabéticos, destacando a importância de objetivar estrategicamente a redução do risco cardiovascular nesses pacientes.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Aging/physiology , Cardiovascular Diseases/epidemiology , Renal Insufficiency, Chronic/epidemiology , Kidney Failure, Chronic/epidemiology , Portugal/epidemiology , Cardiovascular Diseases/etiology , Body Mass Index , Comorbidity , Incidence , Prevalence , Risk Factors , Follow-Up Studies , Longitudinal Studies , Creatinine/blood , Diabetes Mellitus/epidemiology , Renal Insufficiency, Chronic/complications , Dyslipidemias/epidemiology , Cognitive Dysfunction/epidemiology , Glomerular Filtration Rate , Hypertension/epidemiology , Kidney Failure, Chronic/etiology
15.
J. bras. nefrol ; 41(1): 152-156, Jan.-Mar. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1002430

ABSTRACT

ABSTRACT Rapidly progressive glomerulonephritis (RPGN) is a renal disease with an extensive differential diagnosis. This paper reports the case of a 55-year-old female patient diagnosed with Hansen's disease with acute progressive renal impairment after developing lower limb pyoderma. The association between Hansen's and kidney disease has been well documented, with glomerulonephritis (GN) ranked as the most common form of renal involvement. Post-infectious glomerulonephritis (PIGN) in adults has been associated with a number of pathogens occurring in diverse sites. The patient described in this case report had RPGN and biopsy findings suggestive of PIGN with C3 and IgA detected on immunofluorescence and kidney injury secondary to recent infection by Staphylococcus, a well-documented manifestation of renal impairment in patients with Hansen's disease.


RESUMO A Glomerulonefrite Rapidamente Progressiva (GNRP) é um padrão de doença renal com amplo diagnóstico diferencial. O caso reporta uma paciente de 55 anos com deterioração aguda e progressiva da função renal após quadro de piodermite em membro inferior com diagnóstico concomitante de hanseníase. Associação da hanseníase com doença renal é bem descrita, sendo a GN a forma de acometimento renal mais comum. As glomerulonefrites pós-infecciosas (GNPIs) em adultos ocorrem devido a um grande número de patógenos, nos mais diversos sítios. A paciente do caso relatado apresentava quadro de GNRP e achados de biópsia que sugerem GNPI com marcação de C3 e IgA na imunofluorescência, sugestiva de lesão renal secundária a infecção recente por Staphylococcus, uma manifestação bem descrita de doença renal em pacientes com hanseníase.


Subject(s)
Humans , Middle Aged , Complement C3/metabolism , Leprosy, Multibacillary/diagnosis , Acute Kidney Injury/diagnosis , Glomerulonephritis, IGA/diagnosis , Rifampin/therapeutic use , Biopsy , Blood Urea Nitrogen , Fluorescent Antibody Technique , Clofazimine/therapeutic use , Creatinine/blood , Dapsone/therapeutic use , Diagnosis, Differential , Acute Kidney Injury/drug therapy , Glomerulonephritis, IGA/drug therapy , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use
16.
Acta cir. bras ; 34(5): e201900503, 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1010873

ABSTRACT

Abstract Purpose: To analyze the muscle changes with high-intensity aerobic training (HIAT) in an animal model of renal disease (RD). Methods: Twenty one adult Wistar rats were divided into 3 groups: healthy sedentary (HS), RD sedentary (RDS), RD aerobic training (RDAT). RDS and RDAT were subjected to unilateral renal ischemia-reperfusion (10 min) and 21days after that, RDAT was subjected to 6 weeks HIAT (swimming). Serum creatinine (Cr) and muscle morphometry (cross-sectional area = CSA) of gastrocnemius were analyzed. Results: Cr was higher (p = 0.0053) in RDS (0.82 ± 0.04) than in the others (RDAT 0.55 ± 0.04; HS 0.55 ± 0.04). Morphometric analysis (class interval of CSA in μm2/absolute frequency of muscle fibers in each class) indicated that 50th percentile occurred in: HS 7th class (3000.00-3499.00/515), RDS, 8th class (3500.00-3999.00/484), RDAT 5th class (2000.00-2499.00/856). CSA of largest fibers in RDS, RDAT, HS was 9953.00 μm2, 9969.00 μm2,11228.00 μm2, respectively. High frequency of fibers with lower CSA occurred in 4th, 5th, 6th and 7th class in RDA, absence of fibers into 22nd, 23rd classes (RDS and RDAT). Conclusion: HIAT in an animal model of RD resulted in increased the number of muscle fibers with smaller CSA.


Subject(s)
Animals , Physical Conditioning, Animal/physiology , Muscle, Skeletal/physiopathology , Renal Insufficiency/physiopathology , Reference Values , Swimming/physiology , Body Weight/physiology , Reperfusion Injury/physiopathology , Reproducibility of Results , Rats, Wistar , Muscle Fibers, Skeletal/physiology , Creatinine/blood , Disease Models, Animal , Sedentary Behavior , Kidney/physiopathology , Kidney/blood supply
17.
Acta cir. bras ; 34(8): e201900806, 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1038123

ABSTRACT

Abstract Purpose To assess Cyclosporine A (CsA) therapy at an intraperitoneal dose of 15 mg.kg -1 in a rodent model of non-septic renal ischemia. Methods Twenty male Wistar rats were randomized to receive CsA therapy or none therapy before undergoing 30 minutes of renal ischemia followed by reperfusion. Additionally, 10 rats were randomized to undergo the same surgical procedure of the aforementioned animals with neither ischemia nor CsA therapy. Twelve hours after kidney ischemia, the left kidneys were evaluated for histological injury according to Park's criteria. Serum creatinine (Cr), urea nitrogen (Ur) and sodium levels were obtained at different times of the experimental protocol. Results Rodents in the CsA group showed negative results (p<0.05) in serum variables (Cr: 0.41±0.05mg/dL vs . 4.17±1.25mg/dL; Ur: 40.90±3.98mg/dL vs . 187.70±22.93mg/dL) even the non CsA or control group (Cr: 0.35±0.07mg/dL vs . 3.80±1.20mg/dL; Ur: 40.10±4.70mg/dL vs . 184.50±49.80mg/dL). The negative results were also verified in histological evaluation, CsA group had 50% in the very severe grade of lesion, 10% in the severe and 40% in the moderate to severe whereas the control group had 90% in the very severe grade. Conclusion CsA was incapable of preventing the deleterious effects of ischemia-reperfusion injury in rat kidneys.


Subject(s)
Animals , Male , Rats , Reperfusion Injury/drug therapy , Cyclosporine/pharmacology , Immunosuppressive Agents/pharmacokinetics , Kidney/blood supply , Sodium/blood , Urea/blood , Reperfusion Injury/pathology , Rats, Wistar , Creatinine/blood , Disease Models, Animal , Ischemia/prevention & control , Kidney/drug effects
18.
Pesqui. vet. bras ; 38(10): 1981-1988, out. 2018. tab
Article in Portuguese | LILACS (Americas), VETINDEX | ID: biblio-976374

ABSTRACT

A lesão renal aguda (IRA) é uma síndrome complexa, associada à progressão desfavorável, especialmente em cães na unidade de terapia intensiva (UTI) e apresenta alta morbidade e mortalidade. O diagnóstico de IRA requer combinação de testes laboratoriais, como a creatinina sérica e ureia, considerados pouco sensíveis e específicos para a detecção precoce de graus discretos durante a perda de função renal. O biomarcador cistatina C é considerado superior por apresentar uma melhor correlação com a taxa de filtração glomerular. No entanto, existem poucos estudos que demonstram a utilidade da cistatina C em cães na UTI. O objetivo deste estudo foi comparar a cistatina C com o nível sérico de creatinina para detectar o estágio inicial da IRA em cães em terapia intensiva. As dosagens desses analitos foram realizadas no momento da admissão, 24 e 48 horas após. A cistatina C apresentou concentrações mais elevadas em 78,6%, enquanto a creatinina sérica aumentou apenas em 28,5% dos cães. Os resultados demonstraram que a cistatina C pode ser utilizada para a detecção precoce de lesão renal aguda em cães de UTIs devido à sua maior sensibilidade em relação aos marcadores tradicionais.(AU)


Acute kidney injury (AKI) is a complex syndrome, associated with unfavorable progression, especially in dogs in the intensive care unit (ICU), and presents high morbidity and mortality. The diagnosis of AKI requires a combination of laboratory tests, such as serum creatinine and urea, considered to be poorly sensitive and specific for the early detection of discrete degrees during loss of renal function. The biomarker cystatin C is considered superior because it has a better correlation with the glomerular filtration rate. However, there are few studies that demonstrate the utility of cystatin C in dogs in ICU. The objective of this study was to compare cystatin C to creatinine serum level to detect early stage of AKI in dogs in an intensive care. Measurements of these analytes were performed at the time of admission, 24 and 48 hours after. Serum cystatin C presented higher concentrations in 78.6% while serum creatinina elevated in only 28.5% of the dogs. The results demonstrated that cystatin C can be used for the early detection of acute kidney injury in dogs in ICUs because of its greater sensitivity compared to traditional markers.(AU)


Subject(s)
Animals , Dogs , Creatinine/blood , Dogs , Cystatin C/blood , Acute Kidney Injury/blood , Acute Kidney Injury/veterinary
19.
Acta cir. bras ; 33(6): 508-517, June 2018. tab, graf
Article in English | LILACS (Americas) | ID: biblio-949360

ABSTRACT

Abstract Purpose: To compare the preventive effects of N-acetyl cysteine (NAC), ozone preconditioning and ozone treatment against contrast-induced nephropathy (CIN) in an experimental rat model. Methods: Thirty adult male Wistar rats were randomly distributed into five groups (n=6 for each group). Group I served as control and Group II had only contrast agent, while Group III received NAC and Group IV received intraperitoneal ozone 6 hours before and 6 hours after introduction of contrast agent. Ozone treatment was applied for 5 days after the contrast agent was introduced in Group V. After induction of CIN, groups were compared in terms of serum levels of urea, creatinine, neutrophil gelatinase associated lipocalin, protein carbonyl, total antioxidant capacity (TAC) as well as degree of renal injury at histopathologic level. Results: Groups II-V displayed more obvious histopathological alterations such as hemorrhage and renal tubular injury compared with Group I. TAC (p=0.043) and creatinine (p=0.046) levels increased significantly in Group II after the intervention. In Group III, protein carbonyl level diminished remarkably (p=0.046), while creatinine level was increased (p=0.046) following the intervention. TAC level was higher in Group IV (p=0.028) and Group V (p=0.026) following the procedure. Conclusion: The N-acetyl cysteine and ozone treatment may alleviate the biochemical and histopathological deleterious effects of contrast-induced nephropathy via enhancement of total antioxidant capacity and decreasing oxidative stress.


Subject(s)
Animals , Male , Ozone/pharmacology , Acetylcysteine/pharmacology , Contrast Media/adverse effects , Kidney Diseases/chemically induced , Kidney Diseases/prevention & control , Antioxidants/pharmacology , Reference Values , Spectrophotometry/methods , Urea/blood , Ioxaglic Acid/adverse effects , Random Allocation , Reproducibility of Results , Treatment Outcome , Rats, Wistar , Oxidative Stress/drug effects , Creatinine/blood , Protein Carbonylation , Lipocalin-2/blood , Kidney/drug effects , Kidney/pathology , Kidney Diseases/pathology
20.
Braz. j. med. biol. res ; 51(6): e7355, 2018. tab
Article in English | LILACS (Americas) | ID: biblio-889110

ABSTRACT

Chronic kidney disease (CKD) is highly prevalent worldwide. Patients with CKD on hemodialysis are more likely to present behavioral changes and worse quality of life as a result of their routine and complications. They also have higher levels of cytokines. The aim of this study is to assess the relationship between the inflammatory profile and quality of life measured by KDOQL-SF36 in hemodialysis outpatients. Patients older than 21 years of age and on routine hemodialysis for at least 6 months with treatment on a regular weekly basis were included and their anthropometric parameters and serum inflammatory markers were evaluated. Thirty patients consented to participate. Homocysteine (Hcy) levels were correlated with worse glomerular filtration rate (GFR; P=0.003) and creatinine (P=0.002). IL-6 was not correlated with worse nutritional status taking into account body mass index (BMI; kg/m2; P=0.83). On the other hand, TNF-alpha was positively correlated with albumin (P=0.008), nutritional status by BMI (P=0.04), and nutritional status by arm circumference area (P=0.04). IL-6 was correlated with activity limitation (P=0.02) and Hcy with work status (P=0.04). Hcy was correlated with nutritional status and inflammatory markers. In this population, the majority of the sections in KDOQL-SF36 were not correlated with cytokines levels.


Subject(s)
Humans , Male , Female , Adult , Biomarkers/blood , Inflammation/blood , Quality of Life/psychology , Renal Dialysis/psychology , Renal Insufficiency, Chronic/therapy , Body Mass Index , Creatinine/blood , Cytokines/blood , Glomerular Filtration Rate , Homocysteine/blood , Inflammation/etiology , Nutritional Status , Renal Dialysis/adverse effects , Renal Insufficiency, Chronic/blood , Serum Albumin/analysis , Surveys and Questionnaires , Tumor Necrosis Factor-alpha/blood
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